Filing A Nod On Initial Claim - Feedback Is Welcome :)

[Julie1975]

Good morning! I am working on a lengthy NOD for my initial rating. There are things that appear to me were overlooked or not considered. I hope it's okay if I piece-mail it in this thread for feedback. I'm still working on my opening statement but I broke down each contention below using a format found on this site. :)

Here is the first one for my spine, my husband helped me with it. Please let me know what you all think; I've never appealed before so welcome constructive feedback. All medical evidence that I state below will be attached to my NOD.

Specifically, I disagree with the ratings for the following:

--------------------------------------------------------------------------------------

1. Thoracolumbar Spine Rating

a) WHAT: I disagree with the decision for 20% assigned for my thoracolumbar strain and lumbar degenerative disc disease status post spinal fusion, L5, S1/Spinal cord stimulator implants and laminectomy/Pain syndrome with degenerative changes per X-ray.

b) WHY: My medical records and C & P exams reflects forward flexion of the thoracolumbar spine not greater than 30 degrees when factoring in the provisions of 38 CFR 4.40 & 4.45, and as cited in DeLuca v. Brown, 8 Vet. App. 202 (1995).

In regards to my medical contention for the spine, forward flexion not greater than 30 degrees is a more accurate picture of my chronic spine condition, also known as DDD, Spinal Fusion, and Pain Syndrome. As stated in my and my husbands support letter to the VA in my original claim, I am not able to bend over and pick up items due to limited motion of my spine. If I drop an item on the floor I am unable to pick it up and will leave the item on the floor until my husband or kids pick it up. My husband has relocated many items in our home so they are within my reach without having to bend forward (i.e. shampoo, soap, utensils, towels, etc). My ability to bend forward has remained extremely limited. When considered as a whole, my disability picture clearly reflects limited flexion as noted in the medical evidence below IAW C.F.R. §4.7.

c) Evaluation Seeking/Percentage: 40% in accordance with 38 C.F.R § 4.71a; based upon my range of motion of my thoracolumbar spine not greater than 30 degrees and including/considering my newest MRI which reflects my spine is continuing to deteriorate.

d) Medical Evidence:

- 12/17/2014: A range of motion was performed at QTC, San Antonio on as requested by the VA. While the examiner initially marked my forward flexion of the thoracolumbar spine at 60 & 40 degrees respectively, he noted additional limited function of my thoracolumbar spine. The examiner stated the following on my Thoracolumbar Spine Conditions Worksheet, section 20 in the remarks section:

"There are contributing factors of pain, weakness, fatigability, and/or incoordination and there is additional limitation of functional ability of the thoracolumbar spine during flare-ups or repeated use over time. The degree of ROM loss during pain on use or flare-ups is approximately 20 degrees for flexion, 10 degree thorocalumbar extension and all other directions".

Forward flexion on this exam was 20 degrees for flexion and the combined ROM for my thoracolumbar spine was 70 degrees combined.

Additionally, I’ve had three other range of motion exams and I have included a new MRI completed after my initial claim file date:

- 08/19/2011: Range of motion test conducted by Audie L. Murphy VA Clinic in San Antonio Texas was as follows: forward flexion of the thoracolumbar spine is 25 degrees with evidence of painful motion at 20 degrees. Combined range of motion of the thoracolumbar spine not greater than 130 degrees. With painful motion, combined range of motion of the thoracolumbar spine not greater than 80 degrees. This exam noted that I had functional loss and/or impairment of the thoracolumbar spine with the following contributing factors: Less movement than normal, pain on movement, interference with sitting, standing and/or weight bearing. A goniometer was used and repetitive testing was completed during this exam.

- 04/01/2011: Range of motion test conducted by Physical Therapy at the 359th Medical Group, Randolph AFB, Texas was as follows: forward flexion of the thoracolumbar spine is 20 degrees and a combined range of motion of the thoracolumbar spine not greater than 270 degrees. A goniometer was used but repetitive testing was not completed during this exam.

- 12/03/2009: Range of motion test conducted by Physical Therapy at Wilford Hall Medical Center, Lackland AFB, Texas was as follows: forward flexion of the thoracolumbar spine is 27 degrees and a combined range of motion of the thoracolumbar spine not greater than 130 degrees with evidence of painful motion in each direction. A goniometer was used and repetitive testing was completed during this exam.

- 03/25/2014: I had an MRI on 03/25/2014 which was not available when I filed my original claim. The MRI revealed:

“L4-5 disk level: Disc is normal in height and signal. Small broad-based posterior disc protrusion with mild bilateral facet arthrosis and ligament flavum hypertrophy which results in mild bilateral subarticular zone narrowing and mild bilateral neuroforaminal narrowing. No significant central canal stenosis.

L5-S1 disk level: Disc space height loss status post discectomy and disc spacer placement with mild endplate spondylosis with small posterior projecting osteophytes. No significant posterior disc protrusion. There is a small amount of abnormal tissue circumferentially about the thecal sac at the L5-S1 disc space level with asymmetric increased tissue in the left lateral recess and left neural foramen which results in moderate central canal stenosis. Abnormal tissue in the epidural space at L5-S1 favors granulation tissue, though exam is limited without IV contrast, which extends into the bilateral neural foramen resulting in moderate right and moderate to severe left neuroforaminal stenosis and mass effect on the exiting L5 nerve roots.

IMPRESSION:

Postoperative changes status post L5-S1 laminectomy and posterior fusion and L5-1 discectomy and disc spacer placement. Abnormal epidural tissue at the L5-S1 level favoring granulation tissue results in moderate canal stenosis at the L5-S1 level and moderate right neuroforaminal narrowing and moderate to severe left lateral recess and neuroforaminal narrowing with mass effect on the exiting L5 nerve roots.”

[Gastone]

JUlie: Have you filed your NOD yet? If not, just file saying you disagree with the Decision Dated ??/??/201?. Worry about detailing the issues for next couple of weeks and your next correspondence with the VA. Contact your VA (SC Condition) treating Specialist and request that a DBQ be completed. I didn't wait for an appointment to get my DBQ's, take wrii=tten request to the VA Hospital and hand deliver it to your Dr. Worked for me, they usually have time available due to Vets missing appointments. Best evidence you can get is a favorable DBQ by a Specialist. Trumps a General Practicianer C&P opinion.

Get a copy of your C&P clinician notes to include the C&P DBQ from your VA Medical records department. Compare the DBQ to 38 CFR 4, do you rate an increase? Any and all evidence you mentioned above that wasn't available for the raters review needs to be submitted yesterday. If possible hand deliver to yor VARO or send Cert Return Rect US Mail. This might be one of the rare occasions that your VSO Rep could personaly ask the VA Rater for an unofficial reconsideration of your recently denied claim.

Semper Fi

Gastone

[Julie1975]

Gastone,

Thanks for the quick reply! I have not filed the NOD yet--I just received my BBE Monday so am going through everything.

I do not have a VSO Rep and did the claim myself. All of the information I mentioned above (minus the MRI) was available to the Rater and included in my claim file. I'm not sure why the rater didn't consider my complete medical history; he/she seemed to use the C.F.R. loosely. I have other items rated just like my spine, such as carpel tunnel. My carpel tunnel (median nerve) was confirmed through a Nerve Conduction Test two years ago; the VA's contracted C & P examiner clearly marked "INCOMPLETE PARALYSIS = MODERATE" on both Left and Right wrists/hands but yet the rater stated in my BBE letter "Although the examiner reported moderate symptoms, your wholly sensory symptoms are more suggestive of a mild severity level for VA rating purposes".

Boggles my mind that the rater seems to be disputing the physical exam I had with the VA contracted C & P examiner.

It seems to me that this particular rater would pick and choose which ratings apply without considering all evidence. Additionally, I was denied IU and one of the rater's justifications for denial was that i applied for Vocational Rehab, which, according to the rater, is suggestive that I am able to be employed. The crazy thing is, if the rater had dug a little deeper and actually looked at my Voc Rehab application, he/she would have seen that I applied for the VA to assist me in making appointments, getting medical treatment, and aid in my daily living activities. Nowhere on my Voc Rehab app did I state I was looking to be employed. I had a horrible migraine the day of my Voca Rehab briefing so I no-showed. Physically, I just can't work a normal, full-time job. :(

The only specialist I see at this point are my Pain Management Doc and my General Practitioner. Anytime I see another specialist as soon as they hear I am under the care of Pain Management, they won't touch me with a ten foot pole.

My C & P exams were contracted out and I do have a complete copy of all my C & P exams, which I referenced above under the December 2013 date. I was Medically Boarded in the military so that's why there is the other ROM from the VA--I wasn't treated there, I was sent for the exam in case they medically discharged me from active duty.

I think it may be time for me to find a good VSO to help with my claim.

Do I need to send in the disagreement on plain letterhead or do I have to use their form and specify what I'm disputing? I was rated 10% or greater on 13 separate conditions and plan on filing a NOD on six of my SC conditions they rated.

Thanks again,

Julie

Edited October 8, 2014 by Julie1975 (see edit history)

[Navy04]

I agree with Gastone, get the NOD going and then fill in the details. You are doing a great job. I submitted a detailed Patrick's Self Report, that someone sent me the outline on here, for my SSDI claim. It took me almost a week and thousands of words, but I still believe that my SSDI being approved in less than weeks, which is unheard of here in Texas, was due greatly to this detailed report.

[Gastone]

Julie: I think there has been talk of an official VA NOD form being available. Don't sweat it, just go to your E-Ben site and complete a "Stmt in Support of Claim." As long as you say your disagreeing with the VA Decision dated whatever, you have officially file the required NOD. Your next step is to determine how you want the appeal handled. BVA DC Hearing, maybe 3+-5+yrs wait. BVA traveling board or BVA Vidieo Hearing, less than 5 yrs. OR and I am very biased in this, I would recommend a DRO Review with personal hearing. Just from your initial post, you impress me as someone that could handle a 1 on 1 with a DRO. Your claim would be kept local and if you started r

right away, you might get your hearing in less than 3 yrs.

I just came across a VA publication ,"The Veterans Appeals Process" dated 2/28/2014. Just starting out on your Comp Appeals journey, I think this is a Must read. Let me know what you think. Pay very careful attention to New Evidence rules and how they affect your appeal.

Good Luck-It ain't really LUCK!

Semper Fi

Gastone

[rootbeer22]

Julie1975:

It's intersting in that I submitted my first claim 4 months ago and have a similar situation as you do? I was in an Army Tank Accident and 15 month later, involved in another Tank Explosion Accident during the early 80's which late resulted in a an L1-S5 Spinal Fusion in 1991 at an Air Force Base in San Antonio, Texas. To make a long story short, I've had just about every treatment that you can have for back pain, injury and see a very promiment pain specilist in Seattle. I also, have extensive, x-rays, CTs and MRIs that show that my back is in very bad shape. Anyway, when I went for the C & P exam, the APRN Nurse that did it wanted to know why I did not file my disability claim when I retired and was supposed too? Her opinion? Anyway,I'm not a senstive guy but this kind of hurt. Anyway, when we did the Range of Motion measurements she went way past the point of pain and marked down those measuremetns? Anyway, when I said no one ever examined me like that and I felt the ROM measurements were wrong, she said, "Don't worry, the VBA raters will see your -enitre file anyway-and they'll figure it out? But I've read with the new VBMS system that they are so busy that they mainly just look at the C&P and use those results bcause it's the easiest thing for them to do? So, when I look at your case, I know that the C&P really holds all of the cards. I don't blame the raters...they use what they have. So, I'm watching your case, to see what happens and how you approach it? Frankly, I never thought personal opinion or bias would play a role in a VA exam but from reading the posts on hadit.com it does happen...so, I'm keeping my fingers crossed for both of us?

[Julie1975]

Thank you all for the thorough responses. I will submit that NOD and determine the best way to proceed; and check out the VA publication mentioned above.

One more question...if the rater stated I may be entitled to additional benefits. He/she said to use a Statement in Support of Claim to file for, what looks like, degenerative joint disease in my toes and other foot issues (plantar fasciitis and 4 other feet conditions). Can I use the same form 21-4138 to include my NOD and file a claim for what the rater suggested?

Rootbeer22: I will definitely keep you posted and cross my fingers, and arthritic toes, for both of us :)

[Former Member]

Julie, if I were you I would use the NOD form solely for the NOD

and then use a 21- 4138 to claim any other conditions you are going to claim.

The VA is so snafued already, it pays to definitely separate these two issues

as separate issues....so they cannot confuse them.

"All of the information I mentioned above (minus the MRI) was available to the Rater and included in my claim file."

Do you have a copy of the MRI results to refer to in the NOD and attach it to the NOD as evidence?

[Julie1975]

Julie, if I were you I would use the NOD form solely for the NOD

and then use a 21- 4138 to claim any other conditions you are going to claim.

The VA is so snafued already, it pays to definitely separate these two issues

as separate issues....so they cannot confuse them.

"All of the information I mentioned above (minus the MRI) was available to the Rater and included in my claim file."

Do you have a copy of the MRI results to refer to in the NOD and attach it to the NOD as evidence?

Berta,

Thanks for the recommendation; I will use two separate forms.

Yes, I do have a copy of the MRI results and planned on submitting it in my NOD package.

Although all the ROMs mentioned above were included in my initial package, I plan on attaching them to the NOD with the MRI.

This is only one of eight ratings I'm working on for the NOD....sigh

- Julie

[Gastone]

Julie: Just looked at VA form 21-0958 "NOD." Check it out. The old advice, I received,but didn't follow, was to only say you disagree with Claim dated ????? and then wait to tell the VA exactly what you agree with and disagree with, after you recieve the VA Notice advising you of reciept of your NOD. I used a VA "SISOC" form and listed everything that I agreed with, issues that were SC and disagreed with each denial. At the very end I specifically stated that I was requesting the VARO DRO Review with a Personal Hearing.

For info only, I jerked around 11 months before filling the NOD, just procrastination. NOD filed around 10/2010, DRO Hearing notification receive 05/??/2014, DRO Hearing held 06/27/2014. At which time I had (2) DRO Hearing pending, 1st 2010 and 2nd IU NOD from 2012. The DRO said that because I decided at the begining of the "Official DRO Hearing to cover my 2010 NOD" to go informal hearing, he would cover both my NODs. I walked out 35 min later with all issues granted, a very good day.

Semper Fi

Gastone

[Gastone]

Julie:Hit the brakes for a second! Have you ever heard of the VA Appeals Avoidance Program? If you have, your ahead of me. A Vet I work with said his VSO Rep admonished him for not attempting the Appeals Avoidance after he received his claims denial which is now headed for a BVA Vidieo Hearing some time in the next 2+ years. After doing some reading on the VA info site, I think you should investigate this before filing the NOD.Your early on in your 12 month appeal window and DRO Hearings are taking 21/2+ yrs and BVA Hearings can take anywhere from 21/2 to 5 yrs. Check out the VA BVA 2014 Decisions, their taken in order of assigned Docket #. I viewed it 10/8/14, whole lot of 5 yr old appeals, with a generous number of Remands.

Check out GAO-11-812. Report to congress regarding DRO and VA Appeals process. Very interesting information for anyone about to start the VA Appeals Process.

Semper Fi

Gastone

[Julie1975]

Julie:Hit the brakes for a second! Have you ever heard of the VA Appeals Avoidance Program? If you have, your ahead of me. A Vet I work with said his VSO Rep admonished him for not attempting the Appeals Avoidance after he received his claims denial which is now headed for a BVA Vidieo Hearing some time in the next 2+ years. After doing some reading on the VA info site, I think you should investigate this before filing the NOD.Your early on in your 12 month appeal window and DRO Hearings are taking 21/2+ yrs and BVA Hearings can take anywhere from 21/2 to 5 yrs. Check out the VA BVA 2014 Decisions, their taken in order of assigned Docket #. I viewed it 10/8/14, whole lot of 5 yr old appeals, with a generous number of Remands.

Check out GAO-11-812. Report to congress regarding DRO and VA Appeals process. Very interesting information for anyone about to start the VA Appeals Process.

Semper Fi

Gastone

Gastone,

I will definitely check it out. I was looking at the MMWR and just had to sigh at the pending NODs in the current inventory. I've worked on my NOD for the past week and have the "guts" of my disagreement on each contention with exception of IU (I think it's up to 23 pages--my head hurts, my hands hurt, and my poor husband is a one finger typer, hehe). I feel a little beat down about it all and I'm having the never-ending flare up of my sciatic nerve pain which isn't helping.

I think I'll fax of my "SISOC" for the feet issues the rater suggested. At least get those in the queue.

I have been looking at the 2014/2013 BVA decisions to guide my word usage and noticed they are sooooo far behind. I'll let you know which route I go and what I find. Thanks a million for all the input. Time for me to Google "VA Appeals Avoidance Program"

Sorry one more question...how would I know if my bilateral carpel tunnel (Median Nerve) and bilateral radiculopathy (Sciatic Nerve) were rated using the bilateral calculator (not sure if I'm saying that correctly)? I don't see it mentioned anywhere on my letter and both math equations equal exactly 90 percent.

[Gastone]

Julie: My understand of Bi Lateral is: if your 10% r foot and 20% l foot, it gets added together to 31 (1) number up before they do the VA Magic Math calculation. You will have to verify what other parts can get Bi-Lateral ratings. Ears (other than Tinnitus), Feet, Hands, Arms Etc. Just about anything that you have 2 of. Check out the "Pyramiding Avoidance" in regard to rating something like the spine that could have more than 1 SC condition, You only get the Worst conditions rating.

Now as for your pending NOD filing. Don't allow yourself to get overwhelmed, step back and regroup. It's better to take your time, be concise and to the point. Your not a DR and the VA with their DBQ's, from theirs and your outside Dr's will handle the DXing.

Let me know what you think of the Appeal Avoidance Program. Looking back. I would have given it a shot early on, while I got all my Ducks in a row for the DRO Filing. Do you have any NEW evidence to submit regarding your claim? Was there any evidence that you had submitted, that wasn't reviewed in making your denial?

Semper Fi

Gastone

[USMC_HVEQ]

what about DRO Review, but by "de Novo". Esstenially a new rater will relook at everything without the current finidings having any effect on their decision. It worked for me years ago in PTSD, so I can only recommend. It will still take a while regardless. I'd estimate 1-2 yrs minimum.....

[Julie1975]

So I've been doing a lot more research and didn't realize how clueless I was on terminology used by the VA. I do have a couple more questions:

1) When I'm doing my appeal, to support my request I am referencing doctor visits that I already provided the VA. Should I also include copies even though I already sent my entire STRs to the VA when I originally submitted my claim? I don't want to inundate the DRO with documents they already have but...if it makes the DRO's life easier, I'd rather include them. I submitted about 1000 pages of medical records in my original claim.

3) Not one item from my medical records was referenced in my BBE letter. Is that normal?

Gastone - I did not find very much info on the Appeal Avoidance Program. I'm pretty good at Googling and just didn't come up with much.

Since I've last posted, I submitted the SISOC to request consideration of the additional items the VA suggested I claim. I also faxed off a request for a copy of my entire C-file.

I'm also pasting below the beginning of my NOD letter (this will be a continuation to the VA appeal form). I would love some feedback. My entire appeal is up to 27 pages thus far. I just need to fine tune it, get a copy of the new items and attach them.

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

JANE A. DOE

VA File Number: xxxxxxxxx

Refer to: xx/xx

Notice Of Disagreement on Claim Filed 12/01/2013

Rating decision on 10/01/2014

Rating adjudicated by: Salt Lake City Regional Office

Greetings,

This is a notice of disagreement (NOD) to some of my initial VA rating decisions I received on 10/01/2014. Specifically, I disagree with the ratings cited in the attachments which includes my initial ratings for: 1) Thoracolumbar Spine 2) Irritable Bowel Syndrome; 3) Carpal Tunnel Syndrome, Left Hand/Wrist (major); 4) Carpal Tunnel Syndrome, Right Hand/Wrist (minor); 5) Lumbar Radiculopathy Lower Left Extremity; 6) Migraine/Chronic Headaches; 7) Vertigo; and 8) Entitlement to 100 percent Individual Unemployability. Each contention in disagreement is cited in the attachments.

I respectfully request a "De Novo Review" by a Decision Review Officer. Please note that my disability claim was handled under the Benefits Delivered at Discharge program and was adjudicated by the Salt Lake City Regional office. If the VA satisfies my NOD on all issues, I withdraw my request and consider this matter closed.

The key issues I wish to bring to your attention during this complete review are listed in the attached addendum. I have also taken the liberty of identifying some of the key medical documents relating to these issues. Any new items not originally attached to my original claim will be identified under the medical evidence section and in the supporting documents section as “NEW”.

My husband assisted me in typing this NOD and obtaining the evidence. Thank you for you time and consideration on this matter.

Sincerely,

Jane A. Doe

[Gastone]

Julie: As far as a NOD goes, your good. You really don't need much else to put the VA on Notice. You should look up the New Official NOD form, just for comparison, use it or not.

FYI, any New and Material Evidence that you submit from the denial date up to and including a BVA Hearing (You receive a 90 day N & M Evidence Cut off letter approximately 4 months before your BVA hearing is scheduled to take place,) requires that your VARO that has your claim consider this new evidence to see if it changes their denial of your claim. The VARO cannot certify your claim and transfer your C-File to the BVA until the new review has taken place and a supplemental Statement of Case has been issued. You can see how VA BVA Appeals end up taking 4-6 for a hearing. As far as your 12 month period for filing your Official NOD. If you have New & Material Evidence that your sure the VA Rater didn't have, get it all together and File a "Sworn Affidavit" listing each piece of new evidence. Send cert-rtn US Mail. Do this sooner rather than later. While the VARO rater is doing his review, you can be working on your NOD DRO Hearing Request. Trickling evidence in could add substantial time to your DRO Hearing which I think are now running 2-3 Yrs out.

Semper Fi

Gastone

[Gastone]

Julie: If what I recently read regarding how your VARO Rating Dept is suppose to review any and all " New & Material Evidence" submitted post Denial to determine if it changes your Denial, this seems to be a "reconsideration" of your claim without you or your Rep having to request it. With that said, if you even think the VA Rater didn't consider a certain piece of evidence that your absolutely certain was in your C-File, Resubmit it as "New & Material Evidence." Better safe than sorry, right?

Carefully review your VA Denial, regarding the evidence used to make his/her decision. How can you be sure what was in your C-File at the time of the Decision? I requested in writing "FOIA" to personally review my C-File and get a complete copy, 09/2012. EBen showed my FOIA request pending even after I finally received a 9 inch UPS package 01/2014, 15 months. I was never contacted or afforded the opportunity to personally review my C-File at the Det RO. The file I finally received had (2) pages that belonged to another Vet (Different Name) and my documents through the end of 2012, nothing from 2013. My DRO Hearing was held 6/27/14 and all issues were awarded so I haven't pushed the incomplete C-File issue.

Semper Fi

Gastone

[Gastone]

Julie: I'll post the link for The VA Appeal Avoidance article later today. If you get a chance pull up GAO 11-812 regarding Vet Disability Appeals, a Very Good read. It kind of ties in with the continuing review of "New & Material" evidence pertaining to your appeal issues, as the "New Evidence" is received at the VARO having jurisdiction regarding your claim. At any time after your denial and filing of your timely appeal all the way up to the transfer of your C-File to the BVA, the VARO rating department can award your denied issues, resulting in the "Avoidance" of a BVA Hearing. This appears to be the case no matter what Appeal Route you decide after your NOD Filing, Traditional Review (VARO DRO or another Senior Rater), a specific DRO or DRO Hearing (VARO DRO Only) or BVA Hearing (DC, Traveling Board or Video Hearing).

It appears that you could actually get a Denial Reversal prior to your DRO Scheduled Hearing, if your "N&M Evidence" is good enough. Something to think about, how strong is your "New" evidence? DBQ's by Specialists as opposed to GP's or DR's not specifically Credentialed in your medical disability, would be best. In my BVA research, it appears that a MD/DO Credentialed Specialist's opinion always trumps a VA C&P Dr's if he/she is not a credentialed specialist in the area Medical concern. All Dr's know about CAD, but a Cardiologist opinion will carry more weight than a Neurologist. Board Certified Specialist in your area of concern, in my view, is the Gold Standard for a DBQ.

Semper Fi

Gastone

[Julie1975]

Gastone,

Thanks for all the information and the replies. I did read through GA 11-812 and what seems like a million other VA regs and guidance. I will include everything I reference that was not mentioned in the explanation portion of my BBE letter. I'm not disputing most of the C & P exam and felt my examiner for my general exam was very thorough and overall did a great job of capturing my disabilities. I really don't understand how the individual who rated my package came to their conclusion on the eight items listed above. Three or four items appears as they went against the examiners opinion/exam. Are these Raters doctors?. For example on my bilateral Carpel Tunnel, my BBE letter stated:

"Although the examiner reported moderate symptoms, your wholly sensory symptoms are more suggestive of a mild severity level for VA rating purposes".

On my examiner worksheet the doc confirmed a "positive Phalen’s Sign on the right and left median nerve and a positive Tinel’s Sign on the right and left median nerve". The examiner indicated my symptoms included: "constant pain in both my left and right upper extremities and paresthesias and or dysethesias in both my right and left upper extremities". The sensory exam reflected "decreased sensation for light touch bilaterally in my hands/fingers at (C6-8)".

So I have a few items like that whereas the rater essentially didn't give a lot of weight to the examiners exam/opinion (I know I sound like a broken records on this but it seems the VA picks and chooses what they want to believe on those exams).

I called one of the VSOs here in my area and got the guys answering machine saying his office was moving. To be honest, his message was a turn off and lacked the professionalism I would expect from a VSO; which is the same reason I didn't use the Purple Heart organization here in my city. Needless to say I am still without a representative and may just do all the work myself.

I have a call into the VA this morning and going to ask them if they received my SISOC and Privacy Act Request for my C-File. Can't wait to check out the link you post on the Appeal Avoidance program.

I know this entire process will take another year or two and I'm okay with waiting (today at least I feel that way, haha). It is what it is, ya know?

[Navy04]

Sorry to hear of this process driving you crazy. You are right though, that from other Vet's and my 3 Claims thus far, I have seen where the VA picks what it wants to use to Rate or Deny a Condition. I have had a few Exams that went horrible, yet they rated me well, like my R Shoulder 30% Rating just this week, and then other times have Great Docs and Exams, yet the VA denies those conditions. This whole process is so Troubling and Stressful for the Vet and their Families. God Bless and hope you guys have a good weekend.

[Fat]

Looks good to me..........

"NEVER GIVE UP"