Awaiting my NOD outcome

[Patton]

I filed a NOD in January 2017 for limitation of ankle (Right) motion , left Knee strain, lower Back pain, bilateral Plantar Fasciitis and Insomnia (they listed as dysthymic disorder). Since I filed the NOD, I received 30% for persistent depressive disorder (dysthymia) with anxious distress which includes chronic sleep impairment. I currently have a rating of 40% (VA math of 43%). On eBenefits it shows a completion date in November. The wait is driving me crazy. 

In April I had a C&P Exam for my Ankle, Knee and Back. I received a copy of my C-File that included my C&P results. She directly SC my Ankle stating:

• Lateral Collateral Ligament Sprain (chronic) - right
• Acute Ankle Sprains (during Service)
• Right Plantar Calcaneal Enthesophyte resulting in Ankle Pain
• Right ROM: Abnormal Range, Dorsiflexion (normal range 0-20) results 0-10 and Plantar Flexion (normal range 0-45) results 0-20
• Left ROM: Abnormal Range, Dorsiflexion (normal range 0-20) results 0-15 and Plantar Flexion (normal range 0-45) results 0-30

She stated that my knee condition is secondary to my ankle and the results are:

• Left Knee Strain - Bilateral knees
• Left recurrent Patellar dislocation - slight
• Right ROM: Flexion (normal range 0-140) results 0-105 and Extension (normal range 140-0) results 105-0
• Left ROM: Flexion (normal range 0-140) results 0-95 and Extension (normal range 140-0) results 95-0
• The opposing joint does have evidence of damage as indicated by the exam abnormalities documented above.
   

She also stated that my lower back condition is secondary to my Ankle and the results are:

• X-ray view 1: Possible Herniation of Disc. Diminished height L5 - S1 and Spurring on L2, L3 and L4
• X-ray view 2: Spondylosis of the Spine and Spurring on L5
• Lumbosacral Strain
• Radiculopathy
• Involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve) - Right
• Spondylosis of the spine
• Initial ROM: Forward Flexion (normal range 0-90) results 0-75, Extension (0-30) 0-30, Right Lateral Flexion (0-30) 0-30, Left Lateral Flexion (0-30) 0-10, Right Lateral Rotation (0-30) 0-10, Left Lateral Rotation (0-30) 0-20
• After repeated ROM: Forward Flexion (normal range 0-90) results 0-50, Extension (0-30) 0-30, Right Lateral Flexion (0-30) 0-30, Left Lateral Flexion (0-30) 0-20, Right Lateral Rotation (0-30) 0-10, Left Lateral Rotation (0-30) 0-15
• Pain on rest Left Lateral Rotation 
• Interference with sitting and standing
• Passive ROM of the spine was not performed as it is not feasible to do this in a safe and reasonable manner.

I did not get an C&P for bilateral Plantar Fasciitis, but this has been well documented in my Military, VA and Private Medical Records. I did submit all of it when I filed the NOD, except for the shots that I received from the VA after filing. I have a Doctor's (Private) appointment tomorrow for Plantar Fasciitis and he said that he would do a DBQ but at this point, would submitting a DBQ delay, help or hurt my Claim? Or should I wait until the NOD is complete and if the claim is denied for Plantar Fasciitis, reopen it with new evidence (I.E. the shots and DBQ)?

What rating do you think I should receive? How is the Bilateral factor and pyramiding going to affect my claim? Is a secondary condition going to affect my rating?

Any thoughts on my outcome is appreciated and hopefully put my mine at ease!

Thank you,

Patton

[broncovet]

You posted:

Quote

  I did not get an C&P for bilateral Plantar Fasciitis,

A C and P isnt given every time.  It wont be given if there is

a) already medical evidence to support service connection

b) OR it also wont be given if a c and p exam wont change the outcome.    If you are lacking an "in service event", for example, a c and p exam wont provide that.  

YES, waiting drives us crazy.  This is why I recently opted into RAMP, even tho my attorney advised against it.  He said, "there are too many unknowns" in RAMP.    Well,  IMHO, the BIGGEST issue is WHEN.  A legacy appeal to the BVA is taking about 6 years now. At least.  I checked and my 2015 appeal hasnt yet been certified to the board (which takes 773 days, according the the BVA chairmans report), and there are over 140,000 Vets ahead of me in line..that is after I have already waited 3 years.  Given that it will take me another 4 or 5 MORE years, this is totally unacceptable to me in every way.  Even a denial is better, because I can appeal a denial and, at least, not be stuck in a VA "delay mud hole" for 7 years with legacy appeals.  

 

[Patton]

Thanks for the reply broncovet!

I opted into the RAMP and it was received on July 5th. The Plantar Fasciitis is very painful and I have lost many hours of sleep over it. I have never received a rating without an C&P, so that is very concerning to me. 

I think that I should get:

• 10% for Plantar Fasciitis plus 10% for Bilateral.
• 20% for Right Ankle and 10% for the Left or Bilateral?
• 10% for Bilateral Knee (although I have limited ROM in both knees, it is not enough for a rating?).
• 20% for lower back plus 10% for the sciatic nerve.

Does that sound realistic? 

[broncovet]

Maybe.  You know your symptoms better than I do, and you can look up the schedular rating criteria for each, and compare your symptoms (only those which are documented in your cfile!!) with the criteria.  

However,  I did not read in your post where your doctors said the magic words.  Without these magic words, none of this means anything.  

The magic words are :  (drum roll):

Either:

A.  Your (current diagnosis) is "at least as likely as not" due to (in service event or aggravation).  

OR

B.  Your (CURRENT DIAGNOSOS) IS secondary to (an already service connected condition).  

If your doc does not say the "magic words", then SC is a no go.  The magic words are known as the Caluza element trio, and are required for service connection.  Many a Vet, and many a VSO, has overlooked the basics of Caluza and wound up with a denial.   However, people who read hadit, are not often fooled by this, because I repeatedly tell people to mind your Caluza's or get denied.   

[Patton]

I believe these are the "magic words".

Knee - The claimed condition is at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran’s service connected condition.

Provide rationale: Current severity of the service connected CONDITION warrants by proximity, association of the claimed secondary CONDITION. The disorder began subsequent to the service connected condition and is the direct result of the antecedent condition. The medical literature supports this. A nexus is established. Pt' right ankle pain caused an antalgic gait which resulted in poor posture/ambulation contributing to left knee pain/strain.

Back - The claimed condition is at least as likely as not (50 percent or greater probability) proximately due to or the result of the Veteran’s service connected condition.

Provide rationale: Current severity of the service connected CONDITION warrants by proximity, association of the claimed secondary CONDITION. The disorder began subsequent to the service connected condition and is the direct result of the antecedent condition. The medical literature supports this. A nexus is established. As a result of his ankle conditions physical exam reveals he had an antalgic gait. With antalgic gait there is increased rotation and bending of the trunk which could lead to low back symptoms.

Reference: Dr. Ian J. Harrington, B.A.Sc., P. Eng.,M.D., F.R.C.S.(C), M.S., MSc. Strath.). Limping and Back Pain, Discussion paper prepared for The Workplace Safety and Insurance Appeals Tribunal.March 2004,Revised: August 2013.

Ankle - The claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness.

Provide rationale: Veteran had no issues related to the claimed CONDITION prior to military service. Onset of the condition was during service, documented in the Service Medical Records. Medical literature reports that a severe ankle sprain can cause subsequent ankle sprains which result in chronic ankle pain. There is evidence of current, chronic and continuous treatment and care. A nexus has been established.

Reference: https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/

Hopefully others can use the References that she used.