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Question About Some Claims

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Tomahawk

Question

Okay Ill try and keep this short so people with experience dont have to read a book to respond. The long of the short is that it took about 9 years for my to get my disability approved. Im currently rated at 30%. I was told and was under the impression this was for flat feet. My original claim was for left foot condition that at the time was not diagnosed properly. I was discharged medically due to "Hallux Vulgus" yet that was not the underlying condition. At any rate after 9 years they finally came back with the flat foot rating because I didnt have flat feet going in but do now. I actually have RSD in my foot/lower left calf. So I filed for an increase after talking to my pain managment doctor. All of my treatment is done at the VA

It is clearly documented that my foot condition is CRPS/RSD in my VA treatment records. And I have statements in my SMR that clearly indicate RSD back then.

1.) With my claim for the CRPS (granting they approve it) will they back date it to when I filed my original claim as I applied for the increase within 1 year of receiving my 30% decision?

2.) To prove something is service connected do I need the stated issue sited in my SMR or is having multiple "general" treatment for conditions good enough? For example I had an MRI in 2006 of my back that states " There is an apparent left pars defect of L5 suggestive of unilateral spondylolysis. Incidental note of Spina bifida Occult of L5. Sagittal images shows posterior disc bulge at T11-T12 which narrows the spinal canal at thsi level. Conus medullaris is displaced posteriorly. At l4-l5 there is hypertrophy of both facet joints causing mild bilateral beural foraminal narrowing. And in my SMR I have multiple low back strains as well as documented contusions in the T5 and T9 areas. However I never had an MRI when I was in the service.

3.) What is the best way to get a VA doctor to write a nexus? Do I just request a referral from my PCP for a specialist in that area specifically to be examined for the possibility of service connection? For example I have Sleep Apnea with documented sleep troubles while in service and a buddy statement saying I snored and occasionally woke up gasping. I am also on meds that are known to exacerbate OSA. So do I just request to be seen by the sleep lab people again and ask them to review my case or do I actually need to find a doc outside of the VA?

I have more but those are my main concerns for now. Its been over a year since my initial request for increase and due to logistical issues I still havent had my C&P exam so Im trying to get all my ducks in a row prior to going to the regional office.

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It sounds like you were a victim of Shreddergate- then again the VA doesn't shred much I hope- because they usually lose it first.

I can sure relate to your frustrations in sending and resending what they lost or misplaced.I had to do that myself MANY times.

Do you have a copy of the entire Bethesda Report?

"as I was discharged due to the navy doc screwing up my surgery on my foot"

Do you mean you were PEBed or MEBed out? If so are you sure VA has that information?

Were you given any rating by the Navy?

It would be good to get a copy of your C file too as it concerns me that the VA is reconstructing your file.

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There is info on the net on your condition and this article struck me:

"Complex Regional Pain Syndrome Type I (RSD)

CRPS development does not appear to depend on the magnitude of the injury. The sympathetic nervous system seems to assume an abnormal function after an injury.

Since there is no single laboratory test to diagnose CRPS, the physician must assess and document both subjective complaints (medical history) and, if present, objective findings (physical examination)."

http://www.rsds.org/2/what_is_rsd_crps/index.html

It is saying that documented symptoms would have to be considered along with any objective findings.

I was also surprised at the bone scan. I had a bone scan and it revealed I didn't have osteoporosis-I saw the print outs of the scan and I don't know how a bone scan would reveal a neurological condition?

I dont think these VA doctors had a clue as to what your condition really is.

"Ive also requested a consult with my PCP to see a neuro doc." That in my opinion is an excellent idea.If the secondaries you claim are diagfnosed and current, then the neuro doctor would be the one to opine as to whether there is any secondary SC potential here if they grant the prime disability as SC.

"What is the best way to get a VA doctor to write a nexus? Do I just request a referral from my PCP for a specialist in that area specifically to be examined for the possibility of service connection? For example I have Sleep Apnea with documented sleep troubles while in service and a buddy statement saying I snored and occasionally woke up gasping. I am also on meds that are known to exacerbate OSA. So do I just request to be seen by the sleep lab people again and ask them to review my case or do I actually need to find a doc outside of the VA?"

You have evidence there that they need to consider but in my opinion- only a real doctor, and in this case an outside Neuro would be great-can really explain this to VA as to how your condition is from service -and as it appears to be directly related to the 30% SC you get now.That s my opinion as to the nexus to the 30% but a real doctor might agree)

Or it could be aggravated by the SC condition.Then they would have to service connect the 'aggravation'It sounds like the surgery in the military damaged a major nerve in your foot. Do you have the surgical notes in your SMRs?

There is an IMO criteria that any independent IMO doctor has to follow and it is in the IMO forum here.

Has the VA ever prescribed NSAIDs to you and if so do you also have GERD?

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One more thing- there are only 16 claims that I found at the BVA on this condition.

If you go to http://www.index.va.gov/search/va/index.jsp

and then click on the link to the appeals decisions ( the VA s changing their web site around and the regular BVA links dont work) and put the intials of this disabilioty into the search feature and then click on all years and then search- more info will pop up in the 16 decisions that could possibly help you with this claim.

When I see so few similiar disability cases for your disability- it makes me all the more sure that VA docs probably don't have a clue on what it is.

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It sounds like you were a victim of Shreddergate- then again the VA doesn't shred much I hope- because they usually lose it first.

I can sure relate to your frustrations in sending and resending what they lost or misplaced.I had to do that myself MANY times.

Do you have a copy of the entire Bethesda Report?

"as I was discharged due to the navy doc screwing up my surgery on my foot"

Do you mean you were PEBed or MEBed out? If so are you sure VA has that information?

Were you given any rating by the Navy?

It would be good to get a copy of your C file too as it concerns me that the VA is reconstructing your file.

Yes I have a copy of the bethesda report. I was medically discharged from the Marines for "Hallux Vulgus" which is a fancy name for a bunion. However I injured my foot and they did surgery and screwed it up. It was not a bunion. I tore the tendons and ligaments in the foot and it healed wrong as they diagnosed me with a strain and I had to run around on it for 3 weeks before the XO made me go to a podiatrist. I was given 10% at discharge. And Im fairly certain the VA has that info though there is no way for me to tell as they lost my file twice. Actually three times however I saved the letter they sent me after my 3rd submission so they honored that date.

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There is info on the net on your condition and this article struck me:

"Complex Regional Pain Syndrome Type I (RSD)

CRPS development does not appear to depend on the magnitude of the injury. The sympathetic nervous system seems to assume an abnormal function after an injury.

Since there is no single laboratory test to diagnose CRPS, the physician must assess and document both subjective complaints (medical history) and, if present, objective findings (physical examination)."

http://www.rsds.org/...crps/index.html

It is saying that documented symptoms would have to be considered along with any objective findings.

I was also surprised at the bone scan. I had a bone scan and it revealed I didn't have osteoporosis-I saw the print outs of the scan and I don't know how a bone scan would reveal a neurological condition?

I dont think these VA doctors had a clue as to what your condition really is.

"Ive also requested a consult with my PCP to see a neuro doc." That in my opinion is an excellent idea.If the secondaries you claim are diagfnosed and current, then the neuro doctor would be the one to opine as to whether there is any secondary SC potential here if they grant the prime disability as SC.

"What is the best way to get a VA doctor to write a nexus? Do I just request a referral from my PCP for a specialist in that area specifically to be examined for the possibility of service connection? For example I have Sleep Apnea with documented sleep troubles while in service and a buddy statement saying I snored and occasionally woke up gasping. I am also on meds that are known to exacerbate OSA. So do I just request to be seen by the sleep lab people again and ask them to review my case or do I actually need to find a doc outside of the VA?"

You have evidence there that they need to consider but in my opinion- only a real doctor, and in this case an outside Neuro would be great-can really explain this to VA as to how your condition is from service -and as it appears to be directly related to the 30% SC you get now.That s my opinion as to the nexus to the 30% but a real doctor might agree)

Or it could be aggravated by the SC condition.Then they would have to service connect the 'aggravation'It sounds like the surgery in the military damaged a major nerve in your foot. Do you have the surgical notes in your SMRs?

There is an IMO criteria that any independent IMO doctor has to follow and it is in the IMO forum here.

Has the VA ever prescribed NSAIDs to you and if so do you also have GERD?

Yeah the VA did an MRI to get the CRPS diagnosis so Im not sure why he said R/O because of the bone scan. I mean in phase 3 bone density does decrease, but I highly doubt that would happen within 6- 8 months in order to show up on a bone scan. But I did have a bone scan as well at the VA and I do have some kind of porisis ending thing in my foot bones.

Ill have to look around for a neurologist to do an IMO then. Hopefully they will take payments as Im currently living off of my 376 a month disaility and 547 from voc rehab.

As for NSAIDS.. I was on 500mg of Naporsyn for 6 years because of my foot. and I had heartburn from about a year before discharge until May 16th this year. I was on omeprozole for 7 years then switched to prevacid and given an endoscopy. Which showed i had barrets esophagitus a hiatel hernia and 3 erosions on my throat and 2 in my stomach and severe GERDs. After that endoscopy and 3 months on prevacid they had me outsourced to University Hospitals for a second endoscopy to have a Bravo PH monitor implanted in my throat. That tested acid levels while I was still taking prevacid. It showed that I had well above severe acid levels while still on the medication. So they doubled the maxium dose so I was taking 60mg of prevacid 3 times a day still with not relief. So in May they did a Nissen Fundoplication and so far I havent had any reflux. I go in on the 8th to see the chief of surgery and then he is schedulig me for another endoscopy.

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One more thing- there are only 16 claims that I found at the BVA on this condition.

If you go to http://www.index.va....ch/va/index.jsp

and then click on the link to the appeals decisions ( the VA s changing their web site around and the regular BVA links dont work) and put the intials of this disabilioty into the search feature and then click on all years and then search- more info will pop up in the 16 decisions that could possibly help you with this claim.

When I see so few similiar disability cases for your disability- it makes me all the more sure that VA docs probably don't have a clue on what it is.

Thank you very much for the help. Ill take a look at that tonight and see if I can find anything to help. I know my pain management doctor is very familiar with the disease. And Im sure he would have no qualms writing a letter to the RO about it however he has been on an emergency LOA for about a month and Im not sure when/if he is gonna return. Like I said he took really good care of me and was trying everything. I really dont like taking any drugs especially pain meds. So I suffer with the pain as best I can. His next steps were to be spinal injections and if that didnt work then a spinal stimulator. however the guy Im seeing since he left is a joke. He knew nothing about me and literally spent less than 10 minutes askign questions and listening to me. Check and saw my BP was high the passed few times I came in and prescribed BP meds and sent me on my way. Im very pissed off about that and I hope that Im able to get a different doctor next time.

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