dav_marine72

Hi Everyone, I just got my hearing date set for July. If I am successful at the hearing does anyone know the time frame to get a decision and back pay? Thanks.

Hey Berta, I'm looking at BVA cases from 2009 and they are shooting down every Veteran asking for SMC (s) saying they don't have a single 100% disability as the RO did to me. Looks like it might need to go to the CACV to be resolved.

Thanks for everyone's posts. Berta - My rep had never heard of it. I found it on my own. They gave me a one sentence wording: Your grant of IU was based was based on multiple service connected disabilities and therefore does not qualify as a "single 100%" disability.

Sorry in advance for spelling I can't cut and past in this forum. Many people state the VA is out to get them and people think they are nuts. I am a realist and know the VA seems to be for the most part againist all of us. I have worn out my welcome at my VARO. I am seriously considering moving to another state because of the BS. I do admit at times they have given me some good things. Then again my evidence is so strong I guess they need to make it look like they are not totally againist me. Here is the latest: In March of 2009 after a failed 3 level fusion in my back I recieved TDIU. One would say finally! Believe me I understand that getting TDIU was a blessing and I'd be screwed without it because I can't work. Always strings attached with me. The VARO rated me P&T and gave me total + 60% based on the fact I have 10 service connections (I'm 90% by schedule) and I worked until I just could not sit or stand for the day anymore. My service officer calls me with the news. I was overjoyed. Not only did I finally not have to appeal something I was getting an extra $300 or so and of course medical for my wife and small children. I feel guilty all the time because I feel like I'm not a real dad or husband based on all I can't do. Here comes the kicker. I finally recieve the true paperwork on my decision. No P&T, no SMC (s). I call my SO and ask him what is going on. He looks at his paperwork and says it shows P&T and SMC (s). He says let me go up and talk to the VARO manager. The VARO manager tells him after the rating board reviewed my case they decided my 13 year two failed surgery back could possibly get better so they took away P&T and I don't rate SMC because I am TDIU and not a single 100%. Then my SO says he has had this back injury for 13 years, he done over 10 nerve blocks, he has muscle wasting and atrophy of all the muscle groups in his legs, he has had two surgeries that failed including the latest L3-S1 fusion, he is rated 50% for mental and 30% for asthma in addtiona to the 50% back and all the other service connections. My SO says well we are going to appeal this. The DRO (sorry it was a DRO not a manager) tells my SO I'm going to have to deny it because I have to deal with the raters everyday. If I rate againist them there will be trouble. So I appeal anyway and ask for P&T and an explanation of why they cannot award it if they deny me again, I ask for A&A because of all the drugs I am on and the problems they cause, I also ask for SMC (s) back (terminated after the temp 100% for the surgery) based on the CAVC's decision in Bradley vs Peake which stated if a Veteran has TDIU and a service connection can cause TDIU (my back) and has other service connections totaling 60% or more and are seperate and distinct from the TDIU aliment (mental and asthma 50% + 30%). So I submit all my evidence and get scheduled for an A&A exam. The results were suprising favorable. The APRN stating that I needed 24/7 supervision from my wife to protect me from the hazards of my environment based on extremly large doses of narcartics and tranqilizers. She also stated that the Veteran is housebound and only leaves the hosue for medical appointments based on his severe pain and panic attacks. She further went on to say that my back caused moderate to severe functional impairment (my TDIU exam in 2009 stated mild to moderate impairment). Seems like a lock for A&A and SMC (s). I get my decision yesterday. It did not address P&T at all. It just regeritated my temp 100% rating for my surgery. It denied my SMC (s) stating my TDIU was based on multiple service connections. I guess they never heard of bradley vs peake or took the time to look it up after I pointed them to it. The biggest hit of all was they did not address my filing for A&A. The A&A exam / housebound stated right in it I needed 24/7 supervision. I believe I have worn out my welcome at my VARO. I have gone from 10% in 96 to 90% in 2008 and then TDIU in 2009. I appeal items that I feel based on VA law that I deserve. I was told several times by VARO employees that my case file is so big no one wants to work on it. Now the final kicker. I have had 4 SCs on appeal since 2000. An intial 20% rating for my back, a 10% rating for a broken right foot with Pes Cavus and ankle equinus, a broken left foot with Pes Cavus and ankle equinus, and a 0% chronic right testicle pain. These issue took 7 years to leave the VARO before going to the BVA. The BVA ignored a ton of evidence and denied me on all issues, although they did give me 10% for lower extremity weakness from my back which is in both legs. At minimum they could have given me 10% for each as they are supposed to. Then finally in December 2009 I get a joint remand at the CAVC on all issues stating my exams were inadaute and they buried a ton of evidence that was never considered. So my file makes it back to the VARO in Feburary and guess what? There are instructions in my folder to do something but since the VARO hasn't even opened my folder (straight out of a reps mouth in person at the VARO) I have no idea where my case stands. Now my newest denials will head to the BVA where I'm sure they will be denied. My wife hopes I live long enough to collect the back pay.

I was 50% from 2000-2002, 70% from 2002-2007 and 80% in 2008. I recieved TDIU in 2009. The four issues from 2000 if rated higher from 2000-2009 will yield back pay. The clock has stopped in 2009 because they finally gave me 100%.

Hi Vet20, In my experience my the VA considers the medical professionals in this order for physical disabilities: MD, Nurse Practitioner / APRN, Chiropractor, Physical Therapist, Acupuncturists, holistic healers. The also love their own examiners and or VA docs over civilians. If I were you I’d get the nexus letter from the PT and get another from your MD. The MD always seems to carry the heaviest weight unless it’s the VA examiner, which is BS. As I’m sure you know half the time the VA examiner is an APRN and is not a specialist in your particular disability. Even though the PT is down the food chain more positive evidence is always better in my mind.

I had 4 issues awarded joint remand at the CAVC in December 2009. My VARO recieved my case file 3 months ago. The VARO and American Legion can only tell me it's there. They think no one has opened it yet to see what they were ordered to do. I'm so sick of this crap. These 4 issues are from a 2000 appeal............I hope you have better luck.

Hi Everyone, I applied for housebound / 50% + TDIU and A&A back in September of 2009. I recieved TDIU in May of 2009. I was on convelescent leave from March - May 2009 and recieved SMC for total rating plus 60%. This was based on my temp back rating of 100% and my Mental (50%) + Asthma (30%). Then they took it away in May 2009 stating I did not have the 100% rating anymore. After further research in my Veterans benefit manual (worth it's weight in gold) I found this: The 100% ratings under 38 CFR 4.16 (TDIU) and 38 CFR 4.28 (prestablization ratings), 4.29 (ratings for disabilities requiring hospital treatment), and 4.30 (convelescent ratings) of the rating schedule may be used as a basis for entitlement for SMC. See VA Gen. Coun. Prec. 66-91 (Aug. 1991). So I appealed the housebound (which I am) / plus 60%. Then I asked for A&A based on the dangers of my environment because of the weakness in my legs from my back and problems from my meds. I am on 30mg Oxycodone 3 x day, 40mg Oxycontin 3 x day, Ativan 1mg 3 x day, Zoloft 200mg 1 x day, buspar 20mg 5 x day, and muscle relaxers. What I had outlined was some of the incidents that happened to me which includes multiple falls in my house, I started 2 fires on the stove because I passed out, left burners on alot and walked away, flooded my garage because I walked away from a sink with the water running because I was in such severe pain. I was a little worried about the exam because even though I am in severe pain all the time I dont meet any of the other criteria except maybe the danger part. However the examiner was candid and told me it was her first A&A exam. I think that benefitted me. Here is the diagnosis from the exam: Diagnosis: Chronic pain secondary to failed L3-S1 fusion requiring increasing doses of narcatics that results in confusion, dizziness, and problems with balance. PT needs 24/7 supervision from his wife because he is at risk of injury to himself, and reports damage to their home as a result of some of the things he has done (leaving the water on, burning the heating pad.) PT reports being homebound because of chronic pain and panic attacks. PT has mod/severe functional impairment as a result of decreased ROM and subjective complaints. PT is currently unemployed and his wife manages his finances. I hate to say it looks like I should get it knowing the VA but it does look ghood to me. Anyone have any comments or anyone recieving A&A under the danger category?

Chris, Your going to need nexus letters like someone stated earlier. I was in the Corps 91-95. I broke my right foot in boot camp due to pes cavus and my left in Marine Combat Training due to pes cavus. I only had one entry in my service medical records for back pain. I had pain more than that but I'm sure you know in the Corps you suck it up. After I got out my back went south in 97. I tried everything but ended up having a failed L3-4 and L4-5 discectomy. At that point I knew I needed to go after the VA for my back or I could be screwed. I went back to my surgeon but any MD will do. I told him I had back pain alot in the Corps from humping a pack around for 4 years but said nothing. He wrote a letter stating since there was no MRI prior to me going into the Marines and by 2000 I had herniated discs at L3-4, L4-5, and L5-S1 via an MRI there was certainly a chance my back was damaged in the Corps. Then I went to a Podiatrist and had him write a letter stating that because of my Pes Cavus my feet didn't take the shock from all the running and hiking in the USMC and it was possible my feet caused my back to be destroyed. I had already had service connections for my feet because of the factures. I had a spine exam at the VA and the examiner concluded that my back should be service connected directly and that he would have service connected secondary to my feet also. I bring the feet up because of your ankle pain, etc. My feet after I got out went from moderate Pes Cavus, mild equinis to severe Pes Cavus, severe equinis with 0 dorsflexion, tarsal tunnel bilateral and arthitis bilateral. I also have severely diminshed achilles reflexes bilaterally. So as long as you can get letters you'll probably get service connected for the back due to either killing yourself in the Corps or you foot which then killed your back. Once you get connection for the back the scatica will be considered in your neurological rating as will be the foot drop. You need them to say it's possible either scenrio happened in the Corps though. Then you can go after any other secondaries if you have any. I think back if I didn't fight them how screwed I would be. I had a 2nd L3-S1 fusion done over a year ago and have been unable to work ever since and I am rated for TDIU.

Hi Halos, I'm service connected secondary for HTN from my severe spine / lower extermity pain. I was awarded sc in 2002 for 0% and have been fighting them ever since. My htn started in 1997 when my back problems started but I did not file for sc until 2002. I always had moderate htn and have been trying to get 10%. Since I have been on meds since 97 its tough because I only have about 6 readings over ***/ 100. Most of my high readings are like 150/95. However at times I am 120/75. This is because of the oxycodone, oxycontin, and ativan mix I take combined with my htn meds. Based on the rating for 10% I keep getting shot down because they say I don't have an extensive history of readings over ***/100. I keep telling them if I'm on all these drugs including the htn meds and I get readings of 145/95 frenquently wouldn't it make sense if I didn't take these meds I'd be over 100 alot. Getting another decision back in a few weeks. Since this last appeal my lisinipril was increased from 10mg to 20mg a day so we will see if that does anything. I don't know if it's the Hartford, CT VARO being a stickler but they just don't want to budge.

Hi Everyone, This question is sort of in line with the salary while TDIU question. I have been TDIU since May of this year. I had surgery in March and had intended to go back to work afterward. The surgery, an L3-S1 fusion, ended up kicking my butt. Everything imaginable was worst after that. I filed for SS and was denied which is now on appeal scheduled to be in front of a judge in September of this year. My marriage has been going downhill for a while based on my disabilities, finances, and other issues. When all said in done with my VA appeals and SS all our debt will be paid off and life from a monetary stance will be okay. The problem is that I can't take staying home and my wife is miserable. I had a good career as an IT security engineer prior to this surgery. I easily made 100k a year plus my 90% VA. It's now been 10 months since surgery and I feel staying home is causing more issues for my back and mental problems then work actually would. The problem is I don't know if I can handle work. Sitting has always been a huge problem for me. The pain after sitting for 10-15 minutes can be severe. Standing too long can also bring it on too. I'm still on large amounts of opiates including 90 mg of oxycodone and 120 mg of morphine per day. I have been on doses like that since 2006. I don't think at this point I am any worse now than before surgery. Work wasn't always fun and I can suck up a ton of pain but I realize it also made me happy. I would just deal with the pain and then usually lay down as soon as I got home. I'm pretty sure based on the fact I really don't need to lift anything and really just work on my laptop that I could go back to work and make it. Yes I would still need the opiates but at least I'd be out of the house and be making much more money than I am now. One of my wife's major complaints is that we don't go out enough and have fun. My wife constantly says she wants a divorce and to part ways. We have 2 children together and she has one from a previous marriage. Honestly my back got worse and worse since we bought a house and moved in together. The stress of trying to maintain a house and then having small children really did a number on me. Prior to moving in with her I had an apartment that had no upkeep and if I wasn't working or out with friends I was home in a stress free environment. My kids are the most important thing to me. I am starting to think divorce is the way to go. I don't want any of this affecting them (although it probably already has). So even though it kills me I'm thinking going back to work, getting divorced, and seeing my kids as much as I can is the route to go. I think my stress level will go down so much that my back probably will get better. Sorry for turning this into a counseling session but I felt I needed to let it out. My real question is if I go back to work do you think I can try it out for a few months and if I feel I can handle it then let the VA know? I will go from 100% to 90%. I just don't want to tell them and then not be able to handle work. I don't care if I need to pay them back a few months. I just kind of want some security. Has anyone ever heard of someone doing this? I didn't know if the VA had any type of program for this. I know that SS has a return to work program where you can try to go back and if it doesn't work out you don't have to re-apply again you just keep your benefits. Thanks for reading.

Thanks everyone much clearer now!

Hi Everyone, Hope everyone is well I haven't been on for a while. As much as I have learned over the years about VA law I never can seem to grasp the exact meaning of a cue. I have a buddy who I was in the Corps with and he asked me to take a look at his case. The short story is he was on on active duty 94-98. While on off hours he was accidentally shot in the leg. I was already out by then so I don't know the whole story with his treatment while he was in but he finally filed for service connection in 2007. I guess he missed seps class and didn't know about filing as soon as he got out. Well they service connected him obviously because it happened while he was on active duty. They rated him 0% under scar ratings. It looks like all they did was have a skin exam to rate him the first time around. The bullet actually went through his leg so he has an entry scar and a hole where it came out. He didn't know any better and had no service officer so he let the one year appeal period lapse. He decided in 2009 to file for an increase and this time they did a neurological exam and nerve conduction studies. Based on the exam and testing he was awarded 30%. After looking at his evidence and documented symptoms it looks like he should have received 50% at least. My question though is about a cue. What are some examples of a possible cue in this scenario? I guess my main question would be does a cue happen if evidence is present and they didn't rate properly? What about incomplete exams? I know that would work for an appeal in the proper time frame but does it apply to a cue? After reviewing his case file it looks like they definitely should have done a neurological work-up the first time around. He says his symptoms didn't change from his initial filing until present. His symptoms include nerve pain, drop foot, lack of endurance in the leg, limping, etc. The drop foot was documented in his initial filing. Any input would be appreciated. Thanks.

I got TDIU in six months. However it was sort of the right timing for my case. I had a L3-S1 back surgery in March that failed. We asked for TDIU in May because the company I worked for expected me back within 8-10 weeks and because I couldn't come back they fired me. Now I am 80% with 40% back, 10% lower extremity 2nd to back, and mental 50% 2nd to back. I have other service connections including 30% for asthma but the 3 above are the main disabling. In my case even though I can't work solely because of my back and nerve issues, can't sit, stand, or walk very long. I believe the main reason I got TDIU the first time around was mental. I had just received a 50% increase for my mental. When you file for TDIU they schedule a general exam and look at all your medical issues. This is where John999's post comes in. They look at everything and if there is a medical problem that is not SC they will try to use that againist your claim. In my case I have 10 service connections and have no medical problems that aren't SC. So when they did the general medical they found some issues with my back but said all the instability, legs, nerve issues were subjective because they give you the quick neurological exam that I never fail. Then they had to schedule a mental exam because the nurse practitioner giving me the mental exam was not qualified to give it. When I saw the mental examiner I asked him to comment on my work status. He stated that it was not more likely than not that that my mental condition as a whole was making me unemployable but when combined with my back condition it was a significant impairment for me. They used this in the TDIU rating. I think if that wasn't in there and my back combined wasn't combined with my mental they would not have given me TDIU. I of course had the letter stating I was fired for not returning to work because of back. I also assume my prior employer told them about all the time I missed from work due to SC because they quoted this. If you want to post more about your condition someone may be able to help out or give advice. Thanks.

Hi, I had a spinal stimulator trial and it did not do much for me. I'm not sure what kind of trail you had. Mine was with two wires one on each side of my back. They tell me the permanent procedure will be a paddle and should cover more of my back and leg pain. I have been on the meds game for 4 years now. My back issue have been ongoing for 12 years. I have had two failed surgeries including my latest L3-S1 fusion this year. I was at the worst taking 4 30mg oxycodone and 3 40mg 0xycontin. I had seen stories about oxycontin actually increasing the pain instead of helping decrease. My pain clinic doc switched me over to 80mg of methadone and 4 30mg oxycodone a day. What a difference. The methadone is has provided way better relief than the oxycontin or oxycodone ever did. My issue now is that the methadone is driving my asthma crazy. I can take it for a couple of days and then my breathing gets worse. By day five I'm wheezing like mad. I go off and breathing improves. Not sure what you have taken but if you haven't tried methadone it's definitely worth a try. The only down side and reason I can't stay on is the asthma. Keep in touch and let know how things are.

Pete not sure if your post was by mistake and meant for another. Halos2 I have from 2000 - 2009 prior to be TDIU on appeal. 2000-2002 50% 2002-2007 70% 2008 80% 2009 100% My first order of business is to obtain the ratings I deserve for my service connections. This will of course bring back pay hence the sanity behind it. I also have a good chance of getting 100% schedular in this time frame and would like to get it not only for back pay but so they can't hold TDIU over me. Make sense?

Hi Berta, Sorry failed to leave out I was service connected directly for back and examiner said it could have been secondary to feet also. DAV did have POA from 1996-2004. I think I filed for the ankle and was denied but not for pes cavus. The DAV rep had those exact medical records in his possession. I actually assumed since I was diagnosed in 96 and rated under foot injuries, other they were just taking the pes cavus, etc. into consideration. I'll have to find the remand but it more focused on the fact I was diagnosed with tarsal tunnel sydrome in 2000 and that my feet were not looked at for possible neurological ratings either alone or with my back.

Hi All, I was in the Marines 91-95. I broke my 3rd right metatarsal in boot camp and had a stress fracture in my 3rd left metatarsal in Marine Combat Training right after boot camp. After that I sucked up the pain and discomforts in my feet because in the Marines that's what you do. Prior to entering boot camp I had no medical problems including no feet problems. I played baseball, football, etc. no problems. When I got out I went to Disabled American Veterans and filed for service connections for both feet, asthma, and right testicle pain. That was pretty much the extent of medical problems while in service. Focusing on the feet only I was service connected for fractures of the 3rd metatarsal for both feet. I was awarded 10% for my right and 0% for my left. At the time life wasn't hell from a medical stand point and I didn't know VA law at all, so I didn't appeal or anything. I was seen multiple times in 1996 and 1997 at a VA medical center and a civilian podiatrist for both my feet. The VA tried hard orthodics and special shoes for me but nothing helped. I am currently on appeal for both feet from 2000 at the BVA. Current diagnosis is severe pes cavus, rigid feet, weak feet bilateral, and severe ankle equinus which basically means severe limitation of my ROM for both my ankles. The VA podiatrist also diagnosed me as having nerve entrapment at the top of both my feet. They are currently getting me new orthodics to try although he is skeptical they will work and utliatemly thinks I will need ankle braces. Not to add confusion because I want to focus on the feet but I also have a back condition service connection from my feet and a bilateral lower extremity service connection from my back. I am prescribed a cane, back brace, and a rollator for my back because of weakness in my lower extremities and feet. So I had a hearing at the VARO in 2004 for a ton of issues including my feet before the appeal went to the BVA, U.S. Court and now back to the BVA on a joint remand. In the hearing I told the DRO that my problems in my feet were due to the Pes Cavus and ankle instability I have. She said well your only service connected for fractures of your 3rd metatarsal bilaterally so none of that can be considered. She and the DAV rep said I would need to get a nexus letter to try and tie in the conditions to my service connections. I agrued and said I had no problems with my feet prior to the military so as far as I was concerned the VA owned any issues with my feet. My wonderful DAV rep never bothered to check any of my medical records hence why I am not with DAV anymore. I was diagnosed at a VA medical center podiatry consult with pes cavus and ankle equinus in June of 1996. My DAV rep should have picked this up because I was honorablly discharged on November 11, 1995. Hence June of 1996 was within the 1 year presumption period. So my question is after the BVA looks at this do I need to file for service connection and does this go back to 1996 or the date I file for service connection? I guess it would depend if they included the symptoms in my decision as far as the rating? Anyone have any thoughts? Thanks in advance.

Agreed. Thank you all.

Hi All, I'm not trying to double post here it's just something in another post pulled it out. I am currently 10% for residuals of a fracture of the 3rd metatarsal in my right foot and 0% for residuals of a fracture of the 3rd metatarsal in my left foot. I could always tell after my fracture in boot camp in my right foot and being back in training before you know my foot was not the same. All kinds of pain , etc. I sucked it up because I wanted to graduate and get the hell off of that island. Then I end up at Marine Combat Training and do the same thing to my left 3rd metatarsal. By that time I was a Marine even though a boot so treatment was better. After I went on to Motor T school I never looked back on my feet. I never complained and never went to a podiatrist because Marines suck pain up. I was of course in pain whenever we ran or marched but again " ". So after I get out of the Corps of course they service connect me. They give me 0% for both and I complained because my right was definitely bothering me. My left only slightly. So they gave me 10% for right and left the left at 0%. I got out in Nov. 1995 and in 1996 the VA podiatry saw me and diagnosed me with pes cavus, rigid feet, and residuals of 3rd metatarsal fractures. They gave me special shoes, fitted me for 3 different inserts, nothing ever worked. Pain just kept getting worse and worse. I also saw a civilian podiatrist in 97 who diagnosed me with pes cavus, rigid feet, etc. He stated the VA were going in the wrong direction and offered advice for me to take back. He had suggested trying soft insoles versus the hard ones they VA had casted. Around this same time my back went from bad to terrible so I focused on fixing the back. In 2000 surgery officially did not fix my back. So I went after service connection. I had my back surgeon right a nexus letter saying he thought it was possible for my back to have been injured directly in service and possibility second to my feet. It was only 1 year six months after service the back showed up so it wasn't totally out of whack. I had a podiatrist write me a letter stating possibly the feet caused the back condition. The VA examiner stated he thought my back was direct and secondary to my feet based on the way I changed my gait to compensate from walking on the fractured metatarsals. So they connect and give me 20% for my back. I appeal and ask for an increase for my feet because since 1997 my lower back, right testicle, legs, thighs, knees, ankles, and feet all feel like they are in total pain and having numbness, etc. The same civilian podiatrist I saw years earlier had now diagnosed me with tarsal tunnel syndrome bilateral. He also that it was likely my feet caused my back problems by the way. I ended up during steroid shots in both feet but I refused surgery. After having failed back surgery I couldn't deal with another failed one. I went back to the VA podiatry and they had nothing. They sent me to a VA neurologist that looked like she was 90 and she said no neuropathy in my feet or back. So I have a VA hearing in 2004 and we get into the pes cavus and tarsal tunnel, etc. The DRO tells me I need to file service connection for all of these conditions if they are bothering me. I tell her Pes Cavus and rigid feet were in my VA records in 96. She said it does not matter. I said I understand the tarsal tunnel if I even have it (second opinion said no). I told her I don't understand how I could have perfectly fine feet before boot camp and it seems to me that since I did anything within reason that is in my records or is diagnosed by a podiatrist. So this year the USCAVC goes along with my lawyer that based on the different diagnoses, chronic pain, possible neuro deficit from my back issues, and lack of complete exams by the VA examiners over the years and issues a joint remand. So they feet are heading back to the BVA. So like the last back surgery in 2000, I start going back to look at my feet after the failed surgery this March. I see the same doctor that gave me a letter stating my back could have been related to high arch (Pes Cavus) feet. So over the years I have the VA and civilian docs stating I am Pes Cavus and rigid feet which has been causally linked to my metatarsal fractures but I could get a solid letter if needed. It seems to me the fact the VA diagnosed me with high arch feet in 96 less than a year after I was out would be good enough for service connection if needed. So here are the results from the new exam: Chief complaint = bilateral foot pain History of present illness = 18 years (this puts me back to my first fracture in service) Summary: I will brief this. He writes patient comes back to the office after large gap in not being seen (2000). He presents with to discuss his pedal abnormalities and to discuss whether these could be contributory to some of the ever effects of his back condition he is experiencing. He had two back surgeries, which were of questionable success. He is here today not because of back involvement but because his ankle joints bilaterally are causing him significant discomforts. He has a Pes Cavus deformity. He has difficulty ambulating without irritation. He is a 37-year-old terminally disabled Veteran. Current medications noted. Of significant interest are his pain medications and as well as psychiatric issues that have developed because of the pain. VASCULAR – normal ORTHOPEDICALLY – Significant tight Achilles tendon is present. Dorfsiflexion to 90 degrees is barely possible and beyond 90 degrees there is discomfort in the lower extremities. Severe Pes Cavus deformity is noted. Range of motion of the subtalar joint bilaterally is normal. Range of motion of the ankle joint is without crepitus but significantly restricted. IMPRESSIONS: 1. Severe equinus 2. Pes Cavus 3. Compensatory changes in the lower extremity due to the severe equinus Treatment plan recommended: Aggressive stretching plan to be done at home and at physical therapy. Strongly recommend Dyna Splits bilaterally, this device because of the dynamic nature of the splinting which will help increase dorsiflexion and help the ankle joint function more smoothly. Without proper dorsiflexion of the ankle the joint continued discomforts in the foot and subsequent arthritic sequelae of the subtalar and joint may development. Currently I am rated 10% right foot and 0% left foot under CFR 4.71a schedule of ratings - musculoskeletal system / 5284 foot injuries, other: The right is moderate or 10% and the left is 0% My lawyer thinks we should just wait until the BVA makes their decision and see if what they come up with is acceptable versus filing for secondaries now. Just wondering if anyone has a similar situation and what they did with you or anyone that has seen a case like this. Thank you.

Thanks John. I would never have surgery on my feet. I am in that failed back surgery syndrome group. Took me two surgeries to realize they usually make you worse. Oh well I guess if I'm going to be in pain and live a crappy live I will just have to make sure the VA pays me every cent I am entitled too :D

Okay this sounds like a good plan. Give it a few weeks and see it American Legion SO can work out. Sixthcents: wrote “I would certainly NOD the back and legs... adressing in particular loss of lower use of limbs due to atrophy. muscle loss, weakening and nerve damage/neuropathy which all seem to be present. I will say that normally to get a stupid loss of use determination you have to have AFO's, which you dont, but based on the info given for your condition I bet you need them. They simply keep you from falling due to foot drop, and I bet you have that bi-laterally and it's probably already diagnosed. Along with loss of deep tendon ankle reflex... tell me if I am right here huh?” My response: My back and legs are a part of a joint remand, which brings my back, chronic right testicle pain, and residuals of a right and left 3rd metatarsal fracture. When these items first went to BVA the BVA gave me 10% for lower extremity weakness, which obviously was a joke, and the USCAVA thought so too. What's an AFO? You mean an IMO? As far as my back you have seen mostly what have been diagnosed. The feet are a whole different monster. Going into boot camp I had no problems with either of my feet. Broke my right in boot camp and my left in Marine Combat Training. After that I just sucked it up and got out. It was three years later that I had an MRI of my lower back and it was desiccated and degenerated at L3-S1. I was basically told I looked like a 70-year-old man during hard labor his whole life at age 25. Now I had gotten out of the CORPS in November 95. In 96 and 97 I saw the VA podiatrists a few times and a civilian podiatrist. They diagnosed high arch feet (Pes Cavus) bilateral and overall inflexible feet. The VA gave me special shoes and three different sets of inserts. All of these made my feet worse. The civilian doctor said none of these inserts or shoes would help me at all. From 97 to 2000 I focused on fixing my back with everything. Finally had an L3-4 and an L4-5 discectomy and laminectomy done. After that failed I went back on looking at my feet. The same civilian podiatrist I saw years earlier had now diagnosed me with tarsal tunnel syndrome bilateral. He also that it was likely my feet caused my back problems by the way. I ended up during steroid shots in both feet but I refused surgery. After having failed back surgery I couldn't deal with another failed one. So while going after service connection for my back based on direct service (even though I had been out five years) or 2nd to my feet I had my surgeon write a letter stating he looked at all my military and civilian records and thought it was possible my back was injured during service. I had a civilian podiatrist Dr. X write a letter stating with my pes cavus aka high arched feet it was possible my feet did not take the shock as they were supposed to and sent it up to my lower back causing my L3-S1 injuries. The VA examiner came back and said direct service connection. He also stated if there was not enough evidence to connect directly he would have connected me secondary because of the way that I transfer my weight as I walk trying not to bare any weight on the residuals of my 3rd metatarsal fractures. I know this is getting long but it’s key because my right foot is 10% and my left is 0%. They are now coming back to the VA on appeal since 2000. In 2004 I had a hearing and the VA DRO told me if I was to be rated for any with pes cavus or rigid feet I would need secondary connections. My problem with that was that I didn’t have any problems with my feet prior to service. You let me into the service because my feet were fine. First I fracture these metatarsals and then I know I was killing my feet and the pack on doing 25 miles humps or running 10 miles up the mountains of Camp Pendleton. You suck it. You a Marine you don’t say anything. I also have a VA examiner stating my gait changed because of the fracture and had the VA podiatrist in 96 state I had pes cavus and rigid feet. Well that was in the year and a half presumption period. So now that I have a 2nd failed back surgery I decide I better make sure my feet are not going to cause my back to further degenerate and or if the instability in my feet and ankles can get any better. So I go see Dr. X who I saw in 2000 and wrote me the letter stating my feet were possibly the cause of my back injuries. Here is what Dr. X diagnosed: Chief complaint = bilateral foot pain History of present illness = 18 years (this puts me back to my first fracture in service) Summary: I will brief this. He writes patient comes back to the office after large gap in not being seen (2000). He presents with to discuss his pedal abnormalities and to discuss whether these could be contributory to some of the ever effects of his back condition he is experiencing. He had two back surgeries, which were of questionable success. He is here today not because of back involvement but because his ankle joints bilaterally are causing him significant discomforts. He has a Pes Cavus deformity. He has difficulty ambulating without irritation. He is a 37-year-old terminally disabled Veteran. Current medications noted. Of significant interest are his pain medications and as well as psychiatric issues that have developed because of the pain. VASCULAR – normal ORTHOPEDICALLY – Significant tight Achilles tendon is present. Dorfsiflexion to 90 degrees is barely possible and beyond 90 degrees there is discomfort in the lower extremities. Severe Pes Cavus deformity is noted. Range of motion of the subtalar joint bilaterally is normal. Range of motion of the ankle joint is without crepitus but significantly restricted. IMPRESSIONS: 1. Severe equinus 2. Pes Cavus 3. Compensatory changes in the lower extremity due to the severe equinus Treatment plan recommended: Aggressive stretching plan to be done at home and at physical therapy. Strongly recommend Dyna Splits bilaterally, this device because of the dynamic nature of the splinting which will help increase dorsiflexion and help the ankle joint function more smoothly. Without proper dorsiflexion of the ankle the joint continued discomforts in the foot and subsequent arthritic sequelae of the subtalar and joint may development.

Hey Larryj, No I have a real American Legion SO. He is actually a pretty dedicated one and has never done me wrong. This is the Hartford VARO in Newington, CT. There was no statements in the award letters stating "no future exams" The letter that my SO signed off on and that I received a copy from the RO just had entitlement to dependents educational benefits. According to the SO and another poster on here that is the standard way the RO's initiate P&T. If they have any standards that is. Interesting note is in both of the letters under my award for convalescent leave they bumped my back rating from 20% to 40% which all along they said they would not due because my back was at the USCAVC and they didn't have jurisdiction. This was because my ROM had fallen into the 40% versus 20% criteria. They also stated since there is a likelihood of improvement, the assigned evaluation is not considered permanent and is subject to a future examination review. The evaluation they are talking about is my back and they are nuts because I just got a joint remand from the USCAVC for my back to go back to the BVA because they ignored critical evidence. Now under the entitlement to individual unemployability it says entitlement to individual unemployability is granted because the claimant is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. Evidence from your last two employers shows you were unable to make work commitments due to your service connected medical conditions. You had to leave or were fired because of time taken off due to your back condition and required treatment. You experience episodes of your back "locking up" which requires your wife to stay home from work in order to care for you. VA examination dated month/day/2009 stated it is at least as likely as not that your mental condition alone keeps you from working, but when combined with your anxiety/depressive symptoms and viewed in whole you suffer major impairment. Therefore, individual unemployability is granted effective / / / the date we received your claim. I am thinking someone screwed up and gave me entitlement to DEA and they should not have. Then when it was reviewed they yanked it. My SO did go straight to the VARO Monday morning once he got my message that I was denied entitlement to CHAMPVA. He told me he was going to try to push it through no matter what happened. He was telling them I have a wife and four kids and my wife can't work because she needs to be home to take care of me and the kids. Which the VA did admit in my TDIU reasons. I went out and filed for civilan insurance for my wife and kids last week. It will be $600 dollars a month but what are you gonna to do. I have the BVA appeal coming, SS grant, etc.

Hey Commander Bob, Didn't hear a word back yet. My wife has been so stressed out now that health care is not a done deal. We had cobra and it runs out Nov. 1st. I'm not sure the exact attack plan yet. I just finished up my NOD for the same decision based on they severed my entitlement to SMC housebound, filed a claim for Aid and Attendance, and appealed 0% hypertension and 0% eczema. I'm sure they will come back mistake in their favor and I will have to NOD. Funny thing is my main issue although not rated as high as my mental is my back. I've had DDD for over 12 years with two failed surgeries including an L3-4, L4-5 diskectomy and laminectomy in 2000 and then most recently a L3-S1 fusion with titanium cages rods and screws. I also had about 8 injections since 2006, worked up to 3 30mg oxycodone and 3 40mg oxycontins a day, a failed spinal stimulator, had an outside exam by a spine specialist that showed atrophy and muscle wasting of my calves, quads, and some other lower extremity muscle group which he tied back to the L3-S1 nerve roots, I was prescribed a cane, I'm not allowed to drive via my surgeon, not allowed to leave the house alone via my siurgeon, etc. etc. Yet the VARO seems to think my back has a chance of getting better!!!!!!!! LOL. Anyone have any ideas on how to attack the P&T if or should I say when they come back and say they awarded it as an error?

Yeah the problem is the VAROs don't want to admit P&T for anything. You have no control overt the VARO stating P&T. I think it's ridiculous that they award it by entitling you to dependent education benefits chapter 35. However, it does look that way as my SO, a vet on here and many cases at the BVA state this is how it's awarded.