My C&p Exam, Need Some Input

[lcplcookba1]

First I want to thank the members of this forum, wow, what a vast data base created by the finest men and women that ever walked the face of this earth. Semper FI to all.

So I was medically discharged after a HUMMER hit my MC as I was just minding my own business in 1987. The right side of my body was pretty much destroyed. Currently, I am rated at

20% degenerative disc disease 5243

20% residuals first and second metatarsals 5010-5284

10% residuals gamekeeper 5010-5224

10% interverbial disk syndrome 5243-8522

10% post operative residuals removal of the plica 5257

10% Chronic Bronchitis 6600

0% scars 7805

Combined Rating 60%

Rating decision was 2010

Jan 2015 I had another C&P exam

My current issues are increased pain in back, right leg is completely numb and aching I've been diagnosed with peripheral neuropathy of both feet, sleep apnea, High blood pressure high cholesterol, diverticulitis, gout, yada yada yada.

I'm prescribed 8 Vicon a day 2700 mg gabapentin, linsipril, samivstatin, indomethicine oh man its a full hand full of stuff just to function everyday. I have VA shoes, a cane and a walker. I'm not good. But it is what it is.

The DR commented that my Pulmonary exam was terrible but didn't expand. I tried to comply with everything he asked of me but I'm very guarded when it comes to my pain as it takes weeks to heal.

I haven't worked in 2 years and was making 72k as a sheet metal worker. My life feels like its over but I have custody of 3 ids 11,15 and 17 and must carry on for them.

The wait is murder to find out if the VA will rate me 100% IU. Can I get some input from you guys

Thanks Cook BA

I'm 49 Y/O and feel like I'm 70.

(440765218) C&P exam-pdf.pdf

Edited February 2, 2015 by lcplcookba1 (see edit history)

[Navy04]

Sorry to hear of your troubles bud. Paste your C&P exam notes here and we can help you from there. Based on your health issues, it sounds like you have been lowballed to only be 60% SC. I am only 32, was 30 when the Navy retired me, and a Doc told me a few months ago, that I have the insides of a 65 year old man, Lol! Good luck and God Bless. Keep us posted bud

[lcplcookba1]

OK I've attached my full C&P exam notes and findings. The dr states several time that my disabilities adversely affect my ability to maintain employment. Will the VA look at that and decide to give me IU? Also will this exam help with my SSD claim I filed 15 moths ago? Thanks guys and gals for any comments on this matter. Also he said my sleep apnea isn't caused by chronic bronchitis, Is there no nexus between the 2?

C&P exam.doc

[Navy04]

The exam was hard to read, but in my opinion there is plenty there for you to have a few more conditions to be granted SC. Now at what % is hard to say bud. As far as IU, yes the VA could send you the forms for IU, but I would think that currently there is not enough there, unless you have a SC condition with a high % that affects your ability to work tremendously. When it comes to your SSDI claim, every bit of evidence helps. Did you get your Physical and Mental VA Docs to fill out a SSA Mental and Physical Capacity Form? If not I can email it to you or you can google these forms. These forms help tremendously bud. Good luck and keep us posted

[lcplcookba1]

The exam was hard to read, but in my opinion there is plenty there for you to have a few more conditions to be granted SC. Now at what % is hard to say bud. As far as IU, yes the VA could send you the forms for IU, but I would think that currently there is not enough there, unless you have a SC condition with a high % that affects your ability to work tremendously. When it comes to your SSDI claim, every bit of evidence helps. Did you get your Physical and Mental VA Docs to fill out a SSA Mental and Physical Capacity Form? If not I can email it to you or you can google these forms. These forms help tremendously bud. Good luck and keep us posted

yea its a lot to take in. I found 3-4 times the dr said my disability would keep me from working thats why I asked. I also applied for IU at the same time of my claim. I haven't worked in 2 years because of my issues, going to get diabetic shoes on the 28, I was issued a walker and it helps but my pride is a tough hurdle to get over, Soon enough I won't have a choice. My dr said she wouldn't fill out forms for SSD, Its not VA Policy she said

example

Regardless of the Veteran's current employment status, do the

condition(s)

listed in the Diagnosis section impact his or her ability to perform any type

of occupational task (such as standing, walking, lifting, sitting, etc.)?

[X] Yes [ ] No

If yes, describe the functional impact of each condition, providing one or

more examples:

Unable to walk or stand for prolonged periods of time.

Edited January 26, 2015 by lcplcookba1 (see edit history)

[Navy04]

I know that a lot of VA Docs don't want to feel out the SSA forms, and it drives me Fu**** crazy. I was lucky and my VA Docs filled them out for me. As far as you not being able to stand, I agree with that, but you also have to remember that the VA and SSA leach suckers can try to say that you are bad enough to do no Physical Labor but Smart enough to do Admin or Book work jobs. I have seen that more than once bud. Just hang in there and I will pray for both you and I. God Bless

[lcplcookba1]

thanks Navy04 I'll Take it! I never met a sailor I didn't like

Edited January 26, 2015 by lcplcookba1 (see edit history)

[free_spirit_etc]

Good luck with your claim!

It looks like most of the issues that the doctor checked impacted your ability to work, the doctor also stated that they were less likely than not related to your SC conditions. You might want to consider getting an Independent Medical Opinion on this and see if another doctor thinks they are related.

Have you applied for SSDI?

[lcplcookba1]

Good luck with your claim!

It looks like most of the issues that the doctor checked impacted your ability to work, the doctor also stated that they were less likely than not related to your SC conditions. You might want to consider getting an Independent Medical Opinion on this and see if another doctor thinks they are related.

Have you applied for SSDI?

Yes I applied feb 2013, still waiting for my day in court. So the fact the dr found my service connected issues affected my ability to work will the rater take that into consideration on my IU clain. Most of the less likely's were to new claims so Im not surprised. Is there a list of vet friendly Civ drs I can find, I havent worked in 2 yrs so I dont have ins, I live in OH thanks!

[free_spirit_etc]

Are you going for increased ratings also? Some of the ratings seem a bit low in regard to being unemployable. (However, I am not very familiar with TDIU claims). It will definitely help if the doctor states your service connected conditions prevent you from working, or limit you so much that it would be difficult to find a job that you can do.

As far as SSDI, all conditions should be considered, regardless of whether they are service connected or not.

I wouldn't be completely convinced that your service connected conditions are not related to your other conditions. So I think you are wise to seek the opinion of a private physician.

As far as SSDI, you mention a walker and cane. Do you have to use a walker much? Or two canes?

You might want to read http://www.socialsecurity.gov/disability/professionals/bluebook/1.00-Musculoskeletal-Adult.htm

"(1) Definition. Inability to ambulate effectively means an extreme limitation of the ability to walk; i.e., an impairment(s) that interferes very seriously with the individual's ability to independently initiate, sustain, or complete activities. Ineffective ambulation is defined generally as having insufficient lower extremity functioning (see 1.00J) to permit independent ambulation without the use of a hand-held assistive device(s) that limits the functioning of both upper extremities. (Listing 1.05C is an exception to this general definition because the individual has the use of only one upper extremity due to amputation of a hand.)

(2) To ambulate effectively, individuals must be capable of sustaining a reasonable walking pace over a sufficient distance to be able to carry out activities of daily living. They must have the ability to travel without companion assistance to and from a place of employment or school. Therefore, examples of ineffective ambulation include, but are not limited to, the inability to walk without the use of a walker, two crutches or two canes, the inability to walk a block at a reasonable pace on rough or uneven surfaces, the inability to use standard public transportation, the inability to carry out routine ambulatory activities, such as shopping and banking, and the inability to climb a few steps at a reasonable pace with the use of a single hand rail. The ability to walk independently about one's home without the use of assistive devices does not, in and of itself, constitute effective ambulation.'

Also -- You mention you are 49. When do you turn 50?

The whole game changes for Social Security when you turn 50. The standards to meet to be considered disabled are not as limited. They start basing it more on whether you can do the work you used to do, rather than whether you can be retrained to do something else.

http://www.ssa.gov/OP_Home/cfr20/416/416-0963.htm

"© Younger person. If you are a younger person (under age 50), we generally do not consider that your age will seriously affect your ability to adjust to other work. However, in some circumstances, we consider that persons age 45-49 are more limited in their ability to adjust to other work than persons who have not attained age 45. See Rule 201.17 in appendix 2 of subpart P of part 404 of this chapter.

(d) Person closely approaching advanced age. If you are closely approaching advanced age (age 50-54), we will consider that your age along with a severe impairment(s) and limited work experience may seriously affect your ability to adjust to other work.

(e) Person of advanced age. We consider that at advanced age (age 55 or older), age significantly affects a person's ability to adjust to other work. We have special rules for persons of advanced age and for persons in this category who are closely approaching retirement age (age 60 or older). See § 416.968(d)(4)"

Sorry I haven't been much help with the TDIU claim. I just know a little bit more about Social Security.

[Guest]

What most people who suffer from chronic pain don’t think about or is willing to admit is that they most likely suffer from some form of depression/anxiety. You may want to check with your doctor to have him/her refer you to mental health for depression/anxiety due to your service connected conditions and if they treat you, you can also file a claim for depression/anxiety caused by or as a result of your already service connected conditions. Get it documented in your VAMC records and go from there.

This is another way to raise your combine rating percentage.

Hope this helps.

Pete

P.S. I posted this to another post but changed it to fit your situation. Have you filed a claim for depression/anxiety? If VA denies your claim for IU, you may want to file a claim for depression/anxiety but keep in mind that you will need a doctor's nexus statement that your already service connected conditions causes your depression/anxiety or your depression/anxiety is the results of your already service connected conditions.

[georgiapapa]

lcplcookba1,

I wish you well but I have to agree with Navy and others. Based on the comments in your C & P exam and your current ratings, I just do not see TDIU being granted.

The statements by your C & P doctor indicating your current service connected disabilities impact your ability to work is a step in the right direction but you will have a difficult, if not impossible task, trying to get TDIU without a strong IMO using the criteria which can be found on this website. Others on Hadit may give you recommendations on doctors who provide IMOs for your specific conditions.

Other criteria to keep in mind to receive TDIU, you must have,

At least one (1) rating of 60% or higher or;

At least two (2) ratings with one rating of 40% or higher and a minimum combined rating of at least 70%;

and the service connected disabilities prevent the veteran from seeking or working in substantial gainful employment.

Of course, my opinion may differ from others on this website. You should do your own research on TDIU and on your specific disabilities. I would suggest reading 38 CFR part 4 as this contains the rating tables used by the VA to determine ratings based on the severity of your conditions.

Good luck.

[lcplcookba1]

I really appreciate everyones help, good or bad for me, i want to hear it all, The stuff in this exam is just the stuff I could think of that was wrong with me when I spoke to the VSR. Of course I have depression I take 35 pills a day just to get out of bed. and my doc would give me a referal in a heart beat. I hav diverticulitis, bowel issuse from the narcs ED from all the service connected meds My hand was broken and I get 10 percen for risiduals for that which wasnt even part of this exam, I use a hammer for a living I'm sure I could think of 5 more things . Of course they didnt find any nexus between my left leg and my right Ive only had a limp for 30 years That has nothing to do with my right other than bearing most of my weight for 30 years right? right! So Had it is right, they want a pain in the a$$ THEY GOT ONE, LOL I never quit anything in my life, I won't give up, just advance in another direction, as fast as my walker and service connected disabilities will allow of course .If I could find a decent dr who took new patients and didnt have skin in the VA Game, I'd be all set, Oh hey if SS find you unemployable does that help with your VA case. Binder and binder took my case so they obviously thought I had a case anyhow thanks so much guys! If anything it helps to have someone to talk too

Edited January 28, 2015 by lcplcookba1 (see edit history)

[lcplcookba1]

lcplcookba1,

I wish you well but I have to agree with Navy and others. Based on the comments in your C & P exam and your current ratings, I just do not see TDIU being granted.

The statements by your C & P doctor indicating your current service connected disabilities impact your ability to work is a step in the right direction but you will have a difficult, if not impossible task, trying to get TDIU without a strong IMO using the criteria which can be found on this website. Others on Hadit may give you recommendations on doctors who provide IMOs for your specific conditions.

Other criteria to keep in mind to receive TDIU, you must have,

At least one (1) rating of 60% or higher or;

At least two (2) ratings with one rating of 40% or higher and a minimum combined rating of at least 70%;

and the service connected disabilities prevent the veteran from seeking or working in substantial gainful employment.

Of course, my opinion may differ from others on this website. You should do your own research on TDIU and on your specific disabilities. I would suggest reading 38 CFR part 4 as this contains the rating tables used by the VA to determine ratings based on the severity of your conditions.

Good luck.

I found this It would seem to me if the rater is using this criteria and multipul times in my report its repeated that I'm unable to preform work, the logical conclusion is I'm unemployable. what else am I missing

§ 4.2 Interpretation of examination reports.

Different examiners, at different times, will not describe the same disability in the same language. Features of the disability which must have persisted unchanged may be overlooked or a change for the better or worse may not be accurately appreciated or described. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. Each disability must be considered from the point of view of the veteran working or seeking work. If a diagnosis is not supported by the findings on the examination report or if the report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes.

Edited January 28, 2015 by lcplcookba1 (see edit history)

[lcplcookba1]

Are you going for increased ratings also? Some of the ratings seem a bit low in regard to being unemployable. (However, I am not very familiar with TDIU claims). It will definitely help if the doctor states your service connected conditions prevent you from working, or limit you so much that it would be difficult to find a job that you can do.

As far as SSDI, all conditions should be considered, regardless of whether they are service connected or not.

I wouldn't be completely convinced that your service connected conditions are not related to your other conditions. So I think you are wise to seek the opinion of a private physician.

As far as SSDI, you mention a walker and cane. Do you have to use a walker much? Or two canes?

You might want to read http://www.socialsecurity.gov/disability/professionals/bluebook/1.00-Musculoskeletal-Adult.htm

Also -- You mention you are 49. When do you turn 50?

The whole game changes for Social Security when you turn 50. The standards to meet to be considered disabled are not as limited. They start basing it more on whether you can do the work you used to do, rather than whether you can be retrained to do something else.

http://www.ssa.gov/OP_Home/cfr20/416/416-0963.htm

Sorry I haven't been much help with the TDIU claim. I just know a little bit more about Social Security.

I was issued a walker and yes I use it if I know I have to be walking for a distance Mostly just a cane

[georgiapapa]

lcplcookba1,

Personally, I believe the medical conditions you have described make if difficult for you to work and I hope you eventually get TDIU. You and I may reach a logical conclusion that you are unemployable but you are dealing with the VA which applies federal law, written policies and established criteria to reach a conclusion rather than logic or common sense.

Perhaps I overlooked it when I read your C & P report, but I do not recall the examiner saying you are unable to work. The examiner used the following phrases indicating limitations on your ability to work: "unable to walk or stand for prolonged periods of time", "limited bending or lifting", and "unable to engage in strenuous activities." Also, some if not all of the conditions he indicated were causing these limitations were condtions the examiner determined were "less likely than not" caused by your service connected conditions. In other words, most, if not all of your work limitations referenced in your C & P report were not caused by service connected condtions and as a result would be given limited or no consideration for TDIU.

Keep in mind Rating Specialists at your RO have to make their determination as to service connection and severity of service connected conditions based on the evidence they are given and applicable laws and policies. Absent an IMO or other evidence to the contrary, they will heavily rely on the C & P examiner's report to determine if your claimed conditions are service connected. The Rating Specialist will use 38 CFR part 4 and review the symptoms noted by the C & P examiner for your claimed conditions and apply the appropriate disability rating according to your level of disability for each service connected condition. When considering additional disability compensation such as TDIU, the Rating Specialist must follow the criteria set forth by the VA regarding eligibility for TDIU. This criteria includes my references in my previous post. At the present time, you do not meet the criteria since you do not have a single rating at 60% or two ratings or more for a combined rating of 70% and at least one rating of at least 40%. The C & P examiner also never stated you could not engage in all forms of substantially gainful employment (e.g.- sedentary office work).

Again, a good IMO is your best chance of being service connected (primary & secondary) for additional medical conditions and to meet the criteria for TDIU and possibly P & T at some point in the future. A good IMO is a good investment in your financial future.

Good luck and Semper Fi.

[lcplcookba1]

lcplcookba1,

Personally, I believe the medical conditions you have described make if difficult for you to work and I hope you eventually get TDIU. You and I may reach a logical conclusion that you are unemployable but you are dealing with the VA which applies federal law, written policies and established criteria to reach a conclusion rather than logic or common sense.

Perhaps I overlooked it when I read your C & P report, but I do not recall the examiner saying you are unable to work. The examiner used the following phrases indicating limitations on your ability to work: "unable to walk or stand for prolonged periods of time", "limited bending or lifting", and "unable to engage in strenuous activities." Also, some if not all of the conditions he indicated were causing these limitations were condtions the examiner determined were "less likely than not" caused by your service connected conditions. In other words, most, if not all of your work limitations referenced in your C & P report were not caused by service connected condtions and as a result would be given limited or no consideration for TDIU.

Keep in mind Rating Specialists at your RO have to make their determination as to service connection and severity of service connected conditions based on the evidence they are given and applicable laws and policies. Absent an IMO or other evidence to the contrary, they will heavily rely on the C & P examiner's report to determine if your claimed conditions are service connected. The Rating Specialist will use 38 CFR part 4 and review the symptoms noted by the C & P examiner for your claimed conditions and apply the appropriate disability rating according to your level of disability for each service connected condition. When considering additional disability compensation such as TDIU, the Rating Specialist must follow the criteria set forth by the VA regarding eligibility for TDIU. This criteria includes my references in my previous post. At the present time, you do not meet the criteria since you do not have a single rating at 60% or two ratings or more for a combined rating of 70% and at least one rating of at least 40%. The C & P examiner also never stated you could not engage in all forms of substantially gainful employment (e.g.- sedentary office work).

Again, a good IMO is your best chance of being service connected (primary & secondary) for additional medical conditions and to meet the criteria for TDIU and possibly P & T at some point in the future. A good IMO is a good investment in your financial future.

Good luck and Semper Fi.

Yes Sir, thanks for the great jolt of reality. I do agree with what you say. There is one thing to know you can't work and the other is proving it. According to my calculations and followong the federal guide lines. My SC bronchritis will be rated at 30% with an FEV-1 of 62% after inhaler and my DDD at 40% with forward flexion of 25 deg. if all other ratings remain the same gives me a combined rating of 80%. I know God probably grows tired of working these claims, but if He doesn't get mine on a Friday or a Monday, I still have Hope. I've called 15 Dr's offices in the Toledo Area. No Doctors are taking new patients primarily because of Obama Care or so they say. I offered cash, still no takers. Well I'm off tto get my diabetic Shoes from the shoe van man TOPC. I don't have diabeties but I have the foot pain, go figureif I ask again, Social security deems you unemployable, will the VA Follow suit, has anyone found this to be the case? ThanksI ask again

Edited January 28, 2015 by lcplcookba1 (see edit history)

[georgiapapa]

I hope things work out for you. If you get the 40% for DDD and end up with a combined rating of 70%, you would be a good candidate for TDIU as long as your evidence shows your service connected conditions keep you from seeking or working at significant gainful employment. Please keep us posted as I hope you achieve TDIU status or better yet, 100% P & T status so your 3 children will have Chapter 35 educational benefits and Champva healthcare benefits.

Good luck.

[lcplcookba1]

I hope things work out for you. If you get the 40% for DDD and end up with a combined rating of 70%, you would be a good candidate for TDIU as long as your evidence shows your service connected conditions keep you from seeking or working at significant gainful employment. Please keep us posted as I hope you achieve TDIU status or better yet, 100% P & T status so your 3 children will have Chapter 35 educational benefits and Champva healthcare benefits.

Good luck.

thank you Sir I should have a desision soon enough

[free_spirit_etc]

Other criteria to keep in mind to receive TDIU, you must have,

At least one (1) rating of 60% or higher or;

At least two (2) ratings with one rating of 40% or higher and a minimum combined rating of at least 70%;

and the service connected disabilities prevent the veteran from seeking or working in substantial gainful employment.

I thought that too, but I ran across this website http://www.veteranslaw.com/content/total-disability-individual-unemployability-tdiuthat said

"A veteran is entitled to a 100% disability rating if he can establish that his service-connected disability[ies] preclude him from obtaining gainful employment. In VA law, such claims frequently go by the abbreviation “TDIU”, referring to a Total Disability rating based upon Individual Unemployability. It is a common misunderstanding that a veteran can only qualify for a TDIU rating if he meets certain percentage disability requirements: namely, a single service-connected disability rating of 60%, or a combined service-connected disability rating of 70%. Unfortunately, through many of its notices to veterans, the VA is largely responsible for this misunderstanding. The truth is that a veteran can qualify for a TDIU rating any time one or more of his service-connected disability[ies] prevents him from obtaining employment, regardless of the percentage of the disability rating."

So getting TDIU might not be easy without the 60 or 70 percent service connection -- but it might be possible.

[free_spirit_etc]

I ask again, Social security deems you unemployable, will the VA Follow suit, has anyone found this to be the case? ThanksI ask again

Not necessarily. Social Security's decision would be based on whether all your disabilities combined prevent you from working, while the VA will consider the SC disabilities.

I didn't get from the C&Ps that the doctor was saying the conditions prevented you from working, but that they impacted the types of work you could do.

That was one of the reasons I asked if you also had problems with prolonged sitting. I know the C&P stated you had trouble with prolonged walking, and lifting and bending. But a lot of people with back conditions also have trouble sitting for substantial periods - which also rules out many sedentary jobs that someone who is merely unable to walk or stand for long periods can do.

Hopefully you can get a good IMO that can connect the left side conditions to the right side conditions. Maybe you could ask the rater to drag his right side around for about 30 years and see if it doesn't affect his left side.

Edited January 28, 2015 by free_spirit_etc (see edit history)