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Hello! First off, Thank you all! - for this website, your time, and your passion towards helping fellow veterans! Started the PEB process on active duty (2012 at the time), so I'm just trying to sort this out and find where things went wrong. The claims submitted among this process only listed 3 contentions - of which the DoD rated me unfit at 10% W/ severance pay, while the VA rated those conditions (totaled) to 40% upon exiting service. My story - First, I don't agree with the PEB findings, but I signed off on it at the time without a full understanding of "what I could claim", so once the ball got rolling I found myself trying to correct my own mistakes along the way. I want to particularly point out to the Experts here that signing off on my PEB, as well as false statements/misquotations made by an off base neurologist has been used against me in regard to denial for SC TBI. In one denial, they took the exam from the off base neuro i saw, and threw the (positive) other out - Denying me the benefit of the doubt, or even the 50-50 rule.... The situation now is that I have a second doctor, who wrote a Nexus concurring with the diagnosis and rationale of the specialist I was treated by. (So 2 doctors post-service vs. the 1 I saw who didn't have all the details, lay statements, and misquoted me or failed to check the appropriate boxes based on my own testimony. TLDR - I was awarded increase for 1 contention in 2016 to (a total of) 60% - Followed by SC and increase in another (1) contention for an overall rating (total) of 80% in 2017 - Some corrections were made and a rating was re-established with the proper EED and my new total is now 90% (as of late 2019) - it is now 2020 and I have 4 contentions that never made it to SC (yet!) - I experienced narrative changes as to why the VA was denying SC for TBI and 3 other issues - such as "missing diagnosis" - I had included a document from their own specialist specifically stating I was diagnosed with TBI and 2 exams giving extensive detail as to my symptoms/history. Again, thank you for all you have done, and all you continue to do for all of us. to Semper Fi !
Who actually decides or who would need to be contacted regarding changes in agent orange presumptives. I especially wonder about neuropathy which according to VA has to have been manifested to at least 10% within one year of discharge. But, according to multiple sources, this is a disease that was not even diagnosable until recently. That makes it impossible to meet the requirements for presumptive. So, who could actually introduce a change? Thanks Kate
I recently finished a series of C&Ps for various conditions and I was hoping to get some input on just what exactly it all means - I was wondering what if any kind of rating might I be looking at? Is there a possibility for getting back pay? What can I do (possibly in an appeal) to do more to strengthen my case? At this point my case should be done with the gathering evidence phase (I can't check because ebenefits is being weird). All C&P's are done and everything that needed to be turned in is (I hope). The first C&P/DBQ I'd like assistance with is my claim for "Lower Back Condition". Originally I had claimed "chronic lower back pain" only to later find out that really isn't a thing and thus I was denied. When I went in for this most recent exam the reviewing doctor first went to my C-File and saw that I had claimed "chronic lower back pain" back in 2004. He then went into my military treatment record and found considerable amounts of treatment records for several issues in my lumbar spine and beyond. "They should have connected you back in 2004" he said to me. Sufficed to say that his positive first impressions put me a little more at ease with the C&P (which normally turns me into an anxious, nervous wreck). I've now gained access to the DBQ and would like any information that you well informed folks could provide. I've cut it down as much as I thought I could. If a question is missing and/or option is missing assume it wasn't checked. All non-pertinent information I cut out and did some heavy editing as far as formatting goes. Here it is: Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: VA medical records. 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a thoracolumbar spine (back) condition? [X] Yes [ ] No Thoracolumbar Common Diagnoses: [ ] Ankylosing spondylitis [X] Lumbosacral strain [ ] Degenerative arthritis of the spine [ ] Intervertebral disc syndrome [ ] Sacroiliac injury [ ] Sacroiliac weakness [ ] Segmental instability [ ] Spinal fusion [ ] Spinal stenosis [ ] Spondylolisthesis [ ] Vertebral dislocation [ ] Vertebral fracture Diagnosis #1: LS strain, chronic, with LLE radiculopathy Date of diagnosis: 2000s 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's thoracolumbar spine (back) condition (brief summary): During military service, the Veteran did develop chronic left lower back pain with radiation down the left buttock to the calf. On 6/10/2003, an MRI of the LS spine was performed with the following findings: Broad based posterior/central disc bulging at L4-5 without associated neural impingement. After service discharge in 2004, the Veteran continued with intermittent lower back and LLE problems. Repeat lumbar MRi in 2009 was read as normal. Currently he continues with chronic daily left lower back pain with LLE weakness and paresthesias. He is taking Ibuprofen and has a TENS unit as needed. He deniesbowel/bladder/sexual dysfunction related to his lower back. b. Does the Veteran report flare-ups of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words: Increased pain and stiffness c. Does the Veteran report having any functional loss or functional impairment of the thoracolumbar spine (back) (regardless of repetitive use)? [X] Yes [ ] No If yes, document the Veteran's description of functional loss or functional impairment in his or her own words. Stiffness/LLE radiculopathy 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion [X] Abnormal or outside of normal range Forward Flexion (0 to 90): 0 to 75 degrees Extension (0 to 30): 0 to 20 degrees Right Lateral Flexion (0 to 30): 0 to 30 degrees Left Lateral Flexion (0 to 30): 0 to 30 degrees Right Lateral Rotation (0 to 30): 0 to 30 degrees Left Lateral Rotation (0 to 30): 0 to 30 degrees If abnormal, does the range of motion itself contribute to a functional loss? [ ] Yes (please explain) [X] No Description of pain (select best response): Pain noted on exam on rest/non-movement If noted on exam, which ROM exhibited pain (select all that apply)? Forward Flexion, Extension Is there objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine (back)? [X] Yes [ ] No If yes, describe including location, severity and relationship to condition(s): There is localized tenderness over the bilateral paralumbar muscles and the left SI joint and left sciatic notch. b. Observed repetitive use: Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional loss of function or range of motion after three repetitions? [ ] Yes [X] No 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: [X] The examination is neither medically consistent or 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: Not currently flared up. d. Flare-ups Is the exam being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare-up: [X] The examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. Does pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups? [ ] Yes [ ] No [X] Unable to say w/o mere speculation If unable to say w/o mere speculation, please explain: Not currently flared up. e. Guarding and muscle spasm Does the Veteran have guarding or muscle spasm of the thoracolumbar spine (back)? [X] Yes [ ] No Muscle spasm: [X] Not resulting in abnormal gait or abnormal spinal contour Provide description and/or etiology: Left lower back muscle spasm is noted today. Localized tenderness: [X] Not resulting in abnormal gait or abnormal spinal contour Guarding: [X] None 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: [X] None 4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Hip flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle plantar flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Great toe extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 b. Does the Veteran have muscle atrophy? [ ] Yes [X] No 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Knee: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Ankle: Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Provide results for sensation to light touch (dermatome) testing: Upper anterior thigh (L2): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Thigh/knee (L3/4): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Lower leg/ankle (L4/L5/S1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent Foot/toes (L5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [ ] Normal [X] Decreased [ ] Absent 7. Straight leg raising test ---------------------------- Provide straight leg raising test results: Right: [X] Negative [ ] Positive [ ] Unable to perform Left: [ ] Negative [X] Positive [ ] Unable to perform 8. Radiculopathy ---------------- Does the Veteran have radicular pain or any other signs or symptoms due to radiculopathy? [X] Yes [ ] No a. Indicate symptoms' location and severity (check all that apply): Constant pain (may be excruciating at times) Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Intermittent pain (usually dull) Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Numbness Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [ ] None [X] Mild [ ] 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 L4/L5/S1/S2/S3 nerve roots (sciatic nerve) If checked, indicate: [ ] Right [X] Left [ ] Both d. Indicate severity of radiculopathy and side affected: Right: [X] Not affected [ ] Mild [ ] Moderate [ ] Severe Left: [ ] Not affected [X] Mild [ ] Moderate [ ] Severe 10. Other neurologic abnormalities ---------------------------------- [ ] Yes [X] No 12. Assistive devices --------------------- [ ] Yes [X] No 13. Remaining effective function of the extremities --------------------------------------------------- [X] No 14. 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? [X] Yes [ ] No If yes, describe (brief summary): Vital signs are stable; Lungs are clear; Heart is without m/g/r; Abdomen is soft, and without masses or organomegaly or tenderness; Genitalia are normal, no hernias or testicular lesions, the testicles and epididymii are tender to touch bilaterally; 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 15. Diagnostic testing ---------------------- a. Have imaging studies of the thoracolumbar spine been performed and are the results available? [X] Yes [ ] No If yes, is arthritis documented? [ ] Yes [X] No b. Does the Veteran have a thoracic vertebral fracture with loss of 50 percent or more of height? [ ] Yes [X] No c. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): Repeat lumbar MRI has been ordered and is currently pending; when completed and reported, I will review it and add any additional comments as indicated. 16. Functional impact --------------------- Does the Veteran's thoracolumbar spine (back) condition impact on his or her ability to work? [X] Yes [ ] No If yes describe the impact of each of the Veteran's thoracolumbar spine (back) conditions providing one or more examples: The Veteran's current lower back condition would limit his ability to perform repetitive heavy lifting, pushing or pulling. 17. Remarks, if any: -------------------- The Veteran is claiming service connection for a lower back condition. Opinion: It is as least as likely as not that the Veteran's current lower back condition is proximately due to or caused by military service. Rationale: The C file was reviewed. The STRs do document a two year history in 2002 of chronic lower back pain with LLE radiculopathy. This is also noted on separation exam in 2004. I was able to elicit the same symptoms ongoing today, as well as to confirm this on phyiscal examination. Repeat lumbar MRI has been ordered since the last study was in 2009; when completed and reported, I will review it and add any additional comments as indicated. Thus, the service connection is substantiated. 12/23/2015 ADDENDUM STATUS: COMPLETED The Veteran underwent a lumbar MRI on 12/21/2015 with the following findings: L3-4: Mild facet arthrosis with minimal posterior disc bulge L4-5: Mild facet arthrosis with minimal posterior disc bulge L5-S1: Mild facet arthrosis with minonal posterior disc bulge ------END------- Any help interpreting this would be greatly appreciated. The "service connection is substantiated" is pretty straight forward. I'm curious whether or not I have a chance at getting the SC backdated to my original claim. It seems to me (a total non expert) that the evidence is there to support it. I am also curious about whether or not I can refute some of the conclusions that this doctor came to. While an awesome C&P doctor a back expert he is not. Since the writing of the C&P I had a chiropractor evaluation who found several more things than this doctor did. I'm curious if any of it will be enough to make a 10% difference when the rating comes down. In addition I am curious if within my C&P as well as the most recent chiro consult if there isn't evidence for a possible future claim for nerve pain in my lower body. "Many times spinal conditions have other conditions that contribute to the severity of the spinal condition. For example, many spine conditions also cause radiculopathy. These secondary conditions can sometimes be independently ratable." In my C&P I believe I meet all these conditions. I am diagnosed with lumbosacral strain - chronic, as well as Lower Left Extremity radiculopathy. In addition the C&P also diagnosed me with LLE weakness and paresthesias. The following is a list of conditions that the Chiropractor diagnosed me with just 8 days after the C&P doctor finalized his report. ----------Chiropractic Evaluation-------------- LOCAL TITLE: PM&R CHIROPRACTOR CONSULT RESULT STANDARD TITLE: PHYSICAL MEDICINE REHAB CONSULT DATE OF NOTE: DEC 31, 2015@11:04 Midback pain: medial scapula, left worse than right Quality: Burning (small area "about the size of a dime") Radiating: Patient Denies 0-10: 9/10 Timing: Intermittent Worse: working in a "hunched" or bent over position. Better: Standing up /stretching Low Back Pain: Thoraco-lumbar and lower L4-5-S1. Quality: Dull/Ache/sometimes sharp/Throbbing Radiating: buttock/thigh and foot ("tasered"), left worse than right 0-10: 6-7/10 Timing: Intermittent Worse: Standing/coughing while bent over Better: changing positions/activities Trunk ROM: Flexion:Mod dec Pain:Severe Extension:Mild dec Pain:No pain Rotation:Mild dec Pain:No pain Lateral Flexion:Mild dec Pain:No pain Muscle Atrophy: No Seated SLR: Positive L Supine SLR: Positive R (low back pain) Hip hyperextension test: Positive R Kemps test: Negative R L Spinous Process Tenderness: T3-7, L2,3, Right SI Myofascial Tenderness: Bilateral Rhomboids, Thoraco-lumbar paraspinals bilaterally. Lumbar MRI 12/21/2015 Impression: 1. Mild facet arthrosis and minimal disc bulges of the lower lumbar spine without thecal sac or neuroforaminal stenosis. Oswestry Disability Index Questionnaire Section 1 -- Pain Intensity: 2. The pain is moderate at the moment. Section 2 -- Personal Care (Washing, Dressing, etc.): 2. It is painful to look after myself and I am slow and careful. Section 3 -- Lifting: 2. Pain prevents me lifting heavy weights off the floor, but I can manage if they are conveniently placed e.g. on a table. Section 4 -- Walking: 1. Pain prevents me walking more than 1 mile. Section 5 -- Sitting: 3. Pain prevents me from sitting more than one-half hour. Section 6 -- Standing: 2. Pain prevents me from standing for more than 1 hour. Section 7 -- Sleeping: 2. Because of pain, I have less than 6 hours sleep. Section 8 -- Sex Life (if applicable): N/A Section 9 -- Social Life: 3. Pain has restricted my social life, and I do not go out very often. Section 10 -- Traveling: 2. Pain is bad but I manage journeys over two hours. DISABILITY INDEX SCORE: 38% Segmental Dysfunction: L3LP, RPIN, RAI_Sacrum, T3LP, T5LP Assessment: 1. Lumbar: Segmental dysfunction 2. Lumbar: strain 3. Pelvic: Segmental dysfunction 4. Sacrum: Segmental Dysfunction 5. Thoracic: Segmental dysfunction Alright. If you've made it this far thanks for taking the time to read this massive wall of text. If you have some information or experience to offer let me thank you in advance!
I have diabetes mellitus with peripheral neuropathy. I filed a claim for my cataracts due to the diabetes. Now I have an appointment for a C & P Exam. I learned the examiner will use a Peripheral Nerves Conditions (Not Including Diabetic Sensory- Motor Peripheral Neuropathy) Disability Benefits Questionnaire. I wondered why they would they require this exam when my new claim is for cataracts. Thanks for any input.