hypertension Soc And Partial Grant

[Ricky]

Spoke with someone on the 1-800 today. They told me that the DRO had given me a partial grant of my claims on the NOD. She could not tell me what was granted, percentage level etc.... She did say the file is currently with a veterans service rep who would be sending out a SOC within the next few days. Not what I hoped to hear but at least it is movement. Nod was submitted in Aug 05. All claims were already service connected but improperly rated (I felt so).

Feb 05 stroke - SC but no payment. asked for 100% for six months as directed in part 4.

Residuals of stroke - SC rated at 10 percent. IMO from treating Neuro guy, board cert 30 year experience providing that nerve damage has resulted in complete loss of function of left arm/hand, leg/foot and incomplete severe paralysis of left side of face with no recovery possible. Asked for 100% due to complete loss of function of hand and foot and 20 percent for face.

Hypertension - SC rated at 20 percent. Asked for increase to 60% based upon daily readings in excess of 225/135. This lead to Feb 05 Stroke and continues todate. Currently on 5 Sep HBP meds.

Asked for SC for joint pain which SMR's indicate Fibro present (GWV) along with SC for Gerd.

Knowing my luck the paritial grant will be SC for joint pain and gerd with 0% rating.

I will let you guys know since all of you were instrumental in providing me with information which helped me work through the NOD. If it is a bad decision it will be because they failed to apply regs properly and did not use my civilian health care records and IMO's from my treating doctors.

[Guest Berta]

Yes- I forgot Ricky- you did this alone-and you did very well in presenting your case----

Something will happen soon for you- I am sure-

Authorization always meant a good thing in my past claims-and for many at hadit over the years-

with a few days it would usually then end up in Finance- the big magic word-

However- even though my claim had considerable movement the last week or so-

director's office, authorization, rating board, appeals team, authorization yesterday again-

I cannot seem to interpret what is what and

the word Authorization now seems to mean different things to the 800# people.

Your claim is not as involved as mine-but

I do feel this is a good sign in your case.

[Ricky]

Berta

Thanks for the vote of confidence. However, without my fellow vets on this board I would have not gone past first base. And I owe a special thanks to you for personally reviewing my NOD early on.

Ricky

"VA rater = non-medical specialist, commonly referred to by the VA as a "Lay Person"

[Ricky]

Well got it in the mail today. But I am confused. The NOD asked for a review of increase for stroke, HBP, Back injury, Fibro etc..... The envelope contained a rating which said as a result of your Aug 2005 Nod a De Novo Review was conducted and as a result you SC disability for back strain has been increased from 0 percent to 10 percent bla bla bla............... No statement of the case no mention of the other 10 items contained in the NOD!!!!!!!! Any ideals? Does this mean that the only win for me on the NOD is the back rating and a SOC is forthcoming with the other denials...............Help I am losing it!!!!

[Guest jstacy]

Ricky, call them and make an appointment. Take someone with you. You need to look at your claims folder and the evidence the VA has ASAP!!!!!. They tried this bull on me saying they had closed a claim and I have never received a SOC from them. Im glad you do not have a service officer. They are a waste of time and as far as I am concerned absolutely worthless. As you look at the folder take notes. Then ask for a complete copy. These people are good at giving little chunks but in your case you deserve allot more.

When you go to the Regional Office, Be extremely cautious and most of all be polite.

[Ricky]

Even their gracious increase from 0 to 10 on the back issue is enough to make a bald guy like me to grow hair:

-The 0 percent evaluation for a lumbar spine disability is hereby revised on the basis of difference of opinion (38 CFR 3.105b. This revised decision is not based on clear and unmistakable error nor is new evidence available sufficient to justify a different decision. Instead, the following evidence of record has been interpreted differently: examination report of May 18 2005. This examination is considered to show the symptomatology that meets the criteria of a 10 percent evaluation.

-An evaluation of 10 percent is not warranted unless there is forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; etc...............

-An evaluation of 20 percent is not warranted unless there is a forwar flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; etc................

Now as I look at the May 18 2005 C&P examination the doctor stated: Range of motion of the lumbar spine is 45 degrees of flexion (normal 90), extension 15 degrees (normal 30) with limitation of motion of the lumbar spine with use. X-ray notes partial scaralization of L5.

I wonder how the DRO interpreted the doctors report differently? I don't see any words that need interpretation such "slight, some, mild etc limitation of motions. The black and white print says "ROM lumbar spine 45 degrees" which meets the requirements for a 20 percent rating. Am I wrong on this or am I simply plain stupid?

[Guest Berta]

Ricky- I feel you are correct and the DRO is stupid-

and maybe trying to play Doctor-:

"Instead, the following evidence of record has been interpreted differently: examination report of May 18 2005. This examination is considered to show the symptomatology "etc

I certainly would file a NOD immediately- point out exactly why the DRO is wrong and then ask the DRO for the bases of their medical "rationale" here.

My vet rep -astonised that I did not succeed in Sept was told by the DRO that she denied because she did not 'understand medical information' (say what? - My IMO was clear enough for a 12 year old to read it.) So she never read (still waiting for someone there to) and denied-of course I raised hell and something is going on now with my claims-

But your DRO is attempting to re- interpret a medical decision-( as I understand this- maybe I am reading this wrong) it doesn't make sense based on the ROM you have. Is there an MD after this DRO's name?

Maybe a email Inquery sent as Service Complaint ,Attention Director to your VARO via the VA web site will straighten this out-

This is from 38 CFR- and it almost seems like they alered what the percentages actually say---

(For diagnostic codes 5235 to 5243 unless 5243 is evaluated

under the Formula for Rating Intervertebral Disc Syndrome

Based on Incapacitating Episodes):

With or without symptoms such as pain (whther or not it

radiates), stiffness, or aching in the area of the spine

affected by residuals of injury or disease

Unfavorable ankylosis of the entire spine............. 100

Unfavorable ankylosis of the entire thoracolumbar 50

spine................................................

Unfavorable ankylosis of the entire cervical spine; 40

or, forward flexion of the thoracolumbar spine 30

degrees or less; or, favorable ankylosis of the

entire thoracolumbar spine...........................

Forward flexion of the cervical spine 15 degrees or 30

less; or, favorable ankylosis of the entire cervical

spine................................................

Forward flexion of the thoracolumbar spine greater 20

than 30 degrees but not greater than 60 degrees; or,

forward flexion of the cervical spine greater than 15

degrees but not greater than 30 degrees; or, the

combined range of motion of the thoracolumbar spine

not greater than 120 degrees; or, the combined range

of motion of the cervical spine not greater than 170

degrees; or, muscle spasm or guarding severe enough

to result in an abnormal gait or abnormal spinal

contour such as scoliosis, reversed lordosis, or

abnormal kyphosis....................................

Forward flexion of the thoracolumbar spine greater 10

than 60 degrees but not greater than 85 degrees; or,

forward flexion of the cervical spine greater than 30

degrees but not greater than 40 degrees; or, combined

range of motion of the thoracolumbar spine greater

than 120 degrees but not greater than 235 degrees;

or, combined range of motion of the cervical spine

greater than 170 degrees but not greater than 335

degrees; or, muscle spasm, guarding, or localized

tenderness not resulting in abnormal gait or abnormal

spinal contour; or, vertebral body fracture with loss

of 50 percent or more of the height..................

Note (1): Evaluate any associated objective neurologic

abnormalities, including, but not limited to, bowel or

bladder impairment, separately, under an appropriate

diagnostic code.

Note (2): (See also Plate V.) For VA compensation purposes,

normal forward flexion of the cervical spine is zero to 45

degrees, extension is zero to 45 degrees, left and right

lateral flexion are zero to 45 degrees, and left and right

lateral rotation are zero to 80 degrees. Normal forward

flexion of the thoracolumbar spine is zero to 90 degrees,

extension is zero to 30 degrees, left and right lateral

flexion are zero to 30 degrees, and left and right lateral

rotation are zero to 30 degrees. The combined range of motion

refers to the sum of the range of forward flexion, extension,

left and right lateral flexion, and left and right rotation.

The normal combined range of motion of the cervical spine is

340 degrees and of the thoracolumbar spine is 240 degrees.The

normal ranges of motion for each component of spinal motion

provided in this note are the maximum that can be used for

calculation of the combined range of motion.

Note (3): In exceptional cases, an examiner may state that

because of age, body habitus, neurologic disease, or other

factors not the result of disease or injury of the spine, the

range of motion of the spine in a particular individual

should be considered normal for that individual, even though

it does not conform to the normal range of motion stated in

Note (2). Provided that the examiner supplies an explanation,

the examiner's assessment that the range of motion is normal

for that individual will be accepted.

Note (4): Round each range of motion measurement to the

nearest five degrees.

[[Page 51457]]

Note (5): For VA compensation purposes, unfavorable ankylosis

is a condition in which the entire cervical spine, the entire

thoracolumbar spine, or the entire spine is fixed in flexion

or extension, and the ankylosis results in one or more of the

following: difficulty walking because of a limited line of