Interested

Some thoughts and comments .... Does your VA Regional Office have your current mailing address? Though, as you say you have the DAV as a VSO, that may not be a problem or issue. WRT the back conditions .... the answer, is, as always, ... it depends. If the Degenerative Disc Disease, Bulging Disc L3-5 w/arthritis, Synovitis and Scoliosis are all in the same segment of the back (lumbar), you will receive only one rating for the back. However, it's theoretically possible to be service connected for all segments (cervical, thoracic and lumbar). As for the bilateral leg pain, it's can be possible to separate that into two separate evaluations. Though, if the discectomies were successful, it's likely that any evaluation for bilateral leg pain would be 0% and would be incorporated into the back evaluation. Now, to complicate things a bit ...you had a lumbar disectomies/decompressions post separation. Is the VARO running your pending claim aware of the surgery? Do they have a copy of the surgical report? I say this because convalescence under 38 CFR 4.30 http://www.benefits....PART4/S4_30.DOC may be an issue.

There is no absolute bar to service connection (s/c) for W-P-W (or any other hereditary or familial condition) on either Direct, Presumptive, or Aggravated bases. Several VA Office of General Counsel Precedent Opinions (VAOGCPO) have clarified this. That said, I believe he should address his claim on a Direct incurrence basis, and then Aggravated if necessary. Unless he was diagnosed with W-P-W or had additional verifiable heart related symptoms within one year of his separation from Active Duty, it would not appear that s/c on a Presumptive Basis is a player here. If, as you say, your ex-husband did report to a military treatment facility for complaints of racing heart, whatever was written in the Service Medical Records (SMRs) has a great deal more bearing than buddy statements; if I were presented with only the buddy statements and no other evidence, I'd deny this claim. I suggest your ex- get a copy of his SMRs and review them in detail. He then needs to have his cardiologist review them, and specifically those occasions when he reported to the ER/MTF for a racing heart. The cardiologist must review the records and then provide a medical opinion, or nexus letter, that the treatments on ______ (date), ______ (date), etc., were early manifestations of the W-P-W Syndrome that was diagnosed on ______ (date). Service connection on an aggravated basis would be very difficult, IMNSHO, because of the time gap from separation to the date of diagnosis. For service connection on an aggravated basis, the familial/hereditary has to aggravated beyond its due course. Because of that 7 year gap, that might be difficult to prove. As far as the actual rating goes, let's not put the cart before the horse here. I wouldn't care to give a specific number without knowing more information. FWIW, rating criteria for heart conditions are in 38 CFR 4.104 http://www.benefits....ART4/S4_104.DOC ; Diagnostic Codes (DC) 7011 or perhaps 7010 appear to be the most relevant at this time.

Let me quote the OP's last word in his paragraph: "THOUGHTS" ; perhaps I misunderstood his question whether he should file a CUE or not. Likewise, I may be misunderstanding your " ...asking a simple question of our thoughts of the situation." I understood the question to be whether the OP should file a CUE or not ... it that correct? Although the knee-jerk reaction is always 'yes, file the CUE', I saw nothing in what little information that the OP provided that showed a CUE. While I suspect that a claim for increase might be in order, it is difficult to state that unequivocally without review of the veteran's unfiltered record. However, if the intent of any suggestions on this forum is to sludge up the system even more with another claim that has little - if any - chance of success, please be my guest. Now, if you want belittling, I draw your attention to the word "...reply's ..." . It should be 'replies." You're welcome ... just here to help.

So, what was the percent obstruction (unilateral or bilateral) at the time of the VA examination? Believe what you have to or want to believe. Do what you have to do. Good luck, and don't hold your breath.

Some comments .... 1. A Clear and Unmistakable Error (CUE) has to be based on the laws and Rating Criteria in effect at the time of decision (or, in some cases, at the time the claim was made). Do you have a copy of 38 CFR and the Rating Schedule from then? I don't have a copy, and I don't believe I care to try to find out that information either. 2. So, I presume you are telling us that you developed an nasal septal ulcer a couple months after separation in 1970, and that you have had this septal ulcer for 40 years, and that you have had continuing treatments for this specific condition to this day? 3. OK, for discussion's sake, let's presume that the current criteria for rating nasal problems are the same as from 1970-71 .... under what criteria do you believe that a 10% might be warranted. Has your breathing been adversely affected for these 40 years? Is there disfigurement? I know that you don't care for my opinion .. but I think you have too much time on your hands.

Some questions ... 1. Who is this mysterious Lady at VA Office? And, specifically what part of the VA does she represent, that is, the VA Regional Office, the VA Medical Center, or sumpin' else? 2. Who told you that they will only pay SC disability nothing else? This mysterious lady or someone else? 3. Did you recently, and I mean recently, get an upgrade to 100% from your friendly neighborhood VA Regional Office?

Most folks think that all treatments they have in service are recorded in their Service Medical Records (SMRs) - not true. The SMRs record out-patient treatments only - in-patient records are not in the SMRs When a troop was admitted to a hospital for in-patient treatment, SMRs sometimes reported the fact of the admission but not the treatment. Post-discharge treatments are recorded in the SMRs though. In-patient treatment records are maintained by the hospital/medical center for a certain amount of time, and then sent "elsewhere" - they are not destroyed. However, getting these in-patient treatment records can be tedious and long drawn out because you are asking for a file by file search by a real live person through the Records Center. Unless you told the VARO about the hospital admission, it isn't likely that the VARO will ask for the search. When you tell the VARO, however, you have to be fairly specific about the dates. For example, you can't say that you were admitted to some military hospital in 1970. You have to say that you were admitted to Wiesbaden Medical Center in October 1970 for _______ treatment. At worst, the time span must be three months or less.

I wouldn't necessarily view this as pyramiding.

If you have not already filed a claim for disability compensation, fill out a VA Form 21-526 http://www.vba.va.go...-21-526-ARE.pdf and mail or hand-carry it to the closest VA Regional Office. Or, you can file an on-line VONAPP application https://www.ebenefit...ts_myeb_vonapp1 . (Personally, I find the VONAPP somewhat confusing.) Don't forget to add the hand surgery. If you have already filed a claim for compensation, you certainly can use either the 526 or VONAPP. However, you can also use the much simpler VA Form 21-4138 http://www.vba.va.go...21-4138-ARE.pdf or even a simple letter. Whichever way you go, just write something to the effect of: I request service connection for sleep apnea. If you want to get fancy, you can also add that treatment records prior to separation showed the condition, which was verified by polysomnogram on ______.

OK then ... why did you continue with the examination if you perceived the examiner to be so incompetent?

If you believe that the potentially assigned evaluation is too low, you should send in your Notice of Disagreement (NOD) after you receive the formal Rating Decision. As part of the disagreement, state that you had an inadequate exam. Also, it helps to specifically state what your limitations from Parkinson's are. Note: while it's always nice to have a specialist do a C&P examination, it isn't always mandatory - if the examiner follows the exam sheets, which does not appear to be the case here.

Thank you for the clarifications. Without knowing any other information about your situation, I would say that service connection for sleep apnea will be granted. The rating criteria for this condition are in 38 CFR 4.97, Diagnostic Code (DC) 6847 http://www.benefits....PART4/S4_97.DOC . Although you were diagnosed after you separated, the medical treatments from the sleep doctor serve to show presence of the condition on active duty. Besides, it's generally difficult to deny any condition that manifests during the year following discharge. If you have not already filed a VA claim based on residuals of the fractures and the surgeries, don't forget to add those.

Some clarification, please: 1. When were you diagnosed with sleep apnea (month and year are OK)? 2. When were you discharged from Active Duty (month and year are OK)? 3. What was your status (Active Duty, Active Duty for Training, ie., Reserve or Guard) when you first saw the sleep doctor and what was your status when you had your sleep test (polysomnogram) that diagnosed sleep apnea?

Although tinnitus is pretty much a subjective condition, there are round about ways to determine if it's there. Based on your statement After I was denied my primary care VA doc sent me to an audiologist who found no evidence of hearing loss or tinnitus, next my doc set me up with a neurologist and after lots of testing the neuro doc came up with nothing. In my last appointment with the neuro doc, he said he would set me up with an ENT. A few weeks have passed and today I called the VA to check on the ENT appointment and they told me they would not see me because the ENT doc reviewed my chart and said it would not be a justified exam? it appears that a moderate-to-great deal of work up has been done. You will have to overcome or at least match the above findings to prevail. You can certainly proceed with your NOD with the evidence as if, but I wouldn't recommend it. I suggest that you get your own Independent Medical Opinion (IMO) from a paid gun that counter values the audiologist and neurologist. I think this would be difficult. FWIW, some antidepressants have tinnitus as a temporary side effect, that goes away when the medication is discontinued.

Although you said that you were being boarded primarily for your feet, I suggest that you fight - and fight strongly - to have sleep apnea as one of your duty limiting conditions for the MEB and the PEB. Note: you do have a diagnosis of some sort of sleep apnea, conformed by a sleep study (polysomnogram), don't you? I say this because with only feet as your disability, you may be discharged with disability severance pay. However, if you get above 30% from the PEB, you likely will retire from the Army. If your feet are as bad as you wrote, you may well receive that magic 30% based only on your foot/feet. However, it wouldn't hurt to have the OSA mentioned also.

I am guessing that your "VA screwballs" are following the Nehmer Decision and specifically the implementing requirements in the Federal Register http://edocket.acces...f/2010-6549.pdf . Based on some somewhat less than stellar early Rating Decisions on this issue and some "additional training", I'm guessing that the VBA is taking a more liberal view of the claimants and the Nehmer class. You state that you filed a claim for a heart condition in 1985, and I am presuming that you have verifiable boots-on-the ground Vietnam service that could potentially make you a part of the Nehmer class. So, .... from what you wrote and with some astute guessing on my part, I'd say that whichever VARO is processing your inferred Nehmer class IHD/CAD claim is trying to verify a current diagnosis of IHD/CAD. Even though you claimed some sort of vague heart condition in 1985 that was denied, it doesn't matter for purposes of the Nehmer decision. If you are so adamant that you don't want service connection for IHD/CAD, a. Don't go to the C&P. b. Send a letter to the VARO stating that you DO NOT WANT ANY CLAIM FOR IHD/CAD UNDER NEHMER TO PROCEED AND TO CANCEL THE CLAIM IMMEDIATELY. However, I suggest that you proceed with the claim.

Your "Ro has there (sic) own method for issuing the travel pay ... Perhaps an audit caught this at my Varo. " is an incorrect statement. Other than the indirect issue of assigning disability percentages, your friendly neighborhood VA Regional Office - a part of the Veterans Benefit Administration (VBA) - has nothing to do with the payment of any travel pay for medical purposes. The VA Medical Center - a part of the Veterans Health Administration (VHA) - manages the travel pay.

a. Disability - for pay purposes - is determined by Table i, 38 CFR 4.25 and by 38 CFR 4.26. b. Yes. Anyway you compute the three 10%s will round up or down to 30% c. Yes Also, at 30%, you qualify for the additional kicker for dependents (if you are married and/or have dependent children). In your award package, there should be some statement about this and also a VA Form 21-686, Declaration of Status of Dependents. My suggestion ... fill it out.

A Decision Review Officer (DRO) Statement of The Case (SOC) is a continuation of a previous Rating Decision and is in effect a denial of the issues you claimed. It is issued ONLY for the continued/denied issues, as a prelude to being forwarded to the Board of Veterans Appeals (if you so choose). Is it possible that the four issues not mentioned are being granted? If this is the case, the DRO will issue a Decision Review Officer Decision. A DRO Decision is identical in format to a standard Rating Decision, with the exception of the words " Decision Review Officer Decision" on the front. For multiple administrative reasons, you likely would receive the SOC before you receive the DRO Decision. SOMETIMES and SOMEWHERE (usually at the very end) of the SOC will be some cryptic statement somewhat similar to "Other issues within your claim are being addressed in a separate decision." Alternatively, they could have been overlooked. It is not impossible, particularly with so many appealed items.

My (short) review of medical/surgical literature fails to show me that one of the complications from a CABG or other chest-cracking surgical procedure is a hiatal hernia. However, as I am not a thoracic surgeon - and I doubt anyone else here is, I can't definitively say there is no correlation. If you want to pursue this tack to service connection, don't bother with sending in reams of internet information. Although it might be interesting reading in an objective sort of way, it will not prove anything in your situation. What you will NEED is a medical opinion (Independent Medical Opinion, the proverbial nexus) stating that YOUR present condition was caused by YOUR surgery. For this IMO to have any validity, it should be from a cardiothoracic surgeon, that is, someone who knows the territory. Alternatively ... you might pursue service connection on a direct basis. In one of your earlier posts, you said that your service medical records reported treatment for heartburn and indigestion ... have you had continuing medical treatments for that since discharge from service? Has it been an on-going problem? If you want to go this route, you likely will need an IMO as well. You will need the physician, likely a gastro-enterologist this time - to review your Service Medical Records and any other treatment records since your service. The GI doc then needs to state that the condition and treatment rendered on ______, ______, _____ and that continued with civilian treatments on _______, ________, ______, etc., are/were the start of the condition that you have now.

I believe you should be more careful with your medical advice. My copy of Netter's shows the right gastroepiploic (also known as the right gastro-omental) artery relatively far away - well, far as concerns inside the peritoneum - from the esophageal hiatus.

deleted

Yes, if you have keratoconus.

Without guessing too much on my part, what is your question? And, you do realize that your previous claim, which apparently was adjudicated in January 2010, is now closed and that you will need "New and Material" evidence to reopen it?