Result Of C&p "less Likely Than Not"

[Quint7]

Hi All,

I went and got the copy of my C&P for knee and back that was done 10 days ago. The results are unusual. I will start by saying that I claimed an increase for my 0% knee, a claim for my back being secondary to my knee and a reopening that my back alone is SC.

My measurements were:

Knee 0-90 degrees out of 140 degrees.

Back 0-20 degrees forward out of 90 degrees, 0-5 degrees extention out of 30 degrees, 0-20 degrees right lateral flextion out of 30 degrees, left and right rotation is 0-30 degrees out of 30 degrees.

The PA that examined me mentions that I have had therapy for both problems. She also mentions that I had a MRI and that it shows DDD and Stenisis along with disc buldge.

She then states that the "spine condition is less likely as not secondary to his right knee condition. The vet has a lot of other contributing factors to his back condition, including his occupation as a firefighter. The vet's gait was normal on exam today. The MRI findings do not support spinous condition as secondary from the right knee. It is more likely from other causes."

OK, a few things:

I had the actual MRI films with me and I asked the PA to look at them, to which she said "I don't need to, I have the report here".

I have been a firefighter for 11 years. I filed originally for my back upon my end of enlistment in 1994. I also saw a chiropractor in 1998 or 99 (XRays from then show some disc damage already) which is only 1 or 2 years into my firefighting career. She made no mention of this in person or her report yet it claims she reviewed my file.

She claims there are "a lot of other contributing factors" yet other than my job, she does not mention any.

As I posted before, she had 2 huge folders that were my file with her. My exam lasted 20 minutes at most.

Any comments or suggestions?

She states that no further tests are needed.

As I see it, she did not fully review my folder, did not ask my history, automatically took my current career over my explanation that I have had this problem since I was in the service. She did mention that I have had the pain since 1992.

thanks!

jason

I can post any other info from the paperwork I received that might be relavent if I am missing something.

[rentalguy1]

When was the MRI of the spine ordered? Who ordered it? What did the reading radiologist have to say about the MRI? What did the referring physician state about the MRI? When did you acknowledge receipt of the VCAA letter by signing it and sending it in? What additional evidence have you sent to the VARO regarding your claim?

[Quint7]

Sorry, I had put a post up about this before and didn't want to overload the board by reposting it all.

Here you go:

-Discharged 1994, filed for knee and back among other things. Moved a lot, never heard back from VA, but collected GI Bill for years.

-During time in service had knee problems for years (told in my record book) "Nohing can be done" and "not severe enough to rate medical board". Had one documented injury to lower back, told it was a strain.

-I never hear from VA on either claim, just kinda move on with life.

-See a chiropractor for back pain in 2000, 5 years after discharge. XRays show mild disc degeneration. Again, this is only 2- 3 years into Firefighting career. Knee pain is constant for years, I assume I am stuck with it.

-Knee gives out in 2006. Turns out the meniscus is torn and has most likely been since 1989 when I first complained of it. Surgery fixes it, but doc and phys. therapist tell me it will never be right from too many years of favoring the other leg.

-I file a claim and it comes back denied due to "failure to appear". Turns out local VA called a guy with my old number in California and never folowed up with letter. Again, I had had contact with VA through GI Bill and getting checked for Hep C. I file appeal and add back to claim, as a seperate claim and secondary to knee.

I finally find out that I am 0% for knee and not SC at all for back.

-I submit a LOT of evidence, including statements of how it affects my work, medical history, etc.

-I get C&P exam as noted.

My "history" with my back is:

-Injury in USMC, later find out it was denied due to failure to appear in 1994 (I was never contacted then even though I was getting GI Bill). 1993

-Car accident, 2000, started seeing chiropractor after that, but it hurt from 1993. XRays showed degeneration already.

-Fell into basement at a fire. 2002 or so, no hospitalisation, etc. No XRays, just sore.

-Motorcycle wreck, 2004. Injured shoulder and had cuts to other knee. No mention of back problem.

-Almost dropped a patient off of a gurney at work, 2005 or 2006. Back strain.

-Last year it has been getting worse and worse. Finally went to my doc, sent me for XRays and therapy. Therapy failed. Received MRI within last 2 months. back doc told me "you have made the wrong career choices. You have the back of a 60 year old'. Told me I WILL need back fusion sooner than later. He documented that I have had back problems since time in the USMC. Also said that DDD CANNOT be caused by one trauma, that it is from long term abuse of the back and was well on it's way when I was in the service.

-Back doc and therapist also said that the longterm time that I had the knee problems contributed to the back just by me favoring the other leg for years. The actual MRI films are much more revealing than the 'report" and the report here was done by a radiologist. As I said, the doc refused to look at the actual films during the exam.

The C&P doc didnt ask me much backstory. At the end of the interview I told her all of this and she nodded. There is no mention of any of this in the report, nor is there any mention of actual documents that I submitted that support all of this. Just that "she had and reviewed my file".

I have read Dr. bash's reports that connect knee and back. I also have sent more than a few letters to VA discussing that I was never contacted TWICE to appear and that I feel I should be SC for the back going back to 1994.

I called the VA today and asked about getting my entire C file and was told that all that will do is delay, delay, delay and to wait til they decide then get it to use in a appeal. As an outsider looking in, I can totaly see how my evidence supports my claim. I can also see how someone doing a VERY cursory review of my records can brush it off. That is why I have taken the time previously to actually break down all of this into an outline/ timeline that I submitted to the VA.

For what it is worth, the C&P examiner was a PA named Heather at the Rochester NY clinic.

[rentalguy1]

Ok...here's what's going to hurt you:

1. No show for the first C&P. I know it wasn't your fault, but it will still weigh in the VARO's decision.

2. The car accident in 2000, which caused back pain to a degree which made you seek out medical attention.

3. The motorcycle wreck in 2004. Even though there is no medical evidence stating that it injured your back, you can bet that a non-medically trained rater will try to make a connection.

4. Your occupation. It shouldn't matter, but the rater may try to make an issue out of it, especially since the C&P examiner did.

***This could be negative as well: The back doctor stating that one accident cannot cause DDD. This will play to your occupation making your back worse. The good part is that your back doctor is wrong. I am not a medical professional, but I am a "spiney" that has done a lot of research on IVDS (DDD). I also have a claim to change my SC'd back dx code from strain to IVDS. In my claim, I included a scholarly article that states (basically) a traumatic injury to the spine sets the degenerative process in motion. In other words, DDD is a naturally occuring event, but a back injury greatly speeds up the process.

What you need at this point:

1. A IMO, from a different back doctor, that states that your DDD is at least as likely as not is related to the injury to your back that was suffered while on active duty. He will also need to state that he has reviewed all of your SMR's, VAMR's, and Civ medical records.

2. If at all possible, go back to the chiropractor that you saw in 2000. Ask them if the DDD that was seen on the x-rays was possibly caused by the car accident, or if it was most likely there prior to that event. If they say it was there prior to the event, get them to put it in writing.

3. Get buddy letters stating who, what, when, where, why, and how you injured your back while on active duty. Also get statements from anyone that has known you and your back condition since ETS.

4 Gather all old records you can that prove that you were not living at the address/phone number where the VA tried to contact you for the first C&P. Also get together any evidence that you were recieving GI Bill benefits at a different address at the same time as the first C&P.

You will also need a IMO regarding the knee. I forsee a long fight on this one, but with the information you are going to go out an get, you should be able to win on appeal.

[Quint7]

Thanks for the reply. Here is what I have gathered in my mind as far as SC. Like I said, I am trying to be as objective as possible in this nad not just "gimme some money!" if you know what I mean.

When I said that one injury can't cause DDD, I mean that just as they cannot claim that the single injury I had in the the USMC caused it, they cannot claim that the car or motorcycle wreck was the one incident that DID cause it. From my back docs, it is a lifetime of hard work on the back. Well, taht all started at 18 years old with running, marching, driving a tank, etc.

As for the chiro, the XRays already show mild DDD and as I said, that was in 2000, 5 1/2 years after I EAS'd. I included all records from her in my file. Again, the PA that did the exam made no mention of it and didn't cite it. It wasn't just the car wreck that led to me going to the chiro, it was the final straw. I documented this in my letters to VA.

As for getting letters from guys in servce.... never happen. I couldn't find em if you paid me and I can guess that they won't remember. Even girlfriends that I dated that knew about my pain back then and after.... don't think they want me knocking on the door asking for a letter from em.

As for the missed C&P... you have no idea how blown away I am by that whole thing. When I "missed" the one they scheduled for me in April last year and got my denial letter, I asked how the hel I could've denied wanting an exam. they said to call the clinic. the lady there actually got mad at me and said "I spoke to you! You told me to leave you alone that you never wanted an exam! After that I didn't even bother sending a letter out!". I saked if she ever directly asked if she was speaking with ME? "Ugh..... no". So I am guessing something similar happened in 1994/5. I also stated in my claim that I want all claims backdated to 1994 because of this.

Could that be a CUE claim like I have read about?

After finding all of this out, VA told me I had to keep them informed of my location and that VA Medical and VA Educational do not swap info so it was my fault.

As for the knee, it is already 0%. I don't really understand the range of motion rating system, but I gotta think that since I had a reduced ROM that I should get that raised above 0% now.

I plan on talking to my back doc again (as I am getting treatment anyway) and am trying to get my service rep to call me back to see if I should just let it run its course or start gettting BVA decisions and an IMO to send in now.

Dr. Bash has a case just like mine right on his page, but to be honest, I want my back rated as being SC on it's own, like it should have been back in 1994 if they had followed proceedures.

Just some other stuff.....

I collected GI Bill in Californiaand NY in 1994, 1995, 1996, 2000, 2001.

I recieve the Gulf War veterans newsletter whenever they come out with a new one, and have since they first started it (I went for Gulf War registry right after my EAS).

I have paid and filed a tax return every year since my EAS.

I recieved Federal Student aid for college in the 90's and registered but did not get any in the early 2000's.

As I see it, they did not use every source to contact me about my 1994 claim.

As for connecting the knee and back, seems to be a lot of BVA cases that state exactly that. The tough thing is getting them to accept that the "strain" in service makes the back SC.

I hope all of that makes sense and that I am heading down the right path with this.

Like I said in the other posts, my back doc has told me that I stand a pretty good chance of being finished as a firefighter once I get my back fused and that I need to put it off as long as possible. I need 6 more years there to be able to get a pension.

[rentalguy1]

Quint...if it were me, I'd let the chips fall where they may at this point. As soon as you get a decision letter, request a copy of your complete c-file, and your SMR's. If you haven't already, go ahead and get a complete copy of your VAMR's and civillian medical recods. Start looking for BVA cases and CAVC cases that are similiar to yours, and print them. Start searching the net for scholarly articles that cannot be refuted. Med schools and the VA system itself is a good place to look for publication of these articles. Most importantly, get IMO's stating what I wrote earlier. Get as many of them on each condition as you can afford. When you get the decision letter, file a NOD, and then send in the new information that you have gathered. I feel like if you have the correct information, in a large enough quantity, you will win this on appeal.

[Quint7]

Rentalguy,

Thanks again for the reply.

That is the route I figure I am going to take. After asking the C&P guy at the clinic about my C file, it sounds like me just asking for a copy will delay any decision. I made a copy of my Service Medical record when I got out of the Marines, but I have to think that there is more to the actual record than I copied. (Xrays, etc.). I have every medical record since and I have done quick searches of BVA cases on the VA website.

I am hoping that the Rating Board would take into account my statements, esp. about the atitude of my commanding officers about medical treatment equaling malingering or weakness. I even gave examples such as only being able to go to a dentist once in 6 years because training was "more important" and being denied funeral leave for my grandmothers death because "you are too valuable to the unit" (they used this to deny me terminal leave too....). I know that is semantics, but I gotta think that someone on these boards might be an actual vet and experienced what the military is really like, not just what they see on tv, esp. post 9-11. Hell, if I hadn't wanted to just get my enlistment done with, my final physical would've had so much crap listed on it, they would've held me on medical hold for 6 extra months! Instead, I just shut up and said, yep, I'm OK, can I get on with civilian life now?

My vet rep has apparently retired or something and I was never notified, but maybe the new guy will actually take interest in my claim.

From all of this, it seems like the VA could pretty much deny almost everything later on in life saying "Well you did stub your toe once, which probably made you mad, which could explain the PTSD type symptoms as much as the year of combat that you saw".

LOL