Could Very Easily Throw Up, I Feel Lost.

[livingrock21]

Please, please help me.

I just recieved a SSOC. They denied my new C&P. I think theres two factors. The doc, my treating physician, messed part of it up. Also, they misinterpreted evidence again.

________________________________________________________________________________

_______________________________

Here's the rating criteria:

7119 Erythromelalgia:

Characteristic attacks that occur more than once a day, last an average of more than two hours each, respond poorly to treatment, and that restrict most routine daily activities.................................................................. 100

Characteristic attacks that occur more than once a day, last an average of more than two hours each, and respond poorly to treatment, but that do not restrict most routine daily activities........................................................ 60

Characteristic attacks that occur daily or more often but that respond to treatment.......................................................30

Characteristic attacks that occur less than daily but at least three times a week and that respond to treatment....................10

________________________________________________________________________________

_____________________________

Here's what I recieved:

Decision:

Entitlement to increased evaluation for service connected Erythromelalgia currently 30% disabling is denied.

Reasons and Bases:

The veteran submitted treatment reports from the Naval Medical CEnter noting treatment for his Erythromelalgia while on active duty. VA treatment reports and examination note history of symptoms and diagnosis by exclusion. The veteran indicates that the symptoms occure at least once per day lasting two hours or more. VA examiners noted that the veteran's symptoms have never been observed while active. (This is a flat out lie. They were observed while I was active duty. I was able to go to my PCP many times because the hospital was 10 minutes away, and we had an agreement when it got really bad I could come in without and appointment. Now the closest VAMC is atleast an hour and a half away, and I'm not going to make that drive while in pain.). All clinical testing was negative but noted deep perivascular dermatitis and rare eosinophils. There were no chilblains. Skin was normal with no rash or talangectagias. There was no erythema found. Diagnosis of Erythromelalgia was made. Social Security Administration records also note the veteran's disability.

Review confirms current 30% evaluation for the veteran's service connected Erythromelalgia. The current medical evidence does not support entitlement to a higher evaluation.

________________________________________________________________________________

____________________________________

Obviously my treating physician (C&P doc) said nothing about treatment, or lack there of. No treatment has worked. Also, there is nothing on restricting activities, I can't work due to this condition, they even stated it with the SSA records. I also talked about how I can only play with my daughter for a short period of time before I can feel a flare comming on. There were many things that I mentioned about restriction. None of it made it into the exam notes though. The problem is, I had an appointment the day before the C&P, and then the C&P the following day. She decided to combine both appointments. She didn't do the traditional C&P. She wasn't even looking at the criteria when doing the C&P.

I'm not sure if the DRO screwed this up or what, but I also have been seen while flared up. Either my treating physician(C&P Doc) or they misconstrued that information. I haven't been seen at the VAMC while flared, but have been seen while flared (while active duty).

Here are my questions. Can I have the C&P doc ammend this examination and correct it? I know she would due to the errors, or lack of information. Will they look at it again, and issue a new SSOC or decision. I don't want my claim being certified for the BVA. I should be able to get this fixed at the VAMC. I'd be wasting a whole lot of time at the BVA when the evidence is all right there infront of them. What do I do here? Hopefully I can have her ammend this C&P, and get this fixed rather quickly.

Please, please help me. I'm over the edge right now. I had a distant friend OD last night. At this point, I can truely see how life gets to be too much. I can't take any of this. I need a solution, but am affraid I'm limited on time. I feel that if I don't get this taken care of now, it'll be another year before the issue is taken care of, and my family is barely scraping by as it is.

Please.

Tyler

Edited May 20, 2009 by livingrock21

[Stretch]

You have to use the FOIA (records office) for copy of your C&P. I don't see why you can't discuss it with your doctor though she might be reluctant. The doc has a gamut of C&P questions to be asked, and the questions have to be answered. The doc can't shorten it up.

If you are being stalled sometimes you can get a hint from the SSOC, evidence won't be included in the list of evidence. If your C&P is favorable, then you can request a DRO hearing with the new evidence.

[broncovet]

Tyler

I agree with Carlie..give it another day.

But, then "hit em back where it hurts". Here is ONE possibility:

Carefully go through the evidence list on the decision. Then, carefully go through your evidence.

If your evidence differs from the evidence list on the decision, then there is a good chance you are another victim of shredding.

Then, file a special handling request, pointing out the document you think was not considered as evidence. Check your medical exam history and see if you told a doc, which he wrote down, that your episodes were MORE than once per day.

If one of the docs said that in your c file, then you can complain they did not consider this critical evidence.

The VA regurarly shreds evidence so they can deny the claim.

Remember that if your C and P doc said, "once per day" but your REGULAR doc whom you have seen for years says "multiple times per day" you can appeal on the basis that your regular doc who has seen you for years can better judge your condition than a C&P quack who saw you for 20 minutes. Also, look for a second or third doc that also stated you had multiple episodes per day, because 2 or 3 medical opinions trump the single C&P opinion, upon appeal.

Many, many Veterans are victims of VA shredding, but dont even know it.

The VA isnt sending out letters to Veterans to find out if they were a victim. They keep it quiet and only respond if there is a complaint, and even then, may also shred your complaint document.

Edited May 21, 2009 by broncovet

[carlie]

Tyler,

Va has to certify your claim before sending it to BVA.

This usually takes them awhile to do - like at the very minimum

one month.

Being that you just got an SSOC - I doubt you or a rep has filed a Form 9 yet.

That has to be done way prior to a case going to BVA.

Also, you just got the SSOC - you are allowed XX days to respond.

If you do not have a copy of this C&P examination yet -

then I would not do anything until I got that.

I would do what I had to - to get a copy, I'm surprised if you didn't

already get a copy.

In other words I would not contact the doctor about amending her C&P

until I had the opportunity to see what she actually stated.

At this time (without seeing the actual C&P results) you have no idea what this doctor stated.

Just because a decision maker says in the Reasons and Bases,

"C&P examiner states, XXX, XX, XXXX, XXXXX."

does not mean that their words, are truly what the examiner stated in the C&P.

Many times the decision maker will cherry pick the bits and piece's

out of a C&P that they can use to support (justify) their decision.

jmho,

carlie

[Hoppy]

Correct me if I am wrong. Did you not say that the raters said that you have not been seen with active symptoms. You said that you were seen with active symptoms in the military only. The raters by stating that you have not been seen with symptoms are advancing an argument against your claim. If this was not relevent it should not have been stated. If your doctor says that you told her you have active symptoms once a day and they last for a couple days. Then this same or any other doctor has not stated in a report that they have actually seen these symptoms then what you might have is a problem that needs to be addressed before anything else will be done. I guarantee you they are wondering why doctors has not seen current active symptoms.

You need to find out how they are required to weigh the evidence. As of now you are assuming that just because you tell the doctor you have these daily occurence that they are required to give weight to you statement. If you are wrong on this assumption then you can appeal to no avail. You need to find any regulation or instruction that applies to wheteher or not they can rate a claim based on unconfirmed subjective complaints of symptoms of a condition that is known to have visable or measurable symptoms.

Angioedema is rated in the same manner. They count episode per week, year and severity. Angioedema has the same type of reocurrances based on activity, cold weather, foods, to much sun, etc. In my case air polluted with hydrocarbons triggers my reactions. I gave the VA pictures taken, friends statements and several ER reports with full detailed observations of visable symptoms noted by the doctors when the symptoms were severe enough to require hospitalization.

It has been thirteen years since I read BVA cases on the way these types of claims are weighed. However, it never occurred to me to advance my claim based on subjective complaints only. My claim was awarded 26 years after discharge and I never had a C&P!! I have vague recollections that I found specific cases where they required that a doctor actually see the symptoms. That is why I got pictures and statements from friends and submitted the ER reports.

I will research BVA cases over the weekend and pass along what I find.

[Hoppy]

These types of BVA cases caused me to go to the doctor every time I had an outbreak of angioedema after discharge for the purpose of having a doctor document the symptoms. Angioedema is a skin condition with visible symptoms that can be minor or so severe as to lead to throat closure and death.

Basically, the judge did not allow the veteran’s subjective opinion of the condition itself or the veteran’s subjective opinion that there was an increase in severity as evidence. Even though he had previously been service connected for the condition that judge would not even give the veteran credit that he was describing the same condition to the doctors.

Increase in rating:

Skin condition with known visible symptoms. They want the doctor to note what he sees not what the veteran tells the doctor is happening when he is at home.

Read this entire decision

http://www.va.gov/vetapp99/files2/9916192.txt

REMAND:

Thereafter, the RO should have the

veteran undergo a VA examination to

determine the severity of his fungal skin

condition. The claims folder should be

provided to and reviewed by the examiner.

The doctor should examine the veteran's

entire body and fully describe all areas

of fungal infection and residuals. Color

photographs of all affected areas should

be taken.

Read this entire decision at http://www.va.gov/vetapp96/files3/9629033.txt

The RO’s reduction in the veteran’s assigned rating from 10

percent to zero percent was based upon the findings noted in

the March 1994 VA examination report. The veteran reported

that he suffered from recurrent episodes of a skin disorder

manifested by itching and formation of small “bumps” in

various areas of his body. He also complained of occasional

outbreaks of solitary, small, “blister-like” lesions on

various parts of his body that became manifest spontaneously

and required several weeks to heal. However, the VA examiner

found no evidence of any lesions, and the skin was

“completely clear.” He could only diagnose urticaria from

the veteran’s subjective history.

The veteran contends that this examination report should not

have been the basis for the RO’s reduction in his disability

evaluation for urticaria. He argues that this condition is

chronic and frequent, but that it is not always present

during examinations. He notes that heat, humidity, nerves,

and any irritation or abrasion of the skin could trigger a

flare-up, including showers. Therefore, he avers that the RO

unjustly reduced his rating to zero percent for this

condition, as “hardly a day goes by that I am not affected by

it.”…………….

Both the veteran and his wife have provided statements

contending that the veteran has suffered from chronic

dermatologic problems that they associate with his service-

connected urticaria. Although their statements are credible

for the purposes of determining that the veteran has suffered

from recurrent dermatologic symptomatology, these statements

are neither credible nor probative with regard to the nature

or etiology of the veteran’s current symptomatology. The

record does not indicate that either the veteran or his wife

are medical professionals, with the expertise to provide

opinions or diagnoses of the veteran’s current skin problems,

or the etiology and specific severity of each of the multiple

dermatologic disorders noted in the record. Consequently,

their lay statements may be accorded little probative value.

See Espiritu v. Derwinski, 2 Vet.App. 492, 494-95 (1992).

Edited May 22, 2009 by Hoppy

[livingrock21]

Thank you to all!

Hoppy, I greatly appreciate all the time you've spent helping me out. I'm going to have to take into consideration all of this. My doc is very understanding about how hard it is to get down there (a little over an hour and a half) in pain. I have pictures, and I could take more recent pictures.

I wanted to update everyone, and see what everyone thinks. I talked to my doc today. She said it would not be possible to amend the C&P. She described the exam not to me. The rater left a lot out of reasons and bases. In her note she states all the treatments we have tried, along with all treatments while active that all failed. She also indicated that I couldn't work due to this condition, and described how I have to watch being very physical. The rater completely left these two factors out. Now, she did say in her note that the flares occur atleast once per day lasting 2 hours or more. Here's the kicker though that I really believe is going to help my appeal out. This C&P exam was a double appointment. I was supposed to have an appointment with her one day, and the following day have my C&P. She combined them, but still kept them seperate. She did the routine appointment, and then went right into the C&P exam. In the routine appointment she was asking about some of the things that made me flare, and I was telling her. I had told her about two days prior where I had to cut grass, it was real hot and humid that day, and I ended up flaring up for a day and a half straight. This is in her routine notes. That right there shows them that they "occur more then daily". They would have to give me the benifit of the doubt. Also, as far as me ever being seen while having a flare, I have. Many, many, many times. Just not since I've been off active duty. The doc that diagnosed me let me come in anytime I was flared up so she could see it. At that point, I only lived 10 minutes from the hospital also. My wife didn't work, so she was able to drive me. It was actually kind of funny, she'd want second opinions, and would refer me to a dif dr. Well, it seemed like every time an appointment would come up, I wouldn't be flared. That's just how this condition is.

I still need to go down and get a copy of this C&P exam, and also her appointment notes from that day. I called the records department at the VAMC, and they said I could just come down, sign a release and they'd print them out for me on the spot.

Taking all of that in. What do I do from here. I have proof they occur more then daily, and the rest of the rating criteria for 100% is already in her C&P notes. Do I submit her not as evidence, along with a letter explaining everything? If I go that route, I will also contact my congressman and let him know about this fudge. He knows(well his assistant) knows how badly they have treated me thus far. That's why everything has been happening so quickly. I truely think I might be able to get this turned around pretty quickly if I just get proactive about it.

--EDIT--

In the letter that I would send to them, I would spell out which pages of my SMR's show a doc examining my flares also.

Edited May 22, 2009 by livingrock21