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doc25

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Everything posted by doc25

  1. Retro pay is paid only one year back in most cases. In rare cases , when there has been a clear and unmistakable error discovered in claims older than one year...a veteran can appeal the effective date past one year to the original date. During your C&P be honest but don't downplay your symptoms or pain level. Only answer questions they have and be to the point. If the examiner tries to sidetrack you; don't give a response or say," I do not mean seem rude, but I am here to discuss my current condition(s) only.I'll be happy to answer any questions you may have about them."
  2. Veterans won't get the new ruling recognized at the RO or DRO level, they barely understand medical evidence, let alone an overturned ruling for chronic pain. Your appeal can be recognized at the appeal level, in my opinion. Of course, they can get wrong also. Which you keep appealing and appealing and appealing. Never give up and never give in. Keep in mind the language that is being used, Chronic pain is a disability if it impedes earning capacity. For that you don't need a diagnosis, because being in a state of chronic pain will cause you to miss work, which will keep you from getting promoted, getting a raise, or even fired. If you live in an "at will" state, such as Texas, an employer can fire an employee for almost any reason. If you can't keep a job for more than 3-6 months because of your pain, that's also a valid point to bring up in your Notice of Disagreement. Best wishes.
  3. Your welcome. If you do end up getting surgery here's some info to consider. https://www.benefits.va.gov/COMPENSATION/claims-special-hospital_treatment.asp The duration on hospital stays depends on what kind of surgery you will have that will warrant a lengthy hospital stay. Also remember, if your other knee begins or has started bothering you, that's a good indicator to start being seen and build up medical evidence to Secondary connect that knee to your SC Knee.
  4. Yup. According to fowrward1 his depression and anxiety was diagnosed by his VA doc, which is why I provided another route to Secondary service connect the depression or anxiety. It took me two years to Secondary connect OSA to PTSD meds. I was denied twice on a Secondary basis,even though I had a sleep study done and was diagnosed with it; was issued a CPAP machine. The VA pulmonologist filled out the Sleep Apnea DBQ. I used that as new and material evidence to re-open the claim, got a C&P exam and the examiner concurred with the pulmonologist. The C&P examiner did the nexus and provided the rationale for a favorable decision. TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ] a. The condition claimed is at least as likely as not (50% or greater probability) proximately due to or the result of the Veteran's service connected condition. c. Rationale: This is a 36 yr old Veteran who has been SC at 70% for PTSD since 06/28/2015 he also has Obstructive Sleep Apnea (diagnosed on 04/27/09). A study" Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort" concluded: Psychiatric comorbid diagnoses in the sleep apnea group included depression 21.8%, anxiety 16.7%, posttraumatic stress disorder 11.9%, psychosis 5.1 and bipolar disorder 3.3 %. Compared with patients not diagnosed with sleep apnea, a significantly greater prevalence (P<0.0001) was found for mood disorders, anxiety, posttraumatic stress disorder, pyschosis, and dementia in patients with sleep apnea. Sleep apnea is associated with higher prevalence of psychiatric comorbid conditions in Veterans Health Administration beneficiaries. This association suggests that the patients with psychiatric disorders and coincident symptoms suggesting sleep-disordered breathing should be evaluated for sleep apnea.( Sharafkhaneh et.al. Sleep, vol. 28, Nov. 11, 2005)
  5. Do you want the bad news first or the good news first? I'll give you the good news first. You have nexus letters for physical conditions and that's good, because when one doctor says you have a condition and a C&P examiner gives you an unfavorable exam the TIE must go to the veteran. That's the good news. Here's the bad news. If you don't have an in-service diagnosis for depression and anxiety, unfortunately, it will be denied as a direct-service claim. There is another way to get it granted on a SECONDARY basis. But, it's going to take some work on your part and time.You will need to service-connect your knee and lower back first. Depending on the severity of your knee and lower back conditions, if either or those or both keep you from achieving "activities of daily life" or(ADLs) ;such as exercise, work that requires bending, squatting, etc. this can cause or aggravate depression and anxiety. To Secondary connect a condition you must meet these requirements: 1. Must have a service-connected disability 2. Current diagnosis of disability 3. Nexus of opinion stating the minimum threshold phrase "at least as likely as not" and a rational linking #1 and #2.
  6. Was your C&P exam done by QTC or VA?? I ask because your exam will show up in your VA records via myhealthevet or e-benefits and will show what the examiner put. As long as the examiner put "at least as likely as not" in the nexus of opinion, you will get something, but that all depends on the Ratings Scheduler and how the scheduler interprets all the medical evidence. Here is some literature to look over to give you an idea how your degenerative arthritis for your back will be rated. Code 5003: Degenerative arthritis is the second most common rating for any joint condition, and it can get VERY confusing. The most common rating for joint conditions is limitation of motion, partly because conditions are required to be rated under limitation of motion first before they can be rated as degenerative arthritis. If any condition causes a decreased range of motion in a joint, then it MUST be rated on that limited motion. A joint condition can only be rated as degenerative arthritis if it does not have a limited enough range of motion to rate under those codes. Conditions CANNOT be rated under both limitation of motion and degenerative arthritis. Limited motion first, and if not, then only arthritis. Got it? So on to the rating: Once a condition cannot possibly be rated as limited motion of the affected joint, we can proceed with rating it as degenerative arthritis. Please note that there must be x-ray evidence of arthritis in the joints to rate under this code. For rating arthritis, the shoulder, wrist, elbow, hip, knee, and ankle are considered major joints. The finger and toe joints, spine, and sacroiliac joint are considered minor joints. If two or more major or minor joint groups have arthritis and it is occasionally incapacitating, then it is rated 20%. If two or more major or minor joint groups have arthritis but it is never incapacitating, then it is rated 10%. If only a single major or minor joint group has arthritis, it can only be rated more than 0% under code 5003 if there is painful motion. If it hurts to move it, then it rates 10% because of the Painful Motion principle. Hopefully, the Ratings Scheduler gives a favorable percentage. I imagine your car accident aggravated your condition and that will give added weight to a favorable decision. Best wishes on your claim.
  7. It's completely your choice to pursue a claim or not. I was just passing on information. I apologize if I came across intrusively.
  8. File out your NOD but this time substantiate your claim with these two recommendations below. Although, you have a Dr. saying it is medically necessary to use a CPAP, it's not VA language. (I know, I know...it's ridiculous.) Get your Dr. to fill out the Sleep Apnea Disability Benefits Questionnaire https://www.vba.va.gov/pubs/forms/VBA-21-0960L-2-ARE.pdf and write a more detailed Nexus of opinion along the lines likes this. To whom it may concern: "My name is Dr. so and so. I am board certified in my specialty. I have been practicing for so many number of years. I have been treating this patient (your name) for x-amount of months/years. I have reviewed this veteran's service-medical records and it is in my opinion that it is "at least as likely as not (equal to or greater than 50% probability) the veteran's sleep apnea was incurred in-service and has worsened requiring a medically-necessary CPAP machine. RATIONALE: According to sleepapnea.org, The Greek word “apnea” literally means “without breath.” Sleep apnea is an involuntary cessation of breathing that occurs while the patient is asleep. There are three types of sleep apnea: obstructive, central, and mixed. Of the three, obstructive sleep apnea, often called OSA for short, is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. In most cases the sleeper is unaware of these breath stoppages because they don’t trigger a full awakening. Left untreated, sleep apnea can have serious and life-shortening consequences: high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes, depression, and other ailments. Sleep apnea is seen more frequently among men than among women, particularly African-American and Hispanic men. A major symptom is extremely loud snoring, sometimes so loud that bed partners find it intolerable. Other indications that sleep apnea may be present are obesity, persistent daytime sleepiness, bouts of awakening out of breath during the night, and frequently waking in the morning with a dry mouth or a headache. But none of these symptoms is always present. Only a sleep study in a sleep laboratory or a home sleep study can show definitively that sleep apnea is present and how severe it is. Obstructive sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed sleep apnea, as the name implies, is a combination of the two. With each apnea event, the brain rouses the sleeper, usually only partially, to signal breathing to resume. As a result, the patient’s sleep is extremely fragmented and of poor quality. Sleep apnea is very common, as common as type 2 diabetes. It affects more than 18 million Americans, according to the National Sleep Foundation. Risk factors include being male, overweight, and over the age of 40, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and health care professionals, the vast majority of sleep apnea patients remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences. Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotence, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues. Best wishes on your claim.
  9. Complaints in service are not enough medical evidence to grant direct service connection. Although complaints are evidence that there was an event/injury in service related to sleep problems. According the information you provided it appears you have met all 3 Caluza factors: 1. Injury/event incurred in-service. 2. Current Diagnosis 3. Nexus of opinion. In addition, you have a CPAP machine issued. Tentatively, you should be good to go for 50% granted Sleep Apnea. You never know how the Ratings Schedulers will interperet all pertianing information. Best wishes on your claim.
  10. In some cases, some veterans have been granted Depression secondary to Tinnitus. FYI. Take a read and see how this veteran was able to do Secondary connect Depression to Tinnitus. If your Tinnitus worsens over time, it can cause depression. You can't get an increase for Tinnitus as it's capped at 10%, but depression for that has been rated up to 10%, 30%, 50% from my understanding. That will increase your overall percentage, as well. https://www.va.gov/vetapp15/Files2/1515376.txt Here is an article that makes the correlation of Depression secondary to Tinnitus. https://www.hindawi.com/journals/ijoto/2015/689375/ CAD is one to go after. So don't let it go. Hearing loss is a hard one, it will get worse later on, just keep building that evidence. DMII can cause skin problems that can be rated secondary to it. Toenail fungus named Onychomycosis can be caused by DMII. If your DMII gets worse, Sleep Apnea can be caused by DMII,as well and OSA is rated 50% with use of a CPAP.
  11. Yes. And I'll give an example. Service-Connected Tinnitus is capped at 10% but over time it may get worse and it can cause Depression or Anxiety. Depending on the severity of the depression or anxiety any psychiatric disorder it can be rated 0%, 30%, 50%, 70%, or 100%. The most I've seen is Depression 50% secondary to 10% Tinnitus. But, it all depends on the severity. Each secondary disability gets a separate rating from the service-connected disability. Here's a case where the veteran was granted Depression secondary to Tinnitus. https://www.va.gov/vetapp15/Files2/1515376.txt TBI and PTSD have a comorbidity relation to each other so, it really depends on your PTSD symptoms, how the psych doc diagnosis your PTSD using the DSM-5, and how a ratings scheduler interprets the evidence. Here is a better explanation from a research study. https://www.ncbi.nlm.nih.gov/pubmed/29017388 To secondary service connect any disability you MUST meet all criteria: 1. Current Service-Connected Disability 2. Current Disability that is secondary to a SC disability 3. Nexus of Opinion linking #1 and #2.
  12. I have two of the caluza elements: 1. In-service flat foot diagnosis dec 2006 2. Current diagnosis flat feet re-diagnosed June 2016. 3. No nexus yet. I filed a NOD, I received the VA SOC Aug 2017 but I did not meet the 60 day deadline to send in the VA form 9 due to the VA podiatrist I have, not filling out the foot DBQ and providing the nexus of opinion that I requested. I admit I failed to keep pushing and the appeal was closed this august after a year. That's where I'm at.
  13. I have ordered my c-file. I'm giving the Intake Center in Janesville 30 days to furnish my hard copy. If they don't I'll get a federal court order for them to get moving on it. I know I should've gotten a 0% SC for acquired flat feet, at the very least, for getting custom inserts that relieved the pain at the time. As time has gone by, nothing has been helping. New custom inserts, heel cups, and physical therapy at the present time are not helping. So, I'm pretty sure I'm at 30%. As far as (New Service Records) I have new VA records from 2016 to my last podiatry visit three weeks ago. At my last podiatry appt. I showed the podiatrist the 2006 in-service diagnosis and he noted in my VA records. Here is part of his note: Subjective: This 37 year old MALE presents for f/u on a chief complaint of bilateral foot pain although today it is mainly left foot pain. The patient describes the pain as sharp in nature, rated as ~7/10 and localized to the ball of each foot L>>R as well as left achilles insertion. He is wearing the custom functional orthotics and states that he has been stretching and using the DNS. He relates that the pain has been present for ~12 years and has progressively worsened. Other prior tx has consisted of PT with limited improvement. Can this suffice as New service Record? On the other hand, I strongly believe that the VA failed to apply presumption of soundness: 3.304 (b)Presumption of soundness. The veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. Only such conditions as are recorded in examination reports are to be considered as noted. I'm aware that this can be used in a CUE, as a last resort. I would still have to get the Nexus of opinion, which the burden falls on me.
  14. I was initially denied Oct 2007 for bilateral flat feet from my exit service C&P exam. Apparently, the C&P examiner conjured up a bogus diagnosis of congenital flat feet. Stating that it was a developmental deformity from childhood?? In my entrance exam from 1998, "Normal Archs" is clearly and unmistakabley circled. On December 5th 2006, I was diagnosed by a Navy podiatrist with bilateral flat feet and was issued custom foot orthothics. They didn't help much, but what the heck, I used them anyway. When I got out in 2007 up until 2012 I used the orthotics until they were of poor quality. After that I just kept buying store foot inserts that only lasted 3 months at a time. In 2017 I re-claimed flat feet again after my VA podiatrist made the same diagnosis of bilateral flat feet....and was denied a second time. The C&P examiner didn't look at my feet for very long and just said I had an arch when I wasn't on my feet and that there was a very low arch to both feet when I was on my feet. All he did was agree with the previous C&P exam from 2007, according to the second denial letter. I submitted a notice of disagreement, but wasn't able to submit VA form 9 within the 60 day period because my current podiatrist refused to provide a simple Foot DBQ and a nexus of opinion that I requested. Can I re-open the flat feet claim if I can get a private podiatrist to fill out the DBQ and provide a nexus of opinion? I do believe that there was a clear and unmistakable error in the initial and second denials because I entered service with Normal Archs and not any form of flat feet. Can I appeal the effective date back to Oct 2007?
  15. Since you already have MDD and it's gotten worse? you may have hypersomnolence or obstructive sleep apnea sneaking up in there. Do you snore? Have you experienced gasping for air while you sleep? Has a significant other or anyone witnessed you stop breathing as you slept? If you do. You may want to request a pulmonology referral from your PCP to have a sleep study done. If there is hypersomnolence (excessive daytime sleepiness) present or OSA is confirmed with a sleep study, then get a CPAP issued. Hypersomnolence is rated 30% OSA w/ use of CPAP is rated 50% The other way for MDD to get increased is for your psych doc to fill out the a Mental health DBQ other than PTSD and provide a nexus of opinion to substantiate the increase you are claiming. Hope you do get an increase.
  16. Sounds like this is an after-service claim/claims. Have your new VA podiatrist fill out the Foot DBQ https://www.vba.va.gov/pubs/forms/VBA-21-0960M-6-ARE.pdf Your VA PCP needs to fill out the Knee and Hip DBQs: Knee- https://www.vba.va.gov/pubs/forms/VBA-21-0960M-9-ARE.pdf Hip- https://www.vba.va.gov/pubs/forms/VBA-21-0960M-8-ARE.pdf Usually DBQs will suffice to back up all your documentation, BUT; yes there's a BUT, the VA Ratings Schedulers love it when a DBQ doesn't accompany your documentation. Even if it is noted and documented IN-SERVICE from your service medical record(SMR);any and all claims are subject to a denial for almost any B.S. reason. You will also need for your podiatrist and PCP to enter into their notes a nexus of opinion for each condition stating 1 of 3 key phrases for service-connection. 1. "Due to" military service (100% probability) 2. "More likely than not" due to military service(greater than 50% probability) 3. "At least as likely as not" due to military service( equal to or greater than 50% probability) They must provide a clear and concise RATIONALE as well. [VA has quack C&P examiners that aren't always specialists in the conditions a veteran is claiming. You get your podiatrist and PCP to say your conditions ARE service-connected in the format above. You give your claim much needed weight should the C&P examiner try to give you an unfavorable exam. If one dr. says your condition is service connected and the other says is not? That is a tie and the tie always goes to the veteran.] I noticed you're not having ankle and lower back problems. You will eventually. There's a DBQ for those two, as well. And you will need Nexus of opinions for any condition that occurs later on. Why? Because the VA must have competent medical evidence to substantiate each claim. If you have All DBQs and the Nexus of opinions, you will give your claim a boost in getting each condition granted sooner rather than later. It's not a guarantee you'll be granted the first time. But, you'll give that claim a fighting chance. Keep in mind that IF you receive a denial for any condition. Do not give up on it! You will need to dissect the VA reasoning, then get to work on filing a Notice of Disagreement in rebuttal of whatever B.S. reasoning they give. You may need to provide additional evidence or something was overlooked. We veterans have more power over the VA than we are led to believe. Don't forget to claim Tinnitus and Bilateral Hearing Loss. Best wishes on your claims. We're here to answer any of your questions.
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