SPO

So if I am given service connection for a lower back condition that also causes sciatic pain, which is noted in my medical records (not actually sciatica by definition). Is the VA supposed to give rating for each symptom, or just the main claimed condition (lower back pain)?

Out of curiosity what general area do you guys live. I don’t think my area is open yet. But 15 miles down the road is supposed to be.

He provided a diagnosis of psoriatic arthritis of the feet which presents as plantar fasciitis. This is all secondary to psoriasis that I’m already connected for. He provided a nexus, not great one, and there is already another nexus opinion in my file. My question is more a matter of symptoms vs. specific diagnosis and how the va usually leans when rating. By that I mean the condition is psoriatic arthritis but it causes plantar fasciitis, or at least the same symptoms. Also along those lines, can I submit articles, or at least show them to the examiner from reputable sources such as mayoclinic.org to clarify this information since this isn't the most widely known condition?

So I have been reviewing my medical records for my claim and thinking over all the stuff my doctor has told me. So I filed for psoriatic arthritis of the feet (among other things). In my medical records my doctor points out that I have plantar faciitis, he doesn't dive in to any detail in the records. Plantar Facitis can be how this arthritis manifests in the feet, its noted in a lot of medical literature. It is an inflammatory arthritis which effects where the soft tissue joins to the bone in some areas. Now my quetsion is when it comes to rating this, assuming the C&P goes well, should they rate this as plantar faciitis or under the residuals of arthritis such as limited or painful motions? I know the VA will do whatever it wants, just curious what everyone thinks

Here is a link I found. Apparently va has expanded from the original 20 locations and you can search your area and see if they have resumed in person exams https://benefits.va.gov/compensation/claimexam.asp

So I spoke to DAV and they said the exams requested for me did not include my hands or hip, which I filed for on the supplemental. I disputed the first C&P, but the hip and hands I think were somewhat favorable in the first one. I don't know if they are going to use that and get new stuff for everything else. Any ideas?

This was a secondary claim. I’ve been rated for the primary for 10 years. There was a dbq from my doc with a diagnosis in the original arthritis claim. The opted to use my bad c&p to out weigh my docs info. The additional visit notes I submitted from my doc show a diagnosis from before I submitted the original claim.

Yes. They denied my for no clinical diagnosis. I submitted record from 2 new rheumatologists, and more records from my doc that signed by original DBQ. My current doc also wrote me a letter pointing out my diagnosis specifically (have to make it idiot proof for some eaters) Along with a lay statement and a statement pointing out all the things the NP who did the first c&p wrong. I’m hoping my effective dAte will go back to the beginning because the c&p they used to deny me was inadequate and a diagnosis existed the whole time

Yeah, this time around I won't be waiting a year until I can get another copy of my c-file to challenge a bad exam. If something smells funny after its done, I'll be calling DAV and VA on my drive home from the exam. My concern is driving the point home of how severe my condition can be if I go in on a good day, because I can't predict good days from bad and try to schedule based off that.

Since it does appear I have to attend another exam (which is good because the other one was very bad, and I disputed it in my claim), I want to do anything I can to make sure this one goes right. Does anyone have any advice how to ensure I'm rated correctly. This is arthritis that isn't the same everyday, I don't want a good day to completely ruin this whole process. I know I can explain how bad it can get to the examiner, but I don't trust them to take any of that in to account.

It seems there was a misunderstanding. The exam was assigned to qtc so I called them. They said what it meant was I do t have to attend right now if I feel unsafe. They did say they are now attempting to schedule in person and are now working to find a doc for me to go to.

I submitted my supplemental claim a couple weeks ago, and I found out today that the VA requested a new C&P exam. However, according to the VA it is one I am not required to attend. This confuses and worries me because I disputed the in person exam I received in the original claim. Its an arthritis claim so you would think they would want a new set of ROM measurements since the last one was more than a year ago and I brought up multiple issues with it. Anyone have any idea what is going on here.

I spoke to a VA rep at the 800 number yesterday. They said as of yesterday the VA contractors are beginning to resume in person exams. However, it is dependent on your location and the particular contractor/doctor if they chose to do them. Just thought I'd share.

I was taking more about the rater. I’m on supplemental so wondering if they will try to ACE based of my new info (confirmed diagnosis and nexus) and ROM from my old c&p.

Looks like I’ll be in a holding pattern for a while. Mine needs ROM. since they are trying to use ACE can they pick and choose the parts of a c&p to consider as acceptable info? Or is it all or nothing?

Has anyone been scheduled for an in person C&P recently through one of the VA contractors even though VA facilities are closed? Just wondering if all in person exams are on hold or just at VA facilities.

This is exactly what I'm trying to prevent. I'm going to go ahead and include a statement with my supplemental hoping pointing out that I know what they are supposed to be doing will keep them from trying to screw it up. In accordance with: -M21-1, Part III, Subpart iv, Chapter 5, Section C - Effective Dates, III.iv.5.C.6.b. Continuously Pursued Claims, III.iv.5.C.1.e. Determining Whether Date of Claim or Date Entitlement Arose Is Later and 38 CFR 3.2500(h)(1). The entitling criteria of my disabilities was in existence prior to the receipt of the claim by Veteran's affairs, therefore the effective date should be assigned as the date of the Intent to file, November 16, 2018.

I figured it would be a mystery what the VA will do. I was hoping to be able to drop a statement to influence, or least let them know, that I know what they should be doing. Any ideas about the medical records that aren't completely in my favor? for what its worth I was denied for no clinical diagnosis.

Question 1: I've been told that the VA is has been only granting effective dates for supplemental claims back to the date the supplemental was received. In my case it is a supplemental after February 2019 when the new appeals process went into effect, and has not been finally adjudicated (1st decision 5/15/19, HLR decision 2/24/20, now working supplemental). I'm attempting to preemptively keep this from happening and get my effective date back to when the initial claim was submitted. From the research I've done the VA orders and regulation say it should be granted back to the initial, but apparently they are taking date entitlement arose to mean they date they received all the information in the supplemental (i'm not sure if there is confusion between a continuously pursued supplemental, or one after the claim is finally adjudicated). I have provided medical records showing a diagnosis back to before I submitted the initial claim, so the date the entitlement arose should be before the initial claim. Anyone know if I am correct, or what I can do to persuade them to give me the correct effective date without going through appeal? Question 2: Some of the medical records that support the older diagnosis date aren't 100% favorable. While they do show the diagnosis, they show a reduced level of severity (didn't really like this doctor, he wouldn't listen) from what I currently experience. Would this affect my decision? Some of these medical records is now about 2 years old. I just don't want to provide anything the VA can flip and use to deny me. CFR 3.2500(h)(1) M21-1, Part III, Subpart iv, Chapter 5, Section C - Effective Dates - III.iv.5.C.6.b. Continuously Pursued Claims

So I’ve done some research and it seems like this C&p although bad will get me to 100% rating. Should I try to fight this CMP still or let it ride and try to get an increase on the joints they did incorrectly later?

https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014194/M21-1-Part-III-Subpart-iv-Chapter-4-Section-A-Musculoskeletal-Conditions#1p this says painful motion for thumb, pointer, and middle are 10% each for painful motion I think. Ring and pinky can’t get more than 0%

She just notated painful motion on all 10 fingers ( not frozen Not sure if those charts apply or if it would just be 10% per hand)

If I file a claim for arthritis in my hands and the examiner notates an issue with each individual finger will they rate the whole hand together or each individual finger separately?

Going to throw this statement in to hopefully shoot down my exam I believe that the C&P exam that I received in connection with my psoriatic arthritis claim was insufficient. I was unable to make this conclusion for sure until I received a copy of my C-file and verified the what the examiner recorded in the exam, this process took over 11 months which delayed my ability to review the examiners entries and comments. During the exam the examiner did not use a goniometer during the measurement of many of the affected joints. I asked the examiner if it was necessary to use the goniometer at least twice and she stated it was ok. I believe this resulted in inaccurate measurements of range of motion that may negatively effect the final outcome of my claim. The examiner did also not record the my statements accurately. I informed the examiner on every joint that I experience flare ups. I informed the examiner that all the affected joints experience functional loss/impairment, however many of the forms do not reflect this information. There are also no less than 2 instances where the remarks section states no evidence of pain. However, the range of motion section of the exam notates pain. On the arthritis dbq the examiner noted that continuous medication was not required for this condition. However, I made the examiner aware that I was prescribed Stelara and regularly take ibuprofen to manage the pain of this condition. This information was also provided in the form of a DBQ by my doctor, and a letter from the same doctor which should have been reviewed by the examiner. These reports are clearly inconsistent and poorly completed. Due to all of these insufficiencies/errors, I believe my exams are invalid. and this one for the effective date. In accordance with M21-1, Part III, Subpart iv, Chapter 5, Section C - Effective Dates III.iv.5.C.6.b. Continuously Pursued Claims and 38 CFR 3.2500(h)(2), the effective date of this claim, should it be granted, should be the date the initial claim (intent to file) was received.

II.iv.5.C.6.b. Continuously Pursued Claims If an issue is continuously pursued under 38 CFR 3.2500(c) as a higher-level review (HLR), supplemental claim, or appeal to the Board of Veterans’ Appeals (BVA) (or a timely combination of any of those review options, in succession), decision makers must apply the effective date provisions of 38 CFR 3.2500(h)(1), which allows for an effective date based on the date of receipt of the initial claim, or the date entitlement arose, whichever is later. Note: A supplemental claim filed within one year following a decision on the same issue for that same claimant from CAVC, the U.S. Court of Appeals for the Federal Circuit, or the Supreme Court of the U.S. is considered a continuously pursued claim and can be afforded the effective date provisions of 38 CFR 3.2500(h)(1).