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Tomahawk
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Posts posted by Tomahawk
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The VA does new C&P exams on any condition not deemed permanent or "static" every 3 years. It used to be 5 years. This is not them trying to pull a fast one on you. This is standard procedure. And depending on the outcome of the exam, the disabilities in question, and your age it could move your conditions to being static with no future exams scheduled.
With that being said, I believe you are confused about the "protection" rules.
5 year rule: If the rating has been in effect for 5 years, it cannot be reduced unless your condition has improved on a sustained basis (The VA must have documentation supporting this is a permanent improvement).
This means that you have to show improvement over a period of time. A single C&P exam cannot be used to lower your rating. However a C&P along with treatment records can be. However if your condition ceases, service connection can be removed.
10 year rule: A service connected disability rating cannot be terminated if it has been in effect for 10 years. Compensation can be reduced if evidence exists that the condition has improved. The sole exception is if the VA can prove fraud, in which case the VA can terminate the benefits.
This means that you cannot have the service connection severed. You can still be reduced to 0% if the medical evidence supports sustained improvement.
20 year rule: If the rating has been in effect for 20 years, it cannot be reduced below the lowest rating it has held for the previous 20 years. The only exception is if the VA can prove fraud.
This means that if you were granted 10% in 1998, then raised to 20% in 2005 you are protected at the 10% rate this year. In 2025 you would be protected at the 20% rate.
With all of that said, you have held your rating for over 5 years. If your treatment records do not show improvement, then these upcoming C&P exams cannot be grounds to reduce.
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My case was in front of the judge for 3 days. They remanded it. Took a little under a month for the RO to order the C&Ps ordered on remand. Had the exams done and uploaded within 3 weeks of that. It's been 9 months since and no movement on my appeal.
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Any guesses on to how this will be rated?
Stomach and Duodenal Conditions
(Not including GERD or esophageal disorders)
Disability Benefits Questionnaire
Is this DBQ being completed in conjunction with a VA 21-2507,
C&P Examination
Request?
[X] Yes [ ] No
ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete
this document:
[X] In-person examination
Evidence Review
---------------
Evidence reviewed (check all that apply):
[X] VA e-folder (VBMS or Virtual VA)
[X] CPRS
1. Diagnosis
------------
Does the Veteran now have or has he/she ever had any stomach or
duodenum
conditions? [ ] Yes [X] No
2. Medical History
------------------
a. Describe the history (including onset and course) of the
Veteran's stomach
or duodenum conditions (brief summary):
The veteran presents today with the following requested:
"The examiner
is asked to provide the following opinions:a. Is it at
least as likely
as not (a 50 percent probability or greater) that any
current stomach
disability, including GERD, was incurred during the
Veterans period of
active service? Discuss the Veterans reports of frequent
indigestion
and heartburn on his Report of Medical History in
September 1998.b.
Is it at least as likely as not (a 50 percent probability
or greater)
that any current stomach disability, including GERD, was
caused by or
aggravated by his service-connected left foot disability,
to include
his treatment for the condition? Please specifically
discuss the
comments of the August 2010 VA examiner that the use of
nonsteroidal
anti-inflammatoriesin individuals with known GERD may
contribute to the
severity."The veteran reports that he started to develop symptoms
of pyrosis
during his military enlistment in the 1990s and was
medicated with
over-the-counter antacids. Review of the veteran's C-file
shows on his
separation exam he
checked indigestion as a symptom. There are no medical
reports of
symptoms of pyrosis or indigestion noted in his service
medical
records. Review of his CPRS electronic charting notes on a
consult that
was placed, that he started to develop symptoms of
gastroesophageal
reflux disease between 2002 and 2003. His first endoscopy
procedure was
completed earlier this year which documented mild
esophagitis, and
further testing at University Hospitals on an outpatient
basis
diagnosed him with gastroesophageal reflux disease. He had
a treatment
course of
proton pump inhibitors that he failed, and as recently as
May 2010
underwent fundoplication surgery at the Wade Park VA
facility. The
veteran states that since the surgery he has had a very
significant
improvement in the episodes of pyrosis. He states if
eating spicy foods
such as Mexican foods with hot sauce,he will still
experience an
episode of pyrosis, but the frequency is drastically
reduced, and as
long as he maintains lifestyle modifications such as
avoiding those
foods, that he does not experience pyrosis. He does also
complain of an
occasional sharp pain noted after swallowing either large
amounts of
food or liquid, which only lasts for a few minutes and
then resolves
since the surgery."Today the veteran reports that his GERD has become worse
and he is
taking additional medications that now include Omeprazole
40mg daily,
Ranitidine 300mg QHS and Lactobacilus. He reports
increased pyrosis,
more pronounced reflux and some pain in left upper
abdominal area.
Increased belching. Occasional symptoms wake the veteran
at night.
b. Does the Veteran's treatment plan include taking continuous
medication for
the diagnosed condition?
[X] Yes [ ] No
If yes, list only those medications used for the
diagnosed condition:
Omeprazole 20mg
Lactobacillus
3. Signs and symptoms
---------------------
Does the Veteran have any of the following signs or symptoms due
to any
stomach or duodenum conditions? [ ] Yes [X] No
4. Incapacitating episodes
--------------------------
Does the Veteran have incapacitating episodes due to signs or
symptoms of any
stomach or duodenum condition? [ ] Yes [X] No
5. Other conditions
-------------------
Does the Veteran have any of the following conditions? [ ] Yes
[X] No
6. Other pertinent physical findings, complications, conditions,
signs,
symptoms and scars
----------------------------------------------------------------
-------
a. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms related to the
conditions
listed in the Diagnosis Section above?
[X] Yes [ ] No
If yes, describe (brief summary):
Veteran has GERD
b. Does the Veteran have any scars (surgical or otherwise)
related to any
conditions or to the treatment of any conditions listed in
the Diagnosis
Section above?
[ ] Yes [X] No
c. Comments, if any:
No answer provided
7. Diagnostic testing
---------------------
a. Have diagnostic imaging studies or other diagnostic
procedures been
performed?
[X] Yes [ ] No
If yes, check all that apply:
[X] Upper endoscopy
Date: 2009
Results: see belowb. Has laboratory testing been performed?
[ ] Yes [X] No
c. Are there any other significant diagnostic test findings
and/or results?
[X] Yes [ ] No
If yes, provide type of test or procedure, date and
results (brief
summary):
Endoscopic reports confirms mild esophagitis, and other
testing
confirms gastroesophageal reflux disease, and the
veteran is status post fundoplication surgery.
8. Functional impact
--------------------
Do any of the Veteran's stomach or duodenum conditions impact
his or her
ability to work? [ ] Yes [X] No
9. Remarks, if any:
-------------------
The examiner is asked to provide the following opinion
s:a. Is it at least as likely as not (a 50 percent probability
or greater)
that any current stomach disability, including GERD, was
incurred during
the Veterans period of active service? Discuss the Veterans
reports of
frequent indigestion and heartburn on his Report of Medical
History in
September 1998.b. Is it at least as likely as not (a 50 percent probability
or greater)
that any current stomach disability, including GERD, was
caused by or
aggravated by his service-connected left foot disability, to
include his
treatment for the condition? Please specifically discuss the
comments of
the August 2010 VA examiner that the use of nonsteroidal
anti-inflammatoriesin individuals with known GERD may
contribute to the
severity.
2507 requested opinion:a. After a review of the veteran's available medical records
he does not
have a "stomach" condition. The veteran has gastroesophageal
reflux
disease. Although he reported symptoms on his "Report of
Medical History"
in September of 1998 there is no other documentation found in
his service
treatment records that represents objective evidence to
support the
diagnosis. Therefore this examiner would have to resort to
speculation to
determine that his complaints as listed above were the first
manifestations of his gastroesophageal reflux disease.b. Although the use of anti-inflammatory pain medications can
increase the
severity of symptoms and GERD itself there is no baseline
Esophagogastroduodenoscopy to document findings either prior
to his use of
chronic NSAIDs or early in his development of symptoms of
GERD to
establish a baseline. Therefore it would be at least as
likely as not that
the veteran's GERD was aggravated beyond it's normal
progression however
this examiner cannot provide a degree of aggravation because
of the above
rationale.
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Pretty sure I redacted any personal info. Can anyone hazard a guess as to how this will be rated, and whether or not I will need to file a secondary claim after for radiculopathy or if they will grant it automatically?
Back (Thoracolumbar Spine) Conditions
Disability Benefits Questionnaire
Is this DBQ being completed in conjunction with a VA 21-2507,
C&P Examination
Request?
[X] Yes [ ] No
ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete
this document:
[X] In-person examination
Evidence Review
---------------
Evidence reviewed (check all that apply):
[X] VA e-folder (VBMS or Virtual VA)
[X] CPRS
1. Diagnosis
------------
Does the Veteran now have or has he/she ever been diagnosed with
a
thoracolumbar spine (back) condition?
[X] Yes [ ] NoThoracolumbar Common Diagnoses:
[ ] Ankylosing spondylitis
[ ] Lumbosacral strain
[ ] Degenerative arthritis of the spine
[X] Intervertebral disc syndrome
[ ] Sacroiliac injury
[ ] Sacroiliac weakness
[ ] Segmental instability
[ ] Spinal fusion
[ ] Spinal stenosis
[ ] Spondylolisthesis
[ ] Vertebral dislocation
[ ] Vertebral fractureDiagnosis #1: Lumbosacral Degenerative Disc Disease
ICD code: M51.36
Date of diagnosis: 2010
2. Medical history
------------------
a. Describe the history (including onset and course) of the
Veteran's
thoracolumbar spine (back) condition (brief summary):
Veteran presents today claiming service connection for his
lumbosacral
degenerative disc disease secondary to his military service
or secondary
to his service connected left foot post surgery and complex
regional pain
syndrome. Veteran reports chronic daily low back pain that
radiates down
the right lower extremity. The pain will increase with
prolonged periods
of weight bearing, ambulation and repetitive bending. His
pain is managed
with pain clinic. He has had epidural injections. Veteran
reports that his
back began to cause chronic problems approximately 2004-2005.
He reports
altered antalgic gait since 1998 after his military discharge
that became
worse after being diagnosed with complex regional pain
syndrome in 2006.
He also reports that he has fallen on multiple occasions
secondary to his
left lower extremity giving way secondary to his CRPS
resulting in
frequent low back injuries.
b. Does the Veteran report flare-ups of the thoracolumbar spine
(back)?
[X] Yes [ ] No
If yes, document the Veteran's description of the flare-ups
in his or her
own words:
Veteran reports flare ups usually one time per month
lasting 1-2 days.
Sometimes if more than one day will go to emergency room
and is
treated with Toradol. During the flare ups he is in bed
all day.c. Does the Veteran report having any functional loss or
functional
impairment of the thoracolumbar spine (back) (regardless of
repetitive use)?
[X] Yes [ ] No
If yes, document the Veteran's description of functional
loss or
functional impairment in his or her own words.
as above
3. Range of motion (ROM) and functional limitation
--------------------------------------------------
a. Initial range of motion
[ ] All normal
[X] Abnormal or outside of normal range
[ ] Unable to test (please explain)
[ ] Not indicated (please explain)
Forward Flexion (0 to 90): 0 to 60 degrees
Extension (0 to 30): 0 to 0 degrees
Right Lateral Flexion (0 to 30): 0 to 15 degrees
Left Lateral Flexion (0 to 30): 0 to 15 degrees
Right Lateral Rotation (0 to 30): 0 to 15 degrees
Left Lateral Rotation (0 to 30): 0 to 15 degreesIf abnormal, does the range of motion itself contribute
to a
functional loss? [ ] Yes (please explain) [X] NoDescription of pain (select best response):
Pain noted on exam but does not result in/cause functional
loss
If noted on exam, which ROM exhibited pain (select all that
apply)?
Forward Flexion, Extension, Right Lateral Flexion, Left
Lateral
Flexion, Right Lateral Rotation, Left Lateral Rotation
Is there evidence of pain with weight bearing? [X] Yes [ ]
No
Is there objective evidence of localized tenderness or pain
on palpation
of the joints or associated soft tissue of the thoracolumbar
spine (back)?
[X] Yes [ ] No
If yes, describe including location, severity and
relationship to
condition(s):
pain to palpation of the LS spine L4/L5
b. Observed repetitive use
Is the Veteran able to perform repetitive use testing with at
least three
repetitions? [X] Yes [ ] No
Is there additional loss of function or range of motion
after three
repetitions? [ ] Yes [X] Noc. Repeated use over time
Is the Veteran being examined immediately after repetitive
use over time?
[X] Yes [ ] No
Does pain, weakness, fatigability or incoordination
significantly limit
functional ability with repeated use over a period of time?
[ ] Yes [X] No [ ] Unable to say w/o mere speculationd. Flare-ups
Is the exam being conducted during a flare-up? [ ] Yes [X]
No
If the examination is not being conducted during a flare-
up:
[X] The examination is medically consistent with the
Veteran's
statements describing functional loss during flare-
ups.
[ ] The examination is medically inconsistent with the
Veteran's
statements describing functional loss during flare-
ups. Please
explain.
[ ] The examination is neither medically consistent or
inconsistent
with the Veteran's statements describing functional
loss during
flare-ups.
Does pain, weakness, fatigability or incoordination
significantly limit
functional ability with flare-ups?
[ ] Yes [X] No [ ] Unable to say w/o mere speculatione. Guarding and muscle spasm
Does the Veteran have guarding or muscle spasm of the
thoracolumbar spine
(back)? [ ] Yes [X] No
f. Additional factors contributing to disability
In addition to those addressed above, are there additional
contributing
factors of disability? Please select all that apply and
describe:
Less movement than normal due to ankylosis, adhesions,
etc., Weakened
movement due to muscle or peripheral
nerve injury, etc.,
Atrophy of
disuse, Disturbance of locomotion, Interference with
standing
4. Muscle strength testing
--------------------------
a. Rate strength according to the following scale:
0/5 No muscle movement
1/5 Palpable or visible muscle contraction, but no joint
movement
2/5 Active movement with gravity eliminated
3/5 Active movement against gravity
4/5 Active movement against some resistance
5/5 Normal strength
Hip flexion:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
Knee extension:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
Ankle plantar flexion:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
Ankle dorsiflexion:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
Great toe extension:
Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5
[ ] 0/5
b. Does the Veteran have muscle atrophy?
[ ] Yes [X] No
5. Reflex exam
--------------
Rate deep tendon reflexes (DTRs) according to the following
scale:
0 Absent
1+ Hypoactive
2+ Normal
3+ Hyperactive without clonus
4+ Hyperactive with clonusKnee:
Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+
Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+
Ankle:
Right: [X] 0 [ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+
Left: [X] 0 [ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+
6. Sensory exam
---------------
Provide results for sensation to light touch (dermatome)
testing:
Upper anterior thigh (L2):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
Thigh/knee (L3/4):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
Lower leg/ankle (L4/L5/S1):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
Foot/toes (L5):
Right: [X] Normal [ ] Decreased [ ] Absent
Left: [X] Normal [ ] Decreased [ ] Absent
7. Straight leg raising test
----------------------------
Provide straight leg raising test results:
Right: [ ] Negative [X] Positive [ ] Unable to perform
Left: [X] Negative [ ] Positive [ ] Unable to perform8. Radiculopathy
----------------
Does the Veteran have radicular pain or any other signs or
symptoms due to
radiculopathy?
[X] Yes [ ] No
a. Indicate symptoms' location and severity (check all that
apply):
Constant pain (may be excruciating at times)
Right lower extremity: [X] None [ ] Mild [ ] Moderate
[ ] Severe
Left lower extremity: [X] None [ ] Mild [ ] Moderate
[ ] SevereIntermittent pain (usually dull)
Right lower extremity: [ ] None [ ] Mild [X] Moderate
[ ] Severe
Left lower extremity: [X] None [ ] Mild [ ] Moderate
[ ] SevereParesthesias and/or dysesthesias
Right lower extremity: [ ] None [X] Mild [ ] Moderate
[ ] Severe
Left lower extremity: [X] None [ ] Mild [ ] Moderate
[ ] SevereNumbness
Right lower extremity: [ ] None [X] Mild [ ] Moderate
[ ] Severe
Left lower extremity: [X] None [ ] Mild [ ] Moderate
[ ] Severeb. Does the Veteran have any other signs or symptoms of
radiculopathy?
No response provided.
c. Indicate nerve roots involved: (check all that apply)
[X] Involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve)
If checked, indicate: [X] Right [ ] Left [ ] Both
d. Indicate severity of radiculopathy and side affected:
Right: [ ] Not affected [X] Mild [ ] Moderate [ ]
Severe
Left: [X] Not affected [ ] Mild [ ] Moderate [ ]
Severe
9. Ankylosis
------------
Is there ankylosis of the spine? [ ] Yes [X] No10. Other neurologic abnormalities
----------------------------------
Does the Veteran have any other neurologic abnormalities or
findings related
to a thoracolumbar spine (back) condition (such as bowel or
bladder
problems/pathologic reflexes)?
[ ] Yes [X] No11. Intervertebral disc syndrome (IVDS) and episodes requiring
bed rest
----------------------------------------------------------------
-------
a. Does the Veteran have IVDS of the thoracolumbar spine?
[X] Yes [ ] No
b. If yes to question 11a above, has the Veteran had any
episodes of acute
signs and symptoms due to IVDS that required bed rest
prescribed by a
physician and treatment by a physician in the past 12 months?
[ ] Yes [X] No
12. Assistive devices
---------------------
a. Does the Veteran use any assistive device(s) as a normal mode
of
locomotion, although occasional locomotion by other methods
may be
possible?
[X] Yes [ ] No
If yes, identify assistive device(s) used (check all that
apply and
indicate frequency):
Assistive Device: Frequency of use:
----------------- -----------------
[X] Cane(s) [ ] Occasional [ ] Regular [X]
Constantb. If the Veteran uses any assistive devices, specify the
condition and
identify the assistive device used for each condition:
for his service connected left foot condtion with CRPS
13. Remaining effective function of the extremities
---------------------------------------------------
Due to a thoracolumbar spine (back) condition, is there
functional impairment
of an extremity such that no effective function remains other
than that which
would be equally well served by an amputation with prosthesis?
(Functions of
the upper extremity include grasping, manipulation, etc.;
functions of the
lower extremity include balance and propulsion, etc.)
[X] No14. Other pertinent physical findings, complications,
conditions, signs,
symptoms and scars
----------------------------------------------------------------
--------
a. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms related to any
conditions
listed in the Diagnosis Section above?
[ ] Yes [X] No
b. Does the Veteran have any scars (surgical or otherwise)
related to any
conditions or to the treatment of any conditions listed in
the Diagnosis
Section above?
[ ] Yes [X] No
c. Comments, if any:
No response provided
15. Diagnostic testing
----------------------
a. Have imaging studies of the thoracolumbar spine been
performed and are the
results available?
[X] Yes [ ] No
If yes, is arthritis documented?
[ ] Yes [X] No
b. Does the Veteran have a thoracic vertebral fracture with loss
of 50
percent or more of height?
[ ] Yes [X] No
c. Are there any other significant diagnostic test findings
and/or results?
[X] Yes [ ] No
If yes, provide type of test or procedure, date and
results (brief
summary):
Report:
Clinical Information: Back pain with
radiculopathy.
Procedure: Images of the lumbar spine were obtained in
multiple
planes using multiple pulse sequences and compared to
10/23/13.
Findings:
At T11-T12, there is disc dehydration with loss of disc
height.
There is a central disc protrusion again noted
compressing
the
ventral dural sac. The midline dural sac
diameter is mildly
diminished. There is no cord compromise or
foraminal
impingement. An incidental perineural cyst is
seen within the
foramen on the right at this level without
change.
At T12-L1, there is disc dehydration with loss of disc
height.
The disc is normal in configuration.
At L1-L2, there is normal disc signal with preservation
of
disc
height. There is mild disc bulging compressing the
ventral
dural
sac. The midline dural sac diameter is adequate.
There is
no
foraminal impingement.
At L2-L3 and L3-L4, there is normal disc signal
and disc
configuration with preservation of disc height.
At L4-L5, there is disc dehydration with
preservation of disc
height. There is moderate disc bulging compressing the
ventral
dural sac. The midline dural sac diameter is adequate.
There is
mild bilateral foraminal narrowing. There is facet
hypertrophy.
At L5-S1, there is disc dehydration with
preservation of disc
height. There is moderate disc bulging eccentric
towards the
right and compressing the ventral dural sac. The
midline
dural
sac diameter is adequate. There is moderate to
severe
right-sided foraminal narrowing. There is mild
foraminal
narrowing on the left. There is facet
hypertrophy.
The lumbar vertebra and conus medullaris are
normal. No
paraspinal abnormality is seen.
There has been no substantial change from prior
study.
Impression:
1. Disc protrusion at T11-T12.
2. Disc bulging at L1-L2, L4-L5 and L5-S1.
3. Multilevel foraminal narrowing that is most
prominent on
the
right at L5-S1. Right L5 nerve root impingement may be
present.
4. No change from prior study.
Primary Diagnostic Code:
16. Functional impact
---------------------
Does the Veteran's thoracolumbar spine (back) condition impact
on his or her
ability to work?
[X] Yes [ ] No
If yes describe the impact of each of the Veteran's
thoracolumbar
spine (back) conditions providing one or more examples:
The veteran's above noted low back condtions would
impair his
ability for physical work requiring any prolonged
periods of
standing, walking, climbing , repetitive bending or
lifting.
17. Remarks, if any:
--------------------
Provide a medical opinion regarding the etiology of the
Veterans current
low back disability, to include whether it is secondary to his
service-
connected left foot disability with complex regional pain
syndrome. Any
additional examination or testing of the Veteran may be
conducted, if deemed
necessary by the examiner. The examiner is asked to provide the
following
opinions:a. Is it at least as likely as not (a 50 percent probability or
greater)
that the Veterans low back disability was caused by his period
of active
service? Specifically discuss the Veterans complaints of back
pain in July
1996, August 1996, and on his Report of Medical History prior
to
separation.b. Is it at least as likely as not (a 50 percent probability or
greater)
that the Veterans low back disability was caused by or
aggravated by his
service-connected left foot disability, to include complex
regional pain
syndrome? Specifically discuss the report of the 2009 VA
examiner that the
Veteran had an abnormal gait due to a limping left foot.2507 requested opinions:
a. After a review of the veteran's STR's his complaints of back
pain during
his military service consisted of an upper thoracic strain and
no complaints
of low back pain. Therefore it would be less likely than not
that this
veteran's chronic LS condition of degenerative disc disease with
right lower
extremity radiculopathy is directly related to his complaints of
back pain
during his military service.b. The veteran's service connected left foot condition with CRPS
has resulted
in a chronically altered gait as well as multiple falls that
have affected
his back. Therefore it would be at least as likely as not that
this veteran's
current lumbosacral spine condition of degenerative disc disease
with right
lower extremity radiculopathy is secondary to his service
connected left foot
condition with CRPS. -
The way I read the statement is that someone has to form a medical opinion that your obesity was "caused" by the service connected disability.
With that said, I had my SA claim denied based on obesity. Ill look for it when I get home. But it said something along the lines of "while medications taken for SC disability have contributed to weight gain, that alone is not the cause of the obesity as adjusting caloric intake would make up for the reduced activity levels"
Basically the doctor stated that I had sleep apnea because I was overweight, and that I was overweight because I ate too much, not because of the 800 medications I have taken that weight gain is a side effect of.
-
The major problem with your "little gem" is that you still have to have a doctor backing your statement.
" 15. A determination of proximate cause is basically one of fact, for determination by adjudication personnel. VAOPGCPREC 6-2003 and 19-1997. With regard to the hypothetical presented in the previous paragraph, adjudicators would have to resolve the following issues: (1) whether the service-connected back disability caused the veteran to become obese; (2) if so, whether the obesity as a result of the serviceconnected disability was a substantial factor in causing hypertension; and (3) whether the hypertension would not have occurred but for obesity caused by the service- 10. Executive in Charge, Board of Veterans' Appeals (01) connected back disability. If these questions are answered in the affirmative, the hypertension may be service connected on a secondary basis."
You will have to have a doctor state that your SC disability caused the obesity. Which will be much more difficult than you'd expect. Yes lack of exercise due to your SC disability may have been a contributing factor, however your eating habits are more than likely the primary cause in most doctors "professional opinions" -
Is it possible to appeal the diagnostic code used?
In my case, I was granted 30% for CRPS secondary to a post operative foot injury. They rated me under 8599-8521
External popliteal nerve (common peroneal).
8521 Paralysis of:
Complete; foot drop and slight droop of first phalanges of all toes,
cannot dorsiflex the foot, extension (dorsal flexion) of proximal
phalanges of toes lost; abduction of foot lost, adduction weakened;
anesthesia covers entire dorsum of foot and toes............................................... 40
Incomplete:
Severe 30
Moderate............................................................................................................. 20
Mild ................................................................................................................ 10
I believe this is the incorrect diagnostic code because it does not address the atrophy of the muscles below the knee which is what triggered them to reverse their denial before sending the appeal to the BVA. They stated the 1" of atrophy on the calf was enough to separate the CRPS from the SC post operative foot injury.
I believe that they should have rated me under:Sciatic nerve.
8520 Paralysis of:
Complete; the foot dangles and drops, no active movement possible
of muscles below the knee, flexion of knee weakened or (very
rarely) lost........................................................................................................... 80
Incomplete:
Severe, with marked muscular atrophy.............................................................. 60
Moderately severe ............................................................................................. 40
Moderate............................................................................................................. 20
Mild ................................................................................................................ 10
Which would have granted me 60% and not the 30% due to the marked muscular atrophy of the muscles below the knee.
Is this something I can appeal on? Or is it pretty much whatever they rated it under as it is analogous what I am stuck with?
Secondary question to this. This was one of 5 items on appeal to the BVA. They awarded me this prior to certifying my file to the BVA. At my video hearing I stated I was withdrawing that portion of the appeal. When I called the 800 number prior to my 1 year mark to inquiry as to how I would go about appealing the diagnostic code used they stated I couldn't appeal it until the BVA has finished with the claim. If I am able to request it be reviewed under a different diagnostic code, is there some manner in which I can request a DRO review while my stuff is still with the veterans law judge? -
I have yet to received the letter. Though I am indeed employed.
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So I have a pending appeal with the BVA still. However last year I got a phone call from a DRO who was reviewing my file before it was sent to the BVA.
She said they were upping my rating based on the atrophy in my leg and wanted to know if I still wanted to include that part of my appeal.
She also suggested that I file for "mood disorder" because the evidence is in my file for them to grant that.
So in March I filed. I haven't gotten the letter yet but my rating jumped from 60-90% on ebenefits. So it looks like they granted me 70% for the new claim.
Such a relief to have something in this process go so smoothly and it being something they told me about.
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So the likelihood is s certainty. They gave me 70%
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Back pain if it is chronic.
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Just to update. Ohio Specialty Network is a sham. All the guy did was write a report stating that I did indeed have the issues I was requesting him to examine me for and opine on. He would not write an opinion on cause nor correlation. Do not use them for an IMO
- blahsaysme2u and Palma114
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Added the pertinent info to my original post. I understand based on the occupational report it could be 30%. However the fact that he indicated:
"Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively"
makes me think it may be higher. Just curious what the experts/former raters on here think.
My question is based off of reading:
VAZQUEZ-CLAUDIO V. SHINSEKI
In Vazquez-Claudio v. Shinseki, the Federal Circuit ruled that the most important consideration when rating psychological disorders is the symptoms associated with each rating. For example, if a veteran is trying to get a 70% rating, it is less important that he prove that he have "[o]ccupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood," and more important that he prove that he have the symptoms associated with that rating, which include "suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships."
So, in any case where you are trying to receive a higher rating for PTSD, remember that the most important thing you must prove is that you have the symptoms associated with each disability rating.
As the symptom selected is associated with the 70% rating, I am curious what the likelihood is that they will grant the 70%
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So I just had my C&P exam for depression secondary to my CRPS. Based on the exam can anyone speculate on what rating I would get?
SECTION I:
----------
1. Diagnosis
------------
a. Does the Veteran now have or has he/she ever been diagnosed with a mental
disorder(s)?
[X] Yes [ ] No
ICD code: F32.89
If the Veteran currently has one or more mental disorders that conform to
DSM-5 criteria, provide all diagnoses:
Mental Disorder Diagnosis #1: Other specified depressive disorder
ICD code: F32.89b. Medical diagnoses relevant to the understanding or management of the
Mental Health Disorder (to include TBI): complex regional pain syndrome,
OSA, herniated disks
2. Differentiation of symptoms
------------------------------
a. Does the Veteran have more than one mental disorder diagnosed?
[ ] Yes [X] No
c. Does the Veteran have a diagnosed traumatic brain injury (TBI)?
[ ] Yes [X] No [ ] Not shown in records reviewed
3. Occupational and social impairment
-------------------------------------
a. Which of the following best summarizes the Veteran's level of
occupational
and social impairment with regards to all mental diagnoses? (Check only
one)
[X] Occupational and social impairment with occasional decrease in work
efficiency and intermittent periods of inability to perform
occupational tasks, although generally functioning satisfactorily,
with normal routine behavior, self-care and conversationb. For the indicated level of occupational and social impairment, is it
possible to differentiate what portion of the occupational and social
impairment indicated above is caused by each mental disorder?
[ ] Yes [ ] No [X] No other mental disorder has been diagnosed
c. If a diagnosis of TBI exists, is it possible to differentiate what
portion
of the occupational and social impairment indicated above is caused by
the
TBI?
[ ] Yes [ ] No [X] No diagnosis of TBI3. Symptoms-----------For VA rating purposes, check all symptoms that actively apply to theVeteran's diagnoses:[X] Depressed mood[X] Near-continuous panic or depression affecting the ability to functionindependently, appropriately and effectively[X] Chronic sleep impairment[X] Disturbances of motivation and mood--------------
TEST RESULTS: Mr. XXX completed the Beck Depression Inventory-II (BDI-II),
a widely used self-report instrument concerning depressive symptoms
experienced in the last two weeks. There are no norms. The instrument lacks
a
validity scale and is therefore susceptible to either under- or
over-reporting of symptoms. Mr. XXX scored 30, which the test developer
considers to represent "severe" depression.--------------------
OPINION: Mr. XXX's current symptoms meet diagnostic criteria for other
specified depressive disorder, a diagnosis based on depressive symptoms that
do not fully meet diagnostic criteria for a specific depressive disorder.
The
veteran's depressive disorder is as least as likely as not proximately due
to
or the result of complex regional pain syndrome, left lower extremity with
atrophy; and to herniated disks. -
On 11/11/2016 at 11:21 AM, aws2000 said:
if I send an IMO while it's pending at the BVA will that speed up the BVA review? Or is it better to have the IMO with the form 9 I will have to send by 12/5/16. Sorry if this is confusing cause I'm confusing myself as I'm writing it. It's just IMO does not gurantee success, but if necessary I will borrow the money to get it done to better pinpoint and explain what the DRO missed?
First of all. File the Form 9. You are on a deadline with that. You don't need an attorney, or an IMO to send in the Form 9 stating you disagree and want the BVA hearing. Hopefully you are close enough to your regional office that you can hand walk it in to get a time stamped copy for yourself. If not get it in the mail as soon as possible so you don't miss the deadline.
After that you can get the attorney and/or the IMO. If you are going to go the attorney route they probably have a preferred company to use for IMOs.
If you are going to just get the IMO yourself you need to make sure you print out the DBQs for the issues you are claiming. And make sure you have a full copy of your medical records and SMRs for the IMO doctor to you review.
The IMO will need to state it is "at least as likely as not" service related/caused or aggravated by a current SC disability. And then it also has to provide reasoning for that statement. If your IMO does that it is highly likely you will win the appeal.
As far as the VA Backlog goes, you may want to at least reach out to a VSO. There are ways to get it sped up and they can probably help you with that. However once you submit the Form 9 it doesn't just automatically get sent to the BVA. I filed my Form 9 in March of 2013. The DRO didn't review my file again until July of 2016 to then send my case to the BVA in August 2016. I had my video hearing November 3rd. And it is now my understanding that the average wait time after the hearing for the decision to be sent out is about 270 days.
With that said, before they sent my file to the BVA the DRO did review my file and granted one of the conditions I was contesting. So if you do get the IMO and send it in they can indeed review it and possible grant your appeal prior to it getting sent to the BVA
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13 hours ago, aws2000 said:
(2) Sorry, can I get some additional time from the VA to file my form 9 due to seeking an IMO?
I would file the Form 9. If you submit additional evidence after that they will review it and may make a decision before it even goes to the BVA. I filed my Form 9 in 2013. They were finally submitting it to the BVA in July of this year when they reviewed the C-File and granted me 1 of the 5 items on appeal before sending it.
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I have been battling the VA for over 15 years. I have had numerous vet reps throughout that time and in the end I got rid of them all and took the time to do the research myself.
Before finally sending my claim to the BVA, the DRO called me in mid July stating that they reviewed my claim and that 1 of the 5 issues I was contending was going to be granted for me. And they also told me that within that review they saw two other claims that I should have made. Which I found odd. She basically told me that I should look over my file. There are two conditions that are clearly related to my SC Disability and that were I to file for those they would be granted without any issue. However she wouldn't tell me what those two conditions would be. So I need to figure that out once I finish my appeal.
With that said, after an almost 7 year wait I had my BVA hearing last week. I just started a job a month ago that is my first since service to offer medical insurance. So I answered all of her questions, and presented my case, then requested the judge to hold the record open for 60 days so that I can have time to get an IME on 2 of my 4 issues which she granted.
After we finished the hearing and she stopped recording she stated that she was pleasantly surprised. Most veterans who represent themselves aren't prepared, it was clear that I had done my research, and that I did an exceptional job presenting my case. I'm hopeful that she wasn't just blowing smoke and that my case was strong in her eyes already.
So now I have to get the IME's and hope the doctor agrees with the conclusions I have drawn. After that we will see how it goes.
Keep fighting if you believe your cause is just.
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I was under the impression that if you requested a copy of your c-file that the VA was under time constraints on getting you a copy? I applied for a copy in August of 2015. I checked ebenefits today and its stating Estimated Completion: 10/10/2016 - 05/14/2017
Seriously? Up to 2 years wait for a copy of a file that is supposed to be electronic at this point?
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Well. I have my VA medical records which show I have CRPS. Which is already in my 30% service connection. However they rated me as 30% for "post-operative foot injury with complex regional pain syndrome". I just need the doctor to write something to get them to separate it.. The foot in and of itself is practically worthless due to the VA surgeon fusing all of my toes. I have zero movement on my own and they can only be moved by hand a few degrees. My ankle constantly rolls because of this which I thought would have been rated as well but apparently not. But for those 2 issues I shouldn't need anything in my SMR. The foot and the VA surgery that caused the CRPS are already service connected.
As for the rest of my claims that were denied. There are entries in my SMR. But apparently not enough for the C+P doctors to opine in my favor. However everything I claimed is also exacerbated by my already SC condition. So they should be granted on that basis alone.
I do have a copy of my C-File, or at least as complete of a copy as I can. As well as 1 copy left of my SMR.
I do not have a VSO. I fired the one after this last claim because he put all sorts of shit in my claim that I wasn't claiming. He put a claim in for my opposite foot which there is nothing wrong with. He put a claim in for 100% IU. And he didn't include a 2 things I specifically mentioned. I learned the hard way that you shouldn't trust a VSO when they say "Sign this, Ill fill it out when I have time and submit it". been going it alone since.
But I would most assuredly explain to the doctor that he needs to review the records and provide a complete rationale for his findings.
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Ohio Specialty Network is the company's name. http://ohiospec.com/
I told the lady I spoke to I would call back once I had my medical records. I submitted the ROI at my local hospital in person and mailed request to the 2 other hospitals in different states I was treated at. She said once I get them to come in and drop the medical records off and schedule an exam.
It's my intention to print out the DBQs for everything I claimed as well as explain that I need a letter to accompany each that states "more likely than not" "at least as likely" or "was/is caused/aggravated by" if he deems them to be related to service.
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I found a local company that specializes in IME/IMOs typically for lawyers/workers comp cases. I asked about the price for a VA exam and she stated they do them at an extreme discount for vets. She stated $400 for all 5 of the issues I am seeking an IME on. That almost sounds too good to be true.
- blahsaysme2u, chairmnx and flores97
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Does Dr. Ellis require an in person examination? Im quite a distance from OK
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Migraines, Degeneration of lumbar or lumbosacral intervertebral disc, Spondylosis, Spinal stenosis of lumbar region, Obstructive Sleep Apnea, Esophagitis, Hiatal hernia, Gastroesophageal Reflux Disorder, and CRPS/RSD of the Lower Limb.
I've tried Dr. Bash twice and never received a response, so I assumed he is pretty booked up.
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Mine deposited this morning. I think they can come any time between now and the end of October.
C&P Exam
in Veterans Compensation & Pension Exams
Posted
You are likely referring to protected ratings.
5 year rule: If the rating has been in effect for 5 years, it cannot be reduced unless your condition has improved on a sustained basis (The VA must have documentation supporting this is a permanent improvement).
10 year rule: A service connected disability rating cannot be terminated if it has been in effect for 10 years. Compensation can be reduced if evidence exists that the condition has improved. The sole exception is if the VA can prove fraud, in which case the VA can terminate the benefits.
20 year rule: If the rating has been in effect for 20 years, it cannot be reduced below the lowest rating it has held for the previous 20 years. The only exception is if the VA can prove fraud.
Nothing states anything about requiring a C&P exam. Just that improvement is shown.