Here is my NOD letter for a decision for ED and SC for left leg radiculopathy-Thoughts?
NOD Notice of Disagreement
Department of Veterans Affairs
I received a rating decision dated10/05/2010. Consider this letter to be an official “Notice of (NOD) regarding thefollowing denied disability claims: Service connection Left extremities forradiculopathy, and service connection for Erectile Dysfunction/Sexualdysfunction. I disagree with both findings for the reasons noted below.
1) Service Connection for Left leg Radiculopathy denied due tolack of evidence per C&P examiner.
After reviewing the decision of the VA for
my claims of service connection of my left extremities, I feel that the rater overlooked substantive evidence and history of a bilateral condition(tingling/numbness in lower extremities) since my time on active duty, and that the VA rater failed to address that my right service connected extremity wasrated as 10% Radiculopathy (mild incomplete paralysis continued) with the samesymptoms as what my left extremity as had since 2003. Within the same rating decision my service right extremity is called both radiculopathy and “incomplete paralysis”, yet my claim for service connection for my left foot was denied with the same symptoms present.
I have noted below what I feel is
conclusive evidence for service connection for radiculopathy/incomplete paralysis below the knee, based on findings that Left Lower extremity radiculopathy was clinically diagnosed during military service, and was caused by a rated service connected condition (Intervertebral disc syndrome). Thesediagnoses occurred while still on Active Duty, and were a direct result of theinitial back injury, and thus I feel they fulfill the required evidence forservice connection.
Rating Decision
2010
“Service connection for Radiculopathy of the left lowerextremity, claimed as secondary to your service connected intervertebral discsyndrome, lumbar spine, is denied because there is no evidence showing thatleft lower extremity Radiculopathy has been clinically diagnosed, as well as noevidence indicating that the claimed condition otherwise began during or was caused by military service....” [1]
Reasons for Disagreement:
-11JUL2001 Battalion Aid, Ft.
Lee, VA clinic screening notes " that all 10 toes felt numb"and acute lower back pain [2]
-12JUL2001 Dr. so and so Army
notes "b/L parasesthesias" in his exam notes, also lower back pain [3]
-08AUG2001 MRI findings/neurological
narrative notes (my history of Bilateral Radiculopathy was the reason for the MRI in the first place) [4]
-Medical board proceedings were for
back pain/degenerative disc disease/bilateral dysesthesias (NarrativeSummary 1OCT2001)[5]
-VA Exam 17JAN2003 indicates
decreased reflexes bilaterally [6]
-2003 VA Ratings decision grants
service connection for Radiculopathy 10% right leg based on decreased sensationof right great toe, but not left leg, yet same symptoms are present in bothlegs. Treatment medication at that time included 800 mg ibuprofen 4x’s daily,Ultram, and Flexaril.
-Dr. notes both right and
left leg symptoms in herexamination notes 6AUG2010. She did SLR’s, sensory,reflexes, and physical manipulation at that time.
“Strength is slightly diminished on the right leg
compared to the left. He is able to toe and heel walk although he does thiswith some difficulty. He has limited amount of toe raises that he can do rightfoot and left foot but can’t initially do them. The patients gait is antalgic”[7]
-C&P Examiner notes “decreased vibratory sense, left great toe”during 2010 exam. 1
These are symptoms that have beenpresent in my left leg (radiating pain, numbness, decreased sensory) sincebefore I discharged from the Army. I used the terminology “radiculopathy” basedon the VA’s usage of that description for my right extremity, but regardless of whether it’s called “radiculopathy”, “pins and needles”, “bilateral dysesthesias”, it is the same thing. I’m simply using VA’s own description ofthe condition as my basis for calling it radiculopathy. Since my right leg is rated 10% for Radiculopathy (or “incomplete paralysis, Mild”) based onmy lower back condition, I feel that my left leg should be granted 10% and bilateral, on thepresentation of the same symptoms (note current C&P finding of “decreased vibratory sense, left great toe” )1
This itself is consistent with a 10% rating for “mild incomplete paralysis” as used by the VA for my 10% rating in my Right lower extremity. The Examiner notes a lack of clinical evidence. I feel I haveprovided more than enough over a long period of time (since active duty) to indicate chronic pain and numbness is due to my back injury.
2) Service Connection Erectile Dysfunction denied due to lackof evidence from Examiner. I disagree.
“Service connection for erectile dysfunction (also
claimed as sexual dysfunction) , claimed as secondary to your service connectedintervertebral disc syndrome, lumbar spine, is denied because there is noevidence showing that any erectile dysfunction has been diagnosed, as well asno evidence that the claimed condition otherwise began during or was caused bymilitary service….” [8]
Reasons fordisagreement:
-17JAN2003 difficulty with erectionsnoted by VAMC PA, progress notes
“Genitourinary-he reports urinary urgency sometimes has to sit tourinate since back injury. Genitalia-he admits to some problems with erections,which again is secondary to his back injury.”6
-Diagnosis/prescription Paxil for
premature ejaculation noted in letter as secondary to my lower back injury, Dr.so and so
“I have reviewed Mr. X service medical record
pertaining to his back injury that he sustained while in the service in 2002. Isaw him on August 6th and we went through the history and currentissues involved with his low back pain and radiculopathy. At that time he told me that he has had issues with erections and premature ejaculation since that injury was sustained. Therefore it is my opinion that his current symptoms appear to coincide with the injury in the service. We have started him on Paxilas that does tend to help delay ejaculation and hopefully improve hissymptoms.”[9]
-No C&P was scheduled for
erectile dysfunction, no examination given for this condition. Why would aC&P for peripheral nerves be addressing sexual dysfunction? My own doctorhas examined my service records in their entirety, and examined me independently of those records. She has diagnosed premature ejaculation/sexualdysfunction being secondary to my service connected injury, and prescribedmedication for it.
I believe this clearly supports that there is erectile difficulty that is a direct result of my lower
back injury and that a 0% rating (for deformity) with SMC-K should have been granted. I have no priorhistory of sexual dysfunction before my injury during military service. Dr.so and so reviewed with me my entire service medical file and my C-file, inaddition to making her own assessment of my genital issues, and prescribed medical treatment for it, that is ongoing and under continual review. The VAMCvisit on 17JAN2003 where erectile problems were noted was also within one yearof my leaving the military (26FEB2002) and determined at that time by the VAmedical personnel to be secondary to my back injury that is service connected.The C&P Examiner notes no 'clinical' evidence of ED, yet complaints persist from 2003, and further clinical evidence of erectile difficulty was provided in 2010.<
am requesting a “De Novo Review”by a new Decision Review Officer.
Question
brokensoldier244th
Here is my NOD letter for a decision for ED and SC for left leg radiculopathy-Thoughts?
NOD Notice of Disagreement
Department of Veterans Affairs
I received a rating decision dated10/05/2010. Consider this letter to be an official “Notice of (NOD) regarding thefollowing denied disability claims: Service connection Left extremities forradiculopathy, and service connection for Erectile Dysfunction/Sexualdysfunction. I disagree with both findings for the reasons noted below.
1) Service Connection for Left leg Radiculopathy denied due tolack of evidence per C&P examiner.
After reviewing the decision of the VA for
my claims of service connection of my left extremities, I feel that the rater overlooked substantive evidence and history of a bilateral condition(tingling/numbness in lower extremities) since my time on active duty, and that the VA rater failed to address that my right service connected extremity wasrated as 10% Radiculopathy (mild incomplete paralysis continued) with the samesymptoms as what my left extremity as had since 2003. Within the same rating decision my service right extremity is called both radiculopathy and “incomplete paralysis”, yet my claim for service connection for my left foot was denied with the same symptoms present.
I have noted below what I feel is
conclusive evidence for service connection for radiculopathy/incomplete paralysis below the knee, based on findings that Left Lower extremity radiculopathy was clinically diagnosed during military service, and was caused by a rated service connected condition (Intervertebral disc syndrome). Thesediagnoses occurred while still on Active Duty, and were a direct result of theinitial back injury, and thus I feel they fulfill the required evidence forservice connection.
Rating Decision
2010
“Service connection for Radiculopathy of the left lowerextremity, claimed as secondary to your service connected intervertebral discsyndrome, lumbar spine, is denied because there is no evidence showing thatleft lower extremity Radiculopathy has been clinically diagnosed, as well as noevidence indicating that the claimed condition otherwise began during or was caused by military service....” [1]
Reasons for Disagreement:
-11JUL2001 Battalion Aid, Ft.
Lee, VA clinic screening notes " that all 10 toes felt numb"and acute lower back pain [2]
-12JUL2001 Dr. so and so Army
notes "b/L parasesthesias" in his exam notes, also lower back pain [3]
-08AUG2001 MRI findings/neurological
narrative notes (my history of Bilateral Radiculopathy was the reason for the MRI in the first place) [4]
-Medical board proceedings were for
back pain/degenerative disc disease/bilateral dysesthesias (NarrativeSummary 1OCT2001)[5]
-VA Exam 17JAN2003 indicates
decreased reflexes bilaterally [6]
-2003 VA Ratings decision grants
service connection for Radiculopathy 10% right leg based on decreased sensationof right great toe, but not left leg, yet same symptoms are present in bothlegs. Treatment medication at that time included 800 mg ibuprofen 4x’s daily,Ultram, and Flexaril.
-Dr. notes both right and
left leg symptoms in her examination notes 6AUG2010. She did SLR’s, sensory,reflexes, and physical manipulation at that time.
“Strength is slightly diminished on the right leg
compared to the left. He is able to toe and heel walk although he does thiswith some difficulty. He has limited amount of toe raises that he can do rightfoot and left foot but can’t initially do them. The patients gait is antalgic” [7]
-C&P Examiner notes “decreased vibratory sense, left great toe” during 2010 exam. 1
These are symptoms that have beenpresent in my left leg (radiating pain, numbness, decreased sensory) sincebefore I discharged from the Army. I used the terminology “radiculopathy” basedon the VA’s usage of that description for my right extremity, but regardless of whether it’s called “radiculopathy”, “pins and needles”, “bilateral dysesthesias”, it is the same thing. I’m simply using VA’s own description ofthe condition as my basis for calling it radiculopathy. Since my right leg is rated 10% for Radiculopathy (or “incomplete paralysis, Mild”) based onmy lower back condition, I feel that my left leg should be granted 10% and bilateral, on thepresentation of the same symptoms (note current C&P finding of “decreased vibratory sense, left great toe” )1
This itself is consistent with a 10% rating for “mild incomplete paralysis” as used by the VA for my 10% rating in my Right lower extremity. The Examiner notes a lack of clinical evidence. I feel I haveprovided more than enough over a long period of time (since active duty) to indicate chronic pain and numbness is due to my back injury.
2) Service Connection Erectile Dysfunction denied due to lackof evidence from Examiner. I disagree.
“Service connection for erectile dysfunction (also
claimed as sexual dysfunction) , claimed as secondary to your service connectedintervertebral disc syndrome, lumbar spine, is denied because there is noevidence showing that any erectile dysfunction has been diagnosed, as well asno evidence that the claimed condition otherwise began during or was caused bymilitary service….” [8]
Reasons for disagreement:
-17JAN2003 difficulty with erectionsnoted by VAMC PA, progress notes
“Genitourinary-he reports urinary urgency sometimes has to sit tourinate since back injury. Genitalia-he admits to some problems with erections,which again is secondary to his back injury.”6
-Diagnosis/prescription Paxil for
premature ejaculation noted in letter as secondary to my lower back injury, Dr.so and so
“I have reviewed Mr. X service medical record
pertaining to his back injury that he sustained while in the service in 2002. Isaw him on August 6th and we went through the history and currentissues involved with his low back pain and radiculopathy. At that time he told me that he has had issues with erections and premature ejaculation since that injury was sustained. Therefore it is my opinion that his current symptoms appear to coincide with the injury in the service. We have started him on Paxilas that does tend to help delay ejaculation and hopefully improve hissymptoms.” [9]
-No C&P was scheduled for
erectile dysfunction, no examination given for this condition. Why would aC&P for peripheral nerves be addressing sexual dysfunction? My own doctorhas examined my service records in their entirety, and examined me independently of those records. She has diagnosed premature ejaculation/sexualdysfunction being secondary to my service connected injury, and prescribedmedication for it.
I believe this clearly supports that there is erectile difficulty that is a direct result of my lower
back injury and that a 0% rating (for deformity) with SMC-K should have been granted. I have no priorhistory of sexual dysfunction before my injury during military service. Dr.so and so reviewed with me my entire service medical file and my C-file, inaddition to making her own assessment of my genital issues, and prescribed medical treatment for it, that is ongoing and under continual review. The VAMCvisit on 17JAN2003 where erectile problems were noted was also within one yearof my leaving the military (26FEB2002) and determined at that time by the VAmedical personnel to be secondary to my back injury that is service connected.The C&P Examiner notes no 'clinical' evidence of ED, yet complaints persist from 2003, and further clinical evidence of erectile difficulty was provided in 2010.<
am requesting a “De Novo Review”by a new Decision Review Officer.
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