C&P Results, possible ratings?

gsfowler · Oct 30, 2015

Based upon what you wrote, here are some guesses. It would be best to see the whole C&P eval

10% carpal tunnel syndrome
10% cubital tunnel syndrome
10% bilateral knee PFPS
? scars, more than likely no mre than 10%
0% lumbar strain, resolved
0% Dequervain's tendinitis, resolved
10% Allergic Rhinitis
10% on the anxeity

dals · Oct 30, 2015

gsfowler said:
Based upon what you wrote, here are some guesses. It would be best to see the whole C&P eval

10% carpal tunnel syndrome
10% cubital tunnel syndrome
10% bilateral knee PFPS
? scars, more than likely no mre than 10%
0% lumbar strain, resolved
0% Dequervain's tendinitis, resolved
10% Allergic Rhinitis
10% on the anxeity

10 on anxiety? i know it says mild in that paragraph which i have no idea why, mild would be people that dont need meds imo, then she checks off a bunch of 50 % stuff that part doesn't make any sense to me, even the 30 % which im hoping for says panic attacks no more than 1 per week. which is more important, that summary or the "for rating purposes list symptoms" ? i'll work on scanning or something, i think i have a digital copy at work Thanks for the help.

gsfowler · Oct 30, 2015

Rating comes from here: occupational/social impairment due to mild or transient symptoms which decrease work effiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled my medication

Here is what is in the VASRD: Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.

They match up exactly

However this symptom equates to 50%: panic attacks more than once per week

You may want to get clarification as to why there is a contradiction.

dals · Oct 30, 2015

whats the best way to do that? lol this is untreaded waters for me. just sent the MEB package on the 29th i did have part of my LOE describing how my symptoms affect me at work for anxiety.

scoutCC · Oct 30, 2015

dals said:
mild would be people that dont need meds

gsfowler said:
or symptoms controlled by continuous medication.

For mental health, medication will usually lower the rating, not raise it. If the medication successfully treats the symptoms, a lower rating is appropriate. If those panic attacks are treated to the point where they aren't causing issues, the problem becomes a great deal different than someone who meds don't work with.

Its worth remembering the doc doesn't determine the rating, the VARO does. It is normal for multiple medical notes to talk about symptom levels differently, people feel differently on different days. The rater is supposed to sort through those and come up with the overall picture, but then again, the doc doing the DBQ is supposed to as well. That doesn't quite get away from the fact that the doc is being largely influenced by what he saw and heard you say in a very brief window. Most conditions are more complex than what that brief time will reveal.

When establishing symptoms, both frequency and severity, lay evidence can be used effectively. Anyone who has observed or dealt with your symptoms can be asked to describe things. If the picture isn't being painted correctly, add in your own brush strokes. Reading and understanding the VASRD will help you pick the colors to use.

dals · Oct 30, 2015

It's just very frustrating everything she wrote other that cut and pasted part talked about how anxious I was and the symptoms, I've taken medication regularly I actually just saw the behavioral therapist again and she's putting a new referral in to mental health to check into possible medication change for probably the 8th time in 4 years and therapy for the stress. Would that be my best opportunity to have my issues reinforced despite the medication? My PEBLO said to just let him know when there's any new notes added so he can add them to the peb.

Is the paragraph definitive for the rating? If it's a mix wouldn't over 10 be plausible? I've mainly been using www.militarydisabilitymadeeasy.com for reference maybe I should do more reading. On the site it has notes for ratings like may or will need medication to function normally respectfully, that doesn't add up in that case if medication helps with symptoms they're automatically void for ratings. If someone's taking meds to control a disease it doesn't mean they're cured. Her rating boxes she checked are despite my medication afterall, this is complicated. This process is a brain workout I swear I'm getting smarter.

scoutCC · Oct 30, 2015

dals said:
Is the paragraph definitive for the rating?

The paragraph is 100% indicating that the C&P examiner believes a 10% rating best describes and matches your symptoms. The problem with your question is the C&P examiner isn't the definitive source of your rating. So if that paragraph is definitive or not isn't the end of the issue. There are multiple ways of addressing an inaccurate C&P. Some I have heard employed:

1) Complain to the MSC and get a new C&P examination scheduled. I have normally heard this be most successful with ROM measurements, those are kinda of cut and dry so harder to argue against, but can be done incorrectly, so a new exam makes more sense. A MH exam is really just an opinion, fairly susceptible to arguments.
2) Point out how the C&P is inconsistent with your medical record. Draw the raters attention to evidence that is more favorable to the point you want to make and argue why that should be given better weight.
3) Provide new evidence. The C&P examiner hasn't seen everything, doesn't know everything. If you can include facts that the examiner didn't see to reach their conclusion, it makes the conclusion pretty suspect.
4) Provide other opinions. MH is far from a science, more of a religion if you ask me. MH professionals almost never agree. Have a different MH provider, hopefully one with more schooling, provide their own DBQ that counters the C&P examiner's conclusions.

I like militarydisabilitymadeeasy.com. Its not 100%, but the guy has a pretty good understanding of the rules. He translate things into pretty understandable terms. I think his breakdown of the mental health rating scheme is pretty good. It provides good examples of all the factors that can go into things. The problem is you want to say, x, y, z, factors the doctor used wrong. That's really hard to do, sometimes example 4) can help with that. It really takes another doc to say those factors are being weighed incorrectly. It is riskier too, the rater can just decide that the C&P examiner had the correct weighting, they're just opinions after all. The far easier thing you can do is point out factor a, b, c that the C&P examiner didn't note, consider or see. Those would be along the lines of 2) and 3).

dals · Oct 30, 2015

scoutCC said:
The paragraph is 100% indicating that the C&P examiner believes a 10% rating best describes and matches your symptoms. The problem with your question is the C&P examiner isn't the definitive source of your rating. So if that paragraph is definitive or not isn't the end of the issue. There are multiple ways of addressing an inaccurate C&P. Some I have heard employed:

1) Complain to the MSC and get a new C&P examination scheduled. I have normally heard this be most successful with ROM measurements, those are kinda of cut and dry so harder to argue against, but can be done incorrectly, so a new exam makes more sense. A MH exam is really just an opinion, fairly susceptible to arguments.
2) Point out how the C&P is inconsistent with your medical record. Draw the raters attention to evidence that is more favorable to the point you want to make and argue why that should be given better weight.
3) Provide new evidence. The C&P examiner hasn't seen everything, doesn't know everything. If you can include facts that the examiner didn't see to reach their conclusion, it makes the conclusion pretty suspect.
4) Provide other opinions. MH is far from a science, more of a religion if you ask me. MH professionals almost never agree. Have a different MH provider, hopefully one with more schooling, provide their own DBQ that counters the C&P examiner's conclusions.

I like militarydisabilitymadeeasy.com. Its not 100%, but the guy has a pretty good understanding of the rules. He translate things into pretty understandable terms. I think his breakdown of the mental health rating scheme is pretty good. It provides good examples of all the factors that can go into things. The problem is you want to say, x, y, z, factors the doctor used wrong. That's really hard to do, sometimes example 4) can help with that. It really takes another doc to say those factors are being weighed incorrectly. It is riskier too, the rater can just decide that the C&P examiner had the correct weighting, they're just opinions after all. The far easier thing you can do is point out factor a, b, c that the C&P examiner didn't note, consider or see. Those would be along the lines of 2) and 3).

Why would she check off the 30/50% rating boxes? Is she trying to say I can't prove he's lying on those items but I think he is so I'm going to indirectly screw him? I'm mild but she does not check any of the correlating items? It makes no sense why would she put I have panic attacks over once a week and call it mild? 'm going to scan her notes in a minute

1.I'm in Japan so I don't know how easy that would be, is that a option now kind of thing or after I got IPEB results and appeal? It's already submitted.
2. Same as 1?
3 I may have an opportunity with the upcoming appointments I will have at mental could be as soon as this week I can at least make sure my current notes are submitted
4 Is dbq like a memorandum? Or statements in my records? Sorry I'm not familiar Would I be able to use the military psychologist to get that?

dals · Oct 31, 2015

is she saying i have panic attacks regularly but they don't affect me or my job performance? that's ridiculous who has panic attacks that are just i already have in my LOE. hopefully this works its not perfect but may help figure this out decent enough

scoutCC · Oct 31, 2015

4) DBQs can be downloaded from the VA site. They're the same forms the C&P used, Disability Benefits Questionnaire.

Since you are currently meeting retention standards for this condition there are technically no channels to disagree yet. Not until they come to an official rating decision and then you file a NOD. Or you successfully argue to the PEB that it is unfit, then you can do a VARR. A normal VA claim you can keep submitting evidence, it just slows down the process. The VA doesn't want to be slowed down on an IDES case. There is nothing preventing you from sending more information, but if it will be looked at before you start an appeal isn't at all clear.

1) Asking for a new C&P exam is best done before signing the NARSUM. Not sure why Japan makes this a problem. MSC is the guy you turn in your VA claim to, so pretty sure he's available in some sense.

2) After the IPEB probably, as part of the VARR. That's when they are expecting it.
All this is a bit premature. If the rest of your medical file is straight there's no reason why the VARO won't see a problem with the C&P exam on his own and come to his own conclusion. Raters come to decisions different than C&P examiners all the time. They exist primarly because there are multiple pieces of evidence that have to be weighed against each other before a decision makes sense.

The symptom check boxes don't really say much. Yes, the VASRD looks at weekly panic attacks for a 50% rating, but that's one symptom in a huge list and the overall thrust of a 50% is that you're having some pretty regular problems that are interfering with your functioning. If you have a brief panic attack that you deal with, that would qualify for the checkbox, but not really say anything about problems you are having. The overall thrust of her discussion is that you have some problems, but you're dealing with them ok. The drinking is under control. The medication is helping. Marriage problems are being worked out. Some people at work comment, but they haven't adjusted how they deal with you.

Its not problems in the past, its not the number of pills you are taking, that they are rating. Its functional impairment. You have to show them real interference with your life. I can see some issues that are being glossed over though, so it would make complete sense to me that other parts of your medical file address and the rater comes to a conclusion that isn't 10%.

dals · Oct 31, 2015

Alright I feel better now it's just different than other stuff like my carpal tunnel I have the emg's done or whatever it's called it's black and white but mental stuff is harder to do that with I guess

gsfowler · Oct 31, 2015

What are your unfitting conditions? Pain?

dals · Oct 31, 2015

i had scalpho- lunate reconstruction ( the ligament in my wrist it wasn't torn, it was pretty much gone i have no idea how still blows my mind that i would'nt have been in a lot of pain before i noticed it ) in February with a piece of tendon from my forearm to hopefully replace it pretty much, got carpal tunnel surgery the same time went through two months of physical therapy to preserve ROM, started the MEB process in July/August because i thought at the time it was going to be how it felt at that time indefinitely, at the end of august i got a CT scan after the doc noticed on the live x ray machine at the 5 ish month follow up the tendon piece he put in had " stretched way more than he would of liked it to" that's all he said at the time. anyway at the results of the CT scan ( end of august ) the tendon repair definitely detached, 7 hour surgery with the scopes, all the physical therapy, all the scars on my forearm, for nothing. Less than a week later the I-RILO came back unfit MEB officially started and fusion surgery i need is on hold.

Its hard to explain, i can probably pick up something pretty heavy no problem if the cards land in my favor, but i could also pick up a quarter off a table and my wrist/forearm swell up and hurt like hell for 3 days. there is constant pain but its almost been a year now so i guess i'm getting used to it. its called " carpal instability with signs of scalphoid advance collapse " its rare the C&P doc said in 30 years he's seen it 5 times its the type of thing they find on people twice my age im 33 so that's my unfit condition.

I have it rated from the VA at 4/10 constant pain with flare ups of 8/10 pain about twice a week. my profiles are written per my request that i pretty much cant do anything with my left hand no lifting over 5 Lbs but i rarely even do that, it hurts (more) to button anything, tie my boots, if i type too much, randomly for no apparent reason at all. i have carpal and cubital tunnel in the same arm too so that plays in. Ive been a crew chief on C-130's for almost 12 years now i am still pushing for just getting out after finding all of this out because even if the main injury never happened it would have just been my other conditions getting this started, and i feel as though i would be insane long before i made it to 20 years or even my next enlistment the last 3 years have been hell for me with stress i had my anxiety under control before i got to ( Kadena AB, Japan ) went from expediting on the flight line at my last base to being treated like a child and learning very quickly not to trust anyone here its not as bad now but that's only because so many people i worked with before are here now. I decided back in July when i first started learning on this site that the best thing to do is make a decision one way or the other and give it 100 % without changing my mind i could of kept this all going if i wanted to but i barely had any motivation to fight to stay in anyway the way things are going anyway the surgery i will get is either mid carpal fusion or proximinal row carpectomy or something like that, one is fuse 3 bones together to stabilize that part of my wrist, or just completely remove those 3 bones, scalphoid, lunate, and another one cant remember begins with a T i think. at about a year out from whenever i get that done i'll have 60 % of my strength back from what i had and range of motion depends on what i have now which is 30' up or 30 ' down but its difficult and painful, my side/side ROM is abnormal too but i have not looked into that part much. I don't know which surgery i'll get for sure or if i will apply to have it done while im still active duty or wait for the VA to do it. I have no idea what it could be rated as i did find a rating with arthritis with flare ups to be 20 % but if i could do TDRL or whatever its called i would be up for it, but the PEBLO's said they usually only suggest that if there's a decent chance i would be able to do my job after i recover from surgery's and i already know from my hand doc that's impossible, i'll most likely have barely any ROM after i'm in a cast or brace for close to 2 months after surgery.

I have not been able to find anything about a condition like mine except medical journal studies, alot of which are done on cadaver's that have had similar surgeries that i need. Please let me know if you know someone that has anything close or something i could reference for my PEB if i need it, sorry for the wall of text but its a complicated situation.

dals · Nov 3, 2015

Anyone have an idea for what my unfit wrist condition could be categorized for ratings? Thanks for all the replies

poohbear331 · Nov 3, 2015

here is the VA rating language - It all depends on if they say major or minor (1st or 2nd column)- I don't know how they decide if it's major or minor- someone else might be able to explain it.

The Wrist

Rating

Major Minor

5214 Wrist, ankylosis of:

Unfavorable, in any degree of palmar flexion, or with

ulnar or radial deviation...................................................................... 50......... 40

Any other position, except favorable..................................................... 40......... 30

Favorable in 20¼ to 30¼ dorsiflexion................................................... 30......... 20

Note: Extremely unfavorable ankylosis will be rated as loss of use of hands under diagnostic code 5125.

5215 Wrist, limitation of motion of:

Dorsiflexion less than 15¼..................................................................... 10.......... 10

Palmar flexion limited in line with forearm............................................ 10.......... 10

C&P Results, possible ratings?

gsfowler

Super Moderator

dals

PEB Forum Regular Member

gsfowler

Super Moderator

dals

PEB Forum Regular Member

scoutCC

PEB Forum Regular Member

dals

PEB Forum Regular Member

scoutCC

PEB Forum Regular Member

dals

PEB Forum Regular Member

dals

PEB Forum Regular Member

Attachments

scoutCC

PEB Forum Regular Member

dals

PEB Forum Regular Member

gsfowler

Super Moderator

dals

PEB Forum Regular Member

dals

PEB Forum Regular Member

poohbear331

PEB Forum Regular Member