Retro Pay Start Time?

[mrmark1999]

Finally I got 20 % for my ankles the only real question is that I filed in aug 19 2009 but because they said I did not say there was any pain on my first c&p exam ( I did tell them a bout pain and I did tell the examiner in my 1st C&P exam and in my NOD ) they are going from my doctors first IMO in aug 2010 as the retro active pay when pain was first presented .

they are saying that I was given 0% on first exam I was not given any thing I was denied service connection because I had not had a clinical diagnosis .then I filed a NOD was denied ssoc issued then I has a rescheduled C&P exam they said I missed (I know go to any and all exams no matter what )then I finally got a new exam and was denied sent in a new IMO and now I got approved

Question

1) When should I have been awarded my retro active pay

2) Is there any thing I can do a bout it

3) Can it or will it affect my rating of 20%for Achilles tendonitis if I complain

Edited July 20, 2012 by mrmark1999

[carlie]

bump

[Berta]

You stated:

“they are going from my doctors first IMO in aug 2010 as the retro active pay when pain was first presented . “

and:

“then I finally got a new exam and was denied sent in a new IMO and now I got approved “

Did the new IMO clarify what you believe should be the retro date?

Did the VA list the new IMO as evidence and fully consider it in the award letter?

Do you have copies of the actual C & P exams?

But the retro date might be correct based on this VA statement:

“they are saying that I was given 0% on first exam I was not given any thing I was denied service connection because I had not had a clinical diagnosis “

If that statement is true the VA might have a point. Might.

Then again I succeeded in 2 claims whereby my husband, a VA patient, never had a clinical 'diagnosis' of either DMII or IHD from Vietnam, nor any VA treatment for those conditions , until any years after he died, and the DMII was proven 15 years after death ,never appearing diagnosed at all in his VA medical records. Likewise the IHD.

Of course those claims involved a LOT of leg work, medical research, documentation from other non medical entities, and many VA denials before award came- and for the DMII claim,I obtained 3 IMOs.

Would your new IMO doctor ( I assume they are 2 different doctors ?) be willing to again review your medical records to see if there was anything symptomatic that was documented ,that should have warranted an earlier clinical diagnosis?

“they are saying that I was given 0% on first exam I was not given any thing I was denied service connection because I had not had a clinical diagnosis “

That VA statement bothers me as it seems a little odd. Do you have those C & P results and can you scan them and attach them here? (Cover all personal identifying info)

Were you a VA patient prior to the EED they gave you and had you been seen for this condition by the VA?

(or if a private doctor had treated you for this condition, was VA aware of and did they obtain those private medical records)

This still bothers me:

“they are saying that I was given 0% on first exam I was not given any thing I was denied service connection because I had not had a clinical diagnosis “

Did the medical evidence warrant a higher rating, at that time, or was this a "0" only due to the lack of clinical diagnosis?

Which tends to suggest they didnt give an actual C & P exam because there was no 'clinical' diagnosis.

I hope others chime in here.

There is a local situation here and the vet does not have a 'clinical' diagnosis.

I have strongly urged the family to get him down to the local VAMC ASAP as well as file a claim.For TDIU.

His inservice nexus is quite well established.

[mrmark1999]

i am attaching my 2 C&P exams SOC ,SSOC, NOD ans my 2 seprate award letters

[mrmark1999]

I hope all this can help me in determining start of award for retro pay

[Berta]

I didnt expect so much to be attached here. I read some of the C & P exams and the last decision.

Prior to seeing Dr. Schilling in 2010,did you have any treatment records established with the VA or any private doctor that warranted symptoms enough to warrant a clinical diagnosis prior to the EED they gave you?

Did Dr. Schilling's opinions refer to any treatment records prior to August 2010 that showed symptoms that warranted an earlier diagnosis? (and earlier ratable condition?)

Other then the Family practice record of 1997 as well as of January 2011 and the treatment reports from Dr. Schilling in August 2010 and April 2011, do you have any other medical documentation that your condition raised to a ratable level prior to August 2010?

And if so, it isn't on the Evidence list you attached and should be submitted with your NOD.

The point I was trying to make when I rattled off how I proved 2 disabilities )both determined by VA as lending to my husband's death) which were never diagnosed by VA or even treated at all by VA,

was that medical records can often contain enough symptomatology or other clinical findings (X rays, blood work, MRI narrations, ER certs, Ekgs etc etc that can ,in essence, expose conditions a veteran had never been diagnosed with or treated for by the VA and should have been. Or these documented symptoms could warrant a rating higher then what they presently have.

In the IMO from Dr Schilling, did he in fact make any medical statements that,in his opinion, based on his examinations etc,

and his expertise,

that the disability onset as to a ratable level began sooner then August 2010?

He would still need to refer to some documentation however for that.

I have a podiatrist who told me my ankle condition is due to decades of the types of jobs I had in the past.

I am not a vet but my point is, I didnt seek any medical attention until the condition made it difficult for me to walk.

Orthonics and braces however have helped me significantly- good thing- I have a farm and lots of yard work.

So I was not clinically diagnosed (severe pronation in both feet) up to that point because I had no medical records for that

until I told my primary care doctor I was having balance problems and thought I had MS or an inner ear problem, and she referred me to the podiatrist knowing it was most surely an orthopedic problem.

I hope others chime in here.

[mrmark1999]

this was my imo from my doctor let me know what u think

un fortunatly when i went to the doctor in the past i only have one time where i complained of heal pain in jan of 2001 and i have allways been told the same stuff streach take motrin so i did not complain i would take motrin for my knees and that took care of my ankles to a point i hate doctors and do not like to go to them unless i want major surgery to fix my issues no way

ABC Podiatry/East

Patient: XXXXX Account No:XXXXXX Date 5/10/2012

Chief Complaint: Pt presents with longstanding foot and ankle pain. Pt has had foot and ankle pain for about 17 years and this is ongoing even through treatment. Pt was first diagnosed with Achilles tendonitis on August 21, 1995. Pt was in boot camp at Paris Island, SC at the time of diagnosis. Pt had been pain free prior to entering camp. Pt had been training and fell with large backpack and injured his right patella and had pain in knee. Pt was seen for this problem and was put in the medical rehab platoon and was there about 3 months. While in rehab, pt noticed tightness and pain in both legs. Pt was then sent for physical therapy and was given stretching instructions as well as ice for inflammation. Pt also had therapeutic ultrasound done for these problems. This was all in the spring and early summer of 1995.

Pt was running and walking during rehab for bilateral leg pain when he started to have tightness and pain in back of calves and heel areas. Pt was seen August 21, 1995 for pain in feet and shoe irritation as well as blister formation from all of the rehab exercise and diagnosed with Achilles tendonitis and was told to rest. September 26, 1995 pt returns to clinic and was given a diagnosis of shin splints a this time, and told to ice and stretch. In November, 1995 according to a medical review pt is still dealing with Achilles tendonitis and taking NSAID for treatment. Pt was seen on May 21, 1996 and July 24, 1997 and while he was still having problems with his Achilles, his knee pain was greater and this was the focus of the visits. However, his ankles were still painful swollen and documented by his marking the box of painful and swollen joints. This box was not specific to his knee or his ankle. Pt went to Marine Reserves and went back to school. Pt was limited in his activity and had increasing pain because of his Achilles tendonitis and subsequently was gaining weight. Pt got married and started a family and his pain never completely resolved. Pt has been and was at the time taking Ibuprofen regularly. Pt was see by his family doctor January 11, 2001 and was still complaining of heel pain esp in right. Pt has been seen at this office since August 26, 2010. Pt had been complaining of shooting pain and sharp pain in both legs and this was exacerbated by walking and standing. Pt had a long history of Achilles tendonitis. Pt was told about shoegear changes, given ¼ heel lifts, told to stretch and changed his NSAID. Pt returned February 11, 2011 for follow up and was cast for custom molded orthotics and told to continue to stretch. Pt picked up orthotics about 1 month later and also received an ankle foot orthosis for his right ankle and heel. Pt admits some minor improvement through the stretching activities given to him by our office. After usage of custom molded orthotics, pt did obtain increasing relief, however this will not be a permanent change and he will likely have continued pain throughout his lifetime.

Allergies: ERYTHOMYCIN

Medications: Fish Oil-capsule, Ibuprofen 800 mg tablet

Past Medical History: Admits Unremarkable.

Past Surgical History: Admits hernia repair.

Past family and Social History: Denies alcohol and tobacco use

Height: 69 inches Weight 273 pounds BMI 40.31 pulse: 74/min Sitting Blood Pressure: 125/90

• Vascular: Dorsalis pedis and posterior tibial pulses are graded at 2 with digital hair growth present bilateral. CFT with the leg elevated was less than 3 seconds at the distal hallux bilateral. There is no evidence of ischemic skin changes. Temperature was warm at anterior tibia to warm at the distal digits bilateral.
  
• Lymphatic: No popliteal lymphadenopathy noted
  
• Neurolgical: Pt oriented X3, with appropriate affect, no anxiety or depression. Coordination WNL to right and lefty lower extremity. Exam reveals epicritic sensation is intact along defined dermatones to protective threshod, symmetrical Achilles tendon and patellar deep tendon reflexes with a negative clonus and down going toes. Patient is able to heel and toe walk with ease. Normal sharp/dull, vibratory, proprioception, light touch sensation to right and left foot. DTR Achilles 2/4 right, 2/4 left.
  
• Dermatological: No edema, erythema, ecchymosis, open lesions, interdigital macerations or signs of infection evident at this time bilateral.
  
• Musculoskeletal: Good muscle strength to all prime movers of the foot and ankle with adequate muscle tone and symmetry bilateral. Decreased ht in medial long arch BL decrease with wt bear. Pain on palpation posterior heel at insertion of Achilles tendon BL. Decreased dorsiflexion in ankle BL with pain at end ROM.
  
• Xray analysis: Diagnostic lateral BL x rays show large, mature posterior heel spurs BL with possible fracture line in left posterior heel spur. Decreased caldaneal inclination angle BL with degeneration STJ BL. Plantar heel spur right.
  
  
  Impression:
  1. Equinus, BL
     
  2. Achilles tendonitis, BL-chronic. I believe that this is very likely to be connected to his time in the service by approximately 90% level of certainty. This is because before entering the military there was a health evaluation that made no mention of lower extremity pain or problems.
     
  3. 3. Early STJ DJD BL
     

  Plan:

  [*]Diag lateral BL x ray

  [*]Long discussion on eitiology, treatment and prevention of Achilles tendonitis.

  [*]Discuss treatment options for Achilles including physical therapy, home stretching, shoe and insert changes and ultimately surgery either to lengthen Achilles or to inject with platelet rich plasma or use of radiofrequency conlsyion

  [*]I believe that the examiner from February 14, 2012 failed to understand the chronicity of the injury and the fact that he never fully recovered from the initial pain. Pt had other problems from his service including patellar injury at about the same time which were higher priorities at the times of exam in the mid/late 90s therefore his heel pain, even though stil present was not mentioned in the exams. In Aubust, 2010 it was documented that he had gradually gotten worse over the previous month or so, but this condition is intermittently worse at certain times and can be aggrevated by activity or weight as well. However, without the first episode and without full resolution of symptomatology, this would not have been an ongoing issue to this date.

  [*]Pt to return as needed for follow up

  [*]Pt to continue stretching and orthotics/good shoegear