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Brown Envelope And Questions


My Monster

Question

If this is the wrong place to post this I am sorry, feel free to move it.

Mixed bag all around...40%. Lot's of diagnosis that ended with denials due to no treatment shown in SMR. Let's start with what they did grant:

Strain, Left Wrist 10%

Strain, Left Knee 10%

Strain, Right Knee 10%

DDD, L-spine 10%

Tinnitus 10%

Hearing Loss Lft 00%

Denied:

Strain, Rt Wrist

Strain, Bilateral Hip

Bilateral Hand Condition

Strain, Rotator Cuff, Rt Shoulder

"Tennis Elbow", Bilateral

Hearing Loss Rt Ear

SA

GERD

Shingles

GAD

Depression

There are several glaring mistakes in the right up, especially for my back. It states that they didn't find any evidence of radiating pain, I stated where, when and how it shoots down my butt checks and legs. SLR tests hurt like hell. The goniometer was not used to evaluate my any of my ROMs, but they have numbers written down.

For my Carpal Tunnel Syndrome the examiner stated he found that I could pick and tear paper (was never asked to, nor did I pick up and tear anything!), tie my shoes ( um, I wore slip-on sandles so no laces to tie), and that I could fasten buttons (I undid 1 button with my left hand and slid out of my shirt for my x-rays-the examiner wasn't in there).

Shingles is somehow magically cured and you never get it again, at least that is the impression I took from the denial.

GERD was diagnosed and denied because I take over the counter stuff and never went to sick call for it, however looking at all the damn meds I have been prescribed over the years SHOULD service connect it at least as a secondary to my back, right?

Hip strain diagnosed/denied I didn't see a doc about it while in.

He noticed that I didn't move my head very much, asked me if I wanted to add that now to my claim and sent me off to get more x-rays. I called and checked on that claim with the VA, they said it was never submitted. They did ask when the x-rays and claim was made. I explained the story of how the doc was supposed to of added it to the last exam, so they added that over the phone and are asking the examiner where the hell those x-rays are.

The Mental Health part, wow where to start there? The write-up states that since I am a Gulf War vet (to include OEF/OIF) and that I filed within my prescribed 2 year window of retirement that I am entitled to treatment because a mental illness WAS diagnosed. However they denied my diagnosed General Anxiety Disorder and my Depression because it wasn't diagnosed while I was in. The examiner stated during the exam that the depression was due to my back ( now SC ) and that the GAD was more than likely due to the "high stress levels of my jobs", in fact he said I hit every check-point on the criteria for both diagnosis. WTF?! How are they denied then? (VENTING there)

Now for the refresher: I retired in Aug 09. I wasn't a big fan of ME going to sick call, but I did push my Marines to go, bad on me taking care of me I know. One rep says my denials should of been "presumptive" due to be being out less than a year and that if I had made my VA claims via BDD I would of been covered. Great, I spent my last 3 years in Okinawa and the VA rep that flew in for our SEPS class said we were not eligible for that overseas due to not having any examiners there for VA claims. I need to get a copy of my C-file and figure out where to go with this. I have an appointment with my DAV in 2 weeks for him to review this mess. Any input would be appreciated, I am off to make dinner and consume the almighty bourbon before my head explodes...

Monster

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  • HadIt.com Elder

Hi JarHEad.

First of all, are you being treated for any of the claimed disabilities by the VA? If so, do you have copies of your VA med recs?

Secondly, do you have any civilian medical treatment records for any of the claimed disabilities?

Do you have in your possession all of your Service Medical Records and Service Treatment Records?

If you are seeking help for your depression at the VA Med Center, are you receiving regular visits to your psych doctor, and do they have a "group grope" set up for you to attend?

If not, make sure your Primary Care Physician sets you up with a psych appointment and, when there, ask for any group or private therapy that they may have available.

I'm telling you this, so that you may begin documented treatment/evidence for your Major Depressive Disorder.

Semper Fi!

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Fellow JarHead (Larry),

I have not been seen by the VA. I am headed out tomorrow for my VA Medical card. I am tired of "suckin'-up" the pain (bourbon only keeps it at bay for so long), so I will go in when needed. I am going in for epidurals for my back via TriCare. Now that my knee is SC I will be scheduling ortho surgery for it. I have a copy of my SMR, I am going through it with a fine tooth comb to see if I can find any more pertinent entries. I am not receiving mental help at this time. The head examiner seemed shocked that I have not been seen before. I was lucky in hiding my dirt, not the smart thing to do, but that is that. I am losing my temper more frequently and it is more than a growl lately, not at persons mind you, but the desire is getting closer. I try to stay isolated until I get it figured out but there are times I just can't, the family relies on me to keep the "house" going even if I don't feel like it. Sounds like doom and gloom doesn't it? "Bunk up little camper, the sun will be out tomorrow..."

Monster

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There is plenty here you can rebutt but some of these disabilities do need the inservice nexus.

Write to the RO you deal with and ask for copy of your C file.

When you rebutt this ,make sure you mention anything you sent in as evidence is listed ion the decision-if it isnt listed they didnt consider it.

"The examiner stated during the exam that the depression was due to my back ( now SC ) and that the GAD was more than likely due to the "high stress levels of my jobs", in fact he said I hit every check-point on the criteria for both diagnosis. WTF?! How are they denied then? (VENTING there)"

Do you have copy of this exam? That can be requested from the VAMC where the exam was done.Did they mention thia exam at all in the decision?

Did they prescribe NSAIDs for the back or any other condition?

If so the GERD can be secondary to the NSIADs.

The 40% SC is a foot in the door -Congrats on that!

Edited by Berta
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  • Content Curator/HadIt.com Elder

C&P Exam Results

Per Berta, get a copy of this. Don't just get a copy of one exam results, but get copies of all exam results. Do you have a copy of the C&P exam results? If not, get them. Knowing exactly what the docs logged will help you formulate a better response.

C-File

Per Berta, get a copy of this. Don't be surprised if it takes a while to arrive. I have been waiting about six months and still have not received my copy.

Back

My private neurologist did not use a goinometer, but my VA C&P doc did. Ironically, the numbers were just about identical, but the C&P doc's numbers were in ranges like 0-15 or 0-30. Not using the goinometer is bad. I just checked my C&P exam and it did not indicate if the doc used a goinometer or not, though I know they did.

GERD

Per Berta, research your treatment records for your DDD. If they prescribed NSAIDS (ibuprofin, naproxen, etc...) it can cause GERD or other gastro problems. They may need to do an upper GI or a scope exam to confirm GERD.

MH

Revisit the Depression, because you are now SC for DDD. Also, remember you can have only one MH rating, which is for the worst one, regardless of how many MH-related conditions you have. Regardless of your conditions, you should look into being treated. You can get meds and counseling at the VA MH clinic, which might help you feel better. You can also visit your local vet center which is usually more relaxed and inviting, but they don't prescribe meds. You can also see both.

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Agree with Berta. This is a pretty good initial rating. Now they are hoping you accept it and leave them alone. Which of course is not going to happen. Keep the pressure on, especially with the MDD. It should be rated as secondary at the very least. Also the GERD if you have taken NSAIDs. I am 10% for GERD due to years of Motrin and other NSAIDs prescriptions and use. You can google NSAIDs for a list of meds. Definitely pursue the cervical spine DDD. If you have lumbar ddd, you probably have cervical ddd and ROM is important.

If you order your c-file and are waiting for it, make sure you don't miss any deadlines for the NOD. It took over 15 months for me to get my c-file from St Pete. Not sure what VARO you are working with.

Good luck and you will definitely get above the all important 50% in the near future. Get an EMG for your carpal tunnel. That is an accurate way to diagnose CTS. Not tearing paper :) You are now finding out how the C&P examiners work. Deny, Deny, Deny!!

Edited by mags1023
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Berta: I have taken a boat-load full of NSAIDs over the years for my back and other various ailments. I would of thought that once they SC'd my back and knees that they would of automatically tied the GERD and Depression as a Secondary to them. Dumb or niave on my part I guess.

I am working on getting my C-file so I can get a better look at the actual examiner's notes. I went through a QTC office for the exams. They did not mention anything about the psychiatrist tying the depression to my back issues, which he did directly when he was examining me. I need to see his notes. No mention of me stating that my wife takes issue with me snapping at her and the kids, just that she "complains of my anxiousness and constant worrying". There is a blurb of in my SMR of "you were treated for being short-tempered and irritable. You stated that it was just part of my personality, and no other diagnosis or treatment was shown." That was taken from a post deployment assessment and all I wanted to do then was go home at the time. I was short tempered and irritable but not to the extent I am now. Not even close. They pointed out that I "denied being anxiety, nervousness, depression, or excessive worry on my discharge exam". Hell I was in the middle of packing my family up and moving from overseas, I was rushing through everything just to meet the deadlines I had. Dumb, dumb, dumb on my part, it is coming back to haunt me now.

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  • Content Curator/HadIt.com Elder

Prolonged NSAIDS usage hoses up the lining of your stomach. This leads to GERD. Then the VA will probably give you some antacid like omeprazole. That puts out the GERD fire, but causes headaches and hoses up your lower intestines. Seems like a chain reaction here, but remember treatment/side effects of SC conditions can also be SC. Secondary SC, Secondary SC, Secondary SC...

Another case where the QTC examiners cause problems. My C&P examiners have luckily all been VA staff physicians...

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  • HadIt.com Elder

Anything even food has side affects. Its best to learn as much as you can cause for some they learn to late. Its a fine line but for me I know I will never eat another grapefruit not will I take any over the counter pain meds. I will do my best to take my meds as prescribed.

Vync an excellent post thank you.

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I would of thought that once they SC'd my back and knees that they would of automatically tied the GERD and Depression as a Secondary to them. Dumb or niave on my part I guess.

MyMonster,

No disability will be "automatically tied" even as secondary, to an already SC'd disability.

A doctor must provide a nexus in writing and for MH issues it has to be a MH doctor.

jmho,

carlie

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Carlie: What I meant by "automatically tying in" was that I claimed GERD and assumed they would put that in as a secondary to the back. I have to file for GERD and MDD again, now as a secondary to the SC Lumbar DDD? Does this mean another round of C&P exams for both?

Pete and Vync: I am now well versed in what and when I can eat certain foods. LOL Not very often on some of my favorites. The last bit of meds TriCare gave me I thought for sure were going to kill me. Tramadol helps with some of the pain but it makes me heave after every meal, and I thought the GERD was bad before.

Mags: I'm pissed so yup, I am dug in for a fight.

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Carlie: What I meant by "automatically tying in" was that I claimed GERD and assumed they would put that in as a secondary to the back. I have to file for GERD and MDD again, now as a secondary to the SC Lumbar DDD? Does this mean another round of C&P exams for both?

My Monster,

Unless your medical records, progress notes etc... contain everything needed to rate the Gerd and MDD, then yes,

C&Ps maybe ordered by the decision maker.

The MDD will have to be done by a MH professional.

For the Gerd they may order an upper GI to RO Hiatal Hernia.

I have taken VA RX'd aspirin for about 30 years for SC'd Migraines from TBI - I filed a claim for Gerd - decision maker ordered

an upper GI - showed hiatal hernia - C&P examiner stated Gerd was caused by Hiatal Hernia -

no Hiatal Hernia shown in SMR/STRs - claim for Gerd denied.

I suggest an IME/IMO.

jmho,

carlie

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Carlie,

I had the C&P for both the GERD and MDD, and their examiners diagnosed both. Pop Rocks and the barium drink suck, watching the reaction of the stomach on TV was cool but I don't think I want to do it again. If I already had the ordered C&P exams for them will I have to get them done for a second time in order for them to be granted as secondary to my lumbar DDD?

Monster

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  • Content Curator/HadIt.com Elder

I personally think the upper GI procedure would be more bearable if they had a bed with a cushion instead of a hard radiology table.

Regarding the exams, I had the upper GI about 13 years ago, a C&P exam for GERD last month, but no repeat upper GI. The doc opined the connection from my VA treatment records and VA prescription history.

If you don't already have you C&P results, get them.

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Carlie,

If I already had the ordered C&P exams for them will I have to get them done for a second time in order for them to be granted as secondary to my lumbar DDD?

Monster

My Monster,

What you will need is for the doctor to write something like, (for the MDD must be a MH doc),

In my medical opinion the veterans diagnosis of Gerd/MDD is at least as likely as not a secondary condition in relation to

this veterans SC'd XXX.

Then they need to support this statement with their medical rationale.

jmho,

carlie

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