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Everything posted by aoneinsun

  1. I just checked with QTC, and they say that I cannot request the C&P exam Doctor’s notes directly from them. QTC said that after my third and final C&P exam on April 6th, they will bundle everything together and send to the VA. Thereafter, I would then have to request the Doctor’s notes from the VA. Thus, I will not know what the C&P examiner (who I know did a haphazard exam) really said for quite some time. My main concern is if the hip Range of Motion was properly documented (since the examiner did not check for it (nor did he use a goniometer). I have heard that limitations should be documented within the first year of separation from active duty (which is coming up soon on April 30, 2016) to fall within the presumptive period. Might it still be prudent to have a VA attorney and separate medical examiner actually properly measure the left hip range of motion before April 30, 2016? Right now it could look like I’m totally fine with no documented hip ROM issue (if the C&P examiner just put that my hip ROM is normal). Thus, I’m thinking ahead to appeal... Would it be good if I had an independent examiner who had measured left hip ROM BEFORE the one year had elapsed to prove that I really had ROM limitations within the presumptive period? I’m probably over thinking this but… Would it not be necessary to go to the trouble/expense at this point? Can I allow time to elapse beyond the 1 year post separation mark, and simply point to the fact that the examiner didn’t measure the left hip ROM accurately. I do in fact have a well-documented issue with a bulging disc in the back, and left hip piriformis syndrome, and now left leg/hip IT band syndrome recently diagnosed (along with various physical therapist's notations of an off-kilter gait). In light of the C&P examiner’s inadequate exam, and my extensive medical record to document my relate issue, would the left hip measurements probably in fact carry the same “weight” if they are to be collected months from now (with left hip ROM being a logical continuation of the limitation of reduced left hip ROM, which I have been experiencing, albeit not having been properly documented on the C&P exam)? Help much appreciated.
  2. Thanks. I did not quite realize that I had those good options for seeing my record. I think it prudent to know what the Doctor's notes were at least (and to know sooner rather than later). I will request the record. My other thought in wanting to know soon is, should I have an independent medical professional actually use a goniometer (since this has never been done to date) to measure the ROM? My one year after leaving active duty is coming up at the end of April. I understand there is a presumptive period 1 year after leaving active duty wherein limitations/chronic issues are presumed to be attributable to active duty. Would it be prudent to get accurate goniometer measurements performed while I am within the 1 year (rather then wait a few months and fall outside that timeframe)?
  3. I have the distinct feeling that I will end up needing to dispute the ROMs that my examiner will list for me too. Is that best done by asking for another C&P exam (if the examiner did not perform the exam properly / did not properly measure with a goniometer, etc). And/or would this entail contacting a VA attorney who would bring in the appropriate medical personnel to perform an independent exam?
  4. Wow, that is extremely helpful. I'd heard some chatter, but didn't know for sure how how much they really recoup. Thanks much for relating your experience.
  5. I was involuntarily separated from active Air Force in the Reduction In Force measures undertaken last year. I received a separation payout last year (reduced by taxes of course). I've heard that the full gross amount of the separation payout will be recouped. Thus, VA payments for a disability (which I am in the process of being rated for) will be withheld until the separations payout is fully recouped. My question is, does the VA withhold disability benefit payments for the full separation amount (the gross amount), or do they withhold payments for the full separation amount less taxes that had already been withheld at the time of the payout? If it is indeed the full gross amount, then I could be waiting quite a long time to see any payment from the VA. Note, in my case this was a involuntary "full separation pay" and not a disability type retirement situation (if that makes a difference). Any clarification much appreciated!
  6. Thanks. I do think it prudent to see what notes he did make first. I think he probably got the problem with my touching toes issue notated, albeit with his rough eyeball assessment of the angle. The VA Doctor locally eyeballed it as well to be about 15 degree forward flexion. I imagine it should be close to that, and that would be about right (though not done with a goniometer). He didn't measure ROM of the left leg at all though. It would be interesting to see if he put values in there or not. If not, presumably it was skipped by mistake? If it was skipped by mistake would another C&P examiner need to measure those, or perhaps I should have my own Doctor measure the ROM?? If there are values for left leg ROM that seem to indicate that I am perfectly fine (no issues) when he didn't even measure my left leg ROM at all, then at that point should I raise this concern? He did ask if my medical record documented my issues, and I said yes, my medical record does document my issues, and I obviously could verbally articulating my issues to date quite well. If he was running behind, and assumed he didn't need to undertake a full exam to check ROM (particularly of the left hip), then I think that is to error on the side of incompleteness. I guess I will not know until I see the notes... I feel like that is good/prudent to wait and see the notes. And yet I got the distinct impression when he said, "That'll do" at the end that he was somehow holding back and or not fully doing what would be the complete thing to do regarding the left hip examination and documentation of its ROM limitations. Best advice to wait for the notes? Then go from there if/when the left hip ROM is not properly documented? Appreciate the help.
  7. Hi, I had an interesting and bewildering C&P exam with a Dr. covering three items of evaluation; lower extremity varicose veins, piriformis syndrome (left hip), and lumbar condition with herniation (for a disc bulging 5 mm to the left at L4-L5). Here is about how it went… Firstly, I had filled out the summarized history questions for each of the three items. The papers I had diligently filled out simply laid on his desk the entire exam though, and he simply asked me questions as he went through his DBQs. I was very well versed in my medical record and could tell him the brief history (or development) of each condition (along with my medications) in a quick, concise fashion. He was reasonably personable, and he seemed to be pretty pleased with my being quick and to the point (it was towards the end of the day and he was delayed in getting to me). And he seemed to whip through the DBQs with speed. He did inspect my legs for varicose veins (which are really obvious). I was surprised that he didn’t ask if I had aching and fatigue in my legs after prolonged standing or walking or if the compression hosiery I was wearing was helping. He could have found out the answers to those questions if he had read the packet I filled out (he didn’t bother to read that it seemed, nor did I get sense that he read my medical record). I had to specifically say that I had aching while standing for long periods of time, and I didn’t realize I had varicose veins for years until recently. I think he should have asked me that when filling out the Artery & Vein Conditions DBQ at 3B. And I hope he filled that part out… I also explained how I had hip/low back issues after some long runs and landing weirdly on my left leg while playing volleyball. He had me walk (which is in my case limp, barely putting my left foot forward to step) to the office door and back to see my gait. He had me try to lean backwards, forwards, side-to-side, and twist. I could do all pretty well except the leaning forward to touch toes. I could only lean forward maybe 15-20 degrees. I glanced at his notes, and they almost all looked like they said 30 degrees (normal) except I don’t know what he put for forward flexion (I saw nothing but 30 degrees on the sheet, and I don’t know if he put something down later to give an accurate reflection of my forward flexion). I’m wondering about this because the Back (Thoracolumbar spine) conditions DBQ specifically says in Section III (before 3A) to “Measure ROM with a goniometer.” In fact it says 3 repetitions of ROM (at a minimum) are needed. I only did forward flexion twice, and that was because the first time I leaned over he didn’t seem to like it that I couldn’t lean down very far, and so he stood up and showed me how to lean down to touch one’s toes to demonstrate what he was looking for from me. Again I leaned down about as far as I could without pain (which was not much). I don’t know what he wrote down, and I never saw a goniometer once in the exam. Should he have used a goniometer? He didn’t examine me at all, as in seating me on the table, having me attempt to perform straight leg raise tests (which is required at step 12) or palpating for tenderness, etc. It was most like a reporter’s interview (aside from him observing me having trouble touching my toes and him encouraging me to try to do it). One thing he did do that I thought was indeed good was to run a pointy object up and down my legs while I was seated. Interestingly, I had slightly less sensation on the left leg, and I told him this. He also didn’t test my hip flexion, or ankle flexion/dorsiflexion, great toe extension, etc, which is required per the DBQ at step 8A. That seems like that would have been a pertinent thing to assess, especially after observing how small of a step I took with my left foot while demonstrating walking for him. And he was supposed to test for piriformis syndrome (left hip) during this exam, and I even told him that just last week I was also diagnosed by the VA Pain Mgt clinic with IT band syndrome of the left hip for my tension and pain along the outside of the left hip. I have no idea what he put for ROM for my left hip... He got to the end of the last DBQ form that he whipped through (after skipping what I think are essential parts), and then he finished the exam abruptly saying, “Well, that’s it. That’s all. We are done.” When I asked if there was anything else, he was like “No. That’ll do.” At the end of the exam, he seem to notice the envelope full of the papers I had filled out along with my medication list I had diligently prepared. He was like, “What’s this”? I was like, “That is for you, which my medication list and everything.” He acted like “Oh,” and seemed to grab it and take it somewhere. I wonder what he did if anything with that. He seemed to be completely done with me at that point. My Questions: How can I get record of his notes and when might they become available? Is this super relaxed approach, and skipping through what I think are required sections normal? Is this anything like how a C&P exam should go? Is this lack of use of an accurate measuring device going to lend itself to an accurate rating? Should I document that he did not use any accurate measuring device and have my own physician measure my ROM with a goniometer (or would that come later with a VA attorney after the VA denies my claim)? What just happened? Was I supposed to be somehow more demanding during the exam, and if so how could I have done so appropriately? Any advice appreciated!
  8. aoneinsun

    [[Template core/front/global/prefix is throwing an error. This theme may be out of date. Run the support tool in the AdminCP to restore the default theme.]] Recently separated - dealing with disc bulge issues & VA next

    Hi, I have indeed put in for VA disability well within the one year. I'll be going to some VA exams in the next few months for an ongoing lower back bulging disc issue, left hip issue (which I think is Trochanteric Bursitis) and also another issue with TMJ where my mouth will only open a certain width (opening any further has distinct pop/click sound and hurts/aches if going beyond that range of about 1.5 inches in my case). I had been treated for the TMJ issue while in service and given a mouth guard to reduce teeth grinding and told not to open my jaw "too far." My VSO said that I do not have to pay for anything for the VA exams. I will need to attend the VA exams. I have a question though. They will likely see the maximum range I can open my jaw, and the maximum range I can bend over as I attempt to my touch toes, and the maximum amount I can step forward with my left foot. So I am wondering if the VA examiners will carefully measure the degrees exactly with high accuracy equipment such as with a goniometer to ensure a proper rating? I was reading that one may be well advised to have a private physician carefully make the measurements (presumably in concert with a VA attorney). Is it a common issue that during the VA exam they do not make the measurements with precision or overestimate your range of motion… resulting in lowered rating? I heard from a friend with back issues that he had a VA examiner just put in a write up that his back was just fine even though it was not (didn’t sound like the examining Doctor really thoroughly examined him at the exam). I was reading online that one attorney who works with workman’s compensation was saying those Doctors essentially work for the insurance company, and during the exam they are often going to end up reporting that you are just fine (essentially healthy). That workman's comp attorney was even recommending a “sandwich” approach, which is to be seen by your physician for your condition the day before a physical exam AND also be seen by your physician the day after your exam. This way you have a leg to stand on medically/legally when the exam results come back with eschewed results saying you are just fine (since then you can show proof from Doctors that shows the exact measurements of the limitation you were experiencing at the time... the day before and the day after). Of course that would be money I would have to pay out of my pocket, but I can do it if it would be worth it (vs having to go through a merry-go-round of appeals). I’ve been hearing that the VA exam Doctors are not working on the side of the veteran by any means. What are your thoughts? For example I was reading on: http://www.militarydisabilitymadeeasy.com/thespine.html ************************ NOTE: It is important that your physician records correct and thorough measurements for any back condition. The measurements should be measured with a goniometer. If possible, make sure your physician records the range of motion for EVERY direction. As shown in the above images, there should be 6 total measurements taken for both the cervical and thoracolumbar spines. THIS IS VITAL TO A PROPER AND FAIR RATING!!!!! Too often physicians do not record these important measurements properly, and then the service member’s condition is not appropriately rated. ************************ Your thoughts? Appreciate any insights.
  9. aoneinsun

    [[Template core/front/global/prefix is throwing an error. This theme may be out of date. Run the support tool in the AdminCP to restore the default theme.]] Recently separated - dealing with disc bulge issues & VA next

    Hi, Great advice! I sure appreciate it and will post if I can think of any more questions.
  10. aoneinsun

    [[Template core/front/global/prefix is throwing an error. This theme may be out of date. Run the support tool in the AdminCP to restore the default theme.]] Recently separated - dealing with disc bulge issues & VA next

    Hi, Great insight and yes, I'm about to order my military record. Also, I was reading if you have a combined disability rating of 50% or greater, you should be eligible to receive Concurrent Retirement Disability Pay (CRDP). If you receive CRDP, you will receive your full military retirement pay along with your full VA disability compensation. I'm wondering if one must do 20 "good years" to be able to get CRDP? Thus, if I was medically retired from the Reserves below 20 years would I not be able to claim CRDP? I heard it was open to Reservists now with 20 "good years"... But what I don't know is if it can extend to people with less than 20 years (and I don't think so). Anyone know for sure?
  11. aoneinsun

    [[Template core/front/global/prefix is throwing an error. This theme may be out of date. Run the support tool in the AdminCP to restore the default theme.]] Recently separated - dealing with disc bulge issues & VA next

    Hi, I’ve been recently separated as a USAF Captain from active duty due to reduction in force, and I am new to this realm. (I was not medically separated.) I’d sure appreciate some advice. Background While on active duty, I suffered a bulging disc and had a lot of left hip discomfort after some long runs at the unit’s physical training sessions. They called it piriformis syndrome and gave me physical therapy sessions at the base clinic, muscle relaxers, & some pain killers. I’ve long had an issue with my low back which have been well documented throughout my career, and have paid for a chiropractic care out of my own pocket (Tricare does not cover chiropractor) for 10 years to keep my back in decent shape. I was identified as having a mild curve (scoliosis) before joining the service in fact. I suspected something more was wrong since I felt more discomfort in the back (in addition to the left hip), and so I asked for an MRI of my back. That is when they found a 5mm disc bulge at L4-L5, pushing into the nerve root there. The base physical therapy sessions (and some off base message work) did help my left hip muscles loosen, but I was still having left hip pain and back pain. So I did just go through round two of physical therapy off base (about 14 PT sessions). I couldn’t straighten either leg during their straight leg exam. I’m slightly better afterwards but still having about the same issue with what I believe is a bulging disc that is the main culprit for the pain in the hip. I’ve never had any shooting pain down the leg thank goodness. But recently I’ve also had some feeling of pin pricks sticking me in the toes of my left foot while driving, which I think is a bit of sciatica. I’ve also recently had mild twitching episodes/muscle spams, which happen intermittently on my left side. Since I limp and favor my right side, it has been taking all my weight. Recently, I have noticed my right knee has been hurting, and my right ankle too, with my right ankle hurting to lift up too far (angling the right ankle up to the right to far results in an interesting pop sound, which hurts). My 6 months of Tricare benefits post-separation are over, and I’m meeting with the VA doctor for an initial exam in early December. I am wondering how this will unfold. Here are a few of my questions: While standing I have very limited ability to step forward with my left foot (if keeping my left leg straight). I also cannot quite lift my right leg up fully (if keeping the right leg fully straight). I believe this is because of the bulging disc, and sciatic pain that results (felt in the left hip which prevents me from stepping forward very much without going into pain). If I have this issue with BOTH left and right legs, would bilateral factor come into play, or are they likely to say that is all because of the bulging disc (which is what I really think)? I researched and found that limited motion of the hip seems like the most applicable rating along with some radiculopathy (sciatica). Is that the most applicable for rating purposes? They had done an MRI of my left hip, and the MRI came back normal. But I think something may be going on with the hip such as trochanteric bursitis (though I’m no Doctor), since the remaining pain is along the outside of the left hip, and not just the buttock. There is also constant ache deep in the left hip, Should I ask the VA Doctor for examination of the left hip in particular? I assume they will give me a cane to help take the pressure off my right side. I have full range of motion of the right knee, but it has a wired feeling (as though it has been twisted), and it hurts to flex while bearing weight, and it hurts with certain motions. Would this be ratable as secondary to (caused by) the back issue which has forced me to put all this extra weight on the right knee over 8 months? Since I still have full range of motion, is the pain with motion all that must be evident for the knee to be rated more than 0%? Or is pain AND limited motion required for the knee to be rated above 0%? As to the right ankle, I cannot lift my toes up much (dorsiflexion). I think this falls under code 5271: If the ankle is not frozen, but limited in motion. If I lift the ankle up too much it pops, and that hurts. It aches in general. Apparently, the ankle is considered a major joint. If it only has pain and nothing else in this major joint, would that result in a rating higher than 0%? Or is BOTH pain and limited motion required for the ankle to be rated above 0%? I cannot bend down to touch my toes. In fact I cannot bend over much at all without feeling pain in the left hip. I think that will fall under 5237: Lumbosacral or cervical strain. (I certainly cannot bend over more than 30 degrees, which is certainly ratable.) Is 5237 the most applicable for rating purposes? For any of the tests the VA will ask me to do, must I go into pain to ascertain the maximum range that I can flex to? I intend to stop flexing before pain and let the VA examiner know of the pain. With these various issues, should I consult an attorney up front? Are there good attorneys or really, really knowledgeable people about this unfolding process to really get good advice? Who would you recommend? I appreciate any advice and thoughts for pointing me in the right direction for the best help.
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