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  1. Hello, I have more questions than I can find answers so I thought I would create a post to see if any of these can be answered? I apologize for the length. I have read, read, and read some more on this board for years and I very much appreciate any assistance that can be offered. I will also be donating to support this all-important forum once I can get through this snail-pace of a process! I separated from service almost 6 years ago after 14 years in. I am currently rated at 30% disabled as I received 10% each for tinnitus, hypertension and a metatarsal fracture that occurred in service. I also received 0% connection for chronic thoracic & lumbar strain due to morbid obesity (?!). This grant to service connection dates back to the day after I got out of the service. I am not "morbidly obese" and this really bothers me that they have this described as such. I mean, why would they service connect if it's due to being overweight?? Makes no sense to me. Are they inferring that they are taking responsibility for being so called "obese" as well? We all know that you get kicked out of service if you are outside the physical readiness/weight requirements ... very frustrating and even insulting. The C&P examiner told me that he didn't have time to evaluate everything I had claimed so he didn't even look at some of my claimed issues physically, but I was still denied by the VA regardless as no service connection for some of these unexamined claims. Anyways, the C&P doctor told me to basically push through my discomfort (discomfort was evident) when conducting the range of motion part of my back exam, and he even placed his hand on my back when telling me to push further. I did not know at the time that he was not looking out for my best interests...so my range of motion came back within normal limits. I feel that this was wrong on his part but I did not know at the time, and I am afraid if I did complain about this now that I could risk losing my service connection? My back is in very poor condition from the service. In fact, I was on light duty when I separated because of a back injury I sustained a few months prior to my separation. I do have copies of my STR's and I have numerous complaints of back pain throughout my many years in that nothing was done about as they were just complaints noted, and I do not have the STR from the back injury. I was sent to medical and they shot something into my back and I immediately felt relief but my back has not been the same ever since. My back issues are causing me an excessive amount of lost time at my current job. I just went to the VA at the end of last month as a walk-in because the pain was so much and they took x-rays and named FIVE things wrong with just my lower back. I am now waiting for the VA to send these x-rays to my civilian doctor to have a comprehensive MRI done at the local (non-VA) hospital and then I will go forward from there in deciding how to approach this. The VA doctor "just" said I have facet joint arthritis, but VA radiology noted five things wrong? My first question is how should I proceed with adding these conditions and/or getting an increase from 0%? Does anyone know what "chronic thoracic & lumbar strain" service connection covers? Is it just strains or does it encompass the whole lower and middle back and all associated conditions of these areas? My x-rays from the VA in August of this year report "superior plate wedging at T12, this is age-indeterminate and correlation with physical exam for symptoms of point tenderness would be beneficial (again, I was a walk-in at my local VA clinic that day and the doctor didn't have time to see me...). Multilevel anterior endplate spurring throughout the lumbar spine. Lower lumbar predominant facet anthropathy. Bony neural foraminal narrowing at L5-S1. Mild Vascular Calcification". This was all through x-rays so I am sure an MRI will show more...which I will have done soon. Should I even complain about this C&P doctor at this point almost 6 years later or would I risk losing the service connection? I need to know what they have on my back at the VA that caused the service connection, I do know this. I do not have a copy of the record of my back injury from right before I got out and I am thinking/hoping that they do, but I will not know until I get the C-File. I need my C-File (I know, I should have requested it long ago...I am learning). My main question is, can I request a copy of my C-File while I have an open appeal (on other first year out of service claims -- open since 11/2019) and I also just put in for two new claims at the beginning of this month that are moving fairly quickly. I have heard that requesting your C-File can cause delays and possibly affect open claims and appeals you have on-going...and I of course do not want to cause any kind of a delay. Since my separation I have only filed my initial first year claims and I filed appeal on some of those denials. I have waited all of these years and not done anything more because I was under the presumption that you cannot file any new claims until the appeal is processed and closed. I did though just file two new claims this month once I was informed that presumption was wrong. Lastly, does anyone have any recommendations in how I should proceed with all of these new back findings (and also what becomes of the MRI in a couple of weeks) with regard to my already service connected chronic thoracic & lumbar strain -- due to morbid obesity(!!). New and material evidence to reopen? New individual/separate claims? File for an increase in rating? Secondary's? Or, should I wait until I have my C-File to see what they are basing the back service connection off of? Also, shouldn't thoracic and lumbar be two different conditions/disabilities? Sorry this is an overwhelming amount of information; I am so overwhelmed and discouraged by this whole process...and pushing through constant pain to boot. Any suggestions would be greatly appreciated! Thank you!
  2. Hello everyone, I have a question on whether I should submit, or even mention, certain paperwork for my claim. I have recently been awarded Social Security Disability (SSDI) based on my service-connected back condition. As I'm pretty sure that would help me with my VA TDIU claim, there were things the two examining doctors put in their reports that are incorrect and could go against me with my other secondary claims. Therein lies the issue. For example; Social Security (SS) sent me to a doctor to examine my back, and a psychologist for depression and PTSD. The psychologist may have spent 30 minutes with me and put in his report to SS that I had a "mild" mood disorder due to chronic pain and that my mental health condition is "fair." This is something that my wife and daughter strongly disagrees with since they have to put up with me every day. The therapist I talk to every week diagnosed me with major depression and PTSD. MY QUESTION: Since I will be claiming depression and PTSD as secondary claims, should I even submit this psychologists report to the VA? Should I even mention this in my veterans statement? Will the VA have access to my SS file whether I mention it or not? Or if there is a chance the VA will find this report in their search, should I be proactive and rebuke the information in my veteran statement? The report from the doctor that examined my back was full of misinformation. He stated I began having mild back pain in 1975 to 1980. When in fact my back pain started in the mid-1980s while in the military. This is well-documented. He also stated that I have had hypertension for approximately 3 to 4 years and is usually well controlled on medication. I have had hypertension documented for 20 years, and it is NOT well controlled on medication. It often spikes. In fact, my blood pressure at his office visit, documented in his report, was 170/88. This doctor also stated in his report that I have had sleep apnea 5 years, when in fact I have had sleep apnea documented for 18 years. I'm not sure where he got his information, but it certainly didn't come from me. SECOND QUESTION: Even though his report on my back obviously helped me get SS disability, will it hinder me on my hypertension and sleep apnea secondary VA claims? My medical records can definitely back up the dates when these issues started, but am just wondering if I should submit his report and even mention my SSDI approval in my veteran's statement for my TDIU claim? I know this was a little long and I appreciate anybody that took the time to read it. I'm not sure how to proceed and I really appreciate any replies. Thank you!
  3. Does anyone know if bruxism or TMJ can be SC secondary to sleep apnea? If so, how do I do that? Would a sleep doctor or dentist need to write a letter?
  4. I can google things such as "secondary to PTSD" but I was wondering if there is an exhaustive list of (primary) service connected disabilities that vets have used to get secondary service connection.
  5. Hello All, If a secondary condition was awarded on the same original effective date of the primary condition, would the secondary condition also receive an earlier effective date, if one is award for the primary condition. Example: Initially awarded shoulder rating as the primary condition and rotator cuff as the secondary condition with the same effective date (2012). And in 2021 BVA granted a revision of the 2012 rating decision for an earlier effective date. Will the secondary condition also receive the earlier effective date? Thank you.. Add
  6. Hello all, I'm hoping to get some advice from members in this forum that may have been in my shoes, or knows someone who has been. I have been retired 22 years now after 20 years of service. I currently have a VA rating of 70% for back issues and headaches. The 70% rating breaks down to 40% for lower back, 20% for upper, and 10% for headaches. It's been nearly 20 years since I've been back to the VA for a rating increase. My lower back is worse now, and about 6 years ago I ruptured a disk. I also lost my job this past October because my back issues limit my mobility so much. I plan on going back to the VA around October of this year to try for an increase. I'm waiting until October because that will be the 20 year mark of my VA rating. I have definite trust issues and I don't trust the VA, which is why I've waited so long. I wanted to make sure they couldn't take the rating I have away. I've had ongoing mental issues for quite a while now. Upon doing some research, it seems I have many symptoms of PTSD. My wife and daughter are encouraging me to start seeing a psychologist. I have no problem with that, but one of my questions is: would be a good idea to ask the psychologists office upfront if they would provide a NEXUS letter if they feel I do have PTSD related to my military service? My daughter advises me not to do that and to take the chance that they will supply one. Maybe I'm wrong, but I feel it's better to see a psychologist that I know will supply a letter. I feel a NEXUS letter carries a lot of weight, and it's frustrating when specialists tell you that your condition is likely caused by your military service, but they won't supply a letter to back it up. Another question concerns TDIU. I've been working in the maintenance field my entire life. As stated earlier, I was let go from my job because I could no longer effectively perform the duties due to my very limited mobility. Of course my employer gave me a letter that I was let go because they were "cutting back." I know they were protecting themselves because I was one of the more senior and experienced techs there. In any case, my second question is: should I file for TDIU as well as PTSD at the same time, as well as any secondary issues that I feel may be related? Or should I just file for one or the other? All replies and advice is greatly appreciated. Thanks to all who took the time to read this.
  7. Do I need to file for increases and secondary conditions on two different claims? I could not find any areas to go about this on the ebennifits questionnaire backround: had a stroke during a VA spinal surgery. I have several secondaries due to the stroke.
  8. I've been tdiu for 8 years now (lower lumbar 20,right leg 10 pstd 70, bladder 30) I was undergoing surgery for a service connected issue on my spine. long story short, I had a stroke during the surgery and woke up incontinent, ED, headaches, high blood pressure. I've had to use catheters and pads for years now. I only found out a week ago that it was a stroke that caused these issues. The doctors had no clue what happened and where acting like it was some kind of medical mystery, even though i woke up paralyzed and bleeding internally. After that I was rushed back for emergency surgery. Because of some constant testicular pain my non VA neurologist did an MRI called me in and let me know that I had a stroke at this site. this was just a week ago. It's been 6-7 years since that surgery, I only claimed the bladder at the time not having any idea how to navigate the system and just being completely out of it. What category would this claim fall under? It was a VA surgery that caused all this mess Is it pointless to claim chronic pain because I already have a mental rating? is it malpractice? 1151? thank you for the help
  9. Hello everyone. I am already service-connected for my knees but lately I‘ve been having suicidal ideations due to chronic knee pain. My VA Progress Notes state my chronic knee pain contributes to my depression. Some comments left by the VA psychiatrist: - Currently, his chronic knee pain has flared up significantly and this has contributed to recent worsening of his mood. - He notes increased depression this past month because of increased knee pain. States that it has been making him more depressed and irritable. He hasn't been able to sleep well because he wakes up from pain. - Over the weekend had suicidal ideation activated by knee pain. I just want to know if this is good enough for secondary service-connection or if I need more evidence. Also, I do not wish chronic pain on anyone. My provider scheduled an ortho referral at the end of November. I am also scheduled for CBT to deal with the chronic knee pain. Thank you.
  10. I had bilateral knee replacements. The left knee was service connected at the time and the right one wasn't. The Dr said that they both needed replacing, I tried to claim the right knee as secondary and was denied. What can I do?
  11. This post is in reference to an effective date for Migraine Headaches secondary to a Service-Connected condition. 1. I filed migraine headache claim 2015 or 2016, claim denied. 2. Filed a NOD went to BVA, BVA remanded back to VBA to (Take necessary action to implement the grant of service connection for headaches). 3. VBA assigns 0% rating. 4. I then filed for an increase obtained with an IMO report and DBQ (Thank you, Thank you, Thank you, Dr. Valette!). 5. VA increased Migraine Headaches to 50%, effective date 02/27/2020. My question is, are secondary conditions and their effective dates and appealability, any different than a Service-Connected condition? I'm confused because the BVA made their decision in 2018, the VBA origionally assigned a 0% rating effective 03/11/2014. I do not understand the 02/27/2020 effective date, it seems to be ambiguous and I can't find anything stating why the VBA choose that date... Thanks in advance friends... VA Decision Migraines.pdf
  12. So today I found my claim was approved today for Sleep Apnea secondary for PTSD for 50%. As promised I have attached all the documents I sent in with my claim. This claim took less than a month from when I sent it into approval. I have also included a copy of the nexus my doctor wrote. With the proper research and a good nexus you can win this. I hope my research willhelp other win their claims. High Risk.pdf How PTSD relates to obstructive sleep apnea & cpap therapy.pdf My Statement.pdf Obstructive Sleep Apnea and Posttraumatic Stress Disorder.pdf PTSD and Sleep.pdf PTSD Severity Linked to Higher Risk of Sleep Apnea in Veterans.pdf PTSD symptoms go beyond psychological.pdf Sleeo Study.pdf Sleep and PTSD.pdf Sleep apnea found in 57%.pdf Sleep Disordered Breathing in patients with Post-traumatic Stress Disorder.pdf The National Veteren Sleep Disorder Study.pdf The PTSD and Sleep-Apnea Connection.pdf The PTSD-OSA Paradox.pdf VA sleep study Publication.pdf Nexus.docx
  13. Hello all, Seems as this COVID stuff has made my VSO disappear so I'm looking for some help. I was recently diagnosed with Planovalgus Foot (left foot only) with a deformity by the VA Ortho doc. I had flat feet documented on my boot physical but no problems until a few years ago. The deformity is relatively new. My left knee is service connected and my left ankle is service connected, secondary to the left knee. My question is how do I file for the Planovalgus Foot with deformity? Secondary to the left knee or to the left ankle (or both)? I don't know if you can have a secondary to a secondary! Thanks in advance and stay safe!
  14. I am currently rated at 50% for PTSD and just had my C&P exam for an increase. Below is my current C&P results. Also I suffer from Major Depression and Erectile Dysfunction due to my medication. Could these two items be filed as secondary since the examiner did not list them in my C&P exam.Any input would be appreciated on to what my outcome may be. Thank you SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran now have or has he/she ever been diagnosed with PTSD? [X] Yes[ ] No 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: PTSD, moderate to severe, chronic Comments, if any: The trauamtic event was learning that a close friend of his killed two older female civilians. PTSD also causes secondary panic attacks 2-3 times per week. b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): No response provided. 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 reduced reliability and productivity 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 ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes[ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes[X] No 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 [ ] Veterans Health Administration medical records (VA treatment records) [X] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [X] Yes[ ] No If yes, describe: On 11/25/2014, Dr. XXX conducted a C&P Initial Evaluation for PTSD and diagnosed the veteran with PTSD with panic attacks. 2. Recent History (since prior exam) ------------------------------------ a. Relevant Social/Marital/Family history: Mr. XX is currently married to his wife of 10 years. He describes the quality of his current marriage as, "loving - but my wife puts up with me." He reports his irritability and anger can stress his wife. He adopted his wife's 14 year old daughter. He reports he has no friends of his own, but he reports he is friendly with many of his wife's friends. He tends to avoid crowds and group social activities. He is quite close with his parents. His main hobby is drumming and working on computers. Overall his social support is limited. He reports that the primary effect of his psychiatric symptoms on his social relationships are tension and distance caused by irritability, rage (including yelling, swearing, and very occasional violence towards inanimate objects - like punching a hole in the door), withdrawal, and emotional numbing. b. Relevant Occupational and Educational history: Mr. XXX highest level of education is some college. He served in the Airforce. He is currently employed as a cyber security analyst at XXX a telecommunications company called XXX. He has worked at XXX since 2011. In 2012, he was written up for "going off on a customer." He reports he works from home or calls in sick 4-5 days a month due to feeling stressed. He reports during times of stress he impulsively loses his temper when talking with customers or makes careless mistakes. He is a lead, and he has five other analysists who report to him. c. Relevant Mental Health history, to include prescribed medications and family mental health: Mr. XXX denied history of psychiatric hospitalization, receiving out-patient therapy, receiving any type of psychopharmacological treatment, or prior suicide attempts. He has been referred to a psychiatrist by his PCP but he is not currently engaged in therapy. He receives medication management from his private PCP, and he is currently maintained on a regimen of Zoloft, hydroxyzine, prazosin and diazepam. d. Relevant Legal and Behavioral history: No arrests. Received an article 15 in the military after he learned of the murders. e. Relevant Substance abuse history: No response provided. f. Other, if any: No response provided. 3. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. The diagnostic criteria for PTSD, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). The stressful event can be due to combat, personal trauma, other life threatening situations (non-combat related stressors.) Do NOT mark symptoms below that are clearly not attributable to the Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #6 - "Other symptoms". Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: [X] Witnessing, in person, the traumatic event(s) as they occurred to others [X] Learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental; or, experiencing repeated or extreme exposure to aversive details of the traumatic events(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. 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] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [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] Problems with concentration. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] The duration of the symptoms described above in Criteria B, C, and D are more than 1 month. Criterion G: [X] The PTSD symptoms described above cause 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. 4. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Anxiety [X] Panic attacks more than once a week [X] Chronic sleep impairment [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships 5. Behavioral Observations: --------------------------- Mr. XXX was casually dressed, and was cooperative throughout the examination. His speech was fluent. His psychomotor behavior was appropriate. His affect was constricted and his mood was anxious. His insight was intact. Thought process was linear, goal directed, and future oriented. No reported hallucinations or delusions. No reported homicidal or suicidal ideation. 6. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [ ] Yes[X] No 7. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes[ ] No 8. Remarks, (including any testing results) if any: --------------------------------------------------- Veteran's PTSD and panic attacks currently cause moderate socio-occupational impairment.
  15. Question: VA Form 21-526EZ page 8 section 13. Should all the items from the VA Problem list (medical records) be included on the form, including secondary problems and other items such as diabetes or ONLY the service connected problems? Post Vietnam, no AO My spouse's condition has deteriorated in the last 10 years and we need to be re-evaluated. Last year, the VA Rep submitted a claim and the Comp&Pen Doctor asked us for an MRI. From there it gets murky trying to get assistance for documentation.
  16. Hi there! Long time member here but been MIA for awhile. Life has been busy and I have been dealing with health issues. Long story short, I went through a battery of tests to find out what is wrong with me. I did an ANA-TITER test, and it was positive for an auto immune disease. Was referred to the RA doctor for further testing to see if I had lupus. The RA doctor did blood tests and determined I don't have lupus. We did additionally physical exam at the VA back in May and he determined I had Fibromyalgia and diagnosed me with it. We discussed that my Fibromyalgia co-exists with PTSD/MST and IBS. We also discussed that Fibromyalgia can be secondary to my already service-connected PTSD/MST or even maybe my IBS. I discussed this with my representative and we decided to file a claim for Fibromyalgia (non-service connected disability) to an already service-connected disability. Either PTSD/MST or IBS and we asked that they evaluate either causation or aggravation. We filed in July and I had my C&P exam in September. The examiner was asked by the rater to give his medical opinion as to the Fibro being secondary to my PTSD/MST. The rater did not ask if it was possible to be secondary to my IBS like we requested. The examiner did a C&P DBQ for Fibro and that was positive. I do have Fibro, that isn't the issue. The medical opinion is what was disturbing. I was with the examiner for less than 5 minutes. He stated he physically examined me when he did not and he seemed very unknowledgeable about Fibro/PTSD-MST/IBS as co-existing and determining either causation or aggravation. Of course the medical opinion stated, "less likely than not". I was floored, so I went to work for my claim. I contacted my RA doctor and we talked with my representative on the phone as well. By the end of the call he was confident enough to link my PTSD/MST as aggravation to my Fibromyalgia. He wrote a one/two paragraph letter on my behalf. We sent that to the rater. Then I spoke to my MH provider last week and she too wrote me a very good NEXUS letter. That was sent to the rater yesterday. Both my doctor's are at the VA and both stepped out on a limb for me. I am hoping their medical opinions outweigh the negative C&P medical opinion. I am attaching the C&P exams (redacted), the two medical opinions (redacted) - I am hoping I am successful because this will make me 100% scheduler. I am currently 94% overall rated. C&P _Redacted.pdf nexus 2_Redacted.pdf redacted.pdf redacted2.pdf
  17. 38 CFR Book B 3.310 mandates secondary service connection for certain disabilities associated with traumatic Brain Injuries (TBI) I have a couple of QUESTIONs since my MDD rating is still in limbo at the VARO: What does it mean by "...the secondary condition shall be considered a part of the original condition….” Does that mean MDD is to be rated separately as secondary service connected to TBI? OR,does that mean that MMD cannot be rated separately from TBI and receives just ONE rating? How can secondary service connected disabilities avoid the "pyramiding" accusation? §3.310 Disabilities that are proximately due to, or aggravated by, service-connected disease or injury. (a) General. Except as provided in §3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. (b) Aggravation of nonservice-connected disabilities. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 CFR part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. (Authority: 38 U.S.C. 1110 and 1131) (c) Cardiovascular disease. Ischemic heart disease or other cardiovascular disease developing in a veteran who has a service-connected amputation of one lower extremity at or above the knee or service-connected amputations of both lower extremities at or above the ankles, shall be held to be the proximate result of the service-connected amputation or amputations. (d) Traumatic brain injury. (1) In a veteran who has a service-connected traumatic brain injury, the following shall be held to be the proximate result of the service-connected traumatic brain injury (TBI), in the absence of clear evidence to the contrary: (i) Parkinsonism, including Parkinson’s disease, following moderate or severe TBI; (ii) Unprovoked seizures following moderate or severe TBI; (iii) Dementias of the following types: presenile dementia of the Alzheimer type, frontotemporal dementia, and dementia with Lewy bodies, if manifest within 15 years following moderate or severe TBI; (iv) Depression if manifest within 3 years of moderate or severe TBI, or within 12 months of mild TBI; or (v) Diseases of hormone deficiency that result from hypothalamo-pituitary changes if manifest within 12 months of moderate or severe TBI. (2) Neither the severity levels nor the time limits in paragraph (d)(1) of this section preclude a finding of service connection for conditions shown by evidence to be proximately due to service-connected TBI. If a claim does not meet the requirements of paragraph (d)(1) with respect to the time of manifestation or the severity of the TBI, or both, VA will develop and decide the claim under generally applicable principles of service connection without regard to paragraph (d)(1). (3) (i) For purposes of this section VA will use the following table for determining the severity of a TBI: Mild Moderate Severe Normal structural imaging Normal or abnormal structural imaging Normal or abnormal structural imaging LOC = 0–30 min LOC > 30 min and < 24 hours LOC > 24 hrs AOC = a moment up to 24 hrs AOC > 24 hours. Severity based on other criteria PTA = 0–1 day PTA > 1 and < 7 days PTA > 7 days GCS = 13–15 GCS = 9–12 GCS = 3–8 Note: The factors considered are: Structural imaging of the brain. LOC—Loss of consciousness. AOC—Alteration of consciousness/mental state. PTA—Post-traumatic amnesia. GCS—Glasgow Coma Scale. (For purposes of injury stratification, the Glasgow Coma Scale is measured at or after 24 hours.) (ii) The determination of the severity level under this paragraph is based on the TBI symptoms at the time of injury or shortly thereafter, rather than the current level of functioning. VA will not require that the TBI meet all the criteria listed under a certain severity level in order to classify the TBI at that severity level. If a TBI meets the criteria in more than one category of severity, then VA will rank the TBI at the highest level in which a criterion is met, except where the qualifying criterion is the same at both levels. (Authority: 38 U.S.C. 501, 1110 and 1131) [44 FR 50340, Aug. 28, 1979, as amended at 66 FR 18198, Apr. 6, 2001; 71 FR 52747, Sept. 7, 2006; 78 FR 76208, Dec. 17, 2013]
  18. Hello and TYIA for any responses and for reading my long post. BLUF: I would appreciate some insight or just plain ol speculatin on why the VA raters would submit me for a lumbar strain increase (that I didn’t submit for) while working on my current claim? Also, are secondary conditions disqualified in the 60% calculation for SMC Housebound? I know it says the 60% must be separate from the 100% condition, but how does this work if I’m on IU, with secondary conditions? I’m probably overthinking at 4am but why would they submit me for an increase for a condition when I didn’t ask them, and the increase has no bearing on the final rating due to VA math, unless it qualifies me for SMC, or they believe I should be qualified. I’ve never raised the issue of SMC and I’m still learning about it trying to figure out my claim, and I know they are supposed to do due diligence, but that’s not my first hunch since that’s why I’m still in this process. History: I filed a claim in 2015 for PTSD increase and TDIU, was granted increase in 2016 to 70% PTSD, denied TDIU. Combined, 80% with other SC conditions. BBE/VSO said I was denied increase to 100% even though I had a nexus statement from a psychologist saying total social and occupational impairment, at least as likely as not, etc., but they said because I was still employed (I was on long term disability leave but not yet “terminated” and yes they had the relevant evidence through my employer and insurance), and my VA treating provider’s opinion took precedence who didn’t feel my symptoms quite qualified me for total of course, though he‘s a CRNP versus a psychologist and I don’t think he even knows me. I thought they were supposed to take the rating and credentials that favor the Veteran but never mind me. I also survived and was approved for Social Security and life insurance premium waivers during this period without having to appeal, with the same medical information and evidence, with the same VA SC conditions, even coming from VA docs and providers. Of course I appealed the rating and TDIU denial (they can decide) in 2016. I also submitted a new claim for secondaries to PTSD, and in my fog, with that claim an increase for PTSD and TDIU, even though I already had those on appeal. I believe I read or was told somewhere (or maybe my brain made it up) that if I submitted new evidence, the raters could look back at the effective date and could EED to the original claim if the evidence shows and close the appeal. Or, they could approve me from the date of the new claim and the appeal could deal with the stuff before that. But what they did was what they are apparently supposed to do (according to Peggy and the VSOs): defer the appeal related claims to the appeal. DOH. Current Status: Early this month my claim progressed and I was granted an increase to 30% for IBS secondary to my 70% PTSD, and since I had a pre-existing 10% for nerve condition and 20% for lumbar strain, that brought me to 90%. My claim never went to complete and I never got the BBE, ebenefits bounced around from gathering of evidence to pending decision approval within days of my last C&P (I had one for PTSD and one for IBS). I’m not sure why they would give me a C&P for PTSD if they are deferring that part of my claim to appeal as I was told. Maybe they’re just giving me a checkup because my 30 appointments and inpatient stays and shock treatments over the past year weren’t enough medical evidence. I learned of the increase bc I got a small retro and my ebenefits letters and disabilities changed within days, but the claim stayed open. I found out by calling Peggy and VSO that it’s due to an increase for my lumbar strain that someone in the rating chain put in. I do have plenty of evidence in my medical records that show my back is also crap. I got sent to a C&P for my lumbar strain and now I wait in GOE. The C&P examiner, Peggy, VSOs specifically say I was submitted for an increase for my back, not a review. BTW, in ebenefiits in the disabilities section, the PTSD increase is still open, the TDIU disappeared, the IBS is rated, and the lumbar strain doesn’t appear. Yes, I know ebenefits is unreliable and I should find something else to do, but compulsively logging into ebenefits is an activity quite similar to playing a slot machine for me. Every 1 in 10000000 logins I might get a glimmer of hope, and it keeps me going lol. I Wonder: What difference does it make if I’m rated 20% or 30% for my lumbar strain? Why would this be raised since my overall rating won’t change from 90% either way? Trust me, I AM NOT COMPLAINING AND I AM GRATEFUL, anything they do (and they have been getting faster and more Vet-friendly it seems) positive for the Veteran that saves future agony and torture is an appreciated blessing. It would help in the future in qualifying for SMC, but I don’t qualify with the math now. Just wondering if they don’t have enough to do over there, because in the future I’d probably have to get another C&P. Also, I would have to have another condition at 30% for that math to work out, and I pray nothing else worsens enough for that to happen. Does “separate” mean it can’t affect the same body system or it can’t be a secondary condition? Because with secondaries, I could potentially qualify for SMC, and therefore the VA rater would be setting me up for success. Otherwise, it just seems like extra work for them when they could close my case and get their quota numbers and help another Vet...again, not complaining but whoever is on my file seems to be thorough regardless. I know they could be doing anything over there, and I’m glad they’re working on my claim, but just for s&g I’d appreciate any guesses or suggestions, and any help clarifying the SMC Housebound math thing please. Thank you all.
  19. Filed a claim for Esophageal Stricture (DC 7203) Secondary to SC GERD. Below is result of C&P Exam. Seems pretty straight forward. VSRO asks if Stricture is at least as likely as not due to GERD. Examiner responds in the affirmative. Decision letter mentions nothing about esophageal stricture and continues disability rating for GERD for 30%. Viewed many BVA decisions where 7203 can be rated separately and is not considered pyramiding. Filed for Stricture Secondary to GERD after recent EGD Exam diagnosed me with Schatzki ring and Eosinophilic Esophagitis. Both of which cause narrowing of the esophagus. MMEDICAL OPINION SUMMARY ----------------------- DBQ GI Esophageal (including GERD & hiatal hernia): TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection. The Veteran's esophageal condition is at least as likely as not (50 percent or greater probability) proximately due to or the result of GERD, currently rated as hiatal hernia. RATIONALE: EGD Report dated 9/8/17 supports esophagitis which has been linked to chronic reflux of GERD/hiatal hernia. Veteran has no other documented condition to which it could be related. supplemental data: https://my.clevelandclinic.org/health/articles/hiatal-hernia RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: DBQ GI Esophageal (including GERD & hiatal hernia): TYPE OF MEDICAL OPINION REQUESTED: Secondary Service connection. Is the Veteran's esophageal condition, stricture at least as likely as not (50 percent or greater probability) proximately due to or the result of GERD? POTENTIALLY RELEVANT INFORMATION: TAB A: Bedford VAMC Treatment Records, 02/06/2013 to present TAB B: EGD Report b. Indicate type of exam for which opinion has been requested: GI TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ] a. The condition claimed is at least as likely as not (50% or greater probability) proximately due to or the result of the Veteran's service connected condition. c. Rationale: Recent EGD with biopsies supports esophagitis which is mediaclly accepted as having a link to hiatal hernia. TYPE OF MEDICAL OPINION PROVIDED: [ OPINION REGARDING CONFLICTING MEDICAL EVIDENCE ] I have reviewed the conflicting medical evidence and am providing the following opinion: The Veteran's esophageal condition is at least as likely as not (50 percent or greater probability) proximately due to or the result of GERD, currently rated as hiatal hernia.
  20. Have a question. I submitted a claim in E-Benefits for secondary for both my left hip and left foot (due to left discrepancy), which is SC. The plantar fasciitis in my foot was diagnosed by the VA and my hip was diagnosed by a civilian doctor. I uploaded all my VA medical and personal doctors medical evaluation and documents along with a copy of my service medical records. My question is why this was done so fast as my initial claim was put into E-Benefits on 08/02/2017 and now I see its already in the "Preparation for Notification" phase. Also under disabilities claimed it states "mqas review - recoupment adjustment (New)". I did get an SSB payment when I left the service that I have been paying back for years now. My question is this seems too fast for the VA.....and not a good sign. (E-Benefits yesterday) Status of Your Claim: Gathering of Evidence Submitted: 08/02/2017 (Compensation) Estimated Completion: 11/11/2017 - 02/03/2018 Estimated Completion Info Tooltip with additional information Disabilities Claimed: bursitis(secondary to: leg length discrepancy, left lower extremity) (Secondary), (secondary to: leg length discrepancy plantar fasciitis left lower extremity) (Secondary) Current Status: Gathering of Evidence (E-Benefits Today) Status of Your Claim: Preparation for Notification Submitted: 08/21/2017 (Regulatory or Procedural Review) Estimated Completion: 08/24/2017 - 08/28/2017 Estimated Completion Info Tooltip with additional information Disabilities Claimed: mqas review - recoupment adjustment (New) Current Status: Preparation for Notification Representative for VA Claims: VETERANS OF FOREIGN WARS OF THE US
  21. I recently submitted a claim, 09/28/16, for IBS (presumptive to Gulf WAR) and dysthymic disorder. Had C&P exam on 11/16/16 and EBenifits shows Claim Complete on 12/24/16. Received BBE on 01/02/17 only addressing dysthymic disorder (Denied, not SC). There was no mention of IBS and it does not show up at all in my Ebenefits. I should note that C&P exam results clearly note my IBS and referenced my Gulf War Service. Called 1-800 # on 01/02/17 and was informed information on IBS was mailed on 12/21/16 and had to wait 10 days to request copy. Called 1800# yesterday and the woman informed me that I was given incorrect information about the IBS decision being mailed on 12/21/16. She then went into what I will describe as a more technical mode, informing me that she was a VA employee authorized to give and receive claim info. something along those lines. She told me I would have to file an appeal to have it looked at again ( I have no decision to appeal). She then informed me that my best bet would be to file the IBS claim again but this time as secondary to my currently rated GERD. She stressed this strongly and would not answer any of my questions, stating it was my choice to appeal or re=file as secondary. It appeard she was trying to help me out by stressing the Secondary method, but she was very vague and suggested it was the consensus among who she was conversing while I was on hold that I undertake the Secondary path. My questions are does anyone know what occured here? Why was I not notified of a decision either way on IBS? I thought IBS was Presumptive! Is Secondary the best path?
  22. I have asked a lot of questions and i continue to ask alot of questions to learn even more. I think this may be my final question before i file. So i am currently service connected at 80% 60% asthma 30% allergic rhinitus 10% carpal tunnel 10% cystic acne (due to jet fumes) Now here's my question. Back in 2009 i began seeing a shrink for depression. ive been on pills and have gone to a counselor very often ever since. It is believed that my depression came from the 3 plane crashes that i witnessed. And another 1 that i didnt witness, but i was apart of the HR (human remains) team that shipped the 6 recovered bodies home. It is also believed that my depression has come as a result of the severe asthma and allergy pains. Recent my therapist marked me down as bipolar I, fyi. My question is, do you think i would have a better chance claiming bipolar/depression as secondary to the asthma and allergies. Or should i just say that ive been depressed from the plane crashes and hr missions. Or should i just claim depression as its own issue. please help. Thanks.
  23. OK Experts, I am currently rated 30% under migraines for headaches NOS. Before i ever put in a claim, I was experiencing jumping of my left eye. I kept going to my family doctor and telling her about the issue and also at my year eye exams. Explained the issue with my optometrist. Kept being told it could be stress, eye strain, lack of sleep. As my headaches became more frequent due to the issue or thee issue made headaches that much worse and the jumping moved down the side of my face to my lips. Well this scared me so I made an appointment with an opthamology specialist, he ordered a cat scan. Diagnosed as hemificial spasms: hemifacial spasm by definition a disorder of the facial nerve characterized by unilateral involuntary paroxysmal contractions of the facial muscles,caused by high-frequency bursts of motor units lasting from a few msec to several seconds; reported causes include compression of the ipsilateral facial nerve near its exit from the 9pons by a vascular malformation, compression of theipsilateral facial nerve by a posterofossa neoplasm, and idiopathic derivations Condition is the same as having convulsive tics or terret syndrome. I was told by the opthamologist that I could have a surgery or do botox injections. This would help with the tics and the headaches. So I choose to do botox every 4 months. First few rounds went great no issues, now all of a sudden I have muscle weakness and a droopy left eye. Given eye drops to help raise the eye lid. This of course is affecting my vision in my left eye. I filed a claim with hemifacial spasms secondary to migraines, of course the claim was DENIED. VA says that this was not caused by headaches and I know it started when headaches increased and intensified. I was going to drop it and let it go, but now with these new issues and I am being told that they dont know if this will reverse it self or this will be my permanent look. I have until December to file for an appeal. Do I submit a new claim or do I file for muscle weakness, convulsive tics, droopy eye or all separate as secondary to migraines or secondary to botox that was treating the migraines? Thanks in advance
  24. Is it true that for secondary issues you DO NOT need your in service medical records reviewed in order to obtain a Nexus letter? And has anyone had any success in claiming secondary issues? For example I am looking at putting in a claim for neck and hip pain secondary to my service connected lower back pain. I'm being treated for both neck and hip pain by my VA doctor. By treated I mean given Pain killers and muscle relaxers..lol
  25. Hi everyone I saw my Doctor yesterday and I asked and received a IMO for carpal tunnel and cubital tunnel syndrome secondary to right shoulder injury. A little history I'm receiving 20% Rt shoulder, 20% Lt shoulder secondary due to over use 10% Lt Biceps due to over use I would like to know if this is enough to claim service connection for my hand and forearm due to over use ? Here goes nothing . Work Status: NOT ABLE to work at present. Estimated to be permanently disabled from this injury to the left shoulder. He has night symptoms which keep him up at night. Patient demonstrates weakness and numbness in the left hand and forearm consistent with carpal tunnel and cubital tunnel . This is causing him to be unable to utilize his upper extremity and this is related to overuse and repetitive actions.
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