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C&p Exam In Process


ROMAD

Question

Well first post to the forums so here goes. I served on active duty in the AF for 11 years. during my service I developed Cluster Headaches. I received PCS orders to Korea and was sent to the Board and was medically seperated with severance pay and 10% disability. They pushed me out the door and I did not have a seperation physical because there was not enough time and they could not delay the seperation date. Ok so I am told to go to the VA for care and get a disability rating while on TRDL. 1 year later they officially seperated me. I received a 30% rating and had to wait for the amount of my severance to be recouped. Well during this time I have been in to see the docs and have been told there is no cure and they can continue to see me and try and treat the pain. The headaches happen every year several times a year. They have tried me on several medications over the past 10 years, and while on active duty as well. I live 35 miles from the VAMC and could not drive there everytime I got a headache. Not only because I can't drive during an attack but they can't do anything for me. So for six years I had no appts. with the VAMC. During this time I just used the oxygen and rolled around in pain. I am not able to get a statement from previous employers about firing me because of my disability. So now I am asking the VA for an increase in my disability payments and doing Voc rehab. When I spoke with the VA C&P doctor on the 8th it was a short appt and he asked me a few questions and rubbed my feet checked my reflexes and that was about it. But the one thing I did not do is have a complete timeline of when my headaches were and how long they lasted. They really put you off asking sort of matter of fact type questions and taking what you say during this chat as exact. well I received a copy of my C&P exam notes (from ROI request) and they state my condition appears to have not changed and draw conclusions that my dates don't fit what my medical record says. I did not take a copy of them with me to check the dates. My question is how do i fix this? The review is not complete yet but I believe it may be denied. By rating is based on code 8100 my condition is Cluster Headaches with Horner Syndrome. The VA rating guide does not have a code for cluster headaches they use Migraine which I feel is not correct anyway. So what does everyone think did i screw the pooch?

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ROMAD,

Welcome to hadit and thanks for your service.

I'm not at all familiar with any aspects of Horners Syndrome but am familiar with 8100 - Migraines. If you have kept a calander of your headaches I would try to get those put into the records somehow, also - what medications do you take for your SC conditions if any.

Others will chime in soon.

In case you don't have a URL to 38 CFR here it is,

http://ecfr.gpoaccess.gov/cgi/t/text/text-.../38cfrv1_02.tpl

and these are the regs on DC 8100.

8100 Migraine:

With very frequent completely prostrating and prolonged 50

attacks productive of severe economic inadaptability.........

With characteristic prostrating attacks occurring on an 30

average once a month over last several months................

With characteristic prostrating attacks averaging one in 2 10

months over last several months..............................

With less frequent attacks.................................... 0

Also, have you ever gotten a complete copy of your c-file ? If so you may want to go thru it just to make sure you haven't missed anything else you may be entitled to calim for SC.

Welcome !

carlie

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Horners syndrome is actually an ocular problem:

"Common causes of post-ganglionic Horner's syndrome include trauma, CLUSTER MIGRAINE HEADACHE and neck or thyroid surgery.

The diagnosis and the localization of a Horner's syndrome is accomplished with pharmacological testing. Ten percent liquid cocaine (topically applied), works as an indirect acting sympathomimetic agent by inhibiting the re-uptake of norepinephrine at the nerve ending. A Horner's pupil will dilate poorly because of the absence of endogenous norepinephrine at the nerve ending. The test should be evaluated thirty minutes after the instillation of the drops to ensure accuracy. The cocaine test is used to confirm or deny the presence of a Horner's syndrome. However, a positive cocaine test does not localize the lesion. "

How does Horners affect your vision/eyes? If at all, Horners is secondary to cluster migraines and should be eligible for a separate rating as secondary to the migraines.

Ralph

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Horners syndrome is actually an ocular problem:

"Common causes of post-ganglionic Horner's syndrome include trauma, CLUSTER MIGRAINE HEADACHE and neck or thyroid surgery.

The diagnosis and the localization of a Horner's syndrome is accomplished with pharmacological testing. Ten percent liquid cocaine (topically applied), works as an indirect acting sympathomimetic agent by inhibiting the re-uptake of norepinephrine at the nerve ending. A Horner's pupil will dilate poorly because of the absence of endogenous norepinephrine at the nerve ending. The test should be evaluated thirty minutes after the instillation of the drops to ensure accuracy. The cocaine test is used to confirm or deny the presence of a Horner's syndrome. However, a positive cocaine test does not localize the lesion. "

How does Horners affect your vision/eyes? If at all, Horners is secondary to cluster migraines and should be eligible for a separate rating as secondary to the migraines.

Ralph

Well thanks for the info on Horners just curious if you know the code that applies to Horners. if it is a compensable disability it sounds like a CUE because it has been in my records as cluster with Horners and not seperate so as to have to pay a compensation. Have not had an eye exam to check my vision. I do on occasion see spots but not sure if it is related. I guess I will be going to the doctor more over the next few months.

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ROMAD,

Welcome to hadit and thanks for your service.

I'm not at all familiar with any aspects of Horners Syndrome but am familiar with 8100 - Migraines. If you have kept a calander of your headaches I would try to get those put into the records somehow, also - what medications do you take for your SC conditions if any.

Others will chime in soon.

In case you don't have a URL to 38 CFR here it is,

http://ecfr.gpoaccess.gov/cgi/t/text/text-.../38cfrv1_02.tpl

and these are the regs on DC 8100.

8100 Migraine:

With very frequent completely prostrating and prolonged 50

attacks productive of severe economic inadaptability.........

With characteristic prostrating attacks occurring on an 30

average once a month over last several months................

With characteristic prostrating attacks averaging one in 2 10

months over last several months..............................

With less frequent attacks.................................... 0

Also, have you ever gotten a complete copy of your c-file ? If so you may want to go thru it just to make sure you haven't missed anything else you may be entitled to calim for SC.

Welcome !

carlie

Well thank you for responding. I currently take imitrex nasal which is non-formulary but does work. i have also use oxygen therapy with some success. But the Imitrex Nasal spray definately work. I just requested my file be copied so I would have one, but it is currently out of the regional office while they are processing my C&P exam. Getting things in the permanent record can be tough, and my calendar is not complete I am trying to check dates now so I have a better picture of when they occured. But i won't give up, but they do make it hard.

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Well thanks for the info on Horners just curious if you know the code that applies to Horners. if it is a compensable disability it sounds like a CUE because it has been in my records as cluster with Horners and not seperate so as to have to pay a compensation. Have not had an eye exam to check my vision. I do on occasion see spots but not sure if it is related. I guess I will be going to the doctor more over the next few months.

Romad, I talked with an eye MD friend and here's what he said: If you have Horner's, you may show a drooping upper eyelid, dry facial skin and have excessive tearing, etc. Pupils may not adjust as fast as normal. From what he said (and I'm no MD!!) rating could fall under 6009 or 6019, or both. Looks like a 10%er if not rated as part of the cluster migraines.

Apparently this is nerve damage in a nerve bundle going from the hypothalamus (central brain) down to the chest, then up by the carotid artery into the inner ear, then to the eye. Whew! He said there are 3 areas in which the damage could occur and the docs can usually test to see where the actual damage is.

Hope this helps - not sure I understand all of it,

Ralph

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  • HadIt.com Elder

Welcome ROMAD.

Here is another suggestion.

Does the Horners Syndrome or the Cluster Headaches/Migraines keep you from being employed?

Do these problems keep you from doing what you are trained to do?

Do these problems keep you from driving, from being present at your jobsite, etc., etc.?

If so, and you can find a decent M.D. that you can talk to, that you can carry on a personal conversation with, then you need for him/her to make you a diagnosis indicating the above problem(s).

Then you need to get yourself down to your local Social Security office and apply for SSDI and then you need to take this same M.D's. opinion to your VARO, carry it in by hand and give it to them and get a "receipt" from them.

just sayin.......

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Romad- WELCOME here! Best place in town -veteran-

You got great advise here so far- I need to read this all again- but one thing stands out-

Voc Rehab -a two edged sword-

Sometimes the VA thinks this turns a vet into a rocket scientist and they dont want to pay more comp-

My husband went through this crap-30% PTSD, one month Voc Rebah and 2-3 months of some part time crap job at the VA and they tried to lower his comp.

But we fought that ad they did not succeed.

I strongly suggest Romad- that- if this is traditional college- and not online college-

that you ask the college to accomodate your disability.

You would have to specify problems your SC causes-

like maybe you need note takers, due to vision problems, or your disability could obviously interfere with your ability to study well- etc- stuff like that-

But I dont know how this would work if you go to school under Voc Rehab on line-

I sure dont mean to suggest the VA will attempt to lower your comp- just that they do some pretty odd stuff sometimes-

Do you have a vet rep or service officer supporting your claim?

Thank you for your service-

"But i won't give up, but they do make it hard."

We hear you there---persistence is often the name of the game----

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Romand,

Also what i would do if i were you, is ask for another C & P exam, to me it sounds like you got screwed by the A.F. I dont care if you are exiting on a MEB OR PEB (i think its called those) You should ALWAYS get a physical, even if you have to go and set it up yourself. Going from what you said the va might deny your claim.

I kinda wish you were seeing a civ doctor during the time you didn't go to the va. But i still think you shoulda went up to the va to get it documented.

As for myself i have migraines, the va is about 20 mins from me, and you better believe i drive up there for the smallest thing. The can't treat my migraines and the meds the give me i dont take it b/c it screws me up more, but i go there to get it documented.

With the va, they want to see documentation, and in your cases, to see the condition getting worse. What i would do is try to get a primary doc,l see him on the regular and just report your condition. For your claim, you may have to get an outside doc to give you an independent evaluation.

jhmo

Jay

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Romand,

Also what i would do if i were you, is ask for another C & P exam, to me it sounds like you got screwed by the A.F. I dont care if you are exiting on a MEB OR PEB (i think its called those) You should ALWAYS get a physical, even if you have to go and set it up yourself. Going from what you said the va might deny your claim.

I kinda wish you were seeing a civ doctor during the time you didn't go to the va. But i still think you shoulda went up to the va to get it documented.

As for myself i have migraines, the va is about 20 mins from me, and you better believe i drive up there for the smallest thing. The can't treat my migraines and the meds the give me i dont take it b/c it screws me up more, but i go there to get it documented.

With the va, they want to see documentation, and in your cases, to see the condition getting worse. What i would do is try to get a primary doc,l see him on the regular and just report your condition. For your claim, you may have to get an outside doc to give you an independent evaluation.

jhmo

Jay

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Romad- WELCOME here! Best place in town -veteran-

You got great advise here so far- I need to read this all again- but one thing stands out-

Voc Rehab -a two edged sword-

Sometimes the VA thinks this turns a vet into a rocket scientist and they dont want to pay more comp-

My husband went through this crap-30% PTSD, one month Voc Rebah and 2-3 months of some part time crap job at the VA and they tried to lower his comp.

But we fought that ad they did not succeed.

I strongly suggest Romad- that- if this is traditional college- and not online college-

that you ask the college to accomodate your disability.

You would have to specify problems your SC causes-

like maybe you need note takers, due to vision problems, or your disability could obviously interfere with your ability to study well- etc- stuff like that-

But I dont know how this would work if you go to school under Voc Rehab on line-

I sure dont mean to suggest the VA will attempt to lower your comp- just that they do some pretty odd stuff sometimes-

Do you have a vet rep or service officer supporting your claim?

Thank you for your service-

"But i won't give up, but they do make it hard."

We hear you there---persistence is often the name of the game----

Well I am going 3/4 time just to test the waters and I will be attending onsite. The studying might be an issue since my condition is neurologic in nature "Cluster H.A" but I am not sure this will be the answer to getting me reemployed but I will give it a shot. The problem is employers don't like you taking 20 to 30 minutes out of "their time" to administer medicine if you have an attack that is not during your lunch hour or break. but we will see. Thanks for all the good info I appreciate it. I am represented by the Wisconsin department of Veteran Affairs but they don't seem real aggressive in helping with things that may cause conflict. I never thought in a million years that I would ever be hung out to dry by the government I pleadged my allegiance and dedication to.

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I have a state division too representing me in NY and mine are not aggressive at all-among other things-

"I never thought in a million years that I would ever be hung out to dry by the government I pleadged my allegiance and dedication to"

It is the VA's fault-due to the screwed up claims process-

I swear they cause and contribute to stress and anxiety in vets already disabled enough-

I have met some of the BEST people I ever met- who work for VA in all areas-Docs, cemetery, nurses, housekeeping-

and some of the Worst I ever met are at the VA.

It is often hard to tell who is who-when someone is new to the system-

Jay is right - a real doctor- on the outside might be able to help you better with your disability and also provide an independent medical opinion-for your claim-

sounds like you might well need one-

It is not fair- they can be costly-but some private docs do them for free-

but it seems often the only way to support many SC claims these days.

Was your C & P based only on the migraines or was it an actual neurological exam?

And maybe there is more for them to do yet on the exam?

Yeah- maybe you have a CUE in a prior unappealed decision-----

that sure is something to consider-

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I found some claims at the BVA regarding Horner's.

Will this one help:

http://www.va.gov/vetapp03/files/0315793.txt

"ORDER

Clear and unmistakable error in the grant of service

connection for Horner's syndrome with trigeminal neuralgia

not having been shown, severance of service connection for

Horner's syndrome with trigeminal neuralgia was improper;

accordingly, service connection for that disability is

restored.

Service connection for headaches as secondary to Horner's

syndrome is granted."

3 issues, Cue -denied, severance rating restored, and migraines as secondary to Horner's.

Also: http://www.va.gov/vetapp00/files3/0020187.txt

"A schedular evaluation in excess of 20 percent for Horner's

syndrome with impaired accommodation is denied. " However this case is worth reading as to the ratings and DCs.

and This appears to be a remand of the above claim -not sure- but from the CAVC:

http://www.va.gov/vetapp01/files03/0124899.txt

But the BVA again held to their decision- as to the Horner claim:

"2. The schedular criteria for an evaluation in excess of 20

percent for Horner's syndrome with impaired accommodation

are not met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.1,

4.7, 4.20, 4.21, 4.84a, DC 6030 (2001)."

It appears that a proper C & P on Horner's syndrome involves 3 separate C & Ps-

"The June and July 1998 compensation and pension examinations

(i.e., general medical, neurology, and ophthalmology) reflect

that the veteran wore contacts and eyeglasses. The veteran's

pupils were equal, round, and reactive to light and

accommodation on the general medical examination. The

neurologist noted that the eyes had been dilated by

ophthalmology and neither pupil was therefore reactive and

their sizes were both 7 or 8 millimeters. The neurologist

noted that the veteran had Horner's syndrome involving mild

drooping of the left eyelid and a small pupil on the left

side. The veteran reported that his left pupil was "always

usually" small and did not affect his vision. Closure of the

eyelid was normal and puffing of the cheeks and smile, etc.,

was normal. Facial sensation including temperature sensation

was normal. The neurologist reported that he could not

detect any difference in sweat on the two sides of the face"

It sounds like this vet here at hadit-got the GP C & P and still should be given the other ones-as mentioned here.

Edited by Berta (see edit history)
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I found some claims at the BVA regarding Horner's.

Will this one help:

http://www.va.gov/vetapp03/files/0315793.txt

"ORDER

Clear and unmistakable error in the grant of service

connection for Horner's syndrome with trigeminal neuralgia

not having been shown, severance of service connection for

Horner's syndrome with trigeminal neuralgia was improper;

accordingly, service connection for that disability is

restored.

Service connection for headaches as secondary to Horner's

syndrome is granted."

3 issues, Cue -denied, severance rating restored, and migraines as secondary to Horner's.

Also: http://www.va.gov/vetapp00/files3/0020187.txt

"A schedular evaluation in excess of 20 percent for Horner's

syndrome with impaired accommodation is denied. " However this case is worth reading as to the ratings and DCs.

and This appears to be a remand of the above claim -not sure- but from the CAVC:

http://www.va.gov/vetapp01/files03/0124899.txt

But the BVA again held to their decision- as to the Horner claim:

"2. The schedular criteria for an evaluation in excess of 20

percent for Horner's syndrome with impaired accommodation

are not met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.1,

4.7, 4.20, 4.21, 4.84a, DC 6030 (2001)."

It appears that a proper C & P on Horner's syndrome involves 3 separate C & Ps-

"The June and July 1998 compensation and pension examinations

(i.e., general medical, neurology, and ophthalmology) reflect

that the veteran wore contacts and eyeglasses. The veteran's

pupils were equal, round, and reactive to light and

accommodation on the general medical examination. The

neurologist noted that the eyes had been dilated by

ophthalmology and neither pupil was therefore reactive and

their sizes were both 7 or 8 millimeters. The neurologist

noted that the veteran had Horner's syndrome involving mild

drooping of the left eyelid and a small pupil on the left

side. The veteran reported that his left pupil was "always

usually" small and did not affect his vision. Closure of the

eyelid was normal and puffing of the cheeks and smile, etc.,

was normal. Facial sensation including temperature sensation

was normal. The neurologist reported that he could not

detect any difference in sweat on the two sides of the face"

It sounds like this vet here at hadit-got the GP C & P and still should be given the other ones-as mentioned here.

Thanks for the links. It looks like they bundled my Horner's with my headaches. It has been listed in my medical records all the way back to my active duty medical records that I have Horners, but there has never been a seperate rating or anything seperate from my 8100 rating for headaches. It is always refered to as "Cluster Headaches with Horner's Syndrome". saved all 3 links so I will have some Info on Horners. How did you find this and how do I go about finding more specifically about Cluster Headaches and about Horner's Syndrome. If I can find additional ammo it may make it easier to file a CUE since it appears they listed as a disability but never gave a rating for it.

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"If I can find additional ammo it may make it easier to file a CUE since it appears they listed as a disability but never gave a rating for it."

Was that in a final decision that you never appealed?

Are you taking this from a blue rating sheet or the usual list-

you mean they never gave a percentage?

Veteran:

I found 132 hits at the BVA with your disability in it- doesn't mean they all will help but worth looking-

Just click on this and go to BVA

http://www.va.gov/index.htm

then click on BVA on the left and find the search button-

put Horner into the search (I had a heck of a time at first and got no hits)

all 132 should pop up- let me know if they dont.

And use google search ------lots of info there under Horner's syndrome too

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