Sergeant

i have about 4 months of my Post 9-11 GI Bill left. I'm currently using it for an OJT program with the federal government. I'm not at the full pay rate for the job yet. Wondering if I'd be able to use VR either for the remainder of my OJT (1 and a half years left) or to complete my masters since I'll eventually need it to move up.

Thanks and good luck to you as well! I was medically discharged at 26, now I'm 28. Maybe that was a factor?

I got out in 2013 medically, 20% DOD and 30% VA. I just wanted out. I filed another claim later that year and was eventually awarded 90%. I immediately filed for an increase after my award in December and today benefits states I'm awarded 100% but not considered permanent and total. My PTSD (50%) and colitis (30%) were previously considered temporary. I'm assuming, since I haven't gotten a letter (or payment) explaining the new award, that they are still considered temporary. I'm extremely satisfied with the rating, but not sure how to feel about not getting P&T. I know Pennsylvania has a property tax discount for 100% but not sure if that's only for P&T. And I know I won't get Champ for my spouse. Just wondering if anyone can provide some information. Once again, extremely happy for the rating. Especially seeing that I filed everything myself. Thanks all!

Congrats!

Hello everybody! I just completed my C&P exams for a few increases. I'm currently at 90% (I think 89.8 calculated). My disabilities are below: PTSD 50% Mid Right Lumbar Radiculopathy L5-S1 20% Colitis 30% Lumbar L5-S1 herniated disc status post lumbar spine surgery 20% Cervical Sprain/Strain, Cervicalgia 10% Radiculopathy Right Upper Extremity Middle Radicular Nerve 20% Chronic Hip Strain, RH 10% Migraines 30% Hemorrhoids 0% I asked for an increase for the migraines, my lumbar radiculopathy, and L5-S1 herniation, cervical sprain, and hemorrhoids. I also claimed Spinal Stenosis, Degenerative Disc Disease, Peripheral Neuropathy, and GERD. I'm concerned that if granted, I'll only be at 94%-ish. In the meantime, I've been diagnosed with Obstructive Sleep Apnea. I have been out for almost two years but I feel I can relate it to military service. Unsure if I should file a new claim now or wait until this one is finalized. Here's the notes from a few exams: Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes [X] No If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [X] Other: vbms 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a thoracolumbar spine (back) condition? [X] Yes [ ] No Thoracolumbar Common Diagnoses: [ ] Ankylosing spondylitis [ ] Lumbosacral strain [X] Degenerative arthritis of the spine [ ] Intervertebral disc syndrome [ ] Sacroiliac injury [ ] Sacroiliac weakness [ ] Segmental instability [ ] Spinal fusion [X] Spinal stenosis [ ] Spondylolisthesis [ ] Vertebral dislocation [ ] Vertebral fracture Diagnosis #1: Lumbar L5-S1 herniated disc status post lumbar spine surgery Date of diagnosis: unknown Diagnosis #2: INFLAMMATION OF SCIATIC NERVE (20%-SC) Date of diagnosis: unknown 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's thoracolumbar spine (back) condition (brief summary): 27 YO, Marine Corps, 2005 - 2013. He has PMH of Lumbar L5-S1 herniated disc, status/post lumbar spine surgery in June 2012, Laminectomy/Discectomy L5-S1. For pain he takes: Rx ACETAMINOPHEN (OTC) TAB 500MG, TAKE ONE TABLET BY MOUTH TWICE DAILY AS NEEDED FOR PAIN/FEVER and, Rx IBUPROFEN TAB 600MG, TAKE ONE TABLET BY MOUTH THREE TIMES A DAY WITH FOOD OR MILK, FOR PAIN/INFLAMMATION. He has had back Injections, He has been to Physical Therapy, and new appointments are pending. On a pain scale of one to ten, "every day it is an 8/10 pain." WORK HISTORY: He works for the DOD as a Supply Planner, Office Job. He uses a Special Chair and a Leg rest at work. He calls out sick due to back pain 2 times a month. ----------------------------------- The Veteran will need to report for the following exam(s): DBQ MUSC Back (thoracolumbar spine) _________ DBQ MUSC Back (thoracolumbar spine): The Veteran is service connected for Lumbar L5-S1 herniated disc status post lumbar spine surgery which is currently evaluated at 20%. Please evaluate for the current level of severity of the Veteran's service connected disability. If the diagnosis rendered is different from the disability for which the Veteran is service connected, please indicate whether the Veteran's current diagnosis is a progression of the service connected disability or the original diagnosis was in error. The veteran is now also claiming degenerative disc disease, spinal stenosis and peripheral neuropathy. Please address these conditions on the back DBQ. ************************************************************************** ** b. Does the Veteran report flare-ups of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words: He calls out sick from work due to back pain 2 times a month. He states that back pain is "10/10 pain on these days, I can't get out of bed." c. Does the Veteran report having any functional loss or functional impairment of the thoracolumbar spine (back) (regardless of repetitive use)? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words. He does not do yard work anymore, he hires out. The most he can lift and carry is 25 - 30 lbs. Bending is Difficult, taking stairs is difficult. With sitting 15 minutes, he needs to get up and move around. He can walk 15 minutes before needing to stop and rest. He is not able to hunt anymore, he cannot bowl anymore, he cannot hike anymore. He cannot run anymore. Going to the Gym is limited. He goes to the Pool for workouts. 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Forward Flexion (0 to 90): 0 to 20 degrees Extension (0 to 30): 0 to 25 degrees Right Lateral Flexion (0 to 30): 0 to 30 degrees Left Lateral Flexion (0 to 30): 0 to 30 degrees Right Lateral Rotation (0 to 30): 0 to 30 degrees Left Lateral Rotation (0 to 30): 0 to 30 degrees If abnormal, does the range of motion itself contribute to a functional loss? [X] Yes (please explain) [ ] No If yes, please explain: H e has increasing pain with ROM Exercise. Description of pain (select best response): Pain noted on exam and causes functional loss If noted on exam, which ROM exhibited pain (select all that apply)? Forward Flexion, Extension, Right Lateral Flexion, Left Lateral Flexion, Right Lateral Rotation, Left Lateral Rotation Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): Tenderness to palpation in Right paravertebral spine area of the Lumbosacral spine. b. Observed repetitive use Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [X] Yes [ ] No Select all factors that cause this functional loss: Pain ROM after 3 repetitions: Forward Flexion (0 to 90): 0 to 20 degrees Extension (0 to 30): 0 to 15 degrees Right Lateral Flexion (0 to 30): 0 to 20 degrees Left Lateral Flexion (0 to 30): 0 to 15 degrees Right Lateral Rotation (0 to 30): 0 to 30 degrees Left Lateral Rotation (0 to 30): 0 to 30 degrees c. Repeated use over time Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [X] Yes [ ] No [ ] Unable to say w/o mere speculation Select all factors that cause this functional loss: Pain Able to describe in terms of range of motion: [X] Yes [ ] No Forward Flexion (0 to 90): 0 to 20 degrees Extension (0 to 30): 0 to 15 degrees Right Lateral Flexion (0 to 30): 0 to 20 degrees Left Lateral Flexion (0 to 30): 0 to 15 degrees Right Lateral Rotation (0 to 30): 0 to 30 degrees Left Lateral Rotation (0 to 30): 0 to 30 degrees d. Flare-ups Is the exam being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare-up: [X] The examination is medically consistent with the Veteran's statements describing functional loss during flare-ups. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss during flare-ups. Please explain. [ ] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups? [X] Yes [ ] No [ ] Unable to say w/o mere speculation Select all factors that cause this functional loss: Pain Able to describe in terms of range of motion: [X] Yes [ ] No Forward Flexion (0 to 90): 0 to 20 degrees Extension (0 to 30): 0 to 15 degrees Right Lateral Flexion (0 to 30): 0 to 20 degrees Left Lateral Flexion (0 to 30): 0 to 15 degrees Right Lateral Rotation (0 to 30): 0 to 30 degrees Left Lateral Rotation (0 to 30): 0 to 30 degrees e. Guarding and muscle spasm Does the Veteran have guarding or muscle spasm of the thoracolumbar spine (back)? [X] Yes [ ] No Muscle spasm: [ ] None [X] Resulting in abnormal gait or abnormal spinal contour [ ] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Provide description and/or etiology: Slow Antalgic Gait, uses Cain. Localized tenderness: [ ] None [X] Resulting in abnormal gait or abnormal spinal contour [ ] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Provide description and/or etiology: Slow Antalgic Gait, uses Cain. Guarding: [ ] None [X] Resulting in abnormal gait or abnormal spinal contour [ ] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Provide description and/or etiology: Slow Antalgic Gait, uses Cain. f. Additional factors contributing to disability In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None 4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Hip flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle plantar flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Great toe extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 b. Does the Veteran have muscle atrophy? [ ] Yes [X] No 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Knee: Right: [X] 0 [ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Ankle: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatome) testing: Upper anterior thigh (L2): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Thigh/knee (L3/4): Right: [ ] Normal [X] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Lower leg/ankle (L4/L5/S1): Right: [ ] Normal [X] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Foot/toes (L5): Right: [ ] Normal [X] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent 7. Straight leg raising test ---------------------------- Provide straight leg raising test results: Right: [ ] Negative [X] Positive [ ] Unable to perform Left: [X] Negative [ ] Positive [ ] Unable to perform 8. Radiculopathy ---------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [X] Yes [ ] No a. Indicate symptoms' location and severity (check all that apply): Constant pain (may be excruciating at times) Right lower extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Paresthesias and/or dysesthesias Right lower extremity: [ ] None [ ] Mild [ ] Moderate [X] Severe Numbness Right lower extremity: [ ] None [ ] Mild [ ] Moderate [X] Severe b. Does the Veteran have any other signs or symptoms of radiculopathy? [ ] Yes [X] No c. Indicate nerve roots involved: (check all that apply) [X] Involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve) If checked, indicate: [X] Right [ ] Left [ ] Both d. Indicate severity of radiculopathy and side affected: Right: [ ] Not affected [ ] Mild [ ] Moderate [X] Severe 9. Ankylosis Is there ankylosis of the spine? [ ] Yes [X] No 10. Other neurologic abnormalities ---------------------------------- Does the Veteran have any other neurologic abnormalities or findings related to a thoracolumbar spine (back) condition (such as bowel or bladder problems/pathologic reflexes)? [ ] Yes [X] No 11. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ----------------------------------------------------------------------- a. Does the Veteran have IVDS of the thoracolumbar spine? [ ] Yes [X] No 12. Assistive devices --------------------- a. Does the Veteran use any assistive device(s) as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [X] Yes [ ] No If yes, identify assistive device(s) used (check all that apply and indicate frequency): Assistive Device: Frequency of use: ----------------- ----------------- [X] Brace(s) [ ] Occasional [X] Regular [ ] Constant [X] Cane(s) [ ] Occasional [X] Regular [ ] Constant b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: He wears a Back Brace and uses a Cane to Ambulate due to back pain. 13. Remaining effective function of the extremities --------------------------------------------------- Due to a thoracolumbar spine (back) condition, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc.; functions of the lower extremity include balance and propulsion, etc.) [X] No 14. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ----------------------------------------------------------------------- a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [X] Yes [ ] No If yes, are any of these scars painful or unstable, have a total area equal to or greater than 39 square cm (6 square inches), or are located on the head, face or neck? (An "unstable scar" is one where, for any reason, there is frequent loss of covering of the skin over the scar.) [ ] Yes [X] No If no, provide location and measurements of scar in centimeters. Location: Lumbosacral area Measurements: length 3.5cm X width 0.5cm c. Comments, if any: The surgical scar is Verticle. 15. Diagnostic testing ---------------------- a. Have imaging studies of the thoracolumbar spine been performed and are the results available? [X] Yes [ ] No If yes, is arthritis documented? [X] Yes [ ] No b. Does the Veteran have a thoracic vertebral fracture with loss of 50 percent or more of height? [ ] Yes [X] No c. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): SPINE LUMBOSACRAL MIN 6 VIEWS Exm Date: JUN 08, 2015@09:56 Findings: The spine has retained its normal alignment. There are no fractures evident. There are discogenic changes at L5-S1 with mild intervertebral disc space narrowing. The remainder of the intervertebral disc spaces are preserved. There is no evidence of spondylolysis or spondylolisthesis. The visualized portions of the sacrum and sacroiliac joints are unremarkable. There are surgical clips in the right mid abdomen. Impression: Mild intervertebral disc space narrowing at L5-S1. Primary Diagnostic Code: Primary Interpreting Staff: JENNIFER NOZNITSKY, RADIOLOGIST, MD (Verifier, no e-sig) /JN Select an imaging exam... -------------------- MRI REPORT OF 5/28/2013 LARCHMOONT MEDICAL IMAGING IMPRESSION: 1. THERE IS A CENTRAL AND RIGHT PARACENTRAL DISC HERNIATION AT L5-S1 AS DESCRIBED ABOVE WHICH HAS WORSENED SINCE 3/31/2012. THERE IS SLIGHTLY MORE MASS EFFECT UPON THE ANTERIOR MARGIN OF THE THECAL SAC AND THE RIGHT S1 NERVE ROOT SLEEVE. 2. REMAINING LEVELS OF THE LUMBAR SPINE APPEAR UNREMARKABLE. 16. Functional impact --------------------- Does the Veteran's thoracolumbar spine (back) condition impact on his or her ability to work? [X] Yes [ ] No If yes describe the impact of each of the Veteran's thoracolumbar spine (back) conditions providing one or more examples: He could not be gainfully employed in a Physical/Labor type Job. 17. Remarks, if any: -------------------- With the exam today of the Lumbosacral Spine, after repeated use, the Veteran has no Fatigue, Incoordination or Weakness, but he does have Increased Pain with additional repetitive use. /es/ Neurology Service Signed: 06/11/2015 06:54 Headaches (including Migraine Headaches) Disability Benefits Questionnaire Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? [ ] Yes [X] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: If no, check all records reviewed: [X] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [X] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [X] Other: VBMS reviewed. 1. Diagnosis Does the Veteran now have or has he/she ever been diagnosed with a headache condition? [X] Yes [ ] No [X] Migraine including migraine variants ICD code: 346.10 Date of diagnosis: 4/14/2014 2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's headache conditions (brief summary): He developed headaches while serving in the Marine Corps (2009), received a C&P examination for headaches by __________at the Philadelphia VAMC on 4/14/2014. After that evaluation, the headaches became constant and he was evaluated in the Philadelphia VAMC Neurology Clinic on 1/14/2015. He continues to have daily headaches that last all day; they begin in the morning and worsen over the course of the day. Because of the headaches, he has changed jobs and exhausted his sick days; he works for the DOD as a supply planner. At least 2 headaches/week are prostrating. b. Does the Veteran's treatment plan include taking medication for the diagnosed condition? [X] Yes [ ] No If yes, describe treatment (list only those medications used for the diagnosed condition): Topamax, sumatriptan, ibuprofen 3. Symptoms ----------- a. Does the Veteran experience headache pain? [X] Yes [ ] No [X] Constant head pain [X] Pulsating or throbbing head pain [X] Pain localized to one side of the head [X] Pain on both sides of the head [X] Pain worsens with physical activity [X] Other, describe: Most of the headaches are over the left side of his head, but some involve his whole head. b. Does the Veteran experience non-headache symptoms associated with headaches? (including symptoms associated with an aura prior to headache pain) [X] Yes [ ] No [X] Nausea [X] Sensitivity to light [X] Sensitivity to sound [X] Changes in vision (such as scotoma, flashes of light, tunnel vision) [X] Other, describe: Some headaches are accompanied by confusion. c. Indicate duration of typical head pain [X] More than 2 days [X] Other, describe: Headaches are constant. d. Indicate location of typical head pain [X] Left side of head [X] Both sides of head 4. Prostrating attacks of headache pain --------------------------------------- a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating attacks of migraine / non-migraine headache pain? [X] Yes [ ] No If yes, indicate frequency, on average, of prostrating attacks over the last several months: [X] Once every month b. Does the Veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability? [X] Yes [ ] No 5. Other pertinent physical findings, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------------- a. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above? [ ] Yes [X] No b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to any conditions listed in the Diagnosis section above? [ ] Yes [X] No 6. Diagnostic testing --------------------- Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): Head CT scan (9/10/2014, Philadelphia VAMC) Impression No acute intracranial abnormality. 7. Functional impact -------------------- Does the Veteran's headache condition impact his or her ability to work? [X] Yes [ ] No If yes, describe the impact of the Veteran's headache condition, providing one or more examples: Headaches required him to change jobs, from VA to DOD, because he was missing too much work and to take a job with a shorter commute. Because of headaches, he used up his sick leave and has been taking leave without pay. 8. Remarks, if any: ------------------- 1. I have interviewed and examined the Veteran and reviewed the available computerized medical records, including VBMS and CPRS. Among these records were a C&P examination for headaches on 4/14/2014 and an evaluation for headaches at the Philadelphia VAMC Neurology Clinic on 1/14/2015. 2. Based on this information, the Veteran's headache condition has worsened since his previous C&P examination. This is a worsening of the headache condition for which he is service-connected rather than a new condition. /es/ staff neurologist Signed: 06 /08/2015 08:39