I have reviewed this patient's medical records for the purpose of making a medical opinion concerning agent orange
induced peripheral neuropathy R and L leg, and cervical spine trauma (C2-3), lumbar spine trauma and knees
trauma from his 1966-1970 Viet Nam experience. In order to make my evaluation, I have carefully reviewed the
following information:
Service Medical Records; Post service Medical records; Imaging reports; X-rays and MRI's; Other medical opinions;
Telephone medical histories; Medical literature review.
OPINIONS:
It is my opinion that he was likely in Viet Nam.
It is my opinion that his service time auto accident trauma resulted in his current neck degenerative changes and
many of his neurologic disabilities.
It is my opinion that his service time back injury resulted in his current back degenerative changes and many of his
lower extremity neurologic disabilities. This patient's rating of 25 Jan 1995 is therefore inaccurate in its assignment of
20% NSC for codes 5295-5292 because this patient problems were likely service connected at a higher rate.
It is my opinion that his peripheral neuropathy in his lower extremities documented by Drs. Dominic, Kahn and Holder
is likely due to his experience and exposure in Viet Nam to Agent Orange. This patient's rating of 25 Jan 1995 is
therefore inaccurate in itsassignment of 10% NSC for codes 8521 because this patient problems originated in 1969
as documented in service and it is therefore illogical to give him a non service connected code for agent exposure
which he was only exposed to during Viet Nam service.
It is my opinion that his service time car accident resulted in his current knee problems/knee disabilities are these are
likely under-coded medically.
It is my opinion that this patient should have additional diagnostic codes added for his spleenectomy, which was likely
due to the sequella of South East Asia acquired hydatid cyst disease (exhibit page 22) because his records do not
contain another medically plausible etiology of this problem. This opinion is consistent with the opinion of Dr. Dominic
of 1996.
It is my opinion that this patient date of claim should be effective 14 Jan 1970 as he made an application for benefits
concerning his above medical problems (page 17a2 and pages 38/108/109 of patient exhibit) of"... peripheral
neuropathy... low back pain...agent Orange.. .L5-S1.. .neck pain.. .legs buckle.. .rectal leakage..." and his rating of 7
July 1971 is likely incorrect because the this patient's missing medical records were not made available by the
government as per regulation and therefore this patient should not be denied benefits retroactive to 1970 due to the
fault of old government's federal record release policies.
Special Knowledge:
I have special knowledge in the area of spine disease and I am board certified sub specialist and I and a Senior
Member of the American Society of Neuro-Radiology (ASNR). I have performed and interpreted plain x-rays, CT
scans, nuclear medicine scans and MRI scans on thousands of patients with abdominal/bowel/spine/orthopedic
abnormalities and I have correlated my findings with the clinical record. This patient has had several of these imaging
studies and their interpretation is pivotal to the understanding of his pathophysiology. (Please see my attached C.V.).
FACTS: Spine:
21 June 1967 "... .upper back pain x 20 d... fx of C-7 -1966. Mostly muscle pain..." Dr. GLM;
Sept 1967 ".. .intermittent numbness in his R thumb....refer to Neurosurgeon... " Dr. GLM;
8 Jan 1968 "... .chip fracture of the 2nd cervical vertebra... ..sprain-strain cervical.. .neck pain...." Dr. Mitchell;12 April
1968 Profile "....Chronic neck strain and back injury cervical spine....." Dr. Mann;
20 Nov 1969 ".. .old neck injury.. .back trouble.. .back brace....Fx odontoid.. .whip lash type injury to neck Dec 1967
...pain in neck ..." Dr. Turek;
20 Nov 1969 "....Dec 28 1967 U3 profile....since then he has pain in C6-C7 area ...fusion of C2-C3 anterior...and
posterior...."
20 Nov 1969 ".. .pain in cervical spine.. .numbness and tingling in hands and feet..." Dr Tanghe;
1 Feb 1971 ".. .in the Army in Germany we were aware of his extreme back pain...." Judice and Michael Morrison;
8 Sept 1977 ".. .Neck pain with tingling and numbness of right arm..." Dr. Lysek; 22 Jan 1979 "... neck pain....
Numbness... cervical radiculitis..." Dr. Nelson;
3 April 1979 "...chief complaint neck and low back pain..."the whole back tends to bother him".. .he appears disabled
for hard labor..." Dr. Rowland;
28 July 1989 ".. .Chief now is of neck pain and back pain...." Dr. Bair;
12 June 1990 "....there is therefore a reasonable probability of trauma being responsible for this condition of the neck
vertebrae..." Dr. Gorman;
22 April 1992 "... .EMG evidence of possible mild .. .cervical root compression..." Dr. Kahn;
25 June 1992 "...fusion at C2-3...certainly could be on a post-traumatic basis..." Dr. Uglietta;
15 March 1993 "... Central herniated disc at L5-S1...." Dr. Fleishon;
30 Oct 1995 ".. ..fracture of the odontoid mentioned in Doctor Mitchell's report with a fusion C2-3 but it is not
congenital...occurred during 1968 to 1970...high school complete physical...clearance ...patient peripheral
neuropathy which is also service related from 1969 on.... Lower extremities could perhaps be due to Agent Orange
exposure or it could have been from the back and neck injury.. .this patient has suffered from chronic neck, back and
neuropathy all of which are related to the time he had to spend during the Viet Nam conflict...." Dr. Dominic;
25 Oct 1996 "... .It is my medical opinion that it could have resulted from his Tour of duty in Viet Nam..." Dr.
Dominic;17 Dec 2003 ".. .Did veteran have military service in Viet Nam ... Yes .. .05/68 to 01/70.. .numbness [and]
tingling extremities....exposed Agent Orange Fort Devins and FortOrd..." Dr. Holder;
Right and Left Legs:
14 Dec 1992 ".. ..EDX evidence of mild sensory-motor peripheral neuropathy confined to the lower extremities..." Dr.
Kahn;
Right and Left Knees:
10 Oct 2004 Pt. telephone interview. "...L and Rknees.... Swell.... Lock.... give out when twisting.... have pain right
greater them left.... knees have given me problems since 1969 some from car accident and some from jumps... low
altitude covert helicopter night time .... 18-20 foot estimated jumps.. .all of my teeth were cracked in service due to
the car accident trauma and the trauma of hitting hard ground during covert operations...." Benoist, Noel;
Discussion:
It is my understanding that the VA rating board has stated that this patient was not in Viet Nam as a basis for not
service connecting his Agent Orange related medical diagnostic codes. It is my opinion that he was likely in Viet Nam
because Drs. Holder, Errebo and Dominic above both document that he was in Viet Nam and my patient interview on
7 Oct. 2004 also documents that he was in service in Viet Nam and the patient's newly released medical records (17
Oct. 2000) from Viet Nam also document that he served there as per VA hospital document dated 17 Oct 2000
(agent Orange exposure -Yes Viet Nam service yes) and he was registered with the Phoenix Medical Center as agent
orange exposure yes and Viet Nam service Yes at 1310 hours on 22 April 1994 due medical records President
Clinton's director of correspondence (see attached White House letter dated 27 Dec 1995 from James Dorskind)
mailed to record corrections/VA and his currently restricted VA medical records reportedly show that he served in Viet
Nam and his three buddy letters (Grinstead, Alien and Diamond) further document that he was in Viet Nam and his
chest shrapnel on Chest x-ray 2004 suggests that he was in Viet Nam and finally his current PTSD is based on the
stressors he experienced in Viet Nam (as per Dr. Nancy Errbo and Sidney Flame both of Phoenix).
This patient has a complex set of nervous system problems, which involve the cervical/lumbar spines and his
peripheral nervous system. He has had several different types of diagnostic studies and several different physicians
have evaluated him. Many of his symptoms overlap and none of his past physicians have reviewed his entire record
in detail, therefore the exact cause of any single symptom is not clearly apparent from the medical record. Based on
my review of the record it is my opinion that his service time auto accident trauma resulted in his current neck
degenerative changes and many of his neurologic disabilities for the following reasons:

1.   He entered service fit for duty.
2.   He sustained a serious neck injury in service during the car accident in Dec. 1966 in Worcester Mass and his
spine problems subsequent to that accident are well documented in his service medical record entries above.
3.   He has had problems with his neck every since the Dec. 1966 accident according to my telephone medical
histories and the medical records above show continuous and chronic medical problems.
4.   His medical record does not contain another plausible etiology for his neck problems.
5.   Many of his current clinical problems, fecal incontinence, EMG results and his imaging studies are consistent with
a cervical spinal cord and/or root/s secondary to foraminal stenosis and/or cervical disc at C5-6 and/or degenerative
changes, which are all secondary to his longstanding service spine injury.
6.   It is well known that injuries to the spine early in life often lead to advanced degenerative changes later in life due
to the resultant chronic ligament laxity and spine instability as one author states"... At the onset, tearing of ligaments
and subluxation are manifest by local symptoms of low back pain accentuated by the motion which stretches the
ligaments.. .Eventually, symptoms of localized degenerative arthritis are superimposed..." (Turik page 853).
7.   This opinion is consistent with the opinions of Drs. Tanghe, Gorman, Uglietta and Dominic.
It is my opinion that his service time back injury resulted in his current back degenerative changes and many of his
lower extremity neurologic disabilities for the following reasons:
1.   He entered service fit for duty.
2.   He sustained a serious back injury in service during the car accident in Dec 1966 in Worcester Mass and his
spine problems subsequent to that accident are well documented in his service medical record entries above.
3.   His back problems have been documented in service by the Morrison buddy letter
above. 8.   He has had problems with his back every since the Dec 1966 accident according
to my telephone medical histories and the medical records above show continuous
and chronic medical problems.
4.   His medical record does not contain another plausible etiology for his lumbar spine degenerative changes and
symptoms.
5.   Many of his current clinical lower extremity problems and his imaging studies are consistent with lumbar spine
degenerative changes, which are all-secondary to his longstanding service spine injury.
6.   It is well known that injuries to the spine early in life often lead to advanced degenerative changes later in life due
to the resultant chronic ligament laxity and spine instability as one author states"... At the onset, tearing of ligaments
and subluxation are manifest by local symptoms of low back pain accentuated by the motion which stretches the
ligaments.. .Eventually, symptoms of localized degenerative arthritis are superimposed..." (Turik page 853).

Peripheral Neuropathy:
It is my opinion that his peripheral neuropathy in his lower extremities documented by Drs. Dominic, Kahn and Holder
above is likely due to his experience and exposure in Viet Nam to Agent Orange for the following reasons:
1.   He entered service fit for duty.
2.   He was in Viet Nam and was therefore likely exposed to Agent Orange.
3.   Agent Orange is toxic to the nervous system and according to the Institute of Medicine (IOM) reports causes
peripheral neuropathies.
4.   His medical record does not contain another plausible etiology for his peripheral neuropathy.
5. This opinion is consistent with the opinion of both Drs. Dominic and Holder.
L and R Knees:
It is my opinion that his service time car accident resulted in his current knee problems and his knee disabilities are
likely under-coded medically for the following reasons:
1.   He entered service fit for duty.
2.   He sustained serious left and right knee injuries in service during the car accident in Dec 1966 in Worcester Mass
and his knee problems subsequent to that accident are well documented in his service medical record entries.
3.   He has had problems with his knees every since the Dec 1966 accident according to my telephone medical
histories.
4.   The patient has recently been prescribed and given long leg braces by VAMC Phoenix.
5.   His medical record does not contain another plausible etiology for his current knee problems.
6.   The patient has clicking, locking, giving way and swelling for both knees (R>L) and he should be considered for
an additional diagnostic coeds for his knees and an associated additional ranting.


Sincerely,





Craig N. Bash M.D.
Associate Professor of Radiology and Nuclear Medicine
F. Edward Hebert School of Medicine
Reference:
Turik, Samuel L. Orthopedics Principles and Their Application, 2nd ed.
THERE IS ABSOLUTELY NO MEDICAL EVIDENCE ANYWHERE AS TO SURGERY IN MY
UPPER LEFT QUADRANT - CHEST - BECAUSE I
NEVER HAVE HAD SURGERY THERE!
The medical evidence shows:
1.  Peripheral Neuropathy in the right and left leg "secondary to agent orange exposure and agent orange was only
sprayed in the Vietnam bush.
2.  A Hyadadit Ecocalocha Cyst on the spleen from a little worm commonly found in the waters of South East Asia.
3.  Shrapnel in my left chest consistent with the way the Vietcong soldiers wrapped their explosives.
4.  Knee, back, and dental injuries consistent with the injuries from Black Ops night jumps we made in Vietnam.
5.  P.T.S.D. resulting in an imposable time remembering names after Vietnam but no problem from Vietnam back to
kindergarten with a Psychologist analysis that my brain does not want to remember because there are too many
ghosts.
6.  ...and more...
BECAUSE I AM AND WAS WHO I HAVE SAID, THE MEDICAL EVIDENCE HAS CONSTANTLY
AND CONSISTENTLY PROVEN EVERY STORY I HAVE EVER RELATED FROM DATE OF
DISCHARGE TO THIS PRESENT DAY, AND BECAUSE I HAVE ALWAYS TOLD THE TRUTH
OR SAID NOTHING UNTIL I COULD DO SO WITHOUT CREATING A SECURITY BREACH OR
THE DANGER OF BEING PROSECUTED; I HAVE NEVER BEEN CHARGE WITH ANYTHING!
I HAVE NEVER HAD SURGERY IN THE LOCATION MENTIONED HERE SO THE SHRAPNEL
COULD ONLY HAVE COME FROM THE V.C. WHO USED TO WRAP THEIR MORTARS AND
EXPLOSIVES WITH WIRE AND CLIP THE WRAP TO KEEP IT IN PLACE FOR MORE
COLLATERAL DAMAGE WHEN IT GOES OFF. THIS IS WHAT WAS SEEN IN MY CHEST!
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DR. BASH REPORT
IN RE: DISABILITIES OF
NOEL T. BENOIST
REPORT DONE OCTOBER 13, 2004
Craig N. Bash M.D., Neuro-Radiology
7831 Woodmont Avenue, Bethesda, MD 20814
Phone: (301) 767-9525 Fax: (301) 365-2589
E-mail myelinman@hotmail.com
INDEPENDENT MEDICAL EVALUATION        13 Oct 2004
To:VA
Re: Benoist, Noel T.
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