BearGator56

You're correct. I did wind up with 30% for it. Although, they didn't rate me for the acid reflux stating that I wasn't diagnosed, even though they've had me on prescription meds for it for over 4 years now.

I just got the package back. 50% on PTSD. My Gulf War exam also attached. 30% IBS with another 10 for my wrist. Added to the previous 30, for a total of 80%. There were a couple things not rated that they didn't service connect, and one for acid reflux that they said wasn't diagnosed but they've had me on omeprazole for 3 years. Curious about adding alcohol abuse to this. Something I hadn't thought about.

I finally got mine on the BB after just over a month. It's posted in another thread in here. Not sure about the QTC thing.

Start scheduling appointments ASAP. You can start with your general doc. They will ask you questions every time you do your triage intake on your appointments about your general mood, suicidal thoughts, etc. Make sure you are telling your doc about all your feelings and stress that you would like to get involved in PTSD counseling because of them. Make sure you're relating these things to the combat tours you were in and nothing prior to that. Talk about the things you saw and what those dreams are about. That will get the ball rolling. That initial exam just gets you in the door and is nothing to worry about. Just hoops to jump through. But you'll need to stay in the system and keep making appointments. You'll need to enroll in ebenefits and myhealthevet, too. Ebenefits will have where you apply for compensation. You can always talk to a vet rep to help you through the process before you do so. Any injuries, wounds, surgeries, etc you should apply for, even if you get a 0 rating it's still on the books to get you started with any future complications. Here are links to both sites to get you started there: https://www.ebenefits.va.gov/ebenefits-portal/ebenefits.portal?_nfpb=true&_nfxr=false&_pageLabel=Apply https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome

Finally got my C&P from MyHealtheVet Blue Button. It took just over a month from the time of this exam to posting. Any opinions on possible outcome of rating are welcome. I'm thinking 30%, but curious what others think and the possibility of 50%. Thanks in advance. SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-IV criteria based on today's evaluation? [X] Yes [ ] No ICD code: 309.81 2. Current Diagnoses -------------------- a. Diagnosis #1: PTSD ICD code: 309.81 Indicate the Axis category: [X] Axis I [ ] Axis II Diagnosis #2: Alcohol Abuse Indicate the Axis category: [X] Axis I [ ] Axis II b. Axis III - medical diagnoses (to include TBI): GERD; osteoarthritis; prostatitis c. Axis IV - Psychosocial and Environmental Problems (describe, if any): occupational problems;health concerns;absence of mental health treatment d. Axis V - Current global assessment of functioning (GAF) score: 58 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis: Symptoms attributable to PTSD are intrusive thoughts and memories of the identified stressor; emotional reactivity to reminders of the stressor; avoidance and emotional numbing; and, hyperarousal. Symptoms attributable to Alcohol Abuse are recurrent use of alcohol despite associated difficulties, including legal; and, a maladaptive pattern of alcohol use. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [X] Yes [ ] No [ ] No other mental disorder has been diagnosed If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: 100% of the indicated level of occupational and social impairment is attributable to PTSD. The abuse of alcohol is determined to be a means of managing the trauma related symptoms. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ a. Records reviewed (check all that apply): [X] Claims folder (C-file): [X] Yes [ ] No b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No 2. History ---------- e. Relevant Substance abuse history (pre-military, military, and post-military): The Veteran was vague regarding his current consumption of alcohol. He stated that he now drinks less than he used to. He stated that he used to binge (6-7 drinks on a Saturday night). He reported his last binge to have been a month and a half prior to this examination. He gave a history of blackouts, but none in the past two years. He denied the use of tobacco products, or other substances. f. Sentinel Event(s) (other than stressors): No response provided. g. Other, if any: No response provided. 3. Stressors ------------ a. Stressor #1: The Veteran reported that while on a mission during Operation Desert Storm, he and his team were on patrol and came upon a tank that looked as if as enemy soldier was sitting in the commander's seat. He did not respond to their orders and when they approached the tank, saw that about half of his head had been blown away. Brain matter was splattered. This image comes to mind most frequently for the Veteran. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [X] Yes [ ] No 4. PTSD Diagnostic Criteria --------------------------- a. Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, referred to as Criteria A-F, are from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Criterion A: The Veteran has been exposed to a traumatic event where both of the following were present: [X] The Veteran experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. [X] The Veteran's response involved intense fear, helplessness or horror. Criterion B: The traumatic event is persistently reexperienced in 1 or more of the following ways: [X] Recurrent and distressing recollections of the event, including images, thoughts or perceptions [X] Recurrent distressing dreams of the event [X] Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event Criterion C: Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by 3 or more of the following: [X] Efforts to avoid thoughts, feelings or conversations associated with the trauma [X] Markedly diminished interest or participation in significant activities [X] Feeling of detachment or estrangement from others [X] Restricted range of affect (e.g., unable to have loving feelings) Criterion D: Persistent symptoms of increased arousal, not present before the trauma, as indicated by 2 or more of the following: [X] Difficulty falling or staying asleep [X] Irritability or outbursts of anger [X] Difficulty concentrating [X] Hypervigilance [X] Exaggerated startle response Criterion E: [X] The duration of the symptoms described above in Criteria B, C and D is more than 1 month. Criterion F: [X] The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. b. Which stressor(s) contributed to the Veterans PTSD diagnosis?: [X] Stressor #1 5. Symptoms ----------- For VA rating purposes, check all symptoms that apply to the Veterans diagnoses: [X] Depressed mood [X] Anxiety [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 8. Remarks, if any ------------------ Based on this examination and a review of the records, it is determined that the Veteran meets DSM IV-TR criteria for PTSD. It is further determined that this diagnosis is at least as likely as not (50/50 probability), a result of the identified in service stressor. The diagnosis of Alcohol Abuse (per DSM IV-TR criteria) is determined to be at least as likely as not(50/50 probability) proximately due to or the result of the Veteran's PTSD. It is this examiner's opinion that the Veteran has come to use alcohol as a means of managing (albeit maladaptive and counterproductive) PTSD symptoms. The Veteran was provided with a card with the telephone number of the Veteran's Crisis Line (880) 273-8255. He was encouraged to call the 24 hour number in the event of a worsening of symptoms; suicidal impulses; or, for additional information about available mental health resources. The Veteran also consented to a referral to the Trauma Recovery Program.

It's still not on the Blue Button for me. I sent a message and they replied "C&P exams are not uploadable at this moment." I've been busy and haven't been able to follow through. Not sure why it wouldn't be there by now.

I was not happy with this doctor. He saw me for less than 30 minutes and hardly asked me any questions. I had a list with notes that I brought with and he just stuffed it in his file. None of which made it to my file from what I can see. He was in a rush to get me out of there. He was like, "thank you for your service" and waited for me to get up and leave. I brought up something else, barely got a reply, then got the "thank you for your service" again. He said it a total of 4 times as I was trying to bring up issues. I may need to file a complaint on him, if there's a process for that. I'll reserve judgement until the results come back.

He contradicts how he filled it out. He put my statement in of 4-5 a day, but then put occasional. Makes sense.

I had a feeling he screwed me. Would think if it says 4 or 5 movements a day that would be more than "occasional."

I'm all set up on myhealthevet. The info isn't available on the Blue Button yet, although there is a note added (see below). It was done at the Atlanta VA. Date/Time: 19 Sep 2013 @ 0911 Note Title: C&P EXAM Location: ATLANTA VAMC Signed By: JONES,KATHERINE S Co-signed By: JONES,KATHERINE S Date/Time Signed: 19 Sep 2013 @ 0912 ------------------------------------------------------------------------- LOCAL TITLE: C&P EXAM STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: SEP 19, 2013@09:11 ENTRY DATE: SEP 19, 2013@09:12:07 AUTHOR: JONES,KATHERINE S EXP COSIGNER: URGENCY: STATUS: COMPLETED A C&P examination was conducted this date. A complete report is forthcoming. /es/ KATHERINE S. JONES, PH.D., ABPP CLINICAL PSYCHOLOGIST Signed: 09/19/2013 09:12

This is from my Gulf War C&P Exam. Any thoughts on possible rating are appreciated. I didn't feel as if the doctor was as thorough as he should have been, as he asked very few follow up questions and seemed in a hurry to get me out of there. He checked off "occasional" even though I told him this is an every day thing. Intestinal Conditions (other than surgical or infectious), including irritable bowel syndrome, Crohn's disease, ulcerative colitis and diverticulitis Disability Benefits Questionnaire Name of patient/Veteran: XXXX Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: CPRS 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with an intestinal condition (other than surgical or infectious)? [X] Yes [ ] No [X] Irritable bowel syndrome ICD code: 564.1 Date of diagnosis: 9/6/13 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's intestinal condition (brief summary): The veteran stated that he always has diarrhea since gulf war;at times he becomes constipated if occasional bubble comes he may have 4-5 loose stools a day. No history of colonoscopy. No history of gallbladder disease or surgery no loss of weight he had hemorrhoids he takes Pepto-Bismol and Imodium. b. Is continuous medication required for control of the Veteran's intestinal condition? [X] Yes [ ] No If yes, list only those medications required for the intestinal condition: imodium,peptobismol c. Has the Veteran had surgical treatment for an intestinal condition? [ ] Yes [X] No 3. Signs and symptoms --------------------- Does the Veteran have any signs or symptoms attributable to any non-surgical non-infectious intestinal conditions? [X] Yes [ ] No If yes, check all that apply: [X] Diarrhea If checked, describe: as above [X] Abdominal distension If checked, describe: occasionally 4. Symptom episodes, attacks and exacerbations ---------------------------------------------- Does the Veteran have episodes of bowel disturbance with abdominal distress, or exacerbations or attacks of the intestinal condition? [X] Yes [ ] No If yes, indicate severity and frequency: (check all that apply) [X] Episodes of bowel disturbance with abdominal distress If checked, indicate frequency: [X] Occasional episodes [ ] Frequent episodes [ ] More or less constant abdominal distress 5. Weight loss -------------- Does the Veteran have weight loss attributable to an intestinal condition (other than surgical or infectious condition)? [ ] Yes [X] No 6. Malnutrition, complications and other general health effects --------------------------------------------------------------- Does the Veteran have malnutrition, serious complications or other general health effects attributable to the intestinal condition? [ ] Yes [X] No 7. Tumors and neoplasms ----------------------- a. Does the Veteran have a benign or malignant neoplasm or metastases related to any of the diagnoses in the Diagnosis section? [ ] Yes [X] No 8. Other pertinent physical findings, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------------- a. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above? [ ] Yes [X] No 9. Diagnostic testing --------------------- a. Has laboratory testing been performed? [X] Yes [ ] No [X] CBC (if anemia due to any intestinal condition is suspected or present) Date of test: 1/1/13 Hemoglobin: 15.9 Hematocrit: 46 White blood cell count: 5.6 Platelets: 126 b. Have imaging studies or diagnostic procedures been performed and are the results available? [ ] Yes [X] No c. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 10. Functional impact --------------------- Does the Veteran's intestinal condition impact his or her ability to work? [ ] Yes [X] No 11. Remarks, if any: -------------------- The veterans irritable bowel syndrome is a diagnosable but medically un-explained chronic gastrointestinal and multisystem disease of unknown etiology.

This was also added in the commentary: 2. Restatement of requested opinion ----------------------------------- a. Insert requested opinion from general remarks: ALSO, The Veteran is claiming service connection for low back pain and left wrist pain. Please review the medical opinion requests below regarding these two issues: MED OPINION #1: A. Requested DBQ: Peripheral Nerves " Claimed conditions: nerve damage left wrist " Claimed nexus: secondary or related to the in-service left wrist fracture " Opinion requested: Is there a diagnosis of nerve damage in the left wrist? If yes, is it at least as likely as not related to the left wrist fracture in service? B. Available pertinent evidence: " Military Service: Marines from March 14, 1990 to June 28, 1994 " Service Treatment Records (STRs): These records show the left wrist fracture " Private Treatment Records: none " VA Treatment Records: the Atlanta VAMC treatment records (available for your review in CPRS) show that the Veteran has complained of pain in the left wrist. There are images available for your review as well.

This was part of my Gulf War Exam, and it doesn't look like it should be rated from the GW. But, the wrist injury received while I was in the Marines does have nerve issues. Would they continue the rating on it's own, or would I have to re-file again on a claim not under Gulf War? I'm currently rated for the wrist, but nothing to do with the nerve issues. Peripheral Nerves Conditions (not including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire Name of patient/Veteran: XXXX Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: CPRS If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: 1. Diagnosis ------------ Does the Veteran have a peripheral nerve condition or peripheral neuropathy? [X] Yes [ ] No Diagnosis #1: lt ulnar neuropathy ICD code: (354.2) Date of diagnosis: 9/6/13 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's peripheral nerve condition (brief summary): He stated that he developed tingling in the left arm for a long time started while on active duty his left wrist was injured while on active duty no history of neck pain or surgery; no history of elbow injury or surgery. He takes Neurontin; he has mild weakness of the left hand with no history of diabetes mellitus. He has mild wasting of his left hand. b. Dominant hand [X] Right [ ] Left [ ] Ambidextrous 3. Symptoms ----------- a. Does the Veteran have any symptoms attributable to any peripheral nerve conditions? [X] Yes [ ] No Constant pain (may be excruciating at times) Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Intermittent pain (usually dull) Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Numbness Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe 4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Elbow flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Elbow extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Grip: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Pinch (thumb to index finger): Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle plantar flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 b. Does the Veteran have muscle atrophy? [X] Yes [ ] No If muscle atrophy is present, indicate location: lt 1st dorsal interossei Normal side: not measured cm. Atrophied side: not measured cm. 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Biceps: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Triceps: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Brachioradialis: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Knee: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Ankle: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Indicate results for sensation testing for light touch: Shoulder area (C5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Inner/outer forearm (C6/T1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Hand/fingers (C6-8): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Upper anterior thigh (L2): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Thigh/knee (L3/4): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Lower leg/ankle (L4/L5/S1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Foot/toes (L5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent 7. Trophic changes ------------------ Does the Veteran have trophic changes (characterized by loss of extremity hair, smooth, shiny skin, etc.) attributable to peripheral neuropathy? [ ] Yes [X] No 8. Gait ------- Is the Veteran's gait normal? [X] Yes [ ] No 9. Special tests for median nerve --------------------------------- Were special tests indicated and performed for median nerve evaluation? [ ] Yes [X] No 10. Nerves Affected: Severity evaluation for upper extremity nerves and radicular groups ----------------------------------------------------------------------- a. Radial nerve (musculospiral nerve) Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis b. Median nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis c. Ulnar nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [ ] Normal [X] Incomplete paralysis [ ] Complete paralysis If Incomplete paralysis is checked, indicate severity: [ ] Mild [X] Moderate [ ] Severe d. Musculocutaneous nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis e. Circumflex nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis f. Long thoracic nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis g. Upper radicular group (5th & 6th cervicals) Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis h. Middle radicular group Right [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis i. Lower radicular group Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis 11. Nerves Affected: Severity evaluation for lower extremity nerves ------------------------------------------------------------------- Not applicable 12. Assistive devices --------------------- a. Does the Veteran use any assistive devices as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided. 13. Remaining effective function of the extremities --------------------------------------------------- Due to peripheral nerve conditions, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 14. Other pertinent physical findings, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------- a. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above? [ ] Yes [X] No b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms? [ ] Yes [X] No 15. Diagnostic testing ---------------------- a. Have EMG studies been performed? [X] Yes [ ] No Extremities tested: [X] Left upper extremity Results: [ ] Normal [X] Abnormal Date: 1/15/13 b. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): Findings: The left median sensory nerve conduction study (NCS) showed normal peak latency and amplitude. The left ulnar sensory NCS showed normal peak latency and amplitude. The left median motor NCS showed normal distal latency, amplitudes, and conduction velocity. The left ulnar motor NCS was ABNORMAL and showed normal distal latency, normal amplitudes, and DIMINISHED conduction velocities across the ELBOW. The right ulnar motor NCS showed normal distal latency, amplitudes, and conduction velocities. The left median-to-ulnar comparison mixed nerve study showed no significant difference in latencies. Electromyography (EMG) of selected muscles representing the ulnar innervations showed normal insertional activity, no spontaneous activity, and normal voluntary MUAP's. IMPRESSION: 1) Abnormal study. 2) Electrophysiological evidence of LEFT ulnar neuropathy across the elbow consistent with a focal demyelinating process. No evidence of axonal loss. 3) NO electrophysiological evidence of a left median neuropathy at the wrist. PLAN: 1) Prosthetics consult to issue a LEFT elbow brace to the patient 2) Advised patient to protect the elbows with gel pads or towels anytime they are on a hard surface and to limit sleeping with hands overhead 3) Please consider obtaining a LEFT elbow xray given hx of remote injury 4) Can consider hand surgery consult in the future for possible surgical interventions if above conservative measures fail. 5) Thank you the consult. /es/ AMAR G PATEL PM&R PGY 3 Signed: 04/18/2013 14:21 16. Functional impact --------------------- Does the Veteran's peripheral nerve condition and/or peripheral neuropathy impact his or her ability to work? [X] Yes [ ] No If yes, describe impact of each of the Veteran's peripheral nerve and/or peripheral neuropathy condition(s), providing one or more examples: Left ulnar neuropathy condition will limit repetitive moderately strenuous physical activity with his left hand. 17. Remarks, if any: -------------------- the veterans ulnar neuropathy is a disease with a clear and specific etiology and diagnosis. Medical opinion-it is less likely is not, less than 50% probability, that the above condition is related to any specific exposure event experienced by the veteran during service in Southeast Asia; rationale-current medical literature review does not correlate ulnar neuropathy with Gulf War exposure.

They told me I would need to send a letter in writing/fax (Freedom of Information) requesting all of my medical records, etc. Why does this not seem like the same thing you all have done? Good Lord.

So I called the ATL VAMC Release of Information, and they stated that they don't have the C&P there and referred me to the 800-827-1000 number.