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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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    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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Bullwinkle

"Statement of Support of Claim" advice

Question

Hello everyone. Just seeking some friendly advise. I received a SC for Left Cuboid Syndrome at 0% , Left Hip/Thigh Impairment 0%, Left Hip Limit of Flexion at 0% and Trochanteric Bursitis of the Left Hip at 10%. I plan to request an increase for the first three. I drafted a "Statement of Support of Claim" and wanted to get what ever critique or advise I can. I did have an IME done and the doctor was very good and complete in his examination and did a positive write up. I know it's long and so I apologize. Thank you.

 

Left Foot -Left Cuboid Syndrome” (claimed as plantar fasciitis and arthritis) - service connected at 0% established as related to the service connected disability of “leg length discrepancy, left lower extremity”.

 

The evaluation currently assigned to my Left Foot does not accurately reflect the severity of my disability or the pain associated therewith.  The pain on manipulation and use of my feet has worsened to the point that it adversely affects my ability to function under the ordinary conditions of daily life, including employment.

 

I joined the Army October 8, 1975 at age 17 and, as my entrance medical exam records indicate, I had no preexisting conditions noted upon entry into service.

 

From 1975, when I entered the service, up until around 1983 all our military activities, including physical training, combat readiness training and unit missions were conducted in US military issued combat boots while wearing various loads of gear and ammunition ranging from 20-40 lbs. The cushioning for these boots was minimal at best. The problem with my feet started shortly after my hip and leg began to bother me around 1980.

 

I had several instances while in the service related to pain to my legs and feet as indicated in my service treatment records. Many times I had pain without seeking medical attention. When the pain was more frequent and no longer bearable I went to the troop medical clinics. In 1980, while in the service, I began to have pain in the arches of both feet. At the time I had no idea I had a left leg discrepancy or that it could be affecting other areas of my body.

 

On April 25, 1984 I was seen at the 29th General Dispensary in Germany for pain and swelling of my left foot. I was carrying a large wooden equipment box with another soldier when the box slipped and dropped on my lower left leg and foot (See attached STR, dated 25 April 1984).

 

On December 2, 2003 I advised the VA nurse of current ankle pain in the mornings during my VA Primary Care appointment (See attached Martinsburg VA CPC 2 Physician Assistant Note, dated December 2, 2003).

 

May 24, 2016 I was seen for continuous pain in my left foot at the VA Hospital, Martinsburg, WV. I was diagnosed (x-ray) with plantar fascial fibromatosis of my left foot and treated. I was given an anti-inflammatory medication, compression socks and additional heel lifts (See attached VA exam diagnosis and VA Radiology Report, Left foot dated 5/24/2016).

 

I have a sharp, stabbing pain at the base of the heel immediately after I get out of bed in the morning. Most times I have an inability to put the sole of my foot to the floor without pain. I have difficulty walking any distance and an inability to run. Load bearing on my feet is very painful.

 

At times my coordination and balance is affected when I am moving around and the pain causes me to compensate on how I stand or walk. Sometimes my ankles give out and I roll one of them or stumble.

I have walked with a limp after the first five years in the Army and have done so ever since. 

 

I find myself getting slightly depressed at times because of the constant pain affecting my feet.

The pain level I am experiencing averages 6/7 on a good day and 8/9 when I have severe flare ups.

 

The heel lifts I have been given have not been helpful at alleviating any pain in my foot up to this point. I have been wearing the lifts since 1988 and the only impact they have had is to minimize my altered gait somewhat due to my short left leg.

 

The anti-inflammatory (Diclofenac Sodium Topical Gel) helps somewhat but only for a short period of time. There is a logistics issue when using this anti-inflammatory as I have to remove my shoes and socks to apply the gel, so I normally can not apply the gel when I am out of the home.

 

The pain in my left foot is a stabbing pain in the bottom of my foot at the center (arch) and heel. The pain is usually the worst with both feet the first few steps after getting up in the morning, but also by long periods of standing or rising from sitting. The pain is usually worse after exercise, but not as much during it. My feet hurt more as the day goes on. It hurts the most when I climb stairs or after I stand for a long time.

 

The early morning pain returns after about an hour and remains present throughout the day, leaving me unable to walk any real distance or stand without pain.

The pain on manipulation and use of my feet adversely affects my ability to function under the ordinary conditions of daily life, including employment. I currently work as a police officer however I can not perform my current job effectively and now only work part time (8-16 hours a month). 
 
Load bearing on my feet is very painful. The added weight of the gear on the gun belt and the ballistic vest that I must wear (approximately 25 lbs combined) makes the pain in my feet almost impossible to bear. I have difficulty walking any distance and an inability to run. 

In 2016 I earned approximately $10,500 from work and did not receive disability from any source. I have worked and earned even less in 2017.

I am able to drive but after 30-45 minutes the pain is to the point that I have to stop and take a break.

 

I have been compensating for the pain in my feett by changing the way in which I walk and stand. This has contributed to the pain in my knees, hips, and back.

 

I was prescribed an anti-inflammatory (Diclofenac Sodium Topical Gel) that would not affect me taking my prescribed daily aspirin. I apply this medication 2-3 times a day on my feet.

On October 2 and 16 of 2017 I was seen by Dr. Gorenshtein at the Foot and Ankle Center in Winchester, VA. Dr. Gorenshtein diagnosed plantar fascial fibromatosis of my left foot.  I was fitted for an arch support to be used with my current heel lift but again this has not helped with the pain in my foot as its purpose is to protect the arch while it heals.

 

Dr. Gorenshtein advised he will have my left foot laser measured November 27, 2017 in order to make an orthopedic device that will incorporate both a heel left and arch support to be placed in my left shoe. This will alleviate wearing two devices in my shoe as I do now. 

 

I continue to receive treatment twice a month for both my left foot and left hip/leg at the Martinsburg VA Hospital, Winchester (VA) Orthopedic Association and Dr. Gorenshtein at the Foot and Ankle Center in Winchester, VA. at least twice a month.

 

 

Left Hip/Thigh Impairment & Left Hip Limit of Flexion - service connected at 0% each.

 

The evaluation currently assigned to my Left Hip/Thigh Impairment issue does not accurately reflect the severity of my disability or the pain associated therewith.  The pain on manipulation and use of my left leg has worsened to the point that it adversely affects my ability to function under the ordinary conditions of daily life, including employment.

 

Currently I have continuous pain and numbness to my left thigh. The pain and numbness is constant every day and all day and does not let up. On a good day the pain level is 5/6 however when I have a flare up or when standing or driving longer than 15-30 minutes the pain level is at 7/8. Sometimes when I have a flare up the pain is incapacitating to the point I have to immediately stop what I am doing and wait until the pain subsided in order to continue. At the end of the day it is at 7/8.

 

In 1988, while in the Army, I was diagnosed with Left Leg Discrepancy. I believe this discrepancy has caused biomechanical stress in my left thigh, knees, hip and feet.

 

On August 25, 1980 I was seen at the 130th Army General Hospital in Dexheim, Germany for tightness in my left leg. (See attached STR, dated 25 August 1984).

 

December 10, 1980 I was seen at the 130th Army General Hospital in Dexheim, Germany for shin splints (I began to feel pain in both my shins, which lasted about a week to ten days, however the onset of pain was intermittent and bearable for 2-3 years. When the pain was more frequent and no longer bearable I went to the hospital) (See attached STR, dated December 10, 1980).

 

On September 26, 1983 I was seen at the Troop Medical Clinic, Ft. McClellan, AL for pain to my upper left leg and pain in my shins (See attached STR, dated September 26, 1983).

 

On July 14, 1988 I was seen for pain and swelling in my left knee at the Troop Medical Clinic #1, Ft. McClellan, AL. The attending military doctor attributed the pain in my left hip to a 2% biomechanical stress from my left leg discrepancy. This leg length discrepancy has also aggravated and caused pain in my left thigh, knee and hip and foot. (See attached STR, dated July 14, 1988).

 

December 6, 1988 I was seen for right knee pain at the Physical Therapy Clinic, Noble Army Hospital, Ft. McClellan, AL. A permanent heel lift for my left foot was ordered at this time. This heel lift was to compensate for my leg length discrepancy and prevent any further damaged it had caused (See attached STR, dated December 6, 1988).

 

January 29, 1992 seen for left hip pain at the Physical Therapy Clinic, Ft. McClellan, AL. During this examination the doctor measured and recorded my left leg to be 89 cm and my right leg to be 91 cm. The attending military doctor attributed the pain in my left hip to a 2% biomechanical stress from my left leg discrepancy (See attached STR, dated January 29, 1992).

 

June 23, 2003 attended VA Primary Care appointment at the Veterans Administration Hospital, Martinsburg, WV. I advised the staff of left hip pain and numbness in left leg (See attached Martinsburg VA CPC 2 Physician Assistant Note, dated June 23, 2003).

 

December 2, 2003 attended VA Primary Care appointment at the Veterans Administration Hospital, Martinsburg, WV. I advised the staff again of left hip pain and numbness in my left leg as well as ankle pain in both feet, especially in the am when waking up. (See attached Martinsburg VA CPC 2 Physician Assistant Note, dated December 2, 2003).

 

March 17, 2017 I was seen for left hip pain at the Winchester Orthopedic Association, Winchester, VA. I was diagnosed with trochanteric bursitis of the left hip/primary osteoarthritis of the left hip (x-rays). I had begun to feel pain in my outer left leg and hip with numbness and sharp pain since 1980. This pain and numbness lasted about a week each time. The pain was bearable with motrin, however the pain became constant within the last 17 months is extremely painful and constant now (See attached Civilian Medical Report, dated March 17, 2017).

 

March 2017 through April 2017 I completed physical therapy at the Winchester Orthopedic Association, Winchester, VA., however the pain remained (See attached Civilian Medical Report, dated March 17, 2017).

 

May 12, 2017 I received a therapeutic steroid injection (fluid guide x-ray) of the left hip performed by Winchester Medical Center Hospital, Winchester, VA ordered by Winston Cameron, MD of Winchester Orthopedic Association, Winchester, VA. This treatment helped to mitigate some of the pain in my hip however I continue to have shooting pain, numbness, and tingling in my outer left leg on a constant basis when standing, sitting, or walking for periods of 15 minutes or more (See attached Civilian Medical Report, dated May 12, 2017).

 

July 2017 through September 2017 I again completed physical therapy at the Winchester Orthopedic Association, Winchester, VA., however the pain remained in my left leg and left foot. I was referred by the attending doctor to a podiatrist, Alex Gorenshtein, MD at the Foot and Ankle Center in Winchester, VA for the continuous pain in my left foot (See attached Civilian Medical Report, dated July-September 2017).

I have a lack of endurance and my coordination and balance is affected when I am moving around. I have been compensating for the pain in my left leg by changing the way in which I walk and stand. This has contributed to the weakness and pain in my knees, hip, and back.

 

I have difficulty walking any distance and an inability to run. Load bearing on my left leg is very painful.  

The pain in my left leg has altered my daily living to include taking care of myself, personal hygiene, preparing and eating food, standing, sitting, caring for my home or completing home repairs, walking, traveling, recreational and social activities.

 

Decisions must be made and priorities set daily depending on the level of pain I am currently having.

I have compensated, or attempted to compensate, for my pain by changing my daily routine to make things easier or more bearable.

Currently I have continuous pain and numbness to my left thigh. The pain and numbness is constant every day and all day and does not let up. On a good day the pain level is 5/6 however when I have a flare up or when standing or driving longer than 15-30 minutes the pain level is at 7/8.

 

Sometimes when I have a flare up the pain is incapacitating to the point I have to immediately stop what I am doing and wait until the pain subsided in order to continue. A flare up can come on fairly quickly and unexpectedly.

I currently do not have the sufficient physical capacity to meet the occupational demands of my current profession as a police officer and must look at other occupations available that do not require standing, walking or sitting for more than 30 minutes and one that will allow me to stop at times to either lie down and rest or remove my shoes and socks to apply the topical anti-inflammatory medication when needed.

Load bearing on my leg is very painful. The added weight of the gear on the gun belt and the ballistic vest that I must wear (approximately 25 lbs combined) makes the pain in my feet and left leg almost impossible to bear. I have difficulty walking any distance and an inability to run. 

I can not perform my current job effectively and now only work part time (8-16 hours a month). As stated previously, in 2016 I earned approximately $10,500 from work and did not receive disability from any source. I have worked and earned even less in 2017.

 

Sometimes I get stressed and a little depressed from the chronic pain and have difficulty with falling asleep or staying asleep.

I continue to receive treatment twice a month for both my left foot and left hip/leg at the Martinsburg VA Hospital, Winchester (VA) Orthopedic Association and Dr. Gorenshtein at the Foot and Ankle Center in Winchester, VA.

Edited by Bullwinkle
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I did have an IME done and the doctor was very good and complete in his examination and did a positive write up."

I assume you re opening the claim and did not appeal the past decision...?

If the IME doctor followed the IMO/IME criteria here at hadit, and also referred directly to your STRs, and any other probative medical evidence you have, and made a full medical rationale as to what his expertise is and why the medical evidence warrants a rating, then

in my opinion, the VA will focus more on the IMO/IME than the long rendition you have put here.

A diary of documented inservice STRs  and post service medical evidence thats support your claim is good, but this is too much for the VA to read in my opinion.

You are suggesting the TDIU issue as well as  other secondary problems, but the actual claim probably does not cover those issues.

Maybe the IME does.But still those issues  would have to be claimed-with evidence.

I think we could give better advice here if you can scan and attach the IME for us to read.

Cover the name of the Doctor and any other personal identifying info prior to scanning it, ( C file #, name etc)

If it covers what the actual claim covers, than all you might really need to do is refer them in the 21-4138 to the attached IME from Dr._____, as I assume he referred directly to most  of the documentation you posted here.

I did a long cover letter, basically like what you did, but this was prior to sending my evidence to Dr Bash years ago for an IMO.I tabbed the special medical evidence in the stack,all of which the VA had ignored and tried to prevent me from even re opening the claim.

As I recall I simply wrote on the 21-4138 that they needed to consider the enclosed IMO from Dr. Bash and his Curriculum Vitae. 

Long story- that claim took many years, but still it succeeded.

 

 

Edited by Berta

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I agree with Berta, but will add I think she means "RE opening" due to new and material evidence, 38 cfr 3.156 (B) or (c).  

If you are outside of the appeal period(s), then 3.156 (B) wont give you an earlier effective date either, as your claim becomes "no longer pending" once you have exhausted all your appeals, or missed an opportuntity to appeal them timely.  

3.156 C (new service records) should give you an effective date no matter when you submit new service records.  If its NOT new service records, and "any" new, material evidence, then 3.156 b wont get you an earlier effective date, you might as well file a new claim IF you are out of the appeal periods.  

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And, as mentioned before, "EVIDENCE" wins claims, not the Veterans opinion that he deserves more benefits.  For that reason, I try to stay away from "my opinion" and, instead, cite what the doctor or regulation(s) state.  

The VA does not care what you think, the VA (should eventually) grant or deny your claim, based upon the evidence or lack therof.  

I recommend you always do this in the correct order:

Get all your Caluza elements, first, for service connection.  

Then, the symptoms will determine your rating, once service connected.  You would be suprised at how many get this out of order, or even forget all about the Caluza elements of current diagnosis, in service event or aggravation, and nexus.  If you dont know what these mean, look it up or ask.  

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Thanks for the input and advice. I'm still within the appeals period as these ratings were given to me in September  2017. I think after hearing your concerns I will remove the history of STR's and post a one page cover letter with recent medical documentation along with the IME. I will scan in the IME and try and attach it. Thank you again

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Berta......as requested. Attached is my IME. I am trying for an increase from 0% on three (Left Cuboid Syndrome, Left Hip/Thigh Impairment and Left Hip Limit of Flexion). Thank you again.

 

Edited by Bullwinkle
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      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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