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Found 90 results

  1. My VSO let me know that my OSA appeal was denied. My original claim was a direct service connection. I read the sleep apnea field manual from Chris Attig and appealed the decision. On appeal I stated the OSA should be secondary to PTSD and sinusitis. I obtained an IMO from Dr Anaise and a DBQ with the at least as likely as not and medically necessary (CPAP) statements from my psychiatrist. My question is on appeal can you submit evidence to make it a secondary condition or does it need to be filed as secondary from the beginning? I haven't received the RAMP appeal denial letter yet. Also is there a section in the 38 CFR regarding secondary conditions with an original direct service connection claim?
  2. Yesterday when reviewing my medical records I noticed an examiner did a C and P/DBQ addendum. Im currently 70 percent and submitted for an increase(12 months ago) and also filed for IU(2 months ago). I don't know what this nexus means and would like to know if the exam was for the IU or increase claim. This examiner did a table top review as I wasn't present for it. See below: Please utilize this form when responding to VBA requests for either addendums or clarifications of prior VHA examination reports. This Veteran was seen for a C&P examination in December, 2017. At that time it was felt that the most appropriate diagnosis was that of a mood disorder, which was considered to be severe. At that time it was noted that the Veteran had been able to complete a college degree. In July of this year the Veteran was admitted to inpatient treatment, which he successfully completed, and he continued in treatment throught the remainder of this year. Treatment notes reference some improvement in functioning, with the Veteran reporting boredom. At this point, given the available information, I believe it is as likely as not that the Veteran's severe mood disorder would make it impossible for him to maintain employment over an extended period of time. Perhaps vocational rehabilitation, combined with his continuing in treatment might make it possible for him to obtain and maintain employment at a later So my question is.. Does the nexus look favorable? What was this exam for(IU or my increase)? My increase is in front of the DRO and was filed in December of last year after my initial award. The IU claim was only filled a month or two ago. The C and P exam was done 15 days ago. Any assistance would be greatly appreciated
  3. Hello all, I received my disability decision rating for my initial claim about 2 weeks ago. I would like to submit additional evidence to support my claim and receive a higher rating on some disabilities and service connection on the issues denied. On the VA Form 4107, it says I have two options: Start an appeal by submitting a Notice of Disagreement (NOD) Give us evidence we do not already have that may lead us to change our decision I am interested to learn more about option 2, because I have heard appeals can take longer. It is not clear how to submit additional evidence (who should I send to, can I submit through ebenefits online or do I have to mail?). If anyone has experience with submitting additional evidence instead of submitting a NOD, I would love to get your advice on exactly how to submit and how to track and follow up with the VA after submitting. Thank you!
  4. Hey everyone, love the sense of community and support here, long time reader first time contributor...Anyway, just another OIF marine veteran from the mid 2000s here with a few questions. I initially filed a claim in 2010 - was awarded 80% in 2011/2012 and filed an appeal shortly thereafter for tdiu. I was awarded ssdi and have had continual treatment from the va for ptsd, tbi and lower back injury. I was denied initially, filed a nod and hired an attorney. Seven years later my claim seems to have been diversified, my appeal for an increase in rating has been sent to the board (vets.gov shows this as an “open” issue) and beneath that under “closed” issue my appeal for tdiu says GRANTED. When I called the va to ask for more info the rep confirmed a DRO had approved it August 18, 2018 and that it was awaiting final signatures for the paperwork and benefit to be dispersed. My question to you all is does this seem about right? That the DRO granted tdiu while a p&t appeal was pending board review? It’s been over two months since the DRO approved it, how much longer do you think it’ll take to conclude? I saw that awards over 100k need to be authorized by the central office, is this a likely cause in delay? What are some average times between DRO granted benefits and benefits received? Lastly, this has been seven long years and my heart dropped seeing this update, I know anything can get screwed up in the government but would I be foolish to think it’s incoming? My life following Iraq and the things we did to those people had been a nightmare burdened with grief and guilt. While I’m working towards a whole life, the stress of financial burden alleviated would be a great supplement to focus on my recovery without needless strains. I really want this to be true!! Thank you all for your help!
  5. My traditional appeal has been going in awkward direction. I know eBenefits is not reliable but in my case it has been because I confirmed my changes with the BVA ombudsman.  I’ve been been battling back and forth with the BVA for 25 years. However, I’m just caught of guard with the BVA’s recent development. The Judge and her team of her attorney’s that was reviewing my case temporarily placed my folder back in the storage room. My appeal status was “waiting in line to be placed on docket.” My claim was only in that status for a few days and then my claim was then changed to “with appeals judge.”  I learned my claim was reassigned to a new judge, which is the previous judges supervisor. Has anyone experienced this or any know what may be going on?
  6. Yesterday, I received a call from Client Service regarding my Appeal that’s currently on the the BVA Judges desk. I missed the call; however, the lady left a message stating that she will call me back. I called the number back that was on my caller ID and the operator stated the lady that called just wanted to give me an update on my Appeal and will call me back. Has this happened to anyone else? I had several appeals go through the Board but never have I received a call about my Appeal. What is Client Services? Thank you!
  7. ok so ,,,, if you read back on some of my posts you will see the issues i was having with the va, long short.. i was : 20bilat 20bilat 20bilat 20bilat and 40 = 76.4 PAYS 80 NOW IM, 40 bilat 20bilat 20bilat 20bilat and 40. = 83.4 PAYS 80
  8. I appealed for an earlier date for PTSD and Individual Unemployability. I received my 100% December 10, 2010, and appealed to the date I originally applied for benefits (November 2007). I just received the Order approving both but the Order states "It is granted, subject to controlling regulations governing the payment of monetary awards". Does this mean that I get no back pay - as I didn't receive any back pay - just got the approval from Veterans Law Judge, Board of Appeals. Should I appeal the fact that I received no back pay? Any help would be appreciated!
  9. I filed my NOD four years ago, next month. Still waiting for a decision from the DRO. I am wondering how long other Veterans here, have been waiting for an answer on their RO Appeal.
  11. ok so.... little more news about docket #s so when you file your form9 not your nod date not your claim date... its the date you file your form9 for appeal at bva.. not your dro , the bva. then it starts time. i dont mean to sound this way but so much he said she said on here.... the date you sign the form 9 and it is put through the checklists is the day you get a docket. this docket is not disclosed to you the veteran because you probably have an issue with it. thats another point but,.,,, so if you have a few different appeals going and your newest appeal has yet to get a formal form9 then the bva mysteriously is allowed to give you a docket year of the last one. no matter if the others are older... if they roll all into one then you get the last date. some might say who have royalty payments... well its because they are contentions close to each other...FALSE .... EARS HAVE NOTHING TO DO WITH ANKLES...... HANDS HAVE NOTHING TO DO WITH ERECTIONS....... ANYWAY..... GET IN ON THE DISAGREEMENTS OF THE DOCKET RULES AND FIGHT.... ITS ABOUT US BUT ALSO THE ONES TO COME.....
  12. Quick question, my appeal was approved at 100% with eed. After having letters updated, how long does retro pay take to hit? I have heard up to 6 months? And seen people saying as little as 2 weeks? Edit: this is a NOD, at my regional office. Edit 2: my NOD was for an increase, and it was granted to 100%. Which, like I said, is reflected in my letters on ebenefits correctly at 100%. The letters updated last Thursday. Not sure what to think. Thank you all for your help
  13. according to 38 C.F.R. §§ 4.40 and 4.45 i believe i should be increased from 10% to 20% please look at these codes then look at the DBQ from Dr i provided you will see the flare up measurements. Code 5252: If the hip is limited in how far forward (flexion) it can move the leg, then it is rated under this code. If it cannot move the leg more than 10°, it is rated 40%. If it cannot raise the leg more than 20°, it is rated 30%. No more than 30° is rated 20%, and no more than 45° is rated 10%. Code 5253: All other limitations of hip motion are rated under this code. If the hip cannot swing the leg out to the side (abduction) more than 10°, it is rated 20%. If it cannot move the leg inward across the other leg (adduction), it is rated 10%. If it cannot rotate the leg outward (toes point off to the sides) more than 15°, then it is rated 10% DBQ+PG7.pdf this is the page that shows flare ups decrease motion ... the other is page for decreased motion for repeted use over time. please note that the 3 repeated uses was stated no. but these others state yes.
  14. I had infant asthma with all signs and symptoms of asthma gone by the time I was 9 or 10 years old. On my pre-enlistment questionnaire, I marked I that I had had asthma (question says do you have or have you had) I had it as a kid and it was gone. I enlisted in the Navy in 1979 and based upon all the research I have been able to find, with any history of asthma, I don't think I should have been allowed to enlist. I have my service records and they are silent of any respiratory testing to enlist. The best I understand is they accepted me with a presumption of soundness. I had not had any sort asthma symptoms for at least 8-10 years prior to service. During rigorous running and physical training in boot camp, I had an asthma attack and had to go to the dispensary. I filed a claim recently for service connection for asthma because it was aggravated in service and I was treated for an attack in service. I also have a 40% rating for a knee condition and have not been able to do much to be active over the years. At my most recent yearly VA physical, my cholesterol and weight were both going up so I figured I needed to do something to get some exercise. Swimming laps is something suggested to me so I tried that and after about 20 minutes of laps I had to quit because I was having asthma breathing problems. I told my VA doctor who treated me with a daily inhaler and a rescue inhaler. Both have helped improve symptoms. The VA denied my claim for asthma saying it was preexisting. I had been asthma free for almost a decade prior to service. If regulations at the time I enlisted say I should have been disqualified for service, but they let me in with a presumption of soundness, what steps do I take in my appeal? My mother has written a lay statement of the chronology of my childhood asthma and when symptoms were gone. How do I show aggravation v exacerbation? What should a doctors IMO say? Thank you.
  15. I was dropped from 100 % to 90%. The reason was that they claimed my lung had improved and rated them down from 60% to 10% even though I was having problem breathing.I filed an appeal as they used the wrong reading to score my rating. They should have used the DELCO which was low. I was using the DVA as my representative but I never heard one word from them and never received any callbacks. I continued to pursue my shortness of breath and the finally did a right heart cath that showed I had moderate to high pulmonary hypertension. I believed that should have answered the question on the shortness of breath and settled the appeal. But no, pulmonology said that because they saw a wedge pressure between the left side of the heart and the right, it was cardiologists problem and not theirs. Today I just had a left heart cath and everything is clean. No blockage, only .2 tenths of a rise in pressure on the left side. So this proves it's the lungs and an automatic 100%. So I went in and checked on the status of my appeal this evening and it shows that it was withdrawn and has been closed. I did not withdraw it and have no idea who did. I also checked on the request for my C file and it stated that there was no information and the request was closed. So, what do I do now? Tucker
  16. Claim and Appeal status is unavailable Vets.gov is having trouble loading claims and appeals information at this time. Please check back again in a hour. I tried 7 times to do. it's work
  17. I looked at my C-File and the reason they denied my sinusitis was that they said I had no treatment for it in my medical records. In one of my medical records it shows that I told my doctor I had sinusitis. The doctor didn't treat me for it after I told him about it. So the VA says because the doctor didn't treat me for sinusitis that it doesn't matter if I mentioned I had it. At my C&P exam the doctor said it was more likely than not that my sinusitis was caused during basic training. The C&P doctor said also that I had allergic rhinitis. On my last claim I applied for rhinitis and they denied that too. The C&P doctor years before then said that my rhinitis was more likely than not caused during my service too. It's been 5 years so far waiting for my BVA appeal. When I wrote the letter I said "How's it my fault that the doctor failed to treat me for sinusitis when I reported it"? Do you think I'll be giving this sinusitis disability rating or not?
  18. My question is about De Novo Review and how the DRO reviews the evidence. In my DRO hearing I raised the several questions about the Denial of Compensation. Question 1) I addressed the DRO in asking how the VA could change the diagnosis from "Bilateral Patellofemoral Syndrome" to "Osteoarthritis"? Clearly I was Discharged with "Bilateral Patellofemoral Syndrome" under VA Code 5003-5099 Hearing Me: they're basing on traumatic arthritis...okay. I'm not 20 years old no more [sic]... patellofemoral syndrome has progressed from that on up and on up until now we've got an end result of osteoarthritis. DRO: Mm-hmm Me: So, the medical exam... everything's pointing... saying, well, we're denying you for the patellofemoral, but we're gonna give you arthritis. DRO: No, that's not... that's not the case. Me: Well, that's... DRO: (Inaudible)... Me: ...what it says right here. DRO: ...you're essentially service-connected for your knee condition, whether...you know...it's...it may be called different things, but essentially that is what you're service-connected for...is your knee condition. We can't...we don't...we can't evaluate it by splicing out different diagnoses or your...you know...involving your knee. We evaluate based on...like...what we discussed earlier...you know...your range of motion...instability...that kind of thing. Power of Attorney: They're saying that your patellofemoral syndrome has progressed to the point where there's osteoarthritis at this point and that's... that's what you have right now. Me: That's what I got right now... Power of Attorney: Right Me: ...but they're still not warranting...they're...they were denying the patellofemoral. Power of Attorney: Mmm. They're just saying it's...it's not patellofemoral... Me: Yeah. Power of Attorney: ...anymore it's...it's arthritis now. Me: Well, that's the word they used...they denied it. Power of Attorney: Oh, well, they shouldn't have said that. DRO: Yeah, and I'm...I'm not sure that that was a... you know...a completely accurate description in there, but... Me: Well, because...I mean... DRO: All right, do you have anything else? And then the DRO closes out by stating that this Appeal is only about the related evaluation of the knee condition. And if I wanted a earlier effective date I would have to file a Claim for it. My question is if it is a Review of Claim then why is the DRO only going to look at the evaluation and not the complete claim? I mean he is suppose to be bi-partisan and look at all evidence objectively. Should the DRO of looked at the whole Claim because it was a Reopened Claim ?
  19. I received the third response from the VA GC to the CAVC order to correct my RBA by replacing documents obviously missing and relevant in the RBA from the hard copy of my Medical File OPTR and IPTR maintained by the Medical Division. Apparently they were just dumped into contract warehouses without adequate record keeping when the VA finally computerized the Progress Notes and Examination Records. The Pharmacy records and Lab records have been computerized since the late 1980s making it evident that there should be accompanying OPTR and IPTR to match that were requested and at one time in the Comp & Pen hard copy file but were not there when scanned into the computerized record. It has now been over 45 days since the CAVC issued the Order to Correct the RBA to the Secretary. I'm waiting for another 45 days to make it 90 days, 6 responses from the VA GC without the directed "status report" (only stating they are responding) before submitting a request for court ordered stipulations on what the missing records show. Am I on track for this?
  20. Wats up Vets?I have a question.I had two appeals one has been with the Vlj since 12/09/17 for ptsd increase and another one for irritable colon,exema or dermititis on both feet that status was not even recieved at the board..Well now the second appeal is closed and location at the board .I only have my ptsd appeal with Vlj.Anybody have a idea what happened?Thanks for your help
  21. In 2002 i applied for disability claim with VA and it was 100% denied, then i appealed at the time and several items were accepted and i was given a rating in 2003. Many years have passed by and im re visiting my claim due to allot more pain. What i'm wondering is if i can appeal again for a higher rating along with hopefully getting other service connected issues approved this time? I feel it was done quick and minimal just to get me to go away since they initially denied 4 different surgeries while active duty. I also have my first scheduled Dr appointment to get assigned a primary care dr at VA in 2 weeks. Wondering if i should cancel that appointment till im done with an appeal? Kind of worried i may be shooting myself in the foot seeing their dr before a possible appeal. Any thoughts would be great.
  22. So I had a C & P appointment. I got an attorney a couple years ago after my claim was denied. My claim is for Bipolar, PTSD, and Depression. My attorney sent a NOD a little over 2 years ago and I was scheduled for a C & P appointment. The examiner that I had was the same examiner that I had on the claim I was initially denied on. He basically said "there wasn't anything wrong with me after the service". So I had my C & P appointment and the examiner pulled a note that described me mentioning taking anti-depressants prior to the military. I honestly forgot about this. I have attached the nexus letter which makes a link to the military aggravating my condition. Could someone please explain to me what can happen next? I was initially thinking award. But I'm wondering if they are going to ask for records prior to my military(teenage and young adult)... which I wouldn't be able to produce. I'm kinda freaking out because it seems like the link was made but not in the way I was expecting. Attached nexus--- 2. Current Diagnoses ------------------- a. Mental Disorder Diagnosis #1: unspecified bipolar disorder ICD code: F31.9 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): none 3. 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 [ ] No [X] Not shown in records reviewed 4. 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 deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood b. 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 TBI SECTION II: ---------- Clinical Findings: ----------------- 1. Evidence Review ----------------- Evidence reviewed (check all that apply): [X] VA e-folder (VBMS or Virtual VA) [X] CPRS 2. History --------- Page 26 of 139 a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The Veteran has been married for approximately one year; he said lately their relationship has had problems because he feels his wife has not understood his problems. b. Relevant Occupational and Educational history (pre-military, military, and post-military): The Veteran said he had had eight jobs in the past year. He completed a bachelor's degree in psychology at UCA a year ago. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The Veteran is followed in mental health at CAVHS. He takes lamictal, prazosin, and lithium carbonate. He also sees a private counselor. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): n/a e. Relevant Substance abuse history (pre-military, military, and post-military): The Veteran reports drinking every day, having two 30-packs over the course of a week. His last marijuana use was about two and a half years ago. f. Other, if any: n/a 3. Stressors ----------- Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: hearing a soldier getting raped Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [ ] Yes [X] No Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No Page 27 of 139 4. PTSD Diagnostic Criteria -------------------------- No response provided. 5. Symptoms ---------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Inability to establish and maintain effective relationships [X] Suicidal ideation 6. Behavioral Observations ------------------------- The Veteran was cooperative. He displayed some dysphoria. 7. Other symptoms ---------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes [X] No 8. Competency ------------ Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any ------------------------------------------------- The Veteran's symptoms appear to be more consistent with a mood disorder than with those of PTSD. He reported depression while still in the military, but also reported he had been treated for depression prior to the military. In today's examination the Veteran denied depression prior to the military but then conceded it was possible he had been depressed as a teenage, but could not recall details of his depression or the treatment he received. However, the same note indicated that in 2007 the Veteran reported that he had responded well to medication, suggesting that it was possible that his depression was relatively mild. Page 28 of 139 The Veteran's current bipolar disorder is severe. Therefore, it is more likely than not that any mood disorder present before the Veteran's military service was exacerbated by his time in the military. Given the Veteran's ability to complete a bachelor's degree, I did not find evidence that his bipolar disorder precluded all employment; however, it definitely makes it difficult for him to sustain employment. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's
  23. hello all.....does anyone know of a ballpark timeline for dro hearings at the atlanta r o ?
  24. Hey I'm new to the forum and really need help trying to understand what my last C&P means for my rating.. I have been waiting on this since 2010 on appeal and finally got a C&P after remand to RO. Can anyone tell me what possible rating I might receive Semper Fi. Neck (Cervical Spine) Conditions Disability Benefits Questionnaire Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No Evidence Comments: BOARD REMAND 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a cervical spine (neck) condition? [X] Yes [ ] No Cervical Spine Common Diagnoses: No diagnosis provided. Diagnosis #1: CERVICO-OCCIPITAL NEURALGIA ICD code: == Date of diagnosis: 9/28/2015 Diagnosis #2: CERVICAL RADICULOPATHY WITH BULGING DISC ICD code: == Date of diagnosis: 2016 Diagnosis #3: MECHANICAL CERVICAL PAIN SYNDROME ICD code: == Date of diagnosis: 4/29/2015 If there are additional diagnoses that pertain to cervical spine (neck) conditions, list using above format: CERVICAL VERTEBRAE(NECK MUSCLE SPASM), DATE OF DIAGNOSIS, 6/25/1996. CERVICAL HERNIATED AND BULGING DISC, MUSCLE SPASM, AND CORD CONTUSION WITH COMPRESSION MYELOMALACIA, 8/14/12 CERVICAL SPONDYLOSIS AND DEGENERATIVE DISC DISEASE, 9/25/2014. On today's C&P examination, 11/21/17, Veteran reports several incidents in 1992-1995 of blunt trauma including carrying 50 caliber machine gun barrels and ammunition. Involved in ground defensive tactic also known as "Bull in the Ring" in which the marine is in full gear and is potentially tackled by several marines. Following this , Veteran incurred concussion-1992 or 1993). Also went to Bethesda for back school(approx. week). Currently, Veteran reports daily neck pain. Denies neck surgery. Denies no recent physical therapy. Uses Flexeril, Ibuprofen, Oxycodone, and Tens unit for pain relief. Last treated by chiropractor in 2016(Tampa Bay, Florida). b. Dominant hand: [ ] Right [ ] Left [X] Ambidextrous c. Does the Veteran report flare-ups of the cervical spine (neck)? [ ] Yes [X] No d. Does the Veteran report having any functional loss or functional impairment of the cervical spine (neck) (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: Can't do much of any type of physical activity, that's really limited. Obviously a hindrance, job related stuff. Multiple days off from work(pain, stiffness). Can't do lawn activities. Can't wash dishes. Can't play with your kids like you want to. Sleeping is impossible-Sometimes you have to sleep sitting up in a chair. 3. Range of motion (ROM) and functional limitations --------------------------------------------------- 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 (0-45): 0 to 46 degrees Extension (0-45): 0 to 15 degrees Right Lateral Flexion (0-45): 0 to 23 degrees Left Lateral Flexion (0-45): 0 to 14 degrees Right Lateral Rotation (0-80): 0 to 48 degrees Left Lateral Rotation (0-80): 0 to 44 degrees If abnormal, does the range of motion itself contribute to a functional loss? [X] Yes, (please explain) [ ] No If yes, please explain: Limited bending. Description of pain (select best response): Pain noted on examination and causes functional loss If noted on examination, 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 joint or associated soft tissue of the cervical spine (neck)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): Tenderness on palpation of the cervical spine. b. Observed repetitive use Is the Veteran able to perform repetitive use testing with at least three repetitions? [ ] Yes [X] No If no, please provide reason: Unable to perform due to severe pain. c. Repeated use over time Is the Veteran being examined immediately after repetitive use over time? [ ] Yes [X] No If the examination is not being conducted immediately after repetitive use over time: [ ] The examination is medically consistent with the Veteran?s statements describing functional loss with repetitive use over time. [ ] The examination is medically inconsistent with the Veteran?s statements describing functional loss with repetitive use over time. Please explain. [X] The examination is neither medically consistent nor inconsistent with the Veteran?s statements describing functional loss with repetitive use over time. Does pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: This examiner is unable to opine and would otherwise be speculating to state whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. Therefore this examiner cannot describe any such additional limitation due to pain, weakness, fatigability or incoordination. Furthermore, such opinion is also not feasible to give degrees of additional ROM loss due to "pain on use or during flare-ups" without speculation. d. Flare-ups Not applicable e. Guarding and muscle spasm Does the Veteran have guarding, or muscle spasm of the cervical spine? [X] Yes [ ] No Muscle spasm [X] None [ ] Resulting in abnormal gait or abnormal spinal contour [ ] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: Guarding [ ] None [ ] Resulting in abnormal gait or abnormal spinal contour [X] Not resulting in abnormal gait or abnormal spinal contour [ ] Unable to evaluate, describe below: 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. Please describe: Decreased ROM. 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 Elbow 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 Elbow 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 Wrist flexion: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist extension: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Finger Flexion: Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Finger Abduction Right: [ ] 5/5 [X] 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? [X] Yes [ ] No If muscle atrophy is present, indicate location: Upper Arm Provide measurements in centimeters of normal side and atrophied side, measured at maximum muscle bulk: Normal side: 37.5 cm. Atrophied side: 36 cm. 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 clonus Biceps: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Triceps: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Brachioradialis: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatomes) testing: Shoulder area (C5): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent Inner/outer forearm (C6/T1): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent Hand/fingers (C6-8): Right: [ ] Normal [X] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent 7. Radiculopathy ----------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [X] Yes [ ] No If yes, complete the following section: a. Indicate location and severity of symptoms (check all that apply): Constant pain (may be excruciating at times) Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Intermittent pain (usually dull) Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Numbness Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left upper extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe b. Does the Veteran have any other signs or symptoms of radiculopathy? [ ] Yes [X] No c. Indicate nerve roots involved: (check all that apply) [X] Involvement of C8/T1 nerve roots (lower radicular group) If checked, indicate: [ ] Right [ ] Left [X] Both d. Indicate severity of radiculopathy and side affected: Right: [ ] Not affected [ ] Mild [X] Moderate [ ] Severe Left: [ ] Not affected [ ] Mild [X] Moderate [ ] Severe 8. Ankylosis ------------ Is there ankylosis of the spine? [ ] Yes [X] No 9. Other neurologic abnormalities --------------------------------- Does the Veteran have any other neurologic abnormalities related to a cervical spine (neck) condition (such as bowel or bladder problems due to cervical myelopathy)? [ ] Yes [X] No 10. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest ----------------------------------------------------------------------- a. Does the Veteran have IVDS of the cervical spine? [X] Yes [ ] No b. If yes to question 10a 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 11. 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? [ ] Yes [X] No b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided. 12. Remaining effective function of the extremities ---------------------------------------------------- Due to a cervical spine (neck) 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.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 13. 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. 14. Diagnostic testing ---------------------- a. Have imaging studies of the cervical spine been performed and are the results available? [X] Yes [ ] No If yes, is arthritis (degenerative joint disease) documented? [X] Yes [ ] No b. Does the Veteran have a 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): 9/25/2014,MRI Cervical spine:Visibility of the central canal of the cord at the C5 level with diameter of 2mm, not considered to reflect significant syringohydromyelia and not associated with mass or abnormal enhancement. Spondylosis and degenerative disc disease of the cervical spine. Right-sided predominant disc osteophyte complex at C6-7 causes mild right central canal and moderate right neural foraminal stenosis at this level. No other central canal stenosis with milder areas of neural foraminal encroachment detailed above. C2-3:Focal shallow central to right paracentral disc protrusion. No central canal or neural foraminal stenosis. C3-4:Mild generalized disc bulge. Mild right than left neural foraminal stenosis with central canal patent. C6-7:Mild generalized disc bulge with more focal disc osteophyte complex in the right paracentral, right subarticular, and right lateral stations. C7-T1:Negative for disc herniation. 8/14/2012, MRI Cervical spine:Herniated disk C3/4, C5/6, and C6/7 levels. Bulging disk C2/3 and C4/5 levels. Diffuse spondylitic changes. Straightened alignment suggesting muscle spasm. Focal area of cord contusion or compression myelomalacia at C5 level. 15. Functional impact ---------------------- Does the Veteran's cervical spine (neck) condition impact on his or her ability to work? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's cervical spine (neck) conditions, providing one or more examples: Veteran is capable of limited lifting, carrying, and bending. 16. Remarks, if any: -------------------- NOTE:Veteran performed neck flexion repeition which reduced ROM to 32deg. Unable to perform any further repetition for other ROM maneuvers. ************************************************************************* Additional exam request information: For any joint condition, examiners should test the contralateral joint, unless medically contraindicated, and the examiner should address pain on both passive and active motion, and on both weightbearing and non- weightbearing. In addition to the questions on the DBQ, please respond to the following questions: 1. Is there evidence of pain on passive range of motion testing? YES 2. Is there evidence of pain when the joint is used in non-weight bearing? YES **************************************************************************** Medical Opinion Disability Benefits Questionnaire Name of patient/Veteran: 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 Evidence Comments: BOARD REMAND MEDICAL OPINION SUMMARY ----------------------- RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: (a) Please state all diagnoses as to the Veteran's cervical spine, and address all diagnoses already of record: herniated disk and bulging disk of the cervical spine and spondylitic changes, muscle spasm and contusion/compression, spondylosis and degenerative disc disease of the cervical spine, mechanical cervical pain syndrome and radiculopathy. (b) Please provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed cervical spine disability was caused by or etiologically related to active duty. Please specifically address the back injuries and complaints of back pain noted in the STRs. (c) Please specifically address the Veteran's lay statements that he has suffered cervical spine pain since service, and that in service he suffered injury to his neck while carrying heavy equipment and continuous wear of duty gear. (d) Please address the conflicting evidence of record and offer a clarifying opinion, notably the February 2013 VA examination positing a negative nexus, and the April 2016 private opinion positing a positive nexus. b. Indicate type of exam for which opinion has been requested: NECK TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. c. Rationale: Upon review of all available medical evidence, including eVBMS, virtual VA, and Board Remand, the following pertinent information is obtained and reported in 'Evidence Comments': Prior VA Examination, 6/25/96, reports Mr. served in the Marine Corps. he was inducted in 1990 and received separation with an honorable discharge in 1996. Medical History-In 1992, he had onset of pain in the neck area diagnosed at Quantico. Xrays were negative. Impression was muscle spasm and stress. Enlistment RME/RMH for national guard, 4/13/98, reported no neck problems and normal exam of the spine. Miami VAMC, Outpatient clinic, 5/6/2005:Assessment is chronic neck and low back pain-Will get plain films and MRI, does not want any meds. 2/28/2013, VA examination opines "Unable to find SMR evidence of significant neck injury or complaint in service. No evidence to support chronicity of problem for over 10 years post-discharge." THIS OPINION IS GIVEN LOW WEIGHT BECAUSE IT IS NEITHER SUPPORTED NOR CONSISTENT WITH THE RECORDS IN FILE THAT SHOW COMPLAINTS OF NECK PAIN INDICATING A CHRONIC CONDITION. 4/29/15, DBQ neck was completed providing a diagnosis of mechanical cervical pain syndrome and radiculopathy. As received 4/8/16, VA physician, , states that the Veteran suffers from cervico-occipital neuralgia and cervical radiculopathy with bulging disc "are as likely as not a direct result of blunt trauma received during the patient's military career. His conditions are a severe occupational impairment to the veteran and has been exacerbated by many years of continuous wear of duty gear related to his profession." On today's C&P examination, 11/21/17, Veteran is a credible historian and reports several incidents in 1992-1995 of blunt trauma, involving ground defensive tactic also known as "Bull in the Ring" in which the marine is in full gear and is potentially tackled by several marines. Following this , Veteran incurred concussion-1992 or 1993). Veteran also reported chronic neck pain during service was due to carrying 50 caliber machine gun barrels and ammunition. He also went to Bethesda for back school(approx. week). In summary, the Veteran has been under chronic medical care for neck pain first reported during service(6/25/96) and the condition has progressed from cervical muscle spasm to mechanical cervical pain syndrome and radiculopathy, cervical herniated and bulging disc with muscle spasm, cord contusion/compression myelomalacia, cervical spondylosis and degenerative disc disease, cervico-occipital neuralgia, and cervical radiculopathy with bulging disc. A nexus has been established. Therefore, it is at least as likely as not that the claimed condition has direct service connection.
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