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ntowns6702 posted a question in Entitlement - Veterans Compensation Benefits ClaimsCurrently rated 40% for lumbar sprain. recently had mri showing degenerative arthritis, bulging disc and bony protrusion that at times presses on nerve. Had steroid injection but no relief. Physical therapy not helpful next step may be burning nerve ends. Should I file for an increase now? Thanks.
Hi fellow vets! Yesterday I had a C&P exam for a left leg radiculopathy (secondary to Lumbar Strain which I'm currently rated for at 60%). The doctor was really friendly. We went to do the ROM test and after my first test of bending forward he looked at me and said, "Well obviously you are in too much pain to do any further ROM tests." He didn't measure anything related to my radiculopathy. Should I be worried? Or is this a good thing? I'm worried that if the rater doesn't see any ROM measurements it may be flagged. But he made it sound like it was a good thing for me. He was definitely on my side, which is a first for me. Has anybody ever experienced this before? I noticed on the DBQ there is a box with a line that says, "If unable to test, explain why." He told me he would explain that I was in too much pain to complete the ROM test. Seems like a good thing for me, but not sure. Thanks! Kelly, USMC 0351 OIF Combat Vet
In 2002 my back claim was denied by the VA. The reason for the denial was that even though I was seen for back complaints (9 times) There is no diagnosis of a chronic disability. Here is why I think this could very well be a CUE Claim. The determination of no diagnosis of a chronic disability was may by someone unqualified (VARO or Reviewer) to make that determination. There is no documentation from a single medical professional in relation to this claim concerning my medical history. I have seen some case law on this such as Sokowski v. Derwinski that states "Remand was required of the veteran’s claim for service connection for actinic keratoses given that medical evidence contrary to the veteran’s medical evidence was lacking in the record and the BVA merely relied on its own unsubstantiated medical conclusions in denying the claim." or Moore v. Derwinski that says "BVA may not reject medical evidence on the basis of its own unsubstantiated medical conclusions." There actually is a good bit of case law on unsubstantiated medical opinions by the VA and I wondered is my situation could apply.
Hello and TYIA for any responses and for reading my long post. BLUF: I would appreciate some insight or just plain ol speculatin on why the VA raters would submit me for a lumbar strain increase (that I didn’t submit for) while working on my current claim? Also, are secondary conditions disqualified in the 60% calculation for SMC Housebound? I know it says the 60% must be separate from the 100% condition, but how does this work if I’m on IU, with secondary conditions? I’m probably overthinking at 4am but why would they submit me for an increase for a condition when I didn’t ask them, and the increase has no bearing on the final rating due to VA math, unless it qualifies me for SMC, or they believe I should be qualified. I’ve never raised the issue of SMC and I’m still learning about it trying to figure out my claim, and I know they are supposed to do due diligence, but that’s not my first hunch since that’s why I’m still in this process. History: I filed a claim in 2015 for PTSD increase and TDIU, was granted increase in 2016 to 70% PTSD, denied TDIU. Combined, 80% with other SC conditions. BBE/VSO said I was denied increase to 100% even though I had a nexus statement from a psychologist saying total social and occupational impairment, at least as likely as not, etc., but they said because I was still employed (I was on long term disability leave but not yet “terminated” and yes they had the relevant evidence through my employer and insurance), and my VA treating provider’s opinion took precedence who didn’t feel my symptoms quite qualified me for total of course, though he‘s a CRNP versus a psychologist and I don’t think he even knows me. I thought they were supposed to take the rating and credentials that favor the Veteran but never mind me. I also survived and was approved for Social Security and life insurance premium waivers during this period without having to appeal, with the same medical information and evidence, with the same VA SC conditions, even coming from VA docs and providers. Of course I appealed the rating and TDIU denial (they can decide) in 2016. I also submitted a new claim for secondaries to PTSD, and in my fog, with that claim an increase for PTSD and TDIU, even though I already had those on appeal. I believe I read or was told somewhere (or maybe my brain made it up) that if I submitted new evidence, the raters could look back at the effective date and could EED to the original claim if the evidence shows and close the appeal. Or, they could approve me from the date of the new claim and the appeal could deal with the stuff before that. But what they did was what they are apparently supposed to do (according to Peggy and the VSOs): defer the appeal related claims to the appeal. DOH. Current Status: Early this month my claim progressed and I was granted an increase to 30% for IBS secondary to my 70% PTSD, and since I had a pre-existing 10% for nerve condition and 20% for lumbar strain, that brought me to 90%. My claim never went to complete and I never got the BBE, ebenefits bounced around from gathering of evidence to pending decision approval within days of my last C&P (I had one for PTSD and one for IBS). I’m not sure why they would give me a C&P for PTSD if they are deferring that part of my claim to appeal as I was told. Maybe they’re just giving me a checkup because my 30 appointments and inpatient stays and shock treatments over the past year weren’t enough medical evidence. I learned of the increase bc I got a small retro and my ebenefits letters and disabilities changed within days, but the claim stayed open. I found out by calling Peggy and VSO that it’s due to an increase for my lumbar strain that someone in the rating chain put in. I do have plenty of evidence in my medical records that show my back is also crap. I got sent to a C&P for my lumbar strain and now I wait in GOE. The C&P examiner, Peggy, VSOs specifically say I was submitted for an increase for my back, not a review. BTW, in ebenefiits in the disabilities section, the PTSD increase is still open, the TDIU disappeared, the IBS is rated, and the lumbar strain doesn’t appear. Yes, I know ebenefits is unreliable and I should find something else to do, but compulsively logging into ebenefits is an activity quite similar to playing a slot machine for me. Every 1 in 10000000 logins I might get a glimmer of hope, and it keeps me going lol. I Wonder: What difference does it make if I’m rated 20% or 30% for my lumbar strain? Why would this be raised since my overall rating won’t change from 90% either way? Trust me, I AM NOT COMPLAINING AND I AM GRATEFUL, anything they do (and they have been getting faster and more Vet-friendly it seems) positive for the Veteran that saves future agony and torture is an appreciated blessing. It would help in the future in qualifying for SMC, but I don’t qualify with the math now. Just wondering if they don’t have enough to do over there, because in the future I’d probably have to get another C&P. Also, I would have to have another condition at 30% for that math to work out, and I pray nothing else worsens enough for that to happen. Does “separate” mean it can’t affect the same body system or it can’t be a secondary condition? Because with secondaries, I could potentially qualify for SMC, and therefore the VA rater would be setting me up for success. Otherwise, it just seems like extra work for them when they could close my case and get their quota numbers and help another Vet...again, not complaining but whoever is on my file seems to be thorough regardless. I know they could be doing anything over there, and I’m glad they’re working on my claim, but just for s&g I’d appreciate any guesses or suggestions, and any help clarifying the SMC Housebound math thing please. Thank you all.