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Tomahawk

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Everything posted by Tomahawk

  1. You are likely referring to protected ratings. 5 year rule: If the rating has been in effect for 5 years, it cannot be reduced unless your condition has improved on a sustained basis (The VA must have documentation supporting this is a permanent improvement). 10 year rule: A service connected disability rating cannot be terminated if it has been in effect for 10 years. Compensation can be reduced if evidence exists that the condition has improved. The sole exception is if the VA can prove fraud, in which case the VA can terminate the benefits. 20 year rule: If the rating has been in effect for 20 years, it cannot be reduced below the lowest rating it has held for the previous 20 years. The only exception is if the VA can prove fraud. Nothing states anything about requiring a C&P exam. Just that improvement is shown.
  2. The VA does new C&P exams on any condition not deemed permanent or "static" every 3 years. It used to be 5 years. This is not them trying to pull a fast one on you. This is standard procedure. And depending on the outcome of the exam, the disabilities in question, and your age it could move your conditions to being static with no future exams scheduled. With that being said, I believe you are confused about the "protection" rules. 5 year rule: If the rating has been in effect for 5 years, it cannot be reduced unless your condition has improved on a sustained basis (The VA must have documentation supporting this is a permanent improvement). This means that you have to show improvement over a period of time. A single C&P exam cannot be used to lower your rating. However a C&P along with treatment records can be. However if your condition ceases, service connection can be removed. 10 year rule: A service connected disability rating cannot be terminated if it has been in effect for 10 years. Compensation can be reduced if evidence exists that the condition has improved. The sole exception is if the VA can prove fraud, in which case the VA can terminate the benefits. This means that you cannot have the service connection severed. You can still be reduced to 0% if the medical evidence supports sustained improvement. 20 year rule: If the rating has been in effect for 20 years, it cannot be reduced below the lowest rating it has held for the previous 20 years. The only exception is if the VA can prove fraud. This means that if you were granted 10% in 1998, then raised to 20% in 2005 you are protected at the 10% rate this year. In 2025 you would be protected at the 20% rate. With all of that said, you have held your rating for over 5 years. If your treatment records do not show improvement, then these upcoming C&P exams cannot be grounds to reduce.
  3. My case was in front of the judge for 3 days. They remanded it. Took a little under a month for the RO to order the C&Ps ordered on remand. Had the exams done and uploaded within 3 weeks of that. It's been 9 months since and no movement on my appeal.
  4. Any guesses on to how this will be rated? Stomach and Duodenal Conditions (Not including GERD or esophageal disorders) Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 1. Diagnosis ------------ Does the Veteran now have or has he/she ever had any stomach or duodenum conditions? [ ] Yes [X] No 2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's stomach or duodenum conditions (brief summary): The veteran presents today with the following requested: "The examiner is asked to provide the following opinions:a. Is it at least as likely as not (a 50 percent probability or greater) that any current stomach disability, including GERD, was incurred during the Veterans period of active service? Discuss the Veterans reports of frequent indigestion and heartburn on his Report of Medical History in September 1998.b. Is it at least as likely as not (a 50 percent probability or greater) that any current stomach disability, including GERD, was caused by or aggravated by his service-connected left foot disability, to include his treatment for the condition? Please specifically discuss the comments of the August 2010 VA examiner that the use of nonsteroidal anti-inflammatoriesin individuals with known GERD may contribute to the severity. "The veteran reports that he started to develop symptoms of pyrosis during his military enlistment in the 1990s and was medicated with over-the-counter antacids. Review of the veteran's C-file shows on his separation exam he checked indigestion as a symptom. There are no medical reports of symptoms of pyrosis or indigestion noted in his service medical records. Review of his CPRS electronic charting notes on a consult that was placed, that he started to develop symptoms of gastroesophageal reflux disease between 2002 and 2003. His first endoscopy procedure was completed earlier this year which documented mild esophagitis, and further testing at University Hospitals on an outpatient basis diagnosed him with gastroesophageal reflux disease. He had a treatment course of proton pump inhibitors that he failed, and as recently as May 2010 underwent fundoplication surgery at the Wade Park VA facility. The veteran states that since the surgery he has had a very significant improvement in the episodes of pyrosis. He states if eating spicy foods such as Mexican foods with hot sauce,he will still experience an episode of pyrosis, but the frequency is drastically reduced, and as long as he maintains lifestyle modifications such as avoiding those foods, that he does not experience pyrosis. He does also complain of an occasional sharp pain noted after swallowing either large amounts of food or liquid, which only lasts for a few minutes and then resolves since the surgery." Today the veteran reports that his GERD has become worse and he is taking additional medications that now include Omeprazole 40mg daily, Ranitidine 300mg QHS and Lactobacilus. He reports increased pyrosis, more pronounced reflux and some pain in left upper abdominal area. Increased belching. Occasional symptoms wake the veteran at night. b. Does the Veteran's treatment plan include taking continuous medication for the diagnosed condition? [X] Yes [ ] No If yes, list only those medications used for the diagnosed condition: Omeprazole 20mg Lactobacillus 3. Signs and symptoms --------------------- Does the Veteran have any of the following signs or symptoms due to any stomach or duodenum conditions? [ ] Yes [X] No 4. Incapacitating episodes -------------------------- Does the Veteran have incapacitating episodes due to signs or symptoms of any stomach or duodenum condition? [ ] Yes [X] No 5. Other conditions ------------------- Does the Veteran have any of the following conditions? [ ] Yes [X] No 6. 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 the conditions listed in the Diagnosis Section above? [X] Yes [ ] No If yes, describe (brief summary): Veteran has GERD 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 answer provided 7. Diagnostic testing --------------------- a. Have diagnostic imaging studies or other diagnostic procedures been performed? [X] Yes [ ] No If yes, check all that apply: [X] Upper endoscopy Date: 2009 Results: see below b. Has laboratory testing been performed? [ ] Yes [X] No c. 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): Endoscopic reports confirms mild esophagitis, and other testing confirms gastroesophageal reflux disease, and the veteran is status post fundoplication surgery. 8. Functional impact -------------------- Do any of the Veteran's stomach or duodenum conditions impact his or her ability to work? [ ] Yes [X] No 9. Remarks, if any: ------------------- The examiner is asked to provide the following opinion s: a. Is it at least as likely as not (a 50 percent probability or greater) that any current stomach disability, including GERD, was incurred during the Veterans period of active service? Discuss the Veterans reports of frequent indigestion and heartburn on his Report of Medical History in September 1998. b. Is it at least as likely as not (a 50 percent probability or greater) that any current stomach disability, including GERD, was caused by or aggravated by his service-connected left foot disability, to include his treatment for the condition? Please specifically discuss the comments of the August 2010 VA examiner that the use of nonsteroidal anti-inflammatoriesin individuals with known GERD may contribute to the severity. 2507 requested opinion: a. After a review of the veteran's available medical records he does not have a "stomach" condition. The veteran has gastroesophageal reflux disease. Although he reported symptoms on his "Report of Medical History" in September of 1998 there is no other documentation found in his service treatment records that represents objective evidence to support the diagnosis. Therefore this examiner would have to resort to speculation to determine that his complaints as listed above were the first manifestations of his gastroesophageal reflux disease. b. Although the use of anti-inflammatory pain medications can increase the severity of symptoms and GERD itself there is no baseline Esophagogastroduodenoscopy to document findings either prior to his use of chronic NSAIDs or early in his development of symptoms of GERD to establish a baseline. Therefore it would be at least as likely as not that the veteran's GERD was aggravated beyond it's normal progression however this examiner cannot provide a degree of aggravation because of the above rationale.
  5. Pretty sure I redacted any personal info. Can anyone hazard a guess as to how this will be rated, and whether or not I will need to file a secondary claim after for radiculopathy or if they will grant it automatically? Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a thoracolumbar spine (back) condition? [X] Yes [ ] No Thoracolumbar Common Diagnoses: [ ] Ankylosing spondylitis [ ] Lumbosacral strain [ ] Degenerative arthritis of the spine [X] Intervertebral disc syndrome [ ] Sacroiliac injury [ ] Sacroiliac weakness [ ] Segmental instability [ ] Spinal fusion [ ] Spinal stenosis [ ] Spondylolisthesis [ ] Vertebral dislocation [ ] Vertebral fracture Diagnosis #1: Lumbosacral Degenerative Disc Disease ICD code: M51.36 Date of diagnosis: 2010 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's thoracolumbar spine (back) condition (brief summary): Veteran presents today claiming service connection for his lumbosacral degenerative disc disease secondary to his military service or secondary to his service connected left foot post surgery and complex regional pain syndrome. Veteran reports chronic daily low back pain that radiates down the right lower extremity. The pain will increase with prolonged periods of weight bearing, ambulation and repetitive bending. His pain is managed with pain clinic. He has had epidural injections. Veteran reports that his back began to cause chronic problems approximately 2004-2005. He reports altered antalgic gait since 1998 after his military discharge that became worse after being diagnosed with complex regional pain syndrome in 2006. He also reports that he has fallen on multiple occasions secondary to his left lower extremity giving way secondary to his CRPS resulting in frequent low back injuries. b. Does the Veteran report flare-ups of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words: Veteran reports flare ups usually one time per month lasting 1-2 days. Sometimes if more than one day will go to emergency room and is treated with Toradol. During the flare ups he is in bed all day. c. Does the Veteran report having any functional loss or functional impairment of the thoracolumbar spine (back) (regardless of repetitive use)? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words. as above 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Forward Flexion (0 to 90): 0 to 60 degrees Extension (0 to 30): 0 to 0 degrees Right Lateral Flexion (0 to 30): 0 to 15 degrees Left Lateral Flexion (0 to 30): 0 to 15 degrees Right Lateral Rotation (0 to 30): 0 to 15 degrees Left Lateral Rotation (0 to 30): 0 to 15 degrees If abnormal, does the range of motion itself contribute to a functional loss? [ ] Yes (please explain) [X] No Description of pain (select best response): Pain noted on exam but does not result in/cause functional loss If noted on exam, which ROM exhibited pain (select all that apply)? Forward Flexion, Extension, Right Lateral Flexion, Left Lateral Flexion, Right Lateral Rotation, Left Lateral Rotation Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): pain to palpation of the LS spine L4/L5 b. Observed repetitive use Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time 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? [ ] Yes [X] No [ ] Unable to say w/o mere speculation d. Flare-ups Is the exam being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare- up: [X] The examination is medically consistent with the Veteran's statements describing functional loss during flare- ups. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss during flare- ups. Please explain. [ ] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups? [ ] Yes [X] No [ ] Unable to say w/o mere speculation e. Guarding and muscle spasm Does the Veteran have guarding or muscle spasm of the thoracolumbar spine (back)? [ ] Yes [X] No f. Additional factors contributing to disability In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: Less movement than normal due to ankylosis, adhesions, etc., Weakened movement due to muscle or peripheral nerve injury, etc., Atrophy of disuse, Disturbance of locomotion, Interference with standing 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 Hip 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 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: [ ] 5/5 [X] 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: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Great toe extension: 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 b. Does the Veteran have muscle atrophy? [ ] Yes [X] No 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 Knee: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Ankle: Right: [X] 0 [ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [X] 0 [ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatome) testing: 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. Straight leg raising test ---------------------------- Provide straight leg raising test results: Right: [ ] Negative [X] Positive [ ] Unable to perform Left: [X] Negative [ ] Positive [ ] Unable to perform 8. Radiculopathy ---------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [X] Yes [ ] No a. Indicate symptoms' location and severity (check all that apply): Constant pain (may be excruciating at times) Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Intermittent pain (usually dull) Right lower extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Numbness Right lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe b. Does the Veteran have any other signs or symptoms of radiculopathy? No response provided. c. Indicate nerve roots involved: (check all that apply) [X] Involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve) If checked, indicate: [X] Right [ ] Left [ ] Both d. Indicate severity of radiculopathy and side affected: Right: [ ] Not affected [X] Mild [ ] Moderate [ ] Severe Left: [X] Not affected [ ] Mild [ ] Moderate [ ] Severe 9. Ankylosis ------------ Is there ankylosis of the spine? [ ] Yes [X] No 10. Other neurologic abnormalities ---------------------------------- Does the Veteran have any other neurologic abnormalities or findings related to a thoracolumbar spine (back) condition (such as bowel or bladder problems/pathologic reflexes)? [ ] Yes [X] No 11. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ---------------------------------------------------------------- ------- a. Does the Veteran have IVDS of the thoracolumbar spine? [X] Yes [ ] No b. If yes to question 11a above, has the Veteran had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months? [ ] Yes [X] No 12. 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? [X] Yes [ ] No If yes, identify assistive device(s) used (check all that apply and indicate frequency): Assistive Device: Frequency of use: ----------------- ----------------- [X] Cane(s) [ ] Occasional [ ] Regular [X] Constant b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: for his service connected left foot condtion with CRPS 13. Remaining effective function of the extremities --------------------------------------------------- Due to a thoracolumbar spine (back) condition, 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.; functions of the lower extremity include balance and propulsion, etc.) [X] No 14. 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 15. Diagnostic testing ---------------------- a. Have imaging studies of the thoracolumbar spine been performed and are the results available? [X] Yes [ ] No If yes, is arthritis documented? [ ] Yes [X] No b. Does the Veteran have a thoracic vertebral fracture with loss of 50 percent or more of height? [ ] Yes [X] No c. 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): Report: Clinical Information: Back pain with radiculopathy. Procedure: Images of the lumbar spine were obtained in multiple planes using multiple pulse sequences and compared to 10/23/13. Findings: At T11-T12, there is disc dehydration with loss of disc height. There is a central disc protrusion again noted compressing the ventral dural sac. The midline dural sac diameter is mildly diminished. There is no cord compromise or foraminal impingement. An incidental perineural cyst is seen within the foramen on the right at this level without change. At T12-L1, there is disc dehydration with loss of disc height. The disc is normal in configuration. At L1-L2, there is normal disc signal with preservation of disc height. There is mild disc bulging compressing the ventral dural sac. The midline dural sac diameter is adequate. There is no foraminal impingement. At L2-L3 and L3-L4, there is normal disc signal and disc configuration with preservation of disc height. At L4-L5, there is disc dehydration with preservation of disc height. There is moderate disc bulging compressing the ventral dural sac. The midline dural sac diameter is adequate. There is mild bilateral foraminal narrowing. There is facet hypertrophy. At L5-S1, there is disc dehydration with preservation of disc height. There is moderate disc bulging eccentric towards the right and compressing the ventral dural sac. The midline dural sac diameter is adequate. There is moderate to severe right-sided foraminal narrowing. There is mild foraminal narrowing on the left. There is facet hypertrophy. The lumbar vertebra and conus medullaris are normal. No paraspinal abnormality is seen. There has been no substantial change from prior study. Impression: 1. Disc protrusion at T11-T12. 2. Disc bulging at L1-L2, L4-L5 and L5-S1. 3. Multilevel foraminal narrowing that is most prominent on the right at L5-S1. Right L5 nerve root impingement may be present. 4. No change from prior study. Primary Diagnostic Code: 16. Functional impact --------------------- Does the Veteran's thoracolumbar spine (back) condition impact on his or her ability to work? [X] Yes [ ] No If yes describe the impact of each of the Veteran's thoracolumbar spine (back) conditions providing one or more examples: The veteran's above noted low back condtions would impair his ability for physical work requiring any prolonged periods of standing, walking, climbing , repetitive bending or lifting. 17. Remarks, if any: -------------------- Provide a medical opinion regarding the etiology of the Veterans current low back disability, to include whether it is secondary to his service- connected left foot disability with complex regional pain syndrome. Any additional examination or testing of the Veteran may be conducted, if deemed necessary by the examiner. The examiner is asked to provide the following opinions: a. Is it at least as likely as not (a 50 percent probability or greater) that the Veterans low back disability was caused by his period of active service? Specifically discuss the Veterans complaints of back pain in July 1996, August 1996, and on his Report of Medical History prior to separation. b. Is it at least as likely as not (a 50 percent probability or greater) that the Veterans low back disability was caused by or aggravated by his service-connected left foot disability, to include complex regional pain syndrome? Specifically discuss the report of the 2009 VA examiner that the Veteran had an abnormal gait due to a limping left foot. 2507 requested opinions: a. After a review of the veteran's STR's his complaints of back pain during his military service consisted of an upper thoracic strain and no complaints of low back pain. Therefore it would be less likely than not that this veteran's chronic LS condition of degenerative disc disease with right lower extremity radiculopathy is directly related to his complaints of back pain during his military service. b. The veteran's service connected left foot condition with CRPS has resulted in a chronically altered gait as well as multiple falls that have affected his back. Therefore it would be at least as likely as not that this veteran's current lumbosacral spine condition of degenerative disc disease with right lower extremity radiculopathy is secondary to his service connected left foot condition with CRPS.
  6. The way I read the statement is that someone has to form a medical opinion that your obesity was "caused" by the service connected disability. With that said, I had my SA claim denied based on obesity. Ill look for it when I get home. But it said something along the lines of "while medications taken for SC disability have contributed to weight gain, that alone is not the cause of the obesity as adjusting caloric intake would make up for the reduced activity levels" Basically the doctor stated that I had sleep apnea because I was overweight, and that I was overweight because I ate too much, not because of the 800 medications I have taken that weight gain is a side effect of.
  7. The major problem with your "little gem" is that you still have to have a doctor backing your statement. " 15. A determination of proximate cause is basically one of fact, for determination by adjudication personnel. VAOPGCPREC 6-2003 and 19-1997. With regard to the hypothetical presented in the previous paragraph, adjudicators would have to resolve the following issues: (1) whether the service-connected back disability caused the veteran to become obese; (2) if so, whether the obesity as a result of the serviceconnected disability was a substantial factor in causing hypertension; and (3) whether the hypertension would not have occurred but for obesity caused by the service- 10. Executive in Charge, Board of Veterans' Appeals (01) connected back disability. If these questions are answered in the affirmative, the hypertension may be service connected on a secondary basis." You will have to have a doctor state that your SC disability caused the obesity. Which will be much more difficult than you'd expect. Yes lack of exercise due to your SC disability may have been a contributing factor, however your eating habits are more than likely the primary cause in most doctors "professional opinions"
  8. Is it possible to appeal the diagnostic code used? In my case, I was granted 30% for CRPS secondary to a post operative foot injury. They rated me under 8599-8521 External popliteal nerve (common peroneal). 8521 Paralysis of: Complete; foot drop and slight droop of first phalanges of all toes, cannot dorsiflex the foot, extension (dorsal flexion) of proximal phalanges of toes lost; abduction of foot lost, adduction weakened; anesthesia covers entire dorsum of foot and toes............................................... 40 Incomplete: Severe 30 Moderate............................................................................................................. 20 Mild ................................................................................................................ 10 I believe this is the incorrect diagnostic code because it does not address the atrophy of the muscles below the knee which is what triggered them to reverse their denial before sending the appeal to the BVA. They stated the 1" of atrophy on the calf was enough to separate the CRPS from the SC post operative foot injury. I believe that they should have rated me under: Sciatic nerve. 8520 Paralysis of: Complete; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost........................................................................................................... 80 Incomplete: Severe, with marked muscular atrophy.............................................................. 60 Moderately severe ............................................................................................. 40 Moderate............................................................................................................. 20 Mild ................................................................................................................ 10 Which would have granted me 60% and not the 30% due to the marked muscular atrophy of the muscles below the knee. Is this something I can appeal on? Or is it pretty much whatever they rated it under as it is analogous what I am stuck with? Secondary question to this. This was one of 5 items on appeal to the BVA. They awarded me this prior to certifying my file to the BVA. At my video hearing I stated I was withdrawing that portion of the appeal. When I called the 800 number prior to my 1 year mark to inquiry as to how I would go about appealing the diagnostic code used they stated I couldn't appeal it until the BVA has finished with the claim. If I am able to request it be reviewed under a different diagnostic code, is there some manner in which I can request a DRO review while my stuff is still with the veterans law judge?
  9. I have yet to received the letter. Though I am indeed employed.
  10. So I have a pending appeal with the BVA still. However last year I got a phone call from a DRO who was reviewing my file before it was sent to the BVA. She said they were upping my rating based on the atrophy in my leg and wanted to know if I still wanted to include that part of my appeal. She also suggested that I file for "mood disorder" because the evidence is in my file for them to grant that. So in March I filed. I haven't gotten the letter yet but my rating jumped from 60-90% on ebenefits. So it looks like they granted me 70% for the new claim. Such a relief to have something in this process go so smoothly and it being something they told me about.
  11. So the likelihood is s certainty. They gave me 70%
  12. Just to update. Ohio Specialty Network is a sham. All the guy did was write a report stating that I did indeed have the issues I was requesting him to examine me for and opine on. He would not write an opinion on cause nor correlation. Do not use them for an IMO
  13. Added the pertinent info to my original post. I understand based on the occupational report it could be 30%. However the fact that he indicated: "Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively" makes me think it may be higher. Just curious what the experts/former raters on here think. My question is based off of reading: VAZQUEZ-CLAUDIO V. SHINSEKI In Vazquez-Claudio v. Shinseki, the Federal Circuit ruled that the most important consideration when rating psychological disorders is the symptoms associated with each rating. For example, if a veteran is trying to get a 70% rating, it is less important that he prove that he have "[o]ccupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood," and more important that he prove that he have the symptoms associated with that rating, which include "suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships." So, in any case where you are trying to receive a higher rating for PTSD, remember that the most important thing you must prove is that you have the symptoms associated with each disability rating. As the symptom selected is associated with the 70% rating, I am curious what the likelihood is that they will grant the 70%
  14. So I just had my C&P exam for depression secondary to my CRPS. Based on the exam can anyone speculate on what rating I would get? SECTION I: ---------- 1. Diagnosis ------------ a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)? [X] Yes [ ] No ICD code: F32.89 If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: Mental Disorder Diagnosis #1: Other specified depressive disorder ICD code: F32.89 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): complex regional pain syndrome, OSA, herniated disks 2. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [ ] Yes [X] No c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 3. 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? [ ] Yes [ ] No [X] No other mental disorder has been diagnosed 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 3. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively [X] Chronic sleep impairment [X] Disturbances of motivation and mood -------------- TEST RESULTS: Mr. XXX completed the Beck Depression Inventory-II (BDI-II), a widely used self-report instrument concerning depressive symptoms experienced in the last two weeks. There are no norms. The instrument lacks a validity scale and is therefore susceptible to either under- or over-reporting of symptoms. Mr. XXX scored 30, which the test developer considers to represent "severe" depression. -------------------- OPINION: Mr. XXX's current symptoms meet diagnostic criteria for other specified depressive disorder, a diagnosis based on depressive symptoms that do not fully meet diagnostic criteria for a specific depressive disorder. The veteran's depressive disorder is as least as likely as not proximately due to or the result of complex regional pain syndrome, left lower extremity with atrophy; and to herniated disks.
  15. First of all. File the Form 9. You are on a deadline with that. You don't need an attorney, or an IMO to send in the Form 9 stating you disagree and want the BVA hearing. Hopefully you are close enough to your regional office that you can hand walk it in to get a time stamped copy for yourself. If not get it in the mail as soon as possible so you don't miss the deadline. After that you can get the attorney and/or the IMO. If you are going to go the attorney route they probably have a preferred company to use for IMOs. If you are going to just get the IMO yourself you need to make sure you print out the DBQs for the issues you are claiming. And make sure you have a full copy of your medical records and SMRs for the IMO doctor to you review. The IMO will need to state it is "at least as likely as not" service related/caused or aggravated by a current SC disability. And then it also has to provide reasoning for that statement. If your IMO does that it is highly likely you will win the appeal. As far as the VA Backlog goes, you may want to at least reach out to a VSO. There are ways to get it sped up and they can probably help you with that. However once you submit the Form 9 it doesn't just automatically get sent to the BVA. I filed my Form 9 in March of 2013. The DRO didn't review my file again until July of 2016 to then send my case to the BVA in August 2016. I had my video hearing November 3rd. And it is now my understanding that the average wait time after the hearing for the decision to be sent out is about 270 days. With that said, before they sent my file to the BVA the DRO did review my file and granted one of the conditions I was contesting. So if you do get the IMO and send it in they can indeed review it and possible grant your appeal prior to it getting sent to the BVA
  16. I would file the Form 9. If you submit additional evidence after that they will review it and may make a decision before it even goes to the BVA. I filed my Form 9 in 2013. They were finally submitting it to the BVA in July of this year when they reviewed the C-File and granted me 1 of the 5 items on appeal before sending it.
  17. I have been battling the VA for over 15 years. I have had numerous vet reps throughout that time and in the end I got rid of them all and took the time to do the research myself. Before finally sending my claim to the BVA, the DRO called me in mid July stating that they reviewed my claim and that 1 of the 5 issues I was contending was going to be granted for me. And they also told me that within that review they saw two other claims that I should have made. Which I found odd. She basically told me that I should look over my file. There are two conditions that are clearly related to my SC Disability and that were I to file for those they would be granted without any issue. However she wouldn't tell me what those two conditions would be. So I need to figure that out once I finish my appeal. With that said, after an almost 7 year wait I had my BVA hearing last week. I just started a job a month ago that is my first since service to offer medical insurance. So I answered all of her questions, and presented my case, then requested the judge to hold the record open for 60 days so that I can have time to get an IME on 2 of my 4 issues which she granted. After we finished the hearing and she stopped recording she stated that she was pleasantly surprised. Most veterans who represent themselves aren't prepared, it was clear that I had done my research, and that I did an exceptional job presenting my case. I'm hopeful that she wasn't just blowing smoke and that my case was strong in her eyes already. So now I have to get the IME's and hope the doctor agrees with the conclusions I have drawn. After that we will see how it goes. Keep fighting if you believe your cause is just.
  18. I was under the impression that if you requested a copy of your c-file that the VA was under time constraints on getting you a copy? I applied for a copy in August of 2015. I checked ebenefits today and its stating Estimated Completion: 10/10/2016 - 05/14/2017 Seriously? Up to 2 years wait for a copy of a file that is supposed to be electronic at this point?
  19. Well. I have my VA medical records which show I have CRPS. Which is already in my 30% service connection. However they rated me as 30% for "post-operative foot injury with complex regional pain syndrome". I just need the doctor to write something to get them to separate it.. The foot in and of itself is practically worthless due to the VA surgeon fusing all of my toes. I have zero movement on my own and they can only be moved by hand a few degrees. My ankle constantly rolls because of this which I thought would have been rated as well but apparently not. But for those 2 issues I shouldn't need anything in my SMR. The foot and the VA surgery that caused the CRPS are already service connected. As for the rest of my claims that were denied. There are entries in my SMR. But apparently not enough for the C+P doctors to opine in my favor. However everything I claimed is also exacerbated by my already SC condition. So they should be granted on that basis alone. I do have a copy of my C-File, or at least as complete of a copy as I can. As well as 1 copy left of my SMR. I do not have a VSO. I fired the one after this last claim because he put all sorts of shit in my claim that I wasn't claiming. He put a claim in for my opposite foot which there is nothing wrong with. He put a claim in for 100% IU. And he didn't include a 2 things I specifically mentioned. I learned the hard way that you shouldn't trust a VSO when they say "Sign this, Ill fill it out when I have time and submit it". been going it alone since. But I would most assuredly explain to the doctor that he needs to review the records and provide a complete rationale for his findings.
  20. Ohio Specialty Network is the company's name. http://ohiospec.com/ I told the lady I spoke to I would call back once I had my medical records. I submitted the ROI at my local hospital in person and mailed request to the 2 other hospitals in different states I was treated at. She said once I get them to come in and drop the medical records off and schedule an exam. It's my intention to print out the DBQs for everything I claimed as well as explain that I need a letter to accompany each that states "more likely than not" "at least as likely" or "was/is caused/aggravated by" if he deems them to be related to service.
  21. I found a local company that specializes in IME/IMOs typically for lawyers/workers comp cases. I asked about the price for a VA exam and she stated they do them at an extreme discount for vets. She stated $400 for all 5 of the issues I am seeking an IME on. That almost sounds too good to be true.
  22. Does Dr. Ellis require an in person examination? Im quite a distance from OK
  23. Migraines, Degeneration of lumbar or lumbosacral intervertebral disc, Spondylosis, Spinal stenosis of lumbar region, Obstructive Sleep Apnea, Esophagitis, Hiatal hernia, Gastroesophageal Reflux Disorder, and CRPS/RSD of the Lower Limb. I've tried Dr. Bash twice and never received a response, so I assumed he is pretty booked up.
  24. Mine deposited this morning. I think they can come any time between now and the end of October.
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