New MEDBOARD Referral (Navy) - Couple of Questions!

1

18Blade

Well-Known Member
PEB Forum Veteran
Registered Member
Hello All,


First and foremost - if this thread is in the wrong location, please forgive me!

I am currently AD Navy with about 20.5 years of service. Due to a plethora of issues, I was just recommended (and submitted for) a MEDBOARD by my PCM and the senior Medical Officer at the clinic.

As soon as I was done with the conversations with them, I got home and immediately began to research everything I could regarding the process and the VA benefits, etc. Doing so, I have a few questions that I either would like to confirm, or I have not been able to find an answer for. Hoping the combined knowledge of those here can shed some light for me.

1. I keep hearing about this "Nexus" letter, and as far as I can tell, this is a document that illustrates how a given disability is service-related. If that is the case, how necessary would they be for me? I am still active duty, and every disability that I intend to file a claim for is well documented in my Medical Record. None of the issues were pre-existing before I enlisted. Are Nexus letters still required for each disability? If not required, would I benefit from having them?

2. For spinal issues (or any issues, really), how, exactly, do "secondary" issues work? For example, I have a pretty nasty issue with both my lumbar and cervical spine. Specifically for the lumbar, I have, in my medical record, Radiculopathy Lumbar, Degenerative Disc Disease/Osteoarthritis, and Neural Foraminal Stenosis. So if my primary complaint is "lower back pain", and arbitrarily let's say I earn a 20% for that, would I also be able to claim all of those others as secondary? And would each of them be rated individually with their own percentage? The Radiculopathy in my lumbar region, for example, causes both of my quads, and all of my toes, to go numb on a regular basis. But again, what about the arthritis? Or the DDD? This same principal would apply to my cervical spine. Pretty much the same suite of problems there. Can I reasonably expect to be able to claim each of those, or will the VA just lump everything together?

3. Speaking of lumping everything together, I've learned that the VA (in what is, to me, nearly malpractice) lumps each and every mental health issue together in 1 big mess of a claim. For the sake of brevity, I understand they generally will not separate Major Depressive Disorder with Insomnia. However, what happens if insomnia is directly caused by / secondary to the issues I listed in question 2 above? My sleep issues aren't related to depression so much as they are to being woken up all the time due to pain. Has anyone ever claimed both depression and insomnia is this fashion?

4. There is a website that has shown up frequently in my Google searches, and that site is "VAClaimsInsider". On that website, they have a pretty decent explanation of spinal issues and how the VA rates them. One thing that stuck out to me is this quote that says it was updated December of 2023:

"The present VA ratings assigned for degenerative joint disease of the lumbar spine, and radiculopathy of the left and right lower extremities when combined (See 38 C.F.R. § 4.23) are rated as 70 percent disabling."

Now, the CFR section that they refer to has NOTHING to do with a spine or whatnot, but rather it's the section titled "Attitude of Rating Officers". I've reached out to them to ask them to provide the source of that 70% number, but in the interim, does anyone know if this is true?

5. Finally, throughout the entire process, should I have some form of representation? I don't mean to pay for a lawyer or whatever, but I did reach out to Disabled American Veterans. They replied and said they said they can't assist until after I'm retired. I know you get assigned a PEBLO and an MSC, but I don't know that anyone really has my back, and I certainly wouldn't put much Faith in a JAG. Is it really just on me to ensure I'm educated enough on the process and take it on?

Any and all info is greatly appreciated. Thank you in advance,

Shaun
 
18Blade said:
Hello All,


First and foremost - if this thread is in the wrong location, please forgive me!

I am currently AD Navy with about 20.5 years of service. Due to a plethora of issues, I was just recommended (and submitted for) a MEDBOARD by my PCM and the senior Medical Officer at the clinic.

As soon as I was done with the conversations with them, I got home and immediately began to research everything I could regarding the process and the VA benefits, etc. Doing so, I have a few questions that I either would like to confirm, or I have not been able to find an answer for. Hoping the combined knowledge of those here can shed some light for me.

1. I keep hearing about this "Nexus" letter, and as far as I can tell, this is a document that illustrates how a given disability is service-related. If that is the case, how necessary would they be for me? I am still active duty, and every disability that I intend to file a claim for is well documented in my Medical Record. None of the issues were pre-existing before I enlisted. Are Nexus letters still required for each disability? If not required, would I benefit from having them?

2. For spinal issues (or any issues, really), how, exactly, do "secondary" issues work? For example, I have a pretty nasty issue with both my lumbar and cervical spine. Specifically for the lumbar, I have, in my medical record, Radiculopathy Lumbar, Degenerative Disc Disease/Osteoarthritis, and Neural Foraminal Stenosis. So if my primary complaint is "lower back pain", and arbitrarily let's say I earn a 20% for that, would I also be able to claim all of those others as secondary? And would each of them be rated individually with their own percentage? The Radiculopathy in my lumbar region, for example, causes both of my quads, and all of my toes, to go numb on a regular basis. But again, what about the arthritis? Or the DDD? This same principal would apply to my cervical spine. Pretty much the same suite of problems there. Can I reasonably expect to be able to claim each of those, or will the VA just lump everything together?

3. Speaking of lumping everything together, I've learned that the VA (in what is, to me, nearly malpractice) lumps each and every mental health issue together in 1 big mess of a claim. For the sake of brevity, I understand they generally will not separate Major Depressive Disorder with Insomnia. However, what happens if insomnia is directly caused by / secondary to the issues I listed in question 2 above? My sleep issues aren't related to depression so much as they are to being woken up all the time due to pain. Has anyone ever claimed both depression and insomnia is this fashion?

4. There is a website that has shown up frequently in my Google searches, and that site is "VAClaimsInsider". On that website, they have a pretty decent explanation of spinal issues and how the VA rates them. One thing that stuck out to me is this quote that says it was updated December of 2023:

"The present VA ratings assigned for degenerative joint disease of the lumbar spine, and radiculopathy of the left and right lower extremities when combined (See 38 C.F.R. § 4.23) are rated as 70 percent disabling."

Now, the CFR section that they refer to has NOTHING to do with a spine or whatnot, but rather it's the section titled "Attitude of Rating Officers". I've reached out to them to ask them to provide the source of that 70% number, but in the interim, does anyone know if this is true?

5. Finally, throughout the entire process, should I have some form of representation? I don't mean to pay for a lawyer or whatever, but I did reach out to Disabled American Veterans. They replied and said they said they can't assist until after I'm retired. I know you get assigned a PEBLO and an MSC, but I don't know that anyone really has my back, and I certainly wouldn't put much Faith in a JAG. Is it really just on me to ensure I'm educated enough on the process and take it on?

Any and all info is greatly appreciated. Thank you in advance,

Shaun
Click to expand...
You could hire a private IDES attorney. I would not in your situation. That is something! I almost always do recommend an attorney LOL! You don't have any worries since you have 20+ years in so your regular retirement is safe. Even if there are issues with the VA ratings you can appeal them after you get out. For those who have earned a regular retirement they tend to max out compensation as long as their total VA rating is 50% or higher. You don't need a nexus for anything as you have 8+ years AD meaning the military owns it. A nexus would be needed when trying to connect a condition where there isn't evidence but you should have medical evidence for everything. What you do need is to figure out what to claim in addition to your referred condition that the military thinks you are unfit for duty. Then make sure to claim everything. Make sure for things you are claiming you have some sort of paper trail. For example, if you say your have a bum ankle but there is nothing in your medical records about hurting it then it could be denied. So you don't need a nexus letter. You just need to have things in your medical records to back it up. So if you claim it and then you have records for it then its just about describing the symptoms/limitations to the C&P examiner so that they the VA can properly rate it. If you want to claim some conditions that you never got around to being seen for make sure to set an appointment ASAP with your provider so you have something in your medical records. Then bring a copy of those medical records as the C&P examiner may not have access to them depending on when they pulled your medical file.

You are in a really good spot since even if you missed a condition you can apply for it anytime within one year of getting out and they will backdate it to the day after you retire. My wife forgot a few conditions and did so and they were added pretty easily. So you have way less work to do than most. Comb through your medical records and make sure to claim everything. Then make sure you check out symptoms for each condition so that you get an idea of what rating you should have for each condition. Then make sure to list those symptoms out for each condition. You can even bring in notes to help the examiner out instead of trying to do it by memory. If there are any issues with the results you can appeal them after getting out. The only conditions you can appeal while going through the process are the conditions that the PEB finds unfit. For those conditions you can request a VARR to increase the percentage.
 
18Blade said:
Hello All,


First and foremost - if this thread is in the wrong location, please forgive me!

I am currently AD Navy with about 20.5 years of service. Due to a plethora of issues, I was just recommended (and submitted for) a MEDBOARD by my PCM and the senior Medical Officer at the clinic.

As soon as I was done with the conversations with them, I got home and immediately began to research everything I could regarding the process and the VA benefits, etc. Doing so, I have a few questions that I either would like to confirm, or I have not been able to find an answer for. Hoping the combined knowledge of those here can shed some light for me.

1. I keep hearing about this "Nexus" letter, and as far as I can tell, this is a document that illustrates how a given disability is service-related. If that is the case, how necessary would they be for me? I am still active duty, and every disability that I intend to file a claim for is well documented in my Medical Record. None of the issues were pre-existing before I enlisted. Are Nexus letters still required for each disability? If not required, would I benefit from having them?

2. For spinal issues (or any issues, really), how, exactly, do "secondary" issues work? For example, I have a pretty nasty issue with both my lumbar and cervical spine. Specifically for the lumbar, I have, in my medical record, Radiculopathy Lumbar, Degenerative Disc Disease/Osteoarthritis, and Neural Foraminal Stenosis. So if my primary complaint is "lower back pain", and arbitrarily let's say I earn a 20% for that, would I also be able to claim all of those others as secondary? And would each of them be rated individually with their own percentage? The Radiculopathy in my lumbar region, for example, causes both of my quads, and all of my toes, to go numb on a regular basis. But again, what about the arthritis? Or the DDD? This same principal would apply to my cervical spine. Pretty much the same suite of problems there. Can I reasonably expect to be able to claim each of those, or will the VA just lump everything together?

3. Speaking of lumping everything together, I've learned that the VA (in what is, to me, nearly malpractice) lumps each and every mental health issue together in 1 big mess of a claim. For the sake of brevity, I understand they generally will not separate Major Depressive Disorder with Insomnia. However, what happens if insomnia is directly caused by / secondary to the issues I listed in question 2 above? My sleep issues aren't related to depression so much as they are to being woken up all the time due to pain. Has anyone ever claimed both depression and insomnia is this fashion?

4. There is a website that has shown up frequently in my Google searches, and that site is "VAClaimsInsider". On that website, they have a pretty decent explanation of spinal issues and how the VA rates them. One thing that stuck out to me is this quote that says it was updated December of 2023:

"The present VA ratings assigned for degenerative joint disease of the lumbar spine, and radiculopathy of the left and right lower extremities when combined (See 38 C.F.R. § 4.23) are rated as 70 percent disabling."

Now, the CFR section that they refer to has NOTHING to do with a spine or whatnot, but rather it's the section titled "Attitude of Rating Officers". I've reached out to them to ask them to provide the source of that 70% number, but in the interim, does anyone know if this is true?

5. Finally, throughout the entire process, should I have some form of representation? I don't mean to pay for a lawyer or whatever, but I did reach out to Disabled American Veterans. They replied and said they said they can't assist until after I'm retired. I know you get assigned a PEBLO and an MSC, but I don't know that anyone really has my back, and I certainly wouldn't put much Faith in a JAG. Is it really just on me to ensure I'm educated enough on the process and take it on?

Any and all info is greatly appreciated. Thank you in advance,

Shaun
Click to expand...
1. not needed. You don't need to connect a condition to something. if its in your medical records you are good.

2. It's not about secondary conditions as much as ensuring that any conditions that cause you to be unfit to do your job are designated by the PEB as unfitting. Like I said in my large post the stakes aren't really that high for you compared to others. No matter the ratings you will retire with your full pension.

3. Yep all mental health will be lumped into one mental health ratings. So claim it however you want but what really matters are your symptoms and that is how your ratings are determined. There are certain conditions that will be lumped together to not allow pyramiding. For example my wife was rated 10 Asthma and 50% Sleep apnea. She was rated 50% Combined as they are considered together. This is by law. Nothing you can do but claim all the conditions and let the chips fall where they may. Also, you are getting confused by secondary and all that stuff. What you are reading about is for Veterans trying to claim new conditions that they don't have a service connection for. You will have everything service connected regardless if primary, secondary etc since you have served 8+ years AD and are claiming them within 1 year of getting out. In this case before since its done in IDES. Though the ratings don't count and are not finalized until after you get out. That is why you only get proposed ratings.

4.Ratings get updated all the time. I wouldn't look to those type of websites. They prey on veterans and are a for profit organization. I wouldn't worry about it. Just claim you need to and you are good to go.

5. You are fine to do it alone in your circumstances. You will have a PEBLO which is a paper pusher and you do have access to JAG to help review everything at each step. Each time something comes in I recommend sending it over to legal to review before making a decision if you want to concur or appeal. JAG is over worked and they wont' give you near as much time but for those who have a regular AD pension guaranteed you don't have anything much to lose like most do. You will get all of your longevity pension and all of your VA compensation as long as you have 50% VA total or higher. The gross compensation by law can't be higher that what you already have earned so there is little to no stakes in also getting a chapter 61 pension and being found unfit since you get the higher of the 2 and both amounts are the same gross number.
 
Provis said:
1. not needed. You don't need to connect a condition to something. if its in your medical records you are good.

2. It's not about secondary conditions as much as ensuring that any conditions that cause you to be unfit to do your job are designated by the PEB as unfitting. Like I said in my large post the stakes aren't really that high for you compared to others. No matter the ratings you will retire with your full pension.

3. Yep all mental health will be lumped into one mental health ratings. So claim it however you want but what really matters are your symptoms and that is how your ratings are determined. There are certain conditions that will be lumped together to not allow pyramiding. For example my wife was rated 10 Asthma and 50% Sleep apnea. She was rated 50% Combined as they are considered together. This is by law. Nothing you can do but claim all the conditions and let the chips fall where they may. Also, you are getting confused by secondary and all that stuff. What you are reading about is for Veterans trying to claim new conditions that they don't have a service connection for. You will have everything service connected regardless if primary, secondary etc since you have served 8+ years AD and are claiming them within 1 year of getting out. In this case before since its done in IDES. Though the ratings don't count and are not finalized until after you get out. That is why you only get proposed ratings.

4.Ratings get updated all the time. I wouldn't look to those type of websites. They prey on veterans and are a for profit organization. I wouldn't worry about it. Just claim you need to and you are good to go.

5. You are fine to do it alone in your circumstances. You will have a PEBLO which is a paper pusher and you do have access to JAG to help review everything at each step. Each time something comes in I recommend sending it over to legal to review before making a decision if you want to concur or appeal. JAG is over worked and they wont' give you near as much time but for those who have a regular AD pension guaranteed you don't have anything much to lose like most do. You will get all of your longevity pension and all of your VA compensation as long as you have 50% VA total or higher. The gross compensation by law can't be higher that what you already have earned so there is little to no stakes in also getting a chapter 61 pension and being found unfit since you get the higher of the 2 and both amounts are the same gross number.
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Provis,

Awesome, thank you for all that info! Most of what you said is what I was assuming, but I just wanted to make sure.

As far as my own concerns, I’m really just trying to maximize what I get from the VA. Unless the PEB rates me less than 30%, which..I don’t know the general mentality of that team and whatnot.

I also have a really awesome legal officer at my command who I know would be willing to help me throughout the process as well.

In any case, again, I thank you greatly for that response. It was exactly what I was hoping to get!

Shaun
 
Good Morning,

I’m active duty Navy as well! I would be able to answer a bunch of your questions! I just got done going through the MEDBOARD myself. Just got my findings back 2 weeks ago and I’m now awaiting my new retirement date!

Provis is right! You are already over the 20 year mark! So really just focus on your VA. Feel free to shoot me a message. I can walk you through step by step!

Brazzi
 
Good Morning,

Same situation as @Brazzi, just finished with the MEDBOARD myself for a lot of the issues that you are having. Received final findings on 29 Apr 2024 and just waiting on my date. I relied a lot on this forum and it paid off, so if you have questions ask.

My MEB was for lumbar issues a lot like yours. I have detailed it in a post that I made on here a few months back. Back claims are a lot of times severely under rated because they are mostly range of motion based. The radiculopathy is separate from the DDD. I was referred for 4 conditions all related to the spine, and they were lumped into two DOD ratings which put me at 50% DOD. I was also over 20 so I wasn't too worried about he DOD percentage but it was over 30% anyways so there's that.

Check out my previous post and don't hesitate to ask questions there or reach out privately and I will answer anything I can.
 
Thanks again to everyone for the replies.

To follow up, I'm working OT trying to give myself a preliminary rating (VA) based on what I've learned regarding my issues and how the VA rates them via the C&P exams.

Does anyone know how the calculation is done for bi-lateral findings?

Quick example: I have issues in my lumbar spine. So if the VA were to rate my lower back at 30%, and I have lumbar radiculopathy that effects both of my legs and feet, and they were to award me 20% per leg, how would that math work?

I know you 'combine' the two limbs together (20 + 20), but it wouldn't add up to 40. And whatever it DOES add up to, you then add 10% for the bi-lateral factor. But...how is that done?


Shaun
 
18Blade said:
Thanks again to everyone for the replies.

To follow up, I'm working OT trying to give myself a preliminary rating (VA) based on what I've learned regarding my issues and how the VA rates them via the C&P exams.

Does anyone know how the calculation is done for bi-lateral findings?

Quick example: I have issues in my lumbar spine. So if the VA were to rate my lower back at 30%, and I have lumbar radiculopathy that effects both of my legs and feet, and they were to award me 20% per leg, how would that math work?

I know you 'combine' the two limbs together (20 + 20), but it wouldn't add up to 40. And whatever it DOES add up to, you then add 10% for the bi-lateral factor. But...how is that done?


Shaun
Click to expand...

VA Disability Calculator | DAV

Use our VA Disability Calculator to determine your veteran's benefits. Get the support you need with DAV's range of services.
www.dav.org www.dav.org

This calculator breaks the math down by the numbers.

There is no 30% rating for low back. There is only 10%, 20%, and 40%. Pretty unusual to get 100% as it involves complete freezing of your spine, which typically doesn't describe the issues someone has with their spine even if they rarely bend over.

Let's consider a 20% bilateral issue for the legs first. 20% of 100% is 20%, making your disability total 20%. You then have to multiply your percentages by your "able" %. Your "able" % is now 80%, as you are considered 20% disabled at this point. Now the next percentage is also 20%, let's multiply that by 20% again. 20% of 80% is 16% adding up to 36% without a bilateral factor. In this case, 10% of a bilateral factor would be added being 3.6%. Your total disability rating is 39.60%, or 40% rounded. Assuming your back is 40%, you would then have to multiply 40% by 60.40%. 40% of 60.40% is 24.16% typically rounded to 24%, adding up 39.60% and 24% would result in 63.6 rounded to 64%, making your total 60% at that time.

All of that is explained when you press "view calculations" after using that calculator. VA math is a little goofy but makes sense if you want to get into the weeds.
 
Awesome, that's a really great breakdown of the math, and the link is quite helpful.

To clarify that, doesn't the rating process start with your highest percentage first? So if I had a 30 and two 20's, would that math start with the 30 and then do the multiplication based on the two 20's afterward?

Shaun
 
18Blade said:
Awesome, that's a really great breakdown of the math, and the link is quite helpful.

To clarify that, doesn't the rating process start with your highest percentage first? So if I had a 30 and two 20's, would that math start with the 30 and then do the multiplication based on the two 20's afterward?

Shaun
Click to expand...
Yes, I was misguided since the calculator almost always corrects this precedence. Showing the difference in calculations:

30% of 100% is 30%, 20% bilateral added into that would be 20% of 70% which is 14%, 34% total now. 20% of 66% is 12%, totaling 46% with a bilateral factor of 3.6%, so 49.6%.

Let's say we started with the bilateral issue first. 20% of 100% is 20%, 20% of 80% is 16%, totaling 36% with a bilateral factor of 3.6% or 39.6% total. 30% of 60.4% is 18.12, adding up to 57.72%.

Good catch. I never really thought about precedence but that's pretty important in percentages.
 
thanks4urhelp said:
Yes, I was misguided since the calculator almost always corrects this precedence. Showing the difference in calculations:

30% of 100% is 30%, 20% bilateral added into that would be 20% of 70% which is 14%, 34% total now. 20% of 66% is 12%, totaling 46% with a bilateral factor of 3.6%, so 49.6%.

Let's say we started with the bilateral issue first. 20% of 100% is 20%, 20% of 80% is 16%, totaling 36% with a bilateral factor of 3.6% or 39.6% total. 30% of 60.4% is 18.12, adding up to 57.72%.

Good catch. I never really thought about precedence but that's pretty important in percentages.
Click to expand...

No worries!

A follow-on question for that DAV calculator using arbitrary numbers: 20% lower back pain / 20% left radiculopathy / 20% right radiculopathy.

1. 20% for back pain: In the calculator, I click "20%", and then "no bi-lateral factor"
2. 20% for left radiculopathy: In the calculator, I click "20%" and HERE do I choose "bi-lateral lower"?
3. 20% for right radiculopathy: In the calculator, I click "20%" and AGAIN choose "bi-lateral lower"?

Or would I add 20 once for my back (no bi-lateral lower), 20 again for the right side (again, no bi-lateral lower), and then 20 a 3rd time, this time choosing bi-lateral lower?

Same thing for knees. Since both of my knees are injured (not much ROM limitation, just painful joints, which I've learned is 10% each), would I choose 10% TWICE and choose bi-lateral lower twice? Or twice with the percentage and just once adding the bi-lateral factor?

Sorry to be tedious about this, I just want to get the most accurate estimate I possibly can. Thank you greatly!

Shaun
 
18Blade said:
No worries!

A follow-on question for that DAV calculator using arbitrary numbers: 20% lower back pain / 20% left radiculopathy / 20% right radiculopathy.

1. 20% for back pain: In the calculator, I click "20%", and then "no bi-lateral factor"
2. 20% for left radiculopathy: In the calculator, I click "20%" and HERE do I choose "bi-lateral lower"?
3. 20% for right radiculopathy: In the calculator, I click "20%" and AGAIN choose "bi-lateral lower"?

Or would I add 20 once for my back (no bi-lateral lower), 20 again for the right side (again, no bi-lateral lower), and then 20 a 3rd time, this time choosing bi-lateral lower?

Same thing for knees. Since both of my knees are injured (not much ROM limitation, just painful joints, which I've learned is 10% each), would I choose 10% TWICE and choose bi-lateral lower twice? Or twice with the percentage and just once adding the bi-lateral factor?

Sorry to be tedious about this, I just want to get the most accurate estimate I possibly can. Thank you greatly!

Shaun
Click to expand...
Think of it like a part A that needs a part B. If you were to only add one condition under "bilateral factor" it would have nothing to get its factor percentage off of. You'd have to have two conditions considered under two sides, hence "bilateral". If you did one condition no bilateral, another without bilateral, then one as bilateral it would be the same as three conditions without bilateral consideration. That's why the calculator asks what body part for a bilateral factor. If you try this with 20% no bilateral, 20% no bilateral, and 20% left leg and view calculations it will just compute 20% 3 times as normal. You'd have to choose 20% no bilateral, 20% right leg, 20% left leg for the bilateral factor to kick in correctly in the calculator.

As far as your knees go, assuming it's a condition that is eligible for bilateral factor (just guessing it is, but be cautious I'm unaware myself) you would put 10% twice and bilateral factor left and right. Again, refer to that part A that needs a part B example above.

Getting into the weeds, I learned it's a rat race not worth getting into. I tried getting into an estimate and found myself landing at 100% in each guess on how this will go, but ultimately a rater can turn your guess completely upside down by combining one claim or splitting another one up. There's a level of subjectivity when your data does not cleanly fit into the rating schedule, and it makes it impossible to guess since you don't know each document that is considered. Even if you assume everything there's no right answer.

We will never have each detail or each mentality of who will make the final call on our case. I'd say the only time it's worth trying to do this is if you're under 20 years and you want to have a fair guess if you'll be retired or not.

I'd save the calculator and your understanding of how the math works for when your ratings come back so you can fact check everything confidently, but guessing your final rating will only drive you nuts.
 
Yeah, you're right lol.

I can get to 100% on that calculator if I use honest assessments based on the rating schedule for the individual issues I have, but I recognize the need to concede to the assessor's own opinion...which feels a bit 'off' to me, but I do understand it's the reality.

Hopefully these assessors (or whatever they are referred to) aren't of the mindset of trying to nickel/dime us when they do their own calculations. To me, "VA Math" is already a complete farce on its own without having a 3rd party's 'opinion' sway our ability to get the compensation we have earned.

Shaun
 
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