Unofficial Dav Letter-Dro Review Next?

[brokensoldier244th]

Got my unofficial 'white' letter today from DAV.Rt lower extremity radiculopathy continuedService Connection for left lower extremity deniedservice connection for ED is denied. My EMG for left leg came back negative, though id been taking meloxicam and neurotnin as newer medications, that seemed to help with the pain and numbness. No EMG, no radiculopathy, I guess-though I never had one for my right leg-I don't know if they went off the MRI's or what.

The ED was based on my report of it at a VA appt. in 2003 during a C&P, my Dr.'s statement of such in 2010, and her prescribing Paxil for PME, plus issues ive noticed with getting a firm erection after starting neurotnin. I haven't seen her for that yet, though.

The C&P doc wrote up a statement that said there was not enough evidence of either for her to make a decision one way or the other.

Ill get the statement of case and decide if I want to pursue it further or not. I really don't have any other evidence to throw at it right now. Is the list of things submitted via VonApp and Ebenefits the same list of things they evaluated, e.g. is there going to be a list of every thing they considered in the SOC when I get it?Does the act of submitting a NOD and requesting DRO review require me to have a lawyer or court or is it more like submitting more things for 'discovery'? Is 'reconsideration' basically the same thing as a NOD-They both reconsider, but what are the more subtle differences between the two processes?

I thought I had a solid claim. I submitted supporting copies of my own SMR's from 2002 that show both L and R leg radiculopathy, but my C&P then for my initial rating only noted the R leg. I was trying to correct that. My new x rays from a few months ago show decreasing disc spacing in more levels than in 2002, and Im on stronger drugs for pain than I was before.

The ED was noted by my doctor, and I complained of it in 2003 to a VA doctor and in a C &P then as well. I finally went to my Dr to be treated for PME, and we started with Paxil to try to help with that (2 months ago) but now I have trouble getting erect at all (and I take gabapentin for my lower back). She wrote a letter for me that stated based on her evaluation of both me and my service records that my erectile issues were caused by my back. I also had a letter from my wife (RE: Pain and ED issues) and co worker (pain issues, mobility). All in all between my old evidence (for SC of left leg contension) and ED, plus xrays and narratives, etc was some 20 pages. I got copies of it all, typed up a cover sheet noting pages and paragraphs) and sent it off.

One of the hurdles that I have is that my EMG said I was fine, and since I started on these new drugs (mobic and gabapentin) my symptoms in my Rt leg that is already rated are better then they are without. Since the drugs help with both legs, I can't really see how I can show what's going on short of them (or me) getting a new MRI, probably on my own. That may be my next step.

Edited October 10, 2010 by brokensoldier244th

[brokensoldier244th]

Okay, here we go-high points first;

I feel that I should be rated 10% for radiculopathy, left leg-but what do I call it? Bilateral dysthesis? Partial Paralysis?

Is it separate claim, i.e. do i refile and call it something else using the same evidence that I have now (past and present), or do I do an appeal of the same claim pointing out the inconsistency?

Denial for Erectile Dysfunction-in the list of what was considered, my 'statement of support' (clinical visit notes) are listed for my Dr. but I sent in a nexus letter that specifically says "erectile dysfunction" but it is not listed on the decision letter. Decision letter also states that the examiner found no evidence of ED, but she never examined me for ED at all-she asked a few questions and spent the rest of the time on my PN tests.

So-my questions are:

-Do I refile for "What, exactly?" for my left leg service connection? If the pain and numbness, and sensory loss in my toes isn't radiculopathy, then what do I call it? Partial paralysis? My right leg original decision from 2003 has the same symptoms listed by the C&P examiner, and no EMG was done that time.

-Do I appeal with my letter from my Doctor for ED, or just ask them to reconsider?

Reasons for Decisions:

Edited October 10, 2010 by brokensoldier244th

[carlie]

1) Does the act of submitting a NOD and requesting DRO review require me to have a lawyer or court or is it more like submitting more things for 'discovery'?

2) Is 'reconsideration' basically the same thing as a NOD-

They both reconsider, but what are the more subtle differences between the two processes?

broken,

1) No - you are never required to have a lawyer.

2) There are not subtle differences between a NOD and a request for reconsideration.

A NOD has to be filed within one year of the Rating Decision in question.

NOD = Notice of Disagreement - and you present your argument as to why you disagree

with XXX in the Rating Decision.

A Request for Reconsideration = yes - I agree with the Rating Decision but I feel

if the issues are reconsidered with this additional information/evidence, then

the Rating Decision would either grant SC - a higher percentage - a different

effective date, etc... what ever the case may be.

Although one can submit a request for reconsideration - there is no reg to support

that it will be answered quickly or in a timely manner - and while you are waiting

for a response on your request for reconsideration - your NOD clock is still ticking.

[brokensoldier244th]

So I should probably just appeal, request DRO, and pick it apart and submit the nexus letter for ED? I also have a VAMC report from my PCP in 2003 where he states " Genetalia-he admits to some problems with his erections, which again is secondary to his back injury.....".That was already submitted, though-it may have been buried.

What can I do about the SC for the Left Leg radiculopathy? My Rt leg was rated for it, though no EMG was ever done-it was based on my complaints and MRI, etc. I have service records/sick call notes that note bilateral radiculopathy and bilateral dysesthesias. I don't know why they denied it. Should I appeal, or refile a claim and call it 'incomplete paralysis' since that is the wording they used?

Thanks for replying, Carlie!

1) Does the act of submitting a NOD and requesting DRO review require me to have a lawyer or court or is it more like submitting more things for 'discovery'?

2) Is 'reconsideration' basically the same thing as a NOD-

They both reconsider, but what are the more subtle differences between the two processes?

broken,

1) No - you are never required to have a lawyer.

2) There are not subtle differences between a NOD and a request for reconsideration.

A NOD has to be filed within one year of the Rating Decision in question.

NOD = Notice of Disagreement - and you present your argument as to why you disagree

with XXX in the Rating Decision.

A Request for Reconsideration = yes - I agree with the Rating Decision but I feel

if the issues are reconsidered with this additional information/evidence, then

the Rating Decision would either grant SC - a higher percentage - a different

effective date, etc... what ever the case may be.

Although one can submit a request for reconsideration - there is no reg to support

that it will be answered quickly or in a timely manner - and while you are waiting

for a response on your request for reconsideration - your NOD clock is still ticking.

Edited October 10, 2010 by brokensoldier244th

[brokensoldier244th]

Here is what I have so far for my NOD letter....

NOD Notice of Disagreement

Dear Sir or Madame,

I received a rating decision dated 10/05/2010.Consider this letter to be an official "Notice of Disagreement" (NOD) regarding the followingdenied disability claims:

1) Service Connection for Left leg Radiculopathydenied due to lack of evidence per C&P examiner. I disagree-

Below I have noted what I feel is conclusiveevidence for service connection for radiculopathy/incomplete paralysis belowthe knee, based on findings that Left Lower extremity radiculopathy wasclinically diagnosed during military service, and was caused by a rated serviceconnected condition (Intervertebral disc syndrome). These diagnoses occurredwhile still on Active Duty, and were a direct result of the initial backinjury, and thus I feel they fulfill the required evidence for serviceconnection.

Rating Decision 2010

"Service connectionfor Radiculopathy of the left lower extremity, claimed as secondary to yourservice connected intervertebral disc syndrome, lumbar spine, is denied becausethere is no evidence showing that left lower extremity Radiculopathy has beenclinically diagnosed, as well as no evidence indicating that the claimecondition otherwise began during or was caused by military service...."

Reasons for Disagreement:

-11JUL2001 Battalion Aid, Ft. Lee, VA

clinic screening notes " that all 10 toes felt numb" and acutelower back pain

-12JUL2001 Dr. notes "b/L

parasesthesias" in his exam notes, also lower back pain

-08AUG2001 MRI findings/neurological narrativenotes,(my history of Bilateral Radiculopathy was the reason for theMRI in the first place)

-Medical board proceedings were for back

pain/degenerative disc disease/bilateral dysesthesias (Narrative Summary1OCT2001)

-VA Exam 17JAN2003 indicates decreased reflexes bilaterally

-2003 VA Ratings decision grants service

connection for Radiculopathy 10% right leg based on decreased sensation of

right great toe, but not left leg, yet same symptoms are present in bothlegs. Treatment medication at that time included 800 mg ibuprofen 4x's daily,

Ultram, and Flexaril.

-Dr. notes both right and left leg

symptoms in her examination notes 6AUG2010. She did SLR's, sensory, reflexes, andphysical manipulation at that time.

"Strength is slightly diminished on the right leg compared to the left.

He is able to toe and heel walk although he does this with some difficulty. Hehas limited amount of toe raises that he can do right foot and left foot butcan't initially do them. The patients gait is antalgic"

-C&P Examiner notes "decreased vibratory sense, left great toe" during 2010 exam.

These symptoms that have been, present in myleft leg (radiating pain, numbness, decreased sensory) since before Idischarged from the Army. I used the terminology "radiculopathy" based on theVA's usage of that description, but regardless of whether its called"radiculopathy", "pins and needles", "bilateral dysesthesias", it is the samething. I'm simply using VA's own assessment of the condition as my basis forcalling it radiculopathy. Since my right leg is rated 10% for Radiculopathybased on my lower back condition, I feel that my left leg should have beengranted the same based on the presentation of the same symptoms (note currentC&P finding of "decreased vibratorysense, left great toe" This itself is consistent with a 10% rating for "mildincomplete paralysis" as used by the VA for my 10% rating in my Right lowerextremity. The Examiner notes a lack of clinical evidence. I feel I have providedmore than enough over a long period of time to indicate chronic pain andnumbness is due to my back injury.

2) Service Connection Erectile Dysfunctiondenied due to lack of evidence from Examiner. I disagree.

"Service connection for erectile dysfunction (also claimed as sexual

dysfunction), claimed as secondary to your service connected intervertebraldisc syndrome, lumbar spine, is denied because there is no evidence showingthat any erectile dysfunction has been diagnosed, as well as no evidence thatthe claimed condition otherwise began during or was caused by militaryservice…."

Reasons for disagreement:

-17JAN2003 difficulty with erections noted byVAMC PA , progress notes

"Genitourinary-hereports urinary urgency, sometimes has to sit to urinate since back injury.Genitalia-he admits to some problems with erections, which again is secondaryto his back injury."

-Diagnosis/prescription Paxil for premature

ejaculation noted in letter as secondary to my lower back injury, Dr. so and so

"I have reviewed Mr. Satterfield's service medical record pertaining to his back injury that he sustained while in the service in 2002. I saw him onAugust 6^th and we went through the history and current issuesinvolved with his low back pain and radiculopathy. At that time he told me thathe has had issues with erections and premature ejaculation since that injurywas sustained. Therefore it is my opinion that his current symptoms appear tocoincide with the injury in the service. We have started him on Paxil as thatdoes tend to help delay ejaculation and hopefully improve his symptoms."

-No C&P was scheduled for erectile

dysfunction, and other than noting I had it listed the Examiner during myC&P did no physical exam, did not ask about frequency of sexual encounter,or difficulties with sex with my wife, or acknowledge that I had already complained about it in 2003 to a VA practitioner who opined that it was indeedconnected to my back injury.

I feel this clearly states that there iserectile difficulty that is a direct result of my lower back injury. Dr.so and soreviewed with me my entire service medical file, in addition to making her ownassessment of erectile problems, and prescribed medical treatment for it, thatis ongoing. The VAMC visit on 17JAN2003 where erectile problems were noted waswithin one year of my leaving the military (26FEB2002). The Examiner notes no'clinical' evidence of ED, yet complaints persist from 2003, and furtherclinical evidence of erectile difficulty was provided in 2010.

I am requesting a "De Novo Review" by a newDecision Review Officer.

I will be awaiting your reply.

Sincerely,

Edited October 11, 2010 by brokensoldier244th