Possible CUE claim?

[JBrown76]

My husband was medically discharged in 2002. He got his VA rating in 2003. In his VA rating, they state they do not have his complete medical records. On his Rating decision from the VA in KS they state for evidence they have his VA exam in 2003, a partial service medical record that includes his enterance physical from 1993 and 3 pages from his left knee surgery. That was the only medical records they had. 
He got 10% for his left knee, but was denied his right knee, his wrist condition, and his heat stroke where he was air lifted from the field and was a level 3 tramua. 

On his wrist condition, they state- the VA exam found no current disorder. and that there was a history of sprains. They go on to say, the complete service medical records are not available and it is not known whether there were wrist complaints in service. Since no current disorder is found, service connection is dened. 
Aren't they completly contradicting themselves there? And there are no history of sprains in his records, only a diagnosis of wrist tendonitis. 
How could they have done a complete review without his complete records? He even brought a copy of his records with him to his first VA appointment and they stated they had all his records.

He then went back to the VA for an increase in his knee rating and to reopen his right knee and his heat stroke. Again he brought in his right knee surgery MRI, xrays and surgeon notes. The doctor would not look at them since they were on a disk, and refused to let me in the room with him even after he asked to have me with him. Again they did not have his records and he was denied an increase and they denied service connection for his heat stroke. 

He has reopened his claims again this time, and asked for an increase for his left knee. We have notes from 2 civilian doctor stating his conditions have worsened and that they are from his time in service. He also has uploaded to ebenefits his entire medical file and civilian doctors notes. He has 2 screws in his left knee and a 7 inch scar. Does nayone have any advice on how to proceed. Is this a CUE or do we need to just continue to appeal or reopen if he gets denied again? 


 

[vetquest]

Yes you will need to appeal.  Headaches can be related to a heat stroke, did he complain of headaches following his heat stroke?  I am rated 50% for headaches related as primary to heat injury.  He should have a lot more documentation than I have because they did not want to deliver me to medical after my heatstroke until I went into convulsive seizures and I was rated as a heat casualty with it being crossed off and marked heat injury.  You mention your husband's pain.  What type of pain does he have, neuropathic pain?  That can be related to a heat stroke.  Even so if it matches pain he experienced in the military it could be ratable.  They appear to be trying to show that your husband was overweight and susceptible to heat stroke.  You can fight this with a statement that your husband's health has suffered due to the heat injury and he can no longer exercise like he used to.  Does he have exercise intolerance now?  That could be because he has developed a hypoglycemic state when exercising.  I do not know how this happens but it does sometimes. 

Finally I have been diagnosed with PTSD following my heat injury and other veterans have been diagnosed with other mental deficiencies due to heat stroke.  It has a profound effect on the veteran and can cause mental after effects if the veteran was in fear for their life during the stroke.  In my case I was exposed to one veteran that died due to a heat injury and another seriously injured before my injury and I suffered continued heat injuries during and after service.  This was diagnosed as PTSD because they said I was suffering from emotional trauma and re-experiencing the incident.  They never explained how my temperature could get to 108 during these episodes if it was mental trauma.

[doc25]

37 minutes ago, JBrown76 said:

When my husband ETS from Ft Polk, he had a friend at the hospital, who made a copy of his medical file for us. That's the file that we uploaded to ebenefits when we found out they didn't have his records. 
He's going to request his c-file so we can see what evidence they have been using. 

Even though, he thought his recent exam went well .from reading the C&P notes, it did not. The PA stated my husband is morbidly obese (he is not, he overweight but not morbidly obese) he was never weighed so how would the PA know. 
He stated for everything my husband claimed that it was less likely than not caused by military service. the notes state that my husband's pain is only subjective because he did not have any of the objective symptoms of pain such as pupil dilation, sweating, and increased heart rate. He stated that my husband's headaches are not related to his service and that he only had dehydration from his heat injury. Every note from that incident says it is a level 3 heat injury. 
This PA even contradicts the civilian orthopedist that has been treating him. The C&P PA states that he does not have arthritis or joint disease. The civilan doc completed the knee questionairre stating the he has arthritis and joint disease. 

I guess he's going to have to appeal this rating when it comes back. 

This is gross incompetence by the PA. An orthopedic dr. is an expert in Orthopedics. 

PA's and Nurse Practitioner's do not have the same level of expertise as a specialist like an Orthopedic Dr. 

As far as the headaches go, heat stroke can have short-term AND long-term effects.

 

[GeekySquid]

1 hour ago, JBrown76 said:

When my husband ETS from Ft Polk, he had a friend at the hospital, who made a copy of his medical file for us

 

@JBrown76 

Okay, having those files are a good thing, however they may not be a complete set. Sad to say, but since the VA claims to have so few files and you say his entrance was 1993, there is a good bet his other files may have to be requested directly from the base hospitals and units he served in. That is a whole process unto itself.

Before i get into the really long post I want to mention something. The VA is big on "morbid obesity" statements. It comes from using unscientific and inaccurate BMI calculators. Essentially they say that a male (or female) of X age and Y height should weigh Z amount. If you are not there, there are gradient ranges of overweight, obese, morbidly obese, and big old tub of goo.

They use these thumbnail calculations no matter if you are a body builder or truly have "big bones" etc. The more accurate tests are very expensive and generally time consuming.  There are new machines on the market that scan your whole body and then compute you actual body mass but they run from 1800 to 10,000 dollars and I just don't see the VA spending that for the literal thousands of them they would need in their hospitals.

The kinda good thing for you is that with them calling him morbidly obese in the files, once you get the rating things straightened out, the weight will be a justification for an increased rating. It is a fight to connect obesity to service but as a secondary to an injury that prevents you from walking, running or  doing aerobic exercise it is a possibility. If you can chart his BP and Pulse from the time of his entrance to the military, through his nexus and up to today, you might just get a clear picture if he has borderline hypertension and hypertension is a ratable condition. At the very bottom of this post i tell you how I did the charting.

now the long and really boring part of this post. I admit I am anal retentive but doing this type of organization will help you in the long run.

When his C-file shows up go through it carefully.

The C-File is mainly structured as a single PDF with the newest files at Page 1, which should be your request for the C-file.

Things like his medical records, enlistment contracts, pcs orders etc are at the bottom near the last page.

I said mainly because I know in mine after my AFEE's documents there a few files that occurred during service. I cannot say why that happens, just that it happened to my files.

The other posted answers have addressed your questions. I am going to make a couple suggestions about your c-file when you get it.

This may be the most important document you ever get. I would suggest your first action is to burn a copy of it on another disk and put that in your bank safe deposit box. If you don't have safe deposit box, put it in a fireproof box at home, or at a relatives where it is offsite from your house.

I would then upload a copy to the cloud in Dropbox or Drive etc. '

I recommend that your next step is to print a copy of the file.

I would identify what type of printer I have and what kind of toner it takes. If you have an inkjet that is fine and there is a similar option but a toner based printer like my Brother HL-L2340D can be had for about 80 bucks and it is worth the money.

If you have, or chose to get, a toner based printer go on Amazon and find the right toner cartridge for the system through a general search. Then you want to look at the identified alternatives. for example HP wants to sell me a new toner cartridge for about 50 bucks. But i have an alternative type that for 28 bucks I get 3 of the exact same cartridges that print the same 2000 pages as an OEM cartridge from Brother. I am just cheap and the alternative cartridges are excellent.

If you have an inkjet. Go to youtube and look up Printer XXX cartridge refill at home. Try DIY if home does not give you a good match. Watch the videos. It is really easy and the refill kits are a tenth of buying new cartridges. The hard part for me is not making a mess. DOH>

I would then look at the number of files in your C-file. In mine I have 3000. It takes 6 3-inch binders to hold those pages and still be able to turn them to look at them.

There are massive duplicates.  over 1000 duplicates in fact. For example I have 6 copies of ONE specific C&P exam and at least 3 of every other C&P I have taken. It happens because the files come from different systems and VA does not filter for duplicates.

If you are anal retentive like me, what I did was page through and find the duplicates. It takes awhile.

I marked the page that was the first one as the "original" with a tag I got from Amazon. I got thousands of tags for 18 bucks. different colors and shapes.

with that page marked, I went into the C-file and searched it for distinct words on that particular page. Dates are a really good choice for this.

With each file the search returns I compared it to the "original" i had tagged. If it was a match I made a note of the page number in the PDF file and worked my way through all of the duplicates for that search. Then I took that list and one page at a time went through the binders and pulled out the duplicates and put them aside. Whatever page they were duplicates of I wrote that in the header of the duplicate page. Like Duplicate of page 5 (meaning the page in the c-file as your PDF reader numbers them. End to end this took me two weeks working days and doing the sorting at night.

This is a long boring process, but I will promise you that it makes research and gathering proof easier.

Those duplicates you set aside will come in handy in the next step.

Again on amazon you can get a case of 12 1-inch binders for about 8 bucks. 2-inch binders by the case are about 20 bucks. you will want to get a case of these too.

Once you have that first printing and sorting done. it is time to begin serious organization of your files.

You are going to want to decide how to organize things.

Here are some things you can consider. The c-file contains several main types of files that can be grouped. Administrative type documents like evals, contracts, awards, letters and even scanned images of postal tags for proof of mailing.

You also have what for the VA is listed a Clinical Notes. These are sequences of entries made by the VA folks. They  fall into a funny pattern. In my file for example I have a run of 300 pages of just Clinical notes. Then a test result, letter or some other  type file is next in sequence. Then a run of 5 more Clinical notes. This goes on and on. You might have I page of clinical notes then 50 other files then 36 more pages of Clinical notes.

What I did was identify all the clinical notes and then which ones I had duplicates of. I then printed another copy of any that I did not have duplicates of and created a binder of nothing other than Clinical Notes.

I did the same for X-rays and surgical notes, another for Blood test results and Skin related results.

I have a full binder of Cancer treatments, results and tests.

I have a two binders of Military Treatment records separate from the VA records. All said and done i have almost 40 binders. One master set and one that is a working set.

you will find in your organizing that a single page belongs in many different binders. Put a copy of each in the appropriate binders. Remember these are your working copies so having dupes in different binders is okay.

I also highlight what info from each page I want that ties it to the binder.

Put the master copy away and only deal with the duplicate.

There should be exactly the same number of pages in the duplicate as in the master. I am anal retentive. I bought a date stamp that advances automatically every time you stamp a page. They can be expensive so you decide.

That is the really long and boring part that will numb your mind and your fingers. But once done you have a complete set of records in an organized sequence that makes sense to you.

You also still have the electronic copy of the file.

With this combination you can readily find what you need, and all the associated other files that are needed to support your claim.

I will give you an example of how effective this works. In 2018 I got the C-file and did the sort. In that sort I found notes about an MRI i had had done at a previous VAMC. I could not find the Result report but I did find over 50 unique references to it. I printed those pages and contacted the company that did the MRI and on it it said I had a "partially empty sella". I then went back through my electronic copy and found 4 more unique references to that.

I would never have found that if I tried to look through either the massive printed record or just the electronic file as I never knew it existed and I did not know what a sella was, partial, empty or full.

Another use is I charted my weight changes from induction to discharge and then through VA treatment. I was able to use Excel to graph those numbers and I have an explicit binder of just my vitals like height weight BP etc. I have also charted my BP and found a linear growth towards hypertension. My pulse has also gotten more rapid over time.

Using those charts and the MRI result I was able to get my Primary Care Doc to do a consult to Endocrinology to have the right blood tests run to identify which hormones my crushed sella has affected. The sella covers the Pituitary gland and that known as the master gland because it controls your hormones and dozen other things like your Adrenals, Thyroid and Hypothalamus. When crushed it can cause your hormones to go wonky including cortisol which affects weight. It also affects anxiety, depression and a dozen other things. 

That is my long ass post and my solid recommendation for organization. If you got this far you are likely to be a detail oriented person so this type thing may be up your alley. Even if it isn't do what works for you.

The goal is to have a way to lay out your evidence in front of you and make sure you can use it to construct a linear argument with documented evidence of whatever you are working on.

When it is necessary to upload files from your c-file you can use Microsoft Print to PDF to select just the sequence of pages you need and print as a new PDF.

If your civilian records are on paper, scan them to electronic files and do exactly the same thing with them.

I will tell you that once you complete this and you get new information finding related information, doing more accurate searches in your medical records, etc is much much easier. You will get new info and you will be searching the c-file over and over again. It is just a reality. So organize yourself and be prepared.

 

Good luck and keep us posted. Please keep asking questions and giving results. We are here to support you.

[JBrown76]

13 hours ago, GeekySquid said:

 

@JBrown76 

Okay, having those files are a good thing, however they may not be a complete set. Sad to say, but since the VA claims to have so few files and you say his entrance was 1993, there is a good bet his other files may have to be requested directly from the base hospitals and units he served in. That is a whole process unto itself.

Before i get into the really long post I want to mention something. The VA is big on "morbid obesity" statements. It comes from using unscientific and inaccurate BMI calculators. Essentially they say that a male (or female) of X age and Y height should weigh Z amount. If you are not there, there are gradient ranges of overweight, obese, morbidly obese, and big old tub of goo.

They use these thumbnail calculations no matter if you are a body builder or truly have "big bones" etc. The more accurate tests are very expensive and generally time consuming.  There are new machines on the market that scan your whole body and then compute you actual body mass but they run from 1800 to 10,000 dollars and I just don't see the VA spending that for the literal thousands of them they would need in their hospitals.

The kinda good thing for you is that with them calling him morbidly obese in the files, once you get the rating things straightened out, the weight will be a justification for an increased rating. It is a fight to connect obesity to service but as a secondary to an injury that prevents you from walking, running or  doing aerobic exercise it is a possibility. If you can chart his BP and Pulse from the time of his entrance to the military, through his nexus and up to today, you might just get a clear picture if he has borderline hypertension and hypertension is a ratable condition. At the very bottom of this post i tell you how I did the charting.

now the long and really boring part of this post. I admit I am anal retentive but doing this type of organization will help you in the long run.

When his C-file shows up go through it carefully.

The C-File is mainly structured as a single PDF with the newest files at Page 1, which should be your request for the C-file.

Things like his medical records, enlistment contracts, pcs orders etc are at the bottom near the last page.

I said mainly because I know in mine after my AFEE's documents there a few files that occurred during service. I cannot say why that happens, just that it happened to my files.

The other posted answers have addressed your questions. I am going to make a couple suggestions about your c-file when you get it.

This may be the most important document you ever get. I would suggest your first action is to burn a copy of it on another disk and put that in your bank safe deposit box. If you don't have safe deposit box, put it in a fireproof box at home, or at a relatives where it is offsite from your house.

I would then upload a copy to the cloud in Dropbox or Drive etc. '

I recommend that your next step is to print a copy of the file.

I would identify what type of printer I have and what kind of toner it takes. If you have an inkjet that is fine and there is a similar option but a toner based printer like my Brother HL-L2340D can be had for about 80 bucks and it is worth the money.

If you have, or chose to get, a toner based printer go on Amazon and find the right toner cartridge for the system through a general search. Then you want to look at the identified alternatives. for example HP wants to sell me a new toner cartridge for about 50 bucks. But i have an alternative type that for 28 bucks I get 3 of the exact same cartridges that print the same 2000 pages as an OEM cartridge from Brother. I am just cheap and the alternative cartridges are excellent.

If you have an inkjet. Go to youtube and look up Printer XXX cartridge refill at home. Try DIY if home does not give you a good match. Watch the videos. It is really easy and the refill kits are a tenth of buying new cartridges. The hard part for me is not making a mess. DOH>

I would then look at the number of files in your C-file. In mine I have 3000. It takes 6 3-inch binders to hold those pages and still be able to turn them to look at them.

There are massive duplicates.  over 1000 duplicates in fact. For example I have 6 copies of ONE specific C&P exam and at least 3 of every other C&P I have taken. It happens because the files come from different systems and VA does not filter for duplicates.

If you are anal retentive like me, what I did was page through and find the duplicates. It takes awhile.

I marked the page that was the first one as the "original" with a tag I got from Amazon. I got thousands of tags for 18 bucks. different colors and shapes.

with that page marked, I went into the C-file and searched it for distinct words on that particular page. Dates are a really good choice for this.

With each file the search returns I compared it to the "original" i had tagged. If it was a match I made a note of the page number in the PDF file and worked my way through all of the duplicates for that search. Then I took that list and one page at a time went through the binders and pulled out the duplicates and put them aside. Whatever page they were duplicates of I wrote that in the header of the duplicate page. Like Duplicate of page 5 (meaning the page in the c-file as your PDF reader numbers them. End to end this took me two weeks working days and doing the sorting at night.

This is a long boring process, but I will promise you that it makes research and gathering proof easier.

Those duplicates you set aside will come in handy in the next step.

Again on amazon you can get a case of 12 1-inch binders for about 8 bucks. 2-inch binders by the case are about 20 bucks. you will want to get a case of these too.

Once you have that first printing and sorting done. it is time to begin serious organization of your files.

You are going to want to decide how to organize things.

Here are some things you can consider. The c-file contains several main types of files that can be grouped. Administrative type documents like evals, contracts, awards, letters and even scanned images of postal tags for proof of mailing.

You also have what for the VA is listed a Clinical Notes. These are sequences of entries made by the VA folks. They  fall into a funny pattern. In my file for example I have a run of 300 pages of just Clinical notes. Then a test result, letter or some other  type file is next in sequence. Then a run of 5 more Clinical notes. This goes on and on. You might have I page of clinical notes then 50 other files then 36 more pages of Clinical notes.

What I did was identify all the clinical notes and then which ones I had duplicates of. I then printed another copy of any that I did not have duplicates of and created a binder of nothing other than Clinical Notes.

I did the same for X-rays and surgical notes, another for Blood test results and Skin related results.

I have a full binder of Cancer treatments, results and tests.

I have a two binders of Military Treatment records separate from the VA records. All said and done i have almost 40 binders. One master set and one that is a working set.

you will find in your organizing that a single page belongs in many different binders. Put a copy of each in the appropriate binders. Remember these are your working copies so having dupes in different binders is okay.

I also highlight what info from each page I want that ties it to the binder.

Put the master copy away and only deal with the duplicate.

There should be exactly the same number of pages in the duplicate as in the master. I am anal retentive. I bought a date stamp that advances automatically every time you stamp a page. They can be expensive so you decide.

That is the really long and boring part that will numb your mind and your fingers. But once done you have a complete set of records in an organized sequence that makes sense to you.

You also still have the electronic copy of the file.

With this combination you can readily find what you need, and all the associated other files that are needed to support your claim.

I will give you an example of how effective this works. In 2018 I got the C-file and did the sort. In that sort I found notes about an MRI i had had done at a previous VAMC. I could not find the Result report but I did find over 50 unique references to it. I printed those pages and contacted the company that did the MRI and on it it said I had a "partially empty sella". I then went back through my electronic copy and found 4 more unique references to that.

I would never have found that if I tried to look through either the massive printed record or just the electronic file as I never knew it existed and I did not know what a sella was, partial, empty or full.

Another use is I charted my weight changes from induction to discharge and then through VA treatment. I was able to use Excel to graph those numbers and I have an explicit binder of just my vitals like height weight BP etc. I have also charted my BP and found a linear growth towards hypertension. My pulse has also gotten more rapid over time.

Using those charts and the MRI result I was able to get my Primary Care Doc to do a consult to Endocrinology to have the right blood tests run to identify which hormones my crushed sella has affected. The sella covers the Pituitary gland and that known as the master gland because it controls your hormones and dozen other things like your Adrenals, Thyroid and Hypothalamus. When crushed it can cause your hormones to go wonky including cortisol which affects weight. It also affects anxiety, depression and a dozen other things. 

That is my long ass post and my solid recommendation for organization. If you got this far you are likely to be a detail oriented person so this type thing may be up your alley. Even if it isn't do what works for you.

The goal is to have a way to lay out your evidence in front of you and make sure you can use it to construct a linear argument with documented evidence of whatever you are working on.

When it is necessary to upload files from your c-file you can use Microsoft Print to PDF to select just the sequence of pages you need and print as a new PDF.

If your civilian records are on paper, scan them to electronic files and do exactly the same thing with them.

I will tell you that once you complete this and you get new information finding related information, doing more accurate searches in your medical records, etc is much much easier. You will get new info and you will be searching the c-file over and over again. It is just a reality. So organize yourself and be prepared.

 

Good luck and keep us posted. Please keep asking questions and giving results. We are here to support you.

Thank you so much for the response. 
He was never overweight from the time he joined the KS guard until he left active duty. He weighed 148 and is 5'10 when he was discharged in 2002. He was an avid runner while he was in. He was running his 2 mile in 12.30. By the time he was discharged and had so many knee problems, his 2 mile went up to 16.00 if he didn't have to fall out due to the pain. All of that is documented in his records that we have copies of. In the almost 20 years since he got out his weight went from 150-220. But he quit smoking a few years ago as well as not being able to exercise. 
He just went for his yearly physical and does not have high blood pressure, diabetes or any other health issue other than being overweight. Which he and his primary care doc have discussed. He would love to get back into working out and running but it is just too painful. He plans on taking the notes from the C&P to his orthopedist and his primary care doc to see if we can get a head start on a rebuttal. 

I'll be using your tips for when we get the copy of his c-file. 
Thanks again for all the responses. 

[GeekySquid]

18 minutes ago, JBrown76 said:

He was never overweight from the time he joined the KS guard

That info may not help you as presented here in this post.

If he was able to run 16 miles up to the end of his service, even with an occasional fall out, the raters may just view his weigh issues as him leading a more sedentary life as he grows older.

I am not saying they will see it that way,  I am saying it looks like a possibility by the way I read what you posted above.

Odd question, did he ever have a head injury, was he near a blast, have a TBI, a concussion, or even a traffic accident during his service? and if so is it documented?

I bring this up because of something I recently discovered about myself connected to my service.

Humans have something in their heads called a Sella. It surrounds the pituitary gland, which is the master gland that controls our hormones, the hypothalamus, thyroid, adrenal glands etc.

Weight gain can be the result of Cortisol which is a hormone.

 A mild TBI can crush or damage the sella and damage the pituitary in the process. Sometimes what happens is that damage gets worse. think of a sore or wound that slowly gets infected.

Typically the only time a Sella problem is found is through an MRI or autopsy.

The clinical estimates are that millions of people every year have this damage and don't know it. They don't see rapid onset of problems. They can take years to manifest.

This also has a direct link to anxiety, depression, mood, sleep apnea, and ED. All have a hormonal component that could be compromised.

If he did have such an event where he remembers having short term memory loss for a few days. being confused or other symptoms of a concussion it might be worth talking to his doctor about. There are specific hormone tests for Cortisol, Growth Hormone, Testosterone, Luetenizing Hormone and Follicle Stimulating Hormone (this in NOT about hair directly).

These things all work to balance the system and provide feedback loops to each other. If one fails or is overpowered by other things, then many things can/will fail.

It is individual specific so not everyone will have every possible deficit.

I am not suggesting he has this but since my recent discovery of having a partially empty sella, I have seen so many people post and talk about problems that they cannot control and that might have a hormonal component.

If you think about it, someone with PTSD and Anxiety with a hormonal problem could have their own body working against any PTSD treatment by under or over regulation of hormones that control anxiety.

36 minutes ago, JBrown76 said:

I'll be using your tips for when we get the copy of his c-file. 

Like I said, the initial sorting and printing process is mind numbingly boring. However the pay off is in future use of being able to find things quickly with less fumbling through the files trying to guess keywords to search for  or flipping through thousands of pages back and forth.

hell just getting rid of the duplicates will help you.

good luck and keep us informed.

[JBrown76]

On 6/10/2019 at 12:40 PM, GeekySquid said:

That info may not help you as presented here in this post.

If he was able to run 16 miles up to the end of his service, even with an occasional fall out, the raters may just view his weigh issues as him leading a more sedentary life as he grows older.

I am not saying they will see it that way,  I am saying it looks like a possibility by the way I read what you posted above.

Odd question, did he ever have a head injury, was he near a blast, have a TBI, a concussion, or even a traffic accident during his service? and if so is it documented?

I bring this up because of something I recently discovered about myself connected to my service.

Humans have something in their heads called a Sella. It surrounds the pituitary gland, which is the master gland that controls our hormones, the hypothalamus, thyroid, adrenal glands etc.

Weight gain can be the result of Cortisol which is a hormone.

 A mild TBI can crush or damage the sella and damage the pituitary in the process. Sometimes what happens is that damage gets worse. think of a sore or wound that slowly gets infected.

Typically the only time a Sella problem is found is through an MRI or autopsy.

The clinical estimates are that millions of people every year have this damage and don't know it. They don't see rapid onset of problems. They can take years to manifest.

This also has a direct link to anxiety, depression, mood, sleep apnea, and ED. All have a hormonal component that could be compromised.

If he did have such an event where he remembers having short term memory loss for a few days. being confused or other symptoms of a concussion it might be worth talking to his doctor about. There are specific hormone tests for Cortisol, Growth Hormone, Testosterone, Luetenizing Hormone and Follicle Stimulating Hormone (this in NOT about hair directly).

These things all work to balance the system and provide feedback loops to each other. If one fails or is overpowered by other things, then many things can/will fail.

It is individual specific so not everyone will have every possible deficit.

I am not suggesting he has this but since my recent discovery of having a partially empty sella, I have seen so many people post and talk about problems that they cannot control and that might have a hormonal component.

If you think about it, someone with PTSD and Anxiety with a hormonal problem could have their own body working against any PTSD treatment by under or over regulation of hormones that control anxiety.

Like I said, the initial sorting and printing process is mind numbingly boring. However the pay off is in future use of being able to find things quickly with less fumbling through the files trying to guess keywords to search for  or flipping through thousands of pages back and forth.

hell just getting rid of the duplicates will help you.

good luck and keep us informed.

He checked his ebenefits and they denied everything as not service connected. Except his tinnitus from being in field artillary for 6 years. And his left knee scar from surgery was rated at 0%.
Is it normal for a decision to come back that soon? He had his C&P on the 5 of June and they made a decision on the 12? Now we are just waiting on the letter to see what was reviewed. 

As far as evidence goes, if a C&P examiner says that the condition is less likely to have been service connected. But a specialist says Yes it is. I thought according to the tie breaker, they were to give it to the servicemember. His ortho says he has arthirtis and joint disease. His ratings came back saying denied not service connected.

As far as appealing, will a letter from his ortho and primary care doctor help? Or will the VA consider that not new evidence.

Thanks to everyone. Ya'll have been so helpful.