elcamino_77us

Updates: The VA had sent me a letter requesting more information before they sent my case to the Raters. I went ahead and sent them the information concerning my left knee scoping and what the Doctor had found. I also thought it would be a good time to see if they would CUE themselfs on my BVA of 2008 by pointing out the mistakes/misquotes/deliberate misquotes. I ensured that they didn't have to look to hard for them by suppling them with the necessary documents so they could see for themselfs. The following is an excerpt from my reply: The 2008 BVA Decision also referenced part of my 1996 C&P Exam to decide part of my case. The 2005 BVA (Encl 12) remanded part of my case back to the Regional Office for failure to take into consideration DeLuca. The veteran also seeks a compensable initial rating for his service-connected lumbosacral strain. This disability is rated based, in pan, on the limitation of motion of the affected joint or group of joints. 38 C.F.R. § 4.7la, Diagnostic Code 5237 (2005). Regarding orthopedic disabilities, the United States Court of Appeals for Veterans Claims (Court) has held that criteria which provide a rating based on limitation of motion require consideration of 38 C.F.R. §§ 4.40 and 4.45 (regulations pertaining to functional loss of the joints due to pain, etc.). See DeLuca v. Brown, 8 Vet. App. 202 (1995). Therefore, to the extent possible, the degree of additional disability caused by functional losses, such as pain, weakened movement, excess fatigability, or incoordination, should be noted in terms consistent with applicable rating criteria. However, such has not been accomplished in the present case… The doctor that conducted my 1996 C&P Exam never looked at my Service Medical Records and refused to take into consideration any of my medical complaints or statements concerning prior treatments. My understanding is that by failing to do so render’s his medical opinion as an inadequate opinion. A medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty. Bloom v. West, 12 Vet. App. 185, 187 (1999). In the case Bielby v. Brown, 7 Vet.App. 260, 268 (1994), an examiner failed to read the claim file, and the Court held that an independent medical examiner’s opinion is without evidentiary value where he failed to review the veteran’s record, and thus had no basis of fact or data upon which to render an expert opinion. Therefore, the 2008 BVA should have never used any part of my 1996 C&P Exam to decide any part of my case. This, I believe, constitutes another CUE. Due to the new info, I meet with the Doctor last week who completed my C&P back in January. She had called me in to do a follow-up as requested by the raters for my left knee and sinusitis. She used the diagnosis from my MRI prior to my surgery, but stated that she could not use the Doctors Notes from the actual surgery as they were just findings and that you had to be careful about putting too much in there or the raters would just ignore it. She also had x-rays taken of my nasal pathways for the sinusitis claim which is actually to serice connect my sleep apneia. Overall, I think it was a good move and could be very helpfull. I not sure about the Doctor not using the post surgery notes and how it will effect me. Thanks Bill

Thanks for the reply! It will help me go through and see whats really what. Bill

I had my appointment today with the Counsler. She mentioned that I looked familiar inwhich I replied that I had met with her three years ago. After discussing my case in detail, which included that I was a term civil service enployee and that my term would be up in ten months. She informed me that she would have to denie my claim but that I could come back in ten months and reopen it as there were some problems in my case that had to be addressed. First was that my twelve year window had long past. I asked her why as I was finally rated back in 2008. She stated that they apparently had back dated my eligibility date back to Nov 95 when I was discharged. The other part was that since my knee surgery this past July has kept me in a state of limited duty, it would look as if my employer was providing accommodations for my disabilities. However, I told her that within the next two weeks I was due to come off the light duty status. With that, she stated that she would leave my case in limbo so that I may submitt the new paperwork once the doctors release me back to full duty. She also wanted a copy of my notice letter stating that my term had been renewed for the last year and conclude in Sept to support my claim. Once she gets all of this she'll be able to help me. I believe that she is truly trying to help me. However, when the VA finally determined my case, they backdated my disability to my discharge date which in turn, left me without any eligibility. This was why I was denied three years ago. I don't see how they can get away with that type of behaviour. Thanks Bill

Have you heard anything back? Good Luck Bill

This is what I've typed up for my doctor. Before I send it to him, how does it look? Does it need anything? Do you think I'll get the results I'm looking for? The Doctor had stated to my wife that the fibrocartilage represented an old injury to the cartilage where it had tried to heal itself. Thanks Bill On 23 July 2013, you performed a partial medial meniscectomy to repair a medial meniscal tear of the Left Knee. Once inside, you notated that there were other medical issues with my left knee and that most were corrected. The Post OP Diagnosis included but was not limited to; “early degenerative changes medial compartment, moderate degenerative changes of patellofemoral joint.” In your report, you went into depth the conditions which you found as you scoped my Left Knee. I would like to ask you a series of questions concerning those conditions listed, namely but not limited to: “The patellofemoral joint noted mild fraying of the superior portion of the patella but areas of full thickness chondral loss and fibrocartilaginous replacement of the Central portion of the femoral trochlea. Abraded chondroplasty of the frayed chondral surface of the patellofemoral joint was completed.” “Inspection of the medial compartment revealed thinning of the lateral aspect of the medial femoral condyle with fibrillation and fraying and abraded chondroplasty was performed.” 1. Please state you full name and credentials including education, area of practice, years of experience. 2. Can you provide a current diagnosis of my Left Knee? 3. I provided you with a copy of my Service Medical Records and Civilian Medical Records including MRI’s and X-Rays concerning the treatment of my Left Knee. Have you reviewed those records? 4. Do you see a nexus/connection between the current condition of my Left Knee and the Injury/Treatment/Diagnosis in the review of my Service Medical Records? And if so, can you provide a rational to support your opinion? Please Note When Dealing with the VA: The doctor must have all medical records available and refer to them directly in the opinion. In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs when providing a rational to support his opinion. These are the Medical statements regarding possible Service Connection: Is due to- 100% More likely than not- Greater than 50% At least as likely as not- 50% (Benefit of doubt goes to Vet) but doesn’t happen Not at least as likely as not- Less than 50% Is not due to- 0%

Again Thanks Berta!!! "Did the doctor state the right knee had been aggravated by the left knee?" No, as both knees were the result of their own injuries. However, I'msure over time, they they played of of each other. ' “chondromalacia” was that specifically claimed with that medical term?' Yes, this time when I re-opened the case. "In your case do you have Proof of mailing anything you had sent to them?" Not from that time period, I turned everything over to my VSO, The American Legion. There was an appeal filed by The American Legion in 2008, late in the case, that acusses the VA of only using evidence that supports its decision that, "All material evidence benifical to the appellant must be discussed in a statement of reasons or bases." '“They stated that although I had injured my left knee while in service, that I did not have a current left knee disability.” Where are you at on the appeal? Have you filed the NOD yet, or are you going to respond within 60 days with an IMO, to the SOC?' That decision was made in 2008 at the BVA. In July of 2012, I filed a new claim with the VA using the VSO from the State of Georgia. I asked for an increase on my right knee due to surgery along with a few other claims. Plus I reopened the case on my left knee. My case was sent to the Rating Phase last week. If the VA continues its normal course of deciding my claims, I will be denied as usual. "I think the IMO will help you a lot." I agree!!! I believe if I can get a Nexus Letter from the Doctor who did my scope, I will get my left knee Service Connected. However, I don't believe I'll be able to get the date retroactive back to my discharge. Thanks, Bill

Thanks Berta for responding! I injured my left knee in 91' while on active duty. The Base Clinic opinion at the time was an MCL Strain. I have twelve entries in my SMR's for treatment of my left knee between 91- 95 including a Med Board. I have also seen several doctors since I was discharged concerning my left knee. However, the VA has continued to deny a service connection for my left knee. They stated that although I had injured my left knee while in service, that I did not have a current left knee disability. I actually went through my SMR's along with my medical records since, including the VAs, and put together a Timeline for the doctor of my left knee. I was diagnosed with chondromalacia of both knees in 2002 by a private doctor and the VA also determined by MRI in 2010 that I had chondromalacia of both knees as well. I recently received a copy of my C-File which took me 3 years to get. Most of the evidence which I had sent them, including the knee diagnosis of 2002 were not in the copies which I received. There were only two documents other than my SMR's that I received. It looked as if they had copied my SMR's multipal times and sent that to me to complete the request. Prior documents that the VA had quoted in their decisions were missing as well. Again Thanks for the Reply Bill

Back in October of 2012, I reopened my case on my left knee trying to get it service connected along with a few other items. At the end of July, I had to have my left knee scoped. There was a tear of the menicus plus a lot of scarring tissue from where the cartliage had tried to repair itself from an "Old" Injury. The doctor who performed the scope said he didn't have any problem answering questions concerning my knee but didn't understand how to write a VA Nexus letter. Does anybody have a set of questions that a doctor could answer that would help form a type of Nexus Letter? Thank You Bill

Good Afternoon, During my second appeal, the BVA ruled that consideration of 38 C.F.R. 4.40 and 4.45 had never been accomplished in my present case. 38 USCA 5103A & 5103A(d) were also used. My case was remanded back to the VARO again stating that the RO should take into consideration 38 C.F.R. 4.14, 4.40, 4.45, 4.49 and the holding in DeLuca v. Brown, From everything I've read, "Green v. Derwinski," "Nieves-Rodriquez v. Peake" and 38 CFR 4.2, that would made my first two C&P's Inadequate and inadmissible to evaluate a veteran's disability. Another words, if a exam or report has been ruled Inadequate, that record cannot be used to evaluate a veteran's disability. Is this a correct statement??? Thanks Bill

First, I'd like to say Thanks!!! for the help that you are providing!!! It seems to me the BVA might have made some typos or wrong statements that certainly change what the facts were, however, “From what I've been able to figure out, yes the IMO failed to provide a nexus, mainly from what I've read, it lacked a Current Condition. “ and I think that was the problem here. Yes, I agree, unfortunately “The evidence showed that I had arthritis when I was discharged. I'm going to have to check to see is the documents were ever used by the VA for rating purposes. “ Good because that evidence is what the VA needs, and also a confirmed diagnosis of the arthritis and documentation of chronicity. I checked all of the SSOC's and decisions I've got, There was no mention of the Documents. I did find two places they were referenced, one being my BVA Hearing and the second being by a statement form submitted by my VSR. Once my files are back at the Atlanta RO, I will schedule a appointment to look through my C-Files for them along with a couple of other files. I did see where due to an IMO, I was connected for Long Standing DDD. Wouldn't that also Imply that the Arthritis had been there for quite a while. I would think so. I had stated earlier about a couple of questions concerning CUE's, here goes. During my service, I lost part of hearing of my left ear which led to being removed from my MOS. My hearing baseline had to be reset and I was also treated for tinnitus. During my C&P of 1996 for Hearing, it was noted in my report that I also had tinnitus. I did not know that tinnitus was a separate claim at the time. I was service connected for hearing loss at a 0% from the date I was discharged. In 2010, I learned that Tinnitus was a separate claim so I filed for it along with hearing loss from my right ear. The claim was filed and a couple of months later, I received an increase in my deposit even-though the claim had not been finalized. I not sure that it ever has been finalized. I am listed officially as 10% Tinnitus from back in 2010 when I filed the claim. I filed a Freedom of Information Act to get a copy of my records to see what all they had. When I started going through all of the paperwork, I ran across the 1996 C&P Audio Exam which included the statement about the Tinnitus which I did not know about. Now the Question: Would this be a CUE under Inferred Claims or would I best be served by an EED? One last question for the evening. As I stated, I had gone through a PEB right before I was discharged, there is a good chance that I will end up with a Medical Discharge as medical evidence was left out of my Med Board and PEB. As I stated, I had lost my MOS due to my hearing loss which was left out among other things. I was told that the VA would have to completely re-do my claim from the beginning if that happens, does anybody know if this is correct? Again Thanks fo rall of the Help Bill

Ok, I've made a list of the different areas that I either disagreed with or I see where there maybe possible CUE's. Again I found a another problem in my BVA "DOCKET NO. 97-05 565 Jul 17, 2008" concerning misquoting medical records. Dr.Choi wrote, “He does clearly have median nerve distribution numbness symptomatically.” Yet, the BVA felt it necessary to change the wording to make their case. "He did not clearly have any median nerve distribution numbness symptomatically." If you have any questions, I posted Dr. Choi's medical report earlier in this post and my docket number is listed so you can read it for yourself. Bill

I have a question concerning my case, I testified at a BVA hearing and was wondering how much weight is placed upon the testimony as well as the documents entered into evidence? The evidence showed that I had arthritis when I was discharged. I'm going to have to check to see is the documents were ever used by the VA for rating purposes. Thanks Bill

MRRRR5 You're very welcome Bill

The brace that I wore in 2012 was discontinued for use either by the company or by the VA, I'm not sure which. However, I'm sure that the reason was that it did not meet the new policy for clothing wear. Yet, the VA decided to implement the new policy prematurely one year ahead of time. I think that will be the deciding factor. Yes, you're right about getting a copy of the letter, but my NOD was filed back in January. Another Good Point, not sure what it will take for the VA as a whole, to do whats right, I'm thinking a total revamping of their system. Maybe even being able to hold some of them personal responsible for their actions and the result of those actions. Bill

"Was that PEB evaluation for the knee that IS service connected now?" Yes, that was for both knees and my back. However, they did not include all of my medical problems. If they did I should have been medically discharged. That is still a possibility The VA service connected the right knee for arthritis sometime around 2003. Nexus examples I gave him Nexus Letter Example 1.pdf Nexus Letter Example 2.pdf From what I've been able to figure out, yes the IMO failed to provide a nexus, mainly from what I've read, it lacked a Current Condition. SSOC 20080226 SSOC_Redacted.pdf The American Legion's response 20080602 BVA Presentation_Redacted.pdf From what i can tell there was documentation that the VA had in their possession that they completely ignored. They mainly dealt with the back issues. However, the ignored documents prove that I had arthritis 3 1/2 months after my discharge and therefore rated 10% from the date of my discharge under 38 CFR §4.40, §4.45 & possibly §4.59 Dr Choi 28Feb1996_Redacted.pdf Dr Choi 28Feb1996 Addendum 14May1997_Redacted.pdf April 2006 C&P, this time Deluca is actually used. The Examiner was a PA-C Part of her report on my back: "In 1994, he had radiation of midback pain to both lower extremities and bilateral feet with certain movements. He can't say which particular movement that was. He has numbness in the low midback to the left leg, right foot numbness that is constant now. DIAGNOSTIC AND CLINCAL TEST RESULTS: 1. Thoracic spine films - Mild degenerative changes with spurring in the mid to lower thoracic spine. 2. Lumbar spine films - Degenerative changes of the lumbar spine with spurring, and minimal old compression of L3 3. CT of the lumbar spine: T12/L1 mild broad based disc bulge without significant narrowing of the foramen. L1/L2 Disc bulging without significant foramina! narrowing. L2/L3 Broad based disc bulge and bilateral facet degenerative change. L3/L4 Broad based disc bulge. Bilateral degenerative change, moderate central stenosis. L4/L5 Broad based disc bulge. Bilateral facet change and mild to mod central stenosis. L5/S1 Broad based disc bul e. no significant foraminal narrowing. DIAGNOSIS: 1. Lumbar 4/5 and 2/3 minimal disc bulging 2002 2. Multiple levels of bulging disc in the low thoracic, thru out the lumbar and sacral 1 spine with varying degrees of central stenosis 2006 3. Degenerative arthritis with spurring in the thoracic and lumbar spine. 2006 4. Bilateral Retropatellar pain syndrome 1994 5. Left cortical lesion of the distal left femur . MRI 1995, x-ray 2006" On this part I had been involved in two separate accidents which only one of them caused me any problems. However If I hadn't had preexisting conditions from the Military, there would never have been a problem as the car that bumped into the back of mine only damaged my bumper. I was experiencing shots of pain reading from the middle of my back down both of my legs my legs before the accidents. It was ruled Since there was no way to separate the conditions, the VA was responsible for all of the condition. "There has been some progression in L4/5 to mild to moderate central stenosis. This Vet has certainly had further changes in the thoracic, lumbar, sacral spine that is attributed to futher injury in the 2 mentioned MVA's which may still have legal action pending there. In summation there is some progression in the Vets L/S strain and degenerative arthritis there, but within any neurological disability." As you can see, the BVA's misquote of the examiners report completely changes the meaning of her statement concerning stenosis and I believe therefore constitutes a CUE. Would a CUE of part of the BVA decision require a complete redo or would it only effect the part considered in error? Another words would a Cue for the Back help fix the left knee decision? I'm thinking not, but it might also get them to check to see if there might be other errors. Right now my Current Claims are all being tied up with a Appeal on my clothing allowance. I was told by the VA the claim wouldn't effect anything, however...... Once my records are back at the RO in Atlanta, I will make an appointment to review them for the ignored documents. Thanks Bill

Ok, sorry for the delay. Attached is a copy of the VA letter that I was sent. VA Letter 13 Feb 2013 Redacted.pdf Its strange how the VA can take a decision and do want they want. The new policy was put into place one year early Apparently, not all of the braces met the new guidelines so those were promptly dropped and new ones were designed and ordered to take there place. Those of us with the older design were denied our clothing allowance. Bill

Thanks Berta, great job, I do appreciate your wealth of knowledge. I have some answers that will help with your input, plus a question or two.. "What steps did you or your vet rep take with the BVA to get that corrected?" To be honest, none. I just found it. I was trying to get my life back together after a divorce when the VA made their decision. I was somewhat happy that they finally decided in my favor and the fact that the American Legion had sent me a letter stating they had done all they could do. I only recently learn about the misquote as I was researching for my current claim. I had requested a copy of all of my files including the C&P Reports. I believe its obvious once you read the BVA. "Is the left knee already service connected too?" No "If not,is there evidence in your SMRs and/or on your USMC discharge certificate to claim it?" Yes, I had a left knee MCL Strain along with being found unfit by a MedBoard for BILATERAL RETROPATELLAR PAIN SYNDROME but Found Fit by the PEB. I had to check the boxes for knee injuries on my last military exam, as my local clinic didn't think I had a medical problem due to the PEB coming back fit for duty. "Also it is very possibly medically that the SC Right knee problem has significantly affected the use of your left knee, causing 'aggravation of' or secondary disability of the left knee." I'm sure they have both been affecting ech other as my right knee was injured as I left Okinawa in 88. Plus having DDD of the spine didn't help either. "And ...would this doctor be willing to elaborate on what he stated to your wife (hope it is documented too) in writing ,in the form of an IMO, if needed? I guess I am assuming (and could be wrong) that this was a non VA doctor?" The doctor is a Sports Medicine Specialist. I got a report from him today in detail concerning the surgery. The Chondromalacia is really bad in certain parts of my knee. I gave him a complete history outline of my left knee with a copy of all medical file as enclosures along with two examples of Nexus Letters. He stated that he would read through all of it and try and help me out. From what I have read mistaking Chondromalacia for Retropatellar Pain Syndrome is a common mistake, so hopefully this will be easy for him. I also asked him to complete a DBQ on the knee. I told him that the VA Doctor at the C&P did the ROM portions back in January as I would not be able to do that part due to my surgery. NOTE: She was instructed to only complete a DBQ on my right knee, but once I told her that I had reopened my left knee case, she went ahead and did the ROM for the Left knee, but only the ROM, nothing else was filled out on my left knee. "De Luca was decided in 1995 so your older claim appears to have been (should have been) covered by De Luca:" Yes, it should have been but wasn't "A dismissal of part or all of an appeal will have the reason for dismissal within the actual BVA decision. Part of your RO decision however was sent back (remanded) to the sub nom , meaning the AOJ Original Agency of Jurisdiction- The VARO,whose decision you appealed. When did this all happen?" This was apart of the BVA of 2008. "The dismissal of part of the appeal, in my opinion, means just that... the issue (s) dismissed are over. The remand however....what is the current status of the remand?" That is a very GOOD question as I have never heard anything back on any kind of remand pending. If that is the case, does that mean that IF I can get the knee service connected this time will they have to go all the way back to my date of discharge??? "Can you give us the BVA decision Citation Number and docket number for your BVA case?" DOCKET NO. 97-05 565 Aug 27, 2003 DOCKET NO. 97-05 565 Nov 10, 2005 DOCKET NO. 97-05 565 Jul 17, 2008 They are all a continuation from my original claims file of Nov 1995 "What is the 40% SC for?" 20% Low Back Strain 10% Right Knee Arthritis 10% Tinnitius 0% Hearing Loss 0% Hernia "Sorry but one more question: “got my BVA decided in the Fall of 2008” Was that decision due to the result of the remanded part of the claim, after the original BVA claim involving a 1996 C & P exam?" This was the third BVA ruling after the 1996 C&P exam. Even though the report was considered inadequate for the first two BVA's to use, the BVA of 2008 still used part of his science fiction report to make its decision. I do have a question or two concerning the Tinnitus as A CUE however, I will have to wait until tomorrow to ask as it is getting late. I hope I gave you enough info to look up the BVA's so you can help me. I realize that this is kind of late in the game and maybe there's not allot that can be done at this point. Thanks Berta and anybody else willing to help

John999 Thanks for your input, My thoughts are leaning that way especially in light with of your comment about 20%. Bill

Thanks for responding John No, I was discharged Nov 1995 and filed my claim that same month. My C&P Exam was held in March of 1996. The C&P Exam was a complete Joke, which I appealed promptly. Seven years later I testified in front of a traveling BVA in Atlanta after I contacted a Local US Rep and asked about my case as I hadn't heard anything since 1996. The VA Apologized for forgetting about me. After that, the American Legion kept having to appeal due to the constant mistakes the VA was making which included 2 more Inadequate C&P Exams and 1 not as bad C&P Exam plus the fact that the laws kept changing as to who was responsible to hear my case. Again Thanks Bill

My understanding is that anything stocked on the shelves in the regular supply system will not be granted a clothing allowance. I was denied last year for the hinged knee braces as the VA stated the manufacture claims the braces will not harm clothing. Bill

They are also denying clothing allowances for off the shelve braces. That was started last year (2012) even thought the letter I got stated that would go into effect 2013. Bill

I was discharged Nov1995 and Finally got my BVA decided in the Fall of 2008. My VSO was The American Legion and at the end they sent me a letter stating that they had help me as much as possible. I had surgery on my right knee in Aug 2012 and decided that would be a good time to file for an increase. After going through the Georgia Dept of Veterans Services and filing my claim, I began researching here and in other fourms. What I found amazes me. Yes,The American Legion did a good job but at the same time, they really blew it. In making their decission, The BVA relied on information from an inadequate C&P Exam. Plus, they (The BVA) changes the wording of the C&P examiner from within to without: “In summation there is some progression in the Vets L/S strain and degenerative arthritis there, but within any neurological disability.” To: “In summation there is some progression in the Vets L/S strain and degenerative arthritis there, but without any neurological disability.” This completely changed the meaning of the examiners statement. The word “within” used in this particular situation meant to include or encompass all of the neurological disability, in this case bilateral spinal stenosis to the L/S strain and degenerative arthritis. The BVA decission also stated in conjuction with my Left Knee Claim: "appeal dismissed in part, and vacated and remanded in part sub nom. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001)." Last week, I had surgery on my Left Knee. I do not have as of yet, a post-op report from the doctor. According to my wife, the doctor stated that most of the damage in my left knee was the result of an old injury. The only injury that I have had to my left knee was while I was stationed in the Marine Corps. My C&P Exam of 1996 did not include Deluca, My C-File was not view, The Examiner stated to me that he had looked at my x-rays and could not find anything wrong. At the end of the exam, he sent me for x-rays as he stated he didn't have any. All of my complaints of pain or my statements concerning military treatments were ignored. The doctor basicly stated I was a quack. I have also found the medical reports sent in 3 1/2 months after my discharge and a year later with a diagnosis of dengenerative Arthritis of the Spine were ingored. I believe there was a CUE committed as well with my first Audio C&P as I mentioned I had Tinnitus along with my hearing loss. I was service connected for the Hearing Loss but as I didn't know the Tinnitus was seperate, I wasn't service connected for that until 2010. According to what I can find, that would fall under Failure to Fully & Sympathetically Develop Claim. This is just the tip of the ice burge. OK, After reading all of that, can anyone give me some good advice. I'm not sure how to handle the BVA and both their usal of a C&P exam that was I believed, previously considered inadequate or their deliberate changing of the examiners wording to deny an increase. What did the BVA mean when they stated: "appeal dismissed in part, and vacated and remanded in part sub nom. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001)." And what does that mean for me still trying to service connect my left knee with my current claim? Is my statement concerning the Tinnitus being a CUE, correct? Thanks Bill

Thanks for the Help Bill

I agree. I did have a nexus letter, however, it was from my family doctor, in which case the VA blew him and me off. Live and Learn. However I didn't realize that until I started researching here. I won't make that mistake again. My current C&P exam was back in Jan. From the exam results, I'm looking at an increase for my right knee and back. I had reopened my left knee claim trying to sc it as well. I have compiled an timelime of treatment for my left knee and currently in the process of compiling all of their decisions and rational concerning my left knee as well. About eighteen months ago, I had a local Ortho Doctor with a great rep clean-up my AC joint, He did a great job. I'm going to get him to do my nexus letter. I did a search on here for IMO/IME and found two really good post to help with this. Thanks John Bill

Thanks Broncvet, In 2003, the VA doctor stated that the DDD of my Spine was normal for someone my age. However, that didn't take into consideration that three months after I was discharged in 95, I was diagnosed with DDD of the Spine. Until my Decision in 2008, my pain was never mesured or even taken into consideration. Instead, the VA doctors used the term "signicant subjective complaints" and ignored the impact of the pain. They also ignored that fact that I had x-rays while still in the military showing degenitive arthritis which should have resulted in a 10% rating even though my ROM was at a innoncompensable rate. It is my understanding that 38 CFR 4.40, 4.45, and 4.59 should have been firmly in place by the time my first C&P was decided in 2003. Bill