I just filed this NOD yesterday, and I wanted some input from the Hadit members. I feel that I did everything but go to the VARO and walk them through it. This is just the tip of the iceberg. I am still having issues with the VAMC ignoring me for the persistent right flank hernia and my colon. I have had my PCP, two Gastro docs, a Urologist, and a Neurosurgeon, and a Patient advocate request multiple surgical consults with the doctor that performed the hernia repair in 1/2009. After six months, I am still being ignored. As a result of the faulty hernia repair, I have an incarcerated colon and lower spine damage. The spine issue is caused by massive atrophy of the right abdominal wall and makes me lean to the left. After two epidural shots and a discectomy, the constant pain is gone...but for how long? Sorry to get off topic. Please read my letter and offer suggestions.
NOTICE OF DISAGREEMENT 3/6/2011
This is a notice of disagreement (NOD) to the VA letter/s dated 03/15/2010. I disagree with all the adjudicative determinations mentioned in the above referenced VA letter/s and any enclosed thereto, except for those, if any, that I specifically state here that I do not want to appeal. Therefore, my notice of disagreement specifically covers all the determinations made by the Regional Office unless specifically excluded. I also disagree with the RO’s failure to adjudicate issues and claims it was required to adjudicate. I am specifically referring to issues that I may not have discussed but which were reasonably raised by the evidence in my VA Claims file or in the VA’s possession that should have been inferred by the Regional Office. This appeal also includes adjudicative determinations that were mischaracterized by the Regional Office.
I have multiple daily symptoms that have failed to be addressed with the proper severity rating. These include the following:
1. Multiple (4-5) small bowel movements daily, both diarrhea and constipation. Severe cramping and pain throughout the day. During bowel movements, I have sharp burning pain at the sight of the colon incarceration. VA Medical staff have previously diagnosed me with IBC on 11/24/2009.
2. Constant acid in my esophagus. This results in persistent coughing followed by vomiting, usually 2-3 times a week. I am awakened every night with stomach acid and stomach contents in my upper esophagus, which leads to coughing and vomiting. VA Medical Staff has previously diagnosed me with Barrett’s Esophagus 01/05/2010.
3. Daily panic attacks in the morning, followed by depression and exhaustion for the remainder of the day. My wife has to tell me things over and over until I get them done. She has to be involved in decision-making, as I usually just have a complacent attitude. I have violent outbursts 2-3 times a week. It has taken me 9 months with the help of my wife and others to write this letter. VA Medical Staff has increased my current Lexapro dosage, enrolled me in Anger Management classes and a PTSD screening is currently pending.
4. I have difficulty walking, sitting, standing and laying down caused by the constant pain starting in my lower back and traveling down my right leg and into my right arm. I have numbness and tingling down to my toes and fingers of my right side. My right leg will fail to come forward while walking, causing me to fall. On several occasions I have fallen and hit my head, injured my right wrist and hand, and sprained my right ankle. I use a VA issued cane and walker for walking and getting up and down from a sitting position. I cannot lift over 10lbs without pain from my back and my right flank. My wife has to do as much of the heavy lifting as she can, or wait for friends and relatives to assist.
Duodenal Ulcer, current rating: 20%. The VARO decision failed to cover the fact that I have been diagnosed with IBS/ICS and Barrett’s Esophagus with restriction noted in my medical records by VAMC Asheville during 11/2009. According to VA regulations, my symptoms warrant the following ratings:
(7305)Duodenal Ulcer : Moderately severe; less than severe but with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year-40%
(7203)Esophagus, stricture of: Moderately severe; less than severe but with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year-30%
(7319)Irritable colon syndrome (spastic colitis, mucous colitis, etc.): Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress-30%
Depression, current rating: 30%.Daily panic attacks, short term memory loss, confusion, staring off into space for hours. According to VA regulations, my symptoms warrant the following ratings:
(9434) Major Depressive Disorder: Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships 50%
Painful Scar, current rating: 10%. VA rating decision failed to address lower back injury caused and or aggravated by surgery, to include persistent hernia, major muscle atrophy and colon incarceration, sciatic nerve damage. Back injury secondary to Right Nephrectomy 7/1994 and Right Flank Hernia Repair 1/2009-MRI from 11/05/2009 clearly shows posteriolateral lumbar hernia that includes part of the ascending colon. VA is currently providing a cane and a walker to assist in walking. VA prescribed pain medication does not have a significant effect on pain. A private Neurosurgeon has performed two spinal injections in an attempt to relieve the pain. Pain is constant, day and night since 10/03/2009. VAMC Asheville is currently evaluating my current condition for possible corrective surgery of the persistent incisional hernia and incarcerated colon. Corrective surgery for Invertebral Disc Syndrome was performed on 12/13/2010, with additional surgeries required in the future. According to VA regulations, my symptoms warrant the following ratings:
Group XIX. Function: Support and compression of abdominal wall and lower thorax; flexion and lateral motions of spine; synergists in strong downward movements of arm (1). Muscles of the abdominal wall: (1) Rectus abdominis; (2) external oblique; (3) internal oblique; (4) transversalis; (5) quadratus lumborum. Severe-50%
Group XX. Function: Postural support of body; extension and lateral movements of spine. Spinal muscles: Sacrospinalis (erector spinae and its prolongations in thoracic and cervical regions).Cervical and thoracic region: Severe-40%
Severe disability of muscles —(i) Type of injury. Through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring.
(iii) Objective findings. Ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track. Palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area. Muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability:
(A) X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile.
(B) Adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle.
(E) Adaptive contraction of an opposing group of muscles.
(F) Atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle.
(G) Induration or atrophy of an entire muscle following simple piercing by a projectile.
(Authority: 38 U.S.C. 1155
[62 FR 30238, June 3, 1997]
Intervertebral disc syndrome-MRI from 11/05/2009 clearly shows damage to L1 and L5 discs caused by posture misalignment as a result of muscle defects and displaced colon as residual from both Right Nephrectomy 7/1994 and Hernia Repair 1/2009. A more current MRI performed 09/13/2010 by VAMC Asheville supports this evidence, and reveals a worsened condition, requiring additional surgeries to at least stabilize my health. 60%
I request my claim be afforded a de Novo review by a Decision Review Officer and a Statement of Case (SOC) be prepared and forwarded to me.
Question
racemech
I just filed this NOD yesterday, and I wanted some input from the Hadit members. I feel that I did everything but go to the VARO and walk them through it. This is just the tip of the iceberg. I am still having issues with the VAMC ignoring me for the persistent right flank hernia and my colon. I have had my PCP, two Gastro docs, a Urologist, and a Neurosurgeon, and a Patient advocate request multiple surgical consults with the doctor that performed the hernia repair in 1/2009. After six months, I am still being ignored. As a result of the faulty hernia repair, I have an incarcerated colon and lower spine damage. The spine issue is caused by massive atrophy of the right abdominal wall and makes me lean to the left. After two epidural shots and a discectomy, the constant pain is gone...but for how long? Sorry to get off topic. Please read my letter and offer suggestions.
NOTICE OF DISAGREEMENT 3/6/2011
This is a notice of disagreement (NOD) to the VA letter/s dated 03/15/2010. I disagree with all the adjudicative determinations mentioned in the above referenced VA letter/s and any enclosed thereto, except for those, if any, that I specifically state here that I do not want to appeal. Therefore, my notice of disagreement specifically covers all the determinations made by the Regional Office unless specifically excluded. I also disagree with the RO’s failure to adjudicate issues and claims it was required to adjudicate. I am specifically referring to issues that I may not have discussed but which were reasonably raised by the evidence in my VA Claims file or in the VA’s possession that should have been inferred by the Regional Office. This appeal also includes adjudicative determinations that were mischaracterized by the Regional Office.
I have multiple daily symptoms that have failed to be addressed with the proper severity rating. These include the following:
1. Multiple (4-5) small bowel movements daily, both diarrhea and constipation. Severe cramping and pain throughout the day. During bowel movements, I have sharp burning pain at the sight of the colon incarceration. VA Medical staff have previously diagnosed me with IBC on 11/24/2009.
2. Constant acid in my esophagus. This results in persistent coughing followed by vomiting, usually 2-3 times a week. I am awakened every night with stomach acid and stomach contents in my upper esophagus, which leads to coughing and vomiting. VA Medical Staff has previously diagnosed me with Barrett’s Esophagus 01/05/2010.
3. Daily panic attacks in the morning, followed by depression and exhaustion for the remainder of the day. My wife has to tell me things over and over until I get them done. She has to be involved in decision-making, as I usually just have a complacent attitude. I have violent outbursts 2-3 times a week. It has taken me 9 months with the help of my wife and others to write this letter. VA Medical Staff has increased my current Lexapro dosage, enrolled me in Anger Management classes and a PTSD screening is currently pending.
4. I have difficulty walking, sitting, standing and laying down caused by the constant pain starting in my lower back and traveling down my right leg and into my right arm. I have numbness and tingling down to my toes and fingers of my right side. My right leg will fail to come forward while walking, causing me to fall. On several occasions I have fallen and hit my head, injured my right wrist and hand, and sprained my right ankle. I use a VA issued cane and walker for walking and getting up and down from a sitting position. I cannot lift over 10lbs without pain from my back and my right flank. My wife has to do as much of the heavy lifting as she can, or wait for friends and relatives to assist.
Duodenal Ulcer, current rating: 20%. The VARO decision failed to cover the fact that I have been diagnosed with IBS/ICS and Barrett’s Esophagus with restriction noted in my medical records by VAMC Asheville during 11/2009. According to VA regulations, my symptoms warrant the following ratings:
(7305)Duodenal Ulcer : Moderately severe; less than severe but with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year-40%
(7203)Esophagus, stricture of: Moderately severe; less than severe but with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year-30%
(7319)Irritable colon syndrome (spastic colitis, mucous colitis, etc.): Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress-30%
Depression, current rating: 30%.Daily panic attacks, short term memory loss, confusion, staring off into space for hours. According to VA regulations, my symptoms warrant the following ratings:
(9434) Major Depressive Disorder: Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships 50%
Painful Scar, current rating: 10%. VA rating decision failed to address lower back injury caused and or aggravated by surgery, to include persistent hernia, major muscle atrophy and colon incarceration, sciatic nerve damage. Back injury secondary to Right Nephrectomy 7/1994 and Right Flank Hernia Repair 1/2009-MRI from 11/05/2009 clearly shows posteriolateral lumbar hernia that includes part of the ascending colon. VA is currently providing a cane and a walker to assist in walking. VA prescribed pain medication does not have a significant effect on pain. A private Neurosurgeon has performed two spinal injections in an attempt to relieve the pain. Pain is constant, day and night since 10/03/2009. VAMC Asheville is currently evaluating my current condition for possible corrective surgery of the persistent incisional hernia and incarcerated colon. Corrective surgery for Invertebral Disc Syndrome was performed on 12/13/2010, with additional surgeries required in the future. According to VA regulations, my symptoms warrant the following ratings:
Group XIX. Function: Support and compression of abdominal wall and lower thorax; flexion and lateral motions of spine; synergists in strong downward movements of arm (1). Muscles of the abdominal wall: (1) Rectus abdominis; (2) external oblique; (3) internal oblique; (4) transversalis; (5) quadratus lumborum. Severe-50%
Group XX. Function: Postural support of body; extension and lateral movements of spine. Spinal muscles: Sacrospinalis (erector spinae and its prolongations in thoracic and cervical regions).Cervical and thoracic region: Severe-40%
Severe disability of muscles —(i) Type of injury. Through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring.
(ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph © of this section, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements.
(iii) Objective findings. Ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track. Palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area. Muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability:
(A) X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile.
(B) Adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle.
© Diminished muscle excitability to pulsed electrical current in electrodiagnostic tests.
(D) Visible or measurable atrophy.
(E) Adaptive contraction of an opposing group of muscles.
(F) Atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle.
(G) Induration or atrophy of an entire muscle following simple piercing by a projectile.
(Authority: 38 U.S.C. 1155
[62 FR 30238, June 3, 1997]
Intervertebral disc syndrome-MRI from 11/05/2009 clearly shows damage to L1 and L5 discs caused by posture misalignment as a result of muscle defects and displaced colon as residual from both Right Nephrectomy 7/1994 and Hernia Repair 1/2009. A more current MRI performed 09/13/2010 by VAMC Asheville supports this evidence, and reveals a worsened condition, requiring additional surgeries to at least stabilize my health. 60%
I request my claim be afforded a de Novo review by a Decision Review Officer and a Statement of Case (SOC) be prepared and forwarded to me.
Thank you.
Link to comment
Share on other sites
Top Posters For This Question
4
2
1
1
Popular Days
Mar 10
8
Mar 9
2
Top Posters For This Question
racemech 4 posts
Berta 2 posts
jbasser 1 post
broncovet 1 post
Popular Days
Mar 10 2011
8 posts
Mar 9 2011
2 posts
9 answers to this question
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now