Should I file a CUE?

[jonnyohio]

Hello everyone, I really need some advice.  I am about to embark on a long fight, and I hope I have the energy to do it and I hope I'm on the right path.  So I'm hoping at least one person on here can advise me if I'm going down the right path or not.  Here is my story:

In 1997 while in the service I started to have joint pain out of no where.  I went to the doctor because suddenly my ankle started to hurt when I tried to go for a run after work.  They did an x-ray, doctor said it appeared I had arthritis in my foot and asked me if anything else was going on?  I told him, yes, as I had been having pain in my shoulders.  He told me I should see a doctor and have it checked out.  I did, and the doctor did x-rays on my shoulders.  She told me it appeared I had early stage of an inflammatory arthritis.  I asked what I could do about it?  She said there was nothing they could do, just take ibuprofen and exercise, and see a doctor at my next command.  Well, I had extended out 6 months because I was having my first child and thinking of doing another 4 years of service.  After that diagnosis, I decided to separate as I worried about not being able to meet PT standards (In hindsight, I should have stayed in and made them medically discharge me).   My dad had been diagnosed with RA when I was younger, but at the time I was ignorant of it and just thought it was no big deal.  After service I went 10 years of having symptoms on and off again.  At 32, it got bad enough that I decided to try seeing someone about it.  I found out that I could go to the VA for healthcare, which was great because at the time I had no insurance.

So I ended up seeing a Rheumatologist at the VA and a VSO helped me file a claim, and I ordered my service records.  When I got my service records there was next to nothing in it, just my entrance physical and exit exam.  I did not know that my outpatient records had been transferred to another facility.  After a year of going to the VA (2007-2008), the VA Doctor didn't give me a definitive diagnosis, but told me that he was pretty sure it was either seronegative RA or early psoriatic arthritis.  He offered me no treatments other than the same thing the military doctor told me:  NSAIDs and exercise.  Then told me I didn't need to be seen until my symptoms progressed.  So another 10 years went by and slowly it got worse; starting in 2016 I began having more severe flare-ups.  So in (2017) I enrolled once again in the VA healthcare system and started going back.  I got pretty bad, and my GP gave me a steroid burst, started me on diclofenac, and put me in for referrals (also got some imaging scans ordered to check the progress to see if I had any damage).  During this time I started getting noticeable swelling in my finger joints.  So I finally I got a diagnosis for inflammatory arthritis from the VA just this past July and they immediately started me on Plaquenil.  Then a few months later, started me on Sulfalazaline, and will start me on Methotraxate within the next month or so.   I have a new local VSO (old one retired) and she's pretty good.  She said I'd have to file to reopen my previous claim but warned me that it will most likely get denied and I'd have a long fight ahead of me, considering the circumstances.  Prior to meeting with her I tracked down my OP service records and low and behold my appointments are in there.  First, there is an appointment I forgot about that was the first symptom I had related to what they are saying is GERD, and then shortly after is the appointment for my ankle and then right after that is the appointment where it says I was seen for should pain, knee pain, ankle pain, and stiffness in my fingers.  It's hard to read the doctors writing, but near the bottom I can make out this:

"A  R/O Arthritis" and under that it clearly says "R RA Panel DR MGNT"  and then two other things I can not for the life of me read.

From what I understand "A" stands for Assessment and R/O means "Rule Out"
The R stands for recommend, and she was recommending an RA Panel which is a blood test to test for Inflammatory Arthritis.  This all supports my statements I've made in my claim and a statement I said to the VA doctor 10 years ago that is documented in my VA medical records (which I have).

For my ankle pain, it appears that doctor just treated it like it was a sprain.  But makes notes that I told him I heard and felt a "pop".

My original claim was for RA and they rejected stating in their letter than there was no evidence of me being treated for a chronic condition during or after the service.

A couple months ago I got denied for trying to reopen.  I sent them all my VA records and military records, showing that I was seen in the service for the same thing I'm being seen for now, and the VA records now have my diagnosis.  Got denied saying the evidence wasn't new and material, of course.

So this morning I spoke with Dr. Bash, who says he's willing to write a Nexus letter for me and do DBQs (Yes, he is expensive, but he's the best fit for me from what I can see).  He recommended I file a CUE, because he says that I should have been approved in 2007 since my military records show I was seen for it while in the service and it's obvious they thought it was inflammatory and he tells that is an error.  He also told me he is confident I will end up with 100% or close to it, since being on the meds they have me on is an automatic high percentage.  My VSO said that I could take the route of filing a NOD and going through RAMP.  However, she recommended I get a NEXUS letter and possibly a lawyer because she said I might need better help than she can provide, but that if I at least got a NEXUS letter it would greatly improve my chances since that was obviously what the VA is looking for in their response to me.

So my question is, is a CUE the way to go?  It looks complex and risky.  Would you advise I get a lawyer to help me with this?  10 years of back pay is a pretty good amount.  I'm really considering forking over the money to Dr. Bash to get a good medical opinion but it's really intimidating going through this, and I feel like I'm alone.

Edited January 18, 2019 by jonnyohio

[jonnyohio]

32 minutes ago, Berta said:

I tyhought it said No arthritis-maybe that is what VA thought too- if they even read it.

Ha, that's what I initially thought too when I first read it, but then I saw "RA Panel" under it, a term I've become all to familiar with.  It's a set of blood tests that I've had several times.  And then I looked at it closer and realized it was R/o Arthritis.

[Berta]

Were the blood tests results with your SMRs?

It is Very hard to read. I worked on some SMRs from the 1960s long ago-I blew them up on my computer and then tried to figure out how each doctor wrote each letter in each word ----it was miserable-but they were easier to read than this stuff you have.

 

I am sure you decifered  this is correctly

R   Ra Panel
     DR MGNT

Is there any Blood chem work report that calls for these values, in your SMRs?:

 

"The Arthritis Basic Panel includes four tests specifically designed to evaluate inflammation. The Arthritis Basic Panel includes:

• Comprehensive Metabolic Panel (CMP): The CMP contains 14 measurements related to a number of health issues. 
• C-Reactive Protein (CRP), Quantitative: CRP is typically elevates in cases on inflammation or infection.
• Uric Acid: An excess of Uric Acid can cause Arthritis and Gout.
• Sedimentation Rate, Modified Westergren (ESR): An elevated ESR typically indicates there is inflammation in the body."
• https://requestatest.com/arthritis-basic-panel-testing

[jonnyohio]

3 hours ago, Berta said:

Were the blood tests results with your SMRs?

It is Very hard to read. I worked on some SMRs from the 1960s long ago-I blew them up on my computer and then tried to figure out how each doctor wrote each letter in each word ----it was miserable-but they were easier to read than this stuff you have.

 

I am sure you decifered  this is correctly

R   Ra Panel
     DR MGNT

Is there any Blood chem work report that calls for these values, in your SMRs?:

 

"The Arthritis Basic Panel includes four tests specifically designed to evaluate inflammation. The Arthritis Basic Panel includes:

• Comprehensive Metabolic Panel (CMP): The CMP contains 14 measurements related to a number of health issues. 
• C-Reactive Protein (CRP), Quantitative: CRP is typically elevates in cases on inflammation or infection.
• Uric Acid: An excess of Uric Acid can cause Arthritis and Gout.
• Sedimentation Rate, Modified Westergren (ESR): An elevated ESR typically indicates there is inflammation in the body."
• https://requestatest.com/arthritis-basic-panel-testing

Unfortunately, I see no record of the blood tests in my SMRs, and I don't recall if they actually did order the blood work.  However, I was very happy to see documentation in there of every one of the same complaints I still have today, including Apthous Ulcers that have also gradually gotten worse since the military, and a complete lack of any evidence of the same symptoms on my entrance physical exam.  So it shouldn't be too difficult to link the diagnosis from last July to my time in service.

The only one that I've ever gotten a positive on is ESR, and the only record they seem to have is from a test they did last year (also recently had a slightly elevated white blood cell count).  I was going through my VA history from 2007-2008 and it appears that some of the data is missing.  I'm guessing that someone deleted some things or the records were lost, because I remember having more tests done than what's in there.  Also there's no documentation of the last appointment I had where they told me I didn't need to be seen until it got worse (maybe they were worried of me filing a complaint, I don't know).  Nevertheless, it looks like there are still plenty of notes about what symptoms I was having to establish a continuation from the service to present.

Thank your for your advise, Berta.  I really do appreciate you taking the time to help me.  I'm going to focus on getting the IMOs I need before I go into the appeals process and not worry about a CUE for now.