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Found 19 results

  1. I have an remanded issue that was sent to the local RO September 24, I completed my C&P on October 19. Ebenefits currently says Prep for Decision. If the RO denied the issue and sent the remanded issue back to the BVA, how will I know and when will I know this was done? When will I receive back pay for the granted condition?
  2. I am pleased to inform you that the Government has agreed to remand ALL issues on appeal. Since this was consistent with your wishes we accepted the offer on your behalf. What happens next is that the VA attorney will draft a Joint Motion for Remand, that we will review and sign off on. This should occur within the next 30 days, unless VA requires more time. Once the JMR is filed, the Court will approve it and send the case back to the Board. Please let me know if you have any questions at this stage. Kind Regards, Alec U. Ghezzi Training Advising Attorney Vietnam Veterans of America 425 Eye Street NW, Suite 2W.220 Washington, DC 20001 Could this be called a "circle back" to the BVA?
  3. If the Board remands an appeal because an SOC was never issued under a Legacy claim, can a Veteran waive the SOC if the Veteran chooses to do so?
  4. I am not asking for comments on the Monomelic Amyotrophy- I am asking what you feel happened to this claim. and to the IMO............the NOD was filed due to 2 2012 decisions- 8 years ago and the remand is dated 05/05/15. I see no "error" in the BVA decision , and do not understand the representative's idea of 2 year window to fix that error......but you need to read the whole thread to see what happened.
  5. I looked on my ebenefits today and saw that on a "claim for military pay in lieu of compensation was updated/filed in July" Why would this have been filed? I did not file it, and I did not retire from the service. I did have a case that a Court of Veterans Appeals judge was ruling on and my attorney called me a few weeks ago and said the might be open to reviewing IU for me. Is this related possibly? How? I did get a separation payment when I left the service and the VA withheld all disability payments until is was all paid off. It took about 10 yrs but was satisfied. Since then I have received my monthly disability checks with no issues.If anyone can offer opinions about this that would be great. I looked just a minute ago on VA.Gov and see that the claim has now been closed. The purpose of it was listed as Verification of separation pay amount (New)..Does that mean anything to anyone? Thanks
  6. Hello Vets Its been 5 years since I filed my appeal. I am still at 10% sc and I am asking for a rate increase and or TDIU. Since my initial decision my back issues have gotten so much worse. Constant pain in low back with muscle spasms. and now I have neck issuses causing my Right arm to go numb during sleep and throughout day. Opinions on my outcome Anyone have similar problems or can relate to my story. I'm on SSD for 5 yrs as well. One month after I was granted VA comp at 10% I was awarded SS disability unable to work.
  7. So any help would be appreciated. I had won my case at the court of appeals an they were suppose to remand it back down to the bva. The va agreed that they messed up on my diagnosis of brain damage, migraines and PTSD I received from several IEd blast. I have been fighting this for six years now. They contacted me and told I would have to have two more C&P exams so they can render a final decision this was in march of this year. Last month instead of them giving me my exams I was notified that they reviewed my case and did not need to speak to me. Is this right shouldnt I be able to see the dr for a further exam? Also it was even the VA that contacted me, it was an outside agency that sets up appointments with outside doctors that dont work for the va. Then when I logged on to see the status of my case its says due to remand from court of appeals that I will go to front of the line, but it will 16-29 months before I receive final decision. I first applied in 2009 after my last tour in afghanistan, due to the va being the way it is I just stopped messing with it, unitl i got invited to a wounded warrior trip and some very helpful men there told me i was stupid for not pushing it, they used other vulgar terms I will not say on here. Any guidance would be helpful or if anyone has been down this road let me know. Thank You.
  8. Sorry for not being active. There really wasn't anything going on with my Remand until June 29, 2020. I have three issues on Remand; SC for Post Thoracotomy Syndrome including chest wall defect and damage to intercostal nerve, increase bronchial asthma higher than 10% with a EED prior to April 2017 and TDIU. I'd logged in to va.gov last Monday and saw that one of the issues; SC for the Collapsed Lungs was Granted. The other two issues are still open. So, I'm now reading all of the prior cases to try and determine what kind of Rating they are going to assign. The increase for Asthma should be easy; their Ratings Chart calls for at least 30% if function is at a lower percentage or Veteran is using daily cortico steroid inhalers. I have Spiriva and Symbicort every day. The IU is the tricky one. As we all know, you must have at least one issue at 60% or a combination of issues that total at least 70% with one issue at least 40%. Even if the Veteran meets these criteria, IU is still subjective and not a given. I'm going to predict a Rating of 40% or 50% for the Post-thoracotomy plus an increase from 0% to 10% for the scars, 30% for Asthma EED Aug 2014 and TDIU. The VA being what it is, could just lowball me as well. There's just no way to figure them out. If anyone wants to see my Remand and/or the C&P Exam from Dec 2019, just let me know and I will post redacted copies. For all of you who are Legacy, it seems as though 6 months is the average to get your Legacy Appeal Certified to the BVA and then 6 months on average for the VA to work on the Remand. Good luck.
  9. Well folks, I finally crossed the goal line that I have been moving the ball toward since I started this adventure in 2010. A few days ago, I saw all kinds of crazy activity on eBenefits and VA.gov as I went to check on my slow shuffle in the BVA line. I had already had my hearing and had several claims granted, and was waiting for the VA to move forward on the granted conditions, or see if they were were going to handle the remaining two remanded conditions that didn't amount to much anyway. I was sitting back with something like 33,000 claims still ahead of me in the slow march, so I was surprised to see an attorney fee determination claim pop up out of nowhere. I called my attorney and left a message with his office. He called me back a couple of days later excited and says that it looks like I'm about to join the Chapter 35 Club and that they will be retro'ing my EED back to my original claim dates. He said to watch for the mail, and as usual to never trust eBenefits, which I don't, but I still do go to, which I know I shouldn't, but I do. Y'all know what I mean. Anyway, a couple of days later, I get a nice retro in my account, and see that eBenefits is showing 100%, and the letter generator shows the same with the famous language of permanent and total with no future exams scheduled included in the letter. I noticed all of the BVA granted conditions were showing as service connected, except for one, so I'm assuming they are still working on that little one. Also the two remanded conditions have not been decided yet either. One called for a records review in the BVA remand decision and the other for a C&P, so since we now live in a COVID-19 world, who knows how that will work out? So anyway, I'm sitting and waiting on the one granted remaining and two remanded, but everything online shows green lights. I did notice that there is are now two "new" claims open in my eBenefits, one still for the attorney fee determination and one for a "STR-Medical", and when I go to it, it says the claim is a regulatory and procedural review. I'm hoping that some of y'all know what that means. I know that nothing is super "official" until I get the big brown envelope, or white, or brown and white....whatever the VA has in stock at the time, but it is a relief to finally be near the end of the tunnel that started with a VONAPP submission to the VA. Yeah, I said it...VONAPP......the claims are that old. I know I've said it before, but I will say it again. I joined this site back in 2012, and it has provided a wealth of knowledge, counseling and peace of mind, and also served as a place to ventilate. I couldn't have made it without the help of you folks. I also have to say that Asknod's e-book on Amazon saved me tons of trouble in the beginning, and it as handy as a pocket on a shirt as you navigate through the process. Thanks to all of you, and I wish you peace, good health and happiness. I'll be back and forth on here still to check in, and maybe give some advice or get some advice. Thank you all for your service, both in the military and now. God bless each and every one of you. Mark
  10. Just found out today that Huntington WV RO has my Remand. This is good news. I was hoping to avoid having my Remand going back to Philly. Anyway, Huntington has already requested a C&P Exam. I'm going Dec 13th. Pretty quick. Huntington did my hearing loss and tinnitus claim. Claim filed Jul 2019 and Granted Oct 2019. They seem to be quite efficient. Now let's get to the exam; they want another PFT (pulmonary function test) and then a medical exam. Here's the weird part; the medical exam may not be a Doc. They told me his first name. So, my Lawyer wants me to load up my paperwork and bring it with me. Every time that I read and reread the Remand Order, it clearly sets a very high bar for the VBA. For my case, it is a minor victory because the Judge ordered that the previous denial be reversed and the claim reopened. The most important part about this whole process is the amount of research that I had done. The Judge cited in his Order an article that I had sent to the Board about injuries that occur when a chest tube is inserted. Also, the Medical articles that I had sent in about Dyspnea and not being able to take a deep breath. It is so crucial that we get a copy of our C-File and educate ourselves about the process and what we are claiming. The idea that I had sought out a Medical Opinion on my own, on my dime with my own Pulmonologist, may get me to the finish line with a full Grant. Even if you have a Lawyer like me or a VSO; leave no stone unturned. Do your own research and leg work. I have all of the Federal Codes and all of Ratings criteria. Never stop. Never give up. I will let you all know the outcome of my Remand. Ray
  11. 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.
  12. Here is my TBI exam that was ordered in a remand from the BVA. Now I will sit and wait for the decision to be made. Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) Disability Benefits Questionnaire * Internal VA or DoD Use Only* Name of patient/Veteran: England, Larry Adam Indicate method used to obtain medical information to complete this document: [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? [ ] Yes[X] No If no, check all records reviewed: [X] Veterans Health Administration medical records (VA treatment records) [X] Other: VA rating documents as this is a review tbi SECTION I: Diagnosis and medical history ---------------------------------------- 1. Diagnosis ------------ Does the Veteran now have or has he/she ever had a traumatic brain injury (TBI) or any residuals of a TBI? [X] Yes [ ] No [X] Traumatic brain injury (TBI) ICD code: 000 Date of diagnosis: 3/2005 [X] Other diagnosed residuals attributable to TBI, specify: Other diagnosis #1: headaches ICD code: 000 Date of diagnosis: 2005 2. Medical history ------------------ Describe the history (including onset and course) of the Veteran's TBI and residuals attributable to TBI (brief summary): from neuropsych hx 2012: According to medical records intake note from 2nd Medical Group, Barksdale AFB, LA, on 5 MAR 2005, "25-year-old male hit right side of head near temple while cleaning pool on base. Patient hit side of concrete pool. + blurred vision, patient unsure if LOC, + neck and shoulder soreness, - EtOH, + headache at the moment with nausea." Subsequent evaluation that same day by physician revealed: "Mr. England was noted to be in no acute distress, laughing, smiling, alert and oriented x 3, cranial nerves grossly intact, strength 5 x 5." He was diagnosed with a minor head trauma and ordered to return on 7 March 05 for f/u eval prior to being returned to duty. A subsequent medical technician note from 7 March 2005 indicates "patient here for f/ head injury f/u Patient states he's very much better. Still has occ. HA." The subsequent physician note of that same day stated: "?not any worse than any other ou headache. RTD, f/u prn." He was discharged to follow up as needed. There are no other medical records pertaining to this injury. He reported no cognitive difficulties or other residual effects at the time. He also reported an episode of brief loss of consciousness from a MVA during the 9th grade. A CT of the head on MAR 20, 2009 revealed: Study was performed with intravenous contrast. The brain is of normal attenuation. The ventricular system is midline and symmetric. There is no edema or normal enhancement. The globes and orbits appear normal. Impression: Normal brain. rated by neuropsychologist Dr Hughes on 2/8/12 1 memory: mild c/o memory loss without objective findings on testing 2 judgment: normal 3 social interaction: routinely appropriate but with multiple firings from jobs 4 orientation: normal 5 Motor: normal 6 visual-spacial:normal 7 subjective: c/o 3 or more symptoms that mildly affect work or social interactions 8 neurobehavioral: one or more that frequently interfere with work 9 communication: normal 10 Consciousness: normal In summary, based upon this interview, history, and testing, it is clear that the veteran manifests normal organic cognitive capacities but that he has significant emotional/motivational/behavioral difficulties. He likely suffered a mild concussion when he hit his head on the side of the pool; but organic cognitive factors do NOT appear to be involved in a current clinical picture. Indeed, psychiatric factors seem to play an exacerbating role in his symptom picture and are likely responsible for the veteran's reported cognitive and functional difficulties. Diagnostic Impression: Axis I 311 Depression NOS 309.81 PTSD Axis II: 301.83 Borderline personality disorder Axis III: Please see medical record Axis IV: History of volatile interpersonal relationships,lack of coping skills, marital and family problems, unemployment, financial problems Axis V: GAF = 49 Finally, in my professional opinion, the veteran is able to manage his own financial affairs for VA purposes. Please contact me if you have questions concerning this evaluation. states hit head on empty bottom of pool while cleaning it in the service, felt nauseous and vision off, and had headaches without loss of conciousness SECTION II: Assessment of facets of TBI-related cognitive impairment and subjective symptoms of TBI ----------------------------------------------------------------------------- 1. Memory, attention, concentration, executive functions -------------------------------------------------------- [X] A complaint of mild memory loss (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items), attention, concentration, or executive functions, but without objective evidence on testing If the Veteran has complaints of impairment of memory, attention, concentration or executive functions, describe (brief summary): see previous testing and note that this is as least likely as not related to ptsd, he recalled three things, and oriented to day and year 2. Judgment ----------- [X] Normal 3. Social interaction --------------------- [X] Social interaction is occasionally inappropriate If the Veteran's social interaction is not routinely appropriate, describe (brief summary): he feels uncomfortable in group settings and doesn't leave house much not related to tbi 4. Orientation -------------- [X] Always oriented to person, time, place, and situation 5. Motor activity (with intact motor and sensory system) -------------------------------------------------------- [X] Motor activity is normal most of the time, but mildly slowed at times due to apraxia (inability to perform previously learned motor activities, despite normal motor function) If the Veteran has any abnormal motor activity, describe (brief summary): states baseball not as easy as was in past. However had mild tbi and is not as least as likely related to tbi 6. Visual spatial orientation ----------------------------- [X] Normal 7. Subjective symptoms ---------------------- [X] Three or more subjective symptoms that moderately interfere with work; instrumental activities of daily living; or work, family or other close relationships. Examples of findings that might be seen at this level of impairment are: marked fatigability, blurred or double vision, headaches requiring rest periods during most days If the Veteran has subjective symptoms, describe (brief summary): veteran states occ dizzy, ringing in ears for which is sc, headaches,states completely stop from working. only symptom related to tbi is headaches see headaches exam included 8. Neurobehavioral effects -------------------------- [X] One or more neurobehavioral effects that interfere with or preclude workplace interaction, social interaction, or both on most days or that occasionally require supervision for safety of self or others If the Veteran has any neurobehavioral effects, describe (brief summary): veteran states unable to work due to social interaction difficults which have precluded work for 3 years and he has ssdi for this but please see headache rating exam included 9. Communication ---------------- [X] Able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language. 10. Consciousness ----------------- [X] Normal SECTION III: Additional residuals, other findings, diagnostic testing, functional impact and remarks ----------------------------------------------------------------------------- 1. Residuals ------------ Does the Veteran have any subjective symptoms or any mental, physical or neurological conditions or residuals attributable to a TBI (such as migraine headaches or Meniere's disease)? [X] Yes [ ] No [X] Hearing loss and/or tinnitus [X] Erectile dysfunction [X] Headaches, including Migraine headaches [X] Mental disorder (including emotional, behavioral, or cognitive) [X] Other, describe: tinnitus see previous rating exam, mental heal issues see previous rating exams, erectile dysfunction not related to tbi 2. Other pertinent physical findings, scars, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------------- a. 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? [X] Yes [ ] No b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms? [X] Yes [ ] No If yes, describe (brief summary): cn grossly intact, dtrs = and 2+ bilateral, sensation and movement intact, able to heel and toe stand, rhomberg neg, moves all extemities, sensation intact upper and lower extremities. no dysdiadokinisis 3. Diagnostic testing --------------------- a. Has neuropsychological testing been performed? [X] Yes [ ] No If yes, provide date: 2/8/12 Results: I. Memory, attention, concentration, executive functions The veteran has a complaint of mild memory loss (such as having difficulty following a conversation, recalling recent conversations, remembering names of new acquaintances, or finding words, or often misplacing items, attention, concentration, or executive functions, but without objective evidence on testing. II. Judgment The veteran exhibits normal organic judgment capacity but mildly impaired judgment overall as a result of emotional dysfunction. "I get impulsive without worrying about the consequences. I just react to stimuli." For some decision making, he is occasionally unwilling to identify, understand or weigh the alternatives, understand the consequences of choices, or make a reasonable decision due to emotional reasoning. Concerning his judgment, the veteran stated: "On a stable day I have good judgment but on a depressed day I don't. I get impulsive without worrying about the consequences. I just react to stimuli." III. Social interaction The veteran stated his social interaction is routinely appropriate "because I stay reserved." However, he also notes inappropriate reaction to authority resulting in multiple firings from jobs. IV. Orientation The veteran is always oriented to person, time, place, and situation. V. Motor Activity (with intact motor and sensory system) The veteran's motor activity is normal. VI. Visual-Spatial Orientation The veteran's visual-spatial orientation is normal. VII. Subjective symptoms The veteran complains of 3 or more subjective (emotional or pain related) symptoms that mildly interfere with work; instrumental activities of daily living; or work, family, or other close relationships. Examples of findings that might be seen at this level of impairment or: Intermittent dizziness, daily mild-to-moderate headaches, and frequent insomnia. VIII. Neurobehavioral effects The veteran complains of one or more emotional/behavioral symptoms that frequently interfere with work place interaction, social interaction, or both but did not preclude them. "I have had over 15 jobs since I left the military; and I lost them for arguing with coworkers and customers. I'm on Social Security disability for bipolar disorder, PTSD, and depression since May of 2010." IX. Communication The veteran is able to communicate by spoken and written language (expressive communication), and to comprehend spoken and written language. X. Consciousness The veteran's level of consciousness is normal. In summary, based upon this interview, history, and testing, it is clear that the veteran manifests normal organic cognitive capacities but that he has significant emotional/motivational/behavioral difficulties. He likely suffered a mild concussion when he hit his head on the side of the pool; but organic cognitive factors do NOT appear to be involved in a current clinical picture. Indeed, psychiatric factors seem to play an exacerbating role in his symptom picture and are likely responsible for the veteran's reported cognitive and functional difficulties. Diagnostic Impression: Axis I 311 Depression NOS 309.81 PTSD Axis II: 301.83 Borderline personality disorder Axis III: Please see medical record Axis IV: History of volatile interpersonal relationships,lack of coping skills, marital and family problems, unemployment, financial problems Axis V: GAF = 49 Finally, in my professional opinion, the veteran is able to manage his own financial affairs for VA purposes. Please contact me if you have questions concerning this evaluation. b. Have diagnostic imaging studies or other diagnostic procedures been performed? [X] Yes [ ] No If yes, check all that apply: [X] Computed tomography (CT) Date: 3/20/2009 Results: normal c. Has laboratory testing been performed? [ ] Yes [X] No d. Are there any other significant diagnostic test findings and/or results? [ ] Yes [X] No 4. Functional impact -------------------- Do any of the Veteran's residual conditions attributable to a traumatic brain injury impact his or her ability to work? [X] Yes [ ] No If yes, describe impact of each of the Veteran's residual conditions attributable to a traumatic brain injury, providing one or more examples: see included headache exam 5. Remarks, if any: ------------------- none **************************************************************************** Headaches (including Migraine Headaches) Disability Benefits Questionnaire Name of patient/Veteran: Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? [ ] Yes [X] No If yes, list any records that were reviewed but were not included in the If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [X] Other: VA rating documents as this is a review tbi 1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a headache condition? [X] Yes [ ] No [X] Other (specify type of headache): unknown type ICD code: 000 Date of diagnosis: 2005 2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's headache conditions (brief summary): developed headaches at time of tbi in 2005. Had neurologic consult 3/2009 and diagnosed with headaches of unknown type inially treated with ibuprofen b. Does the Veteran's treatment plan include taking medication for the diagnosed condition? [X] Yes [ ] No If yes, describe treatment (list only those medications used for the diagnosed condition): ibuprofen 3. Symptoms ----------- a. Does the Veteran experience headache pain? [X] Yes [ ] No [X] Pulsating or throbbing head pain [X] Pain on both sides of the head [X] Pain worsens with physical activity [X] Other, describe: stress worsens and tinitis increases during headache b. Does the Veteran experience non-headache symptoms associated with headaches? (including symptoms associated with an aura prior to headache pain) [X] Yes [ ] No [X] Nausea [X] Vomiting [X] Sensitivity to light [X] Sensitivity to sound [X] Changes in vision (such as scotoma, flashes of light, tunnel vision) [X] Sensory changes (such as feeling of pins and needles in extremities) [X] Other, describe: headaches vary intensity, frontal headaches on 1-10 7-8 and severe posterior headache 8-9 c. Indicate duration of typical head pain [X] Less than 1 day d. Indicate location of typical head pain [X] Both sides of head [X] Other, describe: both sides of head and back of head 4. Prostrating attacks of headache pain --------------------------------------- a. Migraine / Non-Migraine- Does the Veteran have characteristic prostrating attacks of migraine / non-migraine headache pain? [X] Yes [ ] No If yes, indicate frequency, on average, of prostrating attacks over the last several months: [X] Once every month b. Does the veteran have very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadatability? [X] Yes [ ] No 5. Other pertinent physical findings, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------------- a. 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 b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs and/or symptoms related to any ENGLAND, LARRY ADAM CONFIDENTIAL Page 16 of 17conditions listed in the Diagnosis section above? [X] Yes [ ] No If yes, describe (brief summary): see included tbi physical 6. Diagnostic testing --------------------- 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): ct normal see attached tbi exam 7. Functional impact -------------------- Does the Veteran's headache condition impact his or her ability to work? [X] Yes [ ] No If yes, describe the impact of the Veteran's headache condition, providing one or more examples: veteran states headaches cause him to be unable to function in a job seting due to need for no sensory input during headaches. He states that he has up 5 severe headaches a week lasting up to 2 hours that would prevent him from having full or part time work. 8. Remarks, if any: ------------------- none
  13. Question about the rating and decision process on remands, and my apologies for any inconvenience trying to understand the remand process. When the remand is sent from the BVA to the RO with specific instructions, can the RO make a favorable decision and give a rating on a previously denied claim (remand) if they see fit upon review of the case and file?
  14. Good day to you all, I have a few questions concerning the appeal process as it concerns the decision, BVA, RO, and claim date that hopefully you all can chime in to help clarify. 1. When the BVA letter indicates a "complete grant" for sought benefits, does that mean award the maximum rating allowed? or just award and process? 2. Story Line - In my case, the BVA stated in my letter a few remands (for nasal related issues) and a "complete grant" for sleep apnea (Received the letter 5 days ago). The letter indicated my claim was through a credible lay statement (which described my condition while in service), DBQ from the sleep specialist (who indicated my symptoms started while in service from a nasal injury), and a sleep apnea study performed by VA post service in 2009. The letter indicated consistency of my condition. My claim for sleep apnea was entered in 2013. My question is in regards to the effective date. 2a. What is meant by the date entitlement arose? The va.gov website states "an effective date for service-connection for a disability that is directly linked to an injury or disease that was incurred or aggravated by military service is the date VA receives a claim or the date entitlement arose, whichever is later".. 2b. What is meant by whichever is later? For instance, if these two dates (2/4/2016 for the date Va receives the claim and 1/5/2014 for the date entitlement arose) are in question, which is meant by later... the 2016 date or the 2014 date? 3. If the lay is credible and is indicating the time the condition was first noticed, and the medical evidence through the years also backs up my claim as credible without being a secondary condition, is it possible for the entitlement date to be initialized by back to my date of separation? or would it be the date of the 2009 exam? or would it be when the claim was entered in 2013. 4. Do remands put you in a bad situation or is it for our advantage? As of now I am in Preparation for Decision for the granted condition and the remanded appeals are currently in the works which date back to 2008. I am just trying to get an idea of what to expect prior to a decision. Thank you for your responses in advance.
  15. Hi, I am currently rated at 20% for my shoulder. I went in for a CP exam recently and these were the results. This is a remand exam from the BVA. Am I looking at a decrease to 10 or even zero? I am not bending my shoulder so it may dislocate for any of these people or any examination and I think it may have hurt me. If you could take a look I'd appreciate it. Thanks for your time! Shoulder and Arm Conditions Disability Benefits Questionnaire Name of patient/Veteran: Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No 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 1. Diagnosis ------------ a. List the claimed condition(s) that pertain to this DBQ: Strain with radicular sx b. Select diagnoses associated with the claimed condition(s) (check all that apply): [X] Shoulder strain Side affected: [ ] Right [X] Left [ ] Both ICD Code: S46.019A Date of diagnosis: Left UNK- S/C c. Comments, if any: No response provided d. Was an opinion requested about this condition? [ ] Yes [X] No [ ] N/A 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's shoulder or arm condition (brief summary): *** Note - Veteran was notified that this evaluation is for Compensation and Pension purposes only and he/she is to return to his/her treating clinician for regular medical care =========================================================================== ===== Veteran served in the US Army as a Cav Scout E-5 from 1988-1996 - reports that he is s/c for L shoulder strain with radicular sx. Reports current condition includes the following sx- L shoulder Pain- intermittent Daily lasting 10 minutes to hours 3-7/10 dull to sharp depending on activity Dislocations - Last occurred was 3 years ago - has popping and clicking, sensation of weakness Reports constant L lateral 1st metatcarpal numbness Has additional numbness from axillary region to the Lateral aspect of the L 1st metacarpal- occurs 3-5 x weekly lasting 10 minutes to 2 hours Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work Current Tx Type Duration Response to Medications 1. Medications OTC ASA, Tylenol, Advil as directed PRN- fair results 2. Denies Physical therapy Occupation since discharge- HVAC mechanic now on SSDI since 2013 2. DOMINANT HAND: right 3. POSTURE & GAIT: straight; gait stable, smooth, symmetric b. Dominant hand: [X] Right [ ] Left [ ] Ambidextrous c. Does the Veteran report flare-ups of the shoulder or arm? [X] Yes [ ] No If yes, document the Veteran's description of the flare-ups in his or her own words: L shoulder Pain- intermittent Daily lasting 10 minutes to hours 3-7/10 dull to sharp depending on activity Dislocations - Last occurred was 3 years ago - has popping and clicking, sensation of weakness Reports constant L lateral 1st metatcarpal numbness Has additional numbness from axillary region to the Lateral aspect of the L 1st metacarpal- occurs 3-5 x weekly lasting 10 minutes to 2 hours Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work 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. Veteran would have additional limitations in ROM but unable to quantify the degree of ROM loss as it would vary due to severity of pain , weakness, fatigability and overuse. d. Does the Veteran report having any functional loss or functional impairment of the joint or extremity being evaluated on this DBQ (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: L shoulder Pain- intermittent Daily lasting 10 minutes to hours 3-7/10 dull to sharp depending on activity Dislocations - Last occurred was 3 years ago - has popping and clicking, sensation of weakness Reports constant L lateral 1st metatcarpal numbness Has additional numbness from axillary region to the Lateral aspect of the L 1st metacarpal- occurs 3-5 x weekly lasting 10 minutes to 2 hours Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work 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. Veteran would have additional limitations in ROM but unable to quantify the degree of ROM loss as it would vary due to severity of pain , weakness, fatigability and overuse. 3. Range of motion (ROM) and functional limitation -------------------------------------------------- a. Initial range of motion Left Shoulder ------------- [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 180): 0 to 130 degrees Abduction (0 to 180): 0 to 150 degrees External rotation (0 to 90): 0 to 90 degrees Internal rotation (0 to 90): 0 to 90 degrees If ROM is outside of normal range, but is normal for the Veteran (for reasons other than a shoulder condition, such as age, body habitus, neurologic disease), please describe: Veteran refuses to move L shoulder beyond stated range due to fear of pain and dislocation- poor effort If abnormal, does the range of motion itself contribute to functional loss? [X] Yes (please explain) [ ] No If yes, please explain: limits ROM Description of pain (select best response): Pain noted on exam and causes functional loss If noted on exam, which ROM exhibited pain (select all that apply)? Flexion, Abduction Is there evidence of pain with weight bearing? [ ] Yes [X] No Is there objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue? [ ] Yes [X] No Is there objective evidence of crepitus? [ ] Yes [X] No b. Observed repetitive use Left Shoulder ------ ------- Is the Veteran able to perform repetitive use testing with at least three repetitions? [X] Yes [ ] No Is there additional functional loss or range of motion after three repetitions? [ ] Yes [X] No c. Repeated use over time Left Shoulder ------------- Is the Veteran being examined immediately after repetitive use over time? [X] Yes [ ] No 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: 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. Veteran would have additional limitations in ROM but unable to quantify the degree of ROM loss as it would vary due to severity of pain , weakness, fatigability and overuse. d. Flare-ups Left Shoulder ------------- Is the exam being conducted during a flare-up? [ ] Yes [X] No If the examination is not being conducted during a flare-up: [ ] The examination is medically consistent with the Veteran's statements describing functional loss during flare-ups. [ ] The examination is medically inconsistent with the Veteran's statements describing functional loss during flare-ups. Please explain. [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: 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. Veteran would have additional limitations in ROM but unable to quantify the degree of ROM loss as it would vary due to severity of pain , weakness, fatigability and overuse. e. Additional factors contributing to disability Left Shoulder ------------- 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., Other (please describe) Please describe additional contributing factors of disability: Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work 4. Muscle strength testing -------------------------- a. Muscle strength - 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 Right Shoulder: Rate Strength: Forward flexion: 5/5 Abduction: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No Left Shoulder: Rate Strength: Forward flexion: 5/5 Abduction: 5/5 Is there a reduction in muscle strength? [ ] Yes [X] No b. Does the Veteran have muscle atrophy? [ ] Yes [X] No c. Comments, if any: No response provided 5. Ankylosis ------------ Complete this section if the Veteran has ankylosis of scapulohumeral (glenohumeral) articulation (shoulder joint) (i.e., the scapula and humerus move as one piece). a. Indicate severity of ankylosis and side affected (check all that apply): Left side: [ ] Ankylosis in abduction up to 60 degrees; can reach mouth and head (Favorable ankylosis) [ ] Ankylosis in abduction between favorable and unfavorable (Intermediate ankylosis) [ ] Ankylosis in abduction at 25 degrees or less from side (Unfavorable ankylosis) [X] No ankylosis b. Comments, if any: No response provided 6. Rotator cuff conditions -------------------------- Is rotator cuff condition suspected? Right Shoulder: [ ] Yes [ ] No Left Shoulder: [X] Yes [ ] No If "Yes" complete the following: Hawkins' Impingement Test (Forward flex the arm to 90 degrees with the elbow bent to 90 degrees. Internally rotate arm. Pain on internal rotation indicates a positive test; may signify rotator cuff tendinopathy or tear.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A Empty-can Test (Abduct arm to 90 degrees and forward flex 30 degrees. Patient turns thumbs down and resists downward force applied by the examiner. Weakness indicates a positive test; may indicate rotator cuff pathology, including supraspinatus tendinopathy or tear.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A External Rotation/ Infraspinatus Strength Test (Patient holds arms at side with elbow flexed 90 degrees. Patient externally rotates against resistance. Weakness indicates a positive test; may be associated with infraspinatus tendinopathy or tear.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A Lift-off Subscapularis Test (Patient internally rotates arm behind lower back, pushes against examiner's hand. Weakness indicates a positive test; may indicate subscapularis tendinopathy or tear.) [X] Positive [ ] Negative [ ] Unable to perform [ ] N/A 7. Shoulder instability, dislocation or labral pathology -------------------------------------------------------- a. Is shoulder instability, dislocation or labral pathology suspected? [X] Yes [ ] No If yes, complete questions 7b - 7d below: b. Is there a history of mechanical symptoms (clicking, catching, etc.)? [X] Yes [ ] No If yes, indicate side affected: [ ] Right [X] Left [ ] Both c. Is there a history of recurrent dislocation (subluxation) of the glenohumeral (scapulohumeral) joint? [X] Yes [ ] No If yes, indicate frequency, severity and side affected (check all that apply): [X] Infrequent episodes [ ] Right [X] Left [ ] Both [X] Guarding of movement only at [ ] Right [X] Left [ ] Both shoulder level d. Crank apprehension and relocation test (with patient supine, abduct patient's arm to 90 degrees and flex elbow 90 degrees. Pain and sense of instability with further external rotation may indicate shoulder instability.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A 8. Clavicle, scapula, acromioclavicular (AC) joint and sternoclavicular joint conditions ------------------------------------------------------------------------------ a. Is a clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition suspected? [X] Yes [ ] No If yes, complete questions 8b, 8d and 8e below: b. Does the Veteran have an AC joint condition or any other impairment of the clavicle or scapula? [ ] Yes [X] No c. Does the clavicle or scapula condition affect range of motion of the shoulder (glenohumeral) joint? No response provided d. Is there tenderness on palpation of the AC joint? [ ] Yes [X] No e. Cross-body adduction test (Passively adduct arm across the patient's body toward the contralateral shoulder. Pain may indicate acromioclavicular joint pathology.) [ ] Positive [X] Negative [ ] Unable to perform [ ] N/A 9. Conditions or impairments of the humerus ------------------------------------------- a. Does the Veteran have loss of head (flail shoulder), nonunion (false flail shoulder), or fibrous union of the humerus? [ ] Yes [X] No b. Does the Veteran have malunion of the humerus with moderate or marked deformity? [ ] Yes [X] No c. Does the humerus condition affect range of motion of the shoulder (glenohumeral) joint? No response provided d. Comments, if any: No response provided 10. Surgical procedures ----------------------- No response provided 11. 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 12. Assistive devices --------------------- a. Does the Veteran use any assistive devices? [ ] 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 13. Remaining effective function of the extremities --------------------------------------------------- Due to the Veteran's shoulder and/or arm conditions, 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., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 14. Diagnostic testing ---------------------- a. Have imaging studies of the shoulder been performed and are the results available? [X] Yes [ ] No If yes, is degenerative or traumatic arthritis documented? [ ] Yes [X] No b. Are there any other significant diagnostic test findings or results? [ ] Yes [X] No c. If any test results are other than normal, indicate relationship of abnormal findings to diagnosed conditions: No response provided 15. Functional impact --------------------- Regardless of the Veteran's current employment status, do the condition(s) listed in the Diagnosis Section impact his or her ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.)? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's shoulder conditions providing one or more examples: Condition impacts Occupation/Recreation/Daily activities- Limits carrying, lifting, pushing, pulling and overhead work 16. Remarks, if any: -------------------- Impression- 1. L shoulder strain with residuals of radicular sx as noted- Veteran refused to move L shoulder beyond stated range due to fear of pain and dislocation
  16. 10/22/2014 Decision & Claims File DispatchYour case has been received at BVA, and BVA has mailed your decision to you (and your representative, if any) and will be returning your claims file to the Regional Office. Please note that transit times vary, and there may be some lag time between when BVA forwards your claims file to its appropriate location and when that location receives it.09/04/2014... when i call the 827-1000 number they tell me they cant access my remand,, So how do i get information on the status
  17. Hello, I'll introduce myself with an email I wrote to the VA on AUG 15 My name is Michael Noce and I am an Army veteran of 2 deployments diagnosed with PTSD due to military service. My claim was originally filed in 2005. It was denied and appealed in 2007 and 2009. I also had a travel board hearing. A compensation and pension exam was scheduled but could not be kept due to Hurricane Sandy and transportation issues in 2012. I was given the oppurtunity for a 2nd hearing because the original travel board judge retired. A video hearing was conducted in December 2012 with BVA Judge Susan J. Janec in Philadelphia. I was told a new compensation & pension exam would be scheduled. 7 months later in July 2013, I had an eviction letter forwarded to BVA for a motion to advance my claim due to financial hardship. Almost 2 months later I still haven't received a response other than my claim is still being reviewed, and that is why I'm writing this email to you, Mr. Eric K. Shinseki, NJ Congressman Rob Andrews, and if needed Philadelphia Channel 6 Action News. Like countless others, a chance at having a normal life was sacrificed when I joined the Army. The experience has left me displaced and homeless with a 6 year old boy that I can barely provide for. My family has suffered because of this PTSD. Bouts of suicidal depression, violent outbursts, alcohol and drug abuse, hospitalizations, 2 DUI charges, rehab, excessive absence from work to include LWOP and AWOL, suspensions from work, disrupted family gatherings, no social life, paranoid delusions leaving me unable to leave the bed or house for weeks at a time, and my own mother having to resuscitate me from a drug and alcohol overdose as I tried to ease the pain of my condition. I am asking for my claim of 8 years to please be advanced and expedited so I can have a place to live and provide for my 6 year old son in a country that I proudly and honorably served. Thank you.
  18. I received a letter from BVA which states the following appeals dated 2009 have been remanded back to St. Petersburg Regional office: increase in rating for fibromyalgia ......currently 20%, increase in rating for IBS.....currently 10%. Also, in March 2013 I received service connection for MDD secondary to fibromyalgia....30% . I filed a NOD on the MDD rating. I already had the following appeals at BVA level since 2008 and they went before the VLJ on April 2013 PTSD, Migraines and Bronchitis.. Instead of providing a decision on the appeals which were already at BVA level...they have been remanded back to St. Pete regional office along with appeals for increase in rating ....fibromyalgia, IBS and MDD. Wording on BVA paperwork states:Accordingly, the case is REMANDED for the following action: Schedule the veteran for a hearing before a Veterans Law Judge by videoconference at the St. Petersburg Regional Office. My question is why weren't the appeals that were already at BVA level not addressed?
  19. My BVA claim was remanded to my regional office in St. Pete, Florida. There, they denied my claim for Fibro(Diagnosed and confirm) and High blood pressure (Diagnosed and confirm) even though, I am a gulf war vet that served in the Asian pacific theater (Iraq) as well as being diagnosed with HBP within one year of leaving service and have been on medication since then. Anyhow, on August 31 my claim arrived at the DAV up in D.C. It has been there now for 3 months and those lazy bastards have yet to get to it. I called they stated that they have between 30 to 90 days to get to it. And no doubt they are taking the FULL 90 days. I have questions for those who have been in my same situation 1. How long did it take after they got to your claim was it completed to be sent to the Judge? 6 months, 10 months, 4 years? 2. How long after that did it take the judge to complete your claim? 1 year, 2 years, or 4 years. After 10 years of dealing with the VA my patience is running thin. Thank you in advance.
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