free_spirit_etc

I am not an expert here - but I would say it looks like zero percent since he checked the occasional box. 7319 Irritable colon syndrome (spastic colitis, mucous colitis, etc.): Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress..................................................................... 30 Moderate; frequent episodes of bowel disturbance with abdominal distress................................................................................................................ 10 Mild, disturbances of bowel function with occasional episodes of abdominal distress................................................................................................ 0

Congrats! (And I don't hate you. )

Here are some examples and suggestions that might help guide you: http://www.mnveteranservice.org/documents/Example_Buddy_Statement.pdf http://vetassist.blogspot.com/2006/04/buddy-statements.html Keep on keepin on!

And pay attention to the parts they ignore. If they don't mention it, it is probably important.

I think this is excellent free-spirit! Thanks! It is well written and to the point. It is very possible that those 2 IMos will grant the claim and you pointed out why. This is good too: 17. Though Dr.XXXX handwritten note was not fully-articulated, the supporting evidence shows it was based on established medical principles. I used as evidence a handwritten entry in my husband's med recs (that was crossed out but not by the doctor who wrote it and that brief entry of his became my third IMO, because I contacted him by email on the entry. I am hoping that argument finally convinces them that the note from the doctor is competent and probative evidence. This doctor actually agreed to write an IMO, but then called and told my husband that the Base attorney said the doctors are not allowed to write opinions for VA claims. L Also: “20. Entitlement to service connection based on doubling time and growth rates of cancer is neither unique, nor rare. Service connection has been granted on this basis in numerous claims. “ Although the BVA doesn't consider their past decisions to be probative to anyone but the specific vet the decision is for ,I think it is good that you made this statement here, as to the doubling time and growth rates. And I assume you have those decision links somewhere.but I dont think BVA would even ask for them. I did want to point out that granting on this theory is actually pretty common. I am just hoping they don’t do a search and end up coming up with one of the rare decisions that actually denied the claim. I guess I could include a few cases as an attachment, to help deter any possibility that they might want to do a search. Actually, when I initially just started searching for doubling time and cancer, I found that most claims that advanced that theory were granted. Most of the ones that were not granted had one of the VA examiner’s opining that it would be impossible to now without resorting to speculation, and the veteran / widow only submitting treatises without an accompanying medical opinion. However, there are a few where the private doctors and the VA doctors went back and forth for several rounds with their opinions. In most cases, even if the VA examiner stated that they couldn’t opine, without resorting to speculation – the claim was granted as long as the vet / widow had a supportive IMO- because the VA examiner didn’t directly refute the IMO – they merely said they couldn’t know. Now if the VA examiner directly stated the private doctor resorted to speculation – that is a different matter. But good point in that I might want to include several BVA decisions that support my point to help prevent them from digging and uncovering that 1 out of 20 that might not support it. I Love the way you put this: “19. The only competent medical evidence in the record that specifically addresses whether it is more likely than not my husband’s cancer had its onset in service clearly establishes that it did. “ I actually borrowed that line from a BVA case ;) It pays to make statements with confidence and at the same time negate any VA opinion that you feel is not competent at all. I don’t really think the VA examiner’s opinion is very competent. He barely backed what he said. He just wrote a few lines. He didn’t even address the issue they said he addressed (whether the cancer had its onset in service. He successfully side-stepped that issue by merely talking about in-service treatment. But I was hesitant to point out that the opinion wasn’t really all that adequate, because that could trigger them to remand for a more adequate opinion, which could hold up the claim forever, as well as give them another shot at creating an opinion against my claim. So I figured it might be best to play along and pretend along with them that it is an adequate opinion, but point out that it does not actually conflict with our argument that my husband’s cancer started in service – and that it doesn’t conflict with the IMOs. Sure. Okay. I agree with your doctor. The viral illnesses my husband was treated for in service were not early manifestations of his lung cancer. I agree. However, that does not conflict with the evidence that his cancer actually started in service. It is an established medical principle that most lung cancer is asymptomatic until late stages. So my husband could have cancer in service AND be treated for viral illnesses that had nothing to do with his cancer. I found that a VA doc's opinions (I knocked down two of his opinions) came from a very competent VA doctor who ,after we argued and then made up, was under pressure to prepare an opinion specifically geared to deny my claim. That is what VA wanted from him. That crap just ticks me off! However his opinion was parsed because he DID add a very important statement to the opinion and the last 6 words of it were left out in the SSOC. Those 6 words alone could have changed the tide right away. Yep. That is evidence that the RO DOES know how to read. They like is to believe they didn’t bother to read everything. But they actually read the stuff and know exactly what to ignore and exactly what to distort (and exactly how to distort it and so it looks like they didn’t distort it at all) The words of his exam that the RO left out were something to the affect “unless an autopsy had been done”,meaning an autopsy could have altered his opinion completely. Not only had an autopsy been done, it fully supported that claim and the VA conveniently ignored 13 copies of it from me and deliberately did not give it to this C & P doctor. Boy how low can they go?????? VERY low apparently….. When he found out there was an autopsy the RO kept from him, and that it supported my claim, he was livid and told me he absolutely hated doing C & P exams.I think stuff like that had happened to him before. I think they have a term for the kind of stuff the VA pulled with you. The word “evil” comes to mind… We widows have to keep a clear head ,as you did here, because the VA knows we deal with grief and that alone makes these claims so hard to handle. Yep. I totally agree! You did VERY well here. I only hope the VA regards those IMOs as fully outweighing the C & P doctor.They should because you have 2 For and one against.......Relative Equipoise SHOULD kick in. I also tried to point out that it isn’t just two against one. I tried to point out that the VA examiner’s opinion doesn’t actually conflict with the IMOs. They can actually accept ALL three opinions as probative and still grant the claim. His cancer had its onset in service (IMOs) , but the symptoms he was treated for in service were not related to his lung cancer. (VA doc) Their opinions are actually kind of apples and oranges, but they don’t conflict with each other. The VA doctor never actually opined that his cancer did not start in service. And the IMO did not actually opine that he had symptoms of cancer that were treated in service. So none of the opinions were actually opposed to any of the other opinions. Unless the VA specifically denied the accrued claim.in the same SOC this statement is based on ..I would leave that out at this point because accrued claims are a specific issue. The SOC did address the accrued benefits claim. It states 2. Entitlement to accrued benefits, due to the death of XXX It has a couple paragraphs about accrued benefits and then states “ In reviewing the veteran’s entire claim file for service connection for adenocarcinoma of the lungs at the time of his death. However, since the claimed benefits cannot be granted, (see issue # 1 above), we are unable to grant entitlement to accrued benefits as a result of this claim pending at the time of his death, because no accrued benefits would have resulted from this unsuccessful claim. (** Issue #1 was the DIC claim) You could however tell them that a proper azaward of DIC based in all of the evidence should warrant an accrued award. Thanks! Good point. I guess I should also point out in my argument that he died of the cancer. I left that out. But it must be based entirely on your husband's pending claim at death, that was still in progress when he died. That is where I thought it would be best to point out several times that my husband had submitted evidence to establish the same facts during his lifetime, even if he hadn’t submitted a fully-articulated IMO. I think that is where it was important to point out that his treating physician noted that it would have taken his type of cancer 15 years to reach 1 cm. It was not in the treatment record, and it wasn’t fully articulated, but it WAS in the record (though the SSOC said there was no statement in the record from the doctor. Uhmmm – yes there was. My husband submitted the handwritten note with his initial claim. I guess I could point out that 3.159 does not limit competent medical evidence to only what is written in the treatment record or in formalized IMOs. I also could point out that if the VA denies the claim they are obligated to FULLY explain ALL the evidence in my file that supports my claim because his discharge physical is missing – and so they have a heightened duty to assist. But I hesitate to point that out because I don’t want them to just remand my claim back to find his discharge physical at this point, as I don’t think it is needed to prove my claim. However, if they denied the claim without considering – and fully explaining ALL the evidence that supports the claim (and there is A LOT of journal excerpts, treatise evidence, etc) that should be a basis to get a remand from the CVA because they are fully aware that his discharge physical is missing. (I postponed the Hearing twice while I was trying to obtain a copy from them). But I would MUCH rather just get the claim granted at this point. :)

Note - I was trying to point out some of the evidence submitted by my husband to boost the evidence for the accrued benefits claim -- pointing out evidence in the record at the time of my husband's death. I am not sure if it is better to add it to this argument, or address it in a argument specifically for accrued benefits.

I am working on drafting my final arguments to present to the BVA. Note - I already had my hearing in September. So this would just be a follow-up written argument. This argument addresses the in-service onset part of the claim. I am certainly open to feedback IN SERVICE ONSET 1. My husband was diagnosed with lung cancer, and had a 3.1 cm tumor removed, within a short time after his retirement from a 28-year career in the Air Force. 2. §3.303(d) clearly states “Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.” 3. M21-1MR, Part IV, Subpart ii, Chapter 2, Section B, 3 c. states “Consider whether direct service connection may be established under 38 CFR 3.303(d), even if service connection is claimed for a disease diagnosed after service has ended. Service connection may be granted for a disease diagnosed after discharge when all the evidence establishes that the disease was incurred in service. Do not attempt to establish presumptive service connection for chronic or tropical diseases until the possibility of establishing direct service connection has been ruled out.” 4. Competent medical evidence establishes my husband’s lung cancer had its inception during service, and thus was incurred coincident with his service in the Armed Forces. § 3.303 (a) 5. Two Independent Medical Opinions were submitted at my September 3, 2013 Board Hearing. Both specialists clearly stated that it is more likely than not that my husband’s cancer had its onset while he was serving in the Air Force. 6. Both opinions were written by specialists who are Board Certified in their respective fields in oncology. Both specialists are faculty members at major medical schools and have applicable experience in clinical practice. Both opinions were based on pertinent evidence in the record. Both opinions were well-articulated. 7. There is no medical opinion, nor medical evidence in the record, that conflicts with the recently submitted medical opinions. 8. Though the Supplemental Statement of Case pointed out my husband’s 1996 chest x-ray did not show evidence of cancer, both specialists indicated that it takes a significant amount of time from the point when a cancer starts until it is detectable by x-ray. Dr. XXX, a radiation oncologist, pointed out that chest x-rays can be poor instruments for detecting early stage lung cancer, that false negatives are well documented, and that chest x-rays are known to miss the majority of lung cancers for most of the tumor’s lifespan. This is further supported by evidence from peer reviewed journal articles submitted during my husband’s lifetime. 9. The VA medical examiner’s October 19, 2007 opinion is a rather brief, handwritten note that opines that the signs and symptoms reported in my husband’s SMRs were less likely than not early manifestations of my husband’s cancer. 10. Both Independent Medical Opinions addressed the fact that lung cancer is most often asymptomatic during much of its development. This is further supported by evidence my husband submitted from the U.S. National Cancer Institute's Surveillance, Epidemiology and End Results Program SEER's Training Modules, U.S. Preventive Services Task Force Guide to Clinical Preventive Services, the American Cancer Society, as well as excerpts from articles in peer reviewed medical journals. 11. The VA examiner did not indicate my husband’s lung cancer was not present in service. He merely stated the signs and symptoms reported in my husband’s SMRs were less likely than not early manifestations of the lung cancer. Additionally, he only mentioned the viral respiratory illnesses, and did not discuss the non-viral respiratory illnesses, such as my husband’s chronic bronchitis (initially diagnosed in January 1985). 12. The VA examiner did not actually address the issue of whether my husband’s cancer had its onset in service. However, there was ample evidence in the C-file at that time asserting my husband’s cancer had its onset while he was in the service, and the VA examiner did not refute this in his opinion. 13. There is nothing in the VA examiner's opinion that conflicts with the two Independent Medical Opinions, or the other evidence we have submitted in support of the claim. 14. Though the Supplemental Statement of Case indicated there is no statement from Dr. XXXX in the file which suggests that my husband’s cancer was present during service, my husband submitted the handwritten note from Dr. XXXX when he filed his initial claim for lung cancer. 15. Dr.XXXX noted the doubling times of various types of cancer, starred the “Adeno CA,” noted it was 3.1 cm, and noted DT (doubling time) 6 months. He additionally noted “15 yrs till 1 cm.” Dr.XXX then noted several more sizes, and then noted “3.25 ß 35.” 16. My husband submitted supportive evidence to show that what Dr. XXX had noted was based on sound medical reasoning. The evidence submitted supported the fact that his tumor was 3.1 cm when diagnosed, that adenocarcinoma of the lung has a standard doubling time of 6 months (180 days), that evidence from several sources showed that it generally takes a tumor doubling 30 times to reach the size of 1 cm, 30 doublings X 180 days = 15 years (which Dr. XXX noted “15 yrs till 1 cm”) and that it generally takes a tumor doubling 35 times to reach the size my husband’s tumor was when it was diagnosed. 17. Though Dr.XXXX handwritten note was not fully-articulated, the supporting evidence shows it was based on established medical principles. Considering the fact that my husband had a 3.1 cm tumor removed 2 years post-retirement, his treating physician noting that it would take that type of cancer 15 years to reach the size of 1 cm certainly suggests that my husband’s cancer was present in service. 18. The two recently submitted Independent Medical Opinions further substantiated the same information. 19. The only competent medical evidence in the record that specifically addresses whether it is more likely than not my husband’s cancer had its onset in service clearly establishes that it did. 20. Entitlement to service connection based on doubling time and growth rates of cancer is neither unique, nor rare. Service connection has been granted on this basis in numerous claims. 21. “When the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must weigh against a claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996).” (BVA Citation Nr: 1317665 DOCKET NO. 00-04 807 Decision Date: 05/30/13) 22. I believe that I have established that it is more likely than not that my husband’s cancer started during the time that he was serving in the Air Force, and I respectfully request that service connection be granted for his illness and his death.

They are still dragging the AO issue along... for instance... Guam.....

"they are doing a little different trick with us desert storm vets, they had to pay the vietnam vets,(becasue of the neimer actions, ) but they denied thier ilnesses as long as they could. They know that in this day in age, its and information age, and they cannot hide the information from our generation, but what they do is use trickery, by saying they pay us for undiagnosed ilnesses , but they will not leave an ilness undiagnosed if you are a desret storm vet, the FIND a diagnosis real quick, to deny you. thats thier modern day modus operandi. " Yep. That is why it is important to get your med records and your C-file. Because sometimes the thing they diagnose you with (to keep from paying you for an undiagnosed illness) will actually be in your medical records -- but they won't bother to tell you that....

It looks like they changed the process a bit. You used to receive a provisional discharge - and wouldn't get the final discharge for several years. Now it looks like you get the discharge - and then put you on "post-discharge monitoring" for 3 years where they reinstate your loan if you do not meet the requirements (of earning less than the poverty level). I am not sure if the post-discharge monitoring applies to VA discharges or not. I would say it is a MUCH better system than it used to be though. Back when they did the provisional discharge and the final discharge, you were not eligible to receive a refund for the payments you had made after you were disabled until your debt was finally discharged. So it took 3 years. It looks like under the new system that you can receive your refund MUCH quicker - because they have it set up where your debt has been discharged (but could be reinstated during the post-discharge monitoring). That was a battle I finally gave up on. My husband received his provisional discharge during his lifetime, but had paid several months of payments while he was waiting to hear back from them about his application. He was due a refund for those payments, but would not receive them for three years (when his debt was finally discharged). Well - he died before that. But they sent a letter and said he his debt had been finally discharged - and it said they would refund any payments made retroactive to the date he became disabled. But then they never would refund the money. They said he didn't meet the terms of the provisional discharge because the provisional discharge stated you had to remain disabled for three years. They didn't count dying as a disability. They said he had to LIVE three years to remain disabled. It seemed ridiculous that they would require a disabled person to live three years before they could get their refund. It would seem like if they died within that three year period, they were obviously not able to work within the three year period. PLUS they sent a letter SAYING that any payments made after he became disabled would be refunded. AND they would only TELL me that they would not refund the money. They would not answer any of my letters, and they refused to send me anything in writing saying they would not refund the money. Then the ombudsman said I was sent the letter regarding the refund in error. But he checked it out and said that they said that is the standard letter they send out when someone who is on the disability discharge dies. How crazy is that they they send a deceased person's family a letter telling them they will refund money, and then refuse to refund money, and refuse to even state in writing that the money won't be refunded. It was crazy for sure.

Oh wow! I just read the letters. It looks like they have a different process if you are disabled due to a service connected disability and they grant the permanent discharge much sooner. That's great stuff!

That's great! At first they are just provisionally discharged for a certain number of years. But during that time they don't require payments, or charge interest. I don't remember the exact time-frame now. But I know that you are not allowed to EARN more than the federal poverty level during that time. When they re-evaluate your case after that point, they permanently discharge your loans, as long as you are still disabled.

"By not confirming the diagnosis the let an infection rage and definitely caused permanent residuals as well as putting the Vet in danger of loosing his limb and possibly his life." I am not sure he is out of the woods on this yet, until that is TOTALLY healed up. Findings suspicious for partial occlusion of the distal superficial femoral vein and popliteal veins. This is nonspecific, but could represent acute or chronic deep venous thrombosis. Clinical correlation is suggested. It is so odd (if we are talking about a real doctor) for a doctor to so dismissively discuss what the veteran told him (about being misdiagnosed with DVT) when the report just says the findings were suspicious for __ and that it is nonspecific, but COULD represent ___" Personally, I think the C&P exam should be able to be used as part of the evidence of the pattern of negligence with this veteran. He dismissed the veteran's statements, made a diagnosis that was based on a "suggested, possible, maybe" type report without ordering more testing, and made some off the wall statement about how cellulitis is not associated with diabetes (based on some non-existent search of medical literature). It is beyond ridiculous! To care for him who shall have borne the battle ...

Something interesting about the Section 1151 claims is they can be based on: The direct result of VA fault such as carelessness, negligence, lack of proper skill, or error in judgment, OR Not a reasonably expected result or complication of the VA care or treatment. So even if someone can't prove negligence (which I think you should be able to prove) - they could prove that the disability wasn't a reasonable expected result. I just read a case the other night when I was looking up something else, and the widow was granted SC for the veteran's death because he died, and he wasn't reasonably expected to. Of course, since they granted the claim on that basis - there was no reason to discuss negligence and carelessness. I wonder how easy it is to prevail on a Section 1151 claim on the "reasonably expected" basis, if there wasn't negligence.

I do plan on giving the information and studies to the Veteran to take over the the VAMC and leaving studies and information about this condition for the examiner. He can delever this through the patient advocate and they can deliver it to the doctor, who is a real dumb a** in my opinion. We never know what motivates others, until we have walked in their shoes, however, I will help to re-file this claim and give it one more chance rather than do an appeal. We could file an FDC claim and see what happens.-H I hope you can still get the earlier effective date because he filed for the wrong condition because the VA misdiagnosed him. After all, it isn't a lay person's fault that the VA misdiagnosed him...several times...

http://www.simondodds.com/pathology/microvascular.htm ABC of Vascular Disease Microvascular Disease 1. What is microvascular disease? Microvascular disease is a process through which the very small branches of arteries throughout the body become damaged. Microvascular disease is a common component of other conditions, such as diabetes mellitus and autoimmune diseases. 2. What causes microvascular disease? The very small branches of the arteries are delicate but very important structures. Damage to these vessels results in occlusion of the vessels and impairment of blood flow. In many situations the small arteries can re-grow and overcome the blockage, a process called angiogenesis. This is part of the normal healing process. In microvascular disease the commonest cause is chemicals within the blood that damage the very delicate lining of the small arteries and causes the blood to clot in the artery and block it. Sometimes these chemicals are produced by the body itself as part of the immune response and is called an autoimmune microvascular disease. Occasionally microvascular disease is the result of abnormalities in the cells that form part of the blood. 3. What are the symptoms of microvascular disease? The commonest symptoms are pain and discoloration of the extremities, usually the fingers and toes, sometimes even leading to gangrene. These symptoms are very similar to those cause by occlusion of the larger arteries except that it is not associated with muscle pain on exercise (intermittent claudication) and the blood pressure in the larger arteries is normal. 4. What are the complications of microvascular arterial disease? Microvascular disease usually affects the whole body to some degree and the most serious complications are caused by damage to the vital organs (e.g. heart, brain, kidneys, liver). 5 What can I do to prevent microvascular disease from getting worse? Treatment for microvascular disease is directed at the underlying cause. Lifestyle changes to eliminate factors that aggravate the condition, such as smoking, should be the first line of treatment. A complete medical assessment is required to identify the underlying cause if possible. If there is an autoimmune element to the condition, then referral to a rheumatologist may be required. If there is an abnormality in the blood referral to a haematologist is required. Surgery plays only a secondary role in the management of microvascular disease.

This is just parts of this article: http://emedicine.medscape.com/article/237378-overview Foot infections are the most common problems in persons with diabetes. These individuals are predisposed to foot infections because of a compromised vascular supply secondary to diabetes. Local trauma and/or pressure (often in association with lack of sensation because of neuropathy), in addition to microvascular disease, may result in various diabetic foot infections that run the spectrum from simple, superficial cellulitis to chronic osteomyelitis. Infections in patients with diabetes are difficult to treat because these individuals have impaired microvascular circulation, which limits the access of phagocytic cells to the infected area and results in a poor concentration of antibiotics in the infected tissues. In addition, diabetic individuals can not only have a combined infection involving bone and soft tissue called fetid foot, a severe and extensive, chronic soft-tissue and bone infection that causes a foul exudate, but they may also have peripheral vascular disease that involves the large vessels, as well as microvascular and capillary disease that results in peripheral vascular disease with gangrene.[1, 2, 3, 4, 5] In general, foot infections in persons with diabetes become more severe and take longer to cure than do equivalent infections in persons without diabetes. Diabetes mellitus is a disorder that primarily affects the microvascular circulation. In the extremities, microvascular disease due to "sugar-coated capillaries" limits the blood supply to the superficial and deep structures. Pressure due to ill-fitting shoes or trauma further compromises the local blood supply at the microvascular level, predisposing the patient to infection, which may involve the skin, soft tissues, bone, or all of these combined. Diabetes also accelerates macrovascular disease, which is evident clinically as accelerating atherosclerosis and/or peripheral vascular disease. Most diabetic foot infections occur in the setting of good dorsalis pedis pulses; this finding indicates that the primary problem in diabetic foot infections is microvascular compromise. Impaired microvascular circulation hinders white blood cell migration into the area of infection and limits the ability of antibiotics to reach the site of infection in an effective concentration. Diabetic neuropathy may be encountered in conjunction with vasculopathy. This may allow for incidental trauma that goes unrecognized (eg, blistering, penetrating foreign body). Go to Diabetic Neuropathy for more complete information on this topic. Microbial characteristics The microbiologic features of diabetic foot infections vary according to the tissue infected. In patients with diabetes, superficial skin infections, such as cellulitis, are caused by the same organisms as those in healthy hosts, namely group A streptococci and Staphylococcus aureus. In unusual epidemiologic circumstances, however, organisms such as Pasteurella multocida (eg, from dog or cat bites or scratches) may be noted and should always be considered. Group B streptococcal cellulitis is uncommon in healthy hosts but not uncommon in patients with diabetes. In diabetic individuals, group B streptococci may cause urinary tract infections and catheter-associated bacteriuria in addition to cellulitis, skin and/or soft-tissue infections, and chronic osteomyelitis. Such infections may be complicated by bacteremia. Globally, diabetic foot infections are the most common skeletal and soft-tissue infections in patients with diabetes. The incidence of diabetic foot infections is similar to that of diabetes in various ethnic groups and most frequently affect elderly patients. There are no significant differences between the sexes. Mortality is not common, except in unusual circumstances. The mortality risk is highest in patients with chronic osteomyelitis and in those with acute necrotizing soft-tissue infections. The prognosis for cases of cellulitis, skin and/or soft-tissue infections, and acute osteomyelitis depends on the adequacy of antimicrobial therapy and surgical debridement Cellulitis Cellulitis may involve tender, erythematous, nonraised skin lesions on the lower extremity that may or may not be accompanied by lymphangitis. Lymphangitis suggests a group A streptococcal etiology. If bullae are present, S aureus is the most likely pathogen, but group A streptococci occasionally cause bullous lesions. No ulcer or wound exudate is present in patients with cellulitis. Deep-skin and soft-tissue infections Patients with deep-skin and soft-tissue infections may be acutely ill, with painful induration of the soft tissues in the extremity. These infections are particularly common in the thigh area, but they may be seen anywhere on the leg or foot. Wound discharge is usually not present. Diagnostic Considerations Skeletal and soft-tissue infections of the foot are not limited to individuals with diabetes; therefore, other conditions may need to be considered in the differential diagnosis, depending on the infection and structures affected. In cellulitis, differential diagnosis includes leukoclastic angitis, diabetic dermopathy, chronic venostatic change, and superficial thrombophlebitis.

"Assesment: Massive calf abcess and possible osteomyelities" That would be infection in the bone. Did this end up being part of his final diagnosis? It seems like there is more going on than just the cellulitis.

Were you taking Interferon? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219447/

"He states his leg was red and hot to the touch and painful." This is interesting because from looking at the Merek Manual Cellulitis and DVT often present with similar symptoms. One difference is that with Cellulitis, the skin is hot and red -- and with DVT the skin is cool and normal color or cyanotic. http://www.merckmanuals.com/professional/dermatologic_disorders/bacterial_skin_infections/cellulitis.html Article includes table: Table 1

"I can understand that, but they should be on the side of the Veteran. Then again, they have to be mindful of where there paycheck is coming from." They should be on the side of the truth. And when they distort the truth because of who is paying their paycheck - that is totally unethical. I know it is part of the game -- but that doesn't make it right. The VA examiners should have to give out disclaimers with their opinions. "This opinion does not necessarily reflect the views of a real doctor practicing real medicine. This opinion is more of a pseudo-opinion, written by someone who graduated from medical school who stopped practicing medicine when he agreed to accept paychecks from the VA..."

Maybe we could set up a site on http://www.gofundme.com/ to raise money for his IMOs. And tell his story about how he walked into the VA and now is riding in a wheelchair - but needs to raise money to pay for a private doctor to examine him because the VA doctors don't know that diabetics are at risk for infections.

Don't forget Aid and Attendance!

It looks like cellulitis is pretty easy to diagnose (i.e. even a VA doctor could do it). The symptoms are redness of the skin, where it is hot and painful to touch. The average doctor should be able to look at it and pretty well know. They confirm their suspicion with a blood test. The fact that the veteran improved when he was on antibiotics and got worse when he was off of them should have set up a red flag that they were dealing with an INFECTION! Untreated, it spreads -- and can even enter the blood stream and lymph system.

Harley, This almost sounds like a case for News Coverage. The lack of treatment was bad enough, but after almost killing him - they have the NERVE to deny him coverage -- I wish these VA examiners would have to be accountable for the crap they write. If a licensing board ever read some of their opinions, they should certainly decide they are no competent to practice medicine. The C&P examiner was the idiot - yet he wrote the report to make it look like the veteran was not credible. He couldn't have reviewed much medical literature to make a remark that diabetes was not a risk factor for any type of infection -- especially lower limb infections. My gosh! Even lay people know that diabetics have increased risk for infections. That is why they sell diabetic socks, diabetic shoes, instruct diabetics on proper skin care, etc.