DirtyBulk

I hope so - I am getting crazy anxiety waiting on some of the experts to help me out.

I was SC'ed but rated at 0% because I missed my CP exam appointment due to a field ops I was required to go to.

Can any of the C&P exam experts help me try to hone in on what they think my rating will be based on these notes? There is a ton of stuff that I disagree with, but I will take on that issue after I get my rating. Any help is greatly appreciated. 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 a. Evidence review Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes [X] No If no, check all records reviewed: [X] 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 [X] 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: b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No 1. Diagnosis ------------ a. List the claimed condition(s) that pertain to this DBQ: bilateral patellofemoral pain syndrome b. Select diagnoses associated with the claimed condition(s) (Check all that apply): [X] Patellofemoral pain syndrome Side affected: [ ] Right [ ] Left [X] Both ICD Code: M22.2x1 and M22.2x2 Date of diagnosis: Right 2012 Date of diagnosis: Left 2012 c. Comments (if any): No response provided d. Was an opinion requested about this condition (internal VA only)? [ ] Yes [X] No [ ] N/A 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's knee and/or lower leg condition (brief summary): Bilateral patellofemoral pain syndrome diagonsed in the Marines following a fall from a height when he landed on his knees. He has continued to have pain in both anterior kneessince then. He has not had care for his knees since discharge in 2013. b. Does the Veteran report flare-ups of the knee and/or lower leg? [ ] Yes [X] No c. Does the Veteran report having any functional loss or functional impairment of the joint or extremity being evaluated on this DBQ, including but not limited to repeated use over time? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words: Pain with walking, climbing or decending stairs, and with prolonged standing. He has pain with pressure on the anterior knees, so he cannot kneel down. 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion Right Knee ---------- [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 140): 0 to 70 degrees Extension (140 to 0): 70 to 0 degrees If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: pain with flexion of the knee joint and when walking. Description of pain (select best response): Pain noted on exam and causes functional loss If noted on exam, which ROM exhibited pain (select all that apply)? Flexion Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): pain with palpation of the patella and the anterior joint line. Is there objective evidence of crepitus? [ ] Yes [X] No Left Knee --------- [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 140): 0 to 70 degrees Extension (140 to 0): 70 to 0 degrees If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: pain with flexion of the knee joint and when walking. Description of pain (select best response): Pain noted on exam and causes functional loss If noted on exam, which ROM exhibited pain (select all that apply)? Flexion Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): pain with palpation of the patella and the anterior joint line. Is there objective evidence of crepitus? [ ] Yes [X] No b. Observed repetitive use Right Knee ---------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No Left Knee --------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Right Knee ---------- Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [X] Yes [ ] No [ ] Unable to say w/o mere speculation Select all factors that cause this functional loss: Pain, Lack of endurance Able to describe in terms of range of motion: [ ] Yes [X] No If no, please describe: Increased pain with ambulation and standing. Left Knee --------- Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [X] Yes [ ] No [ ] Unable to say w/o mere speculation Select all factors that cause this functional loss: Pain, Lack of endurance Able to describe in terms of range of motion: [ ] Yes [X] No If no, please describe: Increased pain with ambulation and standing. d. Flare-ups No response provided e. Additional factors contributing to disability Right Knee ---------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None Left Knee --------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None 4. Muscle strength testing -------------------------- a. Muscle strength - 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 Right Knee: Rate Strength: Forward flexion: 5/5 Extension: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No Left Knee: Rate Strength: Forward flexion: 5/5 Extension: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No b. Does the Veteran have muscle atrophy? [ ] Yes [X] No c. Comments, if any: No response provided 5. Ankylosis ------------ Complete this section if the Veteran has ankylosis of the knee and/or lower leg. a. Indicate severity of ankylosis and side affected (check all that apply): Right Side: [ ] Favorable angle in full extension or in slight flexion between 0 and 10 degrees [ ] In flexion between 10 and 20 degrees [ ] In flexion between 20 and 45 degrees [ ] Extremely unfavorable, in flexion at an angle of 45 degrees or more [X] No ankylosis Left Side: [ ] Favorable angle in full extension or in slight flexion between 0 and 10 degrees [ ] In flexion between 10 and 20 degrees [ ] In flexion between 20 and 45 degrees [ ] Extremely unfavorable, in flexion at an angle of 45 degrees or more [X] No ankylosis b. Indicate angle of ankylosis in degrees: No response provided c. Comments, if any: No response provided 6. Joint stability tests ------------------------ a. Is there a history of recurrent subluxation? Right: [X] None [ ] Slight [ ] Moderate [ ] Severe Left: [X] None [ ] Slight [ ] Moderate [ ] Severe b. Is there a history of lateral instability? Right: [X] None [ ] Slight [ ] Moderate [ ] Severe Left: [X] None [ ] Slight [ ] Moderate [ ] Severe c. Is there a history of recurrent effusion? [ ] Yes [X] No d. Performance of joint stability testing Right Knee: Was joint stability testing performed? [X] Yes [ ] No [ ] Not indicated [ ] Indicated, but not able to perform If joint stability testing was performed is there joint instability? [ ] Yes [X] No If yes (joint stability testing was performed), complete the section below: - Anterior instability (Lachman test) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Posterior instability (Posterior drawer test) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Medial instability (Apply valgus pressure to knee in extension and with 30 degrees of flexion) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Lateral instability (Apply varus pressure to knee in extension and with 30 degrees of flexion) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) Left Knee: Was joint stability testing performed? [X] Yes [ ] No [ ] Not indicated [ ] Indicated, but not able to perform If joint stability testing was performed is there joint instability? [ ] Yes [X] No If yes (joint stability testing was performed), complete the section below: - Anterior instability (Lachman test) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Posterior instability (Posterior drawer test) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Medial instability (Apply valgus pressure to knee in extension and with 30 degrees of flexion) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) - Lateral instability (Apply varus pressure to knee in extension and with 30 degrees of flexion) [X] Normal [ ] 1+ (0-5 millimeters) [ ] 2+ (5-10 millimeters) [ ] 3+ (10-15 millimeters) e. Comments, if any: No response provided 7. Additional conditions ------------------------ a. Does the Veteran now have or has he or she ever had recurrent patellar dislocation, "shin splints" (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment? [ ] Yes [X] No b. Comments, if any: No response provided 8. Meniscal conditions ---------------------- a. Does the Veteran now have or has he or she ever had a meniscus (semilunar cartilage) condition? [ ] Yes [X] No b. For all checked boxes above, describe: No response provided 9. Surgical procedures ---------------------- No response provided 10. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ------------------------------------------------------------------------ a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. 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 c. Comments, if any: No response provided 11. Assistive devices --------------------- a. Does the Veteran use any assistive device(s) 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 12. Remaining effective function of the extremities --------------------------------------------------- Due to the Veteran's knee and/or lower leg condition(s), 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 13. Diagnostic testing ---------------------- a. Have imaging studies of the knee been performed and are the results available? [X] Yes [ ] No If yes, is degenerative or traumatic arthritis documented? [ ] Yes [X] No b. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions: No response provided 14. Functional impact --------------------- Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No If yes, describe the functional impact of each condition, providing one or more examples: The Veteran has significant pain in both knees with walking, standing and kneeling so that he would have a difficult time perorming duties which would require those actions. 15. Remarks, if any: -------------------- No response provided

Ha - no I know that I need more then 10%, if you re-read what I wrote you will see that I said a rating for each knee PLUS the 10% for it being a bilateral condition.

He takes his glasses off, looks at me and says "son, you're rated at 90%, you could have been rehabbing your knees for the past 4 years free of charge. Some of those DAV guys are good, but some of them are idiots" At this point, I was extremely frustrated and may have slipped out a few expletives at a louder than normal tone. He told me "son, talk to your primary physician about getting seen by a specialist and ask to get an MRI because you're knee looks somewhat okay, but I imagine an MRI might reveal something else that will explain the pain. Regardless of what happened, we'll take care of you, I know it's been a long journey, but hang in there and have faith. Also, how's your migraines? I see you're rated at 30%, but if they've gotten worse, you should file for an increase. Anyways, hang in there son and I'll make sure I put the info gathered from the exam in today" He was extremely caring and pro active, which is something that I am NOT used to with the VA. I don't have as many complaints as some you guys out there, but still, it hasn't been easy. I just wanted to share this story and hopefully I'll get the rating I deserve - since it's a bilateral diagnose, wouldn't I get a rating for each + 10%? Lord willing, if that happens, I should be pushed to 100% according to Hutsky's excel spreadsheet. That will help my family and I out so much! I am glad I am not in this fight alone and if it wasn't for a bunch of you, I would be in a darker place. Thanks - you guys don't know how much you've done for me. Brothers in arms!

Just an update for everyone: The VA denied my reopened claim for sleep apnea; they stated that no in-service incident was documented that would correlate to my claim for sleep apnea. I can post what the exact quote was, but that was pretty much the gist of it. I was hoping that the VA would not deny my claim, but I was also realistic in the sense that the VA makes you fight for every penny you deserve. I don't know what I am going to do; if I should file a NOD. I had strong buddy statements as lay evidence, but no NEXUS - which, as everyone stated was the major piece of the puzzle that could help me in my case. Any suggestions? Feeling pretty crappy - did everything I could for my Corps and this is the treatment I get. Thanks everyone.

So as of yesterday 9/8/15 - my claim was closed and the BBE was sent out. Today I checked for any updates to my AB8 letter and checked my account for any pending deposits and nothing; hopefully I am one of the few cases where Ebennies doesn't match what the BBE says because I will be extremely bummed out. Like I said it has only been 24 hours since it was closed, so hopefully it just hasn't updated yet. I reached out to my DAV and he is going to contact my RO to see what their system says, but I don't know if it will show anything different. I don't know if he is privy to that information before the BBE comes. Hopefully I won't get shafted, but I am preparing for the worst.

Thanks everyone. It's less then 2 weeks for my BBE to come so I'll just wait it out (while continuously checking ebennies haha) but I'll make sure to keep everyone posted. Hopefully they SC me for OSA - this would rightfully push me to 100% and I can finally try and put this behind me.

I had a question and was wondering if any of you, who are more experienced with the VA claim process, can give some insight on my situation. I am rated at 90%; 1 year out from discharge I was having issues that corresponded with sleep apnea, I told my VA doctor and she ordered me a sleep study, lo and behold - I was diagnosed with OSA and was given a CPAP machine. I submitted a claim for sleep apnea and was denied a percentage because it was not SC'ed. I was a little perturbed because I knew I had MANY documented sleep issues while active duty, but the VA still did not SC me. I went through my SMR with my VSO and we highlighted everything that was related to sleep issues/disturbances, we reopened the claim with submission of new evidence plus really good lay evidence (buddy statements from my actual platoon DOC who admitted that I complained about sleep issues while deployed in Afghanistan, only to deny me special attention and gave me Benadryl as a solution to my problems) - and a few other buddy statements from my former superiors who also denied me medical attention. My original date of estimated completion after reopening the claim was December 2016, but after waiting a month then checking Ebennies's; they moved the date to 9/13-9/20 with a preparation for notification. My question is this: On my ebennies list of disabilities, it's still showing as "sleep apnea not service connected", would this remain this way until I receive the big brown envelope? I just get concerned that I am still not SC'ed because of that. Obviously, that could still be the end result, but I just want to know if the update wouldn't happen until the letter is received by me. Any guidance or help would be greatly appreciated!

No I didn't request one - honestly, didn't even know what a IMO letter was. Let's hope what I submitted will suffice, I know it's an uphill battle. I am hoping that since they moved my decision date up a year it will be good news. Lord willing!

Unfortunately, I do not have a nexus. I am hoping with the really strong lay evidence I provided, which consists of 2 service members admitting they denied me the proper attention I needed, it will get me SCed.

Good luck buddy - it's a stressful situation, but I hope it pans out because the least they can do is take care of us. I feel I have really strong lay evidence, especially because I have 2 service members admitting they denied me proper care.

At the time I did not understand the severity of the issue, but after researching it I understood that it was dangerous. Says a lot about the thought process of some of the doctors.

At the time, I was happy to take anything that helped me sleep, but it was just a short term solution to a long term problem. I am hoping that with this lay evidence, it will get me SC'ed.

Hey all, Just wanted to give you guys an update on the situation. My VSO reopened the claim with new lay evidence. They were your general buddy statements, but one of the statements were from my DOC who was deployed with us for OEF, who admitted to denying me any tests because of where we were and only giving me benadryl for my symptoms - he also states he was aware of all my symptoms, yet he denied me any sleep tests. The second statement was from my former NCO, he admitted to telling me to suck it up and deal with the sleep issues, he admitted to counseling me and switching shifts because of my sleep issues. On top of that, we went through all of my medical records and found many complaints to sick call in regards to sleep trouble, day time drowsiness and overall fatigue because of lack of sleep. One Commander even gave me Xanyx to help "aid with the service member's sleep issues". I have been checking e-bennies every week - in the beginning of July, there was a notice of preparation for decision dated for 08-01-16 through 01-01-17, which was true to the VA's timeline for everything, BUT last week I checked again and they bumped the notice of prepartion date to the end of this month: 08-30-15 through 09-27-15. They moved the date ahead a year, which I am hoping that it's for a good reason, but who knows. Wish me well!

Just an update for you guys: I got 4 buddy statements from people I served with and deployed with. One of them was platoon Doc who stated "SNM came to me multiple times during deployment complaining of sleep issues, I was instructed by my superior to give him benadryl and to tell him that he should suck it up. I do not believe SNM was treated properly for any sleep issues." Also, in the big manila folder of joy, it said "no complaints of sleep issues during time in service." -- I scoured through my medical records and found over 10 instances of complaints of insomnia, lack of sleep, fatigue, head aches, etc. - we attached the specific documents as well. Hopefully that should be able to tip the scale in my favor. My VSO said that statement from my Doc could possibly weigh heavily on the decision. Let's hope so! I will keep you guys informed, thanks for all the help.

Any thoughts or experience in regards to the letter?

Gents, I got my decision letter today on why I was denied. Here's what it says: "Service connection for sleep apnea is the night since his condition either occurred in nor was caused by service. The evidence is not showing event, disease or injury in service. Your service treatment records do not contain complaints, treatment or diagnosis for this condition. We did not find a link between your medical condition in military service." There is definitely at least one complaint of sleep issues, I was prescribed Xanax for it to help me sleep. Is there a chance that I can connect my sleep apnea to my Xanax or Ativan prescription? Those were given to me for my anxiety. What concerns me is that the few times I did complain of sleep issues, they were during appointments for my anxiety, so I'm thinking and hopefully I am wrong, that they took the sleep issues and correlated it as a side effect to my anxiety. Thanks for all the input guys, makes me feel great knowing that I'm not in the fight alone. Semper Fi, do or die!

____________________________________________________________________________________________________________ Gastone - thanks for your prompt response brother. So to answer your questions.... I got diagnosed with PTSD 18 months prior to OSA, with CPAP. I have gained 35+ lbs in the past year and my neck is over 17".

______________________________________________________________________________________________________________ My buddy statements will be extremely descriptive and informative of the different situations. Two of them witnessed me on many occasions "choking" as they would put it while I was asleep, also, my incredibly loud snoring they dealt with while we lived together. My other buddy witnessed me falling asleep during work a few times, then witnessed me getting chewed out immediately. They can provide all of the information that you quoted in the posting up above. Also, my doc during my deployment to Afghanistan said he would vouch for me about all the times i complained to him about waking up middle of the night gasping for air. Honesty, I should have just gotten a sleep study, but I was always told I would get kicked out if it came back positive for OSA. Thanks for your in depth advice, greatly appreciated!

I have the diagnosis, I have 1 or 2 complaints of sleep issues in my SMR, but no NEXUS. Who would I get that from?

So am I correct when I am saying that I should file a NOD? I should add that I discharged Jan '14 and got diagnosed w sleep apnea in March '15. During my visit to the hospital for anxiety, I complained of sleep issues, so is it possible figured that my sleep issues were related to anxiety and not Sleep apnea? I never got tested for Apnea because one of my NCO's at the time said it would get me discharged - he even told me he would vouch for me and tell the VA he said that, but I've always had sleep issues after my first tour Afghan. However, there's not much in my SMR about sleep issues. Just that one complaint I spoke of earlier.

So am I correct when I am saying that I should file a NOD? I should add that I discharged Jan '14 and got diagnosed w sleep apnea in March '15. During my visit to the hospital for anxiety, I complained of sleep issues, so is it possible figured that my sleep issues were related to anxiety and not Sleep apnea? I never got tested for Apnea because one of my NCO's at the time said it would get me discharged - he even told me he would vouch for me and tell the VA he said that, but I've always had sleep issues after my first tour Afghan. However, there's not much in my SMR about sleep issues. Just that one complaint I spoke of earlier.