Vync

Hi everyone, About five years ago, I was diagnosed with atrial fibrulation (i.e. arrhythmias or irregular heart rhythm) and hypertension and require continuous daily medication to keep both conditions under control. My non-VA Cardiologist sent me a draft nexus letter and asked me to get back to him with any changes. The doc merely needs to provide some medical rationale linking my conditions. I am almost finished gathering all the required evidence, but wanted to know if this is a good way to present this to my doc? Thanks, -V (Portion of letter to Cardiologist) Below is a list of Army and VA Medical Center-issued prescription medications which may cause irregular heartbeat side effects and/or abnormal blood pressure. Associated medical records and a list of VA Medical Center-issued prescriptions containing greater details (dosage, schedule, issue dates) are attached. Seldane Hismanol (when the pharmacy ran out of Seldane) - Treat allergic rhinitis, until pulled from the market because they were linked to deaths, arrhythmias, QT prolongation, and torsades de pointes. - Taken consistently from 1992-1997 Sudafed Dimetap Extentab - Decongestants - Taken 4x/day for almost a year Tylenol 3/4 - For TMJ pain - Taken daily as needed Lansoprazole RABEPRAZOLE - Anti-acids - Taken daily since 1995 Albuterol (inhaler and also nebulizer solution) Montelukast Sodium - Used to treat asthma - Taken daily since 1992 Prednisone - Steroid used to treat asthma - Taken periodically, but very frequently in the Army Ibuprofen Naproxen - NSAIDs for TMJ pain - Taken frequently in the Army and also daily since 1995

Hey CannonCocker, Check this out: C-File - When did you initially request a copy? (what year?) - Some of the other folks here said that they have requested a copy of everything new since the last time they requested their C-file, but were not charged. - Maybe ask for proof of when they claim it was sent. - You might consider asking to review your file in person, to verify everything. - If they still are jerks about it, contact your VSO, explain what is going on and ask for help. Additional info about the C-File: - I received my C-File a couple of months ago. It was just left by my front door in a big box. There was no tracking information or signature required. I'm glad I got home from work early that day. I'm (sarcastically) glad they did everything possible to protect my personal information. - When you get it, go through it page by page. Be on the lookout for records belonging to someone else. I had a copy of someone else's claim in my C-File. Privacy violation... - Also, look on the back of each page in the C-file. Sometimes notes are placed there too. Treatment Records - Go to the VAMC Release of Information office and request a copy of your records (some sites can provide it on CD) - Old medical treatment records (VA or military) are probably archived to Missouri. They did that to my records which were older than 2002. I had to wait for them to get them before they would give me my copies. - All of my treatment records were copied and included in my C-File. However, the C-File had a lot more records than the copy I got from the VAMC. Finding an old friend If the friend was in the military, you might try a couple of options: - Try looking them up at military.com, facebook, myspace, or maybe a paid people search service (some charge $50 to do this) - The VA will not give you your friend's contact information, but they can attempt to relay a letter to them. Give the VA a sealed, stamped envelope containing whatever personal letter you want your old friend to receive. Put that envelope inside a larger envelope to the VA along with instructions requesting that they try to locate and forward the envelope to your friend. If your friend is registered in the VA system (medical or otherwise), they are can forward your envelope to your friend's most recent address of record. There is no guarantee of a response. The VA has information about this on their web site. I looked it up several months ago, but don't have the URL/site address handy. Should be easy to find. I hope this helps (IMHO) and wish you good luck.

Here's the link! http://www.veteranstoday.com/2010/06/15/is-the-va-proposing-another-shell-game

Wow, that sounds like some of my old VSO visits. I actually drove to the adjacent county and visited with their VSOs because I had problems getting appointments with mine. Not only did I get right in to see someone, but I found they were considerably more knowledgeable and a whole lot more friendly.

I agree with Pete

If you have not done so already, get a copy of your C&P exam results from your VAMC Release of Information office. It will contain the examiner's opinion. You need to find out exactly why they denied you and then compare it to the rating tables. Also, were you seen by a doctor or a physicians assistant?

You can get tested for squalene antibodies to determine if you are at risk.

Some areas may have a VA outreach clinic which services your area and may be a lot closer to you. This tends to work for basic care. If you need some special labs or other procedures, they'll route you back to the VAMC. You also can ask the VA if they will cover the expenses for you to see a doctor closer to where you live. Of course, they will need to approve this in advance.

Carlie, The VA employee who wrote that decision must have got a 'word a day' calendar for Christmas.

If the index went up, that means inflation. I wonder if the VA will follow up with a cost of living adjustment... Wait, I'm expecting too much... I forgot we are talking about the VA...

I posted parts of the rating schedule below. There are a number of different ways the spine is rated. You can be SC for both conditions, but because of the pyramiding rule, you will only get the higher percentage used in your combined total. However, you might be able to get a separate rating for nerves if you have radiculopathy going into your legs. Your Forward flexion ROM is 20 degrees. Because it is less than degrees, you might get a 40% rating, which is a lot higher than the 10% or 20% rating you would get under 5003. Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine 40 Also, because this is a request to increase your SC rating for lower back, you might want to dig in your records for 12 months preceding the data that you filed the increase request. They are supposed to grant you an EED matching the earliest treatment you had within that 12 month window. They often cheat people out of retro because they don't let them know it's possible. This only applies to increase requests, not new ones. IMHO, I hope this works out well for you. 4.71a - Schedule of Ratings - Musculoskeletal System http://www.warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_71a.DOC 5003 Arthritis, degenerative (hypertrophic or osteoarthritis): Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below: With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations 20 With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups 10 Note (1): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. Note(2): The 20 pct and 10 pct ratings based on X-ray findings, above, will not be utilized in rating conditions listed under diagnostic code 5013 to 5024, inclusive. General Rating Formula for Diseases and Injuries of the Spine (For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes): With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease Unfavorable ankylosis of the entire spine 100 Unfavorable ankylosis of the entire thoracolumbar spine 50 Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine 40 Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine 30 Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis 20 Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height 10 Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. 5235 Vertebral fracture or dislocation 5236 Sacroiliac injury and weakness 5237 Lumbosacral or cervical strain 5238 Spinal stenosis 5239 Spondylolisthesis or segmental instability 5240 Ankylosing spondylitis 5241 Spinal fusion 5242 Degenerative arthritis of the spine (see also diagnostic code 5003) 5243 Intervertebral disc syndrome Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25. Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months 60 With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months 40 With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months 20 With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months 10 Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment.

There are different rules for a new vs. increased SC ratings for earliest effective date (EED). New Claims If you left active duty within 12 months of filing for a new claim, then the EED is the date you left active duty. If you file a new claim 12 or more months after leaving active duty, the EED would be the date you filed. Increased Claims If you file for an increase, the EED usually falls under two categories based on whether or not you have provided the VA with medical treatment records for the specific condition within a 12 month period prior to the date you file. If you submit no medical treatment records, the EED is the date you filed. If you submit medical treatment records covering the period within 12 months prior to filing, the earliest documented date of treatment would be your EED. Here is a hypothetical example: Your back goes out in January, March, and August of 2009. You file an increase claim for you back in December 2009. If you win, the EED would be January. Also, your rating percentage may be tiered depending on how bad off you were or due to specific types of treatment. Unless you submit evidence and specifically tell the VA about any of these earlier treatment dates, they may try to cheat you out of an EED and potentially more retro. If they shaft you, you can always go back and submit the evidence and request the EED be adjusted accordingly. One more thing. The effective date of payment for retro is always the first day of the next month.

I followed Bergie's advice for my C&P exams several months ago, but instead of one day, I stopped the pain/anti-inflammation/relaxers meds about a a week prior to my exam. When I got in there, I felt like the floor of a taxi cab and my range of motion was in the toilet. If your shrink was VA and they listed evidence including VA treatment records, that pretty much is inclusive. I really wish they would provide a detailed list of evidence so that we could verify exactly what was evaluated. I think they skip that so that they can work faster and provide a vague assumption that all evidence was reviewed, which makes it harder to prove they skipped stuff.

Call 1-800-827-1000. If you do not have direct deposit setup with your bank, it is strongly recommended. Not only will it save you a trip to the bank, but you also don't have to worry about it getting lost in the mail.

Your best bet is to request a copies of your service treatment records, military personnel records, and any other treatment records (VA or private). Your MOS or specialty can also play a factor. For example, if you jumped out of airplanes a lot or did some other job that could impact your back, it could justify the potential wear and tear on your body. Other injuries, like to your feet, legs, knees, or pelvis could also be a factor. It can all add up. Get all your papers together and go through them with a fine tooth comb. If you can get a doctor to write a nexus opinion linking your current back problems, it will help. Buddy statements from folks in your unit can help too.

dwragon is correct. Your VSO usually gets notified before you do, but the real result will be in the letter they mail to you. However, they can change the result between the time the VSO received their info and the time you receive your letter. If you have direct deposit setup with the VA, check your bank account every few days. If you get an award, increase, or retro, you usually will see a deposit appear a day or two before you get your letter in the mail.

The ratings of 60% + 10% for your knees combine to 64%. Add the +10% bilateral factor to those and that puts you at 70.4%, which rounds down to 70% even. Add in 60% for IHD and your combined rating becomes 88%, which rounds up to 90%. Hope this helps

Here's a link to the CFR where Dav_marine72 got the info: http://www.warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_71a.DOC Dav_marine72, You beat me to it! I was going to post the same thing!

(Added with working links) Federal Register Vol. 75, No. 109 Tuesday, June 8, 2010 Veterans Affairs Department RULES Nonduplication; Pension, Compensation, and Dependency and Indemnity Compensation; Correction 32293 [2010–13615] http://edocket.acces.../2010-13615.htm NOTICES Agency Information Collection Activities; Proposals, Submissions, and Approvals: Application for Standard Government Headstone or Marker for Installation in a Private or State Veterans' Cemetery 32540 [2010–13602] http://edocket.acces.../2010-13602.htm Certificate of Delivery of Advance Payment and Enrollment 32539–32540 [2010–13600] http://edocket.acces.../2010-13600.htm Dental Patient Satisfaction Survey 32539 [2010–13599] http://edocket.acces.../2010-13599.htm Request for Disinterment 32538–32539 [2010–13598] http://edocket.acces.../2010-13598.htm Veterans Application for Assistance in Acquiring Special Housing Adaptations , 32540 [2010–13601] http://edocket.acces.../2010-13601.htm Health Effects Not Associated With Exposure to Certain Herbicide Agents , 32540–32553 [2010–13653] http://edocket.acces.../2010-13653.htm

This also works for some prosthetic items. Also, if the VA is not able to obtain and/or provide the medication you require, you can always ask the doc for a paper prescription and get it filled at the pharmacy of your choice.

Here's another tip which might help... My VAMC has the PCP clinics broken down into several different groups. For about 13 years, I was always stuck with the residents who were very inexperienced and blindly follow orders without much regard for patients who are legitimately in pain. I constantly had problems with them and my Patient Advocate was able to get me switched over to a full-time Staff Physician who has 20+ yrs experience. This doc knows me and knows how to treat my problems. You might want to look into this, but I don't know how your VAMC is setup.

Sounds more like a zombie pill to me...

Congratulations on winning your claim! I also have a 'temporary' rating, but it is not for MH. It said I would be evaluated at a future date, but they didn't list the date! Doh! I put in an IRIS request to find out. Later in the week they responded and said I would be re-examined for the condition approximately 12 months after the effective date on my claim. I don't know if you will be re-examined at the same interval, but you can find out.

One of my VA docs documented a strong nexus ("is due to") for one of my conditions. I think I was really lucky because the doc had the bedside manner unlike any other VA doc. I thought I was actually seeing a civilian doc. I might need to change my VA primary care provider. My current doc provides good treatment, but what he says to me and what he writes down are usually not the same. I'm sorry, I meant VBA, not BVA. I was thinking about VA Directive 2008-071 (d)(1 and 2) (http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1790). My fault there. Sorry, I am fighting a migraine this afternoon. Just took some meds to make it go away.

Carlie, That makes sense. I recall reading one of the CFR's (not sure which one) and it said that if the Veteran's disability could not be rated accurately by the rating definitions, that they could perform an extraschedular rating. I haven't tried to look this up again, but might try to see what I can find when I get some time.