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Riply

Seaman
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About Riply

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  • Military Rank
    SP4
  • Location
    Georgia

Previous Fields

  • Service Connected Disability
    80%
  • Branch of Service
    USA

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  1. Thanks for that. Very concise and more on point with what I inquired about. So, if the new medical opinion agrees with my IMO, the VARO will render a rating decision and I should be out of the woods. (Hoping for no SSOC.) My attorney did say it was not likely that any Dr. (even hired by the VA) would take the time to find some medical evidence to dispute the already submitted supporting medical evidence provided by my IMO. Looking good, so far. (Maybe.)
  2. Unfortunately, I don't have scan/print capabilities. I copied the pertinent part verbatim by entering it manually. I agree with your reference to interpretation. I'm very accustomed to legalese, and often forget that many people are not. I have tried to smooth it over, and people keep kicking me.
  3. "Suggestion 1) you say in one post you "lawyered up". Okay, if so why are you asking a group of Internet strangers to pony up opinions when you are paying a lawyer for their advice? It suggests you don't trust your lawyer. Considering the frustrated and combative posts from you about an opinion offered, it also suggests you may not like the advice that lawyer gave you." I worked for a law firm for 15 years. Lawyers will never anticipate any outcome, which is why I asked those who have been through this, just to get an idea. This is NOT an indication that I don't trust my attorney, it's an indication that no attorney is going to guess at what may happen since, if it doesn't happen, the client generally feels misled. It has nothing to do with mistrust. "We can only read what you wrote. What you consider "clear" is not always clear based on what you write." What I wrote was clear. The medical evidence was submitted to the VA by a private physician (IMO). Nowhere did I even imply that I personally submitted the medical evidence. I specifically stated it was provided by the IMO Dr. No confusion as to clarity there. " ... look into yourself as to why you feel attacked or feel the need to strike out at that poster ... " I didn't feel "attacked" and never suggested that I did. My only "strike" at the poster was how he drew the conclusion that I had submitted the medical evidence when it was patently clear that I had stated it was provided by a medical doctor. I subsequently apologized to that person, and I fail to see where you think you're so much superior to me that you have a need to continue the narrative and chastise me for something I've already acknowledged and apologized for. I was a bit out of line, I recognized that, and I apologized. So, you decide to keep kicking me over it ? "Suggestion 2) if you do want people here to offer opinions on things like a BVA decision, it is really in your best interest to redact that decision letter and post it. That way the people here can read exactly what is said without any filter you may or may not intend to apply to it." I posted a verbatim excerpt from the pertinent part of the remand ruling. I also quoted specific content directly from the notice before posting the verbatim excerpts.
  4. I did apologize (it's above). Thank you for being Hall Monitor. Your sarcasm is noted. So is your insult.
  5. Yes, the Dr. I had was very thorough. He managed to link a knee injury to lower back, to cervical strain, to lower limb sciatic neuritis, to right arm radiculopathy, and now trying to link the vertigo. His Nexus letter met all the requirements of Caluza, as he did a thorough physical examination (it took 6 hours, believe it or not). The VA actually diagnosed vertigo (through their expert) in 2016, but it was denied as service connected at that time, since the only granted disabilities I had at that time were left knee, hearing loss, and tinnitus. In the current remand order, the BVA specifies that they accept the VA's diagnosis of vertigo. It's now just a matter of connecting that to everything else, specifically, the cervical strain (now part of my current disability). My appeal was filed prior to Feb 2019, but we already got to the BVA before AMA was initiated, so there wasn't much point in opting in, since we're already there. My appeal included the medical evidence and nexus from the private physician. If the VA's new physician review agrees with the existing (submitted) evidence, I should be good to go.
  6. I "lawyered up" from the very beginning. At the very start, I had a private physician submit a Nexus letter and medical evidence to support that (Caluza qualified). As I said early on, there were 9 claims, all tied together by the Nexus letter (Caluza). Initially, 4 were granted and 5 were deferred. After a few months, 3 more were granted and 2 were denied. This brought me from 30% to 60%, then to 80%. One (the vertigo) is under consideration. The last one will follow if the vertigo is granted (Permanent and Total). P&T was deferred, pending the outcome of the vertigo issue. My attorney says if vertigo is granted, P&T will follow. We opted in for the BVA consideration without a hearing. I don't understand the whole process, but I was told that the date of my appeal dictates what system of appeal (the old system, RAMP or AMA) I can use. All evidence was already submitted at that time. There is nothing further to offer up. (Unless the new VA examiner rebuts my expert's opinion.) Anyway, thanks to everyone for the input.
  7. I apologize, brother. I was not intending to attack you. I got a bit frustrated that maybe you didn't understand when the BVA says "the Veteran has provided" something, they mean the Veteran's private physician (IMO expert), not the Veteran himself. I didn't provide anything. The private physician did. I didn't opine about any medical evidence, the private physician did. I DO thank you for trying to help. I'm pretty sure my private physician (IMO expert) covered all the bases: Cervicogenic vertigo 12. Peng B. Cervical Vertigo: Historical Reviews and Advances. World Neurosurg. 2018 Jan;109:347-350. doi: 10.1016/j.wneu.2017.10.063. Epub 2017 Oct 20. Review. PubMed PMID: 29061460. 13. Li Y, Peng B. Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo. Pain Physician. 2015 Jul-Aug;18(4):E583-95. Review. PubMed PMID: 26218949. 14. Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother. 2017 Sep 12;7:12. doi: 10.1186/s40945-017-0040-x. eCollection 2017. Review. PubMed PMID: 29340206; PubMed Central PMCID: PMC5759906. 15. Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther. 2000 Dec;30(12):755-66. Review. PubMed PMID: 11153554. 16. Jung FC, Mathew S, Littmann AE, MacDonald CW. Clinical Decision Making in the Management of Patients With Cervicogenic Dizziness: A Case Series. J Orthop Sports Phys Ther. 2017 Nov;47(11):874-884. doi: 10.2519/jospt.2017.7425. Epub 2017 Oct 9. PubMed PMID: 28992773. 17. Magnusson M, Malmström EM. The conundrum of cervicogenic dizziness. Handb Clin Neurol. 2016;137:365-9. doi: 10.1016/B978-0-444-63437-5.00026-1. Review. PubMed PMID: 27638084.
  8. Finally, something that makes sense and doesn't depart from what I actually have been saying. I did not provide my own medical literature with my own opinion. It was provided by a DOCTOR to support HIS opinion. The VA's expert (Nurse Practitioner) cited literature, but didn't actually include any literature. The BVA has remanded to the VARO and demanded the VARO get a DOCTOR to look at the file and render an opinion. From the remand order (bold and italics also appear in the actual order for remand): "Send the claims file to an appropriate physician to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current vertigo condition was (a) caused, or (b) aggravated (i.e., worsened beyond its natural progression), by a service-connected disability, to include cervical strain. In offering the opinion, the examiner is asked to consider the opinion and medical literature provided by the Veteran's private physician in (month/day/year). The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings." Note that cervical strain is part of my granted disability (and rated). It seems, also, that the BVA emphasized "physician" as they were not satisfied with the unsupported opinion of the nurse practitioner. The notice I got from the VARO specifies that the file has been submitted to (Dr.'s name) for evaluation and opinion and that NO EXAMINATION WILL BE REQUESTED.
  9. I did not provide the medical literature, nor did I opine what it meant. My post CLEARLY states that was provided by my own IMO (medical expert). Why are we arguing over something I didn't even say ?
  10. The thing is, the BVA refers to everything in an appeal as being provided by the Veteran, even if it is provided by a Veteran's representative specialist. It is the Veteran filing the appeal, not the specialist. So, there are TWO parties to the appeal - The Veteran and the VA. Any representative (medical expert) provided medical evidence is considered to be coming from the Veteran. Broncovet is just taking this too literally. I quoted the BVA remand order, and to avoid any further confusion, here is an excerpt verbatim: "The Veteran asserts that he has a current diagnosis of cervicogenic vertigo that was aggravated by his service-connected cervical spine disability, and submitted a private physician's positive etiological opinion and supportive medical treatise evidence (month, day, year). The RO denied the Veteran's claim based on the (month/day/year) opinion of a VA medical examiner who determined that the Veteran's vertigo was less likely than not related to any service connected disability, noting that cervicogenic vertigo is a separate, unrelated entity, and that medical literature does not support such a relationship. In finding the (month/day/year) opinion to be more probative than the Veteran's private physician, the RO noted that its decision was based on a thorough review of the Veteran's relevant military and/or personal history and contained a more convincing rationale." "The Board disagrees with the RO's characterization of the (month/day/year) examiner's opinion. Importantly, the examiner went no further than to provide the limited opinion that the Board notes above, with no actual medical literature referenced, to include numerous medical treatises submitted by the Veteran in (month/day/year). It must also be noted that the (month/day/year) opinion simply states as rationale that cervical spine disabilities can aggravate vertigo with no reference to the specific facts in this case. As such, the Veteran's case must be remanded to obtain additional medical opinion that fully addresses the Veteran's contentions and his supporting evidence."
  11. What are you not understanding ? My IMO (medical professional) provided the medical literature NOT ME. It was provided in support of his opinion that the vertigo WAS service connected. Your entire diatribe suggests that I was the one providing medical evidence. Nowhere did I even suggest that I had submitted that. I didn't cite the medical evidence, the Dr. did. My original and following comments ALL state specifically that the Dr. (my IMO) submitted the medical literature in support of his opinion. How can you possibly get lost in that ? What I am also saying is the the VA's expert (a nurse practitioner) stated that medical literature supports her opinion that the vertigo was NOT service connected, but she did not provide any medical literature. She only referred to some phantom medical literature without citing it. This is why the BVA remanded. The Veteran's medical expert provided medical literature to support his expert opinion about service connection of the vertigo. The VA's medical expert referred to medical literature but did not provide any. How did you end up on the opposite end of the spectrum ?
  12. First, I am not trying to appeal the remand. That's not the issue. I'm actually glad that it was remanded. Second, the notice from the VARO said that my file was being sent to Dr. (name) for review and that NO C&P EXAM IS BEING REQUESTED. The reason given by the BVA for the remand is that the VARO denied the claim stating that the examiner's assessment "contained more convincing rationale" than that provided by the Veteran that the vertigo was not service-connected. "The Board disagrees" is what the remand order says. The NP did not provide ANY medical literature (cases) to support her claim of "less likely", whereas, the Veteran (in an IMO attached to the appeal) did contain medical literature (treatise) to support the service-connection of the vertigo. So, essentially, my guess is that the Board is saying the Veteran presented medical literature, along with medical opinion (IMO) that the vertigo was service-connected, whereas the VARO's examiner provided ONLY an opinion that it was not, and did not support that opinion with medical literature at all. Thus, the board is saying it does not agree that the VARO's examiner's opinion "contained more convincing rationale" to deny than the Veteran's IMO opinion supported by medical literature (evidence) did. In a nutshell, the NP opined the vertigo was not service-connected with no medical treatise to support that opinion other than SAYING that medical literature supports her opinion. The Veteran's IMO opined the vertigo WAS service-connected AND submitted medical literature to support that claim. The Vet's IMO said service-connected with medical literature to support that. The VARO's NP said NOT service-connected based on medical literature but didn't provide that medical literature. In other words, the NP said she had medical literature to say NOT service connected but didn't provide that medical literature. The Vet's IMO said service-connected and provided medical literature to support that. I think the BVA is saying "if the VARO's expert says not service-connected based on medical literature, where is that medical literature ?". "The Veteran says service-connected based on medical literature AND provided that medical literature."
  13. As I said, I already submitted an IMO/IME opinion with my appeal. The reason the BVA remanded was because the VA's NP opined that vertigo was present but "less likely than" service connected without supplying any medical treatise to support that opinion. Let me try this again. (Quoted sections are directly from the BVA's remand order.) The VARO denied vertigo claiming that the NP "determined that the Veteran's vertigo was less likely than not related to any service connected disability, noting that cervicogenic vertigo is a separate, unrelated entity, and that medical literature does not support such a relationship." The VARO further noted it's decision "was based on a thorough review of the Veteran's relevant military and/or personal history and contained a more convincing rationale." "The Board disagrees with the VARO's characterization of the examiner's opinion." This suggests that the BVA does not agree that the NP's opinion outweighs the Veteran's IMO opinion, which WAS supported by medical treatise, as opposed to the NP's opinion, which WAS NOT supported by medical treatise. In short, the NP is claiming that "medical literature does not support" a service connected relationship, WITHOUT even providing any medical literature being used to arrive at that opinion. We fed the Goriya at the start with our IMO including the medical treatise. The NP offered to feed the Goriya, but brought nothing to eat (no medical treatise to back up her opinion). Here is the directive given by the BVA on the remand order: "Send the claims file to an appropriate PHYSICIAN to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current vertigo condition was (a.) caused, or (b.) aggravated (i.e. worsened beyond its natural progression), by a service-connected disability, to include cervical strain. In offering the opinion, the examiner is asked to consider the opinion and medical literature provided by the Veteran's private physician in (date)." It should be noted that the VA has already granted and rated "cervical strain with IVDS" as service-connected. Cervicogenic vertigo is a direct result of cervical strain with IVDS. Thus, if cervical strain with IVDS is granted and rated, then it makes sense that vertigo, which was acknowledged by the VA (but not granted/rated) would be related and would be service-connected as well. All that being said, back to my actual question - all I was asking was is it a good sign that the BVA remanded to the VARO and the VARO sent the file to a physician within days rather than months ? Thanks for everything from everybody.
  14. I do have my Cfile, yes. My IME is a retired Navy MD and now a retired civilian MD. His opinions (DBQ's) were supported by medical treatise. He did review my file and indicated that on the appeal. His CV is extensive. He also provided a Nexus for all related disabling conditions associated with the original service-connected injury on active duty. There were a total of 9 claims, 7 of which the VA has granted, raising me from 30% to 60%, then 80% in a matter of 10 years. The 60% to 80% happened in just 4 months. VA was holding back the vertigo and hypertension claims. They don't seem to be moving on the hypertension claim, but are on the vertigo claim. The original IME on the vertigo (not my expert, but the VA's expert) was a Nurse Practitioner. She opined that the vertigo was "less likely than not" SC but did not provide any medical evidence to support that claim. The VARO had originally requested her to do so, but she did not respond to that request at all. This is why the VARO just denied, resulting in the appeal. The BVA specifically, in the remand ruling, stated that the VARO characterized the IME's opinion as more probative than the Veteran's IME, and that the VARO declares that the IME's opinion "contained more convincing rationale" as to whether the vertigo was service-connected. The BVA ruled that "the Board disagrees" with the RAVO's assessment of the IME's opinion since that opinion contained no rebuttal medical evidence contradicting the Veteran's medical evidence. The interesting thing is that the physician the VARO is now sending the file to for a medical opinion is an MD who was VA's IME for several other claimed disabilities, and who had found in my favor for those after examination. This MD was not asked, at the time, to evaluate the vertigo, but the VARO had, instead, sent that to a Nurse Practitioner as a separate exam and C&P. Now the VARO is sending the file for evaluation of the vertigo service-connection to the same MD that ruled favorably for me on other claims. Although this MD did not, in her C&P (DBQ) address vertigo, because she wasn't asked to, she did address "symptoms" that would be indicative of vertigo (cerebellar gait, etc.). It's wishful thinking, but it seems she'd review what she submitted before and likely support the claim of vertigo as having a nexus to the other claims she ruled favorably on earlier.
  15. I'm new to this site and forum. After several years of struggling, I finally reached 80% SC March 2018, but have appealed other issues that were denied. More specifically, I have SC hearing loss and tinnitus. Other disabilities have been granted, but rated rather low, and those are under appeal as well as vertigo. A week ago, I got a copy of the BVA finding and order of remand to the VARO. In that order, the BVA directed the VARO to obtain a "physician's" assessment of the record as to whether the vertigo was "as likely as not" service connected, as it relates to granted SC for cervical IVDS. My claim for vertigo is "cervicogenic" and not the more common BPPV Vertigo. I had a private physician (expert in VA claims) provide numerous medical treatise associating my granted SC disabilities with the cervicogenic vertigo. When I had the C&P for the vertigo, it was conducted by a NP, not an audiologist, and not a physician. It seems the NP did not provide any rebuttal medical treatise to indicate the cervicogenic vertigo was "less likely as not" SC, which is what she reported on the DBQ / C&P. Here's my question, though. Within a few days of getting the remand notice from the BVA, I get a notice from the VARO that my file has been sent to a physician for review, but no exam will be requested. That quick? Is that a good sign? I really expected the case to be remanded, then sit for another few months before the VARO sent the file to a physician.
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