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#102172 - 12/21/06 05:10 AM Got My VA Rating - Lessons Learned
mmparker Offline
Registered Visitor

Registered: 06/10/04
Posts: 571
Loc: Virginia
Well, I got my VA rating last week. I laughed, I cried, I cheered, I said WTFO!

After 25 years in the Army, of which 22 were on active duty, I had accumulated a long list of ailments to claim, around 51 if memory serves me correctly. Bear in mind that a lot of these were related to my ReA - various joints, skin issues, IBS and the like. Of these 51 one conditions, they addressed 44. The VA found 22 conditions service connected and 18 conditions non-service connected. Three condition were deferred for service connection awaiting further examinations. That left 7 conditions that went to never-never land and were not addressed one way or another. The key issue they failed to address at all was my reactive arthritis, my most serious issue and the one I listed first. Unbelievable! They clearly dropped the ball on that one.

First, what they got right, or appear to have got right, the first time:

Recurrent kidney stones requiring diet/drug therapy 30%

Tennitus - 10%

Left hip degenerative arthritis - 10%

Degenerative disk disease of the cervical spine with osteoporosis - 10%


Now, what rating surprised/confused me:

I had put down on my claim numerous skin issues that happened over the span of my career. This included psoriasis, upper body rash, shingles, allergic contact dermatitis, and skin lesions. Except for the psoriasis, I felt the others should be documented just in case they returned with a vengeance at some future time. The psoriasis occurred during the early days of my ReA. I felt this was a condition that should be connected to my ReA condition and rating as but one of the many manifestations. The psoriasis all but disappeared once I began Enbrel. The VA gave me a dermatology C& P exam to address these issues.

The VA rating stated:

"Service connection for xerosis with actinic damage to the skin (also claimed as psoriasis, upper body rash, shingles, allergic contact dermatitis and lesion to the back)."

They gave me a rating of 30% based on the surface area affected. (20% exposed or 35% total skin area). They said to get a higher rating either more surface area would have to be affected or would have to be on an immune suppressive drug. (You mean like Enbrel, perhaps?)

These five conditions ( 2@30%, 3@10%) combined for a total rating of 60%. Mathematically, it equates to 64.27%. At 64.45% they will round up to a 70% rating so any increase in a current rating or the addition of one more 10% rating will get me to at least 70%. The 17 other service connected conditions were rated at 0% disabling. However, in eleven of these ratings, the VA stated they did not have the right information to assigned a rating and therefore I must go in for another C&P exam.

Ironically, one of my most disabling conditions, in terms of impact to my functionality, is the 5-15 migraines I get a month. The VA rated condition at 0% stating they were not prostrating because I did not leave work or seek medical attention each time I had one. I actually have been prescribed Imitrix injections and have doctors orders to self administer these shots to fight these migraines. I am confident I will win this one on review at a 30% rating given appeals from similar cases I have read from the Board of Appeals website.

Like the migraines, many conditions received a zero percent rating or were deemed non service connected because:

The rater did not know where in my records to look for evidence.

The C&P examiner failed to put down the correct information I relayed to him via my records.

The C&P examiner failed to cover the condition at all in his report or relate them as manifestations of my reactive arthritis.

During my C&P exam, I had a general physical exam, a urology exam, an audiology exam, and a dermatology exam. All but the general exam were done correctly and professionally and all the information and ratings from this area came out pretty much correct. All but two of the issues in my ratings can be tied back directly to the general physical C&P exam. This doctor was extremely dismissive of anything I told him. He didn't even know what ReA was. I showed him my NARSUM from my MEB/PEB which he asked for a copy of to help him in his write up. Again, my ReA was not addressed at all by the VA.


Here are my lessons learned so far:.

1. Ensure you document the truth well. I went out of pocket for a virtual physical cat scan prior to leaving the service which cost me about $600. Those results compelled my docs to order follow-on tests like bone density tests, ultra sounds and a nuclear bone scan. These tests all provided tangible evidence of numerous conditions throughout my body, most notably was the numerous joints that showed at least some damage. While these joints are not too bad now, if they get worse they will be service connected because initial damage was clearly demonstrated while I was still in service.

2. List everything no matter how minor. Who knows what and how it will be rated or connected to other issues. The VA will only rate what you claim.

4. Do your homework. Understand all your conditions and their corresponding VASRD rating criteria. Read cases from the board of appeals and the Court of Appeals Claims for Veteran's Claims to understand how your condition should be rated by the VA..

5. Be proactive. Isolate the records for each condition and hand the C&P doctor a info paper with supporting evidence to help ensure he/she gets it all as C&P exams are usually limited to about a half an hour. Base this info paper on the condition, the manifestations experienced, and how they relate to VASRD rating criteria.

6. Be prepared for your rating to be an iterative process. The further you go into the process, the more control you will have on what information is being included in your rating.

I had expected the outcome from round one to be about a 60% rating from the obvious issues and that I would have to go back and clean up the less obvious issues via reviews and appeals. I was right about the 60%, how they got their was most surprising. For the most part, the things that need to be cleaned up are quite obvious with lots of supporting evidence. once you know where to look.

Regards,

Mike

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#102173 - 12/21/06 05:35 AM Re: Got My VA Rating - Lessons Learned
Ken Delano Offline
Registered Visitor

Registered: 05/26/04
Posts: 1300
Loc: Minnesota
Interesting process isn't it Mike. Always seems like it's more of a prove there isn't anything wrong with them than the other way around.

70% a start. Let's hope that with in the next year you can get that changed to what it should be...
_________________________
I have AS. AS does not have me.

Ankylosing Spondylitis/Psoriatic Arthritis/IBS
COPD (Asthma)/Diabetes

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#102174 - 12/21/06 09:06 AM Re: Got My VA Rating - Lessons Learned
mont974x4 Offline
Registered Visitor

Registered: 03/11/05
Posts: 2309
Loc: Montana
Good start.

I got another letter 2 weeks ago asking if I had anymore evidence to submit....must have been just to keep my file active. Had I said yes they would have waited another 2 months to make a decision. I said no, and asked for an expedited rating.

Of course, expedited means whenever they damn well feel like getting a decision made. :rolleyes:
_________________________
Jay

NOTE: If you aint here to help row the boat then you are welcome to walk the plank.

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#107553 - 04/04/08 03:19 AM Re: Got My VA Rating - Lessons Learned [Re: mont974x4]
mmparker Offline
Registered Visitor

Registered: 06/10/04
Posts: 571
Loc: Virginia
I filed a Notice of Disagreement in September on my original rating I received in February 2007. Yesterday, I got a partial answer with some initial success. I raised ten issues in my NOD and only two were finalized (in the eyes of the VA).

First the good news, the VA raised my ratings for my migraines from 0% to 30%. This elevated my combine VA disability rating from 60% to 80% effective from the date of my retirement. At the bottom of this post I have included the argument I made on my NOD for increasing this rating.

The bad news was that the denied service connection for calcification of bilateral femoral arteries. Their argument is that while there is evidence of such a condition, there is no evidence that it is causing a disability (I am not 100% in agreement with this as its effects have not been evaluated all that well). The reason I brought it up was twofold. First, to get it clearly established that I have this condition at that it began while in service. If it causes problems later, I will have tons of evidence and documentation for getting it connected and rated at that time. Second, as I explained in my NOD, medical studies have tied inflammatory arthritic conditions with atherosclerosis and that this ties to the rating criteria for reactive arthritis (under DC 5009/5002) under the impairment to health considerations. This is an issue I will continue to push as I work my rating for reactive arthritis.

Speaking of reactive arthritis, my most disabling condition, the one the military put me through a medical and physical evaluation board, the one that kept me from being deployable and for which I take around $30,000 dollars in medicines a year to treat (to include suppression of my immune system) and yet it is the condition the VA has failed to rate even though I first filed a claim for it over two years ago. Well, the VA wants to send me back for yet another C&P exam for this condition (#3). The VA is learning however. Bear in mind, since they failed to even address this condition in my initial rating, I used my NOD as an opportunity to educate then on the condition and how it is rated and I included BVA decisions on similar cases. In their response to my NOD, they outlined the rating criteria for reactive arthritis as DC 5009 (arthritis, other types) which is rated under the criteria of DC 5002. So, I am better off than before in which they simply did not even address the condition. However, they stated my NOD requested I be rated for my reactive arthritis due to the chronic residuals.
Partially true, I requested to be rated for this condition and to be rated correctly. That means they have to rate both the constitutional manifestations/impairments to health and the chronic residuals and take the higher rating from those two processes. More educating to do, I guess.

My NOD also requested service connection for two conditions that are tied to the effects of the reactive arthritis or the drugs used to treat this condition. The VA denied service connection for both of these conditions but stated the decision was not final and wanted more information, via a C&P, before a final decision. I am indifferent as to whether they treat them as separate issues or as factors of my reactive arthritis, whatever is the correct answer. But at this point they are not even recognizing them as issues either way.

The VA also stated that three issues in my NOD would be addressed in a separate rating decision that I would receive shortly.

Regards,

Mike

Migraines:

The VA rated my service connected migraines at 0% disabling. Factoring into this decision was the VA position that my migraines were not prostrating and that I could work through the migraines. Nothing could be further from the truth. The statement from my medical evaluation board (See MEB documents at TAB 10) that I could work through the migraines was taken out of context. I was asked if I need to miss work due the migraines. I stated that most of the times, the headaches came on in mid to late afternoon and would not become debilitating until later in the evening after my work day was done. On those occasions where they occurred earlier in the workday, I did not necessarily have to leave work to deal with the problem. If I injected myself with Imitrix and rested, I could abort the headache after 1-2 hours and that I would not leave work to do so. I would have to stop work activity, take the medicine and remain mentally and physically inactive at my desk or elsewhere until the headache lifted. I absolutely cannot perform adequately during the intense phase of the headaches. I stated I could "work through the problem", that is, I could take steps to eliminate the headache to the point I could be functional at work without leaving the work location, in this case, the Pentagon. Given a normal workday of 12-14 hours, it would not make sense leave work for a migraine every time if I could return to working functionality in a few hours with prescription medicine and rest.

My rating decision stated that I said my headaches were not debilitating. My C&P exam actual states, "The condition is not generally debilitating". I don't ever remember telling anyone my headaches were not debilitating as that would not be factually true. I have stated that they were not total debilitating and that if the house was on fire I could manage to get out of bed and get out of the house despite the pain and other effects of the migraine. Before Imitrix, I required bed rest for all of the headaches in order to get them to abate. Even with Imitrix, many of the migraines still require actual bed rest to abate.

My decision defined prostrating attack as one so severe as to require bed and treatment by a physician. Please provide me the cite for this definition of prostrating attack. Is this the official position of the VA and where is this definition documented? Please also provide the official VA documented definition for a "completely prostrating attack" and outline how that definition differs from the definition of a ”prostrating attack”. My VA rating decision also mentions the fact I had not missed work any work due to my migraines. I draw your attention to a Board of Veteran Appeals decision on a case very similar to mine which lead to compensable level rating. Note that this individual was rated at 30% and also did not have to leave work to deal with his headaches. (See BVA decision is at TAB 11)

My headaches probably don't qualify as "completely prostrating" as described in the VASRD 8100 criteria for a 50% rating. However, my headaches are "prostrating" (seriously impairing my functionality) and the frequency of these attacks, 5-15 a month, and rises to the level of a 30% rating order VARD DC 8100.

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#107979 - 04/09/08 07:30 PM Re: Got My VA Rating - Lessons Learned [Re: mmparker]
TrudiD Offline
Registered Visitor

Registered: 01/13/08
Posts: 188
Loc: Michigan
strange...my hubby got a 50% disability for his migraines, no problem! Combining other things (knee, shoulder, IBS, back=combined rating of 10%) so his total is 60%.

odd how one person can get everything & others have to fight for every percentage! I'm so scared to even try to fight for more for me...
_________________________
~ Trudi
35 yo mum to 5 kids!
dx with 'probable AS' in the middle of 1995 in the Navy. positive inflammatory spondyloarthritis dx by the end of that year. no meds really work yet. am trying sulfasalazine plus a lot of alternative therapies.
www.madebytrudi.blogspot.com

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#107982 - 04/09/08 07:46 PM Re: Got My VA Rating - Lessons Learned [Re: TrudiD]
mmparker Offline
Registered Visitor

Registered: 06/10/04
Posts: 571
Loc: Virginia
I received the second part of my statement of my case today stemming from my notice of disagreement from my initial rating decision. This part of the decision addressed three conditions that were initially denied service connection. The new decision granted service connection for all three of these conditions. One condition was rated at 20% and the other two at 0%. I agree with 20% rating and one of the 0% ratings. The other 0% rating will be appealed further. The new 20% rating did not raise my overall disability rating.

All three conditions were well documented in my medical records yet the initial rater failed to service connect any of these conditions. I can only conclude that my initial rating was done by an overworked rater based exclusively on my C&P exams and a cursory, at best, examination of my service medical records. When I filed my NOD, I isolated and highlighted copies of all my records for each of these conditions so that they were easily reviewable. Further my NOD walked the reviewer through my conditions, their history and their appropriate VASRD rating. This seemed to do the trick for the most part.

So, two years after filing my claim, these well documented conditions have been finally service connected and rated. Is it any wonder the VA is backed logged so much? They never have time to do it right but they always have to find time to do it twice.

When I filed my claim, I tried as much as possible to aid the process by getting the right information visible. However, the VA did not want me to organize my records by condition or by any other method. The C&P examiners generally refused to accept copies of records from me to help them document the nature and history of my conditions.

I brought this issue up to the VDBC. Nobody knows my conditions and their history better than I but the first time I really get to weigh in with my version of events is with the NOD. It makes infinitely more sense for me to provide the type of information I did with my NOD early with my application. A good VSO can assist me in documenting my condition and how they should be rated per the VASRD. I would still go to the C&P exam to validate and collect medical information needed but then the rater could be more in the mode of checking the math rather than starting from ground zero. Such a process would not be mandatory but those who were up to the challenge would be awarded with earlier, more accurate ratings while reducing the VA’s workload.

Mike

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#108747 - 04/19/08 03:54 PM Re: Got My VA Rating - Lessons Learned [Re: mmparker]
LuvinGod3fold Offline
Registered Visitor

Registered: 02/25/05
Posts: 449
Mike, I am pending a decision for migraines. I requested 30% at the onset of filing my claim. It is a reopened claim due to the receipt of my Army SMR (which the RO stated in their denial were unavailable and any further attempts to get them would be futile). Well, I guess that was untrue because I received them upon request the following year from NPRC. My claim for migraines, needless to say, was reopened. I'm also taking Imitrex 50mg, along with Motrin 800mg.

My only "new" concern, after reading your post, is that I'm receiving SSD (unemployable due to the AS) and the RO might see that as not interferring with anything. Anyway, my claim is progressing (albeit slowly) and should be decided by May-June timeframe. I will post back then and update you on what was awarded and what is going to be NOD'd (if anything). Thanks for this update...it helped me to be prepared.


Edited by LuvinGod3fold (04/19/08 03:54 PM)

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#251820 - 05/06/13 11:33 PM Re: Got My VA Rating - Lessons Learned [Re: mmparker]
Brandon Offline
Registered Visitor

Registered: 05/06/13
Posts: 2
Hello Everyone,


I submitted for severe migraines. Unfortunately I never went to the Docs when I was in the Marines because I normally kept them under control with over the counter migraine medicine. Since I have been out I'm now on Butalbital and when they get really bad my doctor gives me a shot for them. The VA wants more evidence connecting it to the military. How can I prove that I have been having these since the Marines? Anyone know what to do in this situation? Please help...

Thank you

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