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If there is a solid history of this in her medical records, this is called falsification of medical records, and its a crime. For the practitioner to make that statement, it confers that he/she has reviewed the record and this is a professional opinion. The competency of the practitioner is relied upon by both the VA/Federal Government as well as the claimant/patient who was the subject of the medical opinion. In the DBQ from the C&P exam, it documents what records were used in the review. It should show that they used "VBMS CPRS VISTA". The CPRS is the VA Medical records. If the migraines are documented in the VA records, then you have a reason to complain. If you have solid grounds showing that the migraines are well documented in her records, take it to the VA IG. File a formal complaint. The IG is responsible for investigating criminal acts by federal employee's, or related to federal jurisdiction, which is what a C&P examination is.

VA is best because you can see it on your blue button reports 3 days after the C&P section submits it.

Hardship requests from the VBA can be done in a week. Problem is that they don't request it. Spoke to the Chief of Staff and my VAMC, he said they are set up to expedite hardships for the VBA when it is requested.

Nerves are rated by what they do, not how bad they are damaged. 3 types of nerves involved, sensory, motor, and autonomous. Sensory is feel, motor is movement, and autonomous is reflex for peripherals. Sensations like numbness, shooting pain, tingling, is all sensory. Motor is when your strength, reflex, or coordination is involved. When reflex response is affected, its usually accompanied by substantial motor involvement as well. http://www.benefits.va.gov/WARMS/M21_1MR3.asp This is the instruction book for the RO to rate this. This is the bottom line; Degree of Incomplete Paralysis Description Mild subjective symptoms or diminished sensation Moderate absence of sensation confirmed by objective findings Severe more than sensory findings are demonstrated, such as atrophy, weakness, and diminished reflexes.

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.

They have to follow a specific procedure to reduce your benefits. First off, they have to have evidence that your condition improved. The RO cannot make medical decisions. Go to your PCP and validate the finding that the C&P Nurse noted. All you need is an acknowledgement in a medical record from any medical professional that the disability exists, and that it reflects a 20% disability under the rating schedule, and you have new evidence. Did they tell you what evidence they have?

They acknowledged receipt of your hardship, you should get a letter telling you if they accept it. Took them another 3 weeks for mine to come though. Filed with foreclosure documents May27, they acknowledged receipt Jun 7, and Jul 3 I got officially notified that my case was considered hardship. Settled 3 Sep. Its hard to go a year without a paycheck, that's a fact. Once you get the approval on hardship, it goes faster, but only as fast as the C&P schedule will allow. Mine took about 4 weeks to get in, the day after the C&P it went to pending decision, then pending approval. I went to the EBenefits site and pushed the "Decide my claim" button, and in 3 days it was over. They screwed it up and low balled my rating, but they approved everything I asked for.

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.

Are diagnostic codes (listed in 38 CFR) normally omitted from the Rating Decision?

Sounds like your letter is paying off. Gratz on that. Remember, the only reason you get knocked down is so that you can get back up. You only stay down if you want to be there. keep on fighting the good fight bro...it gets better

All of the evidence is in VA Medical Treatment records. The VA Treatment records are listed as evidence in the Claim Decision. Decision info posted above. (See Saturday at 1045) There isn't a word about any reasons or bases to set aside the multiple examinations in the VA Treatment records. Its very obvious that if they included all of the examinations the VA provided, that a mistake has been made. Should I send a request for them to CUE this by IRIS? Its probably the cheapest route for the VA, and quickest.

Tripped over M21-1, pt 3, subpart IV, in Section G, number 4b (assigning level of incomplete paralysis). This is VA's instruction book on what they should do, how they should do it. If I send in a request via IRIS for them to acknowledge this issue and cue themselves, do you think they would act on it? The table below provides a general description of each level of incomplete paralysis of the upper and lower peripheral nerves. Degree of Incomplete Paralysis Description Mild subjective symptoms or diminished sensation Moderate absence of sensation confirmed by objective findings Severe more than sensory findings are demonstrated, such as atrophy, weakness, and diminished reflexes

Ok, I slowed this down for now. Submitted a basic request for reconsideration w/new evidence on a VBA4138 without mentioning anything about CUE. If they don't respone with a correction, then I do the NOD w/Cue. Same info on RFR should get faster results.

Noted this is still happening. Permanent?

Take the records from the new ENT you saw with you. Personally, I feel the QTC Doc should be held responsible for keeping you from getting what you should be getting if the condition is now found service connected. Providing a professional diagnosis for the US Government has to hold an expectation of professional competence when they seek out licensed professionals that are paid to help you through the completion of DBQ's and medical opinions. I am in a similar situation right now with the results of a C&P exam. There needs to be some sort of legislation or regulation action put in place to punish those who conduct examinations this way. Not only do they harm the Vets who they take money to serve, but they also damage the reputation of the VA, and the Federal Government. When they do this, it should open the doors that will literally threaten their livelihood, leading to the removal of their right to practice medicine for multiple offenses, to countervail the enticement of easy money cranking out C&P exams.

Tried to maximize the impact of overwhelming evidence showing how much was ignored in the record. Got it down to this; This is a Request for Reconsideration for my claim submitted (as listed) 27 May 2015, award/approval date of September 3, 2015. I request reconsideration to correct a Clear and Unmistakable Error. The decision stated; “We have assigned a 10 percent evaluation for your left lower extremity radiculopathy (claimed as partial paralysis sciatic nerve left leg and left foot drop) based on: • mild incomplete paralysis” The decision also stated, “A higher evaluation of 20 percent is not warranted for paralysis of the sciatic nerve unless the evidence shows nerve damage is moderate.” Evidence that was acknowledged as “VAMC (Veterans Affairs Medical Center) treatment records, Orlando/Lake Baldwin VA Medical Centers, from April 13, 2014 through August 31, 2015VAMC (Veterans Affairs Medical Center) treatment records, Orlando/Lake Baldwin VA Medical Centers, from April 13, 2014 through August 31, 2015)”(noted as VAMC Treatment Records from here on), contain examinations by multiple VA Physicians and other health professionals that demonstrate that my condition is much worse than is indicated in the award. In accordance with 38 CFR 4.1., “accurate and fully descriptive medical examinations are required.” In accordance with 38 CFR 4.2, “It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present.” In accordance with 38 CFR 4.6, the requirements for the evaluation of evidence is as follows; “Every element in any way affecting the probative value to be assigned to the evidence in each individual claim must be thoroughly and conscientiously studied by each member of the rating board in the light of the established policies of the Department of Veterans Affairs to the end that decisions will be equitable and just as contemplated by the requirements of the law.” All evidence must be evaluated in arriving at a decision regarding a rating. (38 C.F.R. §§ 4.1, 4.2, 4.6). Through the examinations located in the VAMC Treatement Records; Symptoms of gait disturbance is noted as follows: 12 Mar 2015 1334 at VAMC Lk Baldwin- DR WU, Ying MD (PCP) “not able to do toe/heel walk left side.”, 11 May 2015 @1551 Lone, Hina MD PCP “abnormal gait with steppage on left”, 19 May 2015 @1242 Kirkpatrick, John Orthopaedic Surgeon “Gait is with left foot drop, can do heel and toe rise on right, not on left.”, 29 Jun 2015 @1057 Kirkpatrick, John Orthopaedic Surgeon “cautious ambulation”, 21 Jul 2015 @1720 Rossi, Fabian H MD Neurologist, “Gait: Reduced tandem. Negative Romberg.”, 3 Aug 2015 @ 836 Kirkpatrick, John Orthopaedic Surgeon “gait antalgic left”, 7 Aug, 2015 @1300 PEELER, DOUGLAS PA (C&P Examiner), “SLIGHT LIMP”(New Evidence) 28 Sep 2015 @ 1358 Kirkpatrick, John Orthopaedic Surgeon” gait remains with AFO left leg” Foot Drop is noted as follows: 12 Mar 2015 1334 at VAMC Lk Baldwin- DR WU, Ying MD (PCP) ”worsening sym with left foot weakness” “foot support ordered”, 12Mar 2015 @0831 Anderson, Scott BSCHSA LP CP Othotist-Prosthetist “AFO IS MEDICALLY NECESSARY TO HELP PREVENT ANKLE INSTABILTY DURING WEIGHT BEAR AND AMBULATION.” , 19 May 2015 @0842 Prosthetic follow up by Mead, Todd N Prosthetics-Orthototist BS MA BOCO “AFO IS MEDICALLY NECESSARY TO HELP WITH PLANTAR AND DORSIFLEXION OF FOOT TO PREVENT FOOT DROP”, 19 May 2015 @1242 Kirkpatrick, John Orthopaedic Surgeon “progressed to foot drop in Jan 2015”…” Gait is with left foot drop”, 3 Aug 2015 @ 836 Kirkpatrick, John Orthopaedic Surgeon “still has problem with left foot dorsiflexion. using afo.” “persistent left foot drop”, 05 Aug 2015 @ 1230 Kirkpatrick, John Orthopaedic Surgeon “foot drop added this is form radiculopathy noted on emg”, 7 Aug, 2015 @1300 PEELER, DOUGLAS PA (C&P Examination) No comments entered for Foot Drop, (New evidence)28 Sep 2015 @ 1358 Kirkpatrick, John Orthopaedic Surgeon “patient returns with persistent fot drop…. the persistence of the foot drop and progression of pain in region c/w innervation of myotome and dermatome makes surgery reasonable” The use of a prosthetic (AFO) is noted as follows; 12 Mar 2015 1334 at VAMC Lk Baldwin- DR WU, Ying MD (PCP) “foot support ordered.”, 12 Mar 2015 @0831 Anderson, Scott BSCHSA LP CP Othotist-Prosthetist “PT WAS IN FOR FITTING AND DELIVERY OF OTS AFO “, 11 May 2015 @1026 O'Connor, Terrence C, Orthotist (Orders replacement AFO because OTS AFO was (ill fitting”), 19 May 2015 @0842 Prosthetic follow up by Mead, Todd N Prosthetics-Orthototist BS MA BOCO (replacement AFO fitted and delivered) “PT FITTED WITH ORDERED AFO”, 29 Jun 2015 @1057 Kirkpatrick, John Orthopaedic Surgeon “has afo and walker”, 3 Aug 2015 @ 836 Kirkpatrick, John Orthopaedic Surgeon “using afo.”, 7 Aug, 2015 @1300 PEELER, DOUGLAS PA (C&P Examination) (no mention of AFO, cites no prosthetics used in DBQ report), (New Evidence)28 Sep 2015 @ 1358 Kirkpatrick, John Orthopaedic Surgeon “gait remains with AFO left leg.” Motor/Str/Sensory deficits are noted as follows; 12 Mar 2015 1334 at VAMC Lk Baldwin- DR WU, Ying MD (PCP) “Dorsiflex L5 (right)5 (left) 3+ Plantarflex S1 (right)5 (left)3+”, 11 May 2015 @1551 Lone, Hina MD PCP “decreased muscle mass of left thigh compared to right”, 19 May 2015 @1242 Kirkpatrick, John Orthopaedic Surgeon “Motor exam was grade 5 on the right at Hip flexors, hip adductors, hip abductors, knee extensors, knee flexors, foot dorsiflexion, toe dorsiflexion, foot plantar flexion, ankle inversion, ankle eversion. motor exam on the left was grade 4 Hip flexors, hip adductors, hip abductors, knee extensors, knee flexors, grade 3 toe dorsiflexion, grade 2 foot plantar flexion, ankle inversion, ankle eversion. Sensation was normal on the right, on the left globally decreased except lateral calcaneus (S1) was hypersensitive.”, 29 Jun 2015 @1057 Kirkpatrick, John Orthopaedic Surgeon “left quads grade 2 for lack of extension but 4 to resistance. right quad grade 4. left ankle inversion 2 for range but 4 for resistance. right grade 4. EHL bilateally grade 4. bilateral SLR right S1 sensation decreased.”, 21 Jul 2015 @1720 Rossi, Fabian H MD Neurologist, “NCS/EMG: H-reflex was prolonged on left side. He has a chronic left L5 radiculopathy …..Strength intact 5/5 x 4”. “Sensory: Mild decreased vibration ankles and thermal loss at his left foot….Reflexes: Symmetrical 2+, trace at the ankles, toes downgoing.”, 3 Aug 2015 @ 836 Kirkpatrick, John Orthopaedic Surgeon “EMG/NCV with chronic radiculopathy left L5…. motor grade 5 lower extremities except foot dorsiflexion grade 3+….persistent left foot drop” , 7 Aug, 2015 @1300 PEELER, DOUGLAS PA (C&P Examination) Noted “Sciatic Nerve, Left, Incomplete Paralysis, Mild” ”Thigh/Knee Lower Leg/ankle Foot/toes (Sensory Exam) “Decreased” “Muscle StrengthTesting…Ankle dorsiflexion: Left 4/5” “Constant pain, Paresthsias and/or dysesthesias/Numbness Right/Left Lower extremity Mild” (New Evidence) 28 Sep 2015 @ 1358 Kirkpatrick, John Orthopaedic Surgeon “motor grade 5 lower extremities except left EHL and eversion grade 3 EHL (does not get full rom but has resistance) and grade 4 eversion (normal ROM but overcome easily). sensation decreased left medial malleolus region and dorsum of foot.” Issues noted about problems walking/working as follows: 21 Jul 2015 @ 1720 Rossi, Fabian H “Pt reports weakness in leg that has restrictedhis walking to 0.5 blocks”, 19 May 2015 @1242 Kirkpatrick, John Orthopaedic Surgeon “(pain)worse with walking or standing” “patient by hx and physical exam with lumbar spondylosis, left foot drop, back and leg pain is disabled from prior work that involved standing, lifting, walking such as sales warehouse work, etc.”, 11 May 2015 @ 1422 Fulz Debbie C LPN GC “Factors triggering pain: Lifting, Sitting, Standing, Walking,”, 6 May 2015 Kimberley C. Bradley, MSN RN-BC “States it is getting more difficult to tolerate much walking, but walks as tolerated.” The accumulation of evidence provides consistent notes on Foot Drop, The use of an AFO/Prosthesis, strength primarily is noted at 2/5 to 3/5 in most of the examinations in relation to ankle and foot dorsiflexion, reduced sensation in right and left legs, weakness affecting the ability to walk (see evidence from DR Stewart also noted in Claims Decision about walking issues as well in non VAMC Treatment records). All evidence must be evaluated in arriving at a decision. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. It is a violation of Colvin vs Derwinski for the VA to not give a "reasons and bases" as to why these favorable exams were not considered 38 CFR 4.120 (Evaluations by comparison) states; “Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function. Consider…complete or partial loss of use of one or more extremities …disturbances of gait, tremors… In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances.” As cited in 38 CFR4.124a, under "Diseases of the Peripheral Nerves" in the schedule of ratings, it states; “…When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree." The standard that is set for CUE is that an error is obvious even to a lay person, weighting the evidence, using the examinations almost exclusively from the VAMC Treatment Record, that the Condition of my partial paralysis of my left leg, with foot drop, should be higher than 10%. My condition, when all of the evidence is viewed, more closely reflects a moderately severe condition (in my opinion), which should be rated at 40%. All of this evidence was on hand and before the rating specialist at the time the 10% rating was awarded, but it was not acknowledged, nor was a benefit of the doubt statement made, or any other explanation made, why the evidence in these examinations was disregarded. Accordingly, I request a correction in that part of my Claim Decision as it relates to (rating schedule 8520 Incomplete Paralysis of the Sciatic Nerve (of the left leg)), to reflect a moderately severe rating of 40%. /S/ Joe Vet/date//

should I add this? See example for 40% rating in Citation Nr: 1231015 Decision Date: 09/10/12 Archive Date: 09/19/12 DOCKET NO. 09-50 676 (request for increase higher than 40%, increase denied, both sensory and drop foot conditions in this case

Edited for brevity, see below

Its all going to end up in the same place. Sure, not using the EB site might keep your password safe, because you don't have one. But when you mail in your information, it goes into the same database that all of the EB data goes into, and that is all accessible by the internet. Password security is important. You need to use more complex configurations with numbers and letters in both upper and lower case. But even the best passwords don't help is the servers can be back-doored through software glitches. Hackers find ways to hack into windows on a regular basis that provide them the ability to get into systems using windows. All of the patches you have to install for your operating system testify to that fact.

Also found another BVA case, limited award to 20% for sensory issues (numbness) and weakness only. Foot drop is motor nerves, makes the severity of the condition much worse. See http://www.va.gov/vetapp12/Files5/1233610.txt

27 May 2015 was submission date. I got 1 year retro because it was my 1st claim. I have already sent in the notes on this, because they got my intent to file via EBenefits on 3 March 2015, so peggy told me to send screen shots and they will correct that. Dr. statements are in my VA Med records. Everything I have put on this is based on those exams. C&P was 7 August 2015. The examiner omitted anything about foot drop, called my gait a slight limp, and failed to note that I wore a prosthetic AFO. If you look at the C&P in the VA Med File, it was done by a PA, this decision awarding 10% is correct. They didn't mention the C&P, or any other examinations that were done by MD's, which included 2 PCP's, a neurologist, and a Ortho Surgeon. IF they used the examinations from all of the MD's, they would have to conclude that 10% is not accurate. Its obvious, and that's what make the CUE valid. The only listing for these exams in the report was "VAMC (Veterans Affairs Medical Center) treatment records, OriandolLake Baldwin VA Medical Centers, from April 13, 2014 through August 31, 2015" It also listed 2 examinations by non VA (one of which provided my service connection for my lumbar strain etc), but they concentrated on my low back issue, the severity of the peripheral nerve issue in my legs is developed in my VAMC Treatment records. How would you phrase it, should I copy/paste half my medical file into it, or refer to names, date and times of exams?

I just went through my entire Claim Decision. There is not a single listing of a diagnostic code in the entire document. I was SC for all 3, but none of the conditions are identified by code. Most of the award descriptions I provided were directly from the nexus statements I supplied in the claim. I left them to determine the applicable codes. They are as follows; REASONS FOR DECISION 1. Service connection for lumbosacral strain with intervertebral disc syndrome and degenerative disc disease (also claimed as spinal stenosis, low back strain, lumbar strain (chronic), mild thoracolumbar scoliosis, spinal instability). Service connection for lumbosacral strain with intervertebral disc syndrome and degenerative disc disease (also claimed as spinal stenosis, low back strain, lumbar strain (chronic), mild thoracolumbar scoliosis, spinal instability) has been established as directly related to military service. A 20 percent evaluation is assigned from May 27,2014. We have assigned a 20 percent evaluation for your lumbosacral strain with intervertebral disc syndrome and degenerative disc disease (also claimed as spinal stenosis, low back strain, lumbar strain (chronic), mild thoracolumbar scoliosis, spinal instability) based on: • Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees Additional symptom(s) include: • X-ray evidence of traumatic arthritis • With no incapacitating episodes during the past 12 months • Combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees • Painful motion upon examination The provisions of38 CFR §4.40 and §4.45 concerning functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, and flare-ups, as cited in DeLuca v. Brown and Mitchell v. Shinseki, have been considered and applied under 38 CFR §4.59. A higher evaluation of 40 percent is not warranted for degenerative arthritis ofthe spine unless the evidence shows: • Favorable ankylosis of the entire thoracolumbar spine; or, • Forward flexion of the thoracolumbar spine 30 degrees or less. Additionally, a higher evaluation of 40 percent is not warranted for degenerative arthritis of the spine unless the evidence shows: • intervertebral disc syndrome (IVDS) with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. The effective date ofthis grant is May 27,2014. Effective date assigned via Section 506 ofPL 112-154 which allows a one retroactive grant of service connection for original claims. The evidence of record suggests that this condition existed for some time as you were diagnosed with advance degenerative disc disease per xray on March 12, 2015 2. Service connection for left lower extremity radiculopathy (claimed as partial paralysis sciatic nerve left leg and left foot drop) as secondary to the service-connected disability of lumbosacral strain with intervertebral disc syndrome and degenerative disc disease (also claimed as spinal stenosis, low back strain, lumbar strain (chronic), mild thoracolumbar scoliosis, spinal instability). Service connection for left lower extremity radiculopathy (claimed as partial paralysis sciatic nerve left leg and left foot drop) has been established as related to the service-connected disability oflumbosacral strain with intervertebral disc syndrome and degenerative disc disease (also claimed as spinal stenosis, low back strain, lumbar strain (chronic), mild thoracolumbar scoliosis, spinal instability). An evaluation of 10 percent is assigned from May 27, 2014. We have assigned a 10 percent evaluation for your left lower extremity radiculopathy (claimed as partial paralysis sciatic nerve left leg and left foot drop) based on: • mild incomplete paralysis A higher evaluation of 20 percent is not warranted for paralysis of the sciatic nerve unless the evidence shows nerve damage is moderate. The effective date is the day we granted service connection for your lumbosacral degenerative disc disease, May 27,2014. 3. Service connection for right lower extremity radiculopathy (claimed as sciatic pain right leg) as secondary to the service-connected disability of lumbosacral strain with intervertebral disc syndrome and degenerative disc disease (also claimed as spinal stenosis, low back strain, lumbar strain (chronic), mild thoracolumbar scoliosis, spinal instability). Service connection for right lower extremity radiculopathy (claimed as sciatic pain right leg) has been established as related to the service-connected disability of lumbosacral strain with intervertebral disc syndrome and degenerative disc disease (also claimed as spinal stenosis, low back strain, lumbar strain (chronic), mild thoracolumbar scoliosis, spinal instability). An evaluation of 10 percent is assigned from May 27, 2014. We have assigned a 10 percent evaluation for your right lower extremity radiculopathy (claimed as sciatic pain right leg) based on: • mild incomplete paralysis A higher evaluation of 20 percent is not warranted for paralysis of the sciatic nerve unless the evidence shows nerve damage is moderate. The effective date is the day we granted service connection for your lumbosacral degenerative disc disease, May 27, 2014.

edited for brevity, added below.

This case closely parallel's mine, but they failed to account for my foot drop in the rating decision.

For the claim that they determined that the right knee cyst was not service connected, did you have any form of nexus for that?