Backpay

[cannoncocker]

I received a letter from my DAV REP from Winston-Salem, who is the best I have ever had, seems to be on my claim before the VA is!

It stated two main findigs, started at 60% disability and 20% For Lumbar Strain with pain down legs. That 20% resulted in no increase in Disability Compensation, due to VA Computation.

1. Service connection for Radicular pain pattern left leg; sensory is granted with an evaluation of 10% effective April 19, 2010 (QTC Eam was on 19 April 2010).

2. Evaluation of Lumbar Strain with L5-S1 herniated disc and IVDS involving sciatic nerve; previously claimed as lumbar strain with radiating pain through buttocks and down legs, which is currently 20% disabling, is continued.

That effective increases my disability to 70% and denies any back pay which I have been doing battle over this since April 2008.

Since I know now that this could not be possibly be budget related. Could some knowledgable person post the reasoning for this effective date of April 19, 2010?

Radicular pain pattern left leg; sensory has been established and claimed since 2008 and 2006 MRI's which shows exactly the pinched S1 at L5, Multiple VA Neurrology consults which found Radicular pain pattern left leg and sensory loss. They offered Epidural injections and surgery which I declined. IMO Chronic radiculopathy...2009 about July 2009.

A DAV Rep submitted a Layperson claim for me, stating Low Back Pain. Do I need a degree in medicine to submit a claim but all of the sypmtoms were noted to VA and IMO personell at the same time as Lumbar Strain with L5-S1 herniated disc and IVDS involving sciatic nerve; previously claimed as lumbar strain with radiating pain through buttocks and down legs and Radicular pain pattern left leg; sensory.

I need an opinion, as this was sent by the DAV REP, was this just run up the flag Pole to see if it would fly since nothing has been received from the VA. Should I just take the 70% and go crawl in a hole or fight this on to whatever end this leads?

Time for a lawyer and offer the 6000.00 just to fight it?

Keep on the DAV Rep since he for some reason knows weeks before the VA does before they do.

PS Still resisting IVDS diagnosis and staying with strain even though they write IVDS in their diagnosis. What is that?

Edited May 13, 2010 by cannoncocker

[Pete53]

I hope this helps.

Here's how my situation went:

I was SC 10% for asthma. I met the requirements for 30% last Fall. I met the requirements for 60% last Winter. I pointed this out clearly (and quoted that regulation). The VA did the rest and set my effective dates accordingly.

Most excellent and thanks for helping all of us with VA technicalities. Why give them the chance to screw it up?

[Vync]

Exactly!

[cannoncocker]

Dear Mr. Pete Sir: I did go to A QTC Severity Exam on exactly 19 April 2010, for severity as in how much my "lumbar strain" affected my life and ability to do any sort of work/recreational activities and measured by ROM and fortunately I brought my various MRI's and on a particular question it asked me about my history regarding my so called lumbar strain and I gave , apparently, way too much detail, but I wanted him to know he would be judged against an IMO (spinal surgeon}, one that is infinitely more qualified than him, and images that have been interpret by radiologists which leave very little wiggle room for his VA dictated interpretation. None the less he or the rater did the best they could, as you notice they split the diagnoses into 2 parts, one explicitly stating IVDS, but still not the diagnosis. They are clearly playing hard ball here which I am up for. The VA ran the 10% actual monetary increase up the pole to see if I would roil with that but by spitting the diagnosis they in effect denied the back pay from /April 2008, which is about 6000 bucks which as I said I would be more than willing to hand to a lawyer just because they are trying subterfuge and in general deny a vet by their own admission they deserve. If I rolled on this what chance do you think the next vet would have with this rater and as much as I hate to say it, how would the DAV rep know this far in advance what the VA was planning? Kind of makes one concerned about how friendly they are, but I am prone to conspiracy, especially after a few years of doing the tango with the VA.

Sorry for being so long but maybe somebody will get some use out of this.

Hey there Vync sir, like I said I am prone to conspiracy theory, just like you hopefully dispelled, but I guess it depends on how long this drags on. I still say he is the best DAV Rep I have had and he did tell me he sent the VA a memo that they were slap wrong about the back pay denial. I did not submit a claim for an increase for my back. This was a new claim and went to the DRO and required an IME to re-explain what the VA Radiologists and VA Neurologists explained in detail. The only difference was the nexus, i.e. repetitive heavy lifting, which resulted in Chronic left leg radiculopathy and loss of sensory on bilateral frontal lateral thighs, which by the had moved on to the left cald=f and left outer and bottom lateral foot to large toe. The only effective date I have is the date I submitted my claim. This severity exam was in theory supposed to be for severity, not for the purposse of diagnosis. But they hold the purse strings and adide by whichever rules they choose, or forced to adhere to.

Carlie , I know you've been around the so called VA block an appreciate your effort on my part. As negative as as sound, which in ordinary life I am actually pretty upbeat but the CFR is only as good as the rater is that is suppose to be applying them! It would be helpful to know the verbatim CFR to quote to the DAV Rep so he could quote that to the rater. As in should my diagnosis have been split into 2 parts for legal purposes or for the effective result of denying back pay. I would hand over the back pay in a heart beat to a lawyer to prevent a rater to get a pat on the back for beating a vet out of a legally entitled benefit. I am considering sending that proposal into my rep and having done some research into vet lawyers, for 6000 plus, I would go into my own pocket if it costs more to right this wrong since i have the money to do that, wrong in my opinion and wrong as I can see legally. Please tell me that they are correct not to pay back to initial claim other than normal progression of sciatica, which is what the true diagnosis is, the rusult of a pinched S1 at L5, or IMO Chronic radiculopathy, or:

1. Service connection for Radicular pain pattern left leg; sensory is granted with an evaluation of 10% effective April 19, 2010 (QTC Eam was on 19 April 2010).

2. Evaluation of Lumbar Strain with L5-S1 herniated disc and IVDS involving sciatic nerve; previously claimed as lumbar strain with radiating pain through buttocks and down legs, which is currently 20% disabling, is continued.

Point is nothing stays the same ordinarily. They wouldn’t have found any change in 2008 by the VA Neurologist, but by the QTC Consultant that found absolutely nothing wrong with my back in April 2009 when he initially examined me!

Vync I wrote the above before I read the definition of 38 CFR 3.400 ( o )( 2 ) and ( o ) Increases ( 38 U.S.C. 5110( a ) and 5110( B )( 2 ), Pub. L. 94-71, 89 Stat. 395; §§3.109, 3.156, 3.157 ):

Which boils down to earlist date of submission (18 April 2008) and nothing has changed than the normal progression, to the extent thet didn't even bother to change the diagnosis from lumbar strain, which I had a VSO look up the diagnostic code for Radicular pain pattern left leg; sensory, which the VA has diagnosed radicular pain pattern left leg multiple time dating back to 2008 and shown on MRI image of pinched S1 at L5 in 2008 and VA Neurologist noted thigh numbness and diagnosed it as pulled groin nerve , which has lasted 25 years and my regular doctor diagnosed it as meralgia paresthetica ( is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve that extends from the thigh to the spinal column(http://en.wikipedia.org/wiki/Meralgia_paraesthetica). These have been noted for years(2006) since MRI but the calf and footnumbness tingling developed as a normal progression of the S1 pinch and has been noted since 2008. The ER room had no interest in assessment aqas even the QTC doctor noted. Believ me when I tell you that when a QTC consultant demeans a medical facility it has to be below par, no much below par. They noted pain at waist line and gave me motrin. Went to Bn. aid station next day and no refferal, just changed to a different aspirin. I had to take leave up till the time of my ets rather than cashing out due to the intolerable pain, for a month.

"Earliest date as of which it is factually ascertainable that an increase in disability had occurred if claim is received within 1 year from such date otherwise, date of receipt of claim.

" There is no concievable way they could possibly find 19 April 2010, the date of my severity exam on 1. Service connection for Radicular pain pattern left leg; sensory is granted with an evaluation of 10% effective April 19, 2010. At any rate 10% is laughable.

This been so helpful in that it gives me insight that I am too close to for a clear appraisal.

So after skimming this do you think a lawyer is in order here? Write he DAV Rep and tell him of my intentions, because for a certainty, I will not let this stand, unless there is a consensus that I should write in and tell them I will accept their offer. I tend to find the thought of that loathsome.

Thanks to all. I would appreciate any off the cuff opinions on my course of actions from here. I have laid out most of what has transpired.

Edited May 14, 2010 by cannoncocker

[Pete53]

At least you know what they have and that you do have proof for an earlier effective date.

I will be glad when I see you success posted here about correct effective date

[cannoncocker]

Thank you Pete for ending that on a positive note. Evidence is an excellent thing to have on your side assuming you want to take it to the BVA, since I'm sure Home Boy at the W-S VA would love to push this on up the line a forget all about it. I wish they could be held accountable for a vengeful decision. I would rather keep it in their office and hold them accountable, to extent it is possible, plus it would not take as long and be cheaper.

Always good for a positive statement: such as Woof!

Edited May 14, 2010 by cannoncocker

[Berta]

THANKS Vync -I always forget there is an actual reg that explain the possible one additional year retro.

I copied this to a Officeorg doc so I dont forget this again.