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This may be old news but it's new to me and maybe of use to someone. Change Date January 11, 2016February 1, 2016 a. Considering Separate Evaluations for Disabilities of the Shoulder and Arm Separate evaluations may be given for disabilities of the shoulder and arm under 38 CFR 4.71a DCs 5201, 5202, or 5203 if the manifestations represent separate and distinct symptomatology that are neither duplicative nor overlapping. Reference: For additional information concerning separate and distinct symptomatology, refer to · 38 CFR 4.14, and · Esteban v. Brown, 6 Vet.App. 259 (1994). b. Example of Separate Evaluations for Disabilities of the Shoulder and Arm Situation: A Veteran was involved in an automobile accident that resulted in multiple injuries to the upper extremities. The Veteran sustained the following injuries · a humeral fracture resulting in restriction of arm motion at shoulder level, and · a clavicular fracture resulting in malunion of the clavicle. Result: · assign a 20-percent evaluation for the impairment of the humerus under 38 CFR 4.71a, DC 5202-5201, and · assign a separate 10-percent evaluation for malunion of the clavicle under 38 CFR 4.71a, DC 5203. Notes: · The hyphenated evaluation DC is assigned under 38 CFR 4.71a, DC 5202-5201 because the humerus impairment affects ROM. · The separate evaluation for the clavicle disability is warranted because this disability does not affect ROM. Exception: Multiple evaluations cannot be assigned under 38 CFR 4.71a, DC 5201 for limited flexion and abduction of the shoulder. Reference: For additional information on evaluating shoulder conditions, see Yonek v. Shinseki, 22 F.3d 1355 (Fed. Cir. 2013). c. Assigning Separate Evaluations for Disabilities of the Elbow, Forearm, and Wrist Impairments of the elbow, forearm, and wrist will be assigned separate disability evaluations. The motions of these joints are all viewed as clinically separate and distinct. Assign separate evaluations for impairment under the following DCs. · elbow flexion under 38 CFR 4.71a, DC 5206 · elbow extension under 38 CFR 4.71a, DC 5207 · forearm supination and pronation under 38 CFR 4.71a, DC 5213, and · wrist flexion or ankylosis under 38 CFR 4.71a, DC 5214 or 38 CFR 4.71a, DC 5215. Reference: For additional information on assigning separate evaluations for elbow motion, see M21-1, Part III, Subpart iv. 4.A.1.a. d. Example of Separate Evaluations for Disabilities of the Elbow, Forearm, and Wrist Situation: A Veteran sustained multiple injuries to the right upper extremity in a vehicle rollover accident. The following impairments are due to the service-connected (SC) injuries · elbow flexion limited to 90 degrees · elbow extension limited to 45 degrees · full ROM on supination and pronation with painful supination, and · full ROM of the wrist with pain on dorsiflexion. Result: Assign the following disability evaluations · 20 percent for limited elbow flexion under 38 CFR 4.71a, DC 5206 · 10 percent for limited elbow extension under 38 CFR 4.71a, DC 5207 · 10 percent for painful forearm supination under 38 CFR 4.71a, DC 5213, and · 10 percent for painful wrist motion under 38 CFR 4.71a, DC 5215. Explanation: · Compensable LOM of elbow flexion and extension is present. Separate evaluations are warranted for elbow flexion and extension. · Motion of the forearm is separate and distinct from elbow motion. Therefore, a separate evaluation is warranted for painful supination. · Motion of the wrist is separate and distinct from forearm motion. Therefore, a separate evaluation is warranted for painful motion of the wrist. Note: If elbow flexion is limited to 100 degrees and elbow extension is limited to 45 degrees, assign a single 20-percent disability evaluation under 38 CFR 4.71a, DC 5208. References: For more information on · separate evaluations for motion of a single joint, see - VAOPGCPREC 9-2004, and - M21-1, Part III, Subpart iv, 4.A.1.a · separate evaluations for the elbow, forearm, and wrist, see M21-1, Part III, Subpart iv, 4.A.2.c · evaluating painful motion of a joint, see - 38 CFR 4.59, and - M21-1, Part III, Subpart iv, 4.A.1.c, and · considering impairment of supination and pronation of the forearm, see M21-1, Part III, Subpart iv, 4.A.2.e.

Navy4life, I don't know if this is applicable to what you asked but thought I'd post it. It is from M21-1 and the effective date is recent. IV.ii.2.A.1.b. The Mere Existence of Medical Records Does Not Constitute a Claim The mere existence of medical records does not constitute a claim. There must be some intent by the claimant to apply for a benefit. Notes: Claims for an increased rating were previously an exception to that rule under the historical provisions of 38 CFR 3.157(b). The Standard Claims and Appeals Form regulation eliminated section3.157 and requires submission of claims on prescribed forms effective March 24, 2015.

No, it went back to preparation for decision last week.

Navy4life, let me try to answer all your questions.....I filed a claim for an increase in compensation for cervical spondylosis and several other SC conditions on 21 April 2015. It was a FDC and I had the C & P exam on 10 June 2015 and received the decision on 30 June with two conditions deferred. During the exam I handed the doctor a copy of an EMG that I had from a civilian doctor in 2011. I gave it to him because it was related to my cervical spondylosis. (I wasn't aware of secondary conditions until I started reading this and other forums) He looked at it and said "you have radiculopathy" and handed it back to me.(BTW, the report also said I had moderate CTS which would have been rated at 30% but he didn't mention that.) When he handed it back I thought that was the end of it. I was surprised to see the 20% rating for radiculopathy when I received the decision. The reference to Ellington vs Nicholson is not mine. It is from a change to M21-1. I don't know if it's applicable to either of our claims. I filed a claim for TDIU on 4 August 2015. When I went to the C & P on 4 December 2015, the NP examiner, in all caps on the DBQ, said I didn't have cervical radiculopathy and the numbness and pain was caused by carpal tunnel syndrome. The claim status changed to preparation for decision the following week. It went back to gathering evidence the next day and then I saw another DBQ in my medical records from a doctor providing an opinion on radiculopathy vs CTS. That DBQ was dated 12 Dec 2015. There was no change on eBenefits and when I called Peggy I was told that there is a complex review of my medical records. The DBQ for cervical spine is very long so I am posting only part of the radiculopathy portion. I am also including part of the DBQ from 12 Dec which is probably what generated the "complex review". Neck (Cervical Spine) Conditions Disability Benefits Questionnaire Name of patient/Veteran: Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence review --------------- 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: E-file reviewed 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a cervical spine (neck) condition? [X] Yes [ ] No Cervical Spine Common Diagnoses: No diagnosis provided. Diagnosis #1: Cervical disc degeneration ICD code: 722.4 Date of diagnosis: SC 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's cervical spine (neck) condition (brief summary): Just had NCS on 1/11 that revealed a C7 radiuculopathy 7. Radiculopathy ----------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [X] Yes [ ] No DBQ Medical Opinion 1: Please review the following documents and provide an opinion as to whether or not the Veteran has a diagnosis of any type of right peripheral nerve injury related to service or to his cervical spine. A - Peripheral nerves examination dated 12/5/15, which references EMG from 2014 (which we can't pull up). The examiner states that the right upper extremity symptoms are related to CTS and no other condition. B - EMG from a private medical provider showing mild ulnar neuropathy and C7 radiculopathy of the right upper extremity C - STRs - 10/31/2000 - showing bilatearl cervical radiculopathy, 3-22-01 - complaints of numbness and tingling, 1-25-05 - complaints of numbness and tingling D - STRs - 10/15/03 - Tinel's sign + over the right and left ulnar nerve At the elbow, 12/2/03 - bilateral ulnar nerve neuropathy diagnosed while in service The examiner stated that the right upper extremity is CTS; however, we have the private EMG showing moderal CTS on the right with ulnar neuropathy and C7 radiculopathy. Please review the evidence listed above (noting that you are not restricted to just the evidence above) and state whether or not the Veteran has a diagnosis of right upper extremity radiculopathy secondary to his cervical spine, or right ulnar neuropathy directly related to military service. VBMS reviewed. As noted, veteran appears to have cervical radiculopathy, ulnar neuropathy, and CTS. As each of these abnormalities are in anatomically different locations, they are not mutually exclusive. He has STR noting bilateral cervical radiculopathy in 2000 as well as an '03 dx of ulnar neuropathy and positive exam findings for CTS. It would appear more likely than not that veteran has neuropathies involving all three anatomical locations based on exam and NCS findings and is at least as likely as not that they fit the time frame to connect to service.

I had a C & P last year for increase of cervical spondylosis and disk disease (claimed as neck), and several other sc conditions. I gave the examiner an EMG report diagnosing cervical radiculopathy (which I had not claimed) and when I received the decision the cervical spondylosis remained at 20% but I was given an additional 20% for cervical radiculopathy secondary to the cervical spondylosis. I am concerned now because an existing claim is having a "complex review of medical records" and don't know if they may take away the cervical radiculopathy because I didn't include it in my original claim. This is from "key changes to M21-1III_ii_2_SecC" . · CAVC ruled that complaints noted by a Veteran during a VA examination (and included in the corresponding examination report) do not constitute an informal claim unless "the veteran sufficiently manifested an intent to apply for benefits for a particular disease or injury." References: For more information on · complaints noted by a Veteran during a VA examination, see Ellington v. Nicholson, 22 Vet. App. 141 (2007)

Yes, I saw that Pete. I didn't go over there myself but several Soldiers I served with were having some pretty serious medical issues after they came back. I thought it would be of interest to some veterans who get information from this site I should have cited the source of the article in the original post. It is from military.com

Thanks Iceturkee, I don't think I will get 20% either and probably won't even try. My ROM was less than 60% but the examiner said I had normal ROM so that was the reason for 10%. My X-Ray results are certainly not as bad as your. : Report: Lumbosacral spine: Examination of the lumbosacral spine demonstrates intact bony structures. Mild scoliotic curvature is present. An Paravertebral soft tissues appear normal. The intravertebral disc spaces demonstrate diffuse degenerative changes throughout the lower thoracic spine. There is degenerative disc narrowing at L1-2, L2-3, L4-5 and L5-S1. Disc vacuum is present at L5-S1 with loss of normal disc space at L4-5 and articular sclerosis. Second-degree spondylolisthesis is present at this level. There is advanced posterior element sclerosis from L3-S1. Marginal hypertrophic spur formation occurs at all lumbar levels. No acute injury is identified. Sacroiliac articulations are anatomic with bilateral articular sclerosis. Impression: Lumbosacral spine with degenerative disc disease. L4-5 spondylolisthesis. Diffuse posterior element sclerosis. Degenerative osteophyte formation.

Yes, it does say mild but this is from Title 38. You and Broncovet are probably right that it must be more than mild but it doesn't say that. Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait OR abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis

New research shows that exposure to pesticides and other toxins caused Gulf War Illness among the 700,000 U.S. troops who fought in the first Gulf War. Researchers concluded that exposure to pesticides and ingestion of pyridostigmine bromide (PB) (prophylactic pills intended to protect troops against the effects of possible nerve gas) are "causally associated with GWI and the neurological dysfunction in Gulf War veterans." The research team also cites multiple studies showing a link between veterans' neurological problems and exposure to the nerve-gas agents sarin and cyclosarin, as well as to oil well fire emissions. A report of the study is available in the journal Cortex. http://www.sciencedirect.com/science/article/pii/S0010945215003329

Thanks Vync. I am SC for LUE radiculopathy secondary to cervical spine and pending claim for RUE radiculopathy.

Thanks Broncovet. It doesn't specify mild, moderate, or severe as most of them do, it just says "abnormal spinal contour such as scoliosis". That alone wouldn't get me to 90 but every little bit helps and I have pending claims/appeals.

Is "abnormal spinal contour such as scoliosis" the same as "mild scoliotic curvature? I am SC for cervical spondylosis (20%) and arthritis, thoracic spine (10%). The MRI of the cervical spine and the X-ray of the lumbar/thoracic spine both report mild scoliotic curvature. Just wondering if I should have been rated 20% rather than 10% for thoracic spine.

I just got a call back from Peggy and she read verbatim the first statement I got from the "live chat" with the 4/6/2016 estimated completion date. She said the only document they were waiting for was "a complex review of a medical exam" and they don't need anything from me. I clicked on the "needed from others" button on eBenefits and it said nothing was needed. Thanks for the responses....it appears that the only thing left to do is wait.

I know Buck. That is why I asked again what documents were needed. I did download a record of the "chat" and am saving it. I did look there PWRSLM and everything either has a green dot or a grey dot with "no longer needed" by it. I called the 800 number numerous times and finally got through. I'm waiting for a call back now. Thanks

I checked eBenefits status this morning and status update said "requested documents are past due". I was able to get through on the "live chat" feature for the first time and asked why. I got this as a reply. Your claim is in the decision phase. • If no additional information is needed, we will prepare a decision on your claim • At this time, it is estimated that your claim should be completed by 4/6/2016. • Please understand that this date is an estimate and your claim may take longer based on the specifics of your claim and VA's pending workload. 10:44 AM I asked again what documents were needed and got this: Your claim is currently in the decision phase of processing. If no further information or evidence is needed a decision will be made and you will be notified in writing. At this time, it is estimated that your claim should be completed by 3/23/2016. Please understand that this date is an estimate and that your claim may take longer based on the specifics of your claim and VA's pending workload. 10:48 AM Does anyone know if I was chatting with a human or was it all computer generated? Note the two responses were 4 minutes apart and the estimated completion date changed by two weeks.

When I had a C & P for knees they did the X-ray the same day, after the C & P exam was complete. If they do an MRI they will probably schedule it a later date since it is more involved. If it is a recent injury they may use any images that were done at the time of the injury. Range of motion has been the deciding factor in C & P exams I have had for all joints. Good luck.

Gastone, I am a novice at this, that is why I am asking for opinions from people with more experience on this site. I have also relied heavily on DAV for guidance and pretty much did what they advised me to do to this point. When I retired in 2005,a DAV rep was available during my out processing at Ft McPherson, GA. She took my military medical records and went through them and assisted with filing a claim. She told me that she would take the claim, along with my medical records to VA. Several months later I inquired about the status of my claim. Both VA and DAV said there was no record of a claim and that they didn't have my medical records. I contacted my congressman and after several letters with the congressman's staff parroting what VA told them, I contacted VA in Washington, DC. Two weeks later I got a call from VA stating that they had found my records and was processing my claim. I went through the C & P exams and got the decision that I was rated at 40% but there was no mention of my cervical spine issues. I sent VA an email asking why they didn't consider my cervical spine. A few days later, I received another decision apologizing for their error and awarding me 20% for cervical and a total rating of 60%. A few years later, my right shoulder had gotten much worse and I went to DAV and asked for assistance in requesting an increase. The claim for increase was denied (same C & P examiner that did the original exam). This is getting too long so I will fast forward to 2014 when I again decided to risk going back to DAV for assistance. The RSO seemed very knowledgeable and advised me to request an increase and file for other disabilities. Some were granted and some denied but increased to 80%. He advised me on the NOD with DRO review because he agreed that I should be service connected for hearing loss and should be rated higher on my knees. The original DAV rep that went through my records didn't mention filing for cervical radiculopathy even though my STR was filled with tests to determine what was causing numbness and tingling in my arms and hands. In addition to the cervical radiculopathy, I had also been diagnosed with ulnar neuropathy. I found this site a few months ago and have learned quite a lot from reading posts on here. At his point, it is what it is and I am waiting for the open claim to be decided and then make a decision as to what my next step is. This has taken a very long time to type because of taking breaks for numbness and pain but wanted to give you as much info as I can so that you will better understand my question. The following is from VA's website. VA has interpreted its authority under section 7105 as allowing claimants who filed a NOD to elect either a traditional appeal to the Board or a first level of de novo review within VBA by a Decision Review Officer (DRO). If a claimant elects a DRO review, a VBA employee who processes appeals readjudicates the claim and issues a decision granting the benefits on appeal or a SOC confirming the prior decision. A claimant who elects a DRO review and remains dissatisfied with VA’s decision may still file a substantive appeal to the Board and receive another de novo review of the claim. A claimant may submit additional evidence to support an appealed claim at any point in the process, regardless of whether the appeal is pending at VBA or the Board. If additional evidence is received after the claimant files a NOD but before VA issues the SOC, the evidence will be reviewed by VBA and incorporated into the SOC (if VBA cannot grant benefits). However, Congress did not prescribe the procedures for processing evidence that VBA receives after it issues a SOC in an appeal. Accordingly, under VA regulations, VA will issue a supplemental SOC in these claims and will wait 30 days for the claimant to respond before sending the appeal to the Board. Each time the claimant submits additional evidence, VBA must reconsider its decision on the appealed claim and conduct any necessary development of the claim under its duty to assist the claimant. If VBA’s reconsideration of the appealed claim does not resolve the disagreement, it will issue another supplemental SOC.

PCW, good luck. Post the results of your civilian test. Gastone, I filled a NOD through my DAV RSO and can't do anything until the DRO review. I also have a pending claim and don't want to file for tinnitus or anything else until the open claim is decided sometime in the distant future. I'm not sure I want to file for tinnitus unless it gets worse or I find that my dizziness is somehow connected to the tinnitus. VA said the dizziness (claimed as light headiness by the DAV rep) wasn't service connected even though my STR has several pages of tests trying to determine the cause. I had several MOSs...95B (MP) in Vietnam, a few signal....05F(radio operator), 31C (radio/teletype), 26Q; logistics: 76Y (supply) , 63B,(mechanic) 63Z (maintenance supervisor). The 95B may as well have been 11B during the 68 TET offensive and mini TET in May 68 The guy conducting the hearing test agreed that my hearing got worse while on AD but that it was because of age and not service connected. Did I mention that he was a jerk?...stopped in the middle of the test and said "how did you avoid Vietnam since you are the right age to have been there". Of course I told him that I didn't avoid Vietnam.

Thanks everyone, I appreciate all the responses and advise when given. My reason for filing for hearing loss was to get it service connected...I don't think it is bad enough to warrant compensation at this point. There is no doubt that it is service connected and the person conducting the test was clearly wrong (in my opinion) in using age and OSHA regs in his opinion that it isn't service connected. I didn't claim tinnitus because it isn't constant and varies from a low hiss to a high pitch sound very similar to the loudest noise you get during the hearing test. I never sought treatment while I was on active duty. I was having a lot of dizziness and underwent numerous tests to determine the cause. The doctors notes in my records in reference to the dizziness states "does have tinnitus at times". That same statement was annotated on two occasions but I doubt that it is sufficient to grant service connection if it does get bad enough to file a claim.

Thanks Vync. I filled a NOD through the DAV RSO and requested DRO review. I talked with the RSO last week and he said the DROs are working on 2013 backlog so it will be a while before I hear anything. (mine is mid 2015) I was routinely exposed to very loud noise throughout my career. Ear plugs were unheard of when I went through basic and much of my career. Vietnam wasn't the quietest place I have been. I'm wondering if it could be a CUE since the examiner used age in his opinion that it wasn't service connected.

Thanks, I just tried again and was able to see claim status and letters this time.

Is anyone else having problems accessing claim status/VA letters this morning?

Thanks again Broncovet. I have thoroughly studied the above information and am probably NOT eligible for compensation...just acknowledgement of SC. In my humble opinion, they can NOT use age in determining service connection. I am just seeking opinions from those who have much more knowledge/experience than I have. §4.19 Age in service-connected claims. Age may not be considered as a factor in evaluating service-connected disability; and unemployability, in service-connected claims, associated with advancing age or intercurrent disability, may not be used as a basis for a total disability rating. Age, as such, is a factor only in evaluations of disability not resulting from service, i.e., for the purposes of pension. Contradiction: Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

Thanks Broncovet, it has been some time since I averaged it. I believe it was about 37. I'm not expecting compensation, just service connection because it is getting worse. My retirement physical forms have the statements "bilateral hearing loss" and "routine noise exposure". I was also diagnosed with tinnitus while on AD but didn't claim that. My question is: is it appropriate to use OSHA regulations and age in determining service connection?

Is it appropriate for a C & P examiner to quote an OSHA regulation in reference to hearing loss and age? I had the C & P exam in June 2015 and was denied service connection. I was found to have hearing loss during my retirement physical and on several previous physicals which was noted by the examiner. The idiot examiner only considered noise exposure during my final year of service! Excerpt of DBQ: If present, is the Veteran's right ear hearing loss at least as likely as not (50% probability or greater) caused by or a result of an event in military service? No Rationale (Provide rationale for either a yes, no answer or speculation reason): The veteran's e-file was reviewed for this opinion. Within the veteran's service treatment records are audiometric test results dated 1-25-2005, in the veteran's final year of service. Veteran was a maintenance supervisor, with limited noise exposure at the conclusion of service. Result do indicate a hearing loss for the right ear. When age correction factors are applied, per 29CFR1910.95 Appendix F of the OSHA hearing conservation regulations, the resultant hearing level are not worse than expected for the veteran's age at the time of testing. Thus, the veteran's hearing levels are not poorer than beyond normal progression. Therefore, it is the opinion of this examiner that the veteran's right hearing loss is less likely than not a result of military noise exposure.