Rivet62

I was working in the MyHealth eVet office when the VA did a sharp reduction of what opioids the doctors could prescribe. I mean they just cut it off. Ha! I could see down the hall and into the little glassed-in vending machine area. A vet had come around the corner from the pharmacy and into the vending area where he placed the pharmacy and tore it open and then THREW it across the room. He could be heard yelling all the way down the main corridor, and others in the vending area were cowering in corners...this guy was p*ssed. security came...security is really good. They de-escalate, instead of throw someone on the ground in cuffs. The vet was practically crying. It was like he lost all hope of continuing because he knew he couldn't cope with his pain. Who am I to say though. The other weirdness about the opioid reduction was that it was imposed in Hospice!? The guy is dying anyway. The nurses did all they could. Even in hospice the VAMC tried to impose diet controls...but the nurses were so good. wink wink

There's a lot of things that hem doctors in, to the point where I'm beginning to believe what expats are saying about the healthcare in Mexico = cheap and very good.

I thought about that too. Because right now I don't know if my C&P was favorable or not. All I can do is wait. I guess maybe you should too. Hard to say.

All I know is there's a definite difference between radiculopathy and neurological problems. It seems to me that a sports medicine doctor is more apt to deal with pinched nerve problems, but not neurological problems. I have radiculopathy, and I saw two neuro specialists and they ruled out neurological conditions, both saying (in essence) that my problems are musculoskeletal. Perhaps the request for a C&P with a sports medicine doctor is misplaced? If it were me, I would call 1-800-Peggy and tell them it was the wrong C&P. Just tell them. They'll figure it out. If it were me, I would upload correspondence to VA.gov as well, concerning this particular claim of yours and the C&P you think has little applicability. Request a copy of the completed C&P result from 1-800-Peggy. My C&Ps, in my claim for increases, have been through an outfit called VES (Veterans Evaluation Services) and they will provide the examiner's credentials upon request. Do that.

There's bittersweet irony to having all the access to MWR facilities now that I'm service-connected disabled. Even the prospect of Space A travel as I near a possible 100% P&T is increasingly out of the question. There's a vicious circle I experience between Major Depressive Disrder and my spine problems and I liken it to a cul-de-sac...lol...I have arrived.

I had a weird C&P exam yesterday. My range of motion was like 5 to 10 degrees in every direction in the thoracic lumbar ROM measures. He didn't seem to question that, as he was looking at my back muscles while I was standing doing the forward flexion and backward extension. I was pretty seized up and he called it muscle spasms, which I'm sure it was. My C&P was for DDD, painful motion, and lower extremity radiculopathy. I'm waiting to see if he'll call it inconclusive as a result of spasms, but I would argue spasms are part of what interferes with work. Of course, I would rather not have to argue it at all. What struck me as odd about the ROMs is that he had me sit upright on the examining table and he had me bring my elbows to my side and bent, with my forearms parallel with the floor and my fists clenched then he asked me to twist my torso. I could do all that except twist the torso beyond 5 or 10 degrees. I looked online and saw no one performing that kind of ROM, with elbow bent and to the sides of the body. Has anyone had that kind of ROM for twisting the back? What is he trying to see with my arms like that? I told him he was the first ever to actually measure ROM (but he actually only did it on the top of my head in relation to my back) and he said "well there wasn't much to measure," causing me to think he'll call the C&P inconclusive because muscle spasms have interfered maybe. Well, I have a documented work termination as a result of flare-ups...a medical opinion that I cannot return. I have documented emergency room visits as a result of flare-ups at other jobs. I have lots of documentation. So, my question here is... can the doctor call the C&P inconclusive as a result of muscles spasms interfering? Or are the muscle spasms confirming the C&P findings that will lead to an increase of service-connected ratings? If you look at my signature below my comment you can see my existing ratings. I guess I'm wondering if muscles spasms are radiculopathy. I was pretty seized up after the 25 mile drive to the C&P and the hard seats they had while I waited. I laid down in the examining table and did active straight leg raises, and no more than 25 degrees and he said that's positive (for lower back problems I guess). I didn't get the impression that he was trying to play tricks. He made some negative comments about the VA medical system. He worked for VA decades ago, or maybe it was an internship. But what he did say is that he was trained decades ago as a cardio thoracic specialist (he has since practiced as a DO- not an MD)... anyway, it caused me to remember the new sprinkling of heart related issues my new primary care doctor has given life to from old diagnoses that haven't warranted any real follow up. Do you think that the VBA has purposely gotten this man to opine heart problems and not actual back problems?? I have all imaging and radiology reports that show severe DDD, but an anesthesiologist had told me that smoking interferes with healing the discs and that smoking causes more pain. I know a retired MD and that MD calls that bulls*hit. It appears my C&P examiner is not trained in spine specialty, even though VES says he's trained in that (maybe by a VA qualification to perform rudimentary ROM exams). He is a general practitioner. That's been his career as a DO... so maybe he's qualified. Ok wait.. I'm being silly about this. Saint Lukes hospital in Kansas City says "These include: Pain in the low back Pain, numbness, tingling, or weakness that travels into the buttocks, hip, groin, or leg Muscle spasms" https://www.saintlukeskc.org/health-library/understanding-lumbar-radiculopathy I think my C&P is on the right path. This caught my eye while I was surfing the net for answers (although it involves a future cervical spine claim I have): "Nonoperative treatment includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage. Epidural steroid injections may be helpful but have higher risks of serious complications. In patients with red flag symptoms or persistent symptoms after four to six weeks of treatment, magnetic resonance imaging can identify pathology amenable to epidural steroid injections or surgery. Ok... I have the two anesthesiologists who have refused to do epidural nerve blocks on my lower spine, but neither one of them will say why. All they've said is they refuse me as a candidate for epidural injections! Why can't they say why? I have pressed for answers and they're just button-lipped about it. Is there something about these guys? Some kind of inside code that has them all agreeing that mum's the word when they encounter something they don't want to do?

FURTHER UPDATE: It appears VA accepted my mock VA Form 21-4192, together with all the employee records I had, as fulfilling their request for VA Form 21-4192 from my last federal employer. Now when I look at the list of files that I uploaded it shows them as VA Form 21-4192s, meaning that I satisfied the requests for VA Form 21-4192s even though I couldn't get them from all the employers. I had kept very good records, and I was able to upload those in place of VA Forms 21-4192s.

I got denied for cognitive impairment because VA doesn't seem to acknowledge that such a thing is real with Major Depressive Disorder (MDD), but my VA psychiatrist does. In fact, right there in her office was a brochure listing cognitive impairment as one of the more serious symptoms of MDD. The reason why I don't think VA formally recognizes cognitive impairment as a serious symptom is because they appeared to categorize mine as vascular dementia and I got denied because none of my medical evidence supports that conclusion, while at the same time I was already rated at 70% for MDD alone. I'm taking heart that the proposed VA changes take cognitive impairment seriously and that it is just one more measure in what Hill & Ponton describe as a rubric approach to assessing mental health. The video link that I posted above does not go into a lot of speculation on these VA proposed changes, but what the older female rep said is that VA is attempting to add numerical values to symptoms that add up to a total that better defines the disability for rating purposes. I took that to mean that VA is attempting a rubric approach. Some may ask, what is MDD cognitive impairment like? Well, for me it's not like the immediate environment starts melting like a Salvador Dali painting but it's more like audible and visual cognition of print becomes less defined. So, audible instructions sound like Charlie Brown's teacher, and print becomes blurred and jumbled. I have no problem executing my own original ideas, but taking instruction from others is impeded by MDD cognitive impairment episodes.

This isn't a question. It's a suggestion for claims filers. Yesterday, when I went on VA.gov to check my claim status, it showed a nice list of everything I had uploaded for my TDIU claim/increases. The trouble started when I saw Request 1 and Request 5 and Request 4 all changing on a weekly basis and all with due dates, BUT none of them specified what they wanted me to upload. I made sure to call Peggy and they couldn't see what was wanted. So to cover myself, I uploaded word documents stating that the request(?) lacks descriptions, and I named the file uploads as Lacks_description_of_what_is_wanted.docx. I would return to VA.GOV to check my claim status, and I would notice these as pending and then they would disappear and be replaced with another no-description request and so on. I got the idea that I better copy and paste what I'm looking at, including the list of all the supporting documents I uploaded. Yesterday's list states everything I uploaded, true to the names I had given the files. Today's list does not! Well, to be fair, many of my uploads were simply supporting documents in place of the forms I couldn't get from my past employers. I would suggest that vets keep checking the files that VA acknowledges, and copy and past the list into a Word document and save it according to what date is shown. I know that when you 'print' a webpage to PDF that you can set the preference of having a time stamp and source (the url) display at the bottom and print with the PDF you're creating.

Hill & Ponton uploaded a video to YouTube on this topic a day ago. The video was live streamed Q&A so other things mixed in with the topic. Fast forward to 4:56 to start the video.

Which would suggest prevention, if not a cure the way I'm reading it. Where is VA headed with that? I'll be the first to stand up for whatever cure they say because as much as I loved my F-4s the memories ring in ears. To me it seems like VA is imposing the need to argue harder for a tinnitus initial claim.

Whoa this is good to know. I have a C&P exam tomorrow. Wouldn't it be nice to ask the examiner his opinion on when it became disabling? And to ask him to state that on my C&P exam? I'm assuming when you say 'examiner" that you mean the C&P examiner. Right? Or are you referring to the rating examiner?

Pretty much what that video shows, that Tbird linked me to. After watching it and applying what was said to my drafted SiSoC, then your advice makes total sense.

Ok,,, Right, I'm not arguing for service connect. Keep it in perspective to just the increase relative to increased conditions. That video that Tbird linked me to was so very helpful, and you everyone else here is saying the same thing as the video with only minor variation.

That video that Tbird linked me to recommends a separate SiSofC for each disability that I request for TDIU increase/claim. In my case just 2. I think that makes sense because conditions are intertwined, and besides the C&P exams are separate, so...

Oh yes I found the video helpful. It removed any question I might have. Thank you!

That's clear to me now after watching the video that Tbird gave a link to. OK Good to know

I can see how that's needed.

I think what I'm seeing here is the drawing of a conclusion that VA might see were they to wade through the documentation. Framing the issue of unemployability, by gathering the most pertinent facts, makes the conclusion easier for VA and by the facts presented that conclusion is irrefutable. I was confused by a notion that VA wants to see how it affects the veteran occupationally and socially, but I think what you're showing here is that the subjective observations are best left to layman statements by others who have witnessed the veteran's difficulties firsthand. The Statement in Support of Claim should be used as an objective and concise and condensed summary with facts (premises) which support the objective conclusion. Yes. I see it now. I have a pile of records. Within the records are the facts I want VA to know. I can string those facts together to form the overall conclusion. This approach is similar to what Brokensoldier said when he talked about his way of organizing additional evidence. He said, more or less, that it was like composing an executive summary, an at-glance statement highlighting the most pertinent facts and directing the reviewer to those facts within the body of all the records. What you're saying also supports what DAV says, "do not upload stuff" like a rambling journey that reads like a personal diary. The more I stick to facts, the less chance of things taken out of context that can be used against me in some future appeal that could end with "inconsistencies" because things were taken out of context. Presenting the facts, like you say, frames the context.

I received mail from the Evidence Intake Center, requesting the employers' forms VA Form 21-4192, and in the packet was a form for Statement in Support of Claim (VA Form 21-4138). Is it standard practice for them to send you that form? Is VA trying to tell me that my IU claim would be better supported if I upload one? Or do they usually just send the form to everyone? My service-connected disabilities, for which I'm asking for IU increases, are major depressive disorder and my back issues. I look at this form and wonder do I have to? I started writing about what difficulties I have experienced as a result of service-connected disabilities, finding it hard to exclude all the years since service, and then it dawned on me that the language I'm using "since service" (of the years following my discharge) could suggest that my difficulties largely occurred after service. If I make statements about what started in service and how it has affected me all along to the present day, then am I not restating a nexus that may be at odds with how they arrived at the nexus? Is it possible that I could unintentionally shoot myself in the foot with a Statement in Support of Claim? I have a mental health C&P coming up in 2 weeks. Would I be better off communicating these issues to the Psych examiner?

Some have said that it's wise to report the event afterward to 1-800-Peggy so there's a record of it coming from you. Could the veteran request a second C&P to be sure?

So... there I was trying to get measured ROM privately, cash out of pocket, because getting real measured ROM from healthcare providers is nearly impossible without a referral and ICD-10 diagnostic codes FOR EACH measurement. I've tried physical therapists. Nope. It's all jacked up. Measured ROM must be the Achilles heel of all kinds of claims, because it's made damn near impossible to get them. I have found an answer, I think. I think a chiropractor can do them. I think their measurements are acceptable, at least that's what others say in an old forum topic. I'm about to try it after my upcoming C&P, then I'll have measurements to counter the C&P if I need to. I'll update this thread when I find out.

You said so much better than I could, but this is what I was trying to say. Thank you. That clarifies it.

I am by no means an expert but from what I have gleaned from others who are, here on Hadit, the fact that your approval was at the RO level after the remand tells me that they systematically processed the remand as of the date of the NP's C&P exam. My understanding, in general, from others here, is that the RO processes the latest procedural documentation they have on your claim according to the regulations they must abide by, and questions involving interpretations of law and its application of those interpretations reside with the BVA or CAVC (appealing an effective date). Maybe you can succeed in getting an earlier date by requesting a Higher Level Review (HLR), instead of an appeal, since you have no other new evidence to submit that would require the BVA? I am interested in reading what others say about how you can get the proper effective date (perhaps at the RO level), because I might be facing the same thing.

I didn't know about the split study. I think a split study could be useful to my potential future claim for Central Sleep Apnea. One of the most bothersome things, for me, is having to consciously blow out against the air current coming in, no matter how low I set the BiPAP. In other words, to use it I would have to be half awake to exhale against the air coming. My BiPAP is a Resperonics Dream Station by Philips (one of the recalled devices). Info on that and other Philips devices: https://www.va.gov/vdl/documents/Financial_Admin/CAPRI/dvba_2_7_tm.pdf I've learned from the above link that there are continuous ventilators and non-continuous ventilators (C-PAPs and BiPAPS). Continuous ventilators are for life-support, and non-continuous ventilators are non-life-support. Well, whatever these differences may mean to me, my BiPAP sure seems continuous because I have to exhale hard against the inflow of air. I could never get used to it and the only way I could use it is if I stayed up all night. The sleep specialist at the VAMC told me to just keep using it and I'll get used to it. I just couldn't.