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Please Help Explain These 2 Iris Responses

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usmc1114

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I really wish I would have found this site prior to going for my C&P exam. Anyway, I have submitted 2 IRIS in the past few months and these are the two responses I have received. I am correct in that it is my understanding that my file is sitting in a pile waiting for a rater to review it? Any help in terms of the next step and about how long it could take from until I receive a decision would be greatly appreciated. My claim is being processed through the Detroit, MI location. Thanks!

1. Your claim was sent to the rating board on May 20, 2009. The results of your examinations were recorded on your claim and your claim was sent to the rating board.

2. We show that as of June 8, 2009 your claim is ready for a decision. We are unable to give you a timeline when the rater will review your file as we do not know their caseload.

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  • HadIt.com Elder

Seems like you were examined for low back strain, left knee and left ankle issues. Is that what you put in for? anything more? Do you think the exam went well and covered your issues? Looks good to me the way its written, but I am just another vet with lumbar, knee disabilities and am not medical, just been at it many years.

Questions to consider - Do you take medication or get treatment for your conditions? Do you have ongoinig medical care at the VA or another doctors office? Is that mentioned somewhere else on the exam? All the support documentation aids getting the right rating firstime around. Honestly, I have submitted new information a week or so after an exam that I believed help the VA rate me right.

My questions are learned experiences with getting my own lumbar and knee connections. This seems to be a summary of the c&p exam. There is a worksheet that covers each of these, a guideline of how the exam should be conducted. Do you have a copy? If not I suggest while the exam information is current to you, review the c&p exam for safety sake. http://www.vba.va.gov/bln/21/Benefits/exams/index.htm My last c&p exam report was a few pages long and a bit more detailed.

I am interested in finding out about that meniscus tear, I checked MedlinePlus and it says 'Chondromalacia patella is the softening and degeneration of the tissue (cartilage) underneath the kneecap (patella).' At least in my mind its all connected.

Best to ya,

Cowgirl'up2009!

AS PER REQUESTED BY JOHN999, I AM POSTING THE SUMMARY OF MY C&P EXAM THAT I RECEVIED AT THE VAMC DETROIT. ANY & ALL COMMENTS ARE WELCOME. THANKS EVERYONE!

formation consistent with mild degenerative changes of the tibiotalar joint. No other osseus abnormalities are identified.

Three-view of the left knee done on today's date show no significant osseus abnormalities. There is a 0-degree valgus attitude to the left knee.

Three-view of the lumbosacral spine show a mild right-sided thoracolumbar curvature with normal lumbar lordosis. No significant degenerative changes are noted throughout the lumbosacral spine. There is facet arthrosis noted at the L4- L5 level.

IMPRESSION: 1. Chronic low back strain with early age-related facet

arthrosis. 2. Chondromalacia patella left knee. 3. Left knee medial

meniscus tear. 4. Chronic Achilles tendonitis left ankle and posterior tibial tendon tendonitis.

MEDICAL OPINION: Based on the history obtained today by the veteran himself along with review of the veteran's C-file and objective physical and radiographic evidence reviewed on today's date, it is my opinion that the veteran's current low back condition and left knee condition and left ankle condition have documented onset while enlisted in active military service as described above. These are stable in nature with the exception of low back pain, which subjectively has been becoming more frequent with mild worsening. Also noted on radiographic imaging are age- related changes to the lumbar spine and possible underlying lumbar scoliosis. Therefore, it is my opinion that the veteran's current low back, left knee, and left ankle conditions are at least as likely as not due to injury sustained while in active military service. The exception of this is suspected medial meniscus tear on the left knee, which is different from military service- documented left knee pain, therefore it is felt to be a new condition arising after separation from military service.

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Seems like you were examined for low back strain, left knee and left ankle issues. Is that what you put in for? anything more? Do you think the exam went well and covered your issues? Looks good to me the way its written, but I am just another vet with lumbar, knee disabilities and am not medical, just been at it many years.

Questions to consider - Do you take medication or get treatment for your conditions? Do you have ongoinig medical care at the VA or another doctors office? Is that mentioned somewhere else on the exam? All the support documentation aids getting the right rating firstime around. Honestly, I have submitted new information a week or so after an exam that I believed help the VA rate me right.

My questions are learned experiences with getting my own lumbar and knee connections. This seems to be a summary of the c&p exam. There is a worksheet that covers each of these, a guideline of how the exam should be conducted. Do you have a copy? If not I suggest while the exam information is current to you, review the c&p exam for safety sake. http://www.vba.va.gov/bln/21/Benefits/exams/index.htm My last c&p exam report was a few pages long and a bit more detailed.

I am interested in finding out about that meniscus tear, I checked MedlinePlus and it says 'Chondromalacia patella is the softening and degeneration of the tissue (cartilage) underneath the kneecap (patella).' At least in my mind its all connected.

Best to ya,

Cowgirl'up2009!

You are 100% correct as to what the exam was for..left ankle, knee and back. Here is the full 3 pg report.

This is for service connection fo"r~a~left knee, left ankle, and back condition.

HISTORY: This is a 39-year-old Caucasian veteran enlisted in active military service 12/02/87 through 05/24/94. His primary complaint is low back pain. Regarding this, he states that during boot camp in 1988 while climbing in the mountains he sustained a twisting-type injury to his back and also to his left knee, bringing on throbbing type of pain. He did seek treatment for this. Review of the C-file indicates that in April of 1988 he had a diagnosis of low back strain and chronic lumbar pain, onset after standing, without documented injury. The veteran states that since this time the pain has become more constant and uncomfortable including muscle spasm to the upper lumbar spine. The patient has had formal workup without MRI in the past. He has not had any recommendations for surgical intervention. Radiation is not a significant complaint at this time.

Regarding the left knee, once again during this same incident in 1988 he had a twisting type injury, and also with a reinjury in 1991 during physical therapy-type exercise. Essentially he has had chronic knee pain since approximately 1990 or 1991. On review of the veteran's C- file this is documented as a chronic left knee pain onset during December of 1981. He has been given the diagnosis of chronic chondromalacia patella without evidence of significant injury on the C-file. His current complaints including continuation of throbbing type sensations located to the anterior aspect of the knee, peripatellar region, with a more recent onset of posterior medial joint line pain, increasing with deep flexion, without history of new or recent injury. He does state that his knee feels like it gives out on him occasionally.

Regarding the left ankle, approximately in 1988 he had the onset of pain. He states he has had multiple sprains throughout his military career, reinjuring it on several occasions. Also the pain is located over the posterior aspect of the ankle and near the Achilles tendon. Review of the C-file indicates a history of treatment for left ankle tendonitis and a chronic heel pain with Achilles tendonitis. These conditions have remained relatively stable with the exception of his low back pain.

He denies any change in bowel or bladder habits or any history of infection involving a bone. He is right handed. He is currently employed through the VA in Saginaw in administration. He is on no formal work restrictions. He states he uses an occasional brace to his knee during some activities as well as to the ankle, but none worn on today's visit. His primary complaints are pain with some associated weakness, stiffness, swelling, instability, and locking. He denies heat, redness, or infection. He has previously undergone physical therapy for the left knee, without significant long-term improvement. He has not had injections. He states he gets four to six flareups per month rated as an 8 or a 9 on a scale of 1 to 10. They are associated with overuse and activity, primarily involving the low back and occasionally the left knee, with some alleviation by rest, ice, and Motrin. He also takes an occasional muscle relaxant for his back pain. He denies any side effects. He has not had any orthopedic surgeries. He denies any history of fracture, dislocation, or recurrent subluxations. He states he does have some mild difficulty with strenuous activities involving the left knee and low back, however, not much difficulty walking, driving, grooming, toileting, eating, or shopping. He still is able to participate in recreational activities. He denies any incapacitating episodes over the last 12 months. He denies any orthopedic implants or prosthetic devices.

PHYSICAL EXAMINATION: Physical examination reveals a 39- year-old Caucasian male who appears his stated age. He is cooperative with the examination today. Focused examination of the low back reveals a mild amount of increased tone over the thoracolumbar junction on the left. There are no midline defects or skin markings noted. Sagittal and coronal alignment throughout the lumbar spine is maintained. Flexion is 0 to 80 degrees, extension 0 to 30 degrees, side bending to the right and left 0 to 45 degrees respectively, and rotating to the right and left is 0 to 45 degrees respectively, which is normal. Straight leg raise and Lasegue test are negative. Deep tendon reflexes are brisk +3/4 and equal bilaterally with positive Hoffmann's bilaterally. There are no lateralizing signs. Three-beat clonus is noted bilaterally. Motor and sensory examination reveals +5/5 motor and sensation to the bilateral lower and upper extremities. Heel-toe rise and gait are non-antalgic.

Focused examination of the left knee reveals the skin to be intact. There is no effusion present. There is mild tenderness to palpation in the peripatellar region without significant crepitus. There is mild posterior medial joint line tenderness with positive McMurray's test. ACL and PCL show grade 1 laxity bilaterally. Collateral ligaments are stable to varus and valgus stress. There is no ankylosis and no significant pain with passive range of motion.

Regarding the left ankle, the skin is intact. There is no effusion present. There is no malleolar pain. There is no instability on anterior or posterior drawer. Inversion and eversion along with dorsiflexion and plantar flexion show normal range of motion with the exception of 10-degree loss of dorsiflexion due to tight Achilles tendon. There is tenderness to palpation over the insertion point of the Achilles tendon and over the posterior course of the posterior tibial tendon. Single leg toe rise is tender on the left. Range of motion measured dorsiflexion 0 to 10 degrees, plantar flexion 0 to 45 degrees, inversion 0 to 30 degrees, and eversion 0 to 20 degrees, which is normal. There is no evidence of tendon subluxation. There are no abnormal callosities noted.

Repetitive motion testing per DeLuca criteria revealed no additional limitations of motion due to pain, fatigue, weakness, or lack of endurance tested three times.

IMAGING: Three-view left ankle done on today's date show mild osteophyte formation consistent with mild degenerative changes of the tibiotalar joint. No other osseus abnormalities are identified.

Three-view of the left knee done on today's date show no significant osseus abnormalities. There is a 0-degree valgus attitude to the left knee.

Three-view of the lumbosacral spine show a mild right-sided thoracolumbar curvature with normal lumbar lordosis. No significant degenerative changes are noted throughout the lumbosacral spine. There is facet arthrosis noted at the L4- L5 level.

IMPRESSION: 1. Chronic low back strain with early age-related facet

arthrosis. 2. Chondromalacia patella left knee. 3. Left knee medial

meniscus tear. 4. Chronic Achilles tendonitis left ankle and posterior tibial tendon tendonitis.

MEDICAL OPINION: Based on the history obtained today by the veteran himself along with review of the veteran's C-file and objective physical and radiographic evidence reviewed on today's date, it is my opinion that the veteran's current low back condition and left knee condition and left ankle condition have documented onset while enlisted in active military service as described above. These are stable in nature with the exception of low back pain, which subjectively has been becoming more frequent with mild worsening. Also noted on radiographic imaging are age- related changes to the lumbar spine and possible underlying lumbar scoliosis. Therefore, it is my opinion that the veteran's current low back, left knee, and left ankle conditions are at least as likely as not due to injury sustained while in active military service. The exception of this is suspected medial meniscus tear on the left knee, which is different from military service- documented left knee pain, therefore it is felt to be a new condition arising after separation from military service.

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  • HadIt.com Elder

Sure hope you get service connected and rated correctly first time for whats due you. Medical opinions, phrases and words are key. Interesting is the '1981' date, mentions of 'he denies' and 'without diagnosis of significant injury on the Cfile'. But if it reads 'at least as likely as not' due to injury sustained while in active military service, well, hm. Its been posted somewhere in the physicians guide, but guarentees in life are few..

"is due to" (100% sure)

"more likely than not" (greater than 50%)

"at least as likely as not" (equal to or greater than 50%)

"not at least as likely as not" (less than 50%)

"is not due to" (0%)

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Sure hope you get service connected and rated correctly first time for whats due you. Medical opinions, phrases and words are key. Interesting is the '1981' date, mentions of 'he denies' and 'without diagnosis of significant injury on the Cfile'. But if it reads 'at least as likely as not' due to injury sustained while in active military service, well, hm. Its been posted somewhere in the physicians guide, but guarentees in life are few..

"is due to" (100% sure)

"more likely than not" (greater than 50%)

"at least as likely as not" (equal to or greater than 50%)

"not at least as likely as not" (less than 50%)

"is not due to" (0%)

What steps should I take if I see things that are not true or that I did not say during the C&P exam? As an example, he writes "He still is able to participate in recreational activities". This is not true, I can no longer play softball or basketball like I used to. Also, the December of 1981 info is a typo. I was 11 or 12 yrs old at that time. The date should reflect 1991. Should I submit something now or do I have to wait for the decision and then appeal if the rating is "wrong"? One last question...This claim was initially filed Jan 2008, if I am denied and have to appeal and win on appeal, what date do they use the January 2008 or the date I file the appeal? Thank for everything...I greatly appreciate it.

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  • HadIt.com Elder

Wonders where the 1981 date came from, SMRs or VA med files? or? At the end of my c&p exams, the examiner asked if I wanted to make any statements to support my claim. Doc also wrote down my statements made during the exam. If not sure, maybe best to wait.

Chose to challenge one c&p exam, totally up to the c&p department,rater if a c&p needs redone. So I didnt get a new exam, even though I didnt get the iu, a serious health condition was connected back many years and that was good. IU is NOD processing again now.

An idea is if you have some medical diagnosis saying 'druther' compared to what the doc wrote then maybe request another exam if not hold yer horses is my thought.

cg

What steps should I take if I see things that are not true or that I did not say during the C&P exam? As an example, he writes "He still is able to participate in recreational activities". This is not true, I can no longer play softball or basketball like I used to. Also, the December of 1981 info is a typo. I was 11 or 12 yrs old at that time. The date should reflect 1991. Should I submit something now or do I have to wait for the decision and then appeal if the rating is "wrong"? One last question...This claim was initially filed Jan 2008, if I am denied and have to appeal and win on appeal, what date do they use the January 2008 or the date I file the appeal? Thank for everything...I greatly appreciate it.
Edited by cowgirl
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What steps should I take if I see things that are not true or that I did not say during the C&P exam? As an example, he writes "He still is able to participate in recreational activities". This is not true, I can no longer play softball or basketball like I used to. Also, the December of 1981 info is a typo. I was 11 or 12 yrs old at that time. The date should reflect 1991. Should I submit something now or do I have to wait for the decision and then appeal if the rating is "wrong"? One last question...This claim was initially filed Jan 2008, if I am denied and have to appeal and win on appeal, what date do they use the January 2008 or the date I file the appeal? Thank for everything...I greatly appreciate it.

They will go back to the date and timestamp on your claim.

Looks like you are going to get service connection for your 3 body parts. That is usually the larger battle, getting the VA to grant service connection. ..

My first claim was "chronic back sprain" and the max for it is 40%. I also had a claim for knee and ankle but those were denied. The knee seems to be a joint that the VA likes to deny or lowball.

Keep in mind the VA does not rate for the problem, but the affects of the problem. It is called functional loss and pain. With the back it is radiating pain that really gets you the higher percentages and how far you can bend and rotate without pain. Also it is what level of pain management is required to control your pain. It states you do not have radiating pain from your back. That is probably going to cut your rating on the back to the low side.

How many times a year you are laid up from your back and lose time from work really matters. Also the pain levels and how oftern and what eleviates it matters. You are probably taking flexeral, which is not a bad drug, but it is pretty mild on the pain mangement scale. Also how your bodily functions are impacted by your back, which is why they ask the bowel and urination questions.. that indicates surgery is needed.

While MRI's are important, there are other tests which provide better evidence for your back. An NCV/EMG is a great test, it basically measures any nerve or muscle damage in the leg. And the best evidence of all are the treatment records.

I am not trying to be negative with this post, just trying to set your expecations. I had chronic back sprain with radiuclopathy down the left leg and a dropped foot and got 40%.. which was the max.

But keep in mind that your rating is based upon your diagnosis. If your back gets worst, which it will over time, your rating will change. Eventually my back problems were rediagnosed and at my one year reevaluation it came up, and I filed for an increase and was instantly upped to 80%.

Just make sure that you inform your doctors at the VA of what is going on with your pain and what problems you are having.. and get treated. Get physical therapy for your back, it might help you.

Good Luck and don't worry.

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