free_spirit_etc

"27 cm long 8 cm wide and 5 cm deep. It went from his ankle to above the knee into the thigh. How could that VA doctor not want to do further testing. This is absurd. This was only the first of 3 surgeries. He ended up with a knee surgery from above the knee down over the knee cap and to the patella. about a 6 or 7 inch scar. The another surgery for I&D on the calf which is still mending even now. This scar is about 8" ilong and was 5 inches deep. Still is indented by about an in, this is nasty and the area is painful and very hard, like a board still. He also had an upper thigh asperation of infection fluid done by the radilogist after the seconda surgery." I wonder how much muscle tissue they had to remove in these surgeries.

C&P exam "There is no indication in the medical literature that diabetes is a risk factor for cellulitis. " That is complete and utter BS. It is hard to find medical literature that states diabetes is NOT a risk factor. Also, this went past cellulitis - to be cellulitis with abscess. In fact, it is probably necrotic cellutitis: Did they just drain the leg? Or did they have to clean out the necrotic tissue? The article talks about how it can cause blot clots, drops in blood pressure (sign of the individual becoming septic) and other symptoms you reported. http://cellulitisinfections.blogspot.com/2005/11/necrotizing-cellulitis.html Necrotizing Cellulitis Necrotizing Skin Infections Necrotizing skin infections, including necrotizing cellulitis and necrotizing fasciitis, are severe forms of cellulitis characterized by death of infected tissue (necrosis). Most skin infections do not result in death of skin and nearby tissues. Sometimes, however, bacterial infection can cause small blood vessels in the infected area to clot. This clotting causes the tissue fed by these vessels to die from lack of blood. Because the body's immune defenses that travel through the bloodstream (such as white blood cells and antibodies) can no longer reach this area, the infection spreads rapidly and may be difficult to control. Death is not uncommon, even with appropriate treatment. Some necrotizing skin infections spread deep in the skin along the surface of the muscle (fascia) and are termed necrotizing fasciitis. Other necrotizing skin infections spread on the outer layers of skin and are termed necrotizing cellulitis. Several different bacteria, such as Streptococcus and Clostridia, may cause necrotizing skin infections, although in many people the infection is caused by a combination of bacteria. The streptococcal infection in particular has been termed "flesh-eating disease" by the lay press, although it differs little from the others. Some necrotizing skin infections begin at puncture wounds or lacerations, particularly wounds contaminated with dirt and debris. Other infections begin in surgical incisions or even healthy skin. Sometimes people with diverticulitis, intestinal perforation, or tumors of the intestine develop necrotizing infections of the abdominal wall, genital area, or thighs. These infections occur when certain bacteria escape from the intestine and spread to the skin. The bacteria may initially create an abscess in the abdominal cavity and spread directly outward to the skin, or they may spread through the bloodstream to the skin and other organs. Symptoms and Diagnosis Symptoms often begin just as for cellulitis (see Bacterial Skin Infections: Cellulitis). The skin may look pale at first, but quickly becomes red or bronze and warm to the touch, and sometimes becomes swollen. Later, the skin turns violet, often with the development of large fluid-filled blisters (bullae). The fluid from these blisters is brown, watery, and sometimes foul smelling. Areas of dead skin (gangrene) turn black. Some types of infection, including those produced by Clostridia and mixed bacteria, produce gas (see Bacterial Infections: Gas Gangrene). The gas creates bubbles under the skin and sometimes in the blisters themselves, causing the skin to feel crackly when pressed. Initially the infected area is painful, but as the skin dies, the nerves stop working and the area loses sensation. The person usually feels very ill and has a fever, a rapid heart rate, and mental deterioration ranging from confusion to unconsciousness. Blood pressure may fall because of toxins secreted by the bacteria and the body's response to the infection (septic shock (see Bacteremia, Sepsis, and Septic Shock: Septic Shock). A doctor makes a diagnosis of necrotizing skin infection based on its appearance, particularly the presence of gas bubbles under the skin. X-rays may show gas under the skin as well. The specific bacteria involved are identified by laboratory analysis of infected fluid and tissue samples. However, treatment must begin before a doctor can be certain which bacteria are causing the infection. Treatment and Prognosis The treatment for necrotizing fasciitis is intravenous antibiotic therapy and surgical removal of the dead tissue. Large amounts of skin, tissue, and muscle must often be removed, and in some cases, an affected arm or leg may have to be amputated. People with necrotizing infections caused by anaerobic bacteria (for example, Clostridium perfringens (see What Are Clostridia?) may benefit from treatment in a high-pressure (hyperbaric) oxygen chamber. The overall death rate is about 30%. Older people, those who have other medical disorders, and those in whom the disease has reached an advanced stage have a poorer outcome. Last reviewed/revised February 1, 2003

http://www.medscape.com/viewarticle/749290 Abstract and Introduction Introduction Patients with diabetes have a 30-fold higher risk of lower-extremity amputation due to infection compared with patients without diabetes.[1,2] Diabetic foot infections that are not appropriately treated because of delayed diagnosis or that are inadequately treated lead to lower-extremity amputation in approximately 10% of patients.[3,4] Lower-extremity amputations may be debilitating and can dramatically affect the patient's quality of life. Successful outcome depends upon prompt identification of the infection, followed by appropriate antibiotic therapy in conjunction with good wound care and judicious use of surgical procedures when warranted.[4,5] Community pharmacists can play an integral role in educating patients about foot care and in recognizing ulcers that can lead to skin infections such as cellulitis, which involves the epidermis, dermis, and—in more complicated cases—subcutaneous tissue.[6] Resulting from a cut, abrasion, trauma, or puncture, cellulitis may lead to diabetic foot infection. The presence of a foot wound does not necessarily signify infection; however, an existing infection must be treated. Infection is indicated by the presence of purulent secretions or at least two of the following symptoms: erythema, warmth, tenderness, pain, and induration. The clinician should also be alert for friable tissue, wound tenderness, and/or foul odor.[3]

I think, as far as malpractice goes, the VA and the first private hospital (besides saying that they did not cause harm) would try to point the finger at each other. I am not real familiar with VA malpractice claims, and so I am not sure if the VA just had to contribute, or if they had to be the sole responsible party. But even with that - the VA and private hospital each kept passing the buck for the other one to do something, while the veteran became worse. What is telling is that the veteran had to take himself out from under the care of the VA before he received appropriate treatment. So I am not clear, but when you are under the care of the VA, and they send you somewhere else for part of the treatment - shouldn't they still be putting it all together and overseeing your overall care? As far as malpractice - You would generally have to show two things (and I am not investigating this fully yet - just throwing out some ideas to think about) 1. That the provider was negligent in the standard of care they provided. (I think you got this). 2. That the patient was harmed by that negligence. So you would have to show that the VA's failure to diagnose, misdiagnosis, improper treatment, etc. led to "harm" to the patient. Is he is a worse condition / position than he would have been if it would not have been for their breech in standard of care? If a doctor says he suffers disability that he would not have suffered if the VA would have discovered the infection in the first place and given him appropriate treatment from the start - that would be great!

Wow! I am having trouble getting my brain kicked into full gear today -- but it certainly looks like you have several things going - with both the VA and the private hospital. 1. Failure to diagnose 2. Even worse - Misdiagnosis - which led to 3. Improper treatment that worsened his condition. The fact that the veteran went from fully ambulatory to unable to ambulate - without an adequate diagnoses - while under the care of the VA is horrid! And -- I don't even think this is done playing out yet. Secondary conditions that can arise from the long-term use of antibiotics might not be pleasant. The fact that he is still on antibiotics would lead me to believe the infection is not safely all the way gone (so there still might be a possible risk of him losing the leg). As for standard of care - My gosh! ANY suspicion of ANY type of infection in the lower limbs of diabetics should be taken as a serious matter! He went to the VA with a diagnosis of suspected infection and they didn't check him for infection? Back in the day, when I was a CNA, CNAs were not even allowed to cut toenails on diabetic patients because of the risk of going from a simple nick of the skin to losing an entire leg - because of circulation issues and impaired healing abilities. ANY suspected infection in the foot or leg of a diabetic patient should be considered potentially serious.

http://www.sciencedirect.com/science/article/pii/S0732889399000280 Abstract We conducted a prospective study among 62 hospitalized adults, to evaluate the factors that contribute to the development of cellulitis. The majority of patients had multiple possible predisposing factors, and the most common were: diabetes mellitus (31/62), history of cellulitis (30/62), edema (28/62), peripheral vascular disease (25/62), and skin changes suggestive of tinea pedis (20/62). A significant number of patients reported and were clinically noted to have dry skin (42/62). Large controlled studies are needed to evaluate whether aggressive control of possible risk factors can reduce the incidence of cellulitis.

Is there any way to get the C&P exam declared inadequate and get a new one ordered? Of course that might take awhile, but where the examiner is talking about how the veteran denies having DVT -- even though it was diagnosed is ridiculous. Did the examiner have a copy of the report from the hospital that said he did NOT have DVT, and was in fact over anti-coagulated?

There should be something that shows that using antibiotics short term actually worsened the condition too. Not just that the infection flared back up when the antibiotics were discontinued - but that the inappropriate use of antibiotics actually caused the infection to worsen. It is why they tell people to continue taking antibiotics even when their symptoms improve - because the infection doesn't just come back - it comes back worse.

"There is no indication in the medical literature that diabetes is a risk factor for cellulitis. " It is interesting that Mayo says diabetes IS a risk factor: (Maybe the C&P examiner knows more than the doctors at Mayo Clinic??) http://www.mayoclinic.com/health/cellulitis/DS00450/DSECTION=risk-factors Several factors can place you at greater risk of developing cellulitis: Known injury. Any cut, fracture, burn or even a scrape increases your risk of cellulitis because the injury gives bacteria an entry point. Weakened immune system. Conditions that weaken your immune system leave you more susceptible to infections, such as cellulitis. Conditions that can weaken your immune system include diabetes, chronic leukemias, HIV/AIDS, chronic kidney disease, liver disease and circulation disorders. The use of certain medications, such as corticosteroids, also can weaken your immune system.

Can you get some statements from other people about the change in you pre-stressor and post-stressor? I am not sure the people would have to know exactly what happened. A diagnosis of PTSD already implies that something happened somewhere. By its very nature, it is acquired - stressor occurred somewhere. So statements from other people about a change in you during that time frame would help lend support that whatever happened occurred in the military. That wouldn't necessarily prove the stressor, but it would lend support to your own statements. Have you filed for any other mental conditions? Like anxiety? Or depression? It seems like the stomach problems, the weight loss (to the extent they thought you had an eating disorder) and the suicide watch would all lend support to the idea your were experiencing extreme anxiety in the military.

Yes. I agree. I have no idea what the government accomplishes by "shutting down" the government, and then paying the people who weren't allowed to work. If you are going to pay them anyway, then why send them home in the first place. Why give them a paid vacation. And Harleyman makes a good point about them being non-essential anyway. My husband always went to work when severe weather caused the base to shut down everything but essential functions. He said "Never let yourself be considered non-essential at your job." So he just deemed himself essential and showed up.

Arty_CWO, I am not sure. Did you find out your answer yet?

"Many Vietnam vets got jungle rot (crotch itch) but didnt claim it right because they didnt have the proper medical diagnosis." OMG! I was reading a BVA claim the other day that denied a claim on this because the VA examiner noted that the veteran didn't have any rash on his testicles on the day of the exam. Then the judge (or lawyer writing for the judge) noted that there were no colored pictures taken of the area because the veteran didn't have a rash during the exam. Do they actually take colored photos of your testicles to submit the the VA??? It just seems like that is going a bit far considering the fact that you never know whose C-file your photos might show up in.

Wow Blazer! I just posted a case in here the other day about a veteran who had a claim for increased rating for his heart disease and they denied the increase. The veteran died from the disease and they denied accrued benefits and DIC. She had to fight for that. It would seem like dead would be considered significantly disabled.

Broncovet, Thanks! I am at the BVA level. So do you mean that if I am granted DIC, and accrued benefits for my husband's cancer by the BVA - it will go back to the RO to decide the effective date? AND - I have already brought up to the Board that the RO mentioned accrued benefits for cancer, but did not address whether there were other pending issues in the claim (such as other respiratory illnesses, increased ratings for his SC conditions, etc.) So if the BVA says there are no other pending claims - that means I would need to be ready to take it to the CVA or drop it. I would prefer to have those kicked back to the RO at the moment. So again - I am still trying to answer the question "So to give me more time to work on the other issues, and to keep from complicating the claim at this point when I am trying to get DIC, I am wondering if I could just request that the Board remand the claim to the RO in regard to other potential entitlements for accrued benefits besides the cancer - as the RO has not explored whether there were any other potential pending claims in the first instance, and as the discharge physical is not part of the record, but the VA has not exhausted their remedies to locate it under the duty to assist."

Thanks Berta! That was quick! Vet Lawyer's response for free spirit......and others here who read the post it regarded: I dont remember what forum you posted the question in regarding Chris Attig's blog : "if the Veteran would have provided that evidence to prevail in his or claim but for a failure in the VA’s Duty to Assist, then it is possible that an “accrued benefits” claim can be reopened for submission of additional evidence." This is part of Chris' email response to me to the Duty to Assist part: “The DTA approach is just one of many techniques to try to reopen a previously denied and unappealed AB claim, but it needs to be coupled with NME that would likely have been provided if requested in a VCAA Notice. It's a tough row to hoe, but I've used the approach. This almost sounds like he is talking about reopening a previously denied AB claim in which the widow did not provide evidence for her AB claim because it was not requested in the VCAA notice. That is a bit different than ""if the Veteran would have provided that evidence to prevail in his or claim but for a failure in the VA’s Duty to Assist." And while I am not 100% sure, it may not be a viable approach in a pre-VCAA claim. In those situations, however, a due process violation MIGHT yield the same result; reopening. I just wanted to make sure we all are on the same page.here. DTA has no impact at all, in my opinion on any current claims.That is what the VCAA is for. I think duty to assist still comes into play in existing open claims, because there are plenty of court cases where the vets are still arguing the VA failed in their duty to assist and the CVA is remanding them. This usually seems to involve obtaining documents and ordering exams. The question would be whether the DTA can be used in a claim that has been considered closed. Apparently, it cannot. I know DTA could not be raised in a CUE claim, but I wasn't sure otherwise, especially after reading Mr. Attig's statement about if the Veteran would have provided evidence to prevail in his claim but for ta failure in the VA's Duty to Assist..." THAT sure got my attention! So basically, since they send a letter telling people "send everything you can to prove your case" they are now relieved of the duty to assist otherwise?? Or is it just that the failure has to be raised on appeal while the claim is still open. There are certain duties that the VCAA notice can't cover. For instance, the duty to liberally read your claim (which I guess is covered by the pending unadjudicated claims) or the duty to provide a medical exam or seek a medical opinion. In my husband's case - he initially filed his claim for cancer in 2001 and specifically said his doctor told him his cancer started in service. And he sent in the paper the doctor had written that noted the doubling times. He ALSO claimed that his cancer was related to his asbestos exposure. The VA initially framed the claim as Lung Cancer TO INCLUDE as due to asbestos exposure. But then they limited the scope of the medical opinion to only asking about the etiology of the cancer, without addressing the onset - which was the major premise of his claim. The denial reframed the claim to be Lung Cancer AS DUE TO asbestos exposure. They dropped the "to include." My husband specifically disagreed and pointed out that they were ignoring the major premise of his claim, that it started in service. (This was all pre-Hadit). They just went right on denying the claim again - and pretty well just restated what they said the first time. My husband received the SSOC but he didn't appeal. He honestly thought he had already appealed. This was right around the time he was operated on again and they found out his cancer was inoperable. But not too long after he received the SSOC, he received another letter that told him that his appeal was sent to the BVA. So he thought that meant he had appealed all that he needed to. We found out much later that the appeal that was sent to the BVA was NOT his cancer claim - it was an Old orphan dental claim. So meanwhile he sits back and readies himself for the long wait until the Board hears his decision. In 2006 - He called to see when his case might be heard - and the Board told him they didn't have his claim yet. He called the RO and they said it was not uncommon for them to keep the files even after they send the letter that the claim has been sent to the Board. So he asked about submitting more evidence, and they said to send it to them and they would forward it to the Board. He even sent a letter asking the Board to give him additional time to submit evidence before deciding on his claim. It wasn't until he had contacted a Senator and asked to see if his claim could be expedited when he submitted the evidence, due to terminal illness that he found out that his claim had been considered abandoned. Apparently they don't have to send you a notice when they close a claim as abandoned. That way, they can keep you sitting around waiting for your hearing for a couple years. Anyway, my husband sent a letter asking if the claim was abandoned, and stating he wanted to appeal whatever decision was made to close his claim, but they never responded to that. Anyway -- he sent a HUGE amount of treatise evidence in support of his claim - but instead of notifying him that the claim was reopened, they sent him a letter telling him that if he wanted to reopen his claim, he had to send new and material evidence, and the evidence had to relate to the reasons the claim was previously denied. My husband once again objected to them limiting the claim to that basis, because they had never developed the claim in respect to the in-service onset to begin with. He ask that they adjudicate that part of the claim. And he told them he had already submitted a lot of evidence, but most of it had to do with the in-service onset (which was NOT the reason the claim was denied). So he objected that the kept limiting his claim to AS DUE TO asbestos exposure, and saying he had to submit evidence on that issue to reopen the claim. He didn't even want to submit more evidence about asbestos exposure until they FINALLY acknowledged the in-service ONSET portion of the claim. He said if he sent more evidence about asbestos exposure, they would just keep pretending like that was the only thing it was about. (He didn't put that in the letter, but he told me). Anyway --- I think liberally reading a veteran's claim is part of the duty to assist -- and how liberally do you have to read to catch the part where the veteran kept saying "You are NOT addressing the issue of whether my cancer STARTED in service!!!" But I guess since the VA pretended to get an opinion on that issue after my husband died, and the examiner skirted the topic and discussed whether the symptoms of his viral infections in service were related to his cancer, the VA could say it didn't matter whether they sought a medical opinion during his lifetime because it wouldn't have changed the outcome. And everyone can pretend the VA did their job and assisted him in developing his claim. I don't know. I wasn't leaning toward a failure of duty to assist argument -- but when I read that on Mr. Attig's site - I started to wonder. I was wondering mostly in respect to the other decisions, where the discharge physical was apparently not in the file, yet no one tried to obtain it, or notified him that it wasn't in the file. The SMRs clearly state a discharge physical was done - so they should have known there a missing medical record. And I honestly believe it was not in his file on the other decisions because they NEVER mentioned what was or was not shown on the discharge physical. They just say "Your SMRs." But then, proving that is another matter. But if they know there are missing service records, they have a duty to try to locate them, to inform the veteran of what other evidence they can submit to try to prove what the discharge physical would have shown - and a heightened duty to fully discuss in the reasons and basis all the evidence the veteran had that supported his claim. They never did any of this. In fact with MY claim - I KNOW the discharge physical was missing because I drove to Chicago to look at his file and try to get a copy, I IRISed them when I got home telling them I specifically drove to Chicago to get a copy and neither the person who assisted me or I could find it, and I asked them to look for it and send me a copy. And though they did notify me by IRIS that they did not find it in the file - they did NOT send me a VCAA notice telling me of alternative forms of evidence I could submit, they did NOT mention in the SOC that his discharge physical was missing. They did NOT discuss any evidence that was submitted that was in support of the claim. They did NOT fulfill their heightened duty to assist. After my first denial, I once again started requesting that they find his discharge physical. I notified them that it wasn't in his C-file when I obtained a copy, but that other veteran's records were in my husband's file, and I requested they look in the other veteran's files to see if my husband's discharge physical was in them. They told me they sent me everything they had. And once again, they did not send me a notice of alternative evidence I could submit, they did not mention that his discharge physical was missing from the record, they did not fully discuss the evidence in the record that supported the claim (as required in their heightened duty to assist), etc. in the SSOC. So I really don't think the VA should get by with saying that they did everything possible to assist you because they sent a VCAA notice.

"Praise the Lord and pass the ammunition".

There is nothing that makes them want to diagnose something quicker than claiming for an undiagnosed illness. And then they just leave it at that....without bothering to develop whether the diagnosed illness should be granted SC.

Such WONDERFUL news! Thanks for sharing!

Good luck with that one! In my son's Social Security Survivor claim the decisions kept saying my son was not living with my husband when he died. I objected to this because - GEEZ - they reduced my son's SSI on the basis that he received in-kind support from my husband (i.e. room and board). So how could SSI reduce his benefits because he was living with my husband, but SSA deny his claim because he was not living with my husband? He was either living with us or he wasn't. It seemed rather odd that two branches of the same agency (kind of sort of) could each make different decisions on the matter. Anyway - when I went to review the file before my son's hearing - I noticed an amendment to his application. The amendment stated that my son was reporting that he was NOT living with my husband at the time of his death. The amended application was "electronically signed" by my son (supposedly). It also stated that he had 10 days to disagree. I filed an objection with the judge and stated that as this was the first instance that we even knew my son's application was amended, and that it was amended without his knowledge or consent, that we requested the 10 days to object be waived, as we were objecting within 10 days of our knowledge of the document. I also added that to my discrimination complaint that we filed with the General Counsel. I noted that for a SSA employee to amend my son's application, and electronically sign the amendment without my son's knowledge or consent, while he was adjudicating my son's claim, was fraudulent. My complaint also showed that we were not aware of the amended application until immediately prior to the hearing, and that we objected to the amendment within a few days of discovering it. The General Counsel's response? It wasn't fraudulent because the amendment clearly stated we had 10 days to object from the day it was signed, and we did not object within the time-frame. They have people all the way up the chain that will cover for their dirty little deeds....

"How can they outright deny me for body rash?" They probably felt like they had to deny something and so their computer wouldn't shut down from writing granted too many times.... Congrats on your semi-success!

PG rated of course.....

I think the neck issue is particularly aggravating to me because they just danced around that for years. Yet, when my husband was on hospice he was prescribed morphine. He had lung cancer and a pancreatic mass. But every time he asked for morphine for pain, and I asked where he was hurting, he replied "My neck." So damn it! When a terminal cancer patient only asks for pain medicine because his neck hurts - it just grinds my soul to read all their drivel they created to keep from paying him benefits for the condition. He hurt his neck in service. He claimed it on discharge. Each exam showed some limited range of motion. They finally took an x-ray that at least showed some of the arthritis. And they still didn't grant SC. And it hurt him until he died.

Ahhh.. but he is still going to keep me guessing as to how he contacted the BVA that made other people think he was out of his mind... I can use my imagination and come up with many scenarios. Some of them would actually make good movies.

Ah! You both a wonderful!!!! BUT -- can I ask for a remand on the other (non-cancer) issues - to kick them down the road a bit without losing the right to them?