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  1. Had a C&P exam and these are my symptoms that the Dr checked. Depressed mood, Anxiety, Chronic sleep impairment, Flatten affect, Disturbances of motivation and mood, Difficulty in establishing and maintaining effective work and social relationships, Difficulty in adapting to stressful circumstances, including work and work like setting, and Suicidal ideation. I looked at the criteria and it seems to rate around 50% as l see it. Does anyone see it differently? The Dr checked the box that says Occupational and social impairment with reduced reliability and productivity. McRay the Dr noted that I have low acute risk of suicidal ideation. This isn't just a one off suicidal ideation is mentioned in other section of my medical records.
  2. I have somewhere in my personal files a contemporaneous "restricted report" of some hazing against me that involved forced sodomy. I never claimed it but I do have ratings for depression and anxiety at the most appropriate percentage. Is there a point in me ever claiming MST? I don't know if this is a Pandora's Box that I want to open. Opinions would be appreciated.
  3. Hi, Last week, I was awarded P&T TDIU for a claim that was previously awarded 70% mental health disability rating. Should I now appeal the 70% mental health rating? The word "total" is difference between a 70% and 100% mental health rating, as I read the information. Is P&T unemployable possibly considered as a 100% disability rating? Thanks
  4. Hello, Does anyone know how the VA rates keratoconus currently? The diagnostic code is 6035. I am new to all this and have been unsuccessful in finding the specifics using the VASDR. I have been diagnosed with bilateral keratoeonus and would like to better inform myself on how it is rated. I am awaiting a decision back from the VA but my case and evidence is overwhelming. To date, I have found only one article dating back to 2008 that appeared to show the minimum rating use to be 30% but I am unable to gauge the accuracy. Any assistance is helpful.
  5. Just got rated at 80% but 70% is for depression and they say it's temporary. The money every month has allowed me to breathe and is making things a lot better for my family but now I'm worried about the temporary part. Guess my question is what do I do now should I make appointments at the va or not? I use to go quite often but not anymore. Figure what is the point all those doctors do is stair at a computer and pump me full of drugs that I honestly I don't want and can't have due to my job. What should I do, do I have to make appointments to see a doctor? Thank you for any help.
  6. I've seen on a couple of websites where it stated that your VA rating percentage is protected and they cannot reduce your rating once you reach 55 years old. Is this true? If so, where can I find this in the VA regulations for verification? Thank you to all who reply.
  7. hello, i was told to look into something called smc l. i dont know if i qualify or not. i was given a 100% permanent and total rating in 2015. here are my ailments. biploar disorder 70% Asthma due to jet fuel exposure 60% cystic acne due to jet fuel exposure 30% carpal, allergies, tinnitus each at 10% i also get ssdi 100% and they require me to use my sister to manage my finances. my sister also basically serves as my caregiver. without her i dont believe i can function. she does everything for me from finances, to taking me to appts, to reminding me and sometimes helping me clean. and more. would i be able to apply for smc-l and if so how would i go about doing it. i overheard a family member discussing it with my sister and mom the other day. and it sounds very helpful. thank you
  8. Hello I believe my rating 100 P&T was to high. When I had my exam I explained I believed the medication I was on was making me worse this was three months ago. I got a new psychatrist and he also believes I was on the wrong medication. I truly believe P&T was too high. I rather be rated 100 percent and be reviewed in the future. Is this possible? Would I call or fill out a form? Please just help me with my question I will make my own decision so I do not want to here that this would be a mistake. I truly feel I was over rated and I do not want the P&T I am only inn my twenties I want to try and get better. I am not looking for opinions if its the right choice. if there is someone out there that can let me know if it is possible and how to do this please let me know. Thank you
  9. I tried looking through forums, but cannot find this answer. I had a GERD claim increase on Jan. 2019. I am *fairly* certain it was previously rated at 0% upon discharge and then finally received an increase in Jan. 2019. I cannot find anywhere online when the GERD was previously rated for 0%-I looked through "historical claims/appeals" and it does not show anywhere on there (there is one claim that I submitted a long time ago that says "administrative review-closed, but, it was so long ago, I honestly do not remember what the administrative review was for or what it was related to). Is there anywhere else I can look to find when the original GERD assigned rating of 0% was given? (I am asking as I am thinking of doing a CUE for the 10% rated in Jan. 2019, and I am thinking I need to have the date originally assigned at 0%? ) Or is this something I would need to ask for copies for from the VA? *I know it was previously rated at 0% because I can see where I submitted claims for increase for GERD.....
  10. I recently received a re-exam for my anxiety disorder that I have a 70% rating for. They sent me a packet explaining they want to lower the rating to 30% because of "improvements made". When i told my treating physician about this, he disagreed that any improvements have been made and agrees to write a statement for me to send in as evidence. I'm just curious how much ground his statement can hold against their examiners and if it is likely that they will reduce my rating or leave it as is. Has anyone else submitted doctors statements and had the VA rule in their favor? Is it common?
  11. I received a letter from the BVA dated May 24 , 2018 stating that I had been granted service connection for some issues and a remand for other issues. I am still waiting on an effective date and rating. My question is will the VA implement the grant while waiting on the remand? how long does this process usually take? I was ok while my case was on appeal but since I received my grant I have went crazy. I check e benefits 3 times a day and i cannot stop wondering what my new rating is. How long does this process take? I thought I had won my case but nothing has changed. sooo tired of waiting on the VA. Any info on time would be great or any suggestions to speed this up.
  12. Hi Everyone, In my most recent C&P the examiner noted and measured 2 scars on my neck and jaw. I've read the rating info for scars of the Head/Face/Neck and filled in the chart they had because the first rating option didn't apply. Can someone confirm for me that according to the rating info below, it would qualify me for 30%. There's pain noted in the C&P with each scar in addition to the characteristics noted below. "If there are 6 or more Characteristics, it is rated 80%. If there are 4 or 5 Characteristics, it is rated 50%. If there are 2 or 3 Characteristics, it is rated 30%. If there is 1 Characteristic, it is rated 10%." In addition, during the same C&P the examiner documented and agreed (50% more than likely service related) that I had TMD secondary to broken jaw, painful motion of mandible, reduced ROM, surgical wire in right mandible Thanks in advance! Randy
  13. I have a rating for 10% for:. right knee patellofemoral syndrome, claimed as gout and iliotibial band syndrome Is it common for VA to group conditions, can these be separated? Thanks for the assist...
  14. Hello, everyone! I've been on this site reading all the valuable information while I waited for my new claims to process. A local VSO initiated my intent to file, back in March of this year, and I brought in all of the requested documents for an appointment on July 11. This is when the file was formally submitted to the VA. I had two new claims. I was given two C&P appointments, for each issue...one in July, and the other in August. I called Peggy to find out the status, last Thursday, and I was told that my file had been updated that very day. It appeared there was a rating decision, but I would have to wait for the BBE to find out the details. I checked the site again, a few days later. I finally could see that I had been rated (at 70%) for one issue, but the second issue (bilateral pes planus) had been deferred. On Ebenefits, the entire claim, it appeared, went from "preparing for notification," back to the "gathering evidence" stage. When I called for an explanation, I was told that it possibly needed another signature, but Peggy wasn't for sure. Peggy also said that, according to the notes, there was nothing that the VA needed from me. Today, my Ebenefits account was updated, and it had new information. The new information was put under claim status as "Request 2: Award returned to local VSR for correction." (I inserted a link below to a screenshot of my claim status.) Is anyone familiar with this issue and can explain what it means? Screenshot of claim status
  15. I filed for an increase recently to my 40% rating. In August 2009 my rating was increased from 20% (awarded in 1994) to 1) ankylosing spondylitis /spine thoracolumbar 20%, 2) ankylosing spondylitis/knee 10% 3) ankylosing spondylitis/cervical spine 10%. Since then my range of motion has gotten worse and I have been prescribed prednisone and two years ago Humira. They had rated me under arthritis and range of motion. I went for a C&P in May and saw my new rating on Eben: 1) NEW: (dated 4/27/18) ankylosing spondylitis /spine thoracolumbar spine 10%, 2) UNCHANGED ankylosing spondylitis/knee 10% 3) NEW (dated 5/21/17) ankylosing spondylitis/cervical spine 30%. I filed my intent to file in 4/2017. I haven't received the notification or documents in the mail yet but I am confused, my thoracolumbar spine is worse than in 2009 with worse range of motion. The VA has no way to determine it improved, from the arthritis aspect the joints do not get better and for ankylosing spondylitis I was prescribed Humira which is a step up from prednisone. There was nothing to indicate I improved. Also I have been told by some my rating is bad because they failed to rate the ankylosing spondylitis as an active disease in addition to the general range of motion for arthritis.
  16. 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
  17. This is my latest C&P what am I looking at? Can anyone break this down? 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.
  18. 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.
  19. Hello all. Want to first thank everyone for helping. The information we have received from you all has been incredibly helpful. My dearest husband just received his award letter and the representative forgot to add in two of his disabilities related to his back into the overall rating. He has been recieving these two benefits for several years now and neither of them were mentioned or addressed in his award letter. It simply looks like the VA rep. made a mistake. What should we do and how long does it take to fix a mistake like this? Any ideas?
  20. so during my last c + p exam The Dr. stated that my range of motion has met the criteria for 5251, and 5252, and 5253. now this page says it is lawful to be rated under all these 3 codes. http://www.militarydisabilitymadeeasy.com/hipandthigh.html All three of these codes for limited hip motion CAN be used together. So if the hip is limited in flexion, extension and abduction, then it can be rated three times, once under code 5251, once under code 5252, and once under code 5253. Each code can only be used once, however, so if the hip is limited in abduction and adduction, both are rated under the same code (5253) and so two ratings cannot be given.
  21. Hello all! So the long and short of my story is that I have bipolar disorder. My doctor checked 100% service-connected (diathesis-stress theory and all). I can't drive after 7pm and try not to drive after 6:00pm due to medication side effects (clumsiness from Seroquel and confusion from Lamictal). In the last 2 years, I have probably driven after 7pm about 10-15 times. I tried switching to Vraylar and it was gosh-awful. I mean, you know, people here know. The worst... Anyway, I have failed out of school for the last 4 semesters despite being of average smarts. I have lost 2 very good friends due to my manic states (one was my best friend for 8 years, the other was my 2nd best Army buddy). During the Winter I am usually totally "combat ineffective", as in I can barely leave the house, and do laundry every 3 weeks (instead of every week) and shower every 3 days. I also go for groceries probably every 5 weeks instead of every 3. I am submitting my claim through the DAV and my doctor has checked off deficiencies in: "work, school, family relations, thinking, mood" on one of their special forms. Anyway, I know, it's just a lot of wah, wah, wah on my part (and I'm sorry to the vets who are straight-up paralyzed), and don't get me wrong, I am very lucky to not be a Vietnam vet who has been wronged, or a vet who has lost both both arms... but, can anyone guess what my rating will be? I will not hold it againstanyone even remotely. My C&P exam is on Wednesday and I am pretty anxious. I expect to hear my rating in about 3 months. I think I will be placed at 70%. Any "wake up calls" or advice is welcome. Best regards, Hemi
  22. SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: CH PTSD b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): PARKINSON'S, HIGH TRYGLYCERIDE. HEARING LOSS. 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 [X] Other (please identify other evidence reviewed): STRESSOR NOTE. Evidence Comments: TALKED WITH HIS WIFE MELINDA. SHE STATES THAT GRADUALLY HAS BECOME MORE IRRITABLE, LOOSES HIS TEMPER VERY EASILY, SNAPPS AT HIS KIDS, ARGUMENT. AT NIGHT HE IS RESTLESS IN BED, YELLING AND STARTS SWINGING HIS HANDS AND FEW TIME HE HIT HER IN THE SLEEP. WHEN HE IS OFF MEDS, HE IS MORE WITHDRAWN, LESS ACITVE PHYSICALLY AND MORE IRRITABLE. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military) THIS VET ARRIVED HERE FROM SIGNAL MOUNTAIN, TN, DRIVEN HERE BY HIS WIFE.HE WAS BORN IN FRANCE, HIS FATHER WAS IN ARMY. RAISED IN JASPER, TN. HE WAS RAISED BY BOTH PARENTS. HE HAS ONE BROTHER AND ONE SISTER.NO HX OF ANY KIND OF ABUSE.HE IS MARRIED FOR 31 YRS, ONLY MARRAIGE. THEY HAVE 3 CHILDREN. HE JOINED THE AIR FORCE IN 1985 AND DCED IN 2008 WHEN HE WAS DXED WITH PARKINSON'S. HE HAD 6 TO 7 YRS OF ACTIVE AIRFORCE, STATIONED IN KUWAIT AND IRAQ. HE WAS DCED FROM AIRFORCE RESERVE IN 2008. HIS RANK AT DCED WAS MASTER SERGEANT. b. Relevant Occupational and Educational history (pre-military, military, and post-military): COMPLETED HIGH SHCOLL IN JASPER. HAS BACHELOR IN ORGANIZATIONAL MANAGEMENT.HE WORKED FOR TVA IN NUCLEAR PLANT AND DID ROOT COUSE ANALYSIT. HE WORKED LAST SEPTEMBER 2016 BECAUSE OF PARKINSON's. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): HE DID NOT RECEIVE ANY MH CARE BEFORE HE JOINED THE AIRFORCE, NONE WHILE IN AIRFORCE BUT AFTER DCED FROM AIRFORCE, HAD TO SEEK HELP AT CHATTANOOGA CLINIC.HE WAS THEN DEPRESSED, HIS MOTHER PASSED AWAY, COULD NOT HANDLE THE LOSS, HAD TO GIVE UP WORKING AND FELT HOPLESS AND HELPLESS.HE FELT LOW ELF ESTEEM.HE WAS THEN PRESCRIBED AND NOW HE IS STILL FOLLOWED BY PSYCHIATRIST AT CHATTANOOGA CLINIC.HE STILL FEELS DEPRESSED, SOME ARGUMENT WITH HIS WIFE.HE FREQUENTLY CRIES, FEELS HOPLESS AND SOME TIME GOES THROUGH MOOD SWING BUT DENIES ANY MANIC EPISODES.HE KEEP UP WAKING UP AT NIGHT, FIGHTS IN HIS SLEEP, FEW TIME HE HIT HIS WIFE IN SLEEP AND HAS HEPPENDED FREQUENTLY, FEELS GUILTY ABOUT.HIS WIFE TELLS HIM HE CRIES IN HIS SLEEP AND SCEAMING BUT HE DOES NOT REMEMBER DOING THESE. REPORTS THAT HE AVOIDS CROWD, FEELS MORE SAFE AT HOME. IF HE IS IN UNFAMILIAR SITUATION, DOES GET UNCOMFORTABLE.HE GETS FRIGHETEN IF THERE IS LOUD NOISE.VERY LIMITED SOCIAL LIFE, ONLY TIME GOES OUT WHEN HE ATTENDS THE CHURCH. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): NONE e. Relevant Substance abuse history (pre-military, military, and post-military): NONE f. Other, if any: HIS OWN PHSICAL CONDITION AND LEAD TO GIVING UP JOB AND ROLE REVERSAL WHEN HIS WIFE HAS TO WORK AND HE HAS TO STAY HOME. 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: 2001, AT AIRFORCE BASE IN QUATAR, WAS GOING TO DO PURCHASE WITH HIS PRCHASING AGENT, PERSON PULLS UP AT GATE AND PULLS OUT AK 47, START SHOOTING, HE WAS ONLY THIRD CAR FROM GATE., THIS PERSON WAS SHOTTO DEATH 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? [X] Yes [ ] No Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No If yes, please describe the markers that may substantiate the stressor. MIDDLE OF ATTACK. b. Stressor #2: WHEN HE WAS STATIONED IN SAUDI DURING DESERT STORM, THERE WAS GR 1 TORNADO NEAR THE BASE, BRITISH PILOT HAD TO EJECT HIM SELF FROM 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 If yes, please describe the markers that may substantiate the s tressor. WITNESSING BRITISH PILOT EJECTING FROM AIRPLANE WHEN THERE WAS GR 1 TORNADO AT BASE. 4. PTSD Diagnostic Criteria Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criterion A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criterion A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violence, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) [X] Witnessing, in person, the traumatic event(s) as they occurred to others Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). [X] Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Markedly diminished interest or participation in significant activities. [X] Feelings of detachment or estrangement from others. [X] Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.) Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Hypervigilance. [X] Exaggerated startle response. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 [X] Stressor #2 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment[X] Disturbances of motivation and mood [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Inability to establish and maintain effective relationships 6. Behavioral Observations -------------------------- ALERT,ORIENTEDX3,COOPERATIVE, CASUALLY DRESSED, POOR EYE CONTACT, CONSTANTLY MOVING IN THE CHAIR, VERY FIDGITY. AFFECT IS CONSTRICTED, DECREASED INTENSITY, ANXIOUS MOOD. RATE OF SPEECH NORMAL, GOAL DIRECTED. NO AH/VH OR ANY PERCEPTUAL DISTURBANCES. NOT SUICIDAL OR HOMICIDAL. NO COGNITIVE DEFICIT. 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 -------------------------------------------------- THIS VET DID EXPERINECE TRAMATIC STRESSORS AND HAS EXPERIENCED SXS OF PTSD WITH CO MORBID DEPRESSION AND UNDERGOING MH RX AT CHATTANOOGA CLINIC. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application. ****************************************************************************
  23. OK, so here's my story. I was in Iraq in 2008-09, and started having chest pain. It was dismissed by the army doctors as probably just a strained muscle. Fast forward a few years, and I was diagnosed with pulmonary hypertension and stage one heart failure, both of which are ultimately fatal. I submitted a claim for these conditions, which was denied. I appealed this denied to the DRO in St. Louis, MO. The contention for pulmonary hypertension has a pending rating decision in the system according to my VSO. Here's my issue. I am diagnosed with Pulmonary Hypertension, as well as other diseases. The doctor who did my C&P exam clearly stated that he believed that my PH was service connected. The pending rating states that I am granted service connection for PH. However, in the section that details the rating, it is rated at 30% as "Symptomatic, following resolution of acute pulmonary embolism." In the CFR 38 section 4.97, diagnosis code 6817, Non-tuberculosis diseases of the respiratory system, Pulmonary Hypertension is clearly listed as a 100% condition. I called the 1800 number to check on the rating decision, and I was informed that it was sent to the authorizer, who then sent it back to the rater, and it is now just waiting to be authorized again. Is it possible that the authorizer saw this, and felt that the " Symptomatic, following resolution of acute pulmonary embolism" was not an accurate representation of my diagnosis, and asked for it to be updated?
  24. Under Explanation his letter informs me of a reduction in my PTSD disability rating from 50% to 30%. It lists the reasoning for this decision. They noted all these items as reasons for the reduction but never explained how they arrived at their decision other than "the overall evidentiary record shows":... No where do any of these terms show up in any evaluation in my medical records. I've appealed it. How do they get away with manufacturing this type of evidence? Of course they did not give me due process, I had no predetermination hearing. In my NOD I stated, "To date I have not received this predetermination hearing. I believe this may have been offered in correspondence somewhere, but the confusion of proposed vs. an actual reduction may have clouded the issue. In any event, if I am entitled to a hearing, I request one be scheduled." Do you think I have a case?
  25. First of all wanted to start this out by saying thank you to all the members on this site. I have been doing all my own research and very often arrived here. Today I decided it might be better to get direct contact instead of lurking in the shadows. The short version is that I have not been able to find work after separating, I'm currently on unemployment to keep myself out of debt while I figure this all out. I was in school for a few months and while I was struggling a bit I did my best to push through which was kind of working out for awhile. Eventually I started getting to the point where I could only manage to push myself to get to class and landed right back in bed afterwards. This effect snowballed and now I have just been medically withdrawn from university after missing 2 weeks of class. Those two weeks I could not get out of bed almost the entire time, I have been taking my meds and everything but sometimes depression just decides its going to mess your life up and you don't have the will or energy strong enough to overcome and keep going. But back to the point, the VA awarded me 30% for depression, anxiety and insomnia combined into one rating. Trying to figure out how I am going to get by and what I can do to survive brought me to the vets group on campus where one of the other guys after hearing what was going on suggested trying to get my rating increased and possibly seeing if I am eligible for individual unemployability. After reading how the VA scores depression I believe I might be in the 70% range but I'm not sure how to go about this. I've got the NOD paperwork but didn't want to fire off half cocked. I look to you all for some help with this as time and again I've seen this community help each other navigate the labyrinth that is the VA. My question here is multifaceted, which I will break down for easier reading and responding. 1. When filing a NOD should I go for DRO or traditional? 2. What evidence should I include with this to increase the likelihood of conveying my situation properly? 3. Should I talk to my doctor about trying to raise my percentage or keep the two separate? 4. Should I focus on the depression or give information on insomnia and anxiety as well/ would they all go together? 5. Lastly What sort of timeframe should I expect, I've seen people saying a few months and others waiting years later. Thank you all for any help you can provide and if you need any more information or clarification I will gladly supply it. (There are other things in my disability claim but they are much minor to the mental health issues and I believe the ratings I received for the others were fair or fair enough.)
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