BWA1544

Hello again. Right foot was just rated at 30%. I thought for sure with that high of rating, it would bump my husband over 100% especially with the bilateral factor. Can you please review the summary below and let me know what are you coming up with? I mean, I literally refreshed ebenefits 20 minutes ago and this wasn't there, now it there rated at 30%. Could it be that ebenefits is not fully updated and it will be 100% once they update rest of profile? I'm holding out hope that is the case...look forward to hearing from you and what total rating you tally up. As always, we appreciate your insight and quick responsiveness! Disability Rating Decision Related To Effective Date residuals, shrapnel wound, right foot, MG XI 30% Service Connected 3/26/2018 irritable bowel syndrome (IBS) 10% Service Connected Environmental Hazard in Gulf War 7/6/2018 tinnitus 10% Service Connected 3/21/2005 residual shrapnel wound, left foot, MG XI 10% Service Connected 3/21/2005 residuals, shell fragment wound, right hip, MG XVI 10% Service Connected 3/21/2005 residuals, shell fragment wound, right lateral thigh, MG XIV 10% Service Connected 3/21/2005 patellofemoral pain syndrome, right knee (claimed as right knee condition) 10% Service Connected 3/26/2018 fibromyalgia Not Service Connected Environmental Hazard in Gulf War residuals, shrapnel wound, right buttock, MG XVII 20% Service Connected 3/21/2005 residuals, shrapnel wound, left buttock MG XVII 0% Service Connected 3/21/2005 posttraumatic stress disorder with traumatic brain injury (PTSD/TBI) 70% Service Connected PTSD - Combat 3/26/2018 gastroesophageal reflux disease (GERD) Not Service Connected bilateral hearing loss Not Service Connected

I agree they are killing him with 10% ratings. So frustrating. I'm getting worried his pending foot claim will come back as 10% as well. Below are the notes from exam. Care to guesstimate what it will be? Muscle Injuries Disability Benefits Questionnaire Name of patient/Veteran: xxxxxxxxxxxx Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No ACE and Evidence Review ----------------------- Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence Review --------------- XXXXX, XXXXXXXXXX CONFIDENTIAL Page 25 of 98 Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS SECTION I: DIAGNOSIS -------------------- Does the Veteran now have or has he/she ever been diagnosed with a muscle injury? [X] Yes[ ] No Diagnosis #1: Shrapnel wound foot ICD code: Y 36.23 Date of diagnosis: 2004 Side affected: [X] Right [ ] Left [ ] Both SECTION II: HISTORY OF MUSCLE INJURY ------------------------------------ a. Does the Veteran have a penetrating muscle injury, such as a gunshot or shell fragment wound? [X] Yes[ ] No b. Does the Veteran have a non-penetrating muscle injury (such as a muscle strain, torn Achilles tendon or torn quadriceps muscle)? [ ] Yes[X] No c. Describe the history (including onset and course) of the Veteran's muscle injury: (brief summary): Shrapnel wound right foot from mortar attack in 2004 in Iraq.Taken to field hospital for 3 days and light duty for month.Open tiny wounds cleaned and bandaged.Some shrapnel removed.Right arch painful and tender.Unable to run anymore.On bare foot places weight on lateral side of foot to avoid arch pain. d. Dominant hand [X] Right[ ] Left[ ] Ambidextrous SECTION III: LOCATION OF MUSCLE INJURY -------------------------------------- 1. Shoulder girdle and arm -------------------------- XXXXX, XXXXXXXXXX CONFIDENTIAL Page 26 of 98 Does the Veteran now have or has he/she ever had an injury to a muscle group of the shoulder girdle or arm? [ ] Yes[X] No 2. Forearm and hand ------------------- Does the Veteran now have or has he/she ever had an injury to a muscle group of the forearm or hand? [ ] Yes[X] No 3. Foot and leg --------------- Does the Veteran now have or has he/she ever had an injury to a muscle group of the foot or leg? [X] Yes[ ] No If yes, check muscle group(s) and side affected (check all that apply): [X] Group X: Muscles of the foot: flexor digitorum brevis, abductor hallucis, abductor digiti minimi, quadratus plantae, lumbricales, flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis, dorsal and plantar interossei [X] Group XI: Muscles of the foot, ankle and calf: gastrocnemius, soleus, tibalis posterior, peroneus longus, peroneus brevis, flexor hallucis longus, flexor digitorum longus 4. Pelvic girdle and thigh -------------------------- Does the Veteran now have or has he/she ever had an injury to a muscle group of the pelvic girdle or thigh? [ ] Yes[X] No 5. Torso and neck ----------------- Does the Veteran now have or has he/she ever had an injury to a muscle group in the torso and/or neck? [ ] Yes[X] No 6. Additional conditions ------------------------ XXXXX, XXXXXXXXXX CONFIDENTIAL Page 27 of 98 a. Does the Veteran have a history of rupture of the diaphragm with herniation? [ ] Yes[X] No b. Does the Veteran have a history of an extensive muscle hernia of any muscle, without other injury to the muscle? [ ] Yes[X] No c. Does the Veteran have a history of injury to the facial muscles? [ ] Yes[X] No SECTION IV: MUSCLE INJURY EXAM ------------------------------ 1. Scar, fascia and muscle findings ----------------------------------- b. Does the Veteran have any known fascial defects or evidence of fascial defects associated with any muscle injuries? [ ] Yes[X] No c. Does the Veteran's muscle injury(ies) affect muscle substance or function? [ ] Yes[X] No 2. Cardinal signs and symptoms of muscle disability --------------------------------------------------- Does the Veteran have any of the following signs and/or symptoms attributable to any muscle injuries? [X] Yes[ ] No If yes, check all that apply, and indicate side affected, muscle group and frequency/severity. [X] Fatigue-pain If checked, indicate side affected: [X] Right [ ] Left [ ] Both Indicate muscle group(s) affected (I-XXIII) if possible: Group X and X1 Indicate frequency/severity: [ ] Occasional[X] Consistent[ ] Consistent at a more severe level [X] Impairment of coordination XXXXX, XXXXXXXXXX CONFIDENTIAL Page 28 of 98 If checked, indicate side affected: [X] Right [ ] Left [ ] Both Indicate muscle group(s) affected (I-XXIII) if possible: Group X and X1 Indicate frequency/severity: [ ] Occasional[X] Consistent[ ] Consistent at a more severe level [X] Uncertainty of movement If checked, indicate side affected: [X] Right [ ] Left [ ] Both Indicate muscle group(s) affected (I-XXIII) if possible: GroupX and X1 Indicate frequency/severity: [ ] Occasional[X] Consistent[ ] Consistent at a more severe level 3. Muscle strength testing -------------------------- Rate strength according to the following scale: 0/5 No muscle movement 1/5 Visible muscle movement, but no joint movement 2/5 No movement against gravity 3/5 No movement against resistance 4/5 Less than normal strength 5/5 Normal strength Shoulder abduction (Group III) Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Elbow flexion (Group V) Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Elbow extension (Group VI) Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist flexion (Group VII) Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist extension (Group VIII) Right: [X] 5/5 [ ] 4/5 [ ] XXXXX, XXXXXXXXXX CONFIDENTIAL Page 29 of 98 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Hip flexion (Group XVI) Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee flexion (Group XIII) Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension (Group XIV) Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle plantar flexion (Group XI) Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion (Group XII) Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 If other movements/muscle groups were tested, specify: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Does the Veteran have muscle atrophy? [ ] Yes[X] No SECTION V: OTHER ---------------- 1. Assistive devices -------------------- a. Does the Veteran use any assistive devices as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes[X] No 2. Remaining effective function of the extremities -------------------------------------------------- Due to the Veteran's muscle 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.) XXXXX, XXXXXXXXXX CONFIDENTIAL Page 30 of 98 [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 3. 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 4. Diagnostic Testing --------------------- a. Have imaging studies been performed and are the results available? [X] Yes[ ] No b. Is there x-ray evidence of retained metallic fragments (such as shell fragments or shrapnel) in any muscle group? [X] Yes[ ] No If yes, indicate results: [X] X-ray evidence of retained shell fragment(s) and/or shrapnel Location (specify muscle group I-XXIII, if possible): Group X and X1 Side affected: [X] Right [ ] Left [ ] Both [X] X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect XXXXX, XXXXXXXXXX CONFIDENTIAL Page 31 of 98 of the missile Location (specify muscle group I-XXIII, if possible): Group X and X1 Side affected: [X] Right [ ] Left [ ] Both c. Were electrodiagnostic tests done? [ ] Yes[X] No d. Are there any other significant diagnostic test findings and/or results? [ ] Yes[X] No 5. Functional impact -------------------- Does the Veteran's muscle injury(ies) impact his or her ability to work, such as resulting in inability to keep up with work requirements due to muscle injury(ies)? [X] Yes[ ] No If yes, describe the impact of each of the Veteran's muscle injuries providing one or more examples: No running or prolonged walking. 6. Remarks, if any: ------------------- Mild disability Current diagnosis is progression of SC disability Veteran welcomed. DR introduced Veteran thanked for serving our country Two identifiers correctly answered Purpose of exam explained.Decision of claim solely determined by VBA. Veteran agreed to proceed with exam

Thank you for the quick response. I was reviewing the 2005 claims again as we waited for the 2018 claims to be processed. My husband JUST got a decision on the new claims filed in May 2018 and he is now at 90%. He has a right foot condition that is still pending. I believe if right foot comes through at something 20% or higher and with the proper bilateral rating, he could be at 100%. Below is an updated look at all of his ratings. I have the notes from his recent VA appointment for right foot condition and from what I can tell, I cannot estimate what the rating might be. Disability Rating Decision Related To Effective Date residuals, shrapnel wound, right foot, MG XI 0% Service Connected 3/21/2005 irritable bowel syndrome (IBS) 10% Service Connected Environmental Hazard in Gulf War 7/6/2018 tinnitus 10% Service Connected 3/21/2005 residual shrapnel wound, left foot, MG XI 10% Service Connected 3/21/2005 residuals, shell fragment wound, right hip, MG XVI 10% Service Connected 3/21/2005 residuals, shell fragment wound, right lateral thigh, MG XIV 10% Service Connected 3/21/2005 patellofemoral pain syndrome, right knee (claimed as right knee condition) 10% Service Connected 3/26/2018 residuals, shrapnel wound, right buttock, MG XVII 20% Service Connected 3/21/2005 residuals, shrapnel wound, left buttock MG XVII 0% Service Connected 3/21/2005 posttraumatic stress disorder with traumatic brain injury (PTSD/TBI) 70% Service Connected PTSD - Combat 3/26/2018 Residuals, Shrapnel Wound, Right Foot (claimed As Right Foot Condition) PENDING

You all have been so helpful as I help my husband navigate the disability claim process. As I've learned more about the bilateral rating factor, now I am questioning if his rating of 50% awarded back from 2005 was calculated properly. Can you kind folks help me understand if the below ratings should be 50% or 60%? Do any of the ratings qualify for the bilateral factor? Shrapnel, right foot 0% Tinnitus 10% Shrapnel, left foot 10% shrapnel, right hip 10% shrapnel, right thigh 10% shrapnel, right buttock 20% shrapnel, left buttock 0% bilateral hearing loss 0%

My husband is a purple heart disabled veteran with a current rating of 50% (due to shrapnel injuries from mortar blast). He was in Iraq from ’04-’05. He has just started talking to the VA about filing new claims for PTSD, TBI and a knee injury. While speaking with the VA social worker, she informed him he was diagnosed with PTSD in 2007 and TBI in 2013. He was never informed of these diagnoses at that time. Everything we read online says that there is no way to get an earlier effective date other than the date of his most recently filed claim (March 2018). Looking for advice if anyone has been successful in winning an EDD due to never being notified of the diagnosis? Any other advice you can share while going through this process? Thanks so much in advance for your help.