cervical strain Depressing C&p Examination Results. Any Ideas?

[Ryguy]

These are the results from my C and P Exam I had on Saturday. Any ideas, I was sent back to the local VARO, from a Remand, and this is the C and P Examination requested by the Veterans Law Judge. I'm assuming I will just get denied again from the way this is reading, any thoughts or ideas will be appreciated.

I was praying for secondary or aggravation disability because my neck problems are real!! Here goes my exam.....

Medical Opinion

Disability Benefits Questionnaire

Name of patient/Veteran:

Indicate method used to obtain medical information to complete this

document:

[ ] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) process

because

the existing medical evidence provided sufficient information on which

to

prepare the DBQ and such an examination will likely provide no

additional

relevant evidence.

[ ] Review of available records in conjunction with a telephone interview

with the Veteran (without in-person or telehealth examination) using the

ACE process because the existing medical evidence supplemented with a

telephone interview provided sufficient information on which to prepare

the DBQ and such an examination would likely provide no additional

relevant evidence.

[ ] Examination via approved video telehealth

[X] In-person examination

Evidence review

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

Was the Veteran's VA claims file reviewed? Yes

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

VA TREATMENT RECORDS

VISTA WEB

VBMS

MEDICAL OPINION SUMMARY

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

RESTATEMENT OF REQUESTED OPINION:

a. Opinion from general remarks: BASED ON THEW EVALUATION OF THE VETERAN AND

THE REVIEW OF THE MEDICAL HISTORY, THE EXAMINER MUST EXPRESS AN OPINION AS

TO

WHETHER IT AS AT LEAST AS LIKELY AS NOT THAT THE VETERAN HAS ANY CURRENT

CERVICAL SPINE DISABILITY THAT IS DUE TO THE MARCH 2001 MVA OR ANY OTHER

INCIDENT OF SERVICE. THIS INCLUDES WHETHER THE VETERAN'S CURRENT NECK

DISABILITY HAD IT'S ONSET DURING SRVICE AND /OR WHETHER IT IS LIKELY OR

NOT

THAT THE VETERAN'S CURRENT DEGENERATIVE ARTHRITIS OF THE CERVICAL SPINE/

IVD

SYNDROME IS A PROGRESSION OF THE VETERAN'S REPORTS THAT HIS NECK PAIN

BEGAN

AT E TIME OF THE MARCH 2001 MVA.

b. Indicate type of exam for which opinion has been requested: CERVICAL

SPINE

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE

CONNECTION ]

b. The condition claimed was less likely than not (less than 50%

probability) incurred in or caused by the claimed in-service injury, event

or

illness.

c. Rationale: ALL OF THIS VETERAN'S STRs AS WELL AS VA TREATMENT RECORDS

WERE

REVIEWED. UNFORTUNATELY, STRs ARE SILENT FOR A COMPLAINT OF NECK PAIN IN

SERVICE BY THIS VETERAN. IT WAS NOT UNTIL A PROGRESS NOTE WRITTEN BY

ATTENDING PHYSICIAN IN ATLANTA VA IS NECK PAIN MENTIONED. PROGRESS NOTE

8/2/2006:

"6 MONTHS OF NECK PAIN".

XRAYS PERFORMED AT THAT TIME WERE READ AS NORMAL

CONFIDENTIAL Page 32 of 161

REASON FOR XRAY NOTED IN XRAY REQUEST: "2 WEEKS OF NECK PAIN"

THE ETIOLOGY OF THIS VETERAN'S CURRENT CONDITION CANNOT BE DETERMINED IN

A

COMPENSATION AND PENSION EXAM.

REGARDING STATEMENT OF DR SCHEID 12/26/07 STATING VETERAN'S CONDITION

IS

"SERVICE CONNECTED", THIS IS STRICTLY HIS OPINION WITHOUT BASIS,

SINCE HIS

PROGRESS NOTE OF 8/26/06 STATES: VETERAN COMPLAINS OF NECK PAIN OF SIX

MONTHS

DURATION. IT IS NOT UNCOMMON FOR A PCP TO TAKE A VETERAN'S DESCRIPTION

OF AN

INJURY OR ILNESS AND USE THE TERMS "SERVICE CONNECTED" WITHOUT IT

ACTUALLY

BEING SERVICE CONNECTED.

AS TO DR GUTIERREZ NOTE AT HINES VA DATED 2/2011:

NOTE STATES: "1.Continues with this SC condition. On robaxin and

tramadol/naproxen.

Seems all issue started after MVA when he was in the service. More likely

than not that this is sequelae of injury. I referred him to appeal decision

by

C&P Board since they have access to all files and records."

AGAIN,THIS IS A CASE OF A PCP USING THE TERM "SERVICE CONNECTED"

WHEN IN FACT

THE CONDITION IS NOT YET SERVICE CONNECTED. DR GUTIERREZ ALSO NOTES THAT

C&P

HAS ACCESS TO ALL FILES AND RECORDS AND IMPLIED THAT HE, HIMSELF, DOES

NOT.HENCE,THEY WERE NOT REVIEWED BY HIM.

VETERAN WAS SEPERATED FROM SERVICE IN JULY 2001 AND MADE NO MENTION UNTIL

AUGUST 2006 OVER 5 YEARS LATER OF ANY NECK PAIN. THERE IS NO NEXUS FOR

SERVICE CONNECTION IN THIS EXAMINER'S OPINION. WHICH IS THE SAME

OPINION

REACHED ON PREVIOUS OCCASIONS REGARDING VETERAN'S NECK COMPLAINTS.

*************************************************************************

/es/ JOANNE H PA LATKO

PA-C ORTHO

Signed: 01/10/2015 12:30

Date/Time: 10 Jan 2015 @ 0900

Note Title: C&P ORTHO SPINE

Location: EDWARD J. HINES JR. HOSPITAL

Signed By: LATKO,JOANNE H PA

CONFIDENTIAL Page 33 of 161

Co-signed By: LATKO,JOANNE H PA

Date/Time Signed: 10 Jan 2015 @ 1227

Note

LOCAL TITLE: C&P ORTHO SPINE

STANDARD TITLE: ORTHOPEDIC SURGERY C & P EXAMINATION CONSULT

DATE OF NOTE: JAN 10, 2015@09:00 ENTRY DATE: JAN 10, 2015@12:27:44

AUTHOR: LATKO,JOANNE H PA EXP COSIGNER:

URGENCY: STATUS: COMPLETED

Neck (Cervical Spine) Conditions

Disability Benefits Questionnaire

Name of patient/Veteran:

Indicate method used to obtain medical information to complete this

document:

[ ] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) process

because

the existing medical evidence provided sufficient information on which

to

prepare the DBQ and such an examination will likely provide no

additional

relevant evidence.

[ ] Review of available records in conjunction with a telephone interview

with the Veteran (without in-person or telehealth examination) using the

ACE process because the existing medical evidence supplemented with a

telephone interview provided sufficient information on which to prepare

the DBQ and such an examination would likely provide no additional

relevant evidence.

[ ] Examination via approved video telehealth

[X] In-person examination

Evidence review

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

Was the Veteran's VA claims file (hard copy paper C-file) reviewed?

[X] Yes [ ] No

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

VISTA WEB

ATLANTA VA TREATMENT RECORDS

HINES VA TREATMENT RECORDS

VBMS

CONFIDENTIAL Page 34 of 161

If no, check all records reviewed:

[ ] Military service treatment records

[ ] Military service personnel records

[ ] Military enlistment examination

[ ] Military separation examination

[ ] Military post-deployment questionnaire

[ ] Department of Defense Form 214 Separation Documents

[ ] Veterans Health Administration medical records (VA treatment

records)

[ ] Civilian medical records

[ ] Interviews with collateral witnesses (family and others who have

known the Veteran before and after military service)

[ ] No records were reviewed

[ ] Other:

1. Diagnosis

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

Does the Veteran now have or has he/she ever been diagnosed with a cervical

spine (neck) condition?

[X] Yes [ ] No

[ ] Ankylosing spondylitis

[ ] Cervical strain

[ ] Degenerative arthritis of the spine

[X] Intervertebral disc syndrome

[ ] Segmental instability

[ ] Spinal fusion

[X] Spinal stenosis

[ ] Spondylolisthesis

[ ] Vertebral dislocation

[ ] Vertebral fracture

[X] Other Diagnosis

Diagnosis #1: CHRONIC CERVICAL STRAIN

Date of diagnosis: 2012

Diagnosis #2: NECK PAIN PER VA TREATMENT RECORDS

Date of diagnosis: 8/2/2006

Diagnosis #3: SPINAL STENOSIS

Date of diagnosis: 2012

2. Medical history

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

a. Describe the history (including onset and course) of the Veteran's

cervical spine (neck) condition (brief summary):

VETERAN GIVES HISTORY OF BEING INVOLVRD IN A MOTOR VEHICLE ACCIDENT IN

MARCH OF 2001

JUST PRIOR TO BEING DISCHARGED. HE WAS TAKEN TO THE ED AND TREATED FOR

BACK PAIN. VETERAN STATES HE NEVER SPECIFICALLY SAID THAT HIS NECK HURT,

CONSIDERING EVERYTHING TO BE HIS "BACK". VETERAN STATES NECK

CONFIDENTIAL Page 35 of 161

PAIN BECAME

BOTHERSOME ABOUT 1-2 YEARS AFTER SEPERATION WITH PAIN AND STIFFNESS. HE

NOTED DIFFICULTY GETTING OUT OF BED AND RAISING HIS OFF OF THE PILLOW.

CURRENTLY VETERAN IS BEING TRATED AT HINES VA FOR NECK AND BACK PAIN. HE

WAS SEEN RECENTLY IN HINES ED FOR HIS NECK BECAUSE HIS HOME MEDICATIONS

WERE NOT HOLDING HIM. HE HAS TAKEN A LEAVE OF ABSENCE FROM HIS CUSTOMER

SERVICE POSITION ABOUT 65 MOS AGO AND DOEWS NOT ANTICIPATE RETURNING TO

WORK. VETERAN FEELS THAT HIS NECK CONDITION WAS EXACERBATED BY HIS WORK

AS

A COOK IN SERVICE, LIFTING HEAVY POTS AND PANS. VETERAN DESCRIBES

OCCASIONAL "ELECTRICAL SHORT" TYPE OF PAIN. HE ALSO NOTES

NUMBNESS AND

TINGLING DOWN HIS RIGHT ARM WITH TINGLING IN HIS RIGHT THUMB, ALING WITH

SHOOTING PAIN WITH SPASM IN HIS NECK.

VETERAN SELT TREATS WITH ICE PACKS AND OTHER MODALITIES TO INCREASE HIS

COMFORT LEVEL.

b. Dominant hand:

[ ] Right [X] Left [ ] Ambidextrous

c. Does the Veteran report that flare-ups impact the function of the

cervical

spine (neck)?

[ ] Yes [X] No

d. Does the Veteran report having any functional loss or functional

impairment of the cervical spine (neck) (regardless of repetitive use)?

[X] Yes [ ] No

If yes, document the Veteran's description of functional loss or

functional impairment in his or her own words:

VETERAN NOTES THAT AT TIMES HIS NECK PAIN IS SEVERE ENOUGH TO

PREVENT HIM FROM COOKING. HE LIVES CLOSE BY TO HIS SSISTER AND HER

FAMILY AND AT THESE TIMES THEY ARE ABLE TO ASSIST HIM.

3. Range of motion (ROM) and functional limitations

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

a. Initial range of motion

[ ] All Normal

[X] Abnormal or outside of normal range

[ ] Unable to test (please explain)

[ ] Not indicated (please explain)

Forward Flexion (0-45): 0 to 20 degrees

Extension (0-45): 0 to 20 degrees

Right Lateral Flexion (0-45): 0 to 20 degrees

Left Lateral Flexion (0-45): 0 to 20 degrees

Right Lateral Rotation (0-80): 0 to 50 degrees

Left Lateral Rotation (0-80): 0 to 60 degrees

CONFIDENTIAL Page 36 of 161

If abnormal, does the range of motion itself contribute to a

functional loss? [X] Yes, (please explain) [ ] No

If yes, please explain:

DIFFICULTY DRIVING AN AUTO AS HE HAS DIFFICULTY TURNING HIS NECK

TO

SEE BEHIND AND ALONG SIDE OF HIM.

Description of pain (select best response):

Pain noted on examination and causes functional loss

If noted on examination, which ROM exhibited pain (select all that

apply)?

Forward flexion, Extension, Right lateral flexion, Left lateral

flexion, Right lateral rotation, Left lateral rotation

Is there evidence of pain with weight bearing? [ ] Yes [X] No

Is there objective evidence of localized tenderness or pain on palpation

of the joint or associated soft tissue of the cervical spine (neck)?

[X] Yes [ ] No

If yes, describe including location, severity and relationship to

condition(s):

SPINAL AND PARASPINAL TENDERNESS ON PALPATION WORSE IN RIGHT

PARASPINAL

RE

b. Observed repetitive use

Is the Veteran able to perform repetitive use testing with at least three

repetitions? [ ] Yes [X] No

If no, please provide reason:

TOO PAINFUL

c. Repeated use over time

Is the Veteran being examined immediately after repetitive use over time?

[ ] Yes [X] No

If the examination is not being cond

ucted immediately after repetitive

use over time:

[ ] The examination supports the Veteran?s statements describing

functional loss with repetitive use over time.

[ ] The examination contradicts the Veteran?s statements describing

functional loss with repetitive use over time. Please explain.

[X] The examination neither supports nor contradicts the Veteran?s

statements describing functional loss with repetitive use over

time.

CONFIDENTIAL Page 37 of 161

Does pain, weakness, fatigability or incoordination significantly limit

functional ability with repeated use over a period of time?

[ ] Yes [ ] No [X] Unable to say w/o mere speculation

If unable to say w/o mere speculation, please explain:

UNABLE TO PERFORM REPETITIVE MOTION TESTING TODAY

d. Flare-ups

Is the examination being conducted during a flare-up? [ ] Yes [X] No

If no, does the Veteran report flare-ups? [ ] Yes [X] No

If the examination is not being conducted during a flare-up:

[ ] The examination supports the Veteran?s statements describing

functional loss during flare-ups.

[ ] The examination contradicts the Veteran?s statements describing

functional loss during flare-ups. Please explain.

[X] The examination neither supports nor contradicts the Veteran?s

statements describing functional loss during flare-ups.

Does pain, weakness, fatigability or incoordination significantly limit

functional ability with flare-ups?

[ ] Yes [ ] No [X] Unable to say w/o mere speculation

If unable to say w/o mere speculation, please explain:

VETERAN DOES NOT DESCRIBE FLARE UPS

e. Guarding and muscle spasm

Does the Veteran have localized tenderness, guarding, or muscle spasm of

the cervical spine? [X] Yes [ ] No

Muscle spasm

[ ] None

[ ] Resulting in abnormal gait or abnormal spinal contour

[X] Not resulting in abnormal gait or abnormal spinal contour

[ ] Unable to evaluate, describe below:

Localized tenderness

[ ] None

[ ] Resulting in abnormal gait or abnormal spinal contour

[X] Not resulting in abnormal gait or abnormal spinal contour

[ ] Unable to evaluate, describe below:

Guarding

[ ] None

[ ] Resulting in abnormal gait or abnormal spinal contour

[X] Not resulting in abnormal gait or abnormal spinal contour

CONFIDENTIAL Page 38 of 161

[ ] Unable to evaluate, describe below:

f. Additional factors contributing to disability

In addition to those addressed above, are there additional contributing

factors of disability? Please select all that apply and describe:

Less movement than normal due to ankylosis, adhesions, etc., Weakened

movement due to muscle or peripheral nerve injury, etc.

Please describe:

LESS MOVEMENT/SLOW MOVEMENT DUE TO PAIN

4. Muscle strength testing

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

a. Rate strength according to the following scale:

0/5 No muscle movement

1/5 Palpable or visible muscle contraction, but no joint movement

2/5 Active movement with gravity eliminated

3/5 Active movement against gravity

4/5 Active movement against some resistance

5/5 Normal strength

Elbow flexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Elbow extension

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Wrist flexion:

Right: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Wrist extension:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Finger Flexion:

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Finger Abduction

Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5

b. Does the Veteran have muscle atrophy?

[ ] Yes [X] No

5. Reflex exam

CONFIDENTIAL Page 39 of 161

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

Rate deep tendon reflexes (DTRs) according to the following scale:

0 Absent

1+ Hypoactive

2+ Normal

3+ Hyperactive without clonus

4+ Hyperactive with clonus

Biceps:

Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Triceps:

Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Brachioradialis:

Right: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

Left: [ ] 0 [ ] 1+ [X] 2+ [ ] 3+ [ ] 4+

6. Sensory exam

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

Provide results for sensation to light touch (dermatomes) testing:

Shoulder area (C5):

Right: [ ] Normal [X] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Inner/outer forearm (C6/T1):

Right: [ ] Normal [X] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

Hand/fingers (C6-8):

Right: [ ] Normal [X] Decreased [ ] Absent

Left: [X] Normal [ ] Decreased [ ] Absent

7. Radiculopathy

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

Does the Veteran have radicular pain or any other signs or symptoms due to

radiculopathy?

[X] Yes [ ] No

a. Indicate location and severity of symptoms (check all that apply):

Constant pain (may be excruciating at times)

Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ]

Severe

Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ]

Severe

Intermittent pain (usually dull)

Right upper extremity: [ ] None [ ] Mild [X] Moderate [ ]

CONFIDENTIAL Page 40 of 161

Severe

Left upper extremity: [ ] None [X] Mild [ ] Moderate [ ]

Severe

Paresthesias and/or dysesthesias

Right upper extremity: [ ] None [X] Mild [ ] Moderate [ ]

Severe

Left upper extremity: [ ] None [X] Mild [ ] Moderate [ ]

Severe

Numbness

Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ]

Severe

Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ]

Severe

b. Does the Veteran have any other signs or symptoms of radiculopathy?

[ ] Yes [X] No

c. Indicate nerve roots involved: (check all that apply)

No response provided.

d. Indicate severity of radiculopathy and side affected:

Right: [ ] Not affected [X] Mild [ ] Moderate [ ] Severe

Left: [ ] Not affected [X] Mild [ ] Moderate [ ] Severe

8. Ankylosis

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

Is there ankylosis of the spine? [ ] Yes [X] No

9. Other neurologic abnormalities

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

Does the Veteran have any other neurologic abnormalities related to a

cervical spine (neck) condition (such as bowel or bladder problems due to

cervical myelopathy)?

[ ] Yes [X] No

10. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest

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

a. Does the Veteran have IVDS of the cervical spine?

[X] Yes [ ] No

b. If yes to question 10a above, has the Veteran had any episodes of acute

signs and symptoms due to IVDS that required bed rest prescribed by a

physician and treatment by a physician in the past 12 months?

[ ] Yes [X] No

11. Assistive devices

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

CONFIDENTIAL Page 41 of 161

a. Does the Veteran use any assistive device(s) as a normal mode of

locomotion, although occasional locomotion by other methods may be

possible?

[X] Yes [ ] No

Assistive Device: Frequency of use:

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

[X] Cane(s) [ ] Occasional [X] Regular [ ] Constant

[X] Walker [X] Occasional [ ] Regular [ ] Constant

b. If the Veteran uses any assistive devices, specify the condition and

identify the assistive device used for each condition:

USES CANE/WALKER FOR STABILITY

12. Remaining effective function of the extremities

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

Due to a cervical spine (neck) condition, is there functional impairment of

an extremity such that no effective function remains other than that which

would be equally well served by an amputation with prosthesis? (Functions of

the upper extremity include grasping, manipulation, etc.; functions of the

lower extremity include balance and propulsion, etc.)

[ ] Yes, functioning is so diminished that amputation with prosthesis would

equally serve the Veteran.

[X] No

13. Other pertinent physical findings, complications, conditions, signs,

symptoms and scars

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

a. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs or symptoms related to any conditions

listed in the Diagnosis Section above?

[ ] Yes [X] No

b. Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

Section above?

[ ] Yes [X] No

14. Diagnostic testing

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

a. Have imaging studies of the cervical spine been performed and are the

results available?

[X] Yes [ ] No

If yes, is arthritis (degenerative joint disease) documented?

[X] Yes [ ] No

b. Does the Veteran have a vertebral fracture with loss of 50 percent or

more

of height?

[ ] Yes [X] No

CONFIDENTIAL Page 42 of 161

c. Are there any other significant diagnostic test findings and/or results?

[X] Yes [ ] No

If yes, provide type of test or procedure, date and results (brief

summary):

EMG CERVICAL 2/13/11

Conclusion:

There is electrophysiologic evidence of right ulnar neuropathy at

the elbow

based on the nerve conduction study alone. Given the limited

nature

of the study

(without EMG examination), unable to futher localize.

MRI CERVICAL SPINE 12/2014

Impression:

Straightening of the usual cervical lordosis with very mild

kyphosis at C4-5 level.

C4-5: Central disc protrusion indents cord with moderate

central

stenosis.

C5-6: R paramedian and central extrusion with downward

extension

indents cord with mild to moderate central stenosis.

No abnormal enhancement in cervical or thoracic central

spinal

canal.

T7-8:R paramedian disc protrusion and L paramedian small

disc

extrusion with mild central stenosis.

XRAY CERVICAL SPINE 2006:

NORMAL

15. Functional impact

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

Does the Veteran's cervical spine (neck) condition impact on his or her

ability to work?

[X] Yes [ ] No

If yes, describe the impact of each of the Veteran's cervical spine

CONFIDENTIAL Page 43 of 161

(neck) conditions, providing one or more examples:

MANUAL LABOR WOULD BE DIFFICULT FOR THIS VETERAN

16. Remarks, if any:

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

VA FORM 21-2705 REQUESTED DBQ BACK, HOWEVER BODY OF REQUEST NOTES

CERVICAL

SPINE CONDITION. DBQ CHANGED TO NECK (CERVICAL SPINE)

Signed By: MELENDY,KAREN L

Edited January 14, 2015 by Ryguy

[Mikemmlj]

Sorry that is one tough C and P report. No possibility of buddy statements that the injury occured in the military?

[Ryguy]

Yes, i have a battle buddy statement on file from someone who is still in the military, and they were at the hospital with me when the injury occured

[Berta]

Was this claim filed as secondary to, or due to aggravation of, an established service connected condition?

Obviously you will need an IMO from a real doctor, with expertise in this field, to combat the n negative C & P exam.

Have you gone through your STRs carefully? The VA misses a lot when they say they read them.

[Ryguy]

Berta,

it does say for direct service connection, . I'll research a physician for a spine evaluation right now. Can i switch it from direct service connection to secondary/aggravation? And i have xrays from 2003 from where i was gonna go to a chiropractor, that the examiner didn't even take into consideration, which were one year later after the military.

So with an IMO, does the DBQ also have to be filled out? or just a letter?

Edited January 14, 2015 by Ryguy

[Navy04]

I agree with Berta, I would file it as Secondary. This is what I have done on a few conditions to get under the wire of the VA. I am so sorry to hear of your neck issues. I too have severe issues with Neck and Back. The VA is currently paying for me to see Civilian Back DR for fee based treatment, yet I am not SC, WTH!!! God Bless and keep us posted

[Ryguy]

Navy04, could you tell me or direct me to a link that explains what I would need to do right now to change this to secondary/aggravation. My veteran service representative is so hard to get ahold of, and I think my clock is ticking before this gets in the hands of the veteran service rater. Also can I even do this as secondary while i'm in the middle of a Remand that was sent back to the VA Regional Office