Unsure If C&p Report Is Helpful For My Claim

[sleepyjenn]

I read here often, but post very infrequently. This may be a little long, so my apologies in advance. I recently (May 2007) had a C&P exam done in Columbia, SC for a possible increase in my benefits. I'm currently rated at 40%--30% for residuals of insomnia (persistent daytime hypersomnolence), 20% for cervical radiculopathy and strain with left upper extremity weakness, and 0% for left-sided sacroiliitis. After my initial claim was granted I had sleep studies and MRIs that showed that my 'insomnia' was actually a more serious sleep disorder called Idiopathic CNS Hypersomnia (similar to Narcolepsy, article here for anyone curious) and that I have Cervical Degenerative Disc Disease with loss of lordosis and also Lumbar Disc Disease.

My new claim asked them to consider the new diagnoses for the sleep disorder and the arthritis. When I received the copy of my recent C&P exam for those conditions, I was unsure if what the doctor (Dr. Durkin) had to say was helpful or harmful in any way. He did not have my C-file when he did the exam, and it doesn't appear that he reviewed it afterwards. Some of the things he says are slightly inaccurate, such as that movements of my neck and lower back aren't painful. He also left out a statement that I made to the affect that I didn't believe I was currently able to hold employment outside the home because I didn't know of any employer that would put up with me falling asleep on the job. I would love to know what anyone thinks of whether his report will help or hurt my claim, and of the possible ratings for the conditions based on his report. I'm a little confused by how to interpret the ROM percentages, too. The diagnoses for the hypersomnia and arthritis are well documented with sleep studies and diagnostic imaging, as well as treatment notes from the sleep specialist and neurologist. The symptoms for everything and the ongoing treatment for those symptoms is also well documented in my SMRs. My claim went to the ratings board less than a week after my exam--May 18th, 2007 and it is still there. Thank you in advance for any advice/opinions. The report stated the following:

This 29 year old white female, who is left-handed by her report, served in the active duty military from 05/99-05/05. She states that in 2004 while in military service she became extremely tired and had daytime sleepiness. She also sometimes does not sleep well at night and she attributes this in the past to her neck pain and more recently due to her low back pain. Apparently, she had a sleep study at night which was normal. The daytime study, however, showed a short sleep latency, and apparently a diagnosis of idiopathic hypersomnolence was made. She was placed on Provigil 400mg daily which helped some. She stopped the medication when she became pregnant. She states that she was screened for depression in the military, but otherwise a search for a psychiatric cause for her sleep disorder has not been made. The veteran states that she tries not to drive by herself because she is afraid that she will fall asleep driving. She has not had any motor vehicle accidents attributed to falling asleep.

As far as her neck is concerned, it started bothering her in 2001 while in military service. She denies any injury and denies any problems with her neck prior to military service. She has neck pain which radiates posterolaterally down the left upper extremity into the thumb and index fingers. Her neck does not affect her ability to walk, and she denies any acute incapacitating episodes in the past 12 months in which a physician prescribed bedrest. She has never had any surgery on her neck but has had some facet joint injections which helped for about a month and a half. She states that she had an MRI of her cervical spine in 2006 in Lancaster, CA which showed facet joint disease and some bulging discs. She is not currently working. She has two children and is 30 weeks pregnant with her third child. When she was in the military she worked as an Avionic Sensor Technician doing electronic component repair. She states that the neck would interfere with any kind of work which required lifting more than 5-10 pounds. This limitation on lifting also affects her activities of daily living. She denies any flare-ups and does not use any assistive devices.

As far as her lower back is concerned she began having pain in late 2004 and early 2005 while in military service. She did not have any injury. She denies any problem with her low back prior to military service. She complains of lower lumbar and midline and left sacroiliac pain which sometimes radiates posteriorly down the right thigh to the distal right thigh. Because of her low back, she does not walk any distances. In this way, her low back affects her ability to walk. She denies any acute incapacitating episodes in the past 12 months in which a physician prescribed bedrest. She has never had any surgery on her low back. Prior to her pregnancy, she took Ultram and Vicodin for her low back. Prior to her separation from the military her low back did not interfere with her work, but it seems to have gotten worse. She is concerned that if she were to work her limitation in bending and lifting due to her low back would cause a problem with her work. The limitation in bending and lifting does interfere with her activities of daily living, and her low back bothers her at night. She is pregnant at the present time. She denies flare ups. She does intermittently use a sacroiliac belt which helps a little.

PHYSICAL EXAM: Well developed, obviously pregnant white female in no acute distress.

Neurologic: She is alert and cooperative with normal speech. The cranial nerves are intact. Motor strength and tone are normal in all four extremities, although there is some incomplete effort in the left upper extremity. Her optic discs are sharp. Finger-to-nose and gait are normal. The deep tendon reflexes are 2+ and symmetrical in all four extremities. Light touch sensation is normal in all four extremities.

Examiniation of the cervical spine reveals flexion to 40 degrees and extension to 35 degrees. Rotation is 40 degrees to the right and 45 degrees to the left. She can laterally flex 35 degrees in both directions. These are without pain and do not change with repetitive use on exam. There is no spasm or tenderness on palpation of the neck.

Examination of the low back reveals flexion to 70 degrees. Again, she does have a large gravid uterus. Extension is to 25 degrees. Lateral flexion is 35 degrees in both directions. Rotation is 45 degrees in both directions. Lumbar range of motion is not painful. Cervical range of motion is likewise not painful. The range of motion of the low back is not additionally limited following repetitive use on this exam. There is no spasm on palpation of the lumbar musculature. She is tender over the left sacroiliac joint. Straight leg raising is negative bilaterally.

Clinical and diagnostic tests: none are requested today.

Diagnoses:

1. Idiopathic Hypersomnolence

2. Cervical degenerative disc disease

3. Lumbar disc disease

4. Left sacroiliitis

Comment: The above diagnoses are based on the veterans history and the reports of tests in the general remarks section.

Edited June 15, 2007 by sleepyjenn

[betrayed]

did the doctor use a goniometer to come up with the

"flexion to 40 degrees and extension to 35 degrees. Rotation is 40 degrees to the right and 45 degrees to the left. She can laterally flex 35 degrees in both directions."

§ 4.46 Accurate measurement.

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Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect to landmarks, should be insisted on. The use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department of Veterans Affairs. Muscle atrophy must also be accurately measured and reported.

[sleepyjenn]

did the doctor use a goniometer to come up with the

Yes, he did.

[Berta]

Jenn- what I dont see on the C & P report is a "more than likely" statement.

It seems to be that all of the back and neck disk problems could be related to your SC cervical

Radiculopathy.

It sure does seem obvious that the doc didnt have all of your records-then again I am not a doctor but I was surprised that the doctor did refer to your statements as to your military history

but failed to consider the SC conditions that you have that- in my opinion- seem related to the SC radiculopathy.

Although this condition -radiolopathy-involves nerves and pressures on them-as I understand it- the pressure can come from the disk problems-

I wonder if you should immediately question this C & P with a letter to the RO and a copy of it-

does it say anywhere else that the doctor found this all to be more than likely due to your service by way of the SC cervical radiculopathy?

Did I understand that you are left handed with SC at "0" for left sided sacroiliitis?

Does this SC affect the ability to use your wrist and hand?

The fact that you do not drive due to the sleep disorder - a daytime hypersomnolence -along with these other conditions could potentially render you eligible for TDIU.

Do you have any documentation that shows that you ever fell asleep on any job?

I think you should apply for TDIU.

Edited June 15, 2007 by Berta

[sleepyjenn]

"does it say anywhere else that the doctor found this all to be more than likely due to your service by way of the SC cervical radiculopathy?"

No, what I posted below was the entirety of his report, or at least that's all the VA sent me when I requested a copy of the exam. He really didn't seem to have any opinion at all, about any of my conditions, from the way I read the report. That's why I got curious about how helpful his report is or isn't. It shouldn't be too difficult for the arthritis to be service connected--I've only been out since 2005, and my claim for this was submitted less than a year later (although the VA 'lost' the claim once and I had to resubmit it) and all the symptoms were well documented before I was discharged. It even makes mention in the original letter the VA sent when they granted my disability that I was awaiting a future sleep study and diagnostic images.

"Did I understand that you are left handed with SC at "0" for left sided sacroiliitis?

Does this SC affect the ability to use your wrist and hand?"

Yes, I'm left handed and am SC at 0% for left-sided sacroiliitis. At the time it was granted they said that a higher percentage of 10% wasn't warranted unless there was forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85, or combined ROM greater than 120 but not greater than 235. I think the ROM from my recent C&P fits that criteria now? Yes, it does affect ability to use my wrist and hand because of pain, numbness, tingling, etc. My left arm is significantly weaker than my right, even though the left is my dominant arm.

"Do you have any documentation that shows that you ever fell asleep on any job?"

No way. lol. I started having all the symptoms of this disorder while I was still enlisted, and there was NO WAY I was ever going to allow myself to fall asleep at work. At least not when anyone could see me. I was too scared of the consequences. Did I actually ever fall asleep? Sure, plenty of times. But my friends always made sure I was awake before the supervisor came back to the 'shelter' where we did maintenance. When I was stationed in Korea I even had a supervisor who would let me go sleep in an unused office for part of the night when we weren't busy. No one thought that was odd at all, though, because we worked nights and most of us were tired. Thankfully, I recognized that my symptoms were worsening to the point that I wasn't able to control them anymore, and since I had become an NCO in the last few years of my enlistment I didn't feel I was fulfilling my job requirement because I was too tired to want to do anything--so I initiated my discharge under the Force Shaping program a few years back. Sorry, a long answer just to say that no, I never had any documentation that I fell asleep on the job.

"I think you should apply for TDIU"

Does the VA ever infer this based on the nature of the illness, or do you always have to file separately? The nature of the type of illness I have, like Narcolepsy, pretty much says that I'm not supposed to drive. I think in some states they even take your license once you've been diagnosed with this type of disorder.

Thank you for your comments. B)

Edited June 15, 2007 by sleepyjenn

[Vike17]

sleepyjenn,

Based on that C&P exam report you'll probably receive a 10% rating for your cervical spine and maybe a 10% for your lumbar spine. However, there isn't any nexus statement linking your lumbar spine to your military service or to your cervical spine on a secondary basis. You'll probably receive these ratings based on range of motion because there was no incapacitating episodes noted within the last twelve months for either one. One thng to keep in mind is that you may retain your current rating of 20% for your cervical spine, depending when you were first granted service-connection because you would be afforded the most beneficial evaluation between the old rating crieria (prior to Sept. 2002) and the new criteria (post Sept. 2002 and changes in 2003). One thing I also noticed is that you have weakness in your left arm. This may be neuropathy and would warrant a seperate rating aside from the cervical spine. I did not see a EMG/Nerve conduction study being done to determine the extent of nerve damage if any is present!!!

As far as your 'residuals of insomnia,' the exam doesn't even address that condition. The sleep studies you had done prior to the C&P exam may be sufficient for rating purposes and wasn't needed to be addressed on the exam per instructions from the RVSR.

As far as the examiner not reviewing your C-file before or after the exam, this is not required for increases. The only thing that would require the C-file is if the examiner was asked to make an opinion in regards to your lumbar spine condition. This may have not been required because maybe the RVSR had already decided to award service-connection and just needed the current findings to assign a percentage. I don't know, I don't have the request for exam in front of me to tell you what the VA asked for.

Right now I would just hang tight and see what VA assigns you before you do anything else.

Vike 17

[Pete53]

Jenn:

I had a sleep study done 10 years ago at VA. They said I had moderate sleep apnea. 2 years ago I had another one done and it was severe. How long ago was your study done?

If the VA does not decide in your favor you might want to consider getting an outside Medical Opinion.

Good Luck