Old 5311

I started filling out the form today. My MH doc has been urging me to go IU for 3 yrs. Now that I see the Form, and all it asks, I wonder if it is possible to get schedular at all. It seems intimidating. I'm 90% and 65 yrs old. My Civil Service job has been a stressor for years but I hung in there. I will retire with 28 yrs service. My VSO has told me to be sure to put a statement on the retirement form that I am retiring due to service connected disabilities. Jan. 2 2008 is my last day. Maybe my doc will attach a statement. I'll ask him. Hoping this will help others in the same situation. Does anyone have helpful information regarding this Form? If so please send it. Thanks, Old 5311

No. Source is a reliable, confidential, and very helpful friend. It was a long hard struggle for me. Best of luck with the info. I hope it helps many VETS! All the best.

Berta, check the links at the end of the training letter. Lots of info with rationale.

REFERENCE THIS LETTER IN YOUR CLAIMS! It is their letter developed after years of research. Resubmit all your denied claims. You will prevail.

RED Diver, Yellow Diver, Diving duty is Hazardous Duty recognized by DON for (CRSC)Combat Related Special Compensation!!! Make sure you send every possible document of evidence, including injuries and disabilities you have claimed to the V.A. even if it was denied. Read the instructions carefully and leave nothing out. This is for 20 yr. Retired Vets AND NOW FOR THOSE WITH LESS THAN 20. GO FOR IT, YOU EARNED IT! SCUBA, 5342 and 5311'S. V/r Old 5311

No one knew the long term effects of extensive deep diving since there were no old saturation divers. We were in R&D and labled Subjects. The doctors did express propable early onset of arthritis. Shallow SCUBA divers and Decompression Chamber treatment Hospital Corpsman are also subject to these consequences. Many are injured and do not know of this letter. Hopefully it will help many divers. V/r Old 5311

BERTA, Glad you finally saw this info. I knew you had Vets needing help with diving related injuries. I tried a direct email but you had it blocked. The chemicals intended to remove CO2 were "Baralyme" and "Sodasorb" Those dusty chemical were installed immediately upstream of our inhalation tube. There was one fatality regarding this in SEALAB II but no one believes the cover story. V/r Old 5311

This V.A. Training letter should include Dental Problems. Frequent root canals following and extreme pain during decompression are common. The tooth is very hard tissue therefore Off-gasses very slowly. This often causes caps to loosen or fall off or even fillings to pop out due to a very small space below the filling to expand and cause injury to tooth. This is an oversite and should be considered a consequence of diving especially deep saturation diving. Regards, Old 5311

DEPARTMENT OF VETERANS AFFAIRS Veterans Benefits Administration Washington, D.C. 20420 July 5, 2007 Director (00/21) Training Letter 07-04 All VA Regional Offices and Centers In Reply Refer To: 211 SUBJ: Medical Consequences of Diving Purpose The purpose of this training letter is to provide information on the disabilities that may result from diving. We want to ensure that VA decision makers are informed of the medical consequences of diving so that claims from veterans who were divers in service are properly developed and adjudicated.Who to contact for additional information If you have questions about the content of this letter, please contact Rhonda F. Ford (Rhonda.Ford@va.gov, 202-461-9739). /s/ Bradley G. Mayes Director Compensation and Pension Service Enclosure Medical Consequences of Diving A. Introduction This letter is meant to provide information on the disabilities that may result from diving, so that veterans who were divers will be assured of receiving a thorough and informed consideration of their claims for benefits. The potential medical consequences of diving, which are quite diverse, have not been a focus of VBA training, and there is only limited information available on this subject in general medical textbooks. This letter summarizes the short- and long-term medical effects of diving and provides a brief summary of pertinent technical diving information. Consult the selected references listed at the end of the letter for more detailed information about the historical, technical, and medical aspects of diving. B. Diving techniques Diving techniques include free (breath-hold) diving, snorkeling, SCUBA (Self Contained Underwater Breathing Apparatus) diving, surface supplied air and mixed-gas bounce diving, and saturation diving. This letter focuses primarily on the potential long-term disabling effects of saturation and non-saturation (bounce) diving, including both the residuals of decompression sickness (DCS) and other long-term problems. Under certain circumstances, any type of diving may result in decompression sickness, barotraumas (tissue damage due to increased pressure), and pulmonary overinflation syndromes (trapping of gases in lungs, with potential for rupture of alveoli leading to arterial gas emboli). These conditions are discussed below. 1. Descent As a diver descends, increasing pressure causes increasing amounts of gases in the lungs to diffuse into the body. Increased oxygen can be partially metabolized by the body, but the nitrogen (or other inert gas) that is absorbed remains in the body until removed by pulmonary gas exchange during ascent. 2. Ascent When a diver ascends and the pressure decreases (decompression), the gas that was absorbed on descent diffuses back out of the tissues and is exhaled. However, if the ascent is too rapid, gas bubbles form in tissues and blood vessels, and may result in mechanical blockage of blood vessels to vital organs, compression of nerves, pressure pain within joints, and disruption of other tissues, resulting in symptoms of decompression sickness (DCS). DCS is treated by recompression in a hyperbaric (high pressure) chamber, which reduces the size of bubbles and creates a favorable diffusion gradient that allows a slow, controlled release of the gas from body tissues without allowing the reformation of bubbles. Deeper dives have a greater risk of DCS. What is considered to be a deep dive varies with the type of equipment used, the gas used, and other factors. While 100 feet would be considered a deep dive in recreational diving, a deep dive in commercial and military diving is often 300 feet or more. A diver may need to stop and wait for a period of time several times during the ascent to allow gas diffusion out of the tissues to take place slowly, in order to decrease the risk of DCS. Oxygen may be used during decompression to facilitate the elimination of inert gas. Flying shortly after diving increases the risk of DCS because the ascent to altitude (with decreased pressure) allows residual nitrogen in body tissues to diffuse out as gas bubbles, as on ascent from the dive. 3. Saturation diving Saturation diving is a special diving technique developed by the U.S. Navy in the late 1960s that permits divers to work underwater at great depths for days, weeks, or even months at a time. Examples of its use are for salvage work and for construction projects. Saturation means that a diver has been at a depth long enough (typically 24 hours or longer) for tissues to have absorbed the maximum amount of gas possible for that particular depth, so that gas equilibrium has been achieved. Once saturation has taken place, additional time at depth, whether a day, a week, or a month, will not increase the required decompression time. Although not used as commonly as it once was, because ROVs (remotely operated underwater vehicles) and AUVs (autonomous underwater vehicles) now carry out many routine underwater tasks, saturation diving is still used for certain tasks. Saturation divers live for long periods of time in a chamber pressurized to the desired depth, and work in an extremely harsh, physically demanding environment. While many of the medical effects described in this letter can result from non-saturation diving, some of the effects are more common and more severe in saturation divers. 4. Bounce diving In military and commercial diving, a bounce dive commonly refers to any non-saturation dive. Often multiple bounce dives of different depths and duration are conducted in a single day, and repeated decompressions are necessary. Both bounce diving and saturation diving are considered to be stressful types of diving. In recreational diving, a bounce dive is a descent of short duration (usually less than ten minutes) with an almost immediate ascent to keep the time needed for decompression to a minimum. 5. Advantages of saturation diving One advantage of saturation diving is that the diver will need only a single decompression, which takes place in a pressurized chamber, rather than the multiple decompressions that would be required if multiple shorter dives (bounce dives) were used. Decompression is an extremely long process that may last days or weeks after deep dives of over 200 ft, so the need for only a single decompression saves considerable time and is therefore more efficient. In addition, saturation diving diminishes the overall risk of DCS for a project because there is only one gradual decompression rather than multiple short decompressions. C. DCS (Caisson disease) 1. Time of onset, predisposing factors, and treatment - Symptoms of DCS may appear while still ascending, or almost immediately after surfacing (with 95% occurring within three hours), and nearly all appear within 24 hours after the dive ends. DCS has been divided into various descriptive types (see below) depending on the particular symptoms, but some divers experience multiple types, and it is the specific organs affected rather than the designation of type that is important for rating purposes. Many of the signs and symptoms resolve rapidly, but some persist for weeks or months, and some are associated with permanent injury or disability. Predisposing causes of DCS include technical factors such as inadequate decompression, too rapid ascent, and flying too soon (12-24 hours) after diving; personal factors such as smoking, fatigue, and obesity; and environmental factors such as cold water, heavy physical labor, rough seas, and heated diving suits. However, DCS may occur even when all factors are favorable. Divers with all types of DCS are treated with oxygen combined with recompression in a pressurized chamber, and then undergo gradual decompression while breathing oxygen so that bubbles do not reform. If treatment is begun within minutes of symptom onset, most symptoms resolve, but it is not known whether subtle injury may persist. 2. Type I DCS The musculoskeletal system and skin are primarily affected in this type, with signs and symptoms including: a. mild to severe pain (“ the bends”), mainly in the joints of the arms and legs b. itching, mottling, and rashes of skin 3. Type II DCS The brain, spinal cord, and organs of special sense are primarily affected in this type. Spinal cord damage occurs more often than brain damage. Signs and symptoms include: a. Central nervous system (CNS) DCS - weakness or paralysis (hemiplegia, paraplegia, quadriplegia), decreased sensation, paresthesias, peripheral neuropathy, speech difficulty, headache, bladder and bowel sphincter abnormalities, change in mental status (such as odd behavior, confusion, loss of alertness), and other findings, such as extreme fatigue. However, any type of neurologic deficit may occur. b. Labyrinthine DCS (“the staggers”) - nausea, vomiting, vertigo, nystagmus, loss of equilibrium, tinnitus, and hearing loss. c. Visual disturbances – scotomas, diplopia, vision loss d. Pulmonary DCS (“the chokes”) - respiratory symptoms, such as burning substernal chest pain, cough, shortness of breath, and respiratory distress e. Thrombus formation and nitrogen emboli to any organ – can result in stroke, myocardial infarction, etc., depending on the organs affected f. Hypovolemic shock – tachycardia and postural hypotension g. Most extreme cases – coma and death within hours 4. Arterial gas emboli (AGE) (generally appears within minutes after surfacing) When gas emboli, which are inert gas bubbles that form in the venous blood during decompression, enter the arterial circulation, the emboli can then lodge in coronary and cerebral arteries and in other arteries throughout the body with potentially catastrophic results. One source of gas emboli entering the arterial circulation is overinflation of the lungs due to excessive pressure. This can cause rupture of pulmonary alveoli, which allows gas from the lungs to enter the arterial circulation. Another source of arterial emboli is patent foramen ovale. Almost 30% of people retain a patent foramen ovale, an opening between the left and right atria of the heart that is present in the fetus but that closes by the age of one year in most people. While generally a benign finding, it provides a connection between the right and left sides of the circulation, and therefore may allow gas emboli to enter the arterial circulation. The effects of arterial gas emboli depend on which arteries are affected; stroke, seizures, other CNS effects, and myocardial infarction, for example, may occur. As with other manifestations of DCS, some of the effects of AGE may be transient, but some may cause permanent disability. 5. Long-term and late effects of DCS Although most symptoms of DCS resolve with treatment, residual permanent damage sometimes occurs. Repetitive cases of DCS are believed to cause cumulative damage. a. Dysbaric osteonecrosis is a degenerative disease of bone due to the death of an area of bone tissue (avascular bone necrosis, bone infarct), and is thought to be due to nitrogen embolization. It is believed to be caused by the cumulative effects of unrecognized DCS. It is most common in the shoulders and hips, but may involve any bone. Infarcts in the shaft of a bone are usually asymptomatic and of no clinical significance, but those that are close to a joint may result in persistent pain and severe, disabling arthritis that develops months or years later. Pathologic fractures may also occur. b. Neurologic abnormalities include partial or complete paralysis, peripheral neuropathy, etc. (see Type II DCS manifestations, above). Common residual neurologic symptoms include varying degrees of muscle weakness, sensory deficits or paresthesias, and coordination difficulties. Cognitive deficits are also possible. c. Chronic skin conditions d. Hearing loss, vertigo, tinnitus, dysequilibrium e. Residuals of arterial emboli, with serious examples being myocardial infarction and stroke. D. Toxic effects of gases in diving 1. High pressure nervous (or neurological) syndrome (HPNS) - This condition may appear during diving at great depths (over 600 fsw (feet of salt water)) using a mixture of helium and oxygen. Symptoms include dizziness, nausea, vomiting, tremors, incoordination, fatigue, somnolence, myoclonic jerking, stomach cramps, decreased intellectual performance, and disturbed sleep. These neurological effects limit the depth of human diving. It has been found that adding a small fraction of nitrogen to the gas mixture and using a proper compression rate may reduce the serious symptoms. Whether or not there are long-term residual effects from HPNS is still unclear. 2. Nitrogen narcosis (“the narcs,” “the rapture of the deep”) Nitrogen narcosis results from increased pressure of nitrogen that occurs after a depth of about 100 fsw. It resembles the effects of alcohol intoxication, with euphoria, confusion, irrational behavior, paranoia, and hallucinations. While it resolves upon ascent, it may be deadly, because it may result in coma, or the CNS effects may lead to poor judgment, resulting in fatal accidents. 3. Oxygen toxicity Oxygen toxicity of the CNS may occur when oxygen in high concentrations is inhaled under pressure. It is characterized by muscle twitching, seizures, and vision and hearing problems. There may also be pulmonary effects such as cough and substernal burning with prolonged exposure. Death may result from extreme exposures. Risk of CNS oxygen toxicity increases with increasing depth, increased oxygen fraction, and increased oxygen exposure time. It can begin to occur at a depth of slightly over 170 fsw when breathing air and can occur at depths as shallow as 20 fsw when using an oxygen rebreather. 4. Carbon dioxide toxicity may occur when there are closed (rebreather) diving system malfunctions that allow carbon dioxide to accumulate in the diver's breathing gas. Normally, in rebreather systems the carbon dioxide is removed by a scrubber before fresh oxygen is added and the gas breathed out is recycled. Carbon dioxide toxicity can affect respiration and cause headaches or other CNS effects, including unconsciousness. 5. Atmospheric contaminants such as carbon monoxide, hydrocarbon fuel vapors, or vapors from paints, solvents, or welding fumes may lead to either acute toxic effects, or subtle, unrecognized long-term toxicity. To avoid most of these toxic reactions, deep divers use various mixtures of oxygen, nitrogen, helium, and sometimes hydrogen, with the percentage of oxygen used depending on the depth. In military and commercial diving, great care is taken to reduce known atmospheric contaminants, but unrecognized contamination is a constant risk. E. Other potential long-term effects of diving 1. Ear and hearing effects The diving environment exposes the auditory system to intense pressure changes, noise, physical injury, and contaminated water. This may result in: Chronic otitis externa Hearing loss from noise exposure – one of the most common symptoms of divers Perforated tympanic membrane – may occur from barotrauma from a too rapid descent Round or oval window rupture - The round and oval windows are membrane-covered openings between the middle ear and the inner ear, and the rupture of a window may result in sudden hearing loss, tinnitus, and vertigo. Symptoms may resolve or may require surgery. 2. Neurologic (cognitive) effects There is conflicting medical information about whether or not long-term neurologic effects can result from diving (with and without DCS). Standard neurological examinations and tests ordinarily do not reveal any abnormalities. However, some studies have found that divers have neurological complaints, and subtle abnormalities have been found on special testing. Other studies have shown mild abnormalities on testing but no clinical abnormalities. A concern about the studies is that there are no large-scale controlled studies. The most prominent symptoms reported have been difficulties in concentration and problems with long and short term memory. One study conducted neuropsychological testing in 64 divers before and after deep diving. Some of the divers showed hand tremor, impaired spatial memory, reduced finger coordination, and autonomic nervous system abnormalities after the dives, and these findings did not improve after one year. A study of 156 Norwegian divers compared with 100 nondiving controls reported the following symptoms believed to be related to DCS: fatigue, mood lability, irritability, difficulty concentrating, memory problems, and autonomic nervous system symptoms. Physical findings included tremor, a modified Romberg sign (a test of balance), and decreased sensation in the feet. Another study reported that abnormal neurologic exams were associated with exposure to air and saturation diving and a history of DCS. The changes were considered mainly minor and not sufficient to affect the quality of life. The risk of neurological injuries is believed to be related to DCS, anoxia (from near drowning), and gas toxicities, but no consensus exists as to whether or not diving per se causes brain damage, as many studies show no late effects. 3. Alterations of liver enzymes These have been reported but have not been associated with clinical illness. 4. Pulmonary effects Airflow obstruction due to airway narrowing has been reported, but to date, this change has not been found to affect the diver’s health. A few divers may have significant pulmonary injury. 5. Hypothermia Divers may spend many hours working in cold water. Any of the effects of non-freezing cold injury may be seen, with the hands and feet being most likely to be affected. 6. Thermal injuries Heated suits used to avoid cold exposure may, at times, result in burns. In hot environments, heat stress or even heat stroke may occur. 7. PTSD Potential stressors include experiencing near-death situations in accidents, witnessing the serious injury or death of co-workers, explosions, etc. In one study, 43% of divers said they had experienced the death of a diving friend, and over 80% reported having been in dangerous situations that were difficult to put behind them. 8. Delayed arthritis This includes osteoarthritis, discussed above under dysbaric osteonecrosis, or osteoarthritis secondary to compression arthralgia. Compression arthralgia or compression pains is a condition of painful joints (knees, shoulders, fingers, back, hips, neck, ribs, and occasionally low back) due to increased external pressure. It occurs during rapid compression and may result from interference with joint lubrication. This, in turn, may affect joint function and potentially lead to arthritis, especially after repeated dives. F. Rating implications The only current diagnostic code specific to diving residuals is 5011, Bones, caisson disease of. The condition is rated as arthritis, cord involvement, or deafness, depending on the severity of the disabling manifestations. All of these conditions may be separately evaluated under appropriate diagnostic codes, as they are not likely to have overlapping or duplicative signs and symptoms. However, this letter points out that numerous other disabilities may result from diving. In order to identify their origin as diving-related disabilities, all could be rated under diagnostic code 5011, hyphenated with the appropriate diagnostic code used for the actual evaluation. Many of these conditions will be reported in the service medical records, but some, such as bone infarcts and arthritis, do not appear immediately and may not be reported in service. In other cases, symptoms may have been mild or subtle and went unreported or unnoticed. With a history of diving in service, and evidence of a bone infarct or arthritis, especially of the hip or shoulder, a diving etiology should be considered. The same is true of many other residuals, such as hearing loss, other ear or labyrinthine abnormalities, neurologic abnormalities, and skin abnormalities. Many of the veterans who did saturation diving in the early days (at least from the 1960’s, 70’s, and possibly 80’s) worked under different circumstances from those doing diving today, as new techniques and safety measures have been progressively developed. Therefore, it is possible that early divers experienced more complications than more recent divers. The lists below are some of the disabilities that you may encounter in a veteran with a history of diving, but this is not an exclusive list of all possible disabilities that may result from diving. Musculoskeletal Bone infarcts (Dysbaric osteonecrosis) Osteoarthritis, particularly of shoulders and hips, occurring months to years after diving, due to DCS Arthritis of joints following compression arthralgia, mainly in saturation divers (initial pain occurs mainly in knees, shoulders, fingers, back, hips, neck, and ribs) Chronic skin conditions (hands are a common site) Eczema Infection Ear Chronic otitis externa Hearing loss Perforated eardrum Vestibular problems Tinnitus CNS complications of DCS, including arterial emboli Stroke Seizures Paralysis or weakness Peripheral neuropathy Autonomic symptoms Any other neurologic deficit Other long-term neurologic abnormalities While there are some studies showing long-term neurologic effects and other studies showing none, the studies continue, and raters should be aware of the possibility of neurologic damage in veterans who were divers, whether or not they experienced DCS. Most commonly reported are cognitive effects (short-term memory loss and difficulty concentrating), but other neurologic abnormalities have also been described. Visual disturbances Scotomas Diplopia Vision loss up to complete blindness, either cortical (due to effects on brain) or arterial (due to effects on ophthalmic or retinal arteries) Pulmonary problems – obstruction to airflow, almost always with minimal or no clinical findings, but some divers may have clinically evident restrictive lung disease Cardiac problems – myocardial infarction residuals, arrhythmias Cold injury – any of the non-freezing cold injury residuals Thermal injuries PTSD Medical Opinions: In claims from veterans who were divers, most issues necessitating a medical opinion will be similar to medical opinions needed in any case. The procedures in M21-1MR, III.iv.3.A.9 should be followed. However, when questions arise about the relationship of a claimed condition to diving, particularly when the claimed condition is not addressed in this paper, or when especially complex or unusual questions arise, consultation with medical diving experts may be needed. These questions should be submitted to the Director of Compensation and Pension Service (211) for an opinion. G. Selected references for further information US Navy diving manual (2005), at http://www.supsalv.org/pdf/Diveman.pdf The Merck Manual (18th edition, 2006) Bennet and Elliot's Physiology and Medicine of Diving, 5th edition, A.O. Brubak, T.S. Neuman editors, Saunders Publishers, 2003 Bove' and Davis' Diving Medicine, 3rd edition, A.O. Bove, editor, Saunders Publisher, 1997 Undersea and Hyperbaric Medical Society (UHMS), http://www.uhms.org Long-term effects of diving – http://www.medscape.com/viewarticle/408486 Medical problems - http://www.diversalertnetwork.org/medical/articles and http://www.osha.gov/SLTC/commercialdiving/more.html Brain damage in divers - http://www.bmj.com/cgi/content/full/314/7082/689 Decompression syndrome - http://www.e-med.co.uk/diving/decompression_sickness.php and http://findarticles.com/p/articles/mi_g260...4/ai_2601000406 Technical information about diving and equipment - http://en.wikipedia.org/wiki/Saturation_diving History and background of saturation diving - http://www.divingheritage.com/saturationkern.htm Norwegian studies of North Sea divers, including chronic neurologic effects and PTSD - http://www.nui.no/adm/dokument/Ross.pdf Saturation diving - http://seagrant.wisc.edu/madisonjason11/di...saturation.html High pressure nervous syndrome - http://scuba-doc.com/HPNS.html SCUBA diving medical effects - http://www.scuba-doc.com/LTE.htm Chronic neurological effects - http://scuba-doc.com/chrneur.htm Compression arthralgia - http://www.scuba-doc.com/cmprarth.html

$97.00! Are you sure? Hey, man that is a pittance! How could big brother put such a price on ED? Once Virile, Vigorous and Potent. Now just memories.

Let not your heart be troubled. Your ED C&P will be a Genitor exam. It will be private. I had it a few weeks ago. Then another at Gainesville, FL. Both were done by a very pleasant female doctor. You will be asked to drop your shorts and remain standing. In my case she put on her latex gloves and simply examined my package. She felt the testicles for soreness or tumors. She also examined my penis. (not at all like boot camp) She told me I was anatomically correct, and made the report for the Regional Office. No problem at all and very brief. I have no idea how long it will take for a decision. My ED is a result of taking anti-depressants for >20 years for PTSD. Most of these meds have sexual side effects, so if you are taking meds check them out on yahoo or google. Platonic life is a quality of life issue making the depression much worse. I've heard of the "K" award but knew nothing about it until reading the reply above. My wife is very understanding and is okay with it, I'm not okay with it at all. If anyone has a cure for ED let me know!

Yesterday a fairly large direct deposit from the VA was discovered in my CU account. Nice surprise, but I don't know what it was for. I've akked my VSO and waiting for a reply. Do you think a letter will come soon explaining it? It could be an error. Thanks.

Today I sent a NOD for the 10% OA Appeal. Also sent employer's comments regarding accommodations and many pictures. I sent it via my new DAV VSO at St. Pete. Kelly Sunday. This VSO is a real go-getter. I wish I knew the gender but what ever, the e-mailed NOD was forwarded to the Appeals Board. I had to ask the question about how long it would take to get a response. Typically 2-3 years!! The best thing the VA has going for them is ATTRITION! Last week I sent a Notice of Omission. ED was part 2 of the appeal which was not addressed. ED is a result of years of PTSD meds, trial meds, cocktail meds, and routine anxiety/depression/insomnia meds. Word of advice, check the side effects of your meds, do your refills on time and be careful. The side effects may be causing your symptoms! ED is a real slam to the morale. Feb. 18, 2008 we will celebrate our 41st anniversary. She is a wonderful, faithful wife who honors the Oaths we took before God and witnesses. She is one in a million. If anyone has a success story regarding ED please let me know. Warm FL Regards, Jim Old 5311

Berta, Since you slept on this, you really came up with excellent thoughts. I never considered these factors. The NOD, Pictures w/braces and w-o/braces, and employer's Special Accomodation document should make a good point. My VSO can carry it to the RO and place it in his hands. We'll do it! P.S. I did file for clothing allowance due to the wear and tear the braces have on my trousers. Thanks for your message, Jim NEW WORLD DICITIONARY. Second College Edition. "Outrageous" 1. having the nature of, involving, or doing great injury or wrong. 2. exceeding all bounds of decency or reasonableness; very offensive or shocking. 3. violent in action or disposition; unrestrained.

Thanks Jim, No I have not filed IU. Still working under special accomodation status. I'm Warm, Dry, and comfortable. Thank God! Still bewildered by this rating. Jim

Veteran Forum Friends, Thanks for your thoughts. I Faxed my DAV VSO and will wait for that reply. For the record, I waited nine years for this decision, with the condition worsening continuously. I really expected a >40% rating. Every claim I have submitted has been denied by the same person at St. Pete. You must understand, they are understaffed and have huge case loads. So the easiest thing to do is deny, deny and deny. Then you wait and wait. ATRITION is the main objective! Definitionof atrition: we are gone! I think these VA employees are in low pay grades, although I understand the majority are veterans who must comply with their boss's orders. Annual evals are important and now under NSPS it is a new ball game. Only the good ole boys will see promotions and bonuses. The managers are largely non-vets who avoided the draft somehow. They are promoted, rewarded and recognized for keeping costs low and below budget. I guess I'm just too young to be this darn old! 39 nholdin, not bitter.

•The decision was a disappointing surprise. I am living with a service connected disabling handicap with continuous pain. I cannot stand, walk or take steps. This condition increases my PTSD symptoms. Their decision is for only 10%. Do you have any thoughts or advice on this? Page no. 7 says a 20% evaluation is not warranted unless X-ray evidence shows involvement of two or more major joint groups with incapacitating exacerbations of flexion limited to 30 degrees; or evidence of limitation of abduction lost beyond 10 degrees. This disability is very hard to live with, the limitations are endless. I would think it should be 40-60%. R/"Old 5311"

Chuck75 and Berta, Thanks for the replies. You are exactly right all those add up to 10%. I did get a Statement Of Claim, but do not know about a bilateral factor. I could get 20% if a group of joints were affected. You are right I got low-balled. I have deformity and have lost 2" of height. Also wearing VA issue braces on the legs. Two VA doctors knew my condition was SC and made the notes. They gave the civilian doctors statements credibility. My employer has given me Special Accomodation so I'm thankful for that. Regards "Old 5311"

The VA just determined the following conditions are related to my military service, so connection has been granted: Degenerative joint disease cervical spine, assigned 10%. Degenerative joint disease, lumbar spine, assigned 10%. Osteoarthritis, Left Shoulder, assigned 10%. Osteoarthritis, Right Shoulder, assigned 10%. Osteoarthritis, Left Hip, assigned 10%. Osteoarthritis, Right Hip, assigned 10%. Osteoarthritis, Left Wrist, assigned 10%. Osteoarthritis, Right Wrist, assigned 10%. Osteoarthritis, Left knee, assigned 10%. Osteoarthritis, Right knee, assigned 10%. TOTAL 10% Can this possibly be correct? I am crippled, and have continuous pain, even lying down. I cannot stand, walk or take stairs. The VA knows all this. My hunch is they are waiting on attrition! Someone please explain this decision to me or advise. Thank You.

Be careful here, think it through. My Civ. orthepedic dr. objected to being called a "disability doctor". Fortunately his earler comments were great and were accepted by the VA as credible evidence, with rationale.