Valsacar

I've Dr. Bash and John, I actually found John because I was originally having a hard time getting a hold of Dr. Bash. I'm overseas, so doing everything via email and fedex. So far I've only gotten one aspect of my appeal completed, which cited Dr. Bash as well as my normal doctor. Not only did they reverse a previous decision, but also granted a new condition that I didn't expect. Back pay, even after John's well earned cut, was almost tripple what I paid Dr. Bash... and I still have a number of things on appeal. I was a little worried about having wasted so much money on Dr. Bash, but now I'm glad I did. Statements from my normal doctors are good, but Dr. Bash knows how the VA thinks and is able to tie it together in an easy to digest package, putting it in wording the VA likes to see. For anyone else thinking about hiring help, John Doyle is worth it. He's knowledable, hard working and keeps in constant contact with you. Dr. Bash isn't cheap, but if you've done your part then, IMO, he will bring it all together to put it over the top.

During service I was treated multiple times for fungal infections by the PAs at the clinic. These were persistent, and shortly after I left the service I sought treatment at a civilian hospital. After 2 failed treatment attempts I was sent to an allergist whom diagnosed it as Eczema/Atopic Dermatitis. That treatment actually works. I was still within my year, so I added eczema to my claim. It was denied be cause there was nothing in my records, and their doctor stated the two diseases would not commonly be mistaken for each other (which my doctor states is incorrect, and my own research as found is incorrect). I have an IMO from Dr. Bash for another issue, and he does reference the issues but as that isn't his realm I feel a seperate IMO would make for a stronger appeal. I have a statement from my Allergist, whom verbally said that my previous diagnosis was incorrect (fungal infections) but was not comfortable putting that in writing. He did state that it was very likely that fungal infections during service were secondary infections caused by untreated eczema (due to scratching). He's also told me the fact that I have Allergic Rhinitis (SC) strengthens the position that I had eczema during service (apparently they are related diseases, as is asthma which I forgot to claim and am doing now). So now I'm trying to find a dermatologist to bring it all together. Problem is, I'm currently working overseas so finding a US doctor that can work mainly off records (I can get any tests done and forwarded to them, as I did for Dr. Bash) has been a fruitless journey. Anyone have any suggestions?

Been there, done that... combine OSA with allergic rhinitis and chronic sinusitis keeping the upper airways nice a clogged (deviated septum too) and then eczema making it hard to get to sleep (constant itching)... yeah, I'm a little fatigued during the day.

How long have you had it? It can take a few weeks to a month to get used to it. Have you tried a full face mask? Nasal pillow? A BiPAP might work better for you as well. There is also the TAP-3 device, you need a dentist to make it (I believe the VAMC can do this) if yours is obstructive it might help.

I have also been told that FDC for reconsideration is better than appeal, but John Dorle told me there is a risk to your effective date in doing it. Basically what he said is that the VA would be under no obligation to back date the effective date if you do an FDC for reconsideration instead of doing an appeal.

I have a claim in for this, secondary to Allergic Rhinitis, just trying to get a feel for where I stand. I didn't get a copy of the results, but they did tell me the FEV-1 is 58% so I believe that puts me at 30% rating (assuming it is approved as SC). I don't understand what the other conditions require, so I'll explain my condition. I take albutorol (they call it Ventolin here) to control standard attacks. They were coming VERY frequiently, one inhaler wasn't lasting me even a month. I was using it anywhere from 3 to over 6 times a day. They then put me on a preventative inhaler called Foster that I take daily. With this medication the attacks have dropped drastically, down to a couple times a week instead of multiple times a day. If I don't take it (run out, leave it in a hotel, etc) for more than 2 days I quickly go back to needing to use ventolin multiple times a day. I used to see my doctor monthly, now it is bi-monthly, but that IMO is more because of how their medical system works here. In Korea they don't do medication refils, and can only give a certian amount at a time, so going back often is required. Thanks.

Which letter says that? I was confused at first when I saw my benefits letter (on ebenies) because it had a date like that. The date on that letter (says your disabled, at %, monthly comp... I think it's the A8 but don't quote me on that) is the effective date of your current monthly payments (which changes every year, going up). If you haven't gotten the big brown envelope yet, wait for that, it will have all the dates you need. If that doesn't say effective July then you might need to fight a little to get it back dated. As for the other aspect, I'm not sure on how that all works, there are others here that might be able to help you.

I claimed them and was denied (left service 3 years ago) because I was never "officially" diagnosed, just went to the ER numerous times to get treatment for them. Working on an appeal now, if this is true then my case should have just gotten a little easier. Yes, I've been "officially" diagnosed now.

Thanks, I sent him an email and he returned with a call within an hour! Very nice guy, and helpful. He gave me more information than the DAV (who has my POA right now) ever has...

On his site he said he only does skin diseases in certain cases. In my case, I already have everything needed, it just needs to be backed up (statement of concurrence) by a doctor that speaks VA English. Some journal references would be nice too. DoS is basically useless when you're overseas, unless you're a business. The FMP program just does reimbursement, they don't know anything about doctors or hospitals here (I've tried, still not sure if they Lady I was talking to even knew where Korea was). Even if they could, it would still be a Korean doctor. Part of the problem is cultural, it's nearly impossible to get them to put anything in writing that they are not 100% confidant on. I had one doctor refuse to write it because, "It's only my opinion." It took me almost 6 months to get my allergist to write the statement that I have, and it's only half of what he's verbally told me. He also thinks it's likely that I was misdiagnosed by the Army docs, but it would be rude to put in writing that someone else likely made a mistake...

I've been trying to get a hold of Dr. Bash for about a week, but no luck. Can anyone suggest another doctor that can do a good, strong, VA friendly IMO? I am overseas currently, so I need someone that I can mail my records to and have them reviewed. I have statements from my doctors here, but they don't speak English well so the statements are not as strong, or VA friendly, as they should be. The two things I need an IMO on are Eczema and Migraines. Thanks.

This is an excerpt from my Migraine Log, the first few entries. Please let me know if you think this is good. I would write it as soon as possible after the symptoms faded, I keep a copy on my google account so I can access it no matter where I am. I could reformat it if there is a better way to do this, I just tried to cover everything I could think of each time it happened. My Tramadol is actually for my back pain, but it helps with the migraines as well. I honestly just thought it was something I had to deal with, since every time I went to an ER in the Army they never said anything about possible preventative treatments... This is in a table, but I can't see to find out how to put a table. It goes date, then time (morning/afternoon/evening), details of what happened/felt, and then specifics on symptoms. DATE TIME DETAILS Symptoms 26Oct12 Evening Started towards the end of work day. Took Tramadol, once home had to lie in bed with lights off. Primarily lasted approx 3 hours. Pain: High, Throbbing Sensitivity: Sound, Motion Nausea: No 3Nov12 Afternoon Was playing with my son, at the onset I turned on the TV to occupy him while I laid down. Pain continued, took Tramadol. Primarily lasted approx 2.5 hours. Pain: High, Throbbing Sensitivity: Sound, Light Nausea: Yes 30Nov12 Morning On business trip in Stuttgart, Germany. Woke approximately 0300 with migraine. Attempted Tramadol with lying in bed with lights off. By 7am still in severe pain, went to Army hospital in Stuttgart by taxi. Had to fill out insurance paperwork, very painful to do. Some mistake happened, was left in waiting room for almost 5 hours attempting to shield from the light with sunglasses. Received Trodol, symptoms were manageable within 30 minutes. When I did not report my sponsor contacted the German police, and my local command. Emailed Mr. Hagen back to inform them of what happened and that I was still alive. Primarily lasted 11 hours, until treatment. Pain: High, Throbbing Sensitivity: Sound, Light, Motion Nausea: No 18Dec12 Morning Work with what felt like OSA related headache at approximately 0430. Pain worsened with movement, which is not uncommon for my morning headaches. Upon entering the bathroom and turning on the light pain was severe. Turned off the light, and dropped to the floor holding my head. Felt nauseous, with some dry heaves (painful). Wife found me when she got up at 0515, she got my Tramadol and water. She then made me a cup of coffee, cooled with a few ice cubes so as to not be too hot. I made it to the bed and stayed there until the symptoms subsided enough to function. Primarily lasted approximately 3.5 hours. Mild headache symptoms lasted throughout the morning, took two Alieve at work to help with them. Pain: High, Throbbing Sensitivity: Sound, Light, Motion Nausea: Yes, Dry Heave but No Vomit

I did start a log last year, after the claim came back denied, as I had read that it can be helpful. I will submit that with the claim. I didn't submit a statement either, I did the first one on my own and had heard that they weren't really helpful, same for buddy letters. My wife is the one that sees it the most, as she's the one that normally has to drive me to the ER. Last year I was in Germany on a business trip, to a Military training conference. The last day I had a migraine first thing in the morning (it actually woke me up at like 3am). I was in pain and went straight to the nearest Army hospital. I have the records for that visit, but when I didn't show up the sponsor went a little overboard and contacted my command (as well as the German police). I have the email chain back to my command explaining what had happened. Would that be useful as additional evidence of how it affects my ability to work? I'm not treated by the VA, but I have started seeing a doctor locally and the medication he's given me seems to be helping. It was pretty hard to get him to write anything, culturally over here they don't like putting anything in writing that they cannot say 100%. I was thinking that getting an IMO from a US doctor to back up and concur with his statements would be useful. I knew headaches were, but wasn't sure if migraines were also related. I guess it does seem right, the frequency of migraines did lower after I was diagnosed with OSA and given a CPAP. Should I add that in now, or save it as a backup if they deny it a second time? Thanks for the advice so far, I'm thinking I should find a good US doctor to provide an IMO backing up what I have from my Korean doctors.

I could see this being good, if it was done in this manner: 1. Rate based off of what you have right NOW. Give what you can guarantee the veteran is due based off service records and anything else present in the claim. 2. Give veteran those benefits they you just confirmed they have. 3. Order C&P. 4. Re-evaluate with the new information. 5. Pay veteran back pay for any conditions now SC, or increases to those that were approved in step 1. If this is how it is done, I would say it's a good step. I get some benefits quickly, and get everything I'm due a little later. Think of it this way, I injured my back in service. They can tell from my records that I have a herniated disc (diagnosed in service) with pain. They can give 10% for that, ROM could make it higher but we're not waiting for that before awarding benefits. I also have sciatica down the right leg, records show that it's severe pain, but no mention of muscular atrophy. We can say that's at least a 30%, it might be more so we'll give it 30% provisionally. Now I am able to go to the VA hospital and get treatment I need for these conditions, treatment I may not have been able to afford before. I'm happy, I'm getting my treatment and if it takes them 2 years to give me what I truely deserve (with back pay) so be it. The most important part of this whole system, in my opinion, is I can get treatment without going bankrupt doing it. ---- Now, that said... I have zero faith that this is how it is being done.

First I want to say, I keep seeing people talking about signing up for a membership and then getting VSO assistance. You do NOT need to be a member of any of the vet organizations in order to use them as a VSO. The only requirement is to sign the POA so that they legally have the right to talk to the VA on your behalf. That said, I did my first claim on my own, and made a few mistakes but I did come out with 60%. I decided to go with a VSO for the second round, originally VFW (I was a member at one point, it lapsed) but I couldn't find the contact info I needed from over here (I'm in Korea as a contractor still). I had gotten a card from the DAV, so that seemed like an obvious choice. It didn't take long and I was assigned a rep at the Pittsburg office (which is where all overseas claims go through). Now, he is hard to get a hold of, but I attribute much of that to the time zone difference, it's not easy for me to call and if he's with someone at the time I generally do not request a call back. I hate getting calls at 3am for some strange reason ;). Over all they haven't done too much for me, besides direct me to do an FDC instead of an appeal (C&P didn't do some of the tests that they should have done, so resubmit as a new claim) due to the massive backlog (stats show average wait on appeal at that VARO is 1441 days). I agreed, even if it does risk losing the effective date (but from what I've read, it shouldn't). That's where I am now, working on getting everything together. I prefer to be in control, but a little more assistance from them would be nice. In my case, being that they are local, they have one MAJOR advantage. I have given my fedex account number to my rep so that he can fedex (at my expense, I don't care) anything from the VA to me. Regular mail takes 2 weeks, up to 2 months, to get over here. My 20 day letter (original claim) when they LOST my medical records (digital ones too, they didn't bother asking the Army for a new copy) got to me 21 days after it was sent... The ability to get me VA correspondence (from and to) in a timely manner is more than enough to make me happy.

Eczema was denied for: "Service treatment records show a diagnosis and treatment in service for dermatophytosis. Your claim file was sent to the VA Medical Center in Pittsburgh and an opinion was asked if it was at least a likely as not that the in service treatment for dermatophytosis was the cause for the current diagnosis of atopic dermatitis. After careful review of all the evidence of record the examiner provided to opinion that the condition was less likely as not (less than 50 percent probability) incurred in or caused by service. The rational being that dermatophytosis is a fungal skin condition of the hair, skin and nails and atopic dermatitis is a form of eczema which causes dry, reddened, itchy skin. The two would not typically be mistaken for the other." Here is what my allergist has written (keep in mind I'm overseas so English isn't his first language): "He suffered from several allergic disease as I mentioned above for several years. His dermatologic manifestation were various, basically atopic eczema, however, sometimes they combine with allergic contact dermatitis or fungal infection. Although skin fungal infection is very frequent in working adults, I think his skin manifestation are more likely based on adult-onset allergic eczema. Even if most of allergic eczema (same as atopic dermatitis) could occur in childhood, there was adult-onset type intrinsic allergic eczema could developed in any period in life." For migraines the denial was: "While your service treatment records reflect complaints, treatment, or a diagnosis similar to that claimed, the medical evidence supports the conclusion that a persistent disability was not present in service." I've counted at least 10 ER visits for migraines (sometimes listed as just headache, but doctors notes always say migraine). I assume the real reason for denial is that I was never officially diagnosed (just ER treatments). I now have that, and the DBQ reflects my current state of at least one a month, with 4-7 a year severe enough to warrant a visit to the ER, all others can be controlled with medication or die down after approx 4 hours, anything worse I go to the ER.

NP, Good luck. I'm fighting to get Eczema added, if I do it looks like I'll be at 30%. It should be 60%, but I was on medication when I went and doc said it covered about 30% at the time. Without meds it's over 50%, I tried to go off the meds for a little while before the exam... but I just couldn't take it and went back on them. So bad I couldn't even get to sleep at night.

Yes, it is OR. Keep in mind that when they say systemic, they mean oral or injected, not topical (ie NOT creams).

I have a herniated L4/5 and L5/S1. I also use Tramodol for the pain, which works for the minor stuff. Coritical steroids works well (ESI), lasts for 6-12 months for me. The other medication you mentioned I'm not familiar with, but I also take Celebrex which I'd say is nearly 70% effective. It's a COX-2 inhibiter (what ever that means, I just know it helps). I can't use narcotics, thank you mom, because they have no effect. Doc once explained that some people (apparently fairly rare) metabolise narcotics so fast that they never get a chance to work, my mother and I are both like that... they've tried double and even tripple doses, might as well have been sugar pills. Migraines are fun without narcotics, and of course the back pain we're discussing here. One thing I have, for emergencies only, that works really well (most of the time, except last week) is prednisone. I take 50mg for those days where you litterally can't move because of the pain. My doctor doesn't like giving them, due to the long term damage constant oral steroids can cause, but he does give me 1-2 doses for emergency use. I normally only need it once or twice a year, when the pain comes at a time where I need to deal with it because of some work or family event. If it's not an emergency then I head to the ER. At the ER I've found Torodol works really well, that's what I use to treat my most severe migraines but it also reduces the pain from my back. Of course it's not treating anything, but it does make it so I can function that day. I don't know about your case, but for me I generally have a discomfort level of pain daily. Some days are worse than others, on those I use tramadol to help control it. The steroids and ER visits are for the worst days, which only happen a few times a year for me. When those happen the pain does last for weeks, gradually getting better, but that first day is so bad I can't move at all. I'd suggest looking into getting something like Celebrex for daily (unless that other medication is the same type), and see what they can do for emergency use like my prednisone.

Some quick background, I served for 5 years 8 months (with a break in service). I came in pretty much normal, no major medical problems. I had childhood allergies, like many had, and asthma and grew out of both well over 12 years before joining the Army. During my first term of service I injured my back, but it wasn't too bad at the time (herniated L4/5, 0% rating as there was rare pain and didn't even warrant any real treatment). When I rejoined I was still in normal health, nothing out of the ordinary (besides that injury). The back got worse during service, now both the L4/5 and the L5/S1 are herniated and I require ESI 1-2x a year to control the pain (don't really want to do the surgey if another treatment still works). After I left service it was upgraded to 10% and 10% for sciatica. The doctor did not do a ROM, or evaluate (or even ask) about the sciatica. My award letter did note this and stated that if I provided the ROM they will re-evaluate. I also developed OSA during my second period, most likely do to the 12hr rotating shifts and other nasty things in that nasty command center I lived out of for 3 years. While relatively mild (IMO at least, I know people with FAR worse), it does require a CPAP and was awarded 50%. My ulnar nerve (left arm) has minor paralysis, was awarded 10% for it. Hypertension (stage 1, controlled with medication) I was given 0%. I also was diagnosed with Allergic Rhinitis but forgot to claim it, I have already started a claim for that (should be fairly easy, diagnosed 2 years into my second term, confirmed diagnosis after service, same treatment the entire time). Perential, not seasonal. Antihistimines and flonase. Now for the ones that were denied, which is where I am asking for advice. Eczema, I was not diagnosed until a few months after service. I had these rashes a lot during my second term (started about a year into it). The TMC just called them fungal infections (no actual tests done, just visual inspection) and gave me anti-fungal creams and hydrocortizone. There are a few instances of this in my records, but I stopped going when all I was getting was stuff I could grab at the PX OTC (with my work hours, sick call was on a day off). After service I went to a local doctor (I am overseas, should have mentioned that...) whom thought it might be irritation from soap or hard water. Changed soap, went on vacation, etc and no change. After a few visits he refered me to an allergist. The allergist diagnosed Eczema (AD) and started treatment, topical steroids (a little stronger than hydrocortisone) and antihistimes (basically the same thing I was getting before). He reviewed my service records and said the fungal infections I had before were probably the first instance of it, either a misdiagnosis or the fungal infections were secondary due to untreated eczema (constant scratching increasing the chance of a fungal infection). The rashes in service were in the same locations as the rashes I still have now. The statement I got from him was weak, I didn't know about all the magic words. The other condition is migraines, I have approximately 11 (I need to count again) ER visits for headaches/migraines in the last 3 years of service. I have a number of ER visits after service for the same (average 3-7 a year, ones servere enough to warrant an ER visit, almost 1 a month but those I can control and they go away in 2-4 hours... mostly). This was denied because I never saw a neurologist, nor got an official diagnosis (just the ER records stating visit for migraines). Now for what I have done. I have contacted the DAV to represent me, they have been very helpful so far (but hard to talk to due to the timezone difference). The hospital that did my C&P (ordered by the VA, via the US Embassy here) was terrible (they are no longer approved). They didn't do the ROM for my back, I only saw a generalist for 5 minutes, no review of records, nothing. My claim for Eczema (which was added on) I never even went to the hospital for... My rep at the DAV said the best way would be to do an FDC, with new evidence, vice an appeal (due to the long wait on appeals). So that is what I'm working towards. I have the ROM for the back, and a new DBQ to match. That should be fine, the doctor ACTUALLY did a physical, read my records and talking to me. My allergist did a DBQ for my eczema, he also provided me with a medical certificate that states how long he's treated me for, what he treats me for (with those international numbers, I forget what they are called, for each diagnosis) and that in his medical opinion it is more likely that my fungal infections were most likely secondary infections due to undiagnosed and untreated eczema. I also saw a nuerologist, whom I spoke to for quite some time, and he also reviewed the relevant records. He provided me with a DBQ and medical certificate officially diagnosing me with migraines (also started me on treatments, wow that makes a difference... been 2 months since my last migraine). On the DBQ he states have suffered from migraines for many years, as well as OSA inducted morning headaches. Now for the questions. What am I missing? Is there anything I should do, or add for those two things that I am contending? I want to make sure everything is in order when I put it in the mail. I am honestly not that worried about the percentage (of course, I'd like what is correct), I just want the SC status so that I can cover the cost of treatment. Is there anything I should add in my own statement, besides just what evidence I'm bringing in, and what I believe is correct? Should I seek out more doctors to get additional statements? It's not easy to do over here, their doctors tend to work in black and white so they don't want to put anything on paper unless they are 100% certian. I actually had one doctor tell me he agrees, but when I asked if he could write a statement to that he said "But that's just my opinion, it doesn't mean anything." In my research I came across an appeal case that mentioned the veteran submitted articles from medical journals, highlighted, in support of his contention. Is that a good idea to do, as I do have many that support my eczema claim. Or would that come across wrong, like I'm trying to tell the RO how to do their job? What is the best way to organize everything before I send it in? Of course I'll send it to the DAV (as they are my VSO), but what will make it easiest for them to make a decision? I think that's about it, I can provide more detailed (exact quotes of what was said where) if needed. Thanks.