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glarus

Seaman
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About glarus

Profile Information

  • Military Rank
    Captain

Previous Fields

  • Service Connected Disability
    30%
  • Branch of Service
    USAF

glarus's Achievements

  1. Thank you the advice. Since I'm seeing the orthopedic surgeon now for it (and got a steroid injection in the left AC joint recently, without relief,) I think it will be less awkward to ask at the next appointment. I saw the CBOC GP once after enrolling with the VA health system. She was nice and I would have no qualms about having her as my physician, but I saw no reason to switch doctors. Continuity of care is very important, especially when you have chronic or episodic symptoms with no diagnosis, or something is chronic and needs to be seen in that context. (Off on a tangent,) I'm fortunate to have other coverage through my employer, because the VAMC is 83 miles from my house and 70+ miles past both my local major university medical center and an excellent community hospital system which offers the full range of medical services. My town is a place people from all over the region drive to for excellent healthcare, not away from. I think how we see the VA medical system is a matter of perspective. My boss is retired military and thinks nothing of driving to the VAMC, which is over 90 miles from his house. Military and VA healthcare is all he ever had, and he thinks the VA is great. I was in the healthcare industry before military (medical) service, and I see patients as customers, with freedom of choice and the right to seek a level of service they find acceptable, things not found in state-run, "take it or leave it" medical systems. The idea of taking a day off from work and putting 150 miles on my (frustratingly unreliable) car for an x-ray is a non-starter in a first world country, especially in a town where I can throw a stone in any direction and have a good chance of hitting a doctor's office. No veteran should have to drive past top-rated providers of the services he or she needs. We should all have access to the full range of excellent, local (or for rural veterans, the closest,) health services.
  2. Bottom line up front: I am requesting an increase for my shoulders based on limited range of motion, now rated at 10% each. Range of motion testing using a goniometer isn't something doctors do for diagnosis and treatment , so I don't have the medical documentation to make this a simple, fully-developed claim. Should I submit the request with no supporting documentation and await a C&P, or try to find a physician who would see me to document the limited ROM? I have an orthopedic surgeon (and another where I used to live,) but as many of us know, our doctors' concern and job is treating our problems, not participating in administrative processes. Going to see him because I feel terrible and then asking, "oh by the way, can you help me with this form?" seems like it would be awkward and like the real reason I'm there. It's not. Documentation of injuries and attribution to specific events, times, etc. (in line with the notion of a C&P exam being not at all about treatment,) seems to be a niche field, and not handled by many physicians. But that's just an impression I now have. For all I know, lawyers who handle SSDI claims have Rolodexes full of these guys. My own experience, and what I've read here, certainly suggests it's a widespread problem among VA (and SSDI?) claimants.* I have added a bit more detail below, but in short, the issue is documenting reduced range of motion.** I am rated 10% for each of my shoulders, based on different VA-recognized conditions. Because the rather limited list of conditions in the schedule doesn't include my issues, they are both rated as: 5003 Arthritis, degenerative (hypertrophic or osteoarthritis) When I claimed the conditions, I could abduct my arms higher than shoulder level (I think to 120 degrees, with normal being 180.) I have long been unable to abduct my left arm to shoulder level (to 90 degrees.) Now, I meet the criterion under this section: 5201 Arm, limitation of motion of: Midway between side and shoulder level 30 (major) 20 (minor) At shoulder level 20 20 Abduction on the left side ("major," as I am left-handed,) is permanently limited to well below the shoulder, and on my best days, the right side ("minor") may reach shoulder height. Good day or bad, it's 30 and 20. * I do not use the VA for my care, but it seems those of you who do have the same problem. The "claims" aspect of medicine is one they treat like it's radioactive. Getting an IMO or DBQ involves paying out of pocket or being fortunate enough to have a close relationship with a rare and special care provider. ** I guess a potential question is whether it's due to the S/C conditions, but I don't think it will be a problem. For the left side, VA only lists acromioclavicular (AC) joint degeneration, but the first MRI was done in-service, and the second was done in conjunction with a C&P. The readout for both diagnosed damage to both the AC and glenohumeral joints. The right side has not been imaged by MRI, but I am S/C for rotator cuff tendinopathy (a glenohumeral joint condition.) It was diagnosed in service, and diagnosed and treated post-service. If VA said left side limitation is not due to AC joint degeneration but a glenohumeral joint condition, I would just say OK, call it a new claim if you want, but glenohumeral joint damage is documented in the SMR and in VA's prior decision, and the compensable condition is "limitation of motion."
  3. My situation was somewhat similar. I sought service connection for rhinitis, sinusitis and OSA. Dr. Anaise opined that rhinitis and sinusitis were service connected, and that OSA was secondary to both, as well as to GERD, for which I am already service connected. All three were denied by the claims examiner without the letter from Dr. Anaise, and all three were denied by the DRO with the letter from Dr. Anaise. With respect for OSA seconday to GERD, which should be the easiest since GERD is already service connected, the DRO's position was: "[Dr. Anaise] cited studies which show that sleep apnea can be common in patients with GERD but he did not provide a rationale or discuss evidence to show how your sleep apnea is proximately due to your GERD nor did he discuss evidence to show your sleep apnea is aggravated beyond the natural progression by GERD." Because I don't have the time to perfect this myself (the letter is dated 27 Feb.,) and because this is the last chance I have in the administrative process, I may hire a lawyer. I did notice that the DRO used the same language the claims examiner used. The exact same language for just about everything, with the part about the IMO tacked on. It's not really a fresh, unbiased look at the case if the second person reads what the first person wrote. Is that normal? I see that bguerrero won with Dr. Anaise's letter at the BVA, but I'm afraid I will not prevail, and without making the best case I can, with the help of a lawyer, I will have blown it. Thoughts? Suggestions?
  4. I obtained an IMO after receiving VA's decision on my claim. I got the IMO because I had issues in service, have them now, but "no nexus" (not their words, of course,) so the claims were denied. I have not yet filed a NOD. VA form 4107 ("Your Rights to Appeal Our Decision") says You can send us more evidence to support a claim whether or not you choose to appeal. NOTE: Please direct all new evidence to the address included on our decision notice letter. You should not send evidence directly to the Board at this time. You should only send evidence to the Board if you decide to complete an appeal and, then, you should only send evidence to the Board after you receive written notice from the Board that they received your appeal. If you have more evidence to support a claim, it is in your best interest to give us that evidence as soon as you can. We will consider your evidence and let you know whether it changes our decision. OK, so obviously I would have been well-served to have obtained the IMO before submitting the claim, because now I have a mostly unfavorable decision. A solid, fully-developed claim from the get-go is best, but my time machine is broken. Lesson learned. There is, however, one important thing that came out of the decision: I was granted one service-connected condition, and the IMO uses that one to support the ones which were denied. 1. What exactly is VA saying in form 4107? Should I submit the IMO to the RO before a NOD, just to see what happens? I don't have much time (about two months) left to file a NOD, and it will be timely, no matter what else happens. Is submitting additional evidence in this period between their decision and my appeal even a possibility? Will they add it to the body of evidence they have, and see if it changes their decision (as form 4107 suggests?) Or should I just file the NOD, and include the IMO? I want to ensure that whatever I do, I don't lose my original filing date. That language from form 4107 sounds shady, since not filing a NOD and busting the one year limit forces you to reopen the claim, forfeiting your original filing date. Or is the NOD not really the "appeal," just a notice of intent to do something because you disagree with their decision? (Sorry for the multiple questions, this is really just one question: given the fact that I now have an IMO, what do I do right now, for the fastest, least bureaucratic decision? ) 2. If I file the NOD, I'd like a DRO review, since I believe the IMO will change the outcome of a de novo review. I see nothing on VA's site or forms about how to request DRO review when you're using their now-required form (21-0958.) Do I just attach a memo? Thanks for your insights!
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