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Rockhound
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Posts posted by Rockhound
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The reason why I included Chronic sinusits with Chronic Rhinitis is that they usually occur together, the Rhinitis morely likely than not being a causal facter in developing Chronic sinusitis and both having a causal link to the abnormal structure of the nasal air passage due to the factors caused by a fractured nasal bone and septal deviation due to this trauma.
If one is to claim that the problems are due to an allergic response causing an inflamatory condition, then one must clearly define what the allergin is. This requires objective evidence two out of the following objective symptoms must be present.
1. Nasal obstruction
2. Facian pain, pressure, and/or fullnuss
3. Decreased sense of smell
These same symptoms can be be found with an acquired deviated septum, which is the most commone cause of nasal obstruction, Cocomitant diseases, such as allergic, or vasomotor rhinitis or chronic rhinosinusitis, may potentiate the obstruction caused by a deviated septum.
Plain english means, that a deviated septum can make these condition to be far worse than they would normally be. Which in my understanding, is that if a SC injury, illness makes a non SC condition worse than it would normally be, then that condition must be considered as SC and rated at or above what it normally would have been as if it had been SC. If I am wrong, please let me know.
Also, my argument is that an illness or disease, even if it is not directly caused by the SC condition, but is made worse by the SC condition, then the NSC condition should be SC as secondary to the SC'd condition as if the SC condition had increased in severity above which it normally would have been. In stead of 10%, due to the trauma, it should be evaluated for an increase above what it is rated at now, and the secondary issue rated on its own DC.
Now if I can write this argument up so that the Rater and/or DRO can understand it, maybe I have a shot a reconsideration of their decision.
Rockhound Rider
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UP DATE:
I finally was contacted by the ENT Specialist who I am seeing for an IMO. I don't know if he will be willing to do it or not, but I was told I would have to discus it with him in person. The appointment is for Sept 10, 2009. so I have to gather as much of my records together on this claim, so I will have them with me, if he decides to help me.
I hope to at least get an allergy test out of this, so as to answer once and for all, whether or not I have Non-Allergic or Allergic Rhinitis and a firm diagnosis of Chronic Sinusitis too.
When I said my medical opinion should be noted more than that of the average person, it's because in the past, or rather as since before 2003, I have only my word on my conditions and as to there treatment. For the most part I treated my own symptoms because I did just as much good in managing my sinusitis and/or rhinitis with over the counter medications, since most of which I was ever given was only a higher dosage of what the over the counter stuff was. The antibiotics and antiviral drugs were just useless, since they were given out blindly by the Dr's more for their placebo effect than anything else and to help pump up the profets of the drug industries and I am not even counting the times I was given sample drugs to use also.
The only time I would want to visit a Dr would be when my condition worsened and I needed time away from work to rest up and to keep from giving what I had to others.
It's just that if I said I didn't have these problems or nearly as bad or often before service and/or during service and that things got worse after my injury, then I want it to mean something to the VA Rater and not what he thinks or wants things to be.
I've asked for a completer medical record from the VAMC. I'm opting for all of it to be on a CD/DVD, since a paper printout would not only take more time, so they say, I won't have to worry about paper records getting lost, damaged or so mixed up, it would take forever to find anything.
I just hope it gets here soon so I can go through it all and print out what I need for this claim.
Rockhound Rider :D
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For the general information to all. To equate what a medic does while in the field or aboard ship to that which a NP might be tasked with, is only seperated by the rules, regulations, and laws that govern them.
I will agree to only one stipulation, If I did quite a few of the medical procedures I was not only trained to do, but was required to do as a part of my duty while a Hospital Corpsman in a civilain setting, I would be tried for practicing medicine without a license, but that is how it is, if you are in the field or aboard ship. Your the medical officer that the serviceman/women turns to first when needed. In the field or on board a small ship, who doesn't have an actual Dr. there. This responsiblity falls on the medic or Corpsman to handle the case. That's how it was when I was in the service.
Out in civilian life, I couldn't do nearly one percent of what I did while in the service, that only being because the civilain regulators had no way of quantifying the training and experiences that the medic/corpsman had during his time in service.
I drew blood in the service, out in civilain life, I would still have to go back and start my training all over again. I did symple surgical procedures, conducted physicals, examined, diagnosed, treated and/or dispensed medications. I even analized blood and urine specimans, drawing the blood myself.
I could go on and on about the different things I did as a hospital corpsman in the Navy that I could not do as a civilian without the so called proper schooling, training, and licensing.
I'm sorry, but my training and experience should have more meaning than it does, even after military service, than being a glorified nurses aid who even now, needs to show they have the proper schooling, training, and licensing these days.
Rockhound Rider :)
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Berta: I was a Hospital Corpsman in the Navy. To get their, I had to attend both an A school and B school before being allowed to receive orders to my first duty station as a HN/E2 Hospitalman. At that rank I served at several posts, to include, ward duty with new born infant care and then infant intensive care unit. from their I was transfered to my second posting to ward duty on a proctology surgical recovery ward. This was followed by a posting in the Cardiopalmonary lab as their administrations clerk, also serving as the clerk for the cardiopalmonary lab school. Next duty rotation I served at a Drug Rehab center as an intake physical evaluation clerk. acting as a physicians assistant in giving physicals and assisting the Dr with minor out patient surgical percedures. Upon my request at this time I was transfered from shore duty to Sea duty as a Junior medical officer/ Hospitalman 3rd class aboard a small class DD/Destroyer, where I attended to the medical needs of the enlisted personel aboard ship, this included conducting Sick Call twice a day and any and all emergencies that might arise. One of the duties, of which is of great importants, is that I was also charged with keeping all the medical files of the enlisted men, making entries as needed to show any illness, injuries, and/or treatment that I may note or dispense in the course of my duties. These would be the medical entries that the VA would look at to determine if an injury or illness had occured during service. It was also my duty to keep track of the quality of the potable water aboard ship and the control of any pests or vermin that may have made its way aboard with the use of US Navy regulated pest control chemicals.
Upon my transfer back to shore duty, my temporary duties were at a dispenseries imunisation clinic, dispensing the various shots that are necessary for those personnel who travel to foreign shores. My last duty station was as a Security Personnel at a Navy Hospital as a junior petty office of my post with personnel under my command. At this time I was approved for re-enlistment with approval to attend a Specialty School of my choice and advancement upon its successful completion. This is when I became ill and the time I was injured.
After leaving the service I attended College where I took and passed a class in Human Anatomy and cirtification as a EMT I/ Emergency Medical Technician. As you can see, I have had a varied amount of education and practicle experience in a number of areas, but I note my limited time aboard ship provided the most applicable training and experience of them all, not that the rest didn't have any meaning or cary any less weight in my medical career.
In the course of compiling my claim for my SC nasal fracture and deviated septum and now for secondary issues, I have researched the conditions for which I claiming and find that I probably have or has just as much knowledge about the condition as one would expect of a nurse practitioner except for the surgical aspects of the condition. But for the general knowledge necessary in conducting a physical exam, noting symtoms and their severity and the general knowlege in the basic treatment of these problems, I feel I am just as qualified in my opinion as that of a Nurse Practitioner. However I may have to do some point to point research on lab results and such, and time to update the list of pharmacology used in possible treatments that I would recommend, but on a one to one basis, I think my qualifications as a medical layman should have some weight comparible to that of a NP in this instance.
I know this sounds like a rant to some or most, but my training and experience should have some meaning and cary some weight in this case, at least more than just my word on the matter. What do you say and how do I get my training and experience noted?
Rockhound Rider :)
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Well people, I couldn't stand the elivated pain in my left shoulder, that was previously thought to be the result of burcitus, but now instead of the pain being more in the area of the shoulder socket, it bares its ugly teeth in my bicept or the area between my shoulder socket and elbow and is much more intense than I remembered. Anyway, it got so bad I was forced to seek out an appointment with my PCP and once again was lucky enough to get a next day opening to see her.
If I don't start glowing in the dark from all the radioactive rays I have received this year, I'll probably be picking up scrap metal from the MRI's I've had. LoL Today I had several xrays taken of my shoulder and bicept area, I hope I haven't exceded my limit thus far. Only kidding people.
I go back into town tomarrow for an MRI of my back, hip, and thigh area for the pain and numbness in those areas and I hope I finally got my IMO referal streightened out for my IMO for my current claim in the DRO stage, hope I hear from the IMO specialist for the appointment date soon, because they told me it will probably be a couple of weeks before I can be seen. At least it will give me time to gather up the neccessary medical history that will satisfy the VA as having had access to the same information the C&P examiner and rater had in their opinion and decision.
Anyway, it has been some week thus far and I am not alone either, my kitten, Tammi is getting the last of her baby shots on thursday and also getting her bio chip, so she can be ID'd if she should get, by chance picked up by the dog catcher who has been know to be in the area at times. My kitten and cat are at risk, since they are indoor/outdoor cats, helping to keep the mice population down and since tammi will be getting fixed, she won't be adding to the population of cats either. It's a shame, she's such a cute thing, I hate to do it, but if I don't do it now, and she does get nabbed, it will go worse for me if I don't do it and i can't ill afford a higher fine and having to get her fixed anyway.
Well I feel like I can get some much needed shut eye, that I missed last night, I just hope it doen't mess up getting to sleep later tonight. I've pretty much given up having regular sleep hours, I take it when I can get it and hope things work out in the end.
Rockhound Rider
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Like some if not most of us who are not 50% or better SC'd, I think it is anyway, we have Co-pays to make for our medications, if our income is more than what the VA allows one to receive and not be required to pay Co-pays.
I'm one of those, but I am pretty close to that amount, but my expenses to live takes all that I make on my combined SSDI award and my 10% SC'd disability compensation. Anyway, I have built up a bill as a result of which I had an aggreement in place for a repayment schedule and a income hardship that keeps me from having to pay or accrue additional Co-pays. This has to be updated every three months so that the additional charges can be waved and once a year for the hardship so I won't have to pay these new charges.
Suffice it to say, I still have past owing charges for which I pay a small amount, to pay down and eventually pay off these prior charges. Someone or somehow, wires got crossed and it was believed that I had reneged on the agreement and they attached a percentage of my SSDI to the toon of $138.00 and change. By the time I noted the amount missing from this months SSDI direct deposit and got into see someone about it and even though I called and reported the day the deposit was made, I am being told the amount cannot be recovered this time, but they will make a note on my account so that future problems like this don't or shouldn't happen.
To add to my pain and suffering, I have to update both my income means test and my income hardship, to insure that I will be safe from incurring any additional charges, at least for the next 90 days, when I have to go in and personally talk to a clerk, so they can take any accrued charges in that 90 days and put those charges in the do not have to pay colum.
Mind you, I have cognitive and memory issues that make doing something in 90 days an iffy proposition at best, even if I note it on a calender, which I may or may not remember to look at, if I don't have other appointments or things other than pay bills, listed for that month.
They have nothing in place for consideration of people with similiar issues, that make doing something, even less than a week away, a problem in remembering it has to be done. It's almost gottem to the point that I may have to turn my accounts receivable and accounts payable, to a stranger, just so I can keep up with all that is going on with my bills and such. I only have one person who I would trust, that I have known for a long time, and one brother who is fit to take on such a task, but both, I am sorry to say, have family issues that take up more than a normal amount of their free time to be able to have the time to help me out, so I am left with a stranger who does this for a living and I can ill afford to pay someone to do it, when I can hardly meet my obligations as it stands.
Does anyone know if their is a way to appeal this taking of my money and who I should address it too? Even if I somehow missed a due date or time limit, my problems with my hardship and/or ability to pay hasn't changed, I still pay the agreed upon payback amount each month and I am up to date with that, it is only the information they want, that has to be updated at prescribed times that may be in question.
The letter, saying they are taking the money, came the day after the deposit of the money. I did not get any prior notice that I was in any kind of default at this time. I only received such a letter the first time, which was some time ago, which led to filing the hardship and getting it into place and where by a payback amount and schedule was arranged. I need that money back to stay on schedule, for the repairs needed to my bathroom and for added charges I will incure this coming winter for electricity and propane for heating. Otherwise, I have to somehow find a way, since this amount, although seemingly not that large, when every nickle and dime for bills and living costs are already accounted for, any deviation puts me behind schedule in paying future bills or trying somehow or someway that doesn't cost anything to reduce them.
At this point what I say is no more than a rant and doesn't add any help, it only goes to show my frustration and helplessness to things I can't control or have any power to change as far as I know. Besides, I need to try and, at least get in a nap before I have to get ready and make it to an 0800 a.m. appointment with my PCP.
Rockhound Rider
:P :D B) :) B) -
Rock,
If you can read over again the two different rating decision's.
The one from 1973 that granted SC at zero percent and
the rating decision (Reasons and Bases Section) that provided an
increase to 10 %. It should tell you exactly why VA increased to 10 %.
jmho,
carlie
Carlie: The reason given for the increase was due to the 50% obstruction that was related to the trauma and the deviated septum was also said to be as a result of the trauma, theirfore the SC nasal fracture was increased to 10% due at least 50% obstruction to both sides of the nasal pasages wtih deviated septum due to trauma.
The original SC reason was just for the fractured nasal bone which had been reduced without any complications at that time, rating it at 0% at that time. I tried a couple of times to get an increase, but I didn't know that I needed the percentage of the obstruction noted in the wording of the examination reports and of course the VA Dr. were not forth coming with this information. I've had the same amount of problems with breathing difficulties for much longer than when I first appealed for an increase. If I had told by someone or had been given a proper C%P examination, they couldn't help but notice that had the requisite 50% obstruction way back then.
I must have also had incompetant representation from the SO who helped file my claims for me. They should have checked to see what the requirement was and told me to get someone to make the appropriate statement, but all they did was fill out and file some papers or the minimum they had to do, which as we all know, is about all they did back in the day.
Now I wait while I'm having my claim reviewed by a DRO in the mean time I need to hurry up and get an IMO to rebut the C&P examiners findings, which is why I am a bit mift at either my PCP or the NP for scheduling me with this particular medical professional, when I was trying to get a private referal for my IMO.
I've been having some pain issues that came to light when I weaned myself off my pain meds. It appears that this particular issue has gotten worse, since I don't remember it causing me so much pain. I think the pain meds were covering up additional trauma or some other cause that has caused the pain to feel or appear to have increased. I have managed to get an appointment this A.M. so I will also bring up the issue with the referal to my PCP at the same time. I will have to remember to give her the name and number of this private ENT Specialist, so she can fax her the referal, today if possible. I can then follow it up tomarrow when I come into town once again for a fee basis MRI for my back pain and left thigh muscle numbness that I have been experiencing for awhile now. That started all because I wanted to make my yard fire safe by cutting the weeds down. I tried starting my lawn mower and over did it or hurt it when pulling on the pull cord to start it. I think the twisting motion on my weak back muscles was to much for my disks and vertibraes to take.
I just wish my sleep meds would kick in, but with out the pain meds to help them along, I may be looking at a night without sleep. Been there befor, so it's nothing new for me. I dambed if I do and I'm dambed if I don't. If I take my pain meds, I won't be able to safely drive my own vehicle, but if I don't, my other meds won't work to their potential.
Check out my new post, it's a dilly and shows you how low the VA can get when you owe them money.
Rockhound Rider :P
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Since weaning myself off my pain meds, so I can more safely drive my vehicle, which I had chosen not to drive since being on the pain meds, is getting harder and harder to deal with.
My pain meds have or rather, usually reduced my pain threshold to about 50% for the most part and in some areas it appeared to have reduced it to nearly 0%, since now I am experiencing pain in those areas, like I can't remember, having not had to deal with it in those areas for such a long time.
Life or rather my quality of life, even though I can drive my vehicle without the fear of causing an accident, due to the effects of a narcotic, has actually been reduced, since their are times when the pain is so bad, I am reduced laying in bed with out the strength to anything else. Even lying in bed becomes intolerble at times, I had forgotten how much of my anxiety was connected to my pain level and how often my panic attacks seemed to co-inside with my pain level.
I just don't know how much longer I will be able to contend with the pain, just because of my fear of being in an accident brought on by the affects of the pain meds. Now I fear I may be in an accident, becuase my attention was hampered while dealing with the pain and not on my driving.
I got to go now, because the pain in my hands, while typing is interfereing with my spelling the words I right, I have to keep making corrections as I go along, because my fingers don't seem to want to do or rather type the characters my fingers should reach to, twitching in pain as a move about the different key strokes.
Besides, it's time I should be thinking about something to eat for luch, which brings on a whole new set of pain issues from sitting to standing.
Rockhound Rider :P B) B)
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Can you see your deviated septum when you look up your nose? These things don't heal on their own. It's been my experience, when you sign a release of records to the VA from an outside doctor, you open the door to all the records from that Dr. IMHO.
Question; How long have you been rated for the deviated septum?
Answer; It depends on how you or the VA looks at it I guess. The Service conected Nasal Fracture has been SC since day one from discharge from service, 1973, SC at 0%, I finally got an increase, I'm assuming, becuase it was determined that I met the disability schedule for a deviated septum due to trauma that caused at least 50% obstruction of the nasal passages on each side.
Even the VA Specialist said I had a deviated septum but did not go as far as the IMO Specialist to clarify the 50% obstruction, he only gave an opinion that agreed with the IMO that the deviation was to the left.
The last exam from my PCP stated that the obstruction on that day was 90% for the left side and 80% for the right side due to the deviated septum and sinus problems.
I think there has been a screw up with my referal for another opinion/IMO, but I go in Monday for my CT scan, so I will check on it's status. I don't think the PCP's NP forwarded my request to my PCP to send, by FAX, the referal I requested, since I have yet to hear about any appointment being met with this IMO specialist I hope to see.
Things are kind of comfusing me right now, since I have been suffering through constant pain since weaning myself off my Pain meds. I'm in constant pain all the time now and sometimes it gets so bad, all I can do is lay in bed, because I don't have the strength to do anything else.
I'm without a working bathroom right now. I have been working on the repairing the water damaged subflooring since the middle of last month. I can only work for such a small amount of time, that it seems like I will never get the job done. I still have a small section of sub-flooring to remove, before I can add some cross studs, to reinforce the new areas where the new subflooring sheets of plywood meet the original NDF sheeting.
I won't go into any detail on what I have to do to wash up and use the toilet, lets just say it is, at best, very primative. LoL
Rockhound Rider B) :P
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I guess I'm too medicated to make myself clear. I told my PCP that I did not want to ever be seen by these two VAHC medical personel, who I did not trust to be pro Veteran but Pro Regional Office or non-pro Veteran. The last Time I was examined by this so called specialist, he made diagnostic assumption without doing or relying on specific tests, which after having been done, showed how wrong his diagnostic opinion was. and his report also reflected his negativity to anyone who disagreed with him. The NP who works with him and who has to sign off on the things she does, only rubber stamps what he has said and done in the past.
It's like their insistance that I have a chronic allergic rhinitis condition without have done any allergy tests to prove it and to show what allergin it is that I am chronically allergic to. An opinion like this is no better than if I claim it as chronic non allergic rhinitis due to my SC nasal fracture and deviated septum which due to the obstructive nasal air passages and the cause for abnormal air flow through them, being the cause vs. some sort of allergin.
I don't know if I am being clear or not, since forgetting my key to my cart, I've had to medicate once again for my pain issues, which means I can't drive until I get my pain under control once again and off the narco drugs I take for the pain, even working the keyboard causes me pain believe it or not.
I'm calling it an early night for a change, at least it's not for psychiatric reasons for a change, but given a choice, I think I'd rather be a bit crazy than have to deal with the constant level of pain I have now had to deal with.
Rockhound Rider :D :)
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I think I just got scr&%#d by my PCP NP helper, even though she may have thought she was helping me out. I told my PCP that I did not want to be seen by the in house ENT specialist nor the NP that works with him, I don't trust either one and my PCP knows I would rather pay out of my own pocket than to see either one.
Long story short, I went to the appointment, seeing the ENT NP and she is saying the latest CT scan, the one that my VA Claim for increase was based on, as evidence of a deviated septom, is saying that the CT shows their is no deviated septom.
Now I'm scheduled for a new CT Scan on the 24th of Aug. and I am wigging out that it will come back showing no deviated septom too, and word will get back to the VA regional office and I will loose the 10% increase I worked my ass off getting.
Once again I am walking a tight rope, my next step might have me falling. I'm freaking out over this and don't know which way to turn or how to handle this, should this new CT scan not be favorable.
I feel a rant comming on, so I better go for now.
Rockhound Rider :P B)
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Question: Even though a Veteran's Primary Care Physician did not provide a foundation or medical rational, that the Chronic Sinusitis and/or Non-Allergic Rhinitis was the result of the Veterans Service-Connected Fractured Nasal Bone, with a Deviated Septum due to that trauma, Isn't it sufficiant or rather does it carry any evidentiary weight, in that this condition has been diagnosed, by a prior PCP and that the condition continues to be listed in the Veteran's Axis III list of diagnoses/problems, that the same treatment has been carried forward by the Veteran's other PCP's during the course of history as an outpatient with the VAHS/Veterans Administration Health System. Shouldn't this long standing diagnoses and opinion, even without the medical rationale, have just as much weight as a Nurse Practitioner VA C&P examiner who quotes a medical brief from the Internet especially since they only saw the Veteran that one time? Shouldn't they consider the length of time the symptoms persisted, even though they may not have been present or of sufficiant severity at the time of the C&P Examination?
Also, isn't it stated somewhere in the C.F.R.'s that statements or assurtions made by the Veteran that are not supported/backed up by othe evidence, can not be used against or negatively reflect on the Veterans claims. Point in case. On enlistment Veteran checks off having had problems with sinusitis prior to enlistment, yet at the time of the Physcal, no Acute or Chronic condition or symptoms/evidence was shown the enlistee had an ongoing problem with his sinuses, noting, by checking them as normal in the course of that examination; further evidenced by the Veteran's medical history during service, that he had any ongoing problems of sinusitis or if he had, that the condition was made worse by and during the course of his military service? The problem having arrisen only after the Veteran having sustained a fractured nasal bone and deviated septom, due to trauma, which was found to be SC, also that such injury and deviated septom having occured just prior to Veterans medical discharge for an unrelated psychiatric disorder, Veteran asserting that the Chronic Sinusitis and Non-Allergic Rhinitis only became a problem since the SC condition for which veteran, for the most part, treated himself, simce his MOS was as a U.S. Navy Hospital Corpsman and had sufficient medical knowledge on how to treat such conditions.
Also, Such a condition need not be of sufficient severity to require bed rest and treatment by anitibiotics, for at least a certain number of days, if the same symptoms which did not require bed rest or for which was not treated by antibiotics, so long as the number of days and times the symptoms occered met other standardized requirements.
Ongoing problems and treatment should be sufficient a medical rationale, if such a diagnoses is supported by other Dr's, in this case, not one PCP, but two PCP and even the C&P Examiners report agrees that the Veteran had Chronic Sinusitis and non-allergic Rhinitis, stating that at the time of the exam, they could only attribute the sypmtoms then as being derived from the Allergic form of Rhinitis, even though they provided no proper testing of what the Veteran was allergic to, to otherwise compitantly support their findings, whcih could just as well be those symptoms of Sinusitis and/or Non-Allergic Rhynitis.
Sorry for the long winded question and such, I tend to carry on like this when I don't understand the VA's rationale and the why for they denied my claim, when the evidence appears at least as likely that the problem with chronic Sinusits and/or Non-Allergic Rhinitis is the result of my SC Nasal Fracture and Deviated Septum due to Trauma.
Thank you all for your patiences and hopefully understanding, while I try to do my best to prove my claim, which will probably go down to an IME/IMO needed to rebut the Rationale given by the C&P Examiner who is just a Nurse Practicianer and not a Dr who specializes in ENT/Ears, Nose, and Throat problems and who is board cirtified with more experience in not only treating such problems but also doing surgical procedures to relieve same such symptoms when warrented.
I can honestly say, that since I broke my nose, I haven't had a day go by that I havenlt had some problem associated with obstructed nasal air passages and with problems arrising from it with nasal congestion, runny nose, post nasal drip, pain in and around the sinuses, crusting upon examination and other related issues that support that this problem is of long standing and more likely than not, since the injury to the nose occured or shortly afterwards when the deviated septom began to cause the obstructed airways and associated problems arrising from mouth breathing.
It's late or early, however you look at it, I'm tired, I hurt, my nose is as near to being obstructed 100% to each side that I cannot breath or take air through my nose without feeling like I am sufficating, my mouth is so dry it is difficult to swollow or generate enough saliva to even moisten my lips to whistle for Tom my cat to come in from outside to eat what I have set out for him before his step sister Tammi, with her growing appitite eats hers and then starts on his. Just suffice it to say I am one misserable guy right now.
Plus I have taken to doing more than I am used to doing, since I have decided to start driving my own self about town, which neccesitate me not taking my pain medication at least twenty-four hours prior to driving and as I have found out quite quickly, I must incorporate a nap, once I have finished my running around town, to recoupe some of my strength, being off my pain meds is quite tiring, so I don't find myself dozzing at the wheel during my trip home. Having been a big rig long haul driver, I know this feeling quite well and know and understand my limitations, it is one of the reasons I stopped driving myself, but due to financial and circomstances and considerations that I had no control over, not driving myself is no longer a viable option for me. I do not make this choice lightly nor without considerable thought going into the decision, but for me, and I state that because I do not recommend that others follow my logic and reasons for making the choice I have, I just feel it is the only choice I have right now.
I'm a sissy when it comes to pain, but I've lived with it for so long now, I only hope I can adiquatedly juggle the amount of pain I can indure with my need for the medication I take to help relieve it. Right now, mobility is hampered somewhat and getting to sleep being the number one problem presnetly, but only time will help or rather tell me if my choice was or is justified.
Rockhound Rider :D
p.s. maybe now I can get out and do a bit of fishing, that is if their is enough water left in my favorite fishing spots and is's not to far of a walk to the waters edge. It has been the number one thing I have missed since getting sick, the second is prospecting for gold and gem quality stones, but at this time, that is still outside the relm of my indurance to do, so I will be happy if I can at least get out and do some fishing a time or two before the summer is gone and winter blows its ugly head into the region once agian.
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As a necessary increase, due to the fact that people care little about the disabled, if part of the funds to operate services for the disabled comes out of their pockets, by way of a tax anneciative, I have been force to make a necessary change at how I view my voluntary action to stop driving my own vehicle.
My costs to use the disabled acces van has more than doubled since I started using their services. When I started the program, it cost me two access tickets at a $1.50 each, it has had two increases in those three years and now I pay two tickets at $2.50 each and their is already another increase planned in the near future.
At five dollars a trip just to get me into town and five dollars to get me home, I am looking at $10.00 plus what I might spend using the city bus system to get me where I actually want to go. That ranges from $1.00 to $2.00 for the day. My total then comes to $11.00 to $12.00 each trip I make to go into town for the day of either seeing the Dr. or shopping, or just to take in a movie or some other form of entertainment.
I did the responsible thing in the past and parked my vehicle, which is equipt to handle my scooter or chair and because my scooter is one of the largest the VA authorizes, I was forced to use my electric chair everytime I went into twon becuase it was the right size to acces the Handicapped Vans, Taxis, and city buses.
Now I have come to a cross road of doing the responsible thing and take the cost increases with a grain of salt and continue to use their services vs. saying to H%$# with it all and fire up my Masda pickup and start driving myself again.
I am opting for conveniance of my vehicle over the price gauging I feel the disabled are getting from bothe the city, county and US government. I pay taxes on my property that helps pay for the Access Van service, but since I do not live within a 1/2 mile of a city bus stop, that meets the federal guide lines, They consider me as being in an extended area and by federal guidelines, they don't even have to provide services for those of us in the extended area.
I'm not a happy camper over this issue, since now I have to deal with more pain as I cut back on my pain medication, just so I don't drive while under the influence of a narcotic, If I should be pulled over for whatever reason I might be.
So, If you see a white Mazda B2600I with a Bruno chery picker style lift with either a large electric scooter or chair, you might want to stear clear just to be safe. LoL :D
My insurance is paid for, at least for the next six months and I get my smog check this coming monday, but I might not be able to license it until the 19th Aug when my next SSDI deposit is due. Since I only got a 10 day movement permit, so I can get it ready to smog check, i.e. oil change, coolant change, brake, clutch, power stearing fuilds replaced, and Oh yea, replace the rear end fuilds too, not to mention greasing anything that has a sert fitting to do so.
Well, Tammi is telling me it's time to get some shut eye and I must agree, it has been one of those days where you wish their were more hours in the day, but moan and groan the next day becuase of all that you did.
Sorry guys and gals, but I had to make a choice and for me, I believe it to be the only choice I had open to me at this time. If things change, I may go back they way things were, but instead of parking my vehicle like I did before, I think this time I will maintain the registration and insurance, just in case. Their were several times in the last three years, I could have used having the option of the Access Van or Driving myself.
I never knew a kitten could purrrrrrrrr in their sleep, it's kind of cute when she does it, but I think she is just playing that she is a sleep, it her way of telling me to stop with the computor thing and lets go to bed.
Rockhound Rider :D
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I couldn't take it any longer, dam the pain and to the lung congestion I knew I would have to deal with. I caught my neighbor just as he and his wife were headed into town to work. I asked him if he would help me get my lawnmower into town to a repair shop. I'll have to deal with how the cost of the repair is going to impact me this winter, but the weeds are reaching near waiste deep and it wouldn't take more than a random spark to set it ablaze along with my mobile home, even though I have a fire hydrant right on the edge of my property for the fire dept. to hook too. I doubt they would be able to same any part of my home should a fire start.
My neighbor said I could barrow his while mine was getting repaired. It took me all day to do just about one 1/3rd of my 1/3rd acre lot and boy can I feel the pain I knew would come as a result. I'm maxed out on my muscle relaxants and pain meds and I used the last of my bottled oxygen, but mentally I feel a bit better, worrying less about the fire danger, since that portion of my property that borders the roads has a lot less fuel to feed a fire.
When I came in having finished the last segment of weeds for the day, I fixed my kitten some food before I forgot, since I knew once my meds kicked in, I would, hopefully be fast asleep. Sleeping through most of my pain. But instead of my kitten purring at my feet, knowing what I was fixing, my kitten was no where to be found. Being quite unusual for her to mix a meal, being like a psychic, knowing when I am fixing her something to eat. I went from one end of the house to the other, but no kitten, I was beginning to think she had found her way outside and I wasn't in any shape to go looking for her outside.
Ow and behold, I was about to do just that, when I heard a little meow, It took me a bit of time to zero in on the sound, but finally I found her in the last place I thought she would be. She was inside her carrier case, curled up asleep, the meowing was, I guess her having some sort of dream. I couldn't believe she would go inside her carrier like that on her own, she seems to hate being put in it when we travel outside and away from the house. LoL :P
I guess it's time to find some carpet and take some of the scrap wood I have and make her one of those cat trees, with cubby holes and purches up high, so she has the best of the two things she likes the most. Hiding out of sight when she takes her naps and a place she can get up high to survey her kingdom. LoL I hope I can find a simpathetic carpet store that will either donate some scrap carpet or some they will sale to me cheap.
Well tammy is asleep once again, but she is next to me while I am typing on the keyboard and I think I will take the hint and lay down and try to get some sleep. It's been pretty difficult to do the last few days, so I am hoping the added muscel relaxents, pain, and psych meds will be enough to put me into La La land. Even at midnight it is nearly 90 degrees inside, but the temperature is dropping, even as I type. I just hope I don't sleep in, Wednesday is trash pickup day and I have been neglecting to put out my cans and they are beginning to over flow, which is par for me, since living by myself, I don't generate enough trash to put my cans out each week.
Good night to all and thanks for the words on my kitten.
Rockhound Rider ;)
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Thought everyone would like to see a couple of photos of my idea of Stess Reduction. LoL This is Tammi, she is about 12 weeks old now, I wish she would stop growing and keeps up with her kitten ways. When I feel down in the dumps, all I have to do is watch her playing by herself or when I play with her. All I have to do is remember and watch out for her teeth and claws, they are sharp like a razors edge. NO I won't filem down or cut them off, She will be raised as an indoor/outdoor cat. The only thing we might agree on is that she will be fixed, so no unexpected kittens, although I wouldn't mind have at least one litter from Tammi and Tom, but I can't afford to feed a house full of cats, nor would I relish the job of looking for homes for them, it would be like giving up my own children. LoL :P
Two weeks ago, I would have told you she was a brown mixed breed Tabby with at least some Siamese in her blood line, but now I am not so sure she is going to retain the unusual brown in her Tabby color. Her much older and bigger step brother is a silver Tabbi and gets more silvery as he gets older.
I hope the photos come out OK, at least the AVATAR photo came out ok, but it's a bit to small to get a good idea of her markings.
Rockhound Rider & Tammi
p.s. Just klick over the photo and it should post a full page photo.
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Thanks to the VA and the US Government, I have very little pride left. A government and/or government agency such as the VA, that freely accepts the help from their citizenship, with the promise to take care of them, both medically and/or finanancially, should they become ill or injured during and as a result of that serviece, doesn't deserve the taking of the last bit of pride I have left.
It's not pride that is keeping me from the progams out their to assist those in need, it just that the threshold to meet these programs are such that I make, after allowable deduction, to much income. Some programs don't consider your SSDI or VA Compensation as income, but the program you speak of, does. I make about, so they say, twenty to forty dollars to much to qualify me. I was on, or rather I did at one time, when I was only getting the VA NSC Pension meet their stiff requirements, but that lasted all of one winter and then I was qualified for SSDI, which paid more, loosing my NSC Pension, I made about 20 dollars to much then, so I was no better off while I was on the NSC Pension with help,than I am now on SSDI and 10% SC with no help availble now, because I can't meet the lower income threshold anymore.
With everything costing more these days and our disability checks not even coming close to keep pace with them, I see no further help in the coming years, unless I can find some way to beat the VA or rather win what I feel I deserve and I might add that I do not plan to try and push through any disability I might have, I only want those that, by rights, I truely have coming to me. I haven't even considered a 100% total rating at this time, since I live alone and have managed to do the bare necessities, I just need the financial assistance, that my current disabilities that I believe are SC'd, so that I can continue to live on my own and not have to always be keeping my hand out, each and every time I need extra assistance, such as help with utilites, and other household expenses. It would also be nice, for once, be able to draw up a diet menue that my VA Nutritionist says will help me to loos weight and have the funds available to spend and not worry that I have spent to much on food and now don't have enough to pay ofr my winter heating costs.
Last Winter, my frostless spicket, somehow did not drain off the spicket head after it was turned off and the water that was left inside the head, froze and busted it. It wouldn't be such a problem, but it is the only outside source of water to feed my swamp cooler and if you have been following the weather temperatures for northwestern NV, you would know how hot and miserable it is without some sort of air conditioning. Both me and my new little Kitten Tammi aren't doing much, since the heat just sucks the life out of us. I'm not even worried at how much more my electric bill will be when running the swamp cooler, it cirtainly can't be that much more than running a fan all day and all night.
The cost of my rides into town have more than doubled as of this month, so I have to take that into consideration when winter comes once again and I have to do some fancy scheduling to make sure that when I do come into town, I use the time wisely, seeing my doctor, paying bills and shopping, all on the same day and what a long day that will be, stuck in my electric wheel chair for more than 12 hours on such days. If your like me, such as days like this, it takes me a couple or more just to recharge my batteries, unlike my electric chairs battery's that charge up in about 8 hours or overnight while I sleep, that is try to sleep, which is very hard to do with temperatures, even at this time in the very early mornings. Last I checked at 0:100 a.m. it was 85 degrees inside my mobile home.
I'm kind of rambling and venting now and sort of feeling sorry for myself and for little Tammi, she's lying down just to the back side of my keyboard, still trying to be the little pest, which I love about her, but not having any strength move about like she would normally do when the temperatures were more bearable. LoL
Got to go and throw some cool water on my head, or I will surely have a heat stroke.
A very Hot and Miserable Rockhound Rider :P B) ;)
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I wish I could afford someone like Dr. Bash or someone who is famiiliar and adept at this type of VA examination and opinion, but I can't. I am limited by the funds I have each month, and even then I have to do without the only thing I control of, my dietary needs or cost of food each month.
Once winter comes, I have no options open to me what so ever, since any extra funds go towards heating costs that I don't have in the summer months.
There fore I take what I can and hope for the best. I do go into this letting the Dr know completely what I am looking for and hope they will understand what is expected of them and what their IME/IMO must have and show so that the VA cannot then say they did not review my medical history, give a medical rationale, and a proper opinion as to severity and being because of what happened while in the service. etc. etc. etc..
I managed to get onto the uptodate site and download the complete report, a lot that the C&P examiner did not state in their rationale. In all that I have found, which was referenced from this same report, Structural abnormalities such as trauma to the nasal bone and deviated septum, can be the cause of such conditions as Sinusitis and Rhinitis. Especially when such abnormalities cause the natural air flow thru the nasal passages and sinuses, to be changed. Causing obstruction is the key component here.
Rockhound Rider
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While I continued my research on the Webb, I came across the exact report that the VA C&P Examiner was Quoting from. I failed to understand while reading the C&P report that she did cite the report and I took it to mean that her information was up to date. Instead it is the name of the Webb site Uptodate. The examiner quoted word for word, only that part of the report you can read for free, the complete report costs about $20.00 or more, depending I guess on how much time is spent in the research from the Webb specialist. It appears from the Examiners, that they quoted only that portion of the report that is free and did not look any further.
This is not an opinion from a VA DR., but from a online Webb sight. This is very strange that a VA C&P Examiner would use/Quote an online medical opinion, yet it appears that non of my online medical information was not.
I feel I should complain to someone on this. If they are going to quote such a sourcs, then they should quote the complete information and not just what you would get for free. What I am trying to say is, what's good for the goose is good for the gander.
Sighting my own source, which is just as relyable, would then it seems, put the literature in equipoise. 50/50 and since the literature that she is basing her opinion on is no better than mine, then my information/literature should prevail.
I tried last night to access a more complete report, but for some reason I could not get my log in information to take so I could pay the fee and see what else the Uptodate Webb site would provide. I'm going to try once again.
Rockhound Rider :o
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My mind doesn't work in a logical way, going step by step to a logical conclusion, rather It seems to jump around alot, sometimes forgeting something important, but if I keep the subject forefront in my mind long enough, everything or at least enough gets processed to finally make the logical sence that is needed when putting it down on paper.
One thing that came to me, is that when I was confronted with making a diagnosis when I was the junior medical officer aboard a U.S. Navy Ship at sea, I reference what I could from the current volume of the MERK manual and if that was not sufficient then I took it to my Chief medical officer or relayed my information to the tending Dr of our group and discussed what I had found and what I thought may be the problem and/or correct diagnosis and if he concurred, I would then discuss the proper treatment, if it was available aboard my vessel, if not, then that person was either transfered to the tender where the Dr was or they where transported to the nearest shore hospital for further evaluation and treatment.
The short of it is that I haven't yet looked to see what the Merk manuel has to say on the subject, so that is what I plan to do as a layperson with a medical background.
Also, I am in the process of getting my medical referral arranged, it won't be with I had first chosen to seek an opinion with, but with someone else, since I have found out that their are limited spaces or number of patients that civilain Dr's will see who wish to do so using Medical as their insured payor. Bummer. But I did find someone who will take my appointment, just as soon as my PCP send then a directed Fax to this ENT specialist requesting them by name, then an appoint will be made for the enitial visit. I only hope after explaining what I need and what hoops they will have to jump thru for their opinion to have any baring on my claim, that they will consent for a more complete and thorough IME/IMO. that is complete and up to the task of rebutting what the VA C&P Examiner has opinioned on the subject.
I hope the MERK manual proves probative on this subject, it will make my own personal findings that much more probative in my own mind.
Rockhound Rider
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If I am to explain to a ENT specialist what I need in a IME/IMO to help win my claim, I was hoping their is some Precedent Opinion that would help me or rather my specialist to know what they must provide in order for their opinion to be of sufficient value to rebut that of a NP C&P Examiners findings and what the VARO rater perceives as countering evidence?
I will continue to read what I can, but any help would be appreciated very much since my mind seems to work in sperts before it becomes fatigued to the point I must stop and start fresh another day.
Rockhound Rider
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Thank you Berta! This helps relieve some anxiety I am experiencing on this subject. I do have a question about compitant layman evidence. I was a Hospital Corpsman in the Navy having attained the rank of E-4/Third Class Corpsman. I spent a short period of time as the junior medical officer aboard a small class DD/Destroyer. I was personally in charge of sick call for the Enlisted personel aboard the ship, diagnosing and perscribing medication and keeping medical records that the VARO would consider after service on their claims, when considering if some injury or illness occured while in service. Most of what I had to deal with were similiar problems I have currently with sinusis and or rhinitis, even ear infections, colds, flu like problems and such injuries that you would normally see aboard ship. I even had cause to diagnose a case of viral hepatitus and placing the ship on quarintine until it was lifted by higher authority. one enjury that involved an open fracture brain injury, and eye problems associated with the cleaning of the boiler tubes where personel had to go inside to scrape the sides of the boiler tubes of reosalt like residue that when it mixed with sweat, caused eye irritation and burning which required further evaluation by eye specialist.
After service I went to school to become a EMT II and delivered two babies while undergoing training with my name being written on the cirtificates of birth as the person having facilitated the births. I work as an aid on a stroke unit for a short period and worked a nursing home as well for a temp agency along with private duty for home care aiding a registered nurse.
I am not your tipicle layperson, I understand and can read medical reports and what I do not understand, can access the information that will clear up those deficencies. I have read quite a few different papers on the differential diagnoses and caused for chronic sinusits and rhinitis and can see that it is just as likely as not that any fracture of the nose that causes a deviated septum and that issue is found to be due to such trauma, can be just as likely as not, the cause for a chronic sinusitis or rhinitis condition.
I saw my PCP who wanted to help but she felt I would be better served seeing an ENT specialist and was given a name of one who I could make an enquiry with for a IME/IMO, but their is no guarenty she will assist me in my claim. But that doesn't shut the door on me looking for someone who will. Plus the VA C&P Examiner I thought to be a Dr. turns out to be once again, a Nurse Practitioner. I was led to believe she was a DR. which I find very unethical a best.
I have a lot to do in the following days, I just hope I can make good on all that I need.
Thanks once again for replying, I know you a very busy person of knowledge, I am lifted up that you have been able to take the time once again out of your busy life to help a veteran in need, if only for assurances that I am following the right path on my claim.
I would ask, on my claim for a TBI and residuals that I have been gathering evidence, should I go ahead and submit this claim or should I pospone it for a time, until I get this current claim taken as far as I can? I worry that by submitting another claim, that it will further delay this current one, but waiting will also delay action on this one yet to be submitted.
Rockhound Rider
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I know I need to file a Notice of Disagreement, but have never done this before, since like a dummy in the past, I never went any further with my claims. But now is different and I plan to appeal as long as it takes, even to the Court if I have too.
I have three issues I wish to appeal, (1) two small painful scars at 10%, (2) Chronic Sinusitis, (3) Chronic Non-Allergic Rhinitis, all secondary to a SC Nasal Fracture and Deviated Septum due to Trauma.
I do plan to seek an IME and IMO for these conditions from a private ENT specialist, in the hopes they will be able to provide the evidence I need to rebut the VA's opinion.
Must I make my intentions to NOD the decision within a time frame other than the year in which I can appeal their decision? When should I, If I decide to ask for a DRO, make my desire known to the VARO?
They gave me written notice on what I can do if I disagree with their decision, but since I have never gone this far with my claim, it's a bit of unknown territory for me and a bit daunting/scary for me as well. I don't take disappointments very well and I am a day and a half without my meds, since I stayed in town to make it to a next day appointment to see my PCP on an un-related issue that I thought I would have to wait a month or so to get. Getting the next day was a god send from from the great spirit that looks over me, so I jumped at the chance to see my PCP so soon.
It does nothing for how I feel like a heal to my cat Tom and kitten Tammi that I had to leave them to fend for themselves for this long, even though I make sure that when I do into town they have plenty of food and water for a few days, just in case of things like this coming up. This will be Tammi's first time this long without my super vision, but Tom being an indoor/outdoor cat has had this forced upon him a couple of times in the past.
Well it's time for me to check in at the VAHC for my morning appointment, so I am off probably till I get home tonight, so please make your suggestions and experiences known so I can make my plans for the next step in the Claims process.
Oh yea, should I wait until this NOD or appeal is done before submitting another claim I have been working for some time to get the evidence I needed and it appears I have it now, but I am pretty sure this claim will take some time due to the issues at hand?
Rockhound Rider
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While at the VAHC to make an appointment with my PCP about my back pain and numbness in my left thigh, I picked up my progress note in which I had hope my PCP would step in and give me some help with my denied claim for secondary chronic sinusitis and non-allergic rhinitis, but all she had to say was and I quote: " He had a C&P rating and he was disappointed because it didn't go well. It was determined that he doesn't have rhinitis on the basis of structural damage suffered in the service. I would tend to disagree, but ENT needs to weigh in. The problem is, he and Dr. Coppola don't see eye to eye." Not much to support an opinion on for a rebutall of the C&P Examiner's opinion now is it.
I managed and don't know how, but I got an appointment to see her in the a.m. so I will ask her for the ENT referal she said she would give me so I can hopefully arrange on my dime to get both an IME and IMO to rebut the negative C&P exam, only time and finding a ENT Specialist who will take my Medicare, will tell whether or not I will get the evidence I need for my NOD and/or DRO hearing.
Got to go, it's late and I am using the computor at the Veteran's Hospitality House where I am staying the night, so I don't have to turn around and come back to town, costing me precious funds for the round trip. Spirits be praised.
Rockhound Rider
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It's just as I feared when I read my C&P exam. They are saying that service records show I fractured the tip of my nose and that the sides of my nose were not involved, that the claimed painful scars are not scars but patches of Erythema, that my eye glasses nose pads rest their and are not associated with the nasal fracture.
Also SC for chronic sinusitis as not having been shown to have been treated in service and no evidence to show that the mild sinusitis I had growing up on occasion was worsened by military service, or evidence to show sinusitis was worsened as a result of service.
They are also claiming the chonic sinusitis I claimed was not diagnosed by the VA C&P examiner but rather it was diagnosed as Rhinitis and that their was no other compitant medical or other evidence to show this condition began in service or was caused by service.
How could I be treated for these conditions when it developed as a result of my worsening residules to my SC nasal fracture and deviated septum, when I was discharged shortly after the injury occured. I only resently got my SC nasal fracture with deviated septum increased from 0% to 10% so it follows that these other conditions would increase in severity as well and in the same time line.
Now I have to take all this garbage the VA used to decide my claim and take it to a specialist on my own dime to get all this rebuted with clear medical rationale to rebut the C&P examiners opinion.
Also, apparently my PCP's opinion didn't count since they did not provide the needed rational for their opinion and observations.
Ten months waisted and now I have to provide a NOD and/or request a DRO, hopefully locating a ENT specialist who will do both a IME and a IMO.
Rockhound Rider.
p.s. I had to go and get a buch of chocolate peanutbutter ice cream and chocolate bars to help inhanse my mood meds, even with the comfort food, I doubt I am going to get any quality sleep for awhile.
B)
Neurologist Consult Note (attached)
in VA Disability Claims Research
Posted · Edited by Rockhound
I mere statement of, "it is just as likely as," will not suffice. The IMO will have to not only include that he has reviewed both the service medical records and any civilain or VA medical records, but that they have also examined you and found that your injuries and limitations were consistant with, as per the CFR schedule of disabilite rating/ which percentage rating that matches your condition. Then they must given their rationale/ reason and basis for their opinion, noting specifics of your case and as to how they apply to his opinion and provide any supporting documentation/treateses that he can along with a history of his schooling, specialtese, experience, and any cirtification in any related specialties that support his knowledge and opinion.
This is why it is hard to get a decent opinion to knock down what the VA uses. Unless the IMO is loaded for bear, even if the Evaluation of your condition came from a NP like mine did, your not like to get a change in their opinion or if your lucky, have your IMO used to outweigh the other VA doctors or C&P examiners opinion during the rating process.
Rockhound Rider