[Notice of Results]

So, did they test both legs? If not , you got a freebie. If your EMG results show worse than what you got, though, they go ahead and NOD it. Be careful, too. This happened to me last week. Fell down the stairs off the porch taking the trash out and hit the  sidewalk. Minor concussion, lots of scraping abrasion and a minor sprained ankle. And that was with my BETTER leg stepping off first. 

 

 

[Notice of Results]

you could ask for it but it might take a while.  They probably want to do an EMG test. That would test nerve conductivity. But right now it's two 10 percents you should be getting a bilateral factor in also.  I have a moderate rating for both of my legs but I also have loss of sensation and I occasionally trip and drag my foot on things like stairs and where I have to climb.  It might be that your 10% is actually a blessing because you don't have quite as many issues as some other people. :-) 

[sleep apnea 50%""" back pain severve 40% at most]

Dot- 

 

Agree- probably just in a roundabout way. Sorry for any mis-interpretation. :-)

[sleep apnea 50%""" back pain severve 40% at most]

1 hour ago, Dot09 said:

Ruready,

In my experience with the va drs that treat you at the va will try to dodge compensation in general. I understand that the dr told you that your sleep apnea is secondary to your insomnia. That's just a bad response from that dr. Not all are good.

First off what was your sleep apnea diagnosis?

Was it obstructive, central or both?

Second where is your spine injury?

Is it the cervical, lumbar, thoracic or sacrum?

Third what medications do you take?

The Drs job is to treat you, not try to get compensation for disabilities. All they do is put X and Y into the notes. You can help this process by asking good questions during your appointments and working with the doctor, or you can hope and expect them to connect all of the millions of dots of what is possible or maybe on their own with little input from you. The raters job is to take the notes and turn them into a rating. Pursuing a VA doctor for a rating is a waste of time because it is not their job to get ratings- their job is to treat you. Focus on the treatment and the ratings will usually write themselves over your notes history. 

[sleep apnea 50%""" back pain severve 40% at most]

Cpap /= 50%, though. I had to go about 4 years with a CPAP before they found it service connected. Its not a slam dunk, at least not in the last 8-10 years. *plink plink*

 

[Monthly award amount and back pay]

You dont count the month of the award itself, and you don't count the month you are 'in' since VA pays in arrrears. So there is two months. Also, past years were awarded at different amounts- sometimes that is a factor also if there are multiple years worth of back award to calculate. Also, depending on how many ratings  you had some of them may not have added into the total rating to change it. A 40% + 10% is not 50% for the duration unless that 10% bumps the existing 40- whatever  to 45 or above. You may have to calculate out each rating award against your exiting award to make sure you didnt add some months in there where your total rating didn't actually change. 

[Received DAV letter of award]

Your DAV letters are only a summary. Wait for the actual award letter. The statements and basis of the case usually will list all contentions and the award, and what was used/how it was determined. 

 

CAS

 

[Lookie What the VA Emailed Me]

Its not like there is an agenda against green that might preclude him from thinking otherwise. For every vet that posts here with a negative experience there are thousands of others that did not have a negative experience whose claims were adjudicated and done and they are satisfied with the results. Attitude is what one makes it to be. More healthy to be positive than to look for the negative  or hidden agenda in everything. 

[Propasal to Reduce]

Watchful waiting isn't a made up term- it has a medical meaning. The doctor(s) were not trying to shuffle you out or provide substandard care. If you have had 2 doctors already opine on this I can't see the benefit of spending your own money for another scan and biopsy. While I may have had issues in the past with raters , I have never had questionable care in the 12 yrs I hvae been going to the VA for medical treatment. I may have HAD questions about something that I didnt understand, but I asked, and then followed up on my own with a little research later to see if what they said was tracking. 

 

Did your doctor explain watchful waiting (or, active surveillance, as it is sometimes called)? 

 

http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-watchful-waiting

[Lookie What the VA Emailed Me]

Claims have to be finalized for their decision from the raters, they don't work in a vacuum, so your 'authorizer' is the finalization of the claim. Ive never seen that wording before though, so I can't opine if it is a positive or a negative. Claims above certain amount threshholds need to be finalized by more than 1 person at different seniority levels. You are getting close to done, you may get a note from DAV or other VSO (if you have one) with an unofficial breakdown of what the result is before you get the final letter from VA. 

[Propasal to Reduce]

There should have been a form in there for you to return if you disagree and want a  hearing. Send that back to them and ask for a hearing. They will either re-rate you, ask for another C&P, or schedule a hearing date- all of which will postpone a reduction until the outcome of one of the three previous options. 

[VA Crises LinesI]

Are they not renewing or are you not requesting them soon enough? Ive had issues with waiting for them to renew so I just go onto MyHealthVa and renew them myself. I make sure to give myself a week or so and I get a tracking number when they are sent. I live in Nebraska so maybe it works different up here than in Florida. 

[SSDI and Idividual TDUI]

Yikes. Sounds like my discs, but no surgery. Too scared.

[SSDI and Idividual TDUI]

They can think that but that isn't how it works. Each  agency has their own scales for ratings.

[SSDI and Idividual TDUI]

It should. Let your lawyer know (if you have gone that route) and also if you were injured and discharged after a certain date in 2002  you would be considered and post 9/11 veteran and it is supposed to accelerate your case a bit. 

 

FYI, though, Im in Nebraska and my lawyer said that 2 ALJs have retired and one of their replacements will only be on half caseload starting this summer. SO. the timeline might be rather long. Ive been waiting a year, and im looking at another year, probably before a hearing. 

[How are number of days determined for incapacitating episodes?]

Yes, and you need to VISIT the DOCTOR in order to have it prescribed. Never in my experience has one of my doctors just answered the phone and said "yup, stay in bed for a few days". 

[How are number of days determined for incapacitating episodes?]

Its doctor visits. Thats why ROM is generally easier to get connected to a claim because even doctors dont prescribe bed rest anymore for most injuries. 

[RE-EVALUATION on my service connection]

Just means that there is a possibility

[VA]

1 hour ago, Andyman73 said:

See, now here is what really gets my goat.  OCDMarine, you said your VA MH doc referenced your chronic pain as a major cause of your MDD.  May I ask when you first got hurt, when did the time line of "chronic pain" begin for you?  I sure could have used your VA MH for my C&P exam last fall!
 

I was DXd with MDD this past July by who is now my treating VA MH therapist.  At that time I don't recall that he directly linked it to any of my pain issues.  Now here is a quick little back story on me.  I fell down a flight of stairs on November 21st, 1992...which was only the 5th day of USMC boot camp for me.  I went on to serve all 6 years of my enlistment, and received SCDs of 10% low back pain/sprain/strain(depends on what day of the week it is) and 10% bilateral patella-femoral pain syndrom.  Also 10% for pain/residuals L ankle injury.  All which were treated during my AD years.  I have been receiving prescription NSAIDS and non-NSAIDs from the VA ever since. 

Last year I got the back increased to 40% and the knees each an additional 10%, and 30% for pes cavus w/plantar fasciitis bilateral as well.  All lead back to injuries that were treated while on AD.  I am in the process of a claim for cervical spine w/radiculapathy from the same fall. 

Last fall I filed for depression secondary to chronic pain.  The examiner opined that my MDD was more due to other issues, to include chronic sleep issues, and not my chronic pain...which was very well documented, I might add.  Even the RO told me that she could not go with the physical medical evidence and grant me the MDD secondary, since the examiner chose to ignore the evidence.  I guess over 23 years wasn't chronic enough in my claim.

OCDMarine, I wish you all the success!

Semper Fi.

Andyman

Whether they link it to chronic sleep or chronic pain is moot (unless your chronic sleep isn't SC, but if you are in constant pain it probably should be) Chonic pain is a pretty well accepted driver of depression, but then so is chronic sleep disorders and apnea. My particular situation is such that I complained of pain from the incident forward and at one point was almost docked some pay because I had a verbal out with my top about my constant sick calls. This was in AIT. Once he got to know me a bit as a non-maligerer and I talked to him more about what happened to me he helped me talk to the acting CO at the time so I could get my MEB/PEB started. 

 

The pain, for me, was always in my file from the outset, along with the peripheral numbness in my toes and feet. Years later when I started my MH treatment and was finally diagnosed with MDD I was able to show to my counselor the long continuing connection so that she didnt have to do much. It came out as a fixture over about 7 sessions, too, so there was a clinical history narrative that I had built with her. 

 

If your sleep issues are already SC then having it tied to that rather than pain really shouldn't matter. Sleep, pain, and MDD all go together, too, so it could just be a matter of having to sort it out over some sessions. If its causing you employment issues tell your doc. 'Soft skills' and 'nuanced behavior' issues are part of MDD and can cause severe issues in employment. A history of failing performance, a downward trend in efficiency, write ups, co worker opinions of you being difficult to work with- all of this will contribute towards that. Threats of firing help, too (though, not so much with the MDD issues- those just get exacerbated due to increased stress from the employment problems)

[VA]

You have a claim for depression but your claim for back is going to be based on range of motion and 40% is less than 35* flexion. If you have less than 35degrees of motion, then go for it. The anxiety depression diagnosis you have is similar to mine, though the degree to which it impedes your daily behavior would depend on your interview with the C&P doc and your notes from routine treatment. I was actively working with a 50% rating but similar symptoms as you. Once one gets higher their work life and relationships and ability to deal with people usually starts to fall apart pretty heavily. Not knowing your duration of treatment or tendencies in daily living we can't guess as to a rating, but as far as a claim goes  your notes say pretty much what they need to say to successfully claim it. Better if you have been treated for a while so you have a lot of notes from consistent treatment to support the claim. 

[Cervical MRI results]

Chop shop quips aside, avoid surgery as long as you can in favor of conservative maintenance. Once they cut and put in a cadaver disc or fuse, your other vertebra and discs around it have to compensate for that and eventually (5-6 yrs last I read) youd be in again for another one. 

[Cervical MRI results]

Were you discharged for that injury? If so, thats already your link because your MEB/PEB would have had a line of duty form for the injury. 

[Cervical MRI results]

Are you wondering if it is rateable? Absolutely, to varying degrees. If you look up CFR 38 you can see the exact structure they use for rating the back. 

 

Quote

Quote

THE SPINE

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.

(No. 55 8/5/15)

 

4.71a-21 §4.71a—Schedule of ratings–musculoskeletal system 4.71a-21

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

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

5239 Spondylolisthesis or segmental instability

 

5242 Degenerative arthritis of the spine (see also diagnostic code 5003)

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.

(No. 55 8/5/15)

4.71a-22 §4.71a—Schedule of ratings–musculoskeletal system 4.71a-22

Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes

With incapacitating episodes having a total duration of at least 6 weeks during the

With incapacitating episodes having a total duration of at least 4 weeks but less than

With incapacitating episodes having a total duration of at least 2 weeks but less than

With incapacitating episodes having a total duration of at least one week but less than

past 12 months 60

6 weeks during the past 12 months 40

4 weeks during the past 12 months 20

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.

 

[Nexus Letter for secondary Anxiety/Depression]

The insomnia can be a symptom of MDD/anxiety and so falls under the list of symptoms already accounted for for MDD. Migraines can have all sorts of causes- physical, mental, neurological, sinus- best to rule them out one at a time for migraines otherwise you find yourself with a misdiagnosis due to confirmation bias and spend time chasing the wrong therapy. 

[Nexus Letter for secondary Anxiety/Depression]

If that is what your doc says its right there in black and white. You should only need an IMO if you find yourself in contention with your doctor over diagnosis. Its sounds like your doctor has already connected them.