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garion
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Posts posted by garion
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1 hour ago, flores97 said:
Garion, did you receive an Statement of the Case from VA detailing why they denied!? If you could scan and post the reasons for denial, redacting personal info, we could provide more help. I have to say, that does not make any sense whatsoever for denial after being approved by not one but TWO c&p examiners!! If you don't have the capability to scan the denial, please type the reasons and basis they used in their bs-excuse me, in the denial so we can provide guidance.
I will once I get the denial letter. Thanks Flores97!
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Good day everyone! Could anyone answer me this question? If VA deny service connection to a disability that two different doctors from two different VA C&P's states is service connected, what is my options? I claimed pancreatitis in my original claim and the C&P doctor stated it was service connected but VA denied the claim. I did a reconsideration and the VA sent me to another C&P exam and the new doctors stated that my pancreatitis is service connected. I also submitted medical records from my private doctors stating the same.
Below is BOTH C&P notes from the doctors.
These are the note from the doctor who performed my last C&P Exam.a. The condition claimed is at least as likely as not (50% or greater probability) proximately due to or the result of the Veteran's service connected condition .c. Rationale: Well documented, long standing history of GI issues including chronic cholecystitis and cholecystecomty x 2 with residual complications, GERD (already SC for these conditions), chronic pancreatitis, among other GI conditions. Patient remains symptomatic and continues to have GI follow up and treatment. There is sufficient evidence of record (which was extensively reviewed as part of this exam), and per today's exam, that pancreatitis was at least as likely as not due to or the result of the SC condition.
Here is the C&P exam notes from my FIRST exam. Completely different doctors.Does the Veteran's gallbladder and/or pancreas condition(s) impact on his or her ability to work? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's gallbladder and/or pancreas conditions, providing one or more examples: Veteran states he has to leave early from work due to Abdominal pain. Veteran states on his worse days he has to go to bathroom at least 3 to 4 times during the work day(30 to 45 minutes).8. Remarks, if any------------------1. Veteran's current claimed and diagnosed GI symptoms is at least as likely as not (50 percent or greater probability)a continuation and/or progression of the Veteran's already service connected Chronic Cholecystitis, S/P Cholecystectomy with Acid Reflux.2. C&P Recommendation: Veteran's previous documented abnornomal clinical findings were discussed with Veteran. Veteran is advised to follow-up with his primary medical provider for evaluation and treatment of his ongoing and chronic GI symptoms.
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18 minutes ago, Navy4life said:
Garion;
I am doing well but I am a female ;) No worries...
But my question isn't about requesting medical records that are mine, it's the fact that the award letter with the denials on it shows "evidence considered" as NOT my evidence which makes me believe this is yet another screw up with my denials. Ugh...
I see what you are talking about my sister...(:
You have a legitimate complaint if your denial was decided on the wrong medical information. I hope you have a VSO which would make fixing the issue much easier...
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1 hour ago, Navy4life said:
Buck;
Thank you for your reply. I fully understand that sometimes our claims get shuffled around from time to time BUT my concern is in the EVIDENCE CONSIDERED it clearly states:
So wouldn't that mean that is someone from VA Salem reviewing medical/making medical opinion on medical records in Salem?
This is extremely puzzling b/c I have never been to Salem for any type of VA medical treatment....
navy4life - How are you doing today brother? I know what you mean. The VA was requesting records of treatment at the Fort Monroe facility for the dates of April to June of 2001. The kicker is I wasn't even stateside doing that time... I was still in Europe. Requesting those records from a place I never been held up my claim for at least 4 months! They kept sending out request after request until they met their quota of 6 request. Even though I told them I never been to that facility before! To make matter even worse, Fort Monroe closed down years ago! I still don't understand how the VA didn't know one of their facilities closed down?
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You right Gastone... That was a stupid mistake on my part. I got the records late and my claim was already in "ROE"... I didn't want to slow the claim down by uploading new evidence.
Since getting my medical records, I have 3 different doctors and my Gastro specialist stating I have Chronic Pancreatitis. I have an additional 10 pages of evidence all stating chronic pancreatitis in addition to the C&P doctor stating the same thing.
Gastone, I need to mail the evidence in to the SR Rater or DRO to review? Could I do this through eBenefit or do I need to mail the information? Do you have the address if I need to mail the information?
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Navy4 - Thanks for your response. I meet the criteria for 100% if rated for pancreatitis. The minimum I would receive is 60% which still would put me at 100%. Below is the ratings...
This is what the VA rated me on... Code 7314: Chronic cholecystitis is the constant swelling of the gallbladder most often caused by gallstones. The most common symptom is severe pain near the bottom of the ribs on the right side. In most people, the gallbladder can be removed without serious side effects. If there are frequent severe attacks of pain, it is rated 30%. If there is heartburn and occasional attacks of severe pain, it is rated 10%. If there are only occasional mild symptoms, it is rated 0%.
This is what the VA should have rated me on at 100%... Code 7347: Pancreatitis is the swelling of the pancreas that occurs because the enzymes it produces become active while still in the pancreas. If diabetes and pancreatitis are both present, both cannot be rated. Rate only the one that gives the highest rating. If the whole or part of the pancreas is surgically removed, then rate any continuing symptoms on the following ratings, with the minimum rating of 30%.Ratings:
If there are seriously disabling attacks of stomach pain with very few pain-free periods, significant amounts of fat in the feces, the inability of the small intestine to absorb the necessary nutrients, diarrhea, and severe malnutrition, it is rated 100%.
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I got my rating back. I went from 60% to 90%. The problem is they denied my pancreatitis that would have given me 100%. I want to know the quickest way to get them to correct this?
The VA stated "medical evidence of record fail to show that this disability has been "clinically diagnosed". The evidence does not show a current diagnosed disability".
This is wrong! The C&P doctor diagnosed me with pancreatitis and this statement is directly from her notes 8. Remarks, if any 1. Veteran's current claimed and diagnosed GI symptoms is at least as likely as not (50 percent or greater probability) a continuation and/or progression of the Veteran's already service connected Chronic Cholecystitis, S/P Cholecystectomy with Acid Reflux.
Also this as well... 4. Pancreas conditions: signs and symptoms - a. Does the Veteran have any of the following symptoms attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Abdominal pain, confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies If checked, indicate severity and frequency of attacks (check all that apply): [X] Severe (disabling) Indicate number of attacks of Severe (disabling) abdominal pain in the past 12 months: [ ] 0 [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 [ ] 7 [X] 8 or more [X] Other symptoms, describe: Veteran states he awakens at night he awaken and loses his bowel(defication) . b. Does the Veteran have any of the following signs or findings attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Steatorrhea If checked, describe frequency and severity: Veteran states greacy foul smelling stools 3 times per week. [X] Diarrhea If checked, describe frequency and severity: Veteran states has loose and watery diarrhea. Veteran states his last severe episode was 4 days ago.
Also, I have additional clinical diagnoses from a private specialist which I didn't submit to the VA because I thought the C&P exam would be enough. I haven't had these records long. This is what the Gastroenterology studies reported. DATE OF PROCEDURE: 09/03/2012 Operative Report The patient underwent an endoscopic ultrasound today. PREOP DIAGNOSIS: History of abdominal pain, high pancreatic enzymes.
POSTOP DIAGNOSIS: Chronic pancreatitis.
Prior consent was obtained from the patient after the alternatives, benefits and risks were explained including, but not limited to the risk of bleeding, infection, perforation, aspiration, missed lesion, drug reaction, death and surgery.
Patient was placed in the left lateral position. Bite block was placed. Versed and Demerol were used for this test. A radial endoscopic ultrasound scope was used and advanced into the small bowel without complication. This was limited study with his history of gastric bypass. Parts of pancreas that were evaluated grossly appeared normal except for multiple hyperechoic strands and foci and lobularity of the gland suggestive of chronic pancreatitis. IMPRESSION: As above. Continue low fat diet. I would get a follow up MRCP to further evaluate the pancreatic biliary ductal system. In the future if his symptoms persist in spite of medical management, further and therapy would be an option. Unfortunately his presentation is compounded with history of gastric bypass and if the symptoms persist and above has to be undertaken it has to be through a gastrostomy tube placement. Again, time will tell where his symptoms take us. SA/NB -
I got my rating back. I went from 60% to 90%. The problem is they denied my pancreatitis that would have given me 100%. I want to know the quickest way to get them to correct this?
The VA stated "medical evidence of record fail to show that this disability has been "clinically diagnosed". The evidence does not show a current diagnosed disability".
This is wrong! The C&P doctor diagnosed me with pancreatitis and this statement is directly from her notes 8. Remarks, if any 1. Veteran's current claimed and diagnosed GI symptoms is at least as likely as not (50 percent or greater probability) a continuation and/or progression of the Veteran's already service connected Chronic Cholecystitis, S/P Cholecystectomy with Acid Reflux.
Also this as well... 4. Pancreas conditions: signs and symptoms - a. Does the Veteran have any of the following symptoms attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Abdominal pain, confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies If checked, indicate severity and frequency of attacks (check all that apply): [X] Severe (disabling) Indicate number of attacks of Severe (disabling) abdominal pain in the past 12 months: [ ] 0 [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 [ ] 7 [X] 8 or more [X] Other symptoms, describe: Veteran states he awakens at night he awaken and loses his bowel(defication) . b. Does the Veteran have any of the following signs or findings attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Steatorrhea If checked, describe frequency and severity: Veteran states greacy foul smelling stools 3 times per week. [X] Diarrhea If checked, describe frequency and severity: Veteran states has loose and watery diarrhea. Veteran states his last severe episode was 4 days ago.
Also, I have additional clinical diagnoses from a private specialist which I didn't submit to the VA because I thought the C&P exam would be enough. I haven't had these records long. This is what the Gastroenterology studies reported. DATE OF PROCEDURE: 09/03/2012 Operative Report The patient underwent an endoscopic ultrasound today. PREOP DIAGNOSIS: History of abdominal pain, high pancreatic enzymes.
POSTOP DIAGNOSIS: Chronic pancreatitis.
Prior consent was obtained from the patient after the alternatives, benefits and risks were explained including, but not limited to the risk of bleeding, infection, perforation, aspiration, missed lesion, drug reaction, death and surgery.
Patient was placed in the left lateral position. Bite block was placed. Versed and Demerol were used for this test. A radial endoscopic ultrasound scope was used and advanced into the small bowel without complication. This was limited study with his history of gastric bypass. Parts of pancreas that were evaluated grossly appeared normal except for multiple hyperechoic strands and foci and lobularity of the gland suggestive of chronic pancreatitis. IMPRESSION: As above. Continue low fat diet. I would get a follow up MRCP to further evaluate the pancreatic biliary ductal system. In the future if his symptoms persist in spite of medical management, further and therapy would be an option. Unfortunately his presentation is compounded with history of gastric bypass and if the symptoms persist and above has to be undertaken it has to be through a gastrostomy tube placement. Again, time will tell where his symptoms take us. SA/NB -
Thanks Vync! I went and got a better understanding of how they rate Pancreatitis. The reason they did multiple criteria is because if you had a Total or Partial Pancreatectomy, the minimum the VA can rate you is at 30%.
Read below. It explain things better with the rating.
7347 Pancreatitis:
With frequently recurrent disabling attacks of abdominal pain with few
pain free intermissions and with steatorrhea, malabsorption, diarrhea
and severe malnutrition........................................................................................ 100
With frequent attacks of abdominal pain, loss of normal body weight
and other findings showing continuing pancreatic insufficiency
between acute attacks........................................................................................... 60
Moderately severe; with at least 4-7 typical attacks of abdominal pain
per year with good remission between attacks....................................................... 30
With at least one recurring attack of typical severe abdominal pain
in the past year..................................................................................................... 10
Note 1: Abdominal pain in this condition must be confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies.
Note 2: Following total or partial pancreatectomy, rate under above, symptoms, minimum rating 30 percent.
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I haven't, but I will try to help.
The wording on the 100% part seems a little wierd because of this part "Pancreatitis, total pancreatectomy, and partial pancreatectomy". I don't see how someone can have a total and partial removal of the pancreas at the same time. It might be an accident. Having two signs of pancreatic insufficiency could qualify you for 100%, but the only things missing in the DBQ write up you posted is the "...and unresponsive to treatment" part. Keep in mind that the DBQ's were written to help provide a good picture of a disability at time of examination, but they might not always have every rating criteria question perfectly explained. If the unresponsive statement is documented elsewhere, I recommend you make sure that it is included in the evidence you submitted.
Also, if you do get rated at 100%, consider filing for SSDI (if you haven't already) and also for any rate-able conditions which might be possible to SC as secondary to the pancreatitis and/or the medications used to treat it. If you can get additional %'s to total 60% or are unable to leave home for work (not telecommute either) due to pancreatitis, consider filing for SMC-S.
Good luck! I'm sure someone else will come and add to this or correct it.
Thanks for your response, Vync! I think they mean they are rating on Pancreatitis, Total pancreatectomy and Partial pancretectomy... I am guessing they recognize them as different forms/degrees of pancreatitis.
They have been giving me all kind of medicines to try to get my Pancreatitis in control. They keep increasing my medications and adding new ones. I have been on 5 different medication so far.
Below is the C&P remark.
8. Remarks, if any
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1. Veteran's current claimed and diagnosed GI symptoms is at least as
likely as not (50 percent or greater probability)a continuation and/or progression of
the Veteran's already service connected Chronic Cholecystitis, S/P
Cholecystectomy with Acid Reflux.2. C&P Recommendation:
Veteran's previous documented abnornomal clinical findings were discussed
with Veteran. Veteran is advised to follow-up with his primary medical provider for
evaluation and treatment of his ongoing and chronic GI symptoms.
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From my C&P exam, it looks like I fall under the 100% for Pancreatitis. I also have Anemia and Diabetes. Have anyone on the board been rated for Pancreatitis?
Does the Veteran have any of the following symptoms attributable to any pancreas conditions or residuals of treatment for pancreas conditions?
[X] Yes [ ] No If yes, check all that apply:
[X] Abdominal pain, confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies If checked,
indicate severity and frequency of attacks (check all that apply):
[X] Severe (disabling)
Indicate number of attacks of Severe (disabling) abdominal pain in the past 12 months:
[ ] 0 [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 [ ] 7 [X] 8 or more
[X] Other symptoms, describe:
Veteran states he awakens at night he awaken and loses his bowel(defication) .
b. Does the Veteran have any of the following signs or findings attributable to any pancreas conditions or residuals of treatment for pancreas conditions?
[X] Yes [ ] No If yes, check all that apply:
[X] Steatorrhea
If checked, describe frequency and severity:
Veteran states greacy foul smelling stools 3 times per week.
[X] Diarrhea
If checked, describe frequency and severity:
Veteran states has loose and watery diarrhea.
Veteran states his last severe episode was 4 days ago.
Below is the Criteria for 100%...
Pancreatitis, total pancreatectomy, and partial pancreatectomy: With all of the following ..... 100%
Daily or near-daily debilitating attacks of pancreatitis with few pain-free intermissions;
Two or more signs of pancreatic insufficiency (such as steatorrhea, diabetes, malabsorption, diarrhea, and malnutrition); and Unresponsive to medical treatment.
~With the following .. 60%
Seven or more documented attacks of pancreatitis per year with at least one sign of pancreatic insufficiency (such as steatorrhea, diabetes, malabsorption, diarrhea, or malnutrition) between acute attacks.
~With any of the following .. 30%
Three to six documented attacks of pancreatitis per year with at least one sign of pancreatic insufficiency (such as steatorrhea, diabetes, malabsorption, diarrhea, or malnutrition) between acute attacks; -
I recently had a 2 hour exam and it turned out great. It gave the doctor enough time to ask question and myself enough time to answer and explain what's going on with my health. You aren't being rushed out the office. The doctor was able to diagnosis disabilities that I didn't know was related to my current disabilities. You will actually have enough time to explain what's going on and not have the examiner fill in the blanks for you (which in most cases don't bold well for the vet). Why wouldn't a Veteran not want that? Be grateful for your 2 hour exam because many vets didn't have that opportunity. They was asked a few question and rushed out in 20 minutes. Then a few months later their rating is decreased or denied.
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You should be able to see your notes 3 to 5 days after the doctor post and sign your exam.
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Glad you made it thru the exam bud, and I myself have had a few conditions granted that I did not submit for, yet Examiner noted conditions thru treatment or MRIs. Sounds like a good thing to me.
Thanks Navy04! I just hope they rate me fairly...
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http://blog.militarydisabilitymadeeasy.com/2014/05/rating-arthritis-for-military-disability_12.html
good info on arthritis here
The posterior tibial is a branch from the sciatic. If they rate it as sciatic you might get a higher rating, but if they question it they might want to check that it actually affects the whole sciatic nerve, that could shoot that down. With an EMG, they can detect if the sciatic nerve is affected, where it starts and how much of the nerve is affected. That part where they stick needles into your muscle tissue is a pain, but it gives them exact and scientific fact to base the rating on.
Thanks pwrslm! I already did that test a long time ago. That's how I got my first rating. The problem I am having is which one will they rate me on? It's documented by my C&P and pervious doctors that I have sciatic nerve damage and posterior nerve damage. Each have it's own rating and code.
Here are the ratings.
Code 8520: Paralysis of the sciatic nerve. Complete paralysis: If the foot drops (it cannot be lifted by the muscles in the legs), all the muscles in the leg below the knee do not work at all, and the knee has serious trouble bending (bending the knee doesn’t have to be impossible to rate as complete paralysis of the sciatic nerve, it just has to be limited), it is rated 80%. Incomplete, severe paralysis is rated 60%. Incomplete, moderately severe paralysis is rated 40%. Incomplete, moderate paralysis is rated 20%. Incomplete, mild paralysis is rated 10%.
Code 8525: Paralysis of the posterior tibial nerve. Complete paralysis: If the toes cannot curl or separate, all the muscles on the bottom of the foot cannot move at all, the foot has trouble turning inward (but it can do it), and the foot has trouble pointing (but it can do it), it is rated 30%. Incomplete, severe paralysis is rated 20%. Incomplete, moderate paralysis is rated 10%. Incomplete, mild paralysis is rated 10%.
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sciatic nerve includes the following;
Sciatic
sciatic nerve (DCs 8520, 8620, and 8720)
external popliteal nerve (common peroneal) (DCs 8521, 8621, and 8721)
musculocutaneous nerve (superficial peroneal) (DCs 8522, 8622, and 8722)
anterior tibial nerve (deep peroneal) (DCs 8523, 8623, 8723)
internal popliteal nerve (tibial) (DCs 8524, 8624, and 8724), and
posterior tibial nerve (DCs 8525, 8625, and 8725).
The tibial nerve is a part of the sciatic nerve, so you will be rated only on the sciatic. The sciatic nerve is the largest nerve coming from the lumbar spine, it branches into the listed nerves mostly from about the knee down to the ankle/foot.
Sciatic nerves are in the leg, so they are peripheral nerves, (the peripherals are arms and legs).
Depending on the location of arthritis will depend on how that is rated. The Spine is typically rated as IVDS or DDD instead of arthritis because you get higher ratings in the spine. Need further info for arthritis to figure that out.
The nerve damage is in my ankles and feet from cold weather injury. I am already 10% service connection for each foot for peripheral neuritis (increase) due to cold weather injury and requested an increase. I also was being examined for arthritis (new claim) in both feet in which the VA decided to examine and rate themselves. I guess my injury usually lead to arthritis so the VA decided to do the C&P exam on that as well. The sciatic nerve and posterior tibial nerve damage do to my cold weather injury is something new the doctor found during my C&P exam. She stated in her notes that the arthritis, sciatic and posterior tibial nerve damage is caused by my service connected peripheral neuritis. I have been service connected for peripheral neuritis for over 20 years now.
The VA did say it would be a 2 hour exam and they was checking everything with my feet.
I was thinking all my pain was coming from the cold weather injury but the doctor found other thing like the arthritis which freaked me out. You can't do anything without your feet...
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I requested an increase for Peripheral Neuritis and Arthritis. Below is the results. The C&P examiner also found I had Sciatic Neuritis and Posterior Tibial Nerve damage.
Will the VA rate me separately or together for all four issues? Or are they rated separately?
Thanks!
3. Veteran's current claimed and diagnosed Right and Left Lower
Extremity Peripheral Neuritis due to cold exposure is at least as likely as not(50
percent or greater probability) a continuation and/or progression of the
Veteran's already service connected Right and Left Lower Extremity,
Peripheral Neuritis from Cold Injury.
4. Veteran's current claimed Osteoarthritis of Right Foot/Right
Lower Extremity is at least as likely as not(50 percent or greater
probability)proximately due to or the result of the Veteran's
already service connected Peripheral Neuritis from cold Injury, Left and Right
Lower Extremity condition(s)/disability.
Rationale:
Veteran's current clinical radiologic findings- Right Foot, positive
for objective Right Calcaneal Spurring.
The C&P doctor also wrote this...
11. Nerves Affected: Severity evaluation for lower extremity nerves
a. Sciatic nerve
Right: [ ] Normal [X] Incomplete paralysis [ ] Complete paralysis
If Incomplete paralysis is checked, indicate severity:
[ ] Mild
[X] Moderate
[ ] Moderately Severe
[ ] Severe, with marked muscular atrophy
Left: [ ] Normal [X] Incomplete paralysis [ ] Complete paralysis
If Incomplete paralysis is checked, indicate severity:
[ ] Mild
[X] Moderate
[ ] Moderately Severe
[ ] Severe, with marked muscular atrophy
f. Posterior tibial nerve
Right: [ ] Normal [X] Incomplete paralysis [ ] Complete paralysis
If Incomplete paralysis is checked, indicate severity:
[ ] Mild [X] Moderate [ ] Severe
Left: [ ] Normal [X] Incomplete paralysis [ ] Complete paralysis
If Incomplete paralysis is checked, indicate severity:
[ ] Mild [X] Moderate [ ] Severe
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This article lists by state property tax exemptions for veterans
https://www.veteransunited.com/futurehomeowners/veteran-property-tax-exemptions-by-state/
The list is wrong for Illinois. Illinois just changed it law. 70% or higher pay no property taxes...
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Congrats! How hard was it to get approved for federal disability retirement? I have 25 years and is thinking about putting in for disability retirement...
Thanks
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This is not unusual and this question comes up often on Hadit. It happened to me and many others. Completion date constantly changes and the VA requests documents you already provided. However, if you do not have any proof you already provided the requested documents to the VA and you want to be on the safe side, I would resubmit them again by VA date stamped hand delivery or certified mail return receipt requested. JMO
Good luck to you and thank you for your service.
GP
Thanks Georgiapapa. The requested documents is from "VA medical hospital" so I don't see how they wouldn't have it? My records is all electronic now and I can view my entire medical records on healthevets...
Recently rated 100% SMC-S1
in Entitlement - Veterans Compensation Benefits Claims
Posted
I just got rated 100% SMC-S1 yesterday but I am not P&T. I would like to know what steps I would need to take to get my P&T? Also, being 100% without P&T, do I get commissary ID Card and Dental?