New To This Forum -- My Claim Has Been In The Ratings

[rdawg]

I filed my original claim for degenerative disc disease of the lumbar spine on 30MAr2006. They denied it within 60 days. The SOC said my SMRs show I was treated for DDD/back injury in service but no permenant/chronic condition existed. That was my fault, I signed the 21-4142 to realease my Private Dr's records and put it in my mailbox with the little flag up and the VA never got it. So I submitted a radiology report showing DDD of the lumbar spine on Jul28. It went into the rating board on Jul28 with SMRs and the radiologist report. I called and they said a decision had been made (OCT19th) and I would recieve a letter soon. I caled back and they said it was back in the rating board (OCT23rd). I can't get anyone to tell me why it came out and went right back in. Sometimes they tell me it will be 7-10 days, other times they say it will be 60-90 days.

I'm confused and I can't seem to get a straight answer.

[Guest jstacy]

DId you get a C@P exam for the back? If not, you need to do what you can to get one. Without a medical opinion that links the current condition to in service injury, It is like trying to perform a root canal on a rattle snake, You can and will get bit.

[rdawg]

NO. no C&P yet. They said they had everything they needed to decide my claim. Are they just delaying so they can deny?

I did appoint the AL as my rep and they had me get my Dr. to write a letter in support of claim. He linked my current condition to service. I submitted that around the end of SEP06. My rep said it would go right into the rating board. Is he correct? or was that piece of evidence waiting until the CF came out of the rating board? Is this why it came out and went right back in?

If it was going to be denied why did it take so long and why didin't they schedule me for a C&P exam back in July when they said it was ready to rate? It was ready for denial.

[Guest jstacy]

You dont have to get a C@P exam if a doctor makes the nexus, maybe they will rate it with the information they have. Did the doctor do a range of motion test? I am ataching the C@P criteria for the MD to use. This is what the VA rates IVDS or spinal issues on.

http://www.vba.va.gov/bln/21/Benefits/exams/disexm53.htm

If you have not, you may want to get the doc to use that format.

[rdawg]

Thanks jstacy. My doctor did not use this form or do a range of motion test.

I stil don't see how they could have said it was ready to rate with just the radiologist report back in July. Someone at the 800 number said I could get 10% with the info they had. I get so many different stories from them it's unbelievable.

thanks again.

[Guest jstacy]

That is why I am suprised you did not get a C@P exam for many docs do know the criteria the VA uses to rate disabilities.

Also there is a schedule of rating disabilities for the spine. http://ecfr.gpoaccess.gov/cgi/t/text/text-...0.1.1.5.2.96.26

Edited November 2, 2006 by jstacy (see edit history)

[rdawg]

thanks again. both links are very helpful. I'll keep pressing the RO for a C&P exam.

[Vike17]

rdawg,

One reason why your claim may have came out of the rating activity and then went back in again was because during the authorization phase, they may have found an error in the rating decision such as a typo or wrong effective date, and they sent it back to the RVSR to be corrected. Keep in mind, generally, authorization doesn't change the RVSR's decsion, they just check for really obvious errors such as the ones I jusy mentioned.

You also mentioned that your claim was previously denied and that you received a SOC. Did you submit a Notice of Disagreement in reference to the VA"s denial, and the VA subsequently sent you a SOC? The reason why I ask is because the way explained it in your first post isn't the way VA is suppose to operate. The VA only issues a SOC when the are reaffirming a prior denial of theirs. At any rate, obviously you sent in additional evidence after the initial rating decision and the VA appears to have reconsidered their previous decision based on that additional evidence.

If you didn't receive a C&P exam, the VA may have all the needed medical documentation to rate the claim without an exam; especially if you have medical records that aren't over a year old that are sufficient for rating purposes.

You stated "I signed the 21-4142 to realease my Private Dr's records and put it in my mailbox with the little flag up and the VA never got it"

Always send stuff to the VA "Certified with return receipt" or hand deliver it to the regional office and have them date stamp your copy.

You also said "They said they had everything they needed to decide my claim. Are they just delaying so they can deny?"

That statement doesn't make any sense. Why would the VA want to dely the claim first and then ultimately deny it? The VA wants to work claims as fast as possible. If they wanted to deny it, they would do it right away, so they could take what is called an "End Product" credit for clearing a case off of the books!

Vike 17

[rdawg]

Thanks Vike17.

They said it went to authorization and went back to the ratings board. Does this mean that it was not denied? If it were denied would they send it back?

I mispoke about the SOC. It was a rating decision. No NOD. I just submitted the radiologist report under the rule that I have a year to submit additional evidence.

I now understand how important certified mail is. I won't make that mistake again.

I would hope they would not delay and deny but I'm still pretty new to this process. I've been reading some of the horror stories here and in the Appeals.

Thanks again. What a well thought out response. I really appreciate it.

rdawg

[rdawg]

I just called today and they said a decision has been made and it is with the post team. I should hear something in a couple of weeks. Hopefully it's like Vike17 said, there was some error (an effective date would be nice) that sent it back to the rating board.

Thanks for thehelp. This board is great.

[rdawg]

Does anybody know what vetsnet is. I called the AL today and they said my status was vetsnet and did not know what that meant. They are going to try to find out today but she said the VA was like a ghost town due to the holiday.

BTW. Happy Veterans day to all. Thank you for your sacrifice.

[Guest jstacy]

Actually tommorrow is the Government Version of Veterans DAY, They should be full speed today.

[rdawg]

Evidentally they are all taking leave to extend the weekend. I'm a fed contractor and the feds are pretty scarce here.

[saltydawg]

they said my file was with the post determantion team. dose this mean they have granted s/c. i have nod for ddd in upper & lower back. va doc put this on a dva memorandum paper and gave ti to me i sent it with my nod these are her words. the pathology in mr. _____ neck and lumbar spine could have been caused by heavy lifting such as during his time in the military. she under lined could. i've no c&p.what do ya'll think?

[rdawg]

From what they tell me the file goes to the "post team" no matter what the decision is. this is where they draft the letter telling you their decision.

Did you doc review your service medical records and claims folder?? Everything I read on the decisions from the appeals is that "competent" medical evidence is accepted. Without review of the SMR's and Claims folder it is not competent. To me it is just another way to delay and deny. They have those records and make them available to the C&P examiner. That makes his opinion competent and the private doc's not competent.

My case was in the ratings board when I figured this out. I called the VA to get copies and they said it would have to wait until it came out of the ratings board. It's been there for four months. Once it comes out it could take a while for them to make copies also. They told me there is only one person who makes copies and she is very busy.

[Berta]

"They have those records and make them available to the C&P examiner. That makes his opinion competent and the private doc's not competent."

If any private doc has a copy of all these records too- they certainly can write a good IMO that could potentially combat a negative VA opinion.

Also- in my case the VA examiner only used a few records out of 5 volumes and never looked at any other medical evidence.

My private IMO doctor rebutted with the fact that he had used ALL pertinent records available and even past SOCs and other VA med opinions and statements.

He didnt need SMRs for my claim-but usually the private doctor needs the med recs as well as the SMRs if there is a definite linkage to service that is being questioned by the VA.

[rdawg]

Berta,

Absolutely... I did not mean to imply that any IMO was incompetent. It must be based on the SMR's and clam's folder.

Did you see my earlier post about vetsnet?? What is it??

[rdawg]

Just like I said, delay and deny. I got my denial the day before veterans day. Wooo Whooo.

They said they had enough evidence to decide my claim. What they should have said was they had enough to deny my claim.

The note from my doctor said my degenerative disc disease was related to my back strain in service. The VA said that there was no evidence of DDD in service therefore it cannot be related. WHat a crock. Now for the appeals process.

My new catch phrase will be -- Delay until they die.

[Berta]

Rdawg -did they list the doctor's report you had as evidence and did they refer to it at all in the denial?

Is there evidence of the back strain in your SMRs?

[rdawg]

Here is what they said.

Submitted treatment records form Amreican Radiology showing degenerative changes many years (12) after your discharge. Statement from Dr. J.B. indicates a relationship between your current condition and military service referencing your diagnosis of back strain in 1987. There were no degenerative changes and /or skeletal involvement during military service, noted at seperation, or confirmed by x-ray within one year of your military discharge. Therefore there is no link between your degenerative disc disease and back strain during service. There is no evidence showing continous symptoms or treatment since your military discharge that would provide a link to military service.

To answer Berta's question.

I injured my back in the AF lifting a box of parts. I was seen twice in 1987 for back strain. They gave me Physical Therapy to do at home and sent me on my way. I was a support equipment mechanic for 4 years at Homestead AFB, FL. Shortly after I injured my back I was placed in an administrative position, dealing with paperwork for the same outfit. I don't think I was put on a physical profile. I don't have a copy of my SMRs but will be getting one.

Question for Berta.

When they say "There is no evidence showing continous symptoms."

Can Statements in support from myself, my wife and others who knew me then and witnessed me in pain (from 1987 until now) satisfy the "continous symptoms" requirement? Or does it have to be medical records?

Thanks in advance for any help.

[Berta]

"There is no evidence showing continous symptoms"

They should certainly consider statements from your family and anyone else that can verify the inservice injury and that it caused you continuous problems but they are looking for treatment records to show continuous problems from this that required some medical care.

Then again your USAF job was changed due to the back strain and it probably affected the type of work you did since discharge.

Would Dr. J. B. be able to provide more to the VA as to how back strain can often be self medicated by aspirin etc- yet in time can turn into DDD?

I have a vet locally in similiar situation- 15 years ago inservice documented back problem and now arthritis and other things that a VA doctor said were directly related to the inservice back problem.

Still there is no evidence of continuous treatment and he isnt interested in filing a claim.

But he only took aspirin for these problems until they got worse and affected his job-he works for the VA.I would certainly pursue this- even if there were no continuous treatments.

But were there any treatments after service?

And does VA know about them- even chiropractor treatments---which would show that something was still affecting you?

These claims are often very difficult. Did the back problems show up at any employment physical you had since leaving the military? It appears this is the main reason they denied.

Are you sure in the last almost 20 years you were not treated for this condition by anyone?