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Thanks pete for the advice. On the last claim, in the narrative, the DVA rep noted my intention to file TDIU, not an offical notification using the forms, but on form 21-4138. I have not idea if that will matter, so I am filing the required form next week when I visit with the DVA rep.

Thanks for the advice Berta, I have an appointment scheduled with the local DAV office to fill out and return some required information for 1 of the deferred claims, I got a letter seeking additional information the day after I received the award notification letter. I am planning on sending in the form to request TDIU as well. I have some claims that were deferred in 2008 that I waited until Dec 2010 for the VA to do something, and finally requested an appeal on them. I am just concerned they will never get around to taking action on the claims, even though they have addressed the particular problems in subsequent C & P exams for other issues, but still no action. I wish there was some way to prod them in the right dorection at times, but afraid that will cause them to take longer. SSDI and the VA both agree I am disabled for the same problems but both seem to be just wasting time making me run around in circles over and over.

I am currently rated 70% overall, 40% for traumatic arthritis lumbar spine secondary to surgery for lumbar disc disease 20% paralysis, incomplete, moderate, right sciatic nerve 10% tinnitis left easr 10% right knee DJD/patellafemoral pain syndrome 10% left knee DJD/patellafemoral pain syndrome 10% Irritable bowel syndrome 10% migraines claims currently under appeal Right hip (related to the cause of traumatic arthritis in lumbar spine) I think a high chance this will be rated 20% left shoulder I think a high chance this will be rated 10% right foot deferred claims scars aches/pains neuropathy upper and lower extremities bilateral diabetes skin disorder/acne I am unable to work as a result of my disabilities, am currently working through the SSDI circus (step 3 of the process), haven't worked since march 2010. Should I apply for TDIU? Is there a chance it will slow down more the existing appeal that the VA seems to have stuck in a drawer somewhere? Will it be decided cuncurrent with the existing appeal, or how will that work? What are the odds that I am approved for TDIU? Just wondering what y'all think. Thanks.

Well, I recieved a decision, or at least a partial decision on this claim. I did recieve 2 ratings, 1 expected just lower than expected, and 1 that was not expected. Still quite a few that were either denied or deferred. Also several things that are part of an appeal that were covered in the C & P. The VA can be so frustrating. They rated me as follows: 10% Irritable Bowel Syndrome as a presumptive illness from service in Southwest Asia. I thought with my symptoms it would rate as 30% but am happy with this, it can be appealed later. Symptoms as stated by the rating officer: Soft to loose stool with every episode of of food intake. eating reliably followed by fecal urgency with abdominal cramps. I am not sure I understand the difference, the explaniation of the rating decisions follows. States an evaluation of 10 % is granted if the record shows frequent episodes of bowel disturbance with abdominal distress. A higher evaluation of 30 % is not warranted unless there are symptoms of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. 10 % Miagraines (claimed as headaches) This was a surprise. Went through the "Gulf War Syndrome" exam, of which headaches are part of, and I do have headaches. I also was diaginosed with migraines during my service time. not unhappy about this at all. Deferred on the following: increase for scar, left nose aches/pains (associated with Gulf War Service) Neuropathy bilateral upper and lower extremities Skin disorder/acne diabetes several others that were denied. I guess I am going to have to let the deferred claims work themselves out, but from my experience I will have to file an NOD and then an appeal. I have a pending appeal for several items that were covered during the C & P, that have set for over a year and have not moved from the local office of jurisdiction. I am sure it's because I had another claim in process, hopefully they will begin working on the appeal since everything in the appeal was addressed in the original claim filed in 2008, and were identifed in the last C & P exam. Right hip, included in original C & P and denied, NOD'd, and then appealed Hip Active Range on Motion for each type of motion of this joint : Flexion: to 80 degrees extension: to 0 degrees adductions: to 25 degrees abduction: to 45 degrees internal rotation: to 40 degrees external rotation: to 60 degrees Note: pain is caused with active excursion and is due to back condition and not due to intrinsic hip joint disease: passive excursion is tolerated with normal flexion to 90 degrees. Is there objective evidence of pain on active motion: yes Is there pain on motion after at least 3 repetitions of ROM: unable to test Additional limitations: no reason unable to test: baseline pain with active excursion and baseline impairment makes testing an undue burden Right foot part of original C & P denied, NOD'd, appealed Foot exam right/left Abnormal findings: weakness, circulatory disturbance dscription of abnormal findings: unable to abduct, normally plantat flex toes at MTP joints very cool to touch absent ankle jerk knee jerk hyperactive Sensory exam: sciatic nerve right/left lower vibration: absent pain/pinprick: decreased location: entire limb, more severe anterior thigh, medial calf, and foot light touch: decreased dysesthesias: yes burning pain anterior thigh description of other motorimpairment: unable to abduct, plantar flex toes either foot, marked weakness of right EHL; increased tone in both calves; mild atrophy distal quadriceps effectson usual occupation and resulting work problems: leg symptoms due to SC degenerative disc disease limit walking, standing, sitting and similar activities of the lower extremities. hypertonicity of bilateral plantar flexor muscle groups with overuse related to pain; etiology is likely as not disuse due to severity o SC back and sciatic nerve conditions. Left Shoulder part of original C & P, denied, NOD'd, appealed Left shoulder ROM forward flexion: 90 degrees abduction: to 90 degrees internal and external rotation: to 50 degrees extention: to 30 degrees objective evidence of pain on active motion: yes pain on active motion after at least 3 repetitions of ROM: yes

ok, I wasn't sure. It's hard to figure what they will do with limited experience dealing with them. I would assume the C & P notes will make a decent place to start for filing a claim for those things moving forward, although I am sure there will be some type of contention and a follow up C & P, even though they are noted in the notes. Thanks for the input John.

What about things (not currently rated) in the C & P exam that are stated as resulting from SC issues? Hip Active Range on Motion for each type of motion of this joint : Flexion: to 80 degrees extension: to 0 degrees adductions: to 25 degrees abduction: to 45 degrees internal rotation: to 40 degrees external rotation: to 60 degrees Note: pain is caused with active excursion and is due to back condition and not due to intrinsic hip joint disease: passive excursion is tolerated with normal flexion to 90 degrees. Is there objective evidence of pain on active motion: yes Is there pain on motion after at least 3 repetitions of ROM: unable to test Additional limitations: no reason unable to test: baseline pain with active excursion and baseline impairment makes testing an undue burden Thoraco-lumbar spine ROM active motion: Flexion: 0 to 20 degrees extension: 0 to 0 degrees left lateral flexion: 0 to 10 degrees left lateral rotation: 0 to 10 degrees right lateral flexion: 0 to 10 degrees right lateral rotation: 0 to 10 degrees Objective evidence of pain: yes additional limitations after 3 reps: unable to test reason unable to test: baseline pain and impairment Foot exam right/left Abnormal findings: weakness, circulatory disturbance dscription of abnormal findings: unable to abduct, normally plantat flex toes at MTP joints very cool to touch absent ankle jerk knee jerk hyperactive Sensory exam: sciatic nerve right/left lower vibration: absent pain/pinprick: decreased location: entire limb, more severe anterior thigh, medial calf, and foot light touch: decreased dysesthesias: yes burning pain anterior thigh description of other motorimpairment: unable to abduct, plantar flex toes either foot, marked weakness of right EHL; increased tone in both calves; mild atrophy distal quadriceps effectson usual occupation and resulting work problems: leg symptoms due to SC degenerative disc disease limit walking, standing, sitting and similar activities of the lower extremities. hypertonicity of bilateral plantar flexor muscle groups with overuse related to pain; etiology is likely as not disuse due to severity o SC back and sciatic nerve conditions.

Thanks for the info, it confirms what I thought, my ROM measurement fall outside the normal range. I was just unsure about the secondary rating, but I should hear something within the next 4 weeks or so, I recieved the "Still working on your claim" letter last week, so I am expecting some answer soon. By the way, I have an uncle named Cooter, funny, that's his real name.

Thanks for the advice, I am pretty sure I should hear something in regards to the current claim within the next 4 weeks, so I should be able to make a decision concerning further action. As far as TDIU I have not filed, but have thought seriously about it in the last few months. I am currently semi-retired. I had to have a break from work because of increasing problems with my lumbar spine. I actually started the form yesterday to begin the process, although I have some concerns about the amount of medical evidence. I have always been reluctant to seek medical advice for aliments, raised with the "rub some dirt" attitude, and it has carried over from childhood. I usually only visit a doctor when it's a cut it off or cut it out situation, which I know in this case doesn't help. I guess it will be a learning opportunity on TDIU as well.

I don't have anything in my service medical records that I can recall that involved a head or neck injury other than migraine headaches. I did have several incidents involving my left shoulder, which I have an ongoing claim for. I eventually had surgery after service. As you said, I thought I would have to have a medical statement connecting the cervical spine to the lumbar, but wasn't sure after the C & P and the examiner's question, and the resulting appointments specifically for the cervical spine. Since Mid July, I have had an appointment with my normal VA doctor for my cervical spine, an MRI, an appointment with Neurosurgery, and today I have a EMG/NCV scheduled. Just amazed at how quickly the appointments have been scheduled, and how short a time period between each 1 has been. If there was no possiblity of the cervical spine being rated as secondary to the lumbar spine, would the VA run all these tests? It seems to me that the VA is trying to establish the extent of problems as a function of rating the cervical spine, where if it was not related (secondary), they wouldn't invest the time and money into establishing the extent of disablility.

The first C & P specifically cited "no noted abnormalities of cervical or Thoracic spine". The 2nd C & P was as follows: Diagnosis: Traumatic arthritis lumbar spine secondary to surgery for lumbar disc disease Paralysis, incomplete, moderate, right sciatic nerve, as likely as not secondary to service connected lumbar spine condition. impacts: decreased mobility, problems with lifting and carrying, pain prevents: exercise, sports, recreation severe: chores moderate: shopping, traveling, bathing, dressing, mild: toileting, grooming none: feeding The 3rd C & P has resulted in a diagnosis of HNP c5-c6 broad left posterolateral disk/spur complex effacing the left ventrolateral CSF space along the left c6 root exit zone and causing severe left c6 foraminal impingement, lesser posterior and right posterolaterl disk/spur complexes causing mild narrowing od the cental AP canal diminsions to just under 9 mm and moderate right foraminal stenosis , DDD, Osteophytes, mild to moderate arthrosis in all joints, pain through neck and shoulders, neuritis. The examiner asked questions about guarding and using my upper body to avoid using my lower back, they seemes to think I was avoiding activity that ivolved my lower back and used my arms and shoulders to do things normally done with my lower back, lifting my body weight. Abnormalties of spinal muscles, guarding, spasm, tenderness: yes Description of abnormalities: tenderness ans spasms in cervical and lumbar paraspinous muscles Evidence of spinal ankylosis: yes location and position of ankylosis: lumbar spine ( neutral) Cervical ROM Active motion Flexion: 0 to 30 degrees extention: 0 to 30 degrees left lateral flexion: 0 to 20 degrees left lateral rotation: 0 to 30 degrees right lateral flexion: 0 to 20 degrees right lateral rotation: 0 to 60 degrees objective evidence of pain on active ROM: yes objective pain following repetitive motion: yes additional limitations after 3 repetitions of ROM: unable to test due to pain Right shoulder ROM foward flexion: 120 degrees abduction: to 120 degrees internal and external rotation: to 80 degrees extention: to 30 degrees objective evidence of pain on avtice motion: yes pain on motion after at least 3 repetitions of ROM: yes additional limitations: no Left shoulder ROM forward flexion: 90 degrees abduction: to 90 degrees internal and external rotation: to 50 degrees extention: to 30 degrees objective evidence of pain on active motion: yes pain on active motion after at least 3 repetitions of ROM: yes

Ok, that leads to another question, can it be rated since it was found during a C & P exam, or will I have to get the medical statement stating it is related? Just not clear on that

I have a question about service connected and secondary claims I have had 2 previous C & P exams for my back, knees and shoulder I am currently rated: 40% for Traumatic arthritis lumbar spine secondary to surgery for lumbar disc disease 20% Paralysis, incomplete, moderate, right sciatic nerve 10% tinnitis left ear 10% bilaterally knees for DJD I have an appealable claim for left shoulder residuals from surgery post service for symptoms that manifested during service. I recently had a 3rd C & P for a few other claims seemingly unrelated to any of the above listed claims. The examiner asked if I used my shoulders and arms more when lifting, sitting, raising from a sitting position, and other activities, and if I had headaches or tingling numbness in my hands. This C & P has resulted in numerous appointments, including an MRI for cervical spine that had a diagnosis of HNP (severe impingement) c5-c6, osteophytes(9mm), neuritis, and carpal tunnel. The MRI was listed as "STAT" on the appointment letter. I have an EMG/NVC scheduled for Upper Extremities. All of these have happened at a much faster pace than I have normally experienced with the VA. I have a question about the cervical spine being considered secondary to the lumbar spine. The original C & P specifically cited "no noted abnormalities of cervical or Thoracic spine". The second C & P was dramtically different Diagnosis: Traumatic arthritis lumbar spine secondary to surgery for lumbar disc disease Paralysis, incomplete, moderate, right sciatic nerve, as likely as not secondary to service connected lumbar spine condition. impacts: decreased mobility, problems with lifting and carrying, pain prevents: exercise, sports, recreation severe: chores moderate: shopping, traveling, bathing, dressing, mild: toileting, grooming none: feeding My activities are severely limited as a result of the problems with my back, so my question is: 1. Likeliness of a rating for the cervical spine as secondary to lumbar spine, even if the C & P was not for my cervical spine. 2. If I do not recieve a rating for the problems with my cervical spine, should I start a claim. I have assumed the back pain was natural with the arthritis and DDD so my cervical spine has never been a specific complaint to a doctor. It seems apparent that I have progressive issues with my spine over the previous 3 years Note: All appointments for my lumbar problems and cervical spine have been with VA doctors. Thanks for any and all responses.

Thank you for the responses, I understand what you are saying about the symptoms and the actual condition. I am still allergic to all histamine blockers, so I would need to address each of the symptoms, hives, irratic heart rate, irratic blood pressure, labored breathing, swelling of the tongue. Of course, I avoid anything that will cause a repeat of the Anaphylactic shock, meaning I avoid histamine blockers at all cost, so the documentation consists mostly of of the drug allergy listed in medical records, and not active reactions to anything. I also understand your point of not focusing on the "cause", but in this case I think it is pertinent to the subject matter. the The out gasing of the incinerator resulted in personal on-going physical side effects (typical of exposure to specific toxins released and documented by the DOD at NAF Atsugi, including Dioxins, Furans and heavy metals). Some of the symptoms were immeditate including the allergy, facial rash, and others have been gradual, diabetes, neuropathy, unusual liver and thyroid functions, and other problems. The out gassing and the resulting medical conditions in personnel stationed there have been the subject of congressional hearings and a bill (Senate bill S.3378 ) passed to address the issue. Recently the VA issued a training letter (VA training letter 10-03 Enviromental Hazards in Iraq, Afghanistan, and Other Military Installations) that includes NAF Atsugi personnel and the fact sheets concerning the exposure. Thanks guys for the responses, it will help knowing that I will have to find each of the symptoms and address them individually.

I was stationed at NAF Atsugi in Japan for 3 years (1993-1996), during which time the (SIC) Shinkampo Incinerator Complex was in full operation, spewing a variety of toxins in the air on base. During my tour there, I developed allergies to Bynadryl and other histamine blockers. I had a a very serious incident at 1 point, about 14 hours in the ER at Camp Zama, and 3 weeks SIQ for the reaction to Bynadryl. I also developed other physical problems, including a persistent rash on my face and over the years since my assigment there, I have experienced other health issues that I am filing claims for. the question I have concerns the allergies to Bynadryl and histamine blockers. I have searched through the e-cfr site trying to find the applicable codes for allergies to medicines. I haven't been able to locate anything that would apply and need some help. I know there are people on this site that are very knowledgable about the codes and hope someone can offer some help. Thanks in advance for any help, if this isn't the correct forum please tell me which 1 I should post in.

I posted yesterday about my ongoing claims including a condition that the VA can't seem to identify. I think it is a form of Polymorphous Light Eruption (PMLE). I have always thought it was due to some type of exposure during Desert Shield/Desert Storm, but while looking around today for other vets who have had claims for PMLE I came across this article several times, and other related information about Atsugi. I have strange symptoms similar to the list provided, and was stationed at Atsugi for a little over 3 years, from 1992 through 1996, and was exposed to the incinirator constantly during that time. my wife and I have a daughter who suffers from TB and other upper respritory issues still to this day. Over the past 2 1/2 years of dealing with the VA and researching this ailments, I am still amazed when I find things like this. If anyone was stationed at Atsugi I would suggest you go to http://www.atsugi-incinerator-group.com/ and check out the articles and list of toxic substances you were exposed to. It sheds new light on possible causes for illnesses for anyone stationed there.

I haven't posted anything on my process with the VA in a while, thought I would update where I am. Since my last post I have recieved another rejection notice from the VA concerning my shoulder without an accompanying C&P exam, and have already filed a NOD. It would appear that I am destine to end in an appeal hearing over the remaining claims. Consequently, I have filed for SSDI and have been through 4 of the 5 steps required for qualification. Everything has been pretty smooth through this process, and the doctor for the consult about my pyhsical condition agreed there was significant impairment. I have only listed the conditions for which I am SC on the paperwork for SSDI. I suppose the next step after the completion of the SSDI process will be to apply for TDUI through the VA, with the SSDI determination as further evidence. Since my last post I have also done enough research to determine the probable cause of the rash on my face. I am in the process of finding a deratologist to get a diagnosis, although I am not sure how to find one knowledgable to consult on the condition. It appears the problem is called "Polymorphic light eruption" and is common to service members assigned to "Desert Shield/Desert Storm". I haven't found anything in the CFR related to this particular aliment, but have found numerous studies both DOD and non DOD that attribute it to exposure to substances during the war. I have found a few codes that will probably cover it, such as "unstable scar", but not sure the symptoms will fall under the code. I am sure there are other vets that suffer from this, I would be interested in hearing any experiences dealing with the VA and how they classify this. So far they have tried Roscaea, virus, stress, and even Lupus, none of them match what happens. I have yet to find anything that prevents the outbreaks, which are heat related, I have to manage exposure to direct sunlight and heat. I can't go outside during the summer without a hat covering my face, sun block painted on like white wash, and the knowledge that I will have several weeks if not months of treatment with a variety of topical solutions. Hoping to get some feedback about others with similar problems. Thanks and hope you all had a Merry Christmas.

I am currently going through the appeal process for a group of scars on my face. I am rated at 0% for 2 scars on my face, resulting from a reoccuring rash across my face that reoccurs during very hot periods of the year. It hasn't been classified as rosacea , although I think that is what they want to classify it as. I haven't been able to locate rosacea in the code anywhere, but it is rated as scars. It started while stationed in Japan near an incinerator that was used to dispose of human waste. I am trying to establish enough information for consideration under 7804 code as unstable scars because the outbreaks always occure in the same location and compounds the scaring. Also trying for code 8706 Dermatitis or eczema due to the treatment method used. Have an on going presciption for corticosteriodss and topical treatments. I also have photographic proof of the condition dating back at least 6 years. I have been working on this part of my claim since May of 2008, it can take a while. good luck.

I recieved notification on the claim for my shoulder today, it states that the claim was reopened after being denied on request from me, and denied again. The claim was deferred until I requested an update, then I was notified that it had been denied, then the letter today. The information they state in the letter was incorrect (dates), and the examiner did not use a goniometer to measure the ROM. I have an appointment scheduled to work through the appeals I have pending for other deined claims, so I guess this one gets added to the list as an NOD. Hopefully I have as much success with the NOD as I have had with the others. I will update as it goes along so anyone that has information, input, or questions that I might be able to help with. Thanks for any and all assistance.

I agree completely that you need to be as informed as possible about the condition you are being examined for. There are great resources on this site and the internet is full of information. Start by typing in what you feel, and work from there. The largest advantage a veteran can have in my opinion is a complete copy of their medical record. It has been so important in the process for me. I can reference exact dates. It makes it much easier to make your case if you can show the examiner in your medical record the number of times and the circumstances under which the condition happened. You have to prove that the condition began during your military service. It also helps to know the process you will go through during the exam, and to know if they are following the guidlines the examiner is suppose. Make notes as soon as you leave the exam or during the exam about what they asked, what tools they use for measurements, if they try exceed your tolerance for something. Tell them what you feel and go from there. I have had to file numerous NOD's because I did not know some of these things, but have been successful thus far. Good luck to you all.

Update on the saga, the C & P was completed and recieved notification today that I was awarded 10% for each knee. The left has an effective date of May 2008 and the right has an effective date of Jan 2009. Prior to the increase I was at overall 60%, and it states now at 70%. Unclear on the rating somewhat and not sure about the increase date. Shows the increase to begin back to Aug 2009 after a NOD filed in July. Why would the increase show the original date of the claim and why would it not show an increase for each knee or does that imply bilaaterial rating for the knees, and if so why would it not state that? Not complaining about it, just curious about the nature of the decision. I will see my Rep next week and let him look it over and provide guidance if needed. If anyone here has any knowledge it will be appreciated. Thanks guys.

I have a deferred claim as well, I would stay on top of this if I were you. The VA sent me a similiar letter to inform me that the claim was deferred, I submitted all the information requested and began to wait. After more than a year, I requested an update on the claim, to which they responded that the claim had been denied. Then not a week after the letter explaining the claim had been denied, I recieved a letter offering expidited resolution to the claim. I am waiting for a new C & P, and still am not sure if the claim was denied or deferred. I have scheduled an appointment with the local Veteran rep to try to figure out what is going on. This is the first real problem I have encountered. I do have several claims that are in the appeal process right now, just keep your head up, and make sure you get a complete full copy of your medical record when you retire. Got that advice before I left the Navy and has made the process easier for me, can't argue about what is documented if you don't have the documents. Good luck, and the people on here are very knowledgable. If you don't get an answer in response to questions you have, try searching the forums. The people on here a sharp and know where to find the answers.

Well the C & P exam was for my knees, it would be great if there was some notification associated with scheduling the C & P so you know exactly what it is for. Would help prepare the documents needed for proof during the exams, but I think it went ok anyway. Probably won't hear anything back from the VA for a while. This was an appealed claim, so I guess they have pushed the claim for my shoulder to end.

Thanks for the info about James Queillen VAMC. I still have no idea what the C & P exam is for, would like to know so I am prepared for it, but not a tremendous problem. I will update again once I have gone through the C & P. I am hoping to get all the claims resolved and the appeals completed. Not sure yet what I will have to do about the claim for my shoulder. On every correspondence from the VA it has been listed as deferred, but when the VA Rep questioned the status, they stated it had been denied and was outside the time frame for an appeal. Not sure if they know they will end up rating it, and are trying to avoid paying back pay to the date of the claim, or what. At any rate, will keep the running tally going until all claims are complete, thanks for the inputs and info along the way.

latest update, I went for the EMG/NVC this week, and got the report from the test yesterday. The interpretation was "No definite diagnostic findings. The NC study does not show demyelination or axon loss in the motor or sensory measurements of the nerves of the RLE. Needle exam does not show active or chronic denervation on the right lumbar paraspinals or muscles of the RLE." I am trying to determine how to read the results accurately, not easy, but there appear to be abnormal indications that fall outside the normal range for the tests. Anyone know a good resourse to help interpret the test? Thanks in advance.

Thanks for the responses on the clinic name. The VA Clinic I am going to is in Tennnessee, and I tihnk it's an acronym for something, it's all caps in the title, not the way I would think the name of the Nurse Practioner would be written. I looked it up and found the same information about the facility in Ill., but didn't think it would be the same. Oh well, guess I will find out in a week or so. Thanks again for the responses.