Wendy Ramirez

I was just denied pigmentary glaucoma, pigmentary dispersion syndrome among other eye conditions as not service connected / congenital/hereditary. Would you be able to speak with me regarding your claim and what was submitted? I provided an IMO, nexus letter, service treatment records and 20 years of civilian eye records - still denied. I am starting a NOD, but not sure what to put in it. I do not have any additional records or details to submit.

broncovet, I had an IMO, had them fill out the DBQ and provide a nexus letter. The nexus letter specified which conditions were congenital and which were not. The Dr even stated that although there were conditions that were congenital in nature, from the reviewing my STRs the conditions did not manifest themselves until they were diagnosed 3 years after joining the military. I hoped that would have been enough evidence to win. I do plan on filing a NOD. I am just not sure how to attack it since I do not have any additional evidence to provide.

Has anyone won a pigment dispersion or macular degeneration case that can assist me in filing an appeal? I was just denied for this claim on 10/26/19. I do not have any new records to provide. I am waiting to pick up my C&P exam. I provided 3 years of STRs for these conditions, 5 years of DOD dependent military treatment records, 15 years of post service treatment records, a buddy statement, a nexus letter and a DBQ. The only thing that was listed at MEPS entrance exam in 1994 was vision defect correct with glasses. The first year of service in 1995, second year in 1996 did not show any of these conditions. It wasn't until 1997 while deployed to Bosnia that I started having occasional double vision, photo-sensitivity, frequent dry eyes, tearing, spikes, halos, floaters and night vision issues. When I returned to Germany, I had an eye exam where I was diagnosed with pigment dispersion syndrome, bilateral acute iris transillumination, grade 2 Krukenberg's spindles, macular disease and cystoid macular edema. I was followed every month for progression, then every 6-mo, then to every year where I also received new glasses or contacts. Since the denial (below) states that my conditions are congenital defects, am I wrong to think that these conditions should have been detected pre-enlistment, at enlistment and at every yearly eye exam up until 1997? Then, there would be reason to believe that the issues would have progressed or appeared to finally be seen on an eye exam 3 years later, while in service. It is my understanding from reading the CFRs that if it is a "defect" then there would be no changes or progression of issues/symptoms, therefore no compensation. If it is a disease, there would be progression or symptoms and can be compensated. If the disease was found during military service, then it can be compensated. Here are the details from my denial letter: 1) Service connection for bilateral eye condition is denied (claimed as pigment dispersion syndrome, bilateral acute iris transillumination, grade 2 Krukenberg's spindles, retinal condition to include scars, atrophy and irregularities, vision problem and macular disease The current claim for bilateral eye condition and conditions identified as pigment dispersion syndrome, bilateral acute iris transillumination, grade 2 krukenburg's spindles, retinal condition to include scar, atrophy and irregularities, vision problem, and macular disease are considered congenital or developmental defects which are unrelated to military service and not subject to service connection. (38 CFR 3.303, CFR 4.9) Your conditions are considered congenital or developmental defects, which are unrelated to military service and are not aggravated by it. Additionally refractive errors are due to anomalies in the shape and conformation of the eye structures, and generally of congenital or developmental origin. Defects of form of structure of the eye that are congenital or developmental origin may not be considered disabilities or service connected on the basis of incurrence or aggravation beyond natural progress during service. The fact that a Veteran was supplied with glasses for correcting refractive errors (such as astigmatism, myopia, hyperopia and presbyopia) is not, in itself considered indicative of aggravation by service that would warrant compensation (38 CFR 3.303, 38 CFR 4.9). Therefore, service connection is denied. Favorable findings identified in this decision: Findings of pigment dispersion syndrome, macular disease, and cystoid macular edema are noted in service treatment records. Your private treatment records and VA examination show treatment and diagnosis of pigment dispersion syndrome, dry macular degeneration, lattice degeneration and esophoria. Your service treatment records show findings of pigment dispersion syndrome, macular disease and cystoid macular edema and treatment for conjunctivitis. 2) Service connection for glaucoma, bilateral is denied They fail to mention that these conditions were also found in my STRs (not all issues claimed and in records are congenital): bilateral acute iris transillumination, congenital opacities, grade 2 Krukenberg's spindles (which progressed to grade 3+ in records) , eye strain, problems with peripheral vision, headaches, blurred vision, drusen, macular DISEASE, peri-macular pigmentary DISEASE, pigmentary keratitis, macular retinal pigment epithelium (RPE) etiology unknown, macular mottling, congenital cataracts and their "diagnosis" of conjunctivitis that was actually diagnosed later on by a civilian as lagophthalmos. What should I provide in my appeal? Can I provide court cases where the claim for the conditions were won? Service connection is available for congenital diseases, but not defects, that are aggravated in service. Quirin v. Shinseki, 22 Vet. App. 390, 394 (2009); Monroe v. Brown, 4 Vet. App. 513, 515 (1993). In cases where the appellant seeks service connection for a congenital condition, the Board must indicate whether the condition is a disease or defect and discuss the presumption of soundness. Quirin, 22 Vet. App. at 394-97. It follows that in such cases where a congenital condition is at issue, a VA medical opinion may be needed to determine whether the condition is a disease or defect, whether the presumption of soundness has been rebutted, and if so whether there was aggravation during service. Id. at 395 In this regard, the presumption of soundness does not apply to congenital defects because such defects "are not diseases or injuries" within the meaning of 38 U.S.C.A. §§ 1110 and 1111. See 38 C.F.R. § 3.303(c); see also Quirin at 390 (holding that the presumption of soundness does not apply to congenital defects); Winn v. Brown, 8 Vet. App. 510, 516 (1996) (holding that a non-disease or non-injury entity such as a congenital defect is "not the type of disease- or injury-related defect to which the presumption of soundness can apply"). For purposes of determining whether a disorder is a congenital defect or a familiar disease, VA interprets the term "disease" in 38 U.S.C. §§ 310, 331, and the term "defects" in 38 C.F.R. § 3.303(c), as being mutually exclusive. "Disease" is broadly defined as any deviation from or interruption of the normal structure or function of any part, organ, or system of the body that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown. See VAOPGCPREC 82-90 (citing DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 385 (26th Ed. 1974)). On the other hand, the term "defect," viewed in the context of 38 C.F.R. § 3.303(c), is defined as a structural or inherent abnormality or conditions which are more or less stationary in nature. As noted in VAOPGCPREC 82-90, a Federal court, in drawing a distinction between "disease" and "defect," indicated that disease referred to a condition considered capable of improving or deteriorating, whereas defect referred to a condition not considered capable of improving or deteriorating. See Durham v. United States, 214 F.2d 862, 875 (D.C. Cir. 1954); see also United States v. Shorter, 343 A.2d 569, 572 (D.C. 1975). If it is determined during service that a veteran suffers from a congenital disease, as opposed to a defect, VA cannot simply assume that, because of its congenital nature, the disease must have preexisted service. That is, the presumption of soundness still applies to congenital diseases that are not noted at entry. Quirin at 396-97. VA must then show by clear and unmistakable evidence that the congenital disease preexisted service and was not aggravated thereby in order to rebut the presumption of soundness. Monroe v. Brown, 4 Vet. App. 513, 515 (1993). VA may not rely on a regulation as a substitute for the requirement that it rely on independent medical evidence. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). VA's Office of General Counsel has also confirmed that the existence of a congenital hereditary disease under 38 C.F.R. § 3.303(c) does not always rebut the presumption of soundness, and that service connection may be granted for congenital hereditary diseases which either first manifest themselves during service or which preexist service and progressed at an abnormally high rate during service. See VAOPGCPREC 67-90. =============== The C&P Director referred to General Counsel Opinion (OGC 82- 90) dated on July 18, 1990, which held that service connection may be granted for diseases of congenital, developmental, or familial origin provided that the evidence as a whole establishes that the condition was incurred in or aggravated during service. =============== Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). =============== The veteran’s pigmentary dispersion syndrome with pigmentary glaucoma is currently rated as 10 percent disabling, the minimum rating allowed under 38 U.S.C.A. § 4.84a, Diagnostic Code 6013 (for simple, primary, noncongestive glaucoma). Under this provision, the disability may be given a higher rating based on impairment due to related loss of visual acuity (Diagnostic Codes 6061-6079) or related field loss (Diagnostic Code 6080). ===================== A bilateral eye disorder, diagnosed as pigment dispersion syndrome, was incurred by veteran during active military service, and service connection for the manifestations of that condition, to include increased intraocular pressure, is warranted. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. §§ 3.303, 4.9 (1996). =================== Any help is greatly appreciated.

I saw this post was from 2008, so maybe you have had an answer offline. I was diagnosed in 2001 with rheumatoid arthritis and with auto-immune hepatitis and celiac disease in 2005. I initially was prescribed Imuran, plaquenil and prednisone for auto-immune hepatitis. At some point I was placed on methotrexate and taken off imuran and plaquenil. Have you had any luck getting a disability rating for auto-immune issues? I have been denied compensation stating they are congenital or hereditary, yet, I see other vets on here get service connection.

I have my C-file on cd and it is in one pdf. I have it on my laptop. I have used the search feature many times to find dates and notations, etc. I have also sorted through my c-file and copied out all records that relate to specific claims that I have filed or plan to file. There is plenty of evidence, but VA denies me saying that I only had 3 treatments during service, so it wasn't considered "chronic". They ignored my Statement of Claim and Buddy statements stating that I refused a profile or going back to sick call for knee issues because I was threatened with recycling at the minimum, malingering and discharge at every single visit, along with excessive corporal punishment for missing training while in Basic and AIT. I had a battle buddy that WAS discharged for knee issues in week 3 of basic, so there was definitely fear there. Chronicity was proven with civilian medical records from 2002-2005 for the 2005 claim filed, records from 2005-2014 for the 2014 claim filed, records from 2014-2017 for the 2017 claim filed, etc. As mentioned in my previous post - no civilian medical records that I have provided after my 2005 claim are in my c-file. My records (that are in my c-file) from 2002-2005 were ignored saying they were too far removed from service to be considered service connection. The active service treatment records state the following: 8FEB96 Basic Training - Screening Note of Acute Medical Care Record states this is the 3rd visit. There are no medical records that show the dates or medical entries of the 1st or 2nd visit. constant bilateral knee pain pain present for 4 weeks no signs of improvement training protocol has failed temperature of 99.0 lt. > rt. RPPS (retropatellar pain syndrome) metatarsalgia rt. ortho II insoles naproxen 500, #20, ecotrin, bengay doesn't want profile, LSC Nov 30,1995 c protected refer to PT for additional knee modalities --------------------------------------------------------------------------------- 8 FEB 96 Basic Training - Physical Therapy Consultation sheet ( 3rd visit listed multiple times on records - where are the notes from 1 and 2nd visit?) constant RPPS, poor tracking which is causing rt. foot metatarsalgia, was on ecotrin, bengay. 3rd visit. Have fitted with Orto II insoles. Please evaluate for knee modalities. 3rd visit Provisional diagnosis: ct > rt. RPPS. Rt. metatarsalgia Consultation report: has constant L knee pain/ R knee pain x 2 1/2 weeks. pt states she was told that she has tendonitis in R knee but L knee feels worse. unknown cause of pain. Agg. marching, run/walk, straightening. L knee + locking / giving way many times. no prior history of knee pain. No x-rays done at this time. SLS/SLT causes ipsilateral knee pain L, R; squats cause L>R knee pain. L knee pain on knee extension and hip flexion. TTP peripatellar region + patella tendon, increase in knee pain while approaching terminal knee extension. RPPS along with possible patella tendonitis ------------------------------------------------------------------------------------------- 13 FEB 96 Basic Training - Chronological Record of Medical Care follow up from 8FEB 96 for L knee pain. RPPS + patellar tendonitis, patient reports no decrease in knee pain. has barely noticeable limp on L, SLS/SLT squat Increase in pain L. knee pain. lateral knee pain. NL AROM. + heel strike on L for pain down L lateral tibial region; TTP at L patellar tendon, L suprapatellar area + patellar region. Xrays appear WNL. L RPPS/ITB syndrome no profile per patient --------------------------------------------------------------------------------------------- 13 MAR 96 AIT - Chronological Record of Medical Care (1 visit and I get a "discussed sick call policy" and threats of malingering? - this makes no sense to me) Profile: no running, jumping, marching x7 days. 0 major medical problems. Discussed sick call policy. ---------------------------------------------------------------------------------------------- 1996-1999 Active duty - multiple visits for "flu-like" conditions, mild fevers. No blood work was done. ---------------------------------------------------------------------------------------------- 1999-2001 pregnancies. All of my reports of joint pain or body aches were ignored and attributed to my 3 pregnancies. ------------------------------------------------------------------------------------------------ 2002 Civilian Dependent - finally had blood work ordered and was diagnosed with Rheumatoid Arthritis and potentially other connective tissue disorders after complaining of knee pain to military Drs. since 1996. ----------------------------------------------------------------------------------------------- 2002-2019 still have ongoing knee issues L and R. provided all records to VA regarding knee issues to include RA, auto-immune hepatits, celiac disease auto-immune issues.

Let me clarify because I must not have been clear in my original post. I have all of my active duty treatments records that I requested on three different occasions over the years (specified both maiden and married name) - straight from the National Archives. I have submitted my active duty treatment records with each claim, along with continued care records from civilian Drs since I became a dependent in 1999, until recently. I requested my records multiple times to see if it was my imagination, did I misplace them somehow or if there were records legitimately missing - would another request show more or less records. The treatment records that I feel are missing from my active duty file relate to multiple visits to sick call, while in AIT - or something that warranted a "discussed sick-call policy" and multiple malingering threats. In my opinion, there would have been more than 1 visit to sick call to have those notations made in my treatment records. The dependent records that are definitely missing are related to 2 pregnancies, hospitalizations, retention of birth material, hemorrhages and subsequent D+Cs. Note: I was denied a claim for negligence / USC 1151? because no evidence could be produced in my records showing the events occurred. I looked in my C-file this evening (that I received on a CD from VA last month). I have filed claims in 2005, 2014, 2017 and 2018. My C-file only contains records from civilian Drs for the 2005 claim - although I have provided records from 2005 to the date of filing, for each claim. The evidence for claims after 2005 do not reference any civilian Dr records. They reference my 2005 claim, denial letters and C&P exam to deny me - but still seem to deny me because my conditions aren't "chronic". I am working on getting a nexus for my vision issues, auto-immune disorders - which all tie into each other as well as the joint pain experienced. I hope this makes sense.

I have provided VA with all active duty service treatment records which show the diagnosis, dependent military medical records and 20 years of civilian medical records for all of my knee claims. I had my entire 373 page C-File sent to me on a CD which shows everything medically that I have submitted previously (except my active duty service treatment records for some reason). I have a buddy statement with dates of service showing we served together and outlining noticeable issues. I have requested my medical records on 3 different occasions and they all have came back with the same records. here is my 2006 decision: Rating Decision Phoenix Regional Office 03/30/2006 NAME OF VETERAN VA FILE NUMBER SOCIAL SECURITY NR POA WENDY RAM IREZ ARIZONA VETERANS SERVICE COMMISSION ACTIVE DUTY FOB RAD BRANCH CHARACTER OF DISCHARGE Army Honorabte LEGACY CODES ADD'LSVC COMBAT SPECIAL FUTURE EXAM CODE CODE PROVCDE DATE None JURISDICTION: Original Disability Claim Received 08/29/2005 ASSOCIATED CLAIM(s): ItO; Initial Live Comp/Pension; 08/29/05 NOT SERVICE CONNECTED/NOT SUBJECT TO COMPENSATION (8.NSC Gulf War) 5002 RHEUMATOID ARTHRITIS Not Service Connected, Not Incurred / Caused by Service 5260 BILATERAL PATELLA TENDON LAXITY/PATELLOFEMORAL SYNDROME Not Service Connected, Not Incurred/Caused by Service 6399-6350 CONNECTIVE TISSUE DISORDER Not Service Connected, Not Incurred/Caused by Service 7345 AUTOIMMUNE HEPATITIS Not Service Connected, Not Incurred/Caused by Service 7345 LIVER CONDITION Not Service Connected, Not Incurred/Caused by Service Represented by: ARIZONA DEPARTMENT OF VETERANS SERVICES Rating Decision March 30, 2006 INTRODUCTION The records reflect that you are a veteran of the Gulf War Era. You served in the Army from December 29, 1995 to February 19, 1999. You filed an original disability claim that was received on August 29, 2005. Based on a review of the evidence listed below, we have made the following decision(s) on your claim. DECISION 1 . Service connection for liver condition is denied. 2. Service connection for autoimmune hepatitis is denied. 3 . Service connection for connective tissue disorder is denied. 4. Service connection for rheumatoid arthritis is denied. 5 . Service connection for bilateral patella tendon laxity/patellofemoral syndrome is denied. EVIDENCE VA form 21-526 Application for Compensation and/or Pension received August 29. 2005 with attached statement in support of claim. VCAA letter dated September 9, 2005. Service Medical Records for the period of service from December 29, 1995 to February 19, 1999. Private medical treatment records from Dr. Elizabeth Chang received September 14, 2005. Statement in Support of Claim received September 20, 2005. Private medical treatment records from Dr. Timothy Walker received September 20, 2005. Private medical treatment records from Dr. Mohammed Siddiqui received October 3, 2005. VA Joints Examination dated November 21, 2005 from the VA Medical Center Prescott. Private medical treatment records from Dr. Alan Bracher received December 6, 2005. Private medical treatment records from Dr. Linda Lau received February 17, 2006. REASONS FOR DECISION 1. Service connection for liver condition. We have denied service connection for liver condition because the evidence of record does not show this condition was incurred in or caused by your military service. Your service medical records were negative for any evidence of a liver condition. Your private medical treatment records from Dr. Lau revealed you were diagnosed with a liver mass in January 2005. however, this diagnosis was established 6 years after your discharge from the military, which is too remote from service to be related to service. Service connection may not be established for the claimed disability unless medical evidence shows it was incurred or aggravated by your military service, which was not shown. Therefore, service connection for liver condition is denied. 2. Service connection for autoimmune hepatitis. We have denied service connection for autoimmune hepatitis because the evidence of record does not show this condition was incurred in or caused by your military service. Your service medical records were negative for any evidence of autoimmune hepatitis. Your private medical treatment records from Dr. Lau revealed the diagnosis of autoimmune hepatitis in March 2005, however, this diagnosis was established 6 years after your discharge from the military, which is too remote from service to be related to service. Service connection may not be established for the claimed disability unless medical evidence shows it was incurred or aggravated by your military service, which was not shown. Therefore, service connection for autoimmune hepatitis is denied. 3. Service connection for connective tissue disorder. We have denied service connection for connective tissue disorder because the evidence of record does not show this condition was incurred in or caused by your military service. Your service medical records were negative for any evidence of connective tissue disorder. You did not submit any evidence which shows you have been diagnosed with a connective tissue disorder since discharge from the military. Service connection may not be established for the claimed disability unless medical evidence shows it was incurred or aggravated by your military service, which was not shown. Therefore, service connection for connective tissue disorder is denied. 4. Service connection for rheumatoid arthritis. We have denied service connection for rheumatoid arthritis because the evidence of record does not show this condition was incurred in or caused by your military service. Your service medical records were negative for any evidence of the diagnosis or treatment for rheumatoid arthritis while on active duty. Your private medical treatment records from Dr. Lau revealed the diagnosis of rheumatoid arthritis in January 2005, however, this diagnosis was established 6 years after your discharge from the military, which is too remote from service to be related to service. Service connection may not be established for the claimed disability unless medical evidence shows it was incurred or aggravated by your military service, which was not shown. Therefore, service connection for rheumatoid arthritis is denied. 5. Service connection for bilateral patella tendon laxity/patellofemoral syndrome. We have denied service connection for bilateral patella tendon laxity/patellofemoral syndrome based on your service medical records and VA exam. Your service medical records show you were seen for complaints of bilateral knee pain in February 1996. Subsequent service medical records were negative for any follow up care or treatment for any knee condition. Although your private medical treatment records from Dr. Chang revealed you were being treated for bilateral patella tendon laxity in August 2005, these records show treatment 9 years after your discharge from the military which is too remote form service to related to service. At the VA exam, the VA examiner reported your gait was normal. There were no constitutional symptoms of arthritis. Range of motion findings for both knees were: 0-140 degrees flexion with pain at 120 degrees, both knees. There was no evidence of inflammatory arthritis. There was subpatellar tenderness and grinding noted both knees. There was no evidence of active synovitis or inflammatory changes noted on the exam. X-rays taken showed no definite bony or joint abnormality. The VA examiner diagnosed bilateral knee pain consistent with non-inflammatory arthralgia. A disability which began in service or was caused by some event in service must be considered "chronic" before service connection can be granted. Although there is a record of treatment in service for bilateral knee pain, no permanent residual or chronic disability subject to service connection is shown by the service medical records or demonstrated by evidence following service. Therefore, service connection for bilateral patella tendon laxity/patellofemoral syndrome is denied. Furthermore, pain in and of itself, without an underlying disease process is not a ratable condition subject to service connection, therefore, the current diagnosis of bilateral knee pain is also denied. You also claimed your bilateral knee condition as secondary to any other service connected disabilities. However, you have no service connected disabilities, therefore, service connection on a secondary basis is not possible. REFERENCES: Title 38 of the Code of Federal Regulations, Pensions, Bonuses and Veterans' Relief contains the regulations of the Department of Veterans Affairs which govern entitlement to all veteran benefits. For additional information regarding applicable laws and regulations, please consult your local library, or visit us at our web site, www.va.gov. Here is my C&P exam: Date: DEC 2,2005 Compensation and Pension Exam Report Page: 1 CARL T. HAYDEN VAMC 644 ** FINAL ** Processing time: 39 For JOINTS (SHOULDER/ELBOW/WRIST/HIP/KNEE/ANKLE) Exam Name: RAMIREZ,WENDY LYNN Address:. City, State, Zip+4: GILBERT ARIZONA. 85296 Entered active service: DEC 29,1995 Released active service: FEB 19,1999 Priority of exam: Original SC Examining provider: FRIEDMAN,DAVID J Examined on: NOV 2i,005 Examination results: SSN: C-Number: DOB: Res Phone: Bus Phone: Last rating exam date: TITLE: COMPE TIOM A1 PENSION EXAM DATE OF NOTE: NOV 21, 2005@08:00 ENTRY DATE: DEC 01, 200508:59:27 AUTHOR: FRIEDMAN,DAVID J EXP COSIGNER: URGENCY: STATUS: COMPLETED INSTITUTION:, PHOENIX DIVISION: VAMC PHOENIX,AZ COMPENSATION AND PENSION EXAMINATION JOI1TS (SHOULDER/ELBOW/WRIST/HIPJNNEE/ANKLE) REVIEW OF MEDICAL RECORDS MEDICAL RECORDS WERE: Available and Reviewed CLAIM FILE WAS: Available and Reviewed COMMENTS: serologies performed while active service not aiai1àle to me. SUMMARY OF PROBLEM SPECFIC TEMPLATE PROBLEM: bilatarel knee pain PATE OF ONSET: 1996 CIRCUMSTANCES AND INITIAL MANIFESTATEONS: Patient complaining of bilateral knee pain starting in 1996. She complains of popping and clicking alid swelling at times. She complains of morning stiffness. She has had a evaluation with for auto-immune condition beginning in approx 2002 without any known dx except she has had a Continued on next page C&P Final Report Page: 2 Name: RANIREZ,WENDY LYNN For JOINTS (SHOULDER/ELBOW/WRIST/HIP/KNEE/ANKLE) Exam Exam Results Continued positive ana. She saw rheumatology and in 2004 and was without any particular dx as well.. COURSE SINCE ONSET: Stable CURRENT TREATMENTS: Medication (NSAIDS) CURRENT TREATMENT SUMMARY: ibupofen 800 mg pm naproxen in past - SIDE EFFECTS OF CURRENT TREATMENT: No ADDITIONAL COMMENTS: medications not helpful * *. * * * * * * * * * *. * * * * * * * * * MEDICAL HISTORY HISTORY OF HOSPITALIZATION OR SURGERY: No HISTORY OF TRAUMA TO THE JOINTS: No HISTORY OF NEOPLASM: No DOMINANT HAND: Right DETERMINED BY: Veteran's statement ARE ASSISTIVE AIDS NEEDED FOR WALKIMG: No ARE TERE CONS1ITUTIONAL SYMPTOMS OF ARTHRITIS: No ARE THERE INCAPACITATING EPISODES OF ARTHRITIS: No ARE THERE FUNCTIONAL LIMITATIONS ON STANDING: Yes STANDING LIMITATIONS: Able to stand for 15-30 minutes, AR THERE FUNCTIONAL LIMITATIONS ON WALKING: Yes WALKING LIMITATIONS: Able to walk 1/4 mile DESCRiBE ANY OTHER SIGNIFICANT HISTORY: her limitations on, standing and walking are defined by ain. PHYSICAL EXAMINATION IS A WEIGHT-BEARING JOINT AFFECTED: Yes DESCRIBE GAIT: NOrmal RANGE OF MOTION SUMMARY: Continued on next page VA Form 2507 C&P Final Report Page: 3 Name: RAIVIIREZ,WENDY LYNN SS'T: For JOINTS (SHOULDER/ELBOW/WRIST/HIP/KrTEE/ANKLE) Exam Exam Results Continued SIDE: Right JOINT: Knee T.YPE OF MOTION: Flexion ACTIVE MOTION AGAINST GRAVITY: 0 TO 140 DEGREES PAIN BEGINS AT: 120 DEGREES PAIN ENDS AT: 140 DEGREES ADDITIONAL LOM ON REPETITIVE USE: No * * * * * * * * * * * * * * * * * ,* * * * * * * * * * * * * * SIDE: Right JOINT: Knee TYPE OF MOTION: Extension ACTIVE MOTION AGAINST GRAVITY: 0 TO 0 DEGREES PAIN BEGINS AT: DEGREE PAIN ENDS AT: DEGREES ADDITIONAL LOM ON REPETITIVE USE: No * * * * *.* * * * * * * * * * * * * * * * * * * * * * * * * * SIDE: Left JOINT: Knee TYPE OF MOTION: Fiexion ACTIVE MOTION AGAtNST GRAVITY: 0 TO 140 DEGRES. PAIN EGINS AT: 120 DEGREES PAIN ENDS AT: 140 DEGREES ADDITIONAL LOM ON REPETITtVE USE: No * * * *,* * * * * * * * * * * * * * * * * * * * * * * * * * *: SIDE: Left JOINT: Knee TYPE OF MOTION: Extension ACTIVE MOTION AGAINST GRAVITY: 0 TO 0 DEGREES PAIN BEGINS AT: DEGREES PAIN ENDS AT: DEGREES ADDITIONAL LOM ON REPETITIVE USE: No ******************************* IS THERE LOSS OF A BONE OR PART OF .A BONE: No ARE THERE RECURRENT SHOULDER DISLOCATIONS: No INFLA1IMATORY ARTHRITIS: No IS THERE JOINT ANKYLOSIS: No SUMMARY OF GENERAL JOINT CONDITIONS CONDITION: Crepitus, Painful Movement SIDE: Right Continued on next page C&P Final Report Page: 4 Name: RANIREZ,WENDY LYNN SSN: For JOINTS (SHOULDER/ELBOW/WRIST/HIP/KL'TEE/ANKLE) Exam Exam Results Continued JOINT: Knee BUMPS CONSISIENTT WITH OSGOOD-SCHLATTE5 DISEASE: No CREPITATIOI: No - MASS BEHIND IEE: No CLIC(S OR SNAPS: No GRINDING: 'Yes INSTABILITY.: No PATELLAR ABNORMALITY: Yes TYPE OF PATELLAR ABNORMALITY: Subpateilar Tenderness MENISCUS ABNORMALITY: No RANGE OF MOTION TYPE OF MOTION: Extension ACTIVE MOTION AGAINST GRAVITY: 0 TO 0 DEGREES PAIN BEGINS AT: DEGREES PAIN ENDS AT: DEGREES ADDITIONAL LOM ON REPETITIVE USE: Np. * ** * *** * * ** * *-* ** ** * CONDITION: Painful Movethent SIDE: Left JOINT: Knee CREPITATION': No CLICKS OR SNAPS: No GRINDflG:. Yes INSTABILITY: No PATELLAR ABNORMALITY: Yes TYPE OF PATELLAR ABNORMALITY: Subpatellar Tenderness MENISCUS ABNORMALITY: No * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ,* * * * * * * * * DESCRIBE ANY OTHER SIGNIFICANT PHYSICAL FINDINGS,: There is io evidence of active ynovitis or inflammatory changes on exam. TESTS WERE ALL TEST RESULTS INCLUDED ON THE EXAMINATION REPORT: Yes X-RAYS: Clinical HistOy: bilateral knees- history of knee pain with service. Has mild hepatic inflammation on bx, please look for inflammatory arthritis changes. Continued on next page C&P Final Report Page: 5 Name: PAMIREZ,WENDY LYNN SSN: For JOINTS (SHOULDER/ELBOW/WRIST/HIP/KNEE/ANKLE) Exam Exam Results Continued Report Status: Verified Date Reported: NOV 21, 2005 Date Verified: NOV 21, 2005 Verifier E-Sig:/ES/HERMENEGILDO Ii ALMARIA JR Report: Impression: Three views of the right and left knee show no definite bony or joint abnormality. Primary Diagnostic COde: Primary Interpreting Staff: HERMENEGILDO H ALMARIA JR, Staff Radiologist (Verifier) /HHA DIAGNOS IS SUMMARY OF ALL PROBLEMS, DIAGNOSES ABD FUNCTIONAL EFFECTS: PROBLEM: bilatarel knee pain DIAGNOSIS OR TIOLOGY OF THE PROBLEM: bilatarel knee pain- cOnsiteht with noñ-ihflammatory arthta1gia possible patellar-femoral syndrome. EFFECTS OF THE PROBLEM ON OCCUPATIONAL ACTIVITIES GENERAL OCCUPATIONAL EFFECT: Significanb Effects THIS DISABILITYT S IMPACT ON OCCUPATIONAL ACTIVITIES: Pain RESULTING WORK PROBLEM: DESCRIBE OTHER SIGNIFICANT EFFECTS: ARE THERE EEFECTS OF THE PROBLEM ON THE FOLLOWING DAILY ACTIVITIES: CHORES: Mild SHOPPING: Mild EXERCISE: Mild SPORTS: Mild RECREATION: None TRAVELING: None FEEDING: None BATHING: None DRESSING,: None TOILETING: None GROOMING: None DESCRIBE OTHER EFFECTS: C&P Final Report Page: 6 Name: RAMIREZ,WENDY LYNN SSN: For JOINTS (SHOULDER/ELEOW/WRIST/HIP/KEE/ANKLE) Exam Exam Results Continued ADDITIONAL COMMENTS: This veteran is concerned that she has an autoimmune disease. She has. had an extensive work up with various rheumatologist but no particular dx has been establihed at this point. However, she did have mild inflammatory changes on a liver bx done intraoperatively in 2005 for gallbladder disease. She was active service from 1995-1999. Her sedimentation rate measured in 2005 was 5: which indicates no. wide-spread generajized inflammation in her body, but she is still insistent that her aches/pains today are related to her situation and hé ad es/pains when active duty. Wha is interesing is. th,t she had a C4 level which was depressed/decreased on a receht evaluation by Dr. Chàng, (private rheumatologist) in 2005. I was only asked to evaluate her current knee: condition but if her claim of this autoimmune disease persists, I recommend seeing a rheumatologist ratings exarr!. MEDICAL OPINION WAS AN OPINION REQUESTED: No /es/ DAVID J FRIEDMAN, MD ALLERGY! IMMUNOLOGY Sighed: 12/01/2005 08:59 Name: RAMIREZ,WENDY LYNN Entered active service: DEC 29,1995 Released active service: FEB 19,1999 >>> Future C&P Appointments <<< No future C & P appointments found. Requested exams currently on file: JOINTS (SHOt3LDER/ELBOW/WRIST/HIP/EE/ANKLE) Requested on OCT 21,2005@13:30:15 by PHOENIX-RO - Open This regüest was initiated on OCT 21,2005 at 13:30:15 Requester: FLEMING,SONYA A Requesting Regional Office: PHOENIX-RO VHA Division Processing Request: PHOENIX Exams on this request: JOINTS ** Status of request: New No rated disabilities on file Other Disabilities: General Remarks: CLAIMS FILE BEING SENT FOR REVIEW BY THE EXAMINER. Veteran claims service-connection for: -- bilateral patella tendon laxity/patellofemoral syndrome -4. State to what extent (if any) and in which degrees (if possible) the range of motion or joint function is additionally limited by pain, fatigue., weakness, or lack Of endurance following repetitive use, if more than one of these is present, state, if possible which has the major functional impact. I.f there is additional functional loss due to any of the before mentioned criteria, please tell us he amount of additional fundtional loss in terms of degrees of range of motion. Also, if there is no pain, fatigue, weakness or lack of endurance following repetitive use, please clearly state which of these are not present. )

Hello everyone! I would like your thoughts and opinions on my claims. Sorry that this is long. This issue spans back to 1997. I hope someone can provide insight to what I am doing wrong and can assist me. I have highlighted my specific questions. I have been denied 3 times since 2005 for patellafemoral / chondromalacia, rheumatoid arthritis. All of the results of my claims come back not service connected - which confuses me. I was in the Army from 1995-1999. During my 5th week of basic training I have a documented diagnosis of metatarsalgia, retropatellar pain syndrome, constant bilateral knee pain, patellar tendonitis, ITB syndrome and a "possible connective tissue disorder". Other symptoms and diagnoses were: tenderness to palpitations on peripatellar region, poor tracking of knee, positive heel strike, locking and giving way many times, aggravated by marching, running, walking, straightening, no prior history of knee pain, ipsilateral knee pain, barely noticeable limp, pain on the lateral tibial region, pain on subpatellar and peripatellar region, knee pain on extension and hip flexion, increase in pain while approaching terminal knee extension, with a mild 99.0 fever at each visit. My xrays showed within normal limits. No MRIs, ultrasounds or blood work was performed - except pregnancy tests each time I went to sick call. This was over a period of 3 clinic visits (3 weeks) and 3-4 physical therapy visits. I was prescribed shoe orthotics, Naproxen and Ecotrin. The last entry during basic training states no sign of improvement, bilateral knee pain. In basic training, I denied a 7-day profile, 2 times, because I was threatened with being recycled, and at each clinic visit with malingering and being discharged if I continued to complain of knee issues. When I returned to duty after sick-call, I was forced to do exercises as punishment for missing training and PT that consisted of squats, mule kicks, running multiple laps around the building, doing high-knees while jogging, side to side ice-skaters, deep lunges, running in place and performing one-leg squat stands for close to 1 hour. If I complained, cried or cried out in pain, more punishment was added: planks, jumping jacks and holding a dummy rifle outstretched in my hands, while in a deep squat. I didn't go back to sick call again because each time I asked, I was either denied outright or only allowed to go after PT. When I did go, I was punished which brought more knee pain and stress upon myself. When I got to AIT, I went back to sick call for the same knee issues and to get more medication - here is where it gets interesting. There is only 1 record of any of my visits while in AIT. I have requested records 3 times since 2005 and there is only 1 record. This record does not describe any treatments, no diagnosis, only the profile which states no running, jumping, marching for 7 days, "discussed sick call policy", 0 major medical problems and a notation of LSC Nov 30, 1995 C protected, accused of malingering again, with a plan of return to training. If discussed sick call policy was an issue - wouldn't that be reason to assume to VA rater that I went more than 1 time? I know I went several times. Why wouldn't there be any examination records? After AIT, I did not go to sick call for my knees again because I didn't want to be discharged. I self-medicated with Motrin, ice packs, heating pads for the rest of my service to Germany and 2 tours to Bosnia and Hungary. Motrin and prescribed anti-inflammatories use caused diagnosed vision issues starting in 1997. I just filed a claim 2 days ago. I chaptered out of service in 1999 due to pregnancy. I was not given a medical, dental or vision exit examination and no counseling on VA benefits. I was out-processed fast. I was told since I would be a dependant of a soldier, that my continuity of care would continue at his base and not to worry about anything. I didn't know any better at the time. Now, I know that not having an exit medical exam has apparently screwed me from any disability claims and receiving any ratings. In 1999, 2000 and 2001, for 3 pregnancies at 3 different bases, I complained to my military OB Drs about all-over joint and knee pain, continued mild fevers and fatigue. They blew me off and said it was normal with pregnancy, that I was gaining weight which put stress on my tendons and ligaments and causing them to stretch and that I was going to be tired. I accepted that and trusted the Drs. I have 0 medical records regarding my pregnancy, hospitalizations, hemorrhages after each pregnancy and subsequent D+Cs. They are missing. No records requests have produced them. After my last pregnancy in 2001, I was still having the same issues with joint pain. I finally got blood work done. They found that I had Rheumatoid Arthritis and other potential connective tissue disorders. I had no previous auto-immune issues prior to service. I have no family history of auto-immune issues. I continued on with care as a dependent until 2004 when my husband ETSd from Ft Knox to Phoenix, AZ. When he ETSd, he received a VA briefing and an exit medical. He found out about VA benefits. Of course we were stumped on why this didn't happen for me or I would have filed in 1999. I applied at VA for health care. I was denied treatment at VA hospital in Phoenix, AZ because I did not have any current disability ratings, we made too much money and already had private health insurance. With the help of a VSO, I submitted a claim for my knee issues and Rheumatoid arthritis in 2005. I had a C&P exam in 2005. The examiner determined that I had bi-lateral knee pain consistent with non-inflammatory arthralgia, pain and grinding on both knees, subpatellar tenderness, had a range of motion to 140 degrees but pain at 120. I should be sent to Rheumatology because I mentioned a diagnosis in 2001 (didn't happen). It said that although there are treatments in active service notated, yet subsequent records were negative for any follow up care or treatment for any knee condition. A condition has to be considered "chronic" before service connection can be granted. Wouldn't 4 documented times going to sick call, being threatened with malingering/discharge, being prescribed medication, orthotic insoles with physical therapy, a profile and no improvement be considered "chronic"? Any other civilian records provided for the claim were dismissed stating "were too remote from service to be related to service". No permanent or residual or chronic disability subject to service connection is shown by the service records or demonstrated by evidence following service. Furthermore, pain in itself, without an underlying disease process is not ratable condition subject to service connection. Therefore, the current diagnosis of bilateral knee pain is denied. Bilateral patella tendon laxity/patellafemoral syndrome is also denied. No NOD or appeal was filed at the suggestion of VSO. I filed again in 2006 with more knee evidence and treatments. VSO said to file claim under 38 USC 1151. I was denied. No NOD or appeal was filed at the suggestion of VSO. I filed again in 2014 for painful joints, bilateral inflammatory arthralgia, bilateral patella tendon laxity/patella femoral syndrome, degenerative arthritis, orthopedic condition, right knee condition, left knee condition. I was not provided an examination. I was denied. No NOD or appeal was filed. I have a chain of records spanning since 1997-present showing knee issues and joint pain. I had a knee replacement in 2017 and a revision surgery in 2018. I have been diagnosed with 2 additional auto-immune issues since 2007. I have submitted buddy statements, my own statement of claim and a million medical records. None of my Drs except an allergy and eye dr will write a nexus letter or do a DBQ. I am not sure what else to do. Do I need a lawyer? My previous VSO did not want me to appeal anything or do a NOD upon receiving a denial. Can I do anything with these old claims? They just recently said to reopen the 2005 claim with a new form of supplemental evidence showing the issue progressed to needing a knee replacement. If I didn't appeal it back then, how can I reopen it? If it wasn't service connected, then would the new patellafemoral and pain "Saunders" case help me for reopening a claim from 2005 or should I just file a new claim? in 2017, I filed for personal trauma, depression and anxiety relating to pain. That claim was denied with no service connection and because of no currently disabilities. I did not have a mental health or C&P exam. I received a phone call from VA asking me about sexual trauma. The claim denial said no stressor was found to cause mental health issues and that I had no current diagnosis. The VSO wants me to get a mental health evaluation regarding chronic pain over the past 20+ years causing depression and anxiety when going to the Drs, having issues reporting pain or medical conditions and "sucking it up" until I cause more damage to myself. I see all these veterans on here with ratings for patellafemoral and other issues. I am frustrated that I cannot get another examination or get any service-connection at all - when there are obviously issues reported while in service. Any claim that I file (regardless of the issue filed) - they reference the 2005 C&P exam that was only for my knees and I am denied. I am sitting down with DAV, the new VSO in October to go over everything previously submitted regarding my knees. If none of my civilian Drs over the past 20 years wont provide a nexus letter or DBQ, (although I have a current diagnosis) how can I correlate rheumatoid arthritis to the knee pain, all over joint pain and low-grade fevers? How can I win the patellafemoral that is still present in my right knee? If my left knee is now replaced, but it had patellafemoral and arthritis prior to the replacement, would that even be rateable now? If anyone would like to provide assistance, I would greatly appreciate it.