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Welp, Just found out they closed my claim. Surprise surprise, nothing changed EXCEPT they reduced my GERD from 60% down to 10%! WHY and What the?! So apparently that random C&P without my knowledge played a significant part.
So my questions are the following:
1. Should I reopen my claims or file an appeal?
2. How do I go about getting ALL of my C&P claim notes, especially whatever was said from this C&P without my knowledge?
3. Should I even attempt to ask for the much qualified for increase on other areas of my body, that have gotten worse, or fight this last round of let downs?
I try to explain to everyone when you retire or get out and become a veteran, your own company (the VA) treat you like used tissue. Nobody has any use for used tissue...tossed to the side.
I have had trouble getting my fed ex letter for c&p exams. Anyone else?
I wanted to post here to get some advice. I went to my latest C&P this past Friday May 17th, 2019 for an increase to my original condition of Lumbosacral strain as well as secondary NSAID induced GERD because of taking NSAIDS for years of treating the pain from my back and legs. Here are the issues that I had and am wondering should I submit an additional document to my claim to let the RO know of my concerns before they make a decision or should I wait for decision and then go for higher-level, supplemental, appeal road.
Examiner did not use Goniometer to measure ROM on my back (indicated that I was up to 70 degrees and 20 degrees on everything else) Examiner noted pain during ROM testing but did not indicate at what point in ROM that the pain started so that the accurate ROM could be determined Examiner did not fully review my records as indicated by: they did not note spinal stenosis as a diagnosis which is clearly indicated on my MRI results they indicated that they did a straight leg test with negative results when in fact they never did that test. I never layed down. they indicated that I had not sought treatment for my back since 2017 which is completely false. I have documented treatment records at the VA beginning back in Nov 2018 through this month. they referenced a 2 year old MRI result instead of my MRI from 2 weeks ago they indicated that I was taking pain medication for non-service-connected conditions (neck/knees) which are actually service connected conditions in my file. they didn't record my specific statements about flare-ups and the functional impact saying that I didn't report any at all. Any thoughts would be greatly appreciated.
Thanks in advance.
I recently (October 2018) made my first claim and was examined and rated @ 10% for Tinnitus. Immediately afterwards, I received a letter from the VA stating that they had made an appointment for me for back pain that was from a claim in March of 2000. (I left the USAF in January, 2000). This is the result of that C&P exam.
I was also sent a letter about foot pain that I had claimed in 2000. I ended up filling out more paperwork to explain condition, and sending in medical records from private doctors. I believe that they combined the foot pain, and the back pain into one claim.
I cannot see anything on eBenefits regarding the status these claims since they are so old (that's what they told me).
I am also soliciting opinions as to what the effective date for these claims would be.
Please let me know what you think regarding this DBQ from a C&P exam:
Thank you VERY much!
I am thinking 20, 20, 20. Anyone see anything else?
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 [X] Other (please identify other evidence reviewed): JOINT L
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 [ ] Lumbosacral strain [X] Degenerative arthritis of the spine [X] Intervertebral disc syndrome [ ] Sacroiliac injury [ ] Sacroiliac weakness [ ] Segmental instability [ ] Spinal fusion [ ] Spinal stenosis [ ] Spondylolisthesis [ ] Vertebral dislocation [ ] Vertebral fracture
Diagnosis #1: LUMBAR DDD Date of diagnosis: 2015 BY MRI
Diagnosis #2: THORACOLUMBAR SPINE SEGMENTAL DYSFUNCTION Date of diagnosis: SERVICE CONNECTED
Diagnosis #3: BILATERAL RADICULOPATHY Date of diagnosis: 2018 2. Medical history ----------------- a. Describe the history (including onset and course) of the Veteran's thoracolumbar spine (back) condition (brief summary):
THE VETERAN IS A 42 YO MALE WHO SERVED IN THE MARINE CORP FROM 1995 TO 1999, THE MARINE CORP RESERVE FROM 1999 - 2001, AND THE NATIONAL GUARD FROM 2001 TO 2003 AND AGAIN FROM 2016 TO PRESENT DAY WITH DEPLOYMENT TO AFRICA FROM 2017 TO 2018. HE IS HERE FOR A CURRENT LEVEL OF DISABILITY EXAM FOR THORACOLUMBAR SPINE SEGMENTAL DYSFUNCTION. HE REPORTS SINCE HIS LAST COMP AND PEN EVALUATION AROUND 2013 HE HAS WORSENING PAIN WITH ONSET OF RADICULOPATHY IN BOTH LEGS. HIS PAIN LEVEL RANGE IS FROM A 5-9/10 WITH A THROBBING CHARACTER HAVING OVERLYING SHARP JABS. HE IS STIFF AFTER SITTINIG AND IN THE MORNING. HIS MORNING STIFFNESS WILL LAST 1-2 HOURS. HE STATES IN REGARDS TO HIS RADICULOPATHY HIS LEFT IS WORSE THAN HIS RIGHT AND EXTEND TO HIS FEET BILATERALLY. HE PREVIOUS TREATMENT INCLUDES PHYSICAL THERAPY, CHIROPRACTIC CARE. HE DENIES ANY SURGERY. HE JUST ANOTHER ROUND OF PHYSICAL THERAPY. 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: HIS PAIN WILL ELEVATE TO A 9/10 TWICE A WEEK LASTING A FEW HOURS TRIGGERED BY OVERACTIVITY. HE WILL REST AND USE PAIN CONTROL.
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. HE REPORTS HE DIFFICULTY WALKING FOR LONG DISTANCES, CANNOT SIT IN A HARD CHAIR, HAS PROBLEM SOCIAL FUNCTION ACTIVITIES AND PLYAING WITH HIS CHILDREN. HE CANNOT LIFT OVER 15 POUNDS OR STAND MORE THAN 30 MINTUES. HE HAS PROBLEMS WITH ANY MOVEMENT THAT REQUIRES BENDING, LIKE PUTTING ON HIS SHOES. HE HAS DIFFICULTY CONCENTRATING WHEN HIS PAIN ELEVATES. HE HAS DIFFICULTY DRIVING OVER AN HOUR.
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 35 degrees
Extension (0 to 30): 0 to 10 degrees
Right Lateral Flexion (0 to 30): 0 to 15 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 20 degrees
If abnormal, does the range of motion itself contribute to a functional loss? [X] Yes (please explain) [ ] No If yes, please explain: HE WOULD NOT BE ABLE TO RETREIVE AN ITEM FROM THE FLOOR
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? [X] Yes [ ] 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): TENDERNESS OVER THE LUMBAR VERTEBRAE, PARASPINOUS MUSCLES, BILATERAL SI JOINTS AND BILATERAL SCIATIC NERVES. 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: HE HAS NOT USED HIS BACK REPEATEDLY.
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: HE WAS NOT HAVING A FLARE.
e. Guarding and muscle spasm Does the Veteran have guarding or muscle spasm of the thoracolumbar spine (back)? [ ] Yes [X] No
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: Less movement than normal due to ankylosis, adhesions, etc., Disturbance of locomotion, Interference with sitting, Interference with standing, Other (please describe) Please describe additional contributing factors of disability: INTERFERENCE WITH LIFTING.
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: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5
Knee extension: 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
Ankle plantar 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
Ankle dorsiflexion: 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
Great toe extension: 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
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 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 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: [X] Normal [ ] Decreased [ ] Absent
Thigh/knee (L3/4): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent
Lower leg/ankle (L4/L5/S1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent
Foot/toes (L5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] 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 [X] Moderate [ ] Severe Left lower extremity: [ ] None [ ] Mild [ ] Moderate [X] Severe
Paresthesias and/or dysesthesias Right lower extremity: [ ] None [ ] Mild [X] Moderate [ ] Severe Left lower extremity: [ ] None [ ] Mild [ ] Moderate [X] Severe
Numbness Right lower extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Left lower extremity: [ ] None [X] Mild [ ] 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
b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: BACK BRACE FOR SUPPORT 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? [X] Yes [ ] 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? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): For Official Use Only
Click image to open viewer Priority: MRI LUMBAR SPINE WO CONTRAST
Proc Ord: MRI LUMBAR SPINE WWO CONTRAST
Exm Date: NOV 07, 2015@11:21
Req Phys: Pat Loc: DAL PACT CL10-I2NURSE (Req'g L
Img Loc: MRI
(Case 7346 COMPLETE) MRI LUMBAR SPINE WO CONTRAST (MRI Detailed) CPT:72148
Reason for Study: low back pain chronic
Report Status: Verified Date Reported: NOV 07, 2015
Date Verified: NOV 07, 2015
Verifier E-Sig:/ES/LENA A OMAR, M.D.
MRI Lumbar Spine without contrast dated 11/7/2015
Clinical History: 38-year-old male with history of low back pain
Comparison: Radiograph 8/28/2015
Technique: Sagittal and axial T1 and T2, as well as axial PD
sequences were obtained of the lumbar spine.
Vertebral body height, alignment, and marrow signal are preserved
throughout the lumbar spine. There is either focal fat or
hemangioma in the L1 vertebral body. Vertebral bodies are
unremarkable. The conus terminates at L1-L2.
There is no significant canal or neural foraminal stenosis. No
areas of abnormal signal within the cord are seen. There is a
tiny central disc protrusion at L5-S1 without any significant
narrowing of the thecal sac or neural foramen. Small amount of
fluid is present in the facet joints in the lumbar spine.
Visualized paraspinal soft tissues are unremarkable.
1. Essentially unremarkable MRI of the lumbar spine except for a
tiny central disc protrusion at L5-S1 without any significant
narrowing of the thecal sac or neural foramen.
Primary Diagnostic Code: ABNORMAL
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:
THE VETERAN WORKS AS AN ACCOUNTANT. HE SITS FOR LONG PERIODS AT WORK WHICH ELEVATES HIS BACK PAIN AND DECREASES HIS CONCENTRATION AND WORK CAPACITY. HE WOULD NOT BE ABLE TO WORK A PHYSICALLY DEMANDING JOB REQUIRING PROLONGED WALKING, STANDING OR REPEATED HEAVY LIFTING. HE ALSO WOULD REQUIRE THE ABILITY TO MOVE FROM SITTING TO STANDING POSTIONS WITH A SEDENTARY JOB SUCH AS THE ONE HIS IS CURRENTLY WORKING.
17. Remarks, if any: ------------------- 1. Is there evidence of pain on passive range of motion testing? (Yes/No/Cannot be performed or is 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)
3. If yes, is the opposing joint undamaged (i.e. no abnormalities)? NA
If yes, conduct range of motion testing for the opposing joint and provide ROM measurements.
PASSIVE AND ACTIVE RANGE OF MOTION ARE THE SAME. ***************************************************************************** **********
THE VETERAN HAS A SERVICE CONNECTION FOR THORACOLUMBAR SPINE SEGMENTAL DYSFUNCTION. THIS IS A CHRIOPRACTIC DIAGNOSIS \: "segmental dysfunction, a motion theory concept that states that two articulating joint surfaces cannot interact optimally if they are misaligned. Basis of vertebral subluxation and theory of illness.
SYNONUMS FOR SEGMENTAL DYSFUNCTION OF THE LUMBAR SPINE ARE: LOW BACK PAIN, LUMBAGO, LUMBALGIA.
GIVEN THE SERVICE CONNECTED DIAGNOSIS IS BROAD BASED AND GENERAL BY DEFINITION, THE VETERANS CONFIRMED DIAGNOSIS OF LUBMAR DDD WITH COMPLICATIONS OF BILATERAL LEG RADICULOPATHY WOULD BE INCLUDING AND THEREFORE ALSO SERVICE CONNECTED.
OF NOTE THE VETERAN COMPLAINED OF BACK PAIN, PAIN IN ARMS, LEGA NAD JOINTS DURING HIS DEPLOYMENT IN 2017 TO 2018 WHICH MORE THAN LIKELY WAS DUE TO HIS LUMBAR DDD WITH RADICULOPATHY.
JKWilliamsSr posted a question in VA Disability Compensation Benefits Claims Research Forum,A couple months back before I received my decision I started preparing for the appeal I knew I would be filing. That is how little faith I had in the VA caring about we the veteran.
One of the things I did is I went through the entire M21-1 and documented every CAVC precedent case that the VA cited. I did this because I wanted to see what the rater was seeing. I could not understand for the life of me why so many obviously bad decisions were being handed down. I think the bottom line is that the wrong type of people are hired as raters. I think raters should have some kind of legal background. They do not need to be lawyers but I think paralegals would be a good idea.
There have been more than 3500 precedent setting decisions from the CAVC since 1989. Now we need to concede that all of them are not favorable to the veteran but I have learned that in a lot of cases even though the veteran lost a case it some rules were established that assisted other veterans.
The document I created has about 200 or so decisions cited in the M21-1. Considering the fact that there are more than 3500 precedent cases out there I think it is safe to assume the VA purposely left out decisions that would make it almost impossible to deny veteran claims. Case in point. I know of 14 precedent setting decisions that state the VA cannot ignore or give no weight to outside doctors without providing valid medical reasons as to why. Most of these decision are not cited by the M21.
It is important that we do our due diligence to make sure we do not get screwed. I think the M21-1 is incomplete because there is too much information we veterans are finding on our own to get the benefits we deserve
M21-1 Precedent setting decisions .docx
ADAMS posted a question in VA Disability Compensation Benefits Claims Research Forum,Any one heard of this , I filed a claim for this secondary to hypertension, I had a echo cardiogram, that stated the diagnosis was this heart disease. my question is what is the rating for this. attached is the Echo.
Tbird posted a question in VA Disability Compensation Benefits Claims Research Forum,if you have been thinking about subscribing to an ad-free forum or buying a mug now would a very helpful time to do that.
Thank you for your support
70%&sfsystem posted an answer to a question,OK everyone thanks for all the advice I need your help I called VSO complained about length of time on Wednesday of this week today I checked my E benefits and my ratings are in for my ankles that they were denying me 10% for each bilateral which makes 21% I was originally 80% now they’re still saying I’m 80%
I’m 50% pes planus 30% migraine headaches 20% lumbar 10% tinnitus and now bilateral 21% so 10% left and right ankle Can someone else please do the math because I come up with 86% which makes me 90 what am I missing please help and thank you
I was denied SC for IBS and GERD IN 2011. In 2019 I was awarded SC for GERD. This CUE is for 2011, both GERD and IBS. There are some odd aspects regarding the 2011 decision, the way it was written and the C&P report and the way it was written. I've tried to present this as clearly as I can. Note: the decision contradicts itself. the decision also contradicts the C&P Report. Honestly, I think the rater just got confused because the C&P was so poorly written. *THIS CUE HAS NOT YET BEEN SUBMITTED*Please let me know what you think. Appreciate all comments and suggestions. Thanks.
VA RATING DECISION MARCH 23 2011 GERD IBS.pdf C P REPORT 7312010 GERD IBS.pdf GERD IBS CUE 2011(1).pdf
C P ADDENDUM REQUEST RE DIAGNOSIS 7232010.pdf