C&P Results Ankylosing Spondylitis

[sauerkraut1977]

Hi all. Finally went to the regional office today and got my results to share for some good old feed back. of course in my opinion another shitty exam but starting to get use to them now and I will be an appeals expert one of these days. Sorry I had to attach the results but I got them on paper and I had to scan them as a pdf file because I can not use windows 10 worth a shit. The files open up in the Microsoft edge thing and it will not let me copy and paste them or give me the option to save as a word document. Anyways as usual it says onw thing then another and the doctor says its not service connected in his opinion but he was googling the disease because he did not know what it is. also he only wanted to look at my back only but the disease is complicated and has been caught early enough I do not have much x-ray evidence and it effects my joints more than my back and neck. I look forward to some feedback and computer help if someone knows how I can copy and paste the results in the body of this message. Appreciate you all and thanks again!

Back DBQ.pdf

Back Medical Opinion.pdf

[Vync]

19 hours ago, sauerkraut1977 said:

Hi all. Finally went to the regional office today and got my results to share for some good old feed back. of course in my opinion another shitty exam but starting to get use to them now and I will be an appeals expert one of these days. Sorry I had to attach the results but I got them on paper and I had to scan them as a pdf file because I can not use windows 10 worth a shit. The files open up in the Microsoft edge thing and it will not let me copy and paste them or give me the option to save as a word document. Anyways as usual it says onw thing then another and the doctor says its not service connected in his opinion but he was googling the disease because he did not know what it is. also he only wanted to look at my back only but the disease is complicated and has been caught early enough I do not have much x-ray evidence and it effects my joints more than my back and neck. I look forward to some feedback and computer help if someone knows how I can copy and paste the results in the body of this message. Appreciate you all and thanks again!

Back DBQ.pdf

Back Medical Opinion.pdf

I have been in your exact same situation before. I looked over your attached records.

Service Connection requires three things:
1. Event/injury during service
2. Current diagnosis
3. Doctor connecting #1 and #2 <==== Gotcha

The C&P examiner said your medical records confirm treatment in 1997 and 1998. He also confirms your current diagnosis based on records from 2016.

The doc denied SC because of the long medical record gap between 1998 and 2016. Even if you might have verbally told the doc that it never stopped bugging you, they are holding this 18 year period of no treatment records against you.

Here's what I recommend:

1. If you sought medical treatment for your back between 1998 and 2016, get those medical records. This will help show continuity of care and continuity of symptoms.

2. If you have family or friends who knew you between this time period, consider asking them to write you a buddy statement (look up on this site for the right way to do this). Basically, it would be something like them explaining they have known you personally since whatever date and you were having back problems. If they knew you before you joined in 1997 and after you got out, it can help because they can help state you were ok going in and complained about problems during and/or after getting out. Buddy statements are considered lay statements. They just describe their personal observations. Unless they are a medical professional, they should keep it informal. These statements don't really carry a lot of weight in the eyes of the VA, but the key is to be able to have someone else confirm continuity of symptoms (i.e. he walks funny, he limps all the time, he can't cut the grass, he needs help out of bed, etc...).

3. The best option would be to get a nexus letter/statement from a doctor, preferably a specialist (orthopedic doc/neurologist/rheumatologist). Your C&P exam was done by an MD Internist. A specialist's opinion carries much more weight and "should" overrule the Internist's opinion. The specialist will need to provide a medical opinion stating that your in-service injury is "as likely as not" (or with more certainty "most likely" or "due to") the cause of your current back disability and provide strong medical rationale to back it up. They need to state they reviewed your in-service medical records and current records. There are a lot of good nexus/opinion examples here.

In my situation, I had the same thing happen. I did get treatment outside of the VA, collected those records, and submitted them to the VA along with authorization to release medical release records forms. I was examined and treated by a non-VA orthopedic surgeon and they wrote my opinion. It took a long time, but eventually did win. It stinks that some VA C&P docs are afraid to recognize the obvious.

Well, I hope this helps. Others will come along and share their opinion. Good luck!

 

 

 

 

[sauerkraut1977]

Vync,

My god you are a life saver got and me fired up thank you for the great advice. First thing is I will get my family to write statements for me. Second thing I will do is I will have my rheumatologist at the VA do a statement also for me when I go back on the 13th of July since they are the one's who were finally able to give me a diagnosis and they are really nice and good doctors. On this date I am also to start either Enbrel or Humira shots. Luckily my claim is not to be decided until at least 9/4/16 according to ebenefits and I am sure I will have one or two more exams for everything on the claim. The C&P doctor I do not think he knew what he was doing as you saw on the DBQ  where it says one thing then contradicts itself. I was thinking this claim was not going to be as it is turning out to be and I was more worried about it being rated properly as my research has said that the disease should be rated under code 5240 for the AS and code 5002 for the rheumatoid arthritis since it affects a lot of my joints. Thank you again for the great advise and I will get to work on gathering this evidence so hopefully I want have to do a 3rd appeal.

[Vync]

15 hours ago, sauerkraut1977 said:

Vync,

My god you are a life saver got and me fired up thank you for the great advice. First thing is I will get my family to write statements for me. Second thing I will do is I will have my rheumatologist at the VA do a statement also for me when I go back on the 13th of July since they are the one's who were finally able to give me a diagnosis and they are really nice and good doctors. On this date I am also to start either Enbrel or Humira shots. Luckily my claim is not to be decided until at least 9/4/16 according to ebenefits and I am sure I will have one or two more exams for everything on the claim. The C&P doctor I do not think he knew what he was doing as you saw on the DBQ  where it says one thing then contradicts itself. I was thinking this claim was not going to be as it is turning out to be and I was more worried about it being rated properly as my research has said that the disease should be rated under code 5240 for the AS and code 5002 for the rheumatoid arthritis since it affects a lot of my joints. Thank you again for the great advise and I will get to work on gathering this evidence so hopefully I want have to do a 3rd appeal.

Hey Sauerkraut,
Glad to help!

Keep in mind that the VA often tries to blow off buddy statements at the VARO level, but it is worth having them because. They are also handy on appeal. My DRO accepted my buddy statements and even talked about them. I had statements from my mother, father, friends, and even a buddy I served with.

Some docs might be a bit iffy about writing the nexus statement. The most common excuse is "I did not initially treat you". That's where the "as likely as not" (i.e. 50%/50%) jargon comes in.

You're right about the contradictions in the DBQ. They are all over the place. Just look at section 2 on the DBQ. That doc needed more coffee.

It would be great to win SC and be rated correctly at the same time. However, winning SC status is the most important. That's the biggest hurdle. If they assign an incorrect rating, that can be fixed later. If you read most of the forum posts, you will see about 75% of claims are won on appeal. It's sad, but it's a fact.

[sauerkraut1977]

Hey Vync,

You are so right about how you have to appeal everything to get things right as they should be. I have 2 appeals right filed because when I went in for PTSD they rated me 30% and called it unspecified anxiety and of course with my symptoms I should be 50% to 70% rated on it and then on my rating for bilateral plantar fasciitis I went through the same on the DBQ from the VA PA who did my C&P where it contradicted itself and I got rated at 30% instead of the 50% that I should have got. I go to the VA for everything and I am in treatment with MH and Podiatry and I have had the doctors use the correct "VA Language" in my medical records so I have the evidence I will need for the appeals. I do consider myself so lucky to have the 50% I have because otherwise I could not afford the Enbrel or Humira I will be on for the rest of my life. But it is important and I am very worried about this claim because if I do not get the SC for the AS then I will probably lose my claim for inflammatory arthritis secondary to AS that I filed to make sure I get rated correctly under code 5002 and 5240. All I can do is take your advise and try to get it SC and the worry about ratings later which I only care about the SC part because from what I seen unless your spine s frozen its hard to get more that 10% to 20% which really does not matter. Thank you again for a your help and I hope all is well on your end.

[Vync]

38 minutes ago, sauerkraut1977 said:

Hey Vync,

You are so right about how you have to appeal everything to get things right as they should be. I have 2 appeals right filed because when I went in for PTSD they rated me 30% and called it unspecified anxiety and of course with my symptoms I should be 50% to 70% rated on it and then on my rating for bilateral plantar fasciitis I went through the same on the DBQ from the VA PA who did my C&P where it contradicted itself and I got rated at 30% instead of the 50% that I should have got. I go to the VA for everything and I am in treatment with MH and Podiatry and I have had the doctors use the correct "VA Language" in my medical records so I have the evidence I will need for the appeals. I do consider myself so lucky to have the 50% I have because otherwise I could not afford the Enbrel or Humira I will be on for the rest of my life. But it is important and I am very worried about this claim because if I do not get the SC for the AS then I will probably lose my claim for inflammatory arthritis secondary to AS that I filed to make sure I get rated correctly under code 5002 and 5240. All I can do is take your advise and try to get it SC and the worry about ratings later which I only care about the SC part because from what I seen unless your spine s frozen its hard to get more that 10% to 20% which really does not matter. Thank you again for a your help and I hope all is well on your end.

Because you go to the VA for everything, see if you can go through Myhealthvet's blue button feature and get electronic copies of your entire medical records. Search for yourself to see if you can find dates of treatment for your back during the 1998-2016 gap. C&P docs are supposed to be thorough, but a lot of them are lazy and do just the minimum. You can also go to the VAMC's release of information office and fill out forms to get paper copies or even a CD. If it is a lot of pages, they will probably want to mail it to you later. If the VAMC did any x-rays, MRI's, etc..., check with the radiology department. My VAMC has a separate office which provides digital versions of the images on CD/DVD. They include a viewer so you can even see the pictures for yourself. The official radiology write up is usually stored in your regular medical records, but it never hurts to double-check.

It never hurts to help fill in the gaps. If you can spoon feed the VA the information they need, it makes life job easier at the VARO. Imagine a rater saying, "Wow, this guy did all my work for me. All I need to do is verify..."

[sauerkraut1977]

I will be sure to do that. I cannot a rater actually saying that. I have a picture in my head that they get our claim and look at all the documents and they only read a page or two then say well... lets do 10% and call it a day. I uploaded all my medical records from myhealthvet website after I submitted my claim and I was going to do so again since I am still receiving treatment there so it will be current right before the decision date. It makes me scratch my head in wonder at what the raters think when they are handling our claims and at the same time I do not think I would want that job because I am biased and I would SC everyone. Thanks again!