Claims And Cue

[COOL BREEZE]

I have a rating exam for nerve damage next week. (Pretty quick as the rater called me last week and stated its my turn-(claim to be decided by the end of September) I had written a letter with all the requested medical reports as a call from the VA in Phoenix informed me all of my claims will be decided by 30- September.

These are the issues I had claimed the 12th August 2012(those claims are now being worked on)

1. Upper and lower NP(secondary to cervical spine

2. chronic fatigue (secondary to cervical spine)

3. Bilateral carpal tunnel syndrome(secondary to cervical spine)

4. Temporary 100% for convalescence (increase)

5. Cue Cervical Spine Increase.

I had a cervical fusion done in mid July. I was rated 0% since 1996 for this issue.This issue has been on appeal since 2011(DRO requested.)

So, I sent in the form for the temp 100%, the VA asked for additional information and I submitted the required documents plus every single medical document that was over looked since 1996. I also asked the VA to CUE this claim from 1996 as the original rate exam never properly used the proper method to measure this. The tool is called a gonimeter-measures your ROM. According to the rating manual this must be used. Well, i 2010, they did this exam again, however the rater failed to use the results of this test which would have given me either a 30 or 40% rating. Instead they kept it as a 0%. They also stated there was no evidence I was in a helocopter crash whip whip lash injuries even though this had been submitted to they several times. It was listed on my discharge physical, and several medical reports when I went to be evauluated. I also had 8 other whip lash incidents in the military as well they didn't use. They said subsequent whip lash incidents after military service were more than likely not connected to military service.

So, seeing the opportunity, I faxed and mailed over 100 medical documents high lighted with the yellow memo on the medical evidence along with a copy of the memo from the VA about the use of the gonimeter. Since I had the surgery now, its quite obvious I had issues for years which was clearly documented. They are going to have to rate this higher then a 0 % now. Does anyone beleive they may CUE this back to either 96 or 2010 for failure to go by there guide lines.

Also, I had submitted all the nerve conduction tests from a private doctor that showed I had NP as well. And, it was because of the neck. Since I had at least the 0% for cervical, I used this to apply for secindary. When the rater called me, I clarified what I was asking for. The same night it was all corrected on E-benifits.

I am currently rated at 70 % I am expecting a higher rating of at least 80 or 90 %. And of course I have 3 issues on appeal for 3 years as well.

According to the rating manual, it says at least 6 weeks or more incapacitating epsidodes during the past 12 months. Since I have been on convalescent for 6 weeks, does this count? I have been off work since last april as it was determined by the doctor I was unable to return to work until surgery.

Anyone that has a claim pending from last August or earlier, Phoenix is now reviwing those claims. I was glad I was home when this call came in as this gave me the opportunity to have all the incorrect claims I submitted on e-benifits to be corrected, And, they took care of that nicely. Just hope I get these rated correctly now, Isn't NP easily to be rated correctly as secondary to cervical when the nerve condution test prove this? What about the carpal tunnel which also is indicated.?

And once again, I put this entire package together myself and turned it in to ther DAV at my VA hospital who had no clue on how to do this, or the proper form to use. In fact he told me to wait another 6 months.(For the 100% temp for surgery) The rater is going to rate everything ast the same time, I told this service officier, all I want you to do is to mail in to the VARO to the DAV there. Once the DAV received it, they properly documented what needed to be done and passed it to the VA

[jbasser]

The DAV is your problem. TYou need a Doc to tell the VA what you are telling us and the VA. They wont listen to you.

You need am IMO or your spinning your wheels. Again.

J

[COOL BREEZE]

Actually my nurologist indicated this in his report. And, he stuck a needle in my spine and noted that I had NP. Made some type of noise that indicated a blockage which causes this. At the most, I should get an increase from a 0% for cervical to higher reading. If they would only go by the rating manual!. I will probably have to appeal something again as they obviously are not going to spend a week going through these claims. They are in a hurry. I bet they have a quota of claims that they have to turn out daily, not weekly with the increased hours of over time they have to work.

[jbasser]

Have you ever had a NCS/EMG on the median and ulnar nerves in the arms to the hands?

These tests are usually pretty good but they hurt like heck.

J

[Berta]

I too am concerned here, as Jbasser is...about something

“Does anyone beleive they may CUE this back to either 96 or 2010 for failure to go by there guide lines. “

Sounds to me they might have to ,if the established medical evidence VA had and also the Schedule of ratings at that time ,warranted a compensable percentage.I assume you filed the CUE claim after the other claims?

The Temp convalescent criteria is here at hadit...I was going to search for it but then I read this:

"I put this entire package together myself and turned it in to ther DAV at my VA hospital who had no clue on how to do this, or the proper form to use. In fact he told me to wait another 6 months.(For the 100% temp for surgery) The rater is going to rate everything ast the same time, I told this service officier, all I want you to do is to mail in to the VARO to the DAV there. Once the DAV received it, they properly documented what needed to be done and passed it to the VA."

I commend you for all the work you have done on your claim.

However, what documented proof do you have that the DAV guy actually mailed this or passed it all on to the VARO?

I agree with John on the IMO too

"They are going to have to rate this higher then a 0 % now."

Optimism is great. But Solid evidence from a real doctor is better. You have secondary issues too and an IMO can cover them as well as the higher rating.

"I also asked the VA to CUE this claim from 1996 as the original rate exam never properly used the proper method to measure this."

Did you use the diagnostic code and application of the wrong rating criteria to be the basis for the CUE?

Maybe you do have the IMO that you need:

"Also, I had submitted all the nerve conduction tests from a private doctor that showed I had NP as well. And, it was because of the neck. Since I had at least the 0% for cervical, I used this to apply for secindary." For the secondary.

"it was because of the neck."

Did the private doctor give a clear medical rationale for that?

Looks like they ignored much of your stuff.......Good for you that you 'sent' it in again.....that is the DAV did....maybe.....

"ther DAV at my VA hospital who had no clue on how to do this, or the proper form to use."

Does he know how to mail anything and also obtain a proof of mailing or how to actually pass anything on to the VARO.?

Sorry I seem pessimistic.

My former DAV rep didnt think my survivors claims had a chance years ago, and he was very negative to my husband about his claims before he died. They all succeeded, no thanks to the DAV at all.

Edited August 16, 2013 by Berta

[COOL BREEZE]

Yes, I had all these painful test done in the last 6 months again. Actually, I had them done twice by 2 separate nurologist.

Impression: abnormal Study. THere is electrophysiolgic evidence of a wide spread mixed demyelinating and axonal, senorimotor polyneuropathy in the nerves tested, including the incompressible radial sensory. There is some subtle suggestion-by the reversal of the F-waves-of a median neuropathy at the wrist-but not in isolation, and with a not quite postive lumbrical-interosseus study-one cannot dx as such.

On needle EMG--There is evidence of a mild to low level cervical radulopathy and a low lumbar radiculopathy. Also there is a pattern in many muscles consistent with both a chronic axonal neuropathy and an active radiculopathy as well.

Also, since I had a notice of Disagreement for the cervical rating(it looks like they are going to go ahead and re-rate this now and not wait for a decisonn review officier) that states under 4.46 Accurate measurement. The use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department Of Veterans Affairs. Muscle atrophy must also be acurately measured and reported. This was not done on initial rating in 1996) Also in 2010 they failed to go by the test that was actually done that would have gave me a 40%. Instead, the VA kept it as 0%. How is it possible that all of a sudden I had surgery when the VA was saying there was nothing wrong with me yet all the medical evidence and recent measurement tests stated other wise. This is why I wrote a letter and turned it with my package 2 weeks ago telling the VA they need to CUE themselves back to 1996. Hard telling if they will do that back to 96 or 2010. Since I caught them violating the proper way to measure this, and they did go ahead and put this in as a CUE(increase) I may have a chance at either one. ALso, I just printed out a copy that this measurement method has been in effect since 1976(no changes of this yet) and it was not noted they follow it. Probably just told me to move my neck around. It was notated like the one in 2010, thus I believe they need to Cue them selves. In other words-"busted for not following there own policy".

If one was to let a service officier do your claim, they would never know this. I have a copy at my disposal and use this just like a bible.

Edited August 16, 2013 by COOL BREEZE

[jbasser]

Now yopu have the evidence you need to go after them.

Clearly you have radiculpathy of median nerve. Carpal Tunnel.

It is time to get it put together by a good IMO doc. The Doc needs to outline the history of your condition.

A good IMO is worth its weight. I hope you consider getting one done.

J