Waiting It Out

[Colt]

Hi all:

Looking for a little guidance if there is any to give.

My story: I got out in August 2010 and filed my claim. It's my year mark and I haven't heard anything so I started researching some stuff and found you guys and your plethora of information. I'm going with the assumption that some of my items claimed will get denied due to reading a lot of people's experiences on here. I figure since I've done absolutely nothing on my part so far, you know, since the past year just sitting and waiting--that after reading some of your stories and seeing things I could be doing to help myself out, why not try? I haven't heard from the VA in a while. The last I heard from them was in November 2010 and they sent a letter stating that they needed further evidence for the "following conditions" and listed everything I originally claimed. I contacted my DAV and she said it was normal that they list everything and since I turned in all my medical records to send it back stating to decide the claim. I’ve had no movement since. I check my ebenefits weekly.

I went and picked up my C&P exam copies today (completed September and October 2010), since many of you suggested it. However, I don’t understand everything on there and I couldn’t find my eye and hearing test in there (they were done in the following month of Oct). The records woman said that they combine everything into one document after it’s done so that it prints all at once. Can that mean it is potentially missing? Or maybe I just didn’t get it? Also if the C&P doctor didn't really give a write-up on a specific item claimed does that mean that item will be denied or that maybe there is sufficient evidence to support it in my documents?

I’m not even sure if there is anything I can do right now except wait to see what they come back with and then go from there. I was trying to be proactive, but at this point I think it’s just a guessing game until I hear from them. I haven't contacted my DAV or anyone else since I didn't want to pester anyone. However, I'm hitting that antsy phase, and thought it might be nice to hang around with other 'hurry up and wait' individuals.

On a side note. One of the items I'm claiming is my back. I've got 5 items listed that fall under that.

1. Degenerative Disc Disease

2. Bulging Disc L3-5 w/arthritis

3. Bilateral Leg Pain

4. Synovitis

5. Scoliosis

Will all of that be one combined rating? Also, two weeks after I got out of the military (figures, eh?) I severely herniated and ended up having two discectomies. Can that alter ratings?

[Colt]

You need to learn that the VA is many things. There is the Veterans Health Administration (VHA, the VA Medical Centers, where the great majority of C&PEs are done) and there is the Veterans Benefit Administration (VBA, the VA Regional Office, where decisions on service connection and compensation are made). Unfortunately, they don't always speak well together. So, even though the VA examiner made a note, I recommend that you send in a copy of the operative report if it was done at a civilian facility, or if it was done by the VA, tell the VARO where and when.

I know, forgive me. I'm still trying to learn a lot about what I should do and how to go about it. I type things about assumptions and you would think after 8 years in the military I should know better about who knows what and what they should be doing. ;)

I could always find out if they put something in there about the time off. I know I wasn't allowed to work for 6 weeks per the doctor's orders. I don't know if the 100% is something that is automatically done or if I have to apply for it. On that note, it almost seems more like a hassle to me to go through all that. Although a rough time, I was pretty fortunate with everything.

Thank you though for your input, I appreciate it. For now I guess I'll just start collecting evidence (my records from appointments) until I get back my first results and then go from there. At least this way, I'll know what they need or are missing instead of trying to guess everything. Not to mention I could possibly come to you guys for help to understand everything. Reviewing my one C&P exam, I don't even know if it's in my favor. Would I specificially look under the diagnosis area? Not everything was referred to, which is why I was wondering if the rest would be a wash.

Lastly, if you wouldn't mind, could you elaborate a little about not putting value on the C&P? Would the surgery kind of null and void everything?

[Interested]

I don't know if the 100% is something that is automatically done or if I have to apply for it. If the surgery was done in a civilian hospital, your friendly neighborhood VARO has no way of knowing about it ... you need to apply. For procedures done in a VA Medical Center (with a close-by VARO), I recall a daily report that listed hospital admissions for service connected conditions. "Someone" would usually review this list and determine whether any additional follow-up or action was needed. So, while a claim for convalescence because of surgery in a VAMC MAY result in an automatic claim, I'd still recommend you notify the VARO and claim it.

I have seen folks apply for convalescence based on surgery next month. However, you can't do a Rating Decision prospectively and you must wait until the surgery has been done.

On that note, it almost seems more like a hassle to me to go through all that. Although a rough time, I was pretty fortunate with everything. That's your call - there's no requirement to file.

Lastly, if you wouldn't mind, could you elaborate a little about not putting value on the C&P? Would the surgery kind of null and void everything? Well, in the general course of affairs, the surgery is expected to improve the condition, so the pre-surgery VAE might be be unduly negative. And, normal post-operative items such as wound pain/discomfort during healing or "guarding" might mask the true result.

In your situation, if I had been made aware of the additional disc impingements, I might question how valid the findings from the earlier exam were and order a more recent exam; however, this will keep the issue open that much longer. Or, I might just rate it and let you appeal.

FYI, intervertebral disc syndrome is evaluated under either of two sets of criteria: the General Rating Formula, or Incapacitating Episodes at 38 CFR 4.71a http://www.benefits....ART4/S4_71a.DOC The Diagnostic Codes (DC) for back problems are 5235 through 5243; Intervertebral Disc Syndrome is DC 5243.

I know, forgive me. I'm still trying to learn a lot about what I should do and how to go about it. I type things about assumptions and you would think after 8 years in the military I should know better about who knows what and what they should be doing. ;)

I could always find out if they put something in there about the time off. I know I wasn't allowed to work for 6 weeks per the doctor's orders. I don't know if the 100% is something that is automatically done or if I have to apply for it. On that note, it almost seems more like a hassle to me to go through all that. Although a rough time, I was pretty fortunate with everything.

Thank you though for your input, I appreciate it. For now I guess I'll just start collecting evidence (my records from appointments) until I get back my first results and then go from there. At least this way, I'll know what they need or are missing instead of trying to guess everything. Not to mention I could possibly come to you guys for help to understand everything. Reviewing my one C&P exam, I don't even know if it's in my favor. Would I specificially look under the diagnosis area? Not everything was referred to, which is why I was wondering if the rest would be a wash.

Lastly, if you wouldn't mind, could you elaborate a little about not putting value on the C&P? Would the surgery kind of null and void everything?

[USNDW]

I would recom your claimany treatment you have had since filing your claimany treatment you have had since filing your claim, fill out a VA Form 21-4142 for each doctor or treatment facility and send them in ASAP. If they have not yet rated your claim, they can use the additional information to rate the claim.

Quick start claim? I guess that's a new pilot program that ain't so quick?

After you get copies of your C&P exams you will have a pretty good idea of what you will probably be given service connection on, and what you will not. When the C&P examiners write "At least as likely as not" or "Likely" that the conditions manifested or worsened during service, those are key phrases that will more than likely cause the rater to grant service connection for.

What you really need to check is any conditions you know occurred during service, that the C&P examiners do not comment that they sis. It does happen. Veterans will go to their exams with copies of their medical records, show the examiners where and when they were diagnosed and treated and sometimes they still will note that there is no evidence for that condition. Buddy of mine recently got his C file, C&P examiner noted chronic low back pain worsening with movement and how it affected him physically, then on the last page stated there were no records of an in service injury. Looking over his records, it is listed in muktiple annual physical exams "chronic low back pain". That is why it is important to get a copy of your medical record and the C&P exams so you can compare, and hopefully catch something the examiner missed, and write a letter, or statement to the VARO, or as pointed out, request another exam.

Good luck

[Colt]

Interested, if you don't mind I'm going to use your way of responding. It makes it much easier to read and if I try to multiquote it denies me saying I've quoted too much.

So, while a claim for convalescence because of surgery in a VAMC MAY result in an automatic claim, I'd still recommend you notify the VARO and claim it. My cfile, as it's called, should contain everything they have up to date, correct? Including all of my C&P exams? Can I just go get a copy of that, review it and then see what they are missing and then collect the additional information that I deem pertinent?

Well, in the general course of affairs, the surgery is expected to improve the condition, so the pre-surgery VAE might be be unduly negative. And, normal post-operative items such as wound pain/discomfort during healing or "guarding" might mask the true result. I agree. However, all of my other issues still exist and wouldn't have been affected by surgery. I don't mind them lowering a percentage if it got fixed.

In your situation, if I had been made aware of the additional disc impingements, I might question how valid the findings from the earlier exam were and order a more recent exam; however, this will keep the issue open that much longer. Or, I might just rate it and let you appeal. I see your point. I'm trying to take this as relaxed as can be. I stress far too often about things and this would just be one more heaping pile of crap to add to the list. I've got the time; the frustrating thing is not understanding everything.

Thank you for the links you've provided. I'm going to go through some documents and see what I come up with in regards to my claim.

@ Timestamp

Quick start claim? I guess that's a new pilot program that ain't so quick? That's what I'm thinking. They told me it's like a jumpstart of sorts, since I filed before I got out.

When the C&P examiners write "At least as likely as not" or "Likely" that the conditions manifested or worsened during service, those are key phrases that will more than likely cause the rater to grant service connection for. Unfortunately, I didn't see any kind of phrases like that in my exam that I received. However, once again, there was a lot of stuff that wasn't mentioned in the C&P that I claimed and actually have issues with.

Buddy of mine recently got his C file, C&P examiner noted chronic low back pain worsening with movement and how it affected him physically, then on the last page stated there were no records of an in service injury. Looking over his records, it is listed in multiple annual physical exams "chronic low back pain". I don't have an in service injury though either. There was no specific event for me. It was multiple events that occurred along with the weakening of my discs that would set my back off that would send me to the doctors to get checked out (e.g., lifting a printer, tug of war on enlisted day, running). Eventually after the 4^th year of going in for back issues they sent me to get an MRI and that's when they noted all my 'issues'.

My claim has A LOT of items listed. So much so that when I look at it I feel like at my age I should be broken (did I really go to the doctor's that much?). Granted one issue has secondary issues or other things that are associated with it… still, I feel like it is too much. When I went to the DAV they did add things when going through my file that they wanted to put on there to get SC since later on if it worsened it could be claimed. I didn't embellish at all when I went for my C&P although I was told to act like it was a bad day (even though for my back, it really was). I'm very much a liar when it comes to how I feel. If you ask me how I am, I'll tell you fine, even if I'm not. I tried to be as honest as I could that day, but I still get shy and tend to act better than I am. I can't help it, it's who I am. In this case, I very well could have done a disservice to myself. However, I can't undo it now.

In the end, I'd just be happy if my amount covers my bills. I have 5 specialists that I go to and at $30 a pop, it adds up quick as I'm sure most of you know. One of my meds just cost $205 (after insurance) for a 3 month supply. It's something simple… eye drops, but it's something I need.

I'm still young (I think ) and can work; so one day at a time is okay with me. I'm trying not to overwhelm myself. I'll see about getting the cfile and getting back with you guys.

Edited August 25, 2011 by Colt

[bakerkd]

"I would recom your claimany treatment you have had since filing your claimany treatment you have had since filing your claim"

HUH?

[Colt]

"I would recom your claimany treatment you have had since filing your claimany treatment you have had since filing your claim"

HUH?

I believe it was: I would recommend you claim any treatment you have had since filing your claim.