Source: http://vets.yuku.com/topic/103904/CP-Failed-consider-38-CFR-440-445-459-properly
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C&P Failed to consider 38 CFR §4.40, §4.45 & §4.59 properly in VA Disability Claims (General) Forum Yuku free message boardsUsername or E-mail:Password: ForgotPassword?
> C&P Failed to consider 38 CFR §4.40, §4.45 & §4.59 properly
C&P Failed to consider 38 CFR §4.40, §4.45 & §4.59 properly
Jul 11 13 9:08 PM
I was discharged Nov 1995. My first C&P was conducted in Feb1996. It took 10 years for the VA to finally due my C&P to include Deluca but did not consider all of 38 CFR §4.40, §4.45 & §4.59 correctly. This past fall, I filed a new claim for increase due to surgery. Figuring that the VA would try to find a loophole and deny some of my claims, I began researching and discovered some interesting info which my former VSO had really dropped the ball on. My original C&P was a total joke as my pain was listed as subjective complaints. It didn't matter that I had been treated for chronic back condition and bilateral knee conditions. The BVA in 2005 Remanded my case due to failure to consider 38 CFR §4.40, §4.45 & §4.59 correctly on three of my previous C&P's. But the RSO still ended up using some of the erroneous info in the decision. Once I get a decision concerning my current claim, I'm wondering if I will be able to go back and change to dates on my service connections due to failure to properly consider 38 CFR §4.40, §4.45 & §4.59. Deluca was established in 1995 dealing with ROM and Pain but not taken into account. Burton v. Shinseki 2011which dealt with painful joints showed that the VA was misapplying §4.59 by stating that a painful joint had to have arthritis. Even so, I have x-rays and MRI's showing arthritis of my back while still in. My C&P of 2006 showed Bilateral Stenosis of the spine effecting both legs with partial numbness but I was never given a rating for this. The C&P I had earlier this year addressed the Stenosis. She actually did a good job overall. No complaints!!!Semper FiBill
Jul 11 13 11:01 PM	I won two CUE's based on similar issues with my back rating. It is very frustrating that the C&P Dr's notes in a 15 minute evaluation take more precedence than several years of continuous treatment, radiology reports, medication history...etc. You need to make sure you review the regs at the time of original rating, if you haven't already. IF your stenosis which was/is causing numbness which is caused by nerve abnormalities- your rating could be higher. You didn't state what your original percentage was, so I'm not sure if this applies to you. Since your contending the original decision, I'm assuming it may.My rating was in 1998- I filed for two CUE's based on failure to apply the CFR's at the time of initial rating and failure to rate Sciatica/Radiculopathy. They increased my back from 40 to 60% based on severe radiculopathy that was not included in my original rating (at that time the nerve damage was included in a singular rating- I understand it is now separate BUT if they award you and earlier effective date they will use the regulations that pertained at that time) ....many will argue this, I've lived thought it! I had a DRO hearing, researched on my own, had all my medical documentation to prove my claim and WON the CUE's and received back pay to 1998. (the other was for Migraines that were denied despite in service diagnosis) However, since you are applying for an increase they will re-evaluate using the current regs and it does not benefit the Veteran for back ratings....I'm now living through this, filed for IU and they somehow decided to open a new claim -proposal to reduce back to 40% based on current regs, even though all my documentation, MRI's, EMG's show increased severity of radicular symptoms as well as numerous other symptoms- yet I am rated with IVDS based on incapacitating episodes - which is a BS way to rate the back. Dr's stopped prescribing long term bed rest for back conditions two decades ago- educated ones anyway. Every neurosurgeon I have ever seen has told me to keep up and active as possible to avoid muscular atrophy, stiffness, etc. I think the longest I have ever been prescribed bed rest was 3 days, after my initial injury ( fractured 2 vertebra- later MRI's showed several ruptured discs)....Have you officially stated that you are seeking an earlier effective date in your previous claims? Have you asked for a DRO Hearing assuming you filed a NOD? The only way you'll get an earlier effective date is based on a CUE, but it vaguely sounds to me like you have one as a separate claim to your request for an increase.Just making assumptions as we can't tell what you are actually rated for. Maybe add your time line, including decision dates, NOD's, etc- to better understand your situation. Interact
Jul 12 13 7:07 AM	poppyh-just to add. at my dbq my examination was for djd which was pre existing. I claimed for muscle damage and nerve condition,was denied. btw was treated and hospitalized for what I claimed. there was no mention on dbq for what I claimed.
Jul 12 13 8:33 AM	elcamino,
You had your first c&p in '96. I am assuming the claim was denied. Did you appeal that decision? What is the date of claim for your current appeal?
Jul 15 13 7:08 PM	I served as a Marine Reservist from Dec
81-Sept 83 and went Active Duty 1983. Upon being discharged in Nov 1995, I
filed my VA Claims. Being somewhat proactive, I went to a local Doctor to get
an idea as to what was really wrong with me. During the course of my Marine
Corps Career, I had injured both knees and my back. I started having major
problems with my back in 89 to include going out in the Dentist chair on Base.
By 93, I began having shots of pain starting in my lower back going down my legs.
I had also been removed from my MOS due to a HEARING Loss by our Base Clinic. Eventually,
I was found Unfit for duty by a MED Board for Bilateral Retropatellar Pain
Syndrome and Lower Back Syndrome but that was over turned at the PEB. The
Doctors at the MED Board stood behind me all the way. The Doctors at a local
Army base did the same as they had referred me to the Naval Hospital as I was a
Marine. I had filed a claim for my back
condition, both knees, hearing loss, hernia, and a wrist.
When I walked into my C&P on the 2nd
of Feb 1996, the examiner started telling me how he had looked at all of my
x-rays and couldn’t find anything. After downplaying everything I told him, and
failing to properly exam me, sent me to have x-rays done as he stated he didn’t
have any. Part of his report:
some hearing problems as well as multiple somatic complaints including all
extremities including bilateral knee pain, low back pain, and arm pain. He
denies any bowel or bladder problems or any radiation of the pain from his low
back to his extremities.
He does have 4/5
Waddell……. ASSESSMENT AND PLAN: Mechanical back pain. No evidence of intra- articular
pathology or any neurologic problems. Given his multiple somatic
complaints, probably just represents somatization given his overall affect and
the diffuse nature of his complaints. After a thorough clinical exam today and
over an hour of discussion with him, I can find no hard clinical evidence that
he has any gross organic pathology and, given his Waddell findings, these
patients tend to be somatisizers. I encouraged him in exercise and reassured
him that he has no medical problems and told him we can see up at the VA on an
The Doctor also stated in his report
that he had never looked at my C-File. His exam & report was a complete joke. He just wanted
to get in and out. All complaints of pain were listed as “multiple
somatic complaints.” Two weeks later, I had the results of the MRI from my local Doctor
which was diagnosed as minor disk degeneration. Fifteen months later this was revised:
of 2-28-96.
His diagnosis should have been changed to degenerative arthritis of the lumbosacral spine after his MRI results.
I received a service connection for
Hearing Loss, Hernia, and Lumbosacral strain, all at a 0% rating. Everything
else was denied. I filed a rebuttal of
their findings in a timely manner. After
the SSOC, I never heard from them again. That is until I wrote my local U.S.
Rep during the spring of 2002. I had a BVA Hearing in Jun of 2002 with the VFW
representing me. The BVA took me seriously and ordered another C&P exam two
weeks later. However this exam never
happened. In the meantime, the local doctor who had previously looked at my
back determined the correct diagnosis of my knees as: Bilateral Chondromalacia
Patella. This condition is very similar to what the Navy had determined and my
MRI’s since have verified this as the correct condition. This info was submitted to the EDU which no
longer exist. I finally had my new C&P in May of
2003. This guy wasn’t as bad, x-rays showed arthritis of the right knee, which
was then service connected. To be Honest, I had been rear-ended
while setting at a light in the summer of 2003. Even though it was the car
behind me that received most of the blow with them being shoved into me, I
still ended up with problems. If I
hadn’t have had back problems to begin with, the accident wouldn’t have caused
any problems. However, at that point my sharp pains that I would get from the
middle of my back down both of my legs became partial numbness down parts of
both legs and my right foot. I tried to keep this separate from my VA Case.
However, that was not going to happen due to the VA pulling it on in. However, it work to my advantage as the law states since they can’t separate
the injuries, the VA becomes responsible for all of it. 20030927 Appeal Notice: I received a
letter that my case was being remanded back to the RO from the EDU as case law
had been changed. This letter also
stated that the Doctor who did the May 2003 C&P needed to review the bone
scan the he had ordered. Dec 2004, the Doctor who did the May
2003 C&P verified the bone scan. Even though the bone scan showed
Degenerative Joint Disease of the back along with a MRI from another local
Doctor showing DDD of the Spine, I was still rated at 0% on my back. My Left
knee was still Not Service Connected. However, I did get 10% for my Right Knee.
Again I appealed. I saw a private doctor who was a
neurologist surgeon. This was part of his report:
of his lumbar spine shows that he does have degenerative and arthritic changes
in addition to a broad-based disc at L4-5 that may be compressing both L5 nerve
roots. Review of x-rays of his lumbar spine show also degenerative and
arthritic changes however no evidence of a fracture or subluxation. The risks
and benefits of surgery were discussed in detail with the patient and at this
point I told him I did not think he was a surgical candidate and basically
there was no surgical option for his numbness. I further stated that whatever
back pain he would probably have to live with and this would have to be treated
April 2006, another C&P, this time
Deluca is actually used. The Examiner
was a PA-C
Part of her report on my back: In 1994, he had radiation of midback pain to
both lower extremities and bilateral feet with certain movements. He can't say which particular movement
that was. He has numbness in the low midback to
that is constant now.
CLINCAL TEST RESULTS:
films - Mild degenerative changes with spurring in the mid to lower thoracic
films - Degenerative changes of the lumbar spine with spurring, and minimal old
compression of L3
3. CT of the lumbar spine
- T12/L1 mild broad based disc bulge
without significant narrowing of the foramen.
L1/L2 Disc bulging without
significant foramina! narrowing.
Broad based disc bulge and bilateral facet degenerative change.
L3/L4 Broad based disc bulge. Bilateral degenerative change,
moderate central stenosis.
L4/L5 Broad based disc bulge. Bilateral facet change and mild to
mod central stenosis. L5/S1
Broad based disc bul e. no significant foraminal narrowing.
progression in L4/5 to mild to moderate central stenosis.
In summation there
is some progression in the Vets L/S strain and degenerative arthritis
there, but within any neurological disability.
20080602 BVA Presentation
20080717 Appeal Findings:
There were minimal disc protrusions at
L2/3 and L4/5. The impression was longstanding degenerative disc disease of
nontraumatic origin. In a May 2005 statement, the veteran’s
private physician noted that his primary symptoms were intermittent lower back
pain with frequent right leg radiculopathy, and that this condition was
permanent and that the probability of future resolution was poor.
The VA quoted parts of the April 2006
Thoracic spine films showed mild
degenerative changes with spurring in the mid to lower thoracic spine. Lumbar
spine films showed degenerative changes of the lumbar spine with spurring, and
a minimal old compression fracture of L3. The diagnosis was lumbar 4/5 and 2/3
minimal disc bulging as of 2002, multiple levels of bulging disc in the low
thoracic, throughout the lumbar and sacral spine with varying degrees of
central stenosis as of 2006 and degenerative arthritis with spurring in the
thoracic and lumbar spine as of 2006. The examiner concluded that there had
been some progression of the veteran’s lumbosacral strain and degenerative
arthritis, but without any neurological disability.
However, notice the last sentence. The
VA changed one of the words of the C&P Examiners Report, “within” to
“without.” As my claim covered several years and
different rating codes, they ran several rating codes including IVDS. Final findings on my Back: The
Board has considered rating the veteran’s low back disability under other
pertinent diagnostic codes in order to afford him the most favorable rating
available to him. As such, the Board finds that the veteran’s low back
disability warrants a compensable disability rating under Diagnostic Code 5292,
for limitation of motion of the lumbar spine. Under Diagnostic Code 5292,
slight limitation of motion of the lumbar spine warrants a 10 percent
disability rating, moderate limitation of motion of the lumbar spine warrants a
20 percent disability rating and severe limitation of motion of the lumbar
spine warrants a 40 percent disability rating. 38 C.F.R. § 4.7la, Diagnostic Code
5292. The Board finds that, based upon the evidence of record, the veteran’s
low back disability warrants a 10 percent disability rating as of June 24, 2002
and a 20 percent disability rating as of April 3, 2006.
arthritis confirmed by x-ray while I was still in, as well as MRI within 3
and ½ months after I was discharged. This should have resulted in at least a 10% rating from the time I
was discharged. There were
also medical records stating that I had bilateral radiculopathy as far
back the Corps. These were ignored. The VA RO
changed the wording of the C&P examination. Left Knee:
Even though I had a diagnosis while
still in service and another one in 2002, the PA-C who examined me stated there
was no current diagnosis or disabilities of my Left Knee. She along with the other VA doctors had also
ignored the crepitus that had been diagnosed by three different doctors, two of
them Naval Doctors. In Both Cases, The RO used erroneous
information that was taken from my original C&P from 1996. I had found info
on how to purge erroneous information from my C-File or at least make the
raters question the material. 20120712 – Reopended Left Knee, Increase
of Right Knee and Back plus a few misc claims of which some will go through
without any problems some won’t. I’m
having my left knee scoped next week. The doctor stated that he would document
everything to include taking pictures. I also believe he will do a nexus letter
which shouldn’t be that hard with the timeline I have put together on my Left
My claim is currently in the PREPARATION
FOR DECISION stage and has been for about three months now. I’m waiting to see
what they find first as I added a lot of my records dealing with the
information which they had overlooked. I
read that in 2011 that the VA was in error when dealing with 38 CFR 4.59. That
4.59 is no longer limited to claims involving arthritis. My questions are:
Will I be able to have
my back rated back to my discharge?
Once I get my Left Knee
SC, will I be able to have to rated back to my discharge?
How will the change of
interpretation of 4.59 effect my previous decisions?
19960430 VA Rating Decision
19960825 Rebuttal VA C&P General
Medical Exam 02Feb1996
19961202 SSOC
20020613 Transcript of Hearing BVA
20030927 Appeal Notice
20050311 SSOC
20050311 VA Rating Decision From Appeal
20050311 VA Supplemental Statement of
Rating Decision From Appeal
20050322 Entitlement
20051110 Appeal
20060403 VA C&P Exam Results-Spine
20060926 Developement Letter
20080226 SSOC
20080717 Appeal
20080717 VA Rating Decision From Appeals
20080904 Entitlement
20120712 Applied for increase on Back
and R Knee, Reopened Case on L Knee plus some misc. claims which I may or may
not get. Current Ratings:
5237 Lumbar Strain 20%
5261 Limited Extention of Knee Right 10%
6100 Hearing Loss 0%
7338 Inginal Hernia 0%
Total: 40%Thank YouBill
Trying to Understand Comment
Jul 17 13 8:47 PM	I'm trying to understand the last statement that my Examiner made:"In summation there is some progress in the Vets L/S strain and degenerative arthritis there, but within any neurological disability."Looking this up in the dictionary I find "within" is considered a preposition and can be used to indicate enclosure or containment "Or" to indicate a sitation or circumstance. Does anybody have an understanding as to what she might have been trying to say??? The RO changed the wording to "without," I believe that in itself would constitute a CUE. Is my thinking Correct???Bill