New claim & Appeals questions

[invisible]

I was med boarded through a WTU in 2011, recieved my determination in 2014. After the ourcome of the determination, I hired a Attourney. What hurt me in the determination is that the whole time since seperation, I was pregnant or breastfeeding and therefore that affected MD documentation following my seperation. Every time I went to the VA about things, they said that due to pregnancy etc OBGYN was my primary. I currently recieve 60%, but many of the things they sc with 0% or denied-which I am going to fight. So once I hired a lawyer, and I started to dilegently go to a civilian doctor, to recieve my treatment for all my issues. Fast forward, I have some areas that have empirical tests (sleep apnea, plms/rls from my awesome double board certified MD in sleep and ENT specialty)... but many of the things I recieved 0% on were due to ROM measurements not being limiting enough.

I did not discuss this with my primary care (my intent to claim/appeal bc I didn't want that to make him biased or stereorype me...many people do not understand the difference in MIL/VA disability and SSI/SSDI. They trasnfer their stereotypes of civilian disability over to MIL-related disability...), but all these issues have honestly been getting worse, and I want to get to the root issues. Anyways, my PC MD begun prescribing me gabapetin for nerve pain, cymbalta for fibromyalga, fiercet for headaches and baclopen for muscle spasms. The funny thing is that if you look at the things in my claim (whether denied, SC with any %, I meet all the related symptomology of fibromyalga). Plus there is plently of the same complaints while I was active, brought up to my medical team while in the warrior transition unit, and during my MEB. Just this last month I brought the associated questionaire for FM (It was the most important and I didn't want to overload him) for my MD to fill out. He kept delaying filling it out, and when I finally went to talk to him- he claimed at he didn't remeber diagnosing me with FM. I had even asked him like 6 months ago if other diagnostics or othger specialties needed to be considered- to confirm or rule out his diagnosis, to which he said there was no tests. He told me he didn't feel comfortable filling it out bc it was confusing and that he didn't want to fill out it wrong, and is referring me to a rhumetologist.  

Granted...I should have asked for a referral a while back. But he even seemed iffy filling out the easy ones like headaches, etc. I requested a copy of all my treatment notes from him and his MD notes are sub par and do not mention much, and in some ways contradict. They are good enough to show the rheumatologist, and a perfect segway to let him know up front I want to figure out what is actually going on. My issue is that my attourney had already filed a appeal for some of the things in my original claim, and had filed a new condition for FM. I have gone through my C&P appt, but due to my wishy-washy PC MD, I will not have much other evidence from any forms I needed the PC MD to fill out. The sleep/ENT related ones are filling out and ready, and I might want to add TMJ which I have documented in MIL, flares when the FM stuff flares, and the DDS/MD is one of the ones that mentioned I should go see a rheumatologist beacuse it seems like I have systemic musculoskeletal issues that need to be looked at- FM, tmj, arthritis DDD/DA, msucle spasms, TMJ, etc etc. 

I am dissapointed that certain primary MD's have no problem stating you have certain issues, treating and medicating, and getting paid for F/U's, but without offically diagnosising, or being willing to stand by their treatment, and diagnosis and "too confused" to fill out simple VA packets. If someone graduated medical school and residency, a VA packet is easy. One of my sisters is a MD and I talked to her at length after this happened, and she explained some of the possible reasons why, and that overall, a Rheumy and other specialty MD will be better at taking detailed notes, confidence in diagnosis, etc. 

 

Has anyone else had issues like this with a MD not cooperating?

For DDD/DA, ROM is key, is there anyt exception to that? I have been reading through stuff and the painful motion(4.59) rule would work, or under MS system, Joints (4.45) d, e and f would apply to me, plus I have bad crepedation but my ROM isn't bad enough. Is there another way or terminology? I assume the VA is going to categorize it in the way that best suits them. I do have ddd of the cervical and lumbarsacral- the SI- L5-S1 with osteophyte and boney islands. In my C5/C6 I have a buldging disc, which hasnt had a mri or CT since 2010 during my MEB. The rules they did consider were not the ones I listed above, and unless there is another reason, I guess they considered those to benefit them...

I can include my original claim, and determination details below in a bit if its is helps, just let me know. I apologize if my post is scattered. I have been reading, researching, plus I have taken some classes in A&P, and have a civilian sister who is a MD who can better explain medical things if I need clarification. My issue is that there are so many working parts and variables, not to mention the variables of the VA system. At this point, I am not letting the set back from my PC MD bring me down, I just need to refocus and learn from my oversights... I plan on expalining more, but I tend to be very thorough in figuring out and researching things and don't want to overload anyone willing to read my post. I tend to be long winded and for that, I apologize.

Thanks in advance!

Edited October 25, 2015 by invisible

[lotzaspotz]

Yes, we have.  We wrote the opinion for my husband's doctor, copied it on a thumb drive in the event he wanted to change anything, and he said he would do it.  We offered to pay a fee, but he didn't name a number or talk further about that, but we figured he would once he started writing the opinion.  We then called around the month and a half mark to see how it was going, but he said he had been busy and hadn't gotten to it yet.  At the three month mark we called again, only to be told that time that he didn't want to get involved beyond my husband's medical records in his office and then returned everything to us.  This was certainly his perogative, I just wish he told us up front instead of stringing us along.  

Edited October 26, 2015 by lotzaspotz

[Guest]

A lot of us has been there and done the things you are doing. In my case I had doctors willing to help but really did not know how to help.  I was just as frustrated as they were but I was hospitalized several times due to IBS and GERD. My doctors fumbled around five years before they finally diagnosed me with fibromyalgia, IBS, and Migraines.  At some point in time VA denied all my claims but with the help of my VA doctors I finally got most of my conditions service connected at least to 100% scheduler P & T.  Keep on fighting never give up.

[pwrslm]

Your sister is an MD. 

 

Most of us wish we were related!!  They cannot ignore your sister if she gives you a medical examination and opinion.  DR Bash has done a lot of good for Vets, in area's that he is not a specialist in.  The fact that he researches conditions for the vet, and presents current and valid medical studies and literature to prove his diagnosis and opinions, is too much for the VA to oppose.  As long as your sister puts the medical etiology into her IMO/E (independent medical opinion and/or examination), and details the medical literature that are behind that, then you have a powerful ally. 

Word of warning, it all has to be on the up and up. No fudging the truth, and all should go well.

Edited October 26, 2015 by pwrslm

[Andyman73]

Welcome to Hadit, and thank you for your service.  You will find all you ever wanted to know, here, and so much more!

Semper Fi.

Andyman

[invisible]

Your sister is an MD. 

 

Most of us wish we were related!!  They cannot ignore your sister if she gives you a medical examination and opinion.  DR Bash has done a lot of good for Vets, in area's that he is not a specialist in.  The fact that he researches conditions for the vet, and presents current and valid medical studies and literature to prove his diagnosis and opinions, is too much for the VA to oppose.  As long as your sister puts the medical etiology into her IMO/E (independent medical opinion and/or examination), and details the medical literature that are behind that, then you have a powerful ally. 

Word of warning, it all has to be on the up and up. No fudging the truth, and all should go well.

While it would be nice to ask her to do that, I do not want to go that route. Granted she is a step-sister, but I would rather not take advantage of her, and use her as a sounding board and clarification. 

[Andyman73]

invisible,

I see you!  Not invisible anymore, but I do know what you mean, kinda like that Clay Aiken song about being invisible, and the one line says something about being invisible, oh wait, he already is.

My wife's cousin's husband is an ER Trauma doc(she's a lawyer) and we don't ask too much of him, either.

Gotta tell you this, I didn't notice if you said, but if not, request a complete copy of your C-file and service treatment records, too.  I got my c-file this past summer, and found an old C&P exam from '06, that was never decided, but was SC this summer, from a new claim on same contention, for 30%.  So I'm filing a NOD for EED, earlier effective date.  I'm looking at $50Gs or more possibly...

So, just remember one thing, we here, are all visible, if not to our own selves, to each other.

 

Semper Fi.

Andyman