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    I have memory problems and as some of you may know I highly recommend Evernote and have for years. Though I've found that writing helps me remember more. I ran across Tom's videos on youtube, I'm a bit geeky and I also use an IPad so if you take notes on your IPad or you are thinking of going paperless check it out. I'm really happy with it, I use it with a program called Noteshelf 2.

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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Most Common VA Disabilities Claimed for Compensation:   

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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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zuluvictor81

friend looking for a WAG

Question

        Sorry i can not figure out how to format this better... But long story short i am posting this for a friend since both her and I are confused on how this either of these 2 DBQS read. on one hand the examiner seems say yes and then later on says no but maybe so but then probably not but mostly yes, so if any one can translate all this that would be awesome since this is a 10 year old claim that was remand to the AMC for further development.                      

 

 

                                   Back (Thoracolumbar Spine) Conditions                        Disability Benefits Questionnaire
    Name of patient/Veteran:  XXXXXXXX        Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination    Request?    [X] Yes   [ ] No    
    ACE and Evidence Review    ----------------------    Indicate method used to obtain medical information to complete this document:        [X] In-person examination    
    Evidence Review    --------------

    Evidence reviewed (check all that apply):        [X] VA e-folder (VBMS or Virtual VA)    [X] CPRS
    1. Diagnosis    -----------    Does the Veteran now have or has he/she ever been diagnosed with a    thoracolumbar spine (back) condition?    [X] Yes   [ ] No
    Thoracolumbar Common Diagnoses:       [ ] Ankylosing spondylitis       [X] Lumbosacral strain       [ ] Degenerative arthritis of the spine       [ ] Intervertebral disc syndrome       [ ] Sacroiliac injury       [ ] Sacroiliac weakness       [ ] Segmental instability       [ ] Spinal fusion       [ ] Spinal stenosis       [ ] Spondylolisthesis       [ ] Vertebral dislocation       [ ] Vertebral fracture
    2. Medical history    -----------------    a. Describe the history (including onset and course) of the Veteran's    thoracolumbar spine (back) condition (brief summary):       veteran is SC for a lumbosacral strain
       veteran reports during the last mission, was in C-130 aircraft, landed       hard felt something pop in my back, onset of back pain, approx 2003.
       veteran reports dx with sprynix of the thoracic spine, in 2005 follows       with VA neurology XXXXXX. aqua therapy, no benefit with chiropractor,       ADVSIED AGAINTS INJECTIONS TO SPINE. pain and radicular symproms       progressively worse.
       veteran reports back pain from thoracic spine to lumbosacral region with       radicular symptoms down both legs, veteran reports foot drop both feet,       documented by neurologist.        back pain constant back pain 8/10.       flares - with any bending and twisting, any lifting, standing more than 10       minutes, sitting more than 30 minutes, walking more than 30 minutes,       walking up down stairs with radicular symptoms.        alleviated: moist heat, tens unit
    b. Does the Veteran report flare-ups of the thoracolumbar spine (back)?    [X] Yes   [ ] No        If yes, document the Veteran's description of the flare-ups in his or her        own words:           see above           
    c. Does the Veteran report having any functional loss or functional    impairment of the thoracolumbar spine (back) (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.           pain with prolonges standind/sitting and walking           
    3. Range of motion (ROM) and functional limitation    -------------------------------------------------    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 to 90):           0 to 30 degrees           Extension (0 to 30):                 0 to 5 degrees           Right Lateral Flexion (0 to 30):     0 to 10 degrees           Left Lateral Flexion (0 to 30):      0 to 15 degrees           Right Lateral Rotation (0 to 30):    0 to 20 degrees           Left Lateral Rotation (0 to 30):     0 to 30 degrees
           If abnormal, does the range of motion itself contribute to a           functional loss? [X] Yes (please explain)   [ ] No
       Description of pain (select best response):         Pain noted on exam and causes functional loss                  If noted on exam, 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 joints or associated soft tissue of the thoracolumbar spine (back)?       [X] Yes   [ ] No       If yes, describe including location, severity and relationship to           condition(s):           ttp paraspinal muscles throacic, lumbar sacral region                          b. Observed repetitive use           Is the Veteran able to perform repetitive use testing with at least three       repetitions? [X] Yes   [ ] No          Is there additional loss of function or range of motion after three          repetitions? [ ] Yes   [X] No
    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 conducted immediately after repetitive           use over time:           [ ] The examination is medically consistent with the Veteran's               statements describing functional loss with repetitive use over               time.           [ ] The examination is medically inconsistent with the Veteran's               statements describing functional loss with repetitive use over               time.  Please explain.           [X] The examination is neither medically consistent or inconsistent               with the Veteran's statements describing functional loss with               repetitive use over time.                      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:           speculative                      
    d. Flare-ups           Is the exam being conducted during a flare-up? [ ] Yes   [X] No                  If the examination is not being conducted during a flare-up:           [ ] The examination is medically consistent with the Veteran's               statements describing functional loss during flare-ups.           [ ] The examination is medically inconsistent with the Veteran's               statements describing functional loss during flare-ups.  Please               explain.           [X] The examination is neither medically consistent or inconsistent               with 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:           speculative                      
    e. Guarding and muscle spasm           Does the Veteran have guarding or muscle spasm of the thoracolumbar spine       (back)? [X] Yes   [ ] No              Muscle spasm:          [X] None          [ ] Resulting in abnormal gait or abnormal spinal contour          [ ] 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          [ ] 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:         Disturbance of locomotion, Interference with sitting, Interference with         standing             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              Hip flexion:         Right: [X] 5/5   [ ] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5         Left:  [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5                Knee extension: Right: [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5         Left:  [ ] 5/5   [ ] 4/5   [X] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5                Ankle plantar flexion:         Right: [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5         Left:  [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5                Ankle dorsiflexion:         Right: [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5         Left:  [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5                Great toe extension:         Right: [ ] 5/5   [X] 4/5   [ ] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5         Left:  [ ] 5/5   [ ] 4/5   [X] 3/5   [ ] 2/5   [ ] 1/5   [ ] 0/5             b. Does the Veteran have muscle atrophy?       [ ] Yes   [X] No           5. Reflex exam    -------------    Rate deep tendon reflexes (DTRs) according to the following scale:           0  Absent       1+ Hypoactive       2+ Normal       3+ Hyperactive without clonus       4+ Hyperactive with clonus
       Knee:         Right: [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+         Left:  [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+                Ankle:         Right: [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+         Left:  [ ] 0   [ ] 1+   [X] 2+   [ ] 3+   [ ] 4+             6. Sensory exam    --------------    Provide results for sensation to light touch (dermatome) testing:           Upper anterior thigh (L2):         Right: [X] Normal   [ ] Decreased   [ ] Absent         Left:  [ ] Normal   [X] Decreased   [ ] Absent                Thigh/knee (L3/4):         Right: [ ] Normal   [X] Decreased   [ ] Absent         Left:  [ ] Normal   [X] Decreased   [ ] Absent                Lower leg/ankle (L4/L5/S1):         Right: [ ] Normal   [X] Decreased   [ ] Absent         Left:  [ ] Normal   [X] Decreased   [ ] Absent    Foot/toes (L5):         Right: [ ] Normal   [ ] Decreased   [X] Absent         Left:  [ ] Normal   [ ] Decreased   [X] Absent             7. Straight leg raising test    ---------------------------    Provide straight leg raising test results:       Right: [ ] Negative   [X] Positive   [ ] Unable to perform       Left:  [ ] Negative   [X] Positive   [ ] Unable to perform
    8. Radiculopathy    ---------------    Does the Veteran have radicular pain or any other signs or symptoms due to    radiculopathy?    [X] Yes   [ ] No        a. Indicate symptoms' location and severity (check all that apply):           Constant pain (may be excruciating at times)         Right lower extremity: [X] None   [ ] Mild   [ ] Moderate   [ ] Severe         Left lower extremity:  [X] None   [ ] Mild   [ ] Moderate   [ ] Severe
       Intermittent pain (usually dull)         Right lower extremity: [ ] None   [ ] Mild   [ ] Moderate   [X] Severe         Left lower extremity:  [ ] None   [ ] Mild   [ ] Moderate   [X] Severe
       Paresthesias and/or dysesthesias         Right lower extremity: [ ] None   [X] Mild   [ ] Moderate   [ ] Severe         Left lower extremity:  [ ] None   [X] Mild   [ ] Moderate   [ ] Severe
       Numbness         Right lower extremity: [ ] None   [ ] Mild   [X] Moderate   [ ] Severe         Left lower extremity:  [ ] None   [ ] Mild   [X] 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)           [X] Involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve)                    If checked, indicate:  [ ] Right   [ ] Left   [X] Both                 d. Indicate severity of radiculopathy and side affected:             Right: [ ] Not affected   [ ] Mild   [X] Moderate   [ ] Severe                  Left:  [ ] Not affected   [ ] Mild   [X] Moderate   [ ] Severe             9. Ankylosis    -----------    Is there ankylosis of the spine? [ ] Yes   [X] No

    10. Other neurologic abnormalities    ---------------------------------    Does the Veteran have any other neurologic abnormalities or findings related    to a thoracolumbar spine (back) condition (such as bowel or bladder    problems/pathologic reflexes)?    [ ] Yes   [X] No
    11. Intervertebral disc syndrome (IVDS) and episodes requiring bed rest    ----------------------------------------------------------------------    a. Does the Veteran have IVDS of the thoracolumbar spine?       [X] Yes   [ ] No           b. If yes to question 11a 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       
    12. Assistive devices    --------------------    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                  If yes, identify assistive device(s) used (check all that apply and           indicate frequency):                      Assistive Device:                Frequency of use:           -----------------                ----------------           [X] Brace(s)           [X] Occasional   [ ] Regular   [ ] Constant           [X] Other: tens unit                                  [ ] Occasional   [X] Regular   [ ] Constant                                  
    b. If the Veteran uses any assistive devices, specify the condition and       identify the assistive device used for each condition:       No response provided.           13. Remaining effective function of the extremities    --------------------------------------------------    Due to a thoracolumbar spine (back) 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.)           [X] No
    14. 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           c. Comments, if any:       No response provided           15. Diagnostic testing    ---------------------    a. Have imaging studies of the thoracolumbar spine been performed and are the       results available?       [X] Yes   [ ] No                  If yes, is arthritis documented?              [ ] Yes   [X] No                  b. Does the Veteran have a thoracic vertebral fracture with loss of 50       percent or more of height?       [ ] Yes   [X] No           c. Are there any other significant diagnostic test findings and/or results?       [ ] Yes   [X] No           16. Functional impact    --------------------    Does the Veteran's thoracolumbar spine (back) condition impact on his or her    ability to work?       [X] Yes   [ ] No                  If yes describe the impact of each of the Veteran's thoracolumbar           spine (back) conditions providing one or more examples:              due to this veterans pain, I do not recommend significant physical              labor (IE construction work) or physical work of a moderate nature              (grocery store/department store), but sedentary employment with              restrictions is still possible.                  17. Remarks, if any:    -------------------

    DIAGNOSIS:     CHRONIC LUMBAR STRAIN, SERVICE CONNECTED
    Please address the "Correia" questions found near the bottom of this exam     request.
    ****************************************************************************
    Additional exam request information:
    For any joint condition, examiners should test the contralateral joint,     unless medically contraindicated, and the examiner should address pain on     both passive and active motion, and on both weightbearing and non    weightbearing. In addition to the questions on the DBQ, please respond to     the following questions:
    1.      Is there evidence of pain on passive range of motion testing?     (Yes/No/Cannot be performed or is not medically appropriate)
     not medically appropriate
    2.      Is there evidence of pain when the joint is used in non-weight     bearing? (Yes/No/Cannot be performed or is not medically appropriate)
     not medically appropriate
    3.      If yes, is the opposing joint undamaged (i.e. no abnormalities)?     (Yes/No)
    If yes, conduct range of motion testing for the opposing joint and provide     ROM measurements.
    If no, the examiner is requested to state whether it is medically feasible     to test the joint and if not to please state why the examiner cannot test     the range of motion of the opposing joint.
    ==============================================     Mitchell vs. Shinseki:    It is my medical opinion that it is more likely than not (greater than 50/50    probability) that pain, but not weakness, fatigability or incoordination,    could significantly limit functional ability during flare-ups, or when the    joint is used repeatedly over a period of time and that there is additional    limitation due to pain with change in the baseline range of motion due to    "pain on use or during flare-ups."  It would be pure speculation to state    what additional ROM loss would be present due to pain on use or during    flare-ups since the veteran is not examined during a flare-up.
     4.  Schedule the Veteran for a VA examination to determine the current     severity of her lumbosacral strain.  The examiner is requested to delineate     all symptomology associated with, and the current severity of, the     lumbosacral strain.  The appropriate Disability Benefits Questionnaire     (DBQs) should be filled out for this purpose if possible.  
    The examiner should specifically test the Veteran's lumbar spine range of     motion in active motion, passive motion, weight-bearing, and nonweight    bearing.  If the examiner is unable to conduct the required testing or     concludes that the required testing is not necessary in this case, he or she
    should clearly explain why this is so.   
    The examiner should specifically address whether the Veteran's syrinx and     leg numbness are manifestations of her lumbosacral strain.  
    This veteran with  bilateral lower extremity radiculopathy as noted on    examination.    This veteran's bilateral lower extremity radiculopathy is less likely    secondary to SC lumbosacral strain. There is no cause and effect between    lumbosacral strain and radiculopathy. There is no objective evidence for    denegerative changes as documented on lumbosacral x-ray in 2015 or thoracic    MRI in 2016, a cause for radiculopathy.    According to note dated NOV 25, 2015    "  pHONE NOTE: SPOKE WITH NEUROLOGY THIS DATE APX 246PM  DISCUSSE FINDING S    AND      ALTERGAIT WITH SUSPECION OF UPPER MOTOR NEURONE PROBLEM POSSIBLE CEREBELLUM
    ORIGIN.  wAS TOLD CONDITION IS BEING WORKED UP BY HIM AND FURTHER FOLLOW UP    AND      TESTING PENDING."
    Therfore this veteran's lower extremity radiculopathy is at least as likely    as not secondary to upper motor neuron problem located in the brain.    currently beingworked up through neurology."
    There is no causal relationship between the Veteran's SC lumboscacral strain    and finding of the syrinx at C8 and T1 as noted on MRI.  The syrinx is being    followed by neurology.
        
 

                                                             Gynecological Conditions                        Disability Benefits Questionnaire
    Name of patient/Veteran:  XXXXXXXX        Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination    Request?    [X] Yes   [ ] No    
    ACE and Evidence Review    ----------------------    Indicate method used to obtain medical information to complete this document:        [X] In-person examination    
    Evidence Review    --------------    Evidence reviewed (check all that apply):        [X] VA e-folder (VBMS or Virtual VA)    [X] CPRS
      1. Diagnosis    -----------    Does the Veteran now have or has she ever had a gynecological condition? Yes                Diagnosis #1:  endometriosis                ICD code:         Date of diagnosis:  2002                   Diagnosis #2:  Vit B12 Deficiency                ICD code:         Date of diagnosis:  2012                   Diagnosis #3:  Chronic Pelvic pain                ICD code:         Date of diagnosis:  9/2000           If there are additional gynecological diagnoses, list using above format:    menorrhagia
    dx 2012        2. Medical history    -----------------    Describe the history (including cause, onset and course) of each of the    Veteran's gynecological conditions:        vetean reports dx with HPV had colposcopy while on active duty. last pap    normal.
    veteran reports heavy bleeding while on active duty with severe pelvic pain.    Veteran reports since MST experience h/o heavy bleeding/cramping/abdmoninal    pain, lasts 1-2 weeks. While on active duty was placed on numerous birth    control pills, given lupron injections, not affective. Continues to    experience heavy menstrual flow with severe pelvic pain and painful    intercourse.    Currently on norplant, with no improvement in menstrual flow, heavy flow with    blood clots, reports was advised hysterectomy for severe abdominal pain,    veteran declined at that time.
    laparscopy in service 2001, due to abdominal and heavy bleeding: "craters in    uterus and cervic, thinning of the lining."
    in 2001: colposcopy due to +ve HPV, pap q 6 months,
    =================================    veteran reports B-12 low and iron level low. takes B12 oral form.    methocobolin.
    g1-p2, vaginal delvery x2 pap, 2016, wnl,        3. Symptoms    ----------    Does the Veteran currently have symptoms related to a gynecological    condition, including any diseases, injuries or adhesions of the female    reproductive organs? Yes           If yes, indicate current symptoms, including frequency and severity of       pain, if any: (check all that apply)       [X] Severe pain:    Constant pain       [X] Pelvic pressure       [X] Frequent or continuous menstrual disturbances
    4. Treatment    -----------    a. Has the Veteran had treatment for symptoms/findings for any diseases,    injuries and/or adhesions of the reproductive organs? Yes           If yes, specify condition(s), organ(s) affected, and treatment:       lupron on active duty 10/2000- 12/2000: per history discontinued, not       helpful       norplant currently       ibuprofen/Aleve as needed- for pelvic pain.           Date of treatment: see above        b. Does the Veteran currently require treatment or medications [for    symptoms?] related to reproductive tract conditions? Yes           If yes, list current treatment/medications and the reproductive organ       condition(s) being treated:       B12 oral replacement- daily, IM not affective       Norplant- continous       ferrous sulfate as needed with decrease in iron count              c. If yes, indicate effectiveness of treatment in controlling symptoms:
          [X] Symptoms are not controlled by continuous treatment: for the              following organ/condition:              [X] Conditions of the uterus    5. Conditions of the vulva    -------------------------    Has the Veteran been diagnosed with any diseases, injuries or other    conditions of the vulva (to include vulvovaginitis)? No        6. Conditions of the vagina    --------------------------    Has the Veteran been diagnosed with any diseases, injuries or other    conditions of the vagina? No        7. Conditions of the cervix        --------------------------    Has the Veteran been diagnosed with any diseases, injuries, adhesions or    other conditions of the cervix? Yes           If yes, describe:       abnormal pap while on active duty AS-CUS with +ve HPV, high grade.       colposcopy x1 while on active duty.
       repeat paps with AS-CUS, neg for HPV.           8. Conditions of the uterus    --------------------------    a. Has the Veteran been diagnosed with any diseases, injuries, adhesions or    other conditions of the uterus? Yes        b. Has the Veteran had a hysterectomy? No        c. Does the Veteran have uterine prolapse? No    
    d. Does the Veteran have uterine fibroids, enlargement of the uterus and/or    displacement of the uterus? No        e. Has the Veteran been diagnosed with any other diseases, injuries,    adhesions or other conditions of the uterus? Yes           If yes, describe:       Endometriosis, clinical diagnosis, laparscopy in 2001, wnl, endometrial       biopsy 2001 neg. . Lapraoscopy in 2012 wnl.           9. Conditions of the Fallopian tubes    -----------------------------------    Has the Veteran been diagnosed with any diseases, injuries, adhesions or    other conditions of the Fallopian tubes (to include pelvic inflammatory    disease)? No        10. Conditions of the ovaries    ----------------------------    a. Has the Veteran undergone menopause? No        b. Has the Veteran undergone partial or complete oophorectomy? No        c. Does the Veteran have evidence of complete atrophy of 1 or both ovaries?       Unknown           d. Has the Veteran been diagnosed with any other diseases, injuries,    adhesions and/or other conditions of the ovaries? No        11. Incontinence    ---------------    Does the Veteran have urinary incontinence/leakage? Yes    
 If yes, is the urinary incontinence/leakage due to a gynecologic       condition? Yes              If yes, condition causing it: residual of vaginal deliveries x2              If yes, check all that apply:       [X] Stress incontinence
    12. Fistulae    -----------    a. Does the Veteran have a rectovaginal fistula? No        b. Does the Veteran have a urethrovaginal fistula?        No response provided.        13. Endometriosis    ----------------    Has the Veteran been diagnosed with endometriosis? Yes           If yes, does the Veteran currently have any findings, signs or symptoms       due to endometriosis? Yes                 If yes, check all that apply:          [X] Pelvic pain          [X] Heavy bleeding          [X] Irregular bleeding
          If yes, indicate effectiveness of treatment in controlling symptoms:          [X] Symptoms of endometriosis are not controlled by continuous              treatment
    14. Complications and residuals of pregnancy or other gynecologic procedures    ---------------------------------------------------------------------------    a. Has the Veteran had any surgical complications of pregnancy? No        b. Has the Veteran had any other complications resulting from obstetrical or    gynecologic conditions or procedures? No        15. Tumors and neoplasms    -----------------------    a.  Does the Veteran have a benign or malignant neoplasm or metastases    related to any of the diagnoses in the Diagnosis section?  No        b. Is the neoplasm        No response provided.        c. Does the Veteran currently have any residual conditions or complications    due to the neoplasm (including metastases) or its treatment, other than those already documented in the report above?        No response provided.        d. If there are additional benign or malignant neoplasms or metastases    related to any of the diagnoses in the Diagnosis section, describe using the    above format:        No response provided.        16. 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?  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?  No        c. Comments, if any:        No response provided.        17. Diagnostic testing    ---------------------    a. Has the Veteran had laparoscopy? Yes           If yes, provide date(s) and facility where performed, and results:       laprascopy 2002:       for pelvic pain, unrepsonsive to lupron, OCPS and NSAIDS       " pt had approX A 6 WEEK UTERUS, SLIGHTLY SOFT, questional increased       vascularity. otherwise no other abnormalities noted.
       laprascopy 2011:       chronic pain       results:       "normal appears uterus, Tubes aND ovaries. no adhesions. no pathology       noted in pelvis"           b. Has the Veteran been diagnosed with anemia? No        c. Has the Veteran had any other diagnostic testing and if so, are there    significant findings and/or results? Yes        18. Functional impact    --------------------    Does the Veteran's gynecological condition(s) impact her ability to work? No

        19. Remarks, if any:    -------------------    diagnosis:
    endometriosis
    chronic pelvic pain    B12 deficiency
    menorrhagia
    Veteran with h/o colposcopy 2002 while on active duty secondary to abnormal    paps x2 ASC-US with pos HPV diagnosed in 2001. Subsequent paps  with    diagnosis of ASC-US with neg HPV results: 10/2005: neg pap; 2/2008: neg pap;    7/2015: ASC-US with HPV neg.    There is no objective evidence for a chronic disability.      
    This veteran with a diagnosis of endometriosis is a continuation of the    Endometriosis first diagnosed while on active duty and documented by C&P exam    4/2006,by Dr. Sogor, Obstetrican/Gynecologist.      Eventhough while on active duty diagnostic laprascopy was documented as    "normal" and endometrial biopsy was neg and  repeat laparoscopy in 2012 was    documented to be "within normal limits.", this veteran continues to exibit    clinical signs of endometriosis as first documented while on active duty and    C&P examination 4/10/2006  by Dr. Sogor, Obstetrican/Gynecologist as evidence    by persistant chronic pain.
    This veteran's B12 deficiency is less likely as not secondary to this    veteran's menorrhagia. According to medical literature there is no cause an    affect relationship between Vitamin B12 deficiency and heavy menstrual    bleeding. Veteran with normal CBC levels from 2005-until present, expect one    time low levels 8/2008, otherwise with no evidence for anemia.    There is no evidence for an undiagnosed illness, a diagnosable but medically    unexplained chronic multi-symptom illness of unknown etiology, or a    diagnosable chronic multi-symptom illness with a partially explained    etiology.    This veteran's B12 defiencency is a known condition with specific causes to    included poor diet and decrease of intrinsic factor.
    ============================================

    Active duty service dates:
    Branch: XXXXXXXX
    EOD: 07/21/1999
    RAD: 07/20/2005
    DBQ GYN Gynecological conditions:
    The Veteran has important information in his or her electronic claims folder
    in VBMS and Virtual VA. Please review both folders and state that they were     reviewed in your report.
    MEDICAL OPINION REQUEST
    TYPE OF MEDICAL OPINION REQUESTED: Direct service connection
    OPINION: Direct service connection
    Does the Veteran have a diagnosis of (a) menstrual cramps that is at least     as likely as not (50 percent or greater probability) incurred in or caused     by (the) Veteran testified at her Oct. 2016 Board hearing that she had a B    12 deficiency as a result of heavy bleeding which was not addressed by the     examiner; VA examiner must also address the possibility of the Veteran's
    menstrual cramp disorder pre-existing her active service during service?
    see below
    Rationale must be provided in the appropriate section.
    Examiner: Please state whether the Veteran has a diagnosis of Female Sexual     Arousal Disorder (FSAD). If additional examination(s) are required, please     request and/or perform as necessary.
    The veteran has a diagnosis of Female sexual arousal disorder is at least as    likely as not (50/50 probability) caused by or a result of Chronic pelvic    pain, residual of Endometriosis and MST.    The veteran answered affirmatively to screening questions for FSAD.
    ========================
    Please arrange for the Veteran to undergo an appropriate VA examination in     connection with her claim for entitlement to service connection for a     menstrual cramp disorder.  The claims file should be made available to and     reviewed by the examiner.  All indicated studies should be performed and all findings should be reported in detail.  Based on the examination and review     of the record, the examiner should address the following:
    (a)  Please diagnose any present menstrual disorders to include HPV and     endometriosis.
    The examiner should consider and discuss as necessary the following:
    (i)  The June 2015 VA treatment record noting a diagnosis of HPV; and
    (ii)  The Veteran's October 2016 Board hearing testimony indicating her B-12     deficiency was a result of heavy bleeding.  
    (b)  Is it at least as likely as not (a 50 percent or greater probability)     that the signs or symptoms of the Veteran's menstrual disorder represent an     objective indication of a chronic disability resulting from an undiagnosed     illness or a medically unexplained chronic multi-symptom illness related to     the Veteran's Persian gulf service?
    NO
    (c)  If the answer to (b) is no, does the evidence of record clearly and     unmistakably show that the Veteran had a menstrual disability that existed     prior to her entry onto active duty?
    YES, There is evidence in the STRs that the veteran had menstrual disturbance    to include menstrual cramping and intermittent pelvic pain secondary to    ruptured ovarian cyst prior to entering service. Pain was described as    intermittent and improved after starting BCPs.
    The examiner should consider and discuss as necessary the following:
    (i)  An April 2006 VA examination noting the Veteran reported having ovarian
    cysts at age 16;
    (ii)  A November 2006 VA treatment record noting the Veteran reported being     prescribed oral contraceptives due to menstrual cramping at age 16;
    (ii)  An August 2011 VA treatment record noting the Veteran had a history of
    ovarian cysts and ruptures as early as age 16; and
    (iii)  A July 2014 VA examination for irritable bowel syndrome noting the     Veteran reported she had heavy periods for all of her life.  
(d)  If the answer to (c) is yes, does the evidence of record clearly and     unmistakably show that the preexisting menstrual disorder was not aggravated
    by service or that any increase in disability was due to the natural     progression of the disability?
    NO, there is objective evidence that pre-existing menstrual cramping and    intermiitent pelvic pain was aggravated beyond normal progression secondary    to service.    Per History, veteran reported started to experience intense and wide spread    pelvic pain and menstrual cramping post MST incident while on active duty.    Multiple trials of differenct BCPs with no improvement of symptoms.    Veteran with h/o Lupron injections for pelvic pain for 6 months with no    benefit    While on active duty pelvic ultrasound in 2000 with no evidence for ovarian    cysts.     Laparscopy 2002 within normal limits with normal ovaries and no evidence of    cysts    In 2000 veetran was dx with chronic pelvic pain.    Veteran was diagnosed with Endometriosis, clinically, while on active duty.
    The examiner is informed that aggravation is defined for legal purposes as a
    chronic worsening of the underlying condition versus a temporary flare-up of
    symptoms beyond its natural progression.  
    Please identify any such evidence with specificity.  
    (e)  If the answer to either (c) or (d) is no, is it at least as likely as     not (a 50 percent or greater probability) that any diagnosed menstrual     disorder is etiologically related to the Veteran's active service?
    Yes, the veteran's diagnosis of chronic pelvic pain and endometriosis is    etiologically related to the veteran's active service.    The veteran's current chronic pelvic pain and endometriosis is a continuation    of the conditions first documented while on active duty.
    Yes, the veteran's menorrhagia is a progression of this veteran's chronic    pelvic pain and endometriosis first diagnosed while on active duty.
    The examiner should consider and discuss as necessary the following:
    (i)  The Veteran's September 2000 and March 2001 STRs noting treatment for     endometriosis; and
    (ii)  The Veteran's October 2015 VA examination for PTSD noting the Veteran     experienced military sexual trauma.  
    The examiner should set forth a complete rationale for all findings and     conclusions.  If the examiner cannot provide an opinion without resort to     speculation, the examiner should provide an explanation as to why this is so
    and note what, if any, additional evidence would permit such an opinion to     be made.    
 
 

Edited by zuluvictor81

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I see what you mean about the Yes's and No's in the  BACK & Lower Extremity DBQ.

A couple things caught my eye. 1. The mention of the Vet being capable of some sort of Sedentary work, takes IU off the table for now. 2. The Dr stating that what's going on with the Lower Extremities is related to an issue in the Brain, NOT the BACK, appears to remove the legs as to being Secondary to the already SC'd BACK condition. 

What is her current SC% for the BACK?

The 2nd DBQ didn't help her due to all the discussion regarding her Pre-Service DX's and the Dr stating that the current disability picture is the Normal Progression and not Aggravated by her Active Duty. The Low B-12 Negative Nexus doesn't help, as well as the Negative Association regarding Gulf War Service.

I did see a mention of "MST," has she filed a Claim for MST/PTSD?  With MST Markers and possible MSR documentation, a PTSD Award is a certainty.

I don't think either DBQ helped to get a Remand Award for an Increase (BACK), Secondary SC for Lower Extremities or SC for the Gynecological Issue, BUT what do I know.

Semper Fi

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I agree with Gastone  and especially about the MST.

Have your friend to see a VA MST Coordinator.  get paper trail started ect,,ect,,,...

How long was this C&P ...LOT'S OF QUESTIONS.  Long Exam!!! '' Wow'' 2 DBQ's But dang they were long.

Edited by Buck52

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She is at 20% currently for her back which is rated as lower lumbar strain with numbness in legs. they just never rated the lower legs back then which is why the appeal was in.. mind you that this service connection is over 10 years old. The nurse used a MRI interpreter recommendation to look for possible upper motor neuron issues and was never a diagnoses and Her Nuero doctor already ruled that out to begin with... Not to mention she goes on to say something that lower radiculopathy couldn't be cause by lower back injury.

Yes she is already sc for ptsd/mst

A lot of what she said in both DBQ's are pure nonsense and contradict each other.

The appointment was only a hour long and these 2 dbq's were not the only ones...lol

And she said she was never even asked more then half these questions..

Edited by zuluvictor81

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I skimmed over this but did not see the term, "the veterans condition was at least as likely as not due to the hard landing in service".  

Absent above nexus, you wont be getting service connection for the condition.  

Dont make the mistake of estimating a rating until you have the big 3:  Current diagnosis, In service event or aggravation and nexus.  Unless I missed it (possible) I did not see a nexus.  

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the lumbar strain with lower leg numbness was already verified and service connected over 10 years ago. so the hard landing was already established and service connected prior. for some reason she felt the need to mention it.

These are probably the most confusing DBQ's ive ever seen. So much back and forth on what she is saying and a lot of speculation.

 

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