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    • NOD / DRO or TARP?
      All, Thank you for the response's. Due to me posting all of my documents intermittently, there seems to be some confusion with the timeline and issues. I will attempt to run thru this chronologically and repost all documents including my 2015 decision which I had not previously posted and answer all questions. March 2009- Filed original Claim for the following issues and received results October 2009 (see 2009 - Rating Sheet below) I do not have the entire decision packet: TBI - 10 % SC Residuals, gallbladder removal - 0% SC Back Condition - declined SC Psoriasis - declined SC PTSD - declined SC / Stressor conceded as combat action badge. October 2010 - Filed NOD / DRO for PTSD March - 2011 - Appeal decision received. I never stated that PTSD was due to MST. The paragraph on page 2 of 2011Appeal decision below is just the last part of 10 pages that I cut out covering rules and US code that they sent in the letter. The actual decision starts at the bottom of that page. Results: PTSD declined - I did not submit any new evidence. Diagnosed as "adjustment disorder with mixed anxiety and depressed mood". Blamed on me worrying about my husband returning to Iraq, even though he had just returned??? October 2014  - Initiated following claims: (I had transferred to the North Texas VA and had finally began receiving treatment after being fed up with OKC VA. I live in southern Oklahoma, so its a drive for me to go to either one) PTSD - Re-open Claim. TBI - Request for increase. May 2015 -  I reported for C&P exams at the Dallas VA clinic for PTSD and TBI. I'm not sure if this is relevant, but I received a call while my husband and were driving there stating that the TBI examiner had to leave early and that they would have to re-schedule that exam. I protested because it is a 3 hour drive. They called me back 10 minutes later stating that he would conduct the exam. He seemed pissed the whole time. His not stated that No TBI residuals were present.  This is also the exam where the PTSD screener stated "However, it should be pointed out that most of the symptoms the veteran described during today's MH examination certainly those common to a PTSD diagnosis- she also described during her 7/8/09 Initial PTSD examination, in Oklahoma City, three years PRIOR to her son's illness."  ( see 2015 C&P exam notes below) June 2015 - Latest decision received. Results (see 2015 - decision part 1 &2 below): TBI - Decreased to 0% SC PTSD - 50% SC May 2016 - Wondering what my best next COA should be? Would like to get PTSD effective date back to 2009 and get TBI increased to at least percentage it was before. I have about 50 days to file my NOD. Q&A: Berta: What did the C & P doc diagnose you with? 2009 - TBI (SC) and adjustment disorder with mixed anxiety and depressed mood (not SC) 2015 - No TBI residuals and PTSD w/ major depressive disorder.   Berta: Have you googled the doctor who did the C & P? I do not know the Doctor's name from 2009. But I have found several articles referring a Dr. Gail Poyner who was conducting PTSD exams at OKC VA at the time. She was fired from the VA in 2010 for applying test to Veterans to see if they were malingering or faking. He research paper can be found here: http://link.springer.com/article/10.1007%2Fs12207-010-9076-x?LI=true I would like to have my C-File to see if she conducted the evaluation.   Gastone: What did you claim as the PTSD Stressors in your 09 app for PTSD? Combat Action Badge   Gastone: The 1st Denial, discussed "No Evidence of Personal Assault," MST? No MST ever claimed. The paragraph that covers MST due to MST was just the last paragraph of 10 pages of regulations that they sent with the decision. Actual decision starts at the bottom of that page.   Gastone: Did you know anything about the DRO Process Requirement, for the N & M Evidence? I did. My fault I didn't send any. I was fed up with OKC VA and assumed they would send me for a new C&P exam. Stupid on my part.   Gastone: Did you ever get a copy of your 09 PTSD C & P DBQ? No, I did not. Blue button records do not go back that far. I have requested a copy of my C-File. EBenefits states that I will get it between NOV 2017 and NOV 2018.   Gastone:  Do you currently have a VA MH Psychiatrist/Psychologist that treats you on a regular basis? I was being seen at Bohnam, TX VA. After they kept switching Dr's a few times, I now just get my meds re-filled thru my family physician. My husband is active duty, so we are on tri-care prime remote. I also qualify for VA choice, but have not used it.   Gastone: Have they given you an official PTSD DX? I have a PTSD diagnosis and receive 50% SC in 2015.   Berta: Did they have the incident reports? I faxed in two incident reports. They do not show on the evidence list, but stressor was conceded with CAB.   Flores97: Email congressman for C-File. Thank You for the advice. I emailed my congressman today and reiterated the time crunch I am under.     2011 - Appeal decision.pdf 2015 - C&P exam Notes.pdf 2015 - decision part 1.pdf 2015 - decision part 2.pdf 2009 - Rating Sheet.pdf
    • Full Knee Replacement
      I just came back from the Ortho doctor in town he said I need a full knee replacement for my service connected injury after looking at past 11 years of x-rays from the VA and what he just took today. The Marine Corps. somehow don't keep x-rays after a certain period of time. The VA says they will not do one until I'm 60 years old, all they wanted to do was give me injections for the pain. What I have now is a Torn ACL and I'm running bone on bone, and my knee cap is just about gone so here is the question. I already receive 20% for my left knee, due to the past 3 surgery's. So after having the knee replacement what will I be looking at? for an increase? Does the VA have to pay for this since I live 178 miles from the Nearest VA hospital? because they are still telling me if you were injured on active duty you must go to the VA hospital even through the VA says They will not do a knee replacement until I'm 60? I already talked to two Veterans in town at the Vet center and they had the same problem but they paid for it out of their own pocket for the surgery then filed for an increase award. So far they are still waiting for the VA to answer them back. any ideals on the best route to take? I hate to get this done out in a local hospital then fine out the VA will not pay and give me an increase for the full knee replacement. Thank for any information on this subject.
    • CUE? Not using SMR?
      I'm trying to piece together every decision and the docs from the c-file. I cannot for the life of me find the evidence listed as "treatment records from VAMC dated Sept 2003 and received 10-23-03.  Are they required to have the actual document/documents in the c-file as evidence? Also, there certainly were more progress notes about the foot conditions outside of Sept 2003. Would they have been required to get all records on condition from the VAMC?     Thanks as usual!
    • Code Sheet
      A filing for a disease secondary to an existing one is not an increase. Each disease that evolvves as a secondary is a stand alone claim. If you win, the rating diagnostic code will be an amalgam of the primary rating such as DC 7354 for hepatitis C and the second disease such as Porphyria cutanea tarda. The rating sheet would read 7354-7815. I have two like that. the other one is 7354-7700 ( 60% anemia -old 1994 DC 7700). I appealed for 100% for it based on the similarity to 4.115a (dialysis) because there was no 100% rating for porphyria phlebotomies-just 40% under DC 7704. It's called rating by analogy when there is no specific code for a disease/injury. Look at 38 CFRs 4.20 and 4.27   § 4.20 Analogous ratings. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin § 4.27 The diagnostic code numbers appearing opposite the listed ratable disabilities are arbitrary numbers for the purpose of showing the basis of the evaluation assigned and for statistical analysis in the Department of Veterans Affairs, and as will be observed, extend from 5000 to a possible 9999. Great care will be exercised in the selection of the applicable code number and in its citation on the rating sheet. No other numbers than these listed or hereafter furnished are to be employed for rating purposes, with an exception as described in this section, as to unlisted conditions. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part, or system, of the body involved; the last 2 digits will be “99” for all unlisted conditions. This procedure will facilitate a close check of new and unlisted conditions, rated by analogy. In the selection of code numbers, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With diseases, preference is to be given to the number assigned to the disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. Thus, rheumatoid (atrophic) arthritis rated as ankylosis of the lumbar spine should be coded “5002-5240.” In this way, the exact source of each rating can be easily identified. In the citation of disabilities on rating sheets, the diagnostic terminology will be that of the medical examiner, with no attempt to translate the terms into schedule nomenclature. Residuals of diseases or therapeutic procedures will not be cited without reference to the basic disease.
    • CUE? Not using SMR?
      He had 3 0% disabilities that were combined to make the 10%. I guess that ended when he was awarded 30% PTSD IN 2003. 
    • Auto Adaptive Reimbursement
      He deals with a rep in Tucson but I think that falls under Phoenix.It was the Tucson rep that told him that they stopped doing it.I found the link you posted before I asked the question on here.I just wanted to make sure it was still an active program.I will pass this on to him.Thanks.
    • A Tid bit of good news
      I just wanted to post this as I think it counts as some good news.  I received a letter from my lender stating that my student loans have been forgiven.  I should receive a discharge statement here within 4 to 6 weeks.  Although I received a letter from SS on my denial for qualifying for benefits, this student loan news has put a smile on my face.  Onward and forward I shall go.
    • Space A Travel For 100% Pt Sc Dav Petition
      Further research https://rules.house.gov/bill/113/hr-4435 http://amendments-rules.house.gov/amendments/BILIFL_019_xml516141039463946.pdf   Rules #1 Revised] AMENDMENT TO THE RULES COMMITTEE PRINT FOR H.R. 4435 OFFERED BY MR. BILIRAKIS OF FLORIDA At the end of subtitle C of title VI, add the following new section: 1 SEC. 6ll. TRANSPORTATION ON MILITARY AIRCRAFT ON 2 A SPACE-AVAILABLE BASIS FOR DISABLED 3 VETERANS WITH A SERVICE-CONNECTED, 4 PERMANENT DISABILITY RATED AS TOTAL. 5 (a) AVAILABILITY OF TRANSPORTATION.—Section 6 2641b of title 10, United States Code, is amended— 7 (1) by redesignating subsection (f) as sub- 8 section (g); and 9 (2) by inserting after subsection (e) the fol- 10 lowing new subsection (f): 11 ‘‘(f) SPECIAL PRIORITY FOR CERTAIN DISABLED 12 VETERANS.—(1) The Secretary of Defense shall provide, 13 at no additional cost to the Department of Defense and 14 with no aircraft modification, transportation on scheduled 15 and unscheduled military flights within the continental 16 United States and on scheduled overseas flights operated 17 by the Air Mobility Command on a space-available basis VerDate 0ct 09 2002 10:37 May 15, 2014 Jkt 000000 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 C:\USERS\GMKOSTKA\APPDATA\ROAMING\SOFTQUAD\XMETAL\7.0\GEN\C\BILIFL~1.XM May 15, 2014 (10:37 a.m.) F les #1 Revised] 1 for any veteran with a service-connected, permanent dis- 2 ability rated as total. 3 ‘‘(2) Notwithstanding subsection (d)(1), in estab- 4 lishing space-available transportation priorities under the 5 travel program, the Secretary shall provide transportation 6 under paragraph (1) on the same basis as such transpor- 7 tation is provided to members of the armed forces entitled 8 to retired or retainer pay. 9 ‘‘(3) The requirement to provide transportation on 10 Department of Defense aircraft on a space-available basis 11 on the priority basis described in paragraph (2) to vet- 12 erans covered by this subsection applies whether or not 13 the travel program is established under this section. 14 ‘‘(4) In this subsection, the terms ‘veteran’ and ‘serv- 15 ice-connected’ have the meanings given those terms in sec- 16 tion 101 of title 38.’’. 17 (b) EFFECTIVE DATE.—Subsection (f) of section 18 2641b of title 10, United States Code, as added by sub- 19 section (a), shall take effect at the end of the 90-day pe- 20 riod beginning on the date of the enactment of this Act. ◊ VerDate 0ct 09 2002 10:37 May 15, 2014 Jkt 000000 PO 00000 Frm 00002 Fmt     ----------------- I copied and pasted this in case it disappears, I also saved it from the site.
    • Space A Travel For 100% Pt Sc Dav Petition
      This is what I read   I'm a 100% DAV. Can I travel Space-A? Retirees (meaning those with a blue DD Form 2 including medically-retired) are eligible for Space-A. Despite rumors to the contrary, 100 percent disabled veterans in possession of DD Form 1173 or DD Form 2765 (replaces the DD Form 1173) identification cards are NOT entitled to Space-A travel aboard DoD aircraft. If your ID card is brown and the bottom right says "DAVPRM" (Disabled Veteran Permanent) then there is no entitlement for Space-A travel. Any changes to Space-A eligibility rules will be published as an immediate change to DoD 4515.13r and advertised accordingly (Reiteration HQ AMC/DONP 091704z Mar 99 and Reference PASSENGER SERVICE UPDATE DTG: 261800Z OCT 01 para 1.H). If it helps any, here's a small compilation of various efforts that folks have sent me that involve expanding the Space-A privilege to 100 Percent DAVs, widows, widowers, etc.... FY15 NDAA FY12 NDAA Bill S-1768 Bottom Line as of May 2015: Per AMC HQ, regarding H.R. 4435 Amendment 15 stating that 100% disabled veterans can fly Space-A, no guidance has been passed down to terminals to allow this. Until the DoD issues a memo incorporating any changes into DoD's Transportation Regulation  http://www.spacea.net/faqs/spacea-eligibility http://milvetstravel.net/dod.html  

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Jayg

Ankle Rating Decision Questions. Lowballed?

12 posts in this topic

I was granted 20% for "marked limited motion of the ankle. This is maximum disability evaluation for an ankle condition without ankylosis or a frozen ankle."

Thanks to others, I've been plowing through the rating schedules. I had before but it's so vast I hadn't known where to look.

Here's my award decision...

"A review of your medical records indicated that you were treated for an inversion sprain of your left ankle in February 1980. Treatment records shoed tht the ankle was short casted for two weeks. Records showed a full normal range of motion with no pain and release to limited duty on February 28, 1980. Your separation examination date May 6, 1981 does not show any residual disability of the left ankle or complaints of any disability of the left ankle at service separation. A review of your VA treatment records from as early as April 2001 does not show any complaints of a disability of your left ankle. VA records from February 2002 show treatment for complaints of a left knee conditon, but there is no record of complaints of a left ankle condition. Lay statements provided [by] David Ott [Col. ret., my then Capt., battery commander] indicated his knowledge of injury and treatment for the left ankle injury. Your recent VA examination on your left ankle showed swelling with no effusion. Mild bony enlargement and deformity was noted. Dorsiflexion was limited to 0 degrees with plantar flexion to 14 degrees. Pain was noted on the range of motion testing with additional limitation of motion due to pain, weakness and fatigue. Based on evidence of severe inversion sprain in active service and continued complaints of pain in the left ankle and the VA examintation showing a marked limitation of motion in the ankle due to pain and weakness, we will grant service connection for your left ankle with a 20 percent disability evaluation. An evaluation of 20 percent is assigned for marked limited motion of the ankle.

This is the maximum disability evaluation for an ankle condition without ankylosis or a frozen ankle."

I took this to mean that's all I could get on the ankle but now I'm thinking that may not be true. I looked up "ankylosis" and found this definition... "stiffness or fixation of a joint by disease or surgery" Stiff it is! I haven't had surgery but I do have arthritis- djd.

The rating schedule section;

THE ANKLE

Rating

5270 Ankle, ankylosis of:

In plantar flexion at more than 40º, or in dorsiflexion at more

than 10° or with abduction, adduction, inversion or eversion

deformity 40%

In plantar flexion, between 30º and 40º, or in dorsiflexion,

between 0º and 10º 30

In plantar flexion, less than 30º 20

5271 Ankle, limited motion of:*

Marked 20* (my award rating)

Moderate 10

5272 Subastragalar or tarsal joint, ankylosis of:

In poor weight-bearing position 20

In good weight-bearing position 10

5273 Os calcis or astragalus, malunion of:

Marked deformity 20

Moderate deformity 10

5274 Astragalectomy 20

In poor weight-bearing position 20

In good weight-bearing position 10

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Now I don't understand all that. But my ankle will roll out from under me suddenly and w/out warning. Is there more I can claim or appeal on this joint?

There is evidence of complaint in those in between years and they have it too. But I don't think that's any longer an issue here- or is it?

Sorry this is long but I need TDIU and I don't have the reuesite percentage yet. I have to claw at every straw I can find.

Too, my file has been sent to VMAC for a 'medical opinion" but I haven't been able to find out for what yet. The arthritis would be my guess.

You all have been great and I am most appreciative of all the advice given and experience you have shared.

Any further help would be most apprecciated.

Thank you.

J

Edited by Jayg

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I am going for My C&P next friday. It is supposed to be for my right ankle.

In 2002, during my flight training, I had a "very bad" sprain in my right ankle. Military Doc's told me Ice, elevation, and motrin for 2 weeks would take care of it.

I had my initial C&P in april of 2005 and they granted service connected with 0% compensation.

Since the 2005 C&P my right ankle got so bad that i could hardly walk on it at times. I went to a podiatrist, and an ortho doctor to see what the problem was. They told me that my ankle looked like one that belonged to someone twice my age. They said that i have arthitus and alot of soft tissue damage due to a free floating mass cause by prior trauma. My ortho doc sent me for an MRI which also showed my ATFL tendon is severely attenuated, "Tore." My orto doc recomended 2 surgerys 1 arthoscopic to smooth the arthritus that is currently present and the other to reconstruct my torn ligament.

On the 6th i went through the arthoscopic and it is healing OK. I still have moderate pain and very limited motion in the ankle.....

I guess the moral of the story is The VA had all the evidence when i went through my 1st C&P and they chose to ignore it. Now I have had more problems and They probably will ignore it once again.

This time I even sent them a CD with my full MRI on it.....

Edited by jbasser

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wow i dont know how that happened...... how do you edit post on this site... sorry thats a bit off topic.

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No, the question of your disability since your injury in service is no longer an issue, otherwise you wouldn't have received the 20%.

And, yes, according to your limited (non-existing) ROM, you should have been granted 30%.

All you can do, at this point, is to file an NOD and hit them with a doctor's statement that you have NO ROM not only due to your DJD but ALSO due to your PAIN. Matter-of-fact, that is essentially what your VA C&P actually said. Pain MUST be considered along with the limited ROM. I had the same problem, exactly.

ALL you're going to get is 30%, UNLESS you can convince them that your ankle disability has caused your "loss of use of" your ankle/foot.

Documentation, Medical Opinions, etc. etc., you know the drill.

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No, the question of your disability since your injury in service is no longer an issue, otherwise you wouldn't have received the 20%.

And, yes, according to your limited (non-existing) ROM, you should have been granted 30%.

All you can do, at this point, is to file an NOD and hit them with a doctor's statement that you have NO ROM not only due to your DJD but ALSO due to your PAIN. Matter-of-fact, that is essentially what your VA C&P actually said. Pain MUST be considered along with the limited ROM. I had the same problem, exactly.

ALL you're going to get is 30%, UNLESS you can convince them that your ankle disability has caused your "loss of use of" your ankle/foot.

Documentation, Medical Opinions, etc. etc., you know the drill.

Specifically, my C&P on that ankle says

2+ swelling w/out effusion(?jg)

Objective evidence of pain with guarding and grimacing. Pain is present @ 0 degrees and increases throughout range of motion testing. Pain does not end. (brother and how! JG) There are additional limitations of range of motion or joint function secondary to pain, fatigue, weakness or lack of endurance following repetitve use. The major functional impairment is pain."

ROM

Active - dorsiflexion 0 - 0, plantar flexion 0 - 14

Passive - dorsiflexion 0 - 0, plantar flexion 0 - 20

with repetitive ROM dorsiflexion 0 - 0, plantar flexion 0 - 14

She goes on to murder me... I mean state, "no tendon damage, no bone joint or nerve damage. No muscle herniation, no loss of muscle function. No joint is affected."

This examiner took two personal calls arguing on the phone with her (I presume) husband. Hooo did I catch it. I royally disagree with her closing analysis and that ROM testing is really wide open to debate from what I saw.

She made the statement "gait steady" on one page and "he attempts but is unable to rise on his heels and toes for gait testing." on another. :angry:

There are plenty of notes in my records saying "gait weak transferring." <_<

This was back in 2006. Frankly, I'd welcome another C&P exam.

I just provided the additional information to better help suggestion.

Am I appealing for rating under 5270 instead of 5271 from which they rated me? Is pain a seperate rating factor?

I have an NOD in but hadn't addressed the ankle thinking it was at max as suggested. I'm going to nod this one asap but I want to know 'text and verse,' if I may, on which my disagreement will be based.

The doctor's statement is tough. I've been unemployed since 2004, on food stamps, just keeping the lights on and the price of everything going up. I have to get as far as I can w/out, or at least before, paying doctors bills. :blink:

I'll take the 30%! That would make me 50% instead of 40%. (I presume it would replace, not add to the current 20%) I'm clawing my way up this bloody ladder. And so far I have been granted nothing for pain or other secondary conditions.

Thanks again!

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Jayq,

If you are asking what does "2+ swelling w/out effusion(?jg)" mean;

They are saying that you have swelling without abnormal buildup of joint fluid.

Hope that helps some.

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Jayq,

If you are asking what does "2+ swelling w/out effusion(?jg)" mean;

They are saying that you have swelling without abnormal buildup of joint fluid.

Hope that helps some.

That does explain that. Thanks. My ankle, both now actually, are mainly both hard swollen, deformed, rather than puffy though they can and do get that way.

What I'm trying to find out here is if there are specific codes I can refer to to seek and increase my evaluation. I've read the read but s'truth, do not entirely comprehend it. I know it was suggested I could go for 30%. Does that include the pain or is that a second factor?

I am just a bit overawed here and not just exactly sure which way to bounce. As I noted elsewhere, things seem to be moving now and I want to strike while that's so.

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Jayg,

I would file a claim for arthritis secondary to the ankle, this could possibly get you a additional 10% rather quickly while you are filing a NOD on the origional award.

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I would go to the psychiatrist and claim that the pain and disability from your leg is depressing you and making it impossible to work. Meanwhile, find a shrink who will do an IMO to evaluate your emotional condition. Most disabled people in pain are depressed. This could add some points to your rating.

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I would go to the psychiatrist and claim that the pain and disability from your leg is depressing you and making it impossible to work. Meanwhile, find a shrink who will do an IMO to evaluate your emotional condition. Most disabled people in pain are depressed. This could add some points to your rating.

Of course I'm depressed. I'd be crazy if I wasn't in this mess! But those psyche drugs and counselors scare the bejabbers out of me and I will avoid them as long as I can. That's a weapon of last resort.

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Are you on pain meds for your ankle(s)?

Also, I would agree with the suggestion to file for the arthritis as secondary to the current disability condition. Injuries can and usually do promote the advancement of arthritis, especially DJD (which I have also been diagnosed with). Best regards.

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Are you on pain meds for your ankle(s)?

Also, I would agree with the suggestion to file for the arthritis as secondary to the current disability condition. Injuries can and usually do promote the advancement of arthritis, especially DJD (which I have also been diagnosed with). Best regards.

Pain meds? Oh yeaa. <_< The arthritis isn't restricted to the ankle. VA calls it "severe debilitating arthritis."

I take methadone for pain and Mirapex for neuropathy daily, and for "as needed" Tramadol, Baclofen (for lower back), and Naproxen 500mg.

I will definitely file for the pain as suggested. Thanks!

Edited by Jayg

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