Punisher

I'm going to jump in here, rather than start a new string. I am 50 years old, 100% P&T VA. Some of the more significant disabilities are PTSD (70%), Migraines (50%), and TBI (40%). I have not been able to work since the beginning of 2019. I applied for SSDI once I could no longer work and the VA actually did a great job breaking down how the mental health issues affect my ability to maintain gainful employment. I had SSA perform the expedited application process as they're supposed to for 100% P&T vets. Initial application was denied, giving false statements that I do not qualify for benefits because "you are not disabled under our rules." Under their "rules," it states: For Disabled Worker's Benefits: You must have the required work credits (check), and your health problems must: - Keep you from doing any kind of substantial work (check), and - Last, or be expected to last, for at least 12 months in a row (check), or be expected to result in death. The SSA never had me do a single exam with them, relying 100% on my VA records and exams. So, I appealed it with the "Reconsideration" process. Once again, I never saw a single SSA doctor for any exams and they continued to exclusively go by my VA records. My appeal was also denied, stating that they found the original decision to be "proper under the law." So now I'm stuck going to phase 3, the ALJ Hearing. I do not have a lawyer and I'm very cautious in hiring one, but recognize that one is finally needed. I don't typically trust them, especially to remain proactive, and "IF" I eventually receive approval, am not super excited to hand over a large percentage to someone else. Can anyone point me in the right direction on where to find a great lawyer who has experience working with 100% P&T vets? Any other insights on this process will be very appreciated.

I just saw this.... The first letter that came, stating that nearly everything was deferred, including PTSD, added that and referenced a specific C&P exam. The DAV never helped me with any of my claims package, but when I reached out to them about this, they said it was because of my migraines, which was the only decision in that first letter. They also pointed to the ref'd date. So naturally, I believed that until I looked it up in my calendar and saw it was a TBI/PTSD C&P (deferred by that letter). That's what also made me nervous since it was using an exam that wasn't approved. The migraine decision was simply to continue it (50%). Question to all: When someone receives a 100% P&T rating decision (schedular), does that apply to every condition/disability or does it really just apply to whichever condition deemed you P&T? Maybe that's a stupid question, but the VA does rate everything separately and just wondering how this plays out in the future.

All, I finally got my letter from the VA on Friday, with all the info included from the decision, and it's reflected on eBenefits too! They took away my Insomnia and replaced it with the PTSD rating since they combined the symptoms. They also combined TBI instead of waiting longer to separate the overlapping symptoms, but though the letter said the TBI would be combined, backdated to the same day as the PTSD (04/27/2020), there is still a "residuals of traumatic brain injury (TBI)," rated at 40%. I was surprised that, if I'm finally 100% P&T (officially now), in that big thick package, there was nothing overtly stating that, neither in writing nor in any checkbox like I've read about. They do show benefits we're eligible for that fit that category. Also, they used to show statements saying whether I'd have further exams or not, but that wasn't mentioned in there either. Any thoughts or comments on re-examinations? When you become 100% P&T, does that automatically apply to everything you're rated for? Thanks again everyone! I couldn't have done this without this Forum--I had no other outside help. Not even from VSO!

Berta, I apologize for my convoluted write-up, but it was pretty difficult to describe this craziness. That's what the DAV told me the VA had based it on, and after having SO many exams and appts in such a short timeframe, I also thought that day must have been my Neurology appt, but I finally looked at my calendar yesterday and saw I had a PTSD/TBI C&P Exam that day. So now I'm more worried than ever about my P&T if it's, in fact, based on an exam for a claim that's still "deferred" and pending. Have you, or anyone else here, ever seen the VA do that? I've never heard of that and I was even a Career Councilor during my military career and been a member here for years. (Still nowhere near an expert on these matters though) Are you referring to dropping the IU/TDIU? If so, I realize it could help with a few things, including a future SSDI claim as well, however, I feel my 100% Schedular P&T is safer and enables my kids to use it to pay for school now, rather than take any risks of NOT having it or waiting 20 years for a temp TDIU to become permanent. Also, the two forms they're asking for will be very difficult, mostly the employer one, as I haven't worked there for over 1.5 years and the people I worked for are no longer around, nor did they know much about my MH info. Therefore, I do not see the results being helpful in my case.

Berta, No worries, I really appreciate you taking the time to respond. You must read thousands of these! So this has gotten a bit messy, but first, for the exact reasons you stated (the benefits for my family) this is paramount for me to get it right. For a few days, I was going by the Regional DAV's response above, but turns out the first part was completely wrong. I got my letter and the only two things that were actually decided were 1) that I had basic eligibility to DEA based on 06/23/2020 and 2) that their evaluation of my Migraines, currently at 50%, is continued. So I was a bit confused when I read that. (Stick a pin in that for a minute...) I spoke to another National DAV guy who told me NOT to just call the VA over the phone as I told him I was going to do at that point (last Friday 7/10/2020) to clear everything up, including the whole IU/TDIU mess. He urged me to submit a signed statement for everything, so over the weekend, I did a 21-4138 and uploaded it to my claim, explaining just my reasons for not wanting to pursue IU/TDIU and to close or remove it, mark the two forms as no longer needed, and continue to process any pending claims in order to make a decision without further delay. That got things moving yesterday, Monday 7/13/2020, to the next phase (Gathering Evidence), but all they did with the IU and forms was to move the due dates 3 days to the right (8/3/2020) and the expected completion date moved up to Nov. Then today, I got a call from the contractor doing the C&P that they needed to schedule another exam............ for Migraines! That was literally the ONLY disability they actually made a decision on in the letter and I thought, per the DAV's explanation, that it was the connection which had qualified me for the P&T. Can you see where I'm really getting confused now? I also noticed, upon further inspection of the date the letter referred to (06/23/2020) going back to my calendar, that it was actually a TBI exam I had labeled as PTSD. Whoa! So I called the VA, spoke to the rudest, most condescending person I've ever encountered on the phone, (which has NEVER been my experience, probably just luck), and leaving that whole drama aside, he said he put in a message to remove the IU/TDIU, but beyond that, he wasn't helpful. Any thoughts? Even though this is SUPER painful for my psyche (remember what kind of issues I'm dealing with), I do figure that most of this SHOULD work itself out. That said, I'm very uneasy about my P&T being based on something that is supposedly "Deferred" and/or will be undergoing yet another exam. Sorry this has been so long in the tooth, but this is the most convoluted situation I've seen since embarking on this journey.

Those slowly showed up, one at a time as pending (PTSD, TBI, IU). The PTSD also is now listed at the bottom of the actual full list of my disabilities, but only says "Deferred." I received 2 letters from the VA yesterday, but they were both for the pending claim, even though the decision on the closed claim was supposedly mailed a few days earlier. I reached out to the Regional DAV, since they'd be able to see what's going on, and here is their response: "VA Rating Decision dated 06/30/2020 granted you 100% permanent and total (P&T) effective 06/23/2020, effective the date of the migraine examination because this brought your overall rating to 100% without the TBI and Mental Health (MH) issues. The VA is still going to work on those issues and resolve them as it would potentially give the 100% P&T and earlier effective date. The TBI and MH has gone back to the examiner for clarification. The VA has asked the examiner to try and separate the symptoms between the two conditions (TBI) and MH). No matter the outcome you will maintain the 100% P&T status but the outcome could provide an earlier date of the 100% P&T." That shed quite a bit of light on what's going, but whether or not they backdate the P&T, I don't see that making much difference as the timeline isn't very much and I was already at 100% Temp before. I've also been checking my other disability percentages and they haven't changed on that eBenefits page yet (i.e., Migraines 50 --> 100%) Thanks again for your response!

broncovet, so you're saying to just blow them off? That just doesn't "feel" like the right strategy--at least with anything else I've dealt with when it comes to the Federal Govt. I know you've got more experience in this department, but still... I think my biggest concern here is that it appears to be attached now to my PTSD and TBI review claims, so I just don't want to risk anything being denied or reduced with those if I merely blow them off without at least contacting them, explaining my circumstances/case, and requesting for them to cancel just that piece of the claim, letting them know explicitly that I do not desire to apply for the IU/TDIU. No? I do value your input and appreciate the response.

Thanks to everyone for the responses! I REALLY appreciate it. Based on feedback and what I recently found in the VA Benefits Summary Letter on eBenefits, stating I now have a 100% P&T rating, I definitely do not want to mess with it or pursue that IU/TDIU application. (for several reasons) I do, however, want the PTSD decision to be finalized as well as the RFE for my already connected TBI that was moved over to my PTSD claim from the other set of RFE claims submitted by the VA, which is now complete. So, does anyone have recommendations on how to handle having the VA cancel or remove the claim/application for the IU/TDIU without it somehow reflecting negatively on me or disturbing the rest of the claim? Would it be as easy, possibly, as calling the VA's 1-800 # and requesting that over the phone? This is now my most critical piece to solve. Thanks again!

Update to what I wrote earlier. Although I've been at 100% temporary schedular for the last few years, and my claim for PTSD now show as "Deferred" with the RFE for the TBI moved into that claim, the RFE claim for Migraines and Insomnia shows as complete and letter sent on 6/30/2020. I checked in the VA Letters page, then the VA Benefits Summary Letter, the one that includes whether or not someone is P&T, and it shows that I'm now 100% P&T as of 6/23/2020. There is probably something in the letter they sent that explains the new change, though the clock is ticking for the forms they're requesting to be completed for the IU/TDIU. If they've only finally determined my current disabilities to be P&T, without a decision on the PTSD, I wouldn't imagine more would hurt my case. So, if all that is going on, it makes even less sense to me that they opened an IU/TDIU application on my behalf. Again, I really do not believe I'll be able to complete the employer form, or at best, if I find someone to fill it out, they will not have knowledge of the crucial evidence.

I need some guidance or suggestions from the experts. I am currently at 100% schedular (temporary, not P&T). My higher Service connections are: Dermatitis with Psoriasis (also claimed as psoriasis guttate, eczema/dermatitis) = 60% Migraine including migraine variants - also claimed as decreased concentration = 50% Residuals of traumatic brain injury (TBI) = 40% Insomnia disorder - also claimed as sleep disorder and insomnia 10% and a dozen other 10% ratings for tinnitus, arthritis, degenerative disc/joint disease/lumbar spine, and as well as injuries to every joint. I submitted a PTSD claim and it was moving right along and I'd already completed all C&P exams for it as well as the ones for another set of RFE claims the VA submitted for three other conditions (Migraines, TBI, Insomnia) that are still temporary ratings. Now, two of the three RFE claims show as complete and the VA website says they sent a letter; however, one of the conditions (TBI) got moved over to my PTSD claim and the status went from the exams being complete and in the last phase or so, with a projected completion date sometime this month to December! On top of that, the VA started a claim for "IU" on my behalf without asking me, so they also added the couple of VA forms required with the due date of 7/31/2020. The IU part might not sound bad, but I was already 100% (temporary unfortunately) without the PTSD service connection and I believe I made a compelling case for at least 50% of that, if not 70% as I met most of that criteria. So, I've always heard, read, seen in videos, and even been told directly that when someone is at 100%, albeit temporary, it's not wise to apply for TDIU since it pays the same AND the VA may then reduce other percentages. Also, as you know, it can be easier for them to later remove the TDIU classification for technicalities. Lastly, those forms are the worst part for me. I DO NOT want to have to fill those out, especially the one you have to bring to your former employer. My company was located off-base, so they never even observed my daily performance. The military supervisors who were over me have since moved on as it's been over a year. Finally, I usually burned up PTO to cover all the time away for appts and physical therapy, which they knew about, but as for PTSD issues I was going through, I sure as hell did not disclose to them as it was none of their business, super private, embarrassing, and I would have been worried about my security clearance! The only thing about canceling the IU is that I don't want it to look like I AM capable of pursuing "gainful employment." I would just definitely prefer to retain my 100%, which should be even stronger with a PTSD condition/connection added to my current list. What is your take on all this? Do you know if there's a way that I can have them close or remove the IU portion and the required forms? Besides not wanting to apply for that or do the forms, I also do not want this to hold the rest of my claim(s) up or give them an easier way to assign lower percentages. Any help would be much appreciated.

Big Country, My dates were very similar. I received my service connection decision in October and was paid the regular monthly payment on November 1st. My effective date for everything is 1 June 2015 (My date of retirement). I actually filed in Jan 2015, but of course the date becomes the retirement date. I received my retro pay about a week ago, however, by my calculation, they owed me for June-September yet I only received 3 months worth. I got the statement a few days later showing they paid Jul, Aug, and Sept. I spent a week trying to get through to the VA about the month they shorted me, finally scheduling a callback after hours. When the lady from the VA called, she kept talking out of both sides of her mouth. (Long story) Bottom line, she said they do not owe the missing month's payment. So, to all you HadIt vets, does the VA need to pay us to our effective date, which is shown in our e-Benefits, or can they just decide to not pay us for the first month (like they're trying to tell me)? Thanks in advance!

Navy04, Belated congrats! Your story, and guidance here, has been one of the inspirations for me to keep plugging away. From one USN O-4 to another--"Fair Winds and Following Seas!"

Thanks John! I'm still waiting on my initial claim to come back. It's been at "Preparation for Decision" for nearly 3 months now. I am able to work, but needed to retire from Service because I couldn't take it anymore physically. I was fortunate enough to find a work-from-home job, so I'm able to get up whenever I need to, stretch my back out on a Swiss Ball, take breaks when I'm hurting too much, etc.. I'm hoping to get 100%, SC, but do not want to seek IU because I want to be able to keep working at home and not worry about it.

Any thoughts on how the C&P comments (2 posts ago) will affect/influence my claim?

That's definitely something I'll have to keep in mind. I'm actually hoping that my claim for Chronic Sleep Impairment, which is in that block of "Mental Disorders" as well. In fact I have most of what's in that block in red below, that supposedly is worth 30%. From the eCFR: General Rating Formula for Mental Disorders Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).30

My C&P Dr wrote this for nearly every joint: Is there evidence of pain with weight bearing? [X] Yes Have imaging studies of the knee been performed and are the results available? [X] Yes [ ] No If yes, is degenerative or traumatic arthritis documented? [X] Yes [ ] No If yes, indicate knee: [ ] Right [ ] Left [X] Both Functional impact: Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No If yes, describe the functional impact of each condition, providing one or more examples: Light physical employment: sales/teaching. She also added blurbs in there for my shoulders saying something to the effect of "no overhead work." What do you think? Thanks again!

This string is close to what was documented in my C&P for similar IVDS and osteoarthritis in my lower back. The arthritis is documented throughout my C&P exam notes for basically every major joint. What I've been wondering, as I've been stuck in the "Preparation For Decision" since I retired at the beginning of June, 2015, is whether the VA will rate each of my injuries in those major joint areas or will they simply just combine everything into one overall degenerative arthritis rating. Does anyone know? Thanks in advance!

Ping Jockey, You are a Saint for breaking that all down and posting here! I wish I'd seen it before turning in my claim, but saving the pertinent pieces to be ready for any appeals. I have three different skin conditions and the C&P Doc wrote them up separately, but not anticipating VA will award them as such--I'm anticipating the VA would lump into one disability for "The Skin"... Thanks again for posting!!!

CMDCMX30, I was wondering, especially since our situations and timelines were so close, had you uploaded a DD-214 as soon as you had it? I just dug out my copy of the claim I submitted back in Jan 2015 and noticed a "sticky note" I'd placed on the folder as a reminder to upload mine. When the VA Rep told me to do that, I was worried I'd forget in the ensuing months, and of course, I did thinking they should have a copy. Since retiring, NONE of the offices that were supposed to receive a copy from PSD got one. So I've spent a ton of time trying to fix everything--including my retirement pay, which was once again screwed up today. (Though I'd declined SBP, having had to have my wife's "permission" to do so, and gotten it notarized per the requirement, they automatically started deducting it from my pay.) I uploaded a copy of my DD-214 yesterday, hoping that either they were waiting on it and didn't bother to tell me or that maybe they'd wake up once it hits the inbox. Thanks in advance!

CMDCMX30, Wow!!! I officially retired one month to the day before you and have been stuck at the "Preparation for Decision" stage ever since. The rest of my timeline is almost identical to your up to that point. Congrats!

Took a while to clean it up and still takes up a lot of lines, but here is the section just for the shoulders: **************************************************************************** Shoulder and Arm Conditions Disability Benefits Questionnaire Name of patient/Veteran: ACE and Evidence Review ----------------------- Page 51 of 150 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 a. Evidence review Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: CPRS AND VISTA WEB. C-FILE REVIEWED PER VBMS AND VIRTUAL VA. ALL ROM FOR THIS EXAM WAS COMPLETED WITH THE USE OF A GONIOMETER. b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No 1. Diagnosis ------------ a. List the claimed condition(s) that pertain to this DBQ: BILATERAL SHOULDER CONDITION b. Select diagnoses associated with the claimed condition(s) (check all that apply): [X] Rotator cuff tendonitis Side affected: [ ] Right [X] Left [ ] Both Page 52 of 150 ICD Code: 840.9 Date of diagnosis: Left 2014 [X] Other (specify): Other diagnosis: rt shoulder: labral tear and DJD of the AC joint Side affected: Right ICD code: 840.9 Date of diagnosis (right side): 9/2005 ******************************************************************** c. Comments, if any: No response provided d. Was an opinion requested about this condition? [ ] Yes [X] No [ ] N/A 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's shoulder or arm condition (brief summary): Veteran with a hx of bilateral shoulder complaints, left greater than rt. LEFT SHOULDER: He gives a hx of left shoulder pain since the Fall of 2013. This occured while he was on a deployment and was doing pulls ups. Has had chronic pain ever since. Was seen and evaluated and underwent an MRI of the left shoulder later that documented rotator cuff tendonitis. Pain has since continues. Pain is daily and can last from hours to the entire day. Always brought on by overhead work. Pain ranges from a 2-7/10. No hx of any left shoulder injections. Increased pain with increased activity. RIGHT SHOULDER: Veteran a hx of rt shoulder pain since 2004. This occured during a softball game. He collided with another player and injured the rt shoulder at that time. Pain has continued ever since. He completed an MRI of the rt shoulder in 2005. He was sent to PT for this condition. Pain at this time occurs daily and will range from 1 hour to all day with a pain scale of 1-7/10. Increased pain with activity. Per review of medical records, He completed an MRI of the rt shoulder in 2005 that documented a labral tear along with DJD of the rt shoulder. current tx: naproxen 500mg po twice per day as needed/or motrin prn, topical analgesia prn. NO surgical hx. Page 53 of 150 In regards to additional per cent loss of motion during rep movement, this examiner is not able to accurately determine additional loss of motion without resorting to mere speculation. Examiner is unable to determine any measurable objective evidence to determine additional loss of motion during rep movement. No flares. b. Dominant hand: [X] Right [ ] Left [ ] Ambidextrous c. Does the Veteran report flare-ups of the shoulder or arm? [ ] Yes [X] No d. Does the Veteran report having any functional loss or functional impairment of the joint or extremity being evaluated on this DBQ (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: NO weights, pull ups. NO contact sports. Avoids overhead work. 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion Right Shoulder -------------- [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 180): 0 to 175 degrees Abduction (0 to 180): 0 to 150 degrees External rotation (0 to 90): 0 to 90 degrees Internal rotation (0 to 90): 0 to 90 degrees If ROM is outside of normal range, but is normal for the Veteran (for reasons other than a shoulder condition, such as age, body habitus, neurologic disease), please describe: n/a If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: limited overrhead work Page 54 of 150 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)? Flexion, Abduction, External rotation, Internal 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 joint or associated soft tissue? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): pain diffuse Is there objective evidence of crepitus? [ ] Yes [X] No Left Shoulder ------------- [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 180): 0 to 165 degrees Abduction (0 to 180): 0 to 155 degrees External rotation (0 to 90): 0 to 90 degrees Internal rotation (0 to 90): 0 to 90 degrees If ROM is outside of normal range, but is normal for the Veteran (for reasons other than a shoulder condition, such as age, body habitus, neurologic disease), please describe: n/a If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: limited overhead work 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)? Flexion, Abduction, External rotation, Internal rotation Is there evidence of pain with weight bearing? [X] Yes [ ] No Is there objective evidence of localized tenderness or pain on palpation of Page 55 of 150 the joint or associated soft tissue? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): diffuse but most sig over the supraspinatus tendon. Is there objective evidence of crepitus? [ ] Yes [X] No b. Observed repetitive use Right Shoulder -------------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No Left Shoulder ------------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Right Shoulder -------------- Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: In regards to additional per cent loss of motion during rep movement, this examiner is not able to accurately determine additional loss of motion without resorting to mere speculation. Examiner is unable to determine any measurable objective evidence to determine additional loss of motion during rep movement. No flares. Page 56 of 150 Left Shoulder ------------- Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: In regards to additional per cent loss of motion during rep movement, this examiner is not able to accurately determine additional loss of motion without resorting to mere speculation. Examiner is unable to determine any measurable objective evidence to determine additional loss of motion during rep movement. No flares. d. Flare-ups: No response provided e. Additional factors contributing to disability Right Shoulder -------------- In addition to those addressed above, are there additional contributing factors of disability? Please select all that apply and describe: None Left Shoulder ------------- 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. Muscle strength - 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 Right Shoulder: Rate Strength: Forward flexion: 5/5 Abduction: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No Left Shoulder: Rate Strength: Page 57 of 150 Forward flexion: 5/5 Abduction: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No b. Does the Veteran have muscle atrophy? [ ] Yes [X] No c. Comments, if any: No response provided 5. Ankylosis ------------ Complete this section if the Veteran has ankylosis of scapulohumeral (glenohumeral) articulation (shoulder joint) (i.e., the scapula and humerus move as one piece). a. Indicate severity of ankylosis and side affected (check all that apply): Right side: [ ] Ankylosis in abduction up to 60 degrees; can reach mouth and head (Favorable ankylosis) [ ] Ankylosis in abduction between favorable and unfavorable (Intermediate ankylosis) [ ] Ankylosis in abduction at 25 degrees or less from side (Unfavorable ankylosis) [X] No ankylosis Left side: [ ] Ankylosis in abduction up to 60 degrees; can reach mouth and head (Favorable ankylosis) [ ] Ankylosis in abduction between favorable and unfavorable (Intermediate ankylosis) [ ] Ankylosis in abduction at 25 degrees or less from side (Unfavorable ankylosis) [X] No ankylosis b. Comments, if any: No response provided 6. Rotator cuff conditions -------------------------- Is rotator cuff condition suspected? Right Shoulder: [X] Yes [ ] No If "Yes" complete the following: Hawkins' Impingement Test (Forward flex the arm to 90 degrees with the elbow bent to 90 degrees. Internally rotate arm. Pain on internal rotation indicates a positive test; may signify rotator cuff tendinopathy or tear.) Page 58 of 150 [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A Empty-can Test (Abduct arm to 90 degrees and forward flex 30 degrees. Patient turns thumbs down and resists downward force applied by the examiner. Weakness indicates a positive test; may indicate rotator cuff pathology, including supraspinatus tendinopathy or tear.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A External Rotation/ Infraspinatus Strength Test (Patient holds arms at side with elbow flexed 90 degrees. Patient externally rotates against resistance. Weakness indicates a positive test; may be associated with infraspinatus tendinopathy or tear.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A Lift-off Subscapularis Test (Patient internally rotates arm behind lower back, pushes against examiner's hand. Weakness indicates a positive test; may indicate subscapularis tendinopathy or tear.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A Left Shoulder: [X] Yes [ ] No If "Yes" complete the following: Hawkins' Impingement Test (Forward flex the arm to 90 degrees with the elbow bent to 90 degrees. Internally rotate arm. Pain on internal rotation indicates a positive test; may signify rotator cuff tendinopathy or tear.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A Empty-can Test (Abduct arm to 90 degrees and forward flex 30 degrees. Patient turns thumbs down and resists downward force applied by the examiner. Weakness indicates a positive test; may indicate rotator cuff pathology, including supraspinatus tendinopathy or tear.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A External Rotation/ Infraspinatus Strength Test (Patient holds arms at side with elbow flexed 90 degrees. Patient externally rotates against resistance. Weakness indicates a positive test; may be associated with infraspinatus tendinopathy or tear.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A Lift-off Subscapularis Test (Patient internally rotates arm behind lower back, pushes against examiner's hand. Weakness indicates a positive test; may indicate subscapularis tendinopathy or tear.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A 7. Shoulder instability, dislocation or labral pathology -------------------------------------------------------- Page 59 of 150 a. Is shoulder instability, dislocation or labral pathology suspected? [X] Yes [ ] No If yes, complete questions 7b - 7d below: b. Is there a history of mechanical symptoms (clicking, catching, etc.)? [ ] Yes [X] No c. Is there a history of recurrent dislocation (subluxation) of the glenohumeral (scapulohumeral) joint? [ ] Yes [X] No d. Crank apprehension and relocation test (with patient supine, abduct patient's arm to 90 degrees and flex elbow 90 degrees. Pain and sense of instability with further external rotation may indicate shoulder instability.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A If positive, indicate side affected: [X] Right [ ] Left [ ] Both 8. Clavicle, scapula, acromioclavicular (AC) joint and sternoclavicular joint conditions ------------------------------------------------------------------------------ a. Is a clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition suspected? [X] Yes [ ] No If yes, complete questions 8b, 8d and 8e below: b. Does the Veteran have an AC joint condition or any other impairment of the clavicle or scapula? [X] Yes [ ] No If yes, indicate severity and side affected, and answer 8c below: [X] Other, describe: DJD ON MRI SCAN FROM 9/2005 AT THE AC JOINT [X] Right [ ] Left [ ] Both c. Does the clavicle or scapula condition affect range of motion of the shoulder (glenohumeral) joint? [ ] Yes [X] No d. Is there tenderness on palpation of the AC joint? [ ] Yes [X] No e. Cross-body adduction test (Passively adduct arm across the patient's body toward the contralateral shoulder. Pain may indicate acromioclavicular Page 60 of 150 joint pathology.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A 9. Conditions or impairments of the humerus ------------------------------------------- a. Does the Veteran have loss of head (flail shoulder), nonunion (false flail shoulder), or fibrous union of the humerus? [ ] Yes [X] No b. Does the Veteran have malunion of the humerus with moderate or marked deformity? [ ] Yes [X] No c. Does the humerus condition affect range of motion of the shoulder (glenohumeral) joint? No response provided d. Comments, if any: No response provided 10. Surgical procedures ----------------------- No response provided 11. 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? [ ] Yes [X] No c. Comments, if any: No response provided 12. Assistive devices --------------------- No response provided 13. Remaining effective function of the extremities Page 61 of 150 --------------------------------------------------- Due to the Veteran's shoulder and/or arm conditions, 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., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 14. Diagnostic testing ---------------------- a. Have imaging studies of the shoulder been performed and are the results available? [X] Yes [ ] No If yes, is degenerative or traumatic arthritis documented? [X] Yes [ ] No If yes, indicate shoulder: [X] Right [ ] Left [ ] Both b. Are there any other significant diagnostic test findings or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): Exam Date/Time: 12/04/2014 14:28 Procedure Name: MRI SHOULDER LT W/O CONTRAST Reason for Study: Clinical History: Impression: Report: MRI SHOULDER LT W/O CONTRAST Exm Date: 12/04/2014 14:28 Req Phys: Pat Loc: Img Loc: MEDICAL GROUP Service: Exam: 14033464 MRI SHOULDER LT W/O CONTRAST CPT: MRI,JOINT,UP EXTRM;WO CONT MAT Report Status: VERIFIED Date Verified: 12/05/2014 09:00 Page 62 of 150 Report: Reason for Order: Please evaluate for RTC dysfunciton of possible supraspinatus pain and subscapularis as well as labrum dysfunction of the left shoulder. Pain continues and xray showed possible RTC impingement due to subacromial space narrowing. Order Comment: REPORT: RESCODE'S REPORT MRI left shoulder: There are plain films available for correlation dated 4/28/14. Technique: Multiplanar, multisequence images of the left shoulder are provided without contrast utilizing routine protocol. Findings: There is severe acromioclavicular arthrosis. This focally depresses the supraspinatus myotendinous junction. The supraspinatus tendon is heterogeneous, compatible with tendinosis. There is a small amount of subacromial bursal fluid. There is no focal fluid signal in the supraspinatus or infraspinatus tendons to suggest tear. The subscapularis tendon is intact and signal is unremarkable. The biceps tendon is anatomically positioned in the bicipital groove. At the level of the biceps anchor, there is mild biceps tendon signal heterogeneity, compatible with biceps tendinosis. Superior labral morphology is grossly unremarkable. No intrinsic signal abnormalities to suggest superior labral tear are appreciated. Labral morphology anteriorly Page 63 of 150 and anteroinferiorly is unremarkable with no intrinsic foci of fluid signal to suggest labral tear. There is a small focus of fluid signal in the posterior labrum that extends from mid glenoid level to the inferior quadrant, and is suspicious for a posterior labral tear. Recommend clinical correlation for signs of posterior instability. Anterior and posterior bands of the inferior glenohumeral ligament are grossly unremarkable. Impression: Stigmata of rotator cuff impingement with supraspinatus tendinosis. No definite evidence for a supraspinatus tear. A chronic tear could be obscured by scar tissue but there is no significant subacromial subdeltoid bursal fluid. Possible labral tear, posterior inferior quadrant, as above. Biceps tendinosis. Date Transcribed: 12/05/2014 09:00 Primary Intrepreting Staff: Primary Interpreting Assistant: Technologist: Facility: MEDICAL GROUP ******************** Exam Date/Time: 11/07/2014 07:28 Procedure Name: SHOULDER, RT (4V, IMPINGEMENT SERIES) Reason for Study: Clinical History: Impression: Report: SHOULDER, RT (4V, IMPINGEMENT SERIES) Page 64 of 150 Exm Date: 11/07/2014 07:28 Req Phys: 64969 Pat Loc: Img Loc: Medical Group Service: Exam: 14033468 SHOULDER, RT (4V, IMPINGEMENT SERIES) CPT: SHOULDER, RT (4V, IMPINGEMENT SERIES) Report Status: Complete Date Verified: 11/07/2014 09:08 Report: Reason for Order: Continued pain and weakness with pain in the supraspinatus and with apprehension test. May have RTC dysfunction. Please evaluate Order Comment: REPORT: SEE RADIOLOGIST'S REPORT 4 views of the right shoulder were obtained. Findings: There is no acute fracture or malalignment. The acromioclavicular and glenohumeral joints are normal. The bone mineralization is normal. Impression: Normal right shoulder. Date Transcribed: 10/27/2014 16:05 Facility: MEDICAL GROUP ************ MRI of the rt shoulder dated 9/25/2005: labral tear and also DJD at the AC joint. c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions: N/A Page 65 of 150 15. Functional impact --------------------- Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's shoulder conditions providing one or more examples: LIGHT PHYSICAL EMPLOYMENT: SALES/TEACHING. 16. Remarks, if any: -------------------- No remarks provided ****************************************************************************

All, Gotcha! I will follow-up later with the "Rest of the Story." As for getting IU, I honestly don't want it. Sure, I'm hoping to get 100% SC from the total of the e-CFR, but I want to be able to earn a little extra cash and not worry about it. As it is, I was fortunate enough to land a work-at-home job, so I'm feeling extremely blessed right now and it has been much easier to deal with all the VA appts and manage my pain from home. Thanks again!

In my last post, I meant that I had taken the Advair for years, but stopped it before coming here and hadn't had any major episodes in this location. Other duty stations I still had wheezing dispite using Allegra, Flonase for my sinus, and regular Albuterol inhalers. So, I was put on the Advair, which worked well. I was hoping having all that in my SMR would help, but I've read on Hadit that if conditions haven't appeared over the course of the last year, the VA wouldn't rate it.

Navy04, Thank you for welcoming me and your response. I too am a Navy O-4, so thought about choosing "Navy04_Jr." or something like that for a User ID. ;o) I am a bit confused by what you said though. It looks like you just got out a couple of years back, so I don't know if wording has changed, but I have my entire C&P exam write-up and the only verbiage referencing the "occupational" part was in the one I posted earlier. It was repeated, virtually the same, for both shoulders, knees, and a couple other body parts. It always shows up in the "Functional Impact" section and you can tell those were in the boxes where she had to select or click in the soft copy of the DBQ. "15. Functional impact --------------------- Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's shoulder conditions providing one or more examples: LIGHT PHYSICAL EMPLOYMENT: SALES/TEACHING. As for the second part about being related to the military, I'm sure your situation was probably similar to mine. I enlisted in 1988 and officially retired last month, so I figure anything that happened during that time was related to being in the military--unless an investigation was conducted and a finding of it not being "in the line of duty" was determined. I'd have to look again, but I believe the history part usually showed that injuries due to PT, training, etc. was mentioned. So, when the injuries happened during someone's service, does that have to be proven? Again, if so the history portion should cover it. I'm also waiting to file a Secondary Claim as some tests the VA just ran on me diagnosed me with "Chronic Renal Disease," which is supposedly synonymous with Chronic Kidney Disease. Thanks again in advance!