[Falling Off A Deuce And A Half]

In another topic I referred to falling off the tailgate of a deuce and a half with a cast on my leg for a sprained ankle.

A fellow asked...

"Is there a record of the incident of falling out of the 2 1/2T? Medical, or otherwise?"

There is.

Well documented in fact. It was noted in my medical records since the cast had to be checked as it was thought to have cracked. I have a support letter from my former Battery Commander (artillery) that mentions that particular event and I have the letters I wrote home to my parents at the time describing it. That enough? :P

I bring this here because he never responded and I would like to know if there is any significance to this. I think the questor was "rentalguy." I'll have to go back and look.

[Service Connected Osteoarthritis And Degenerative Joint Disease]

JQ, if you have a "record of severe debillitating arthritis", to what do they attribute that?

Have they said?

No. No comment as to cause at all.

I see my Dr. next week and am going to try and get him to put it in his progress notes.

[Service Connected Osteoarthritis And Degenerative Joint Disease]

I am at 40% and in a similar boat with the arthritis but have not worked since 2004. I just yesterday got a SSOC and it stated continued denial of TDIU but made a point of mentioning the record of "severe debilitating arthritis." My ankles, knees hips and back are a mess with neuoropathy too.

I am connected for ankle injury and flat feet so I think they're telling me that if I can convince them my arthritis is service connected, I'll get it. I could then claim the side effects of the heavy meds (methadone for pain) I'm on too.

Can I ask how you got connected for arthritis???

I have scrounged a couple medical studies referring to it but I'm thin on the ground there. My sole provider is the VA and my Dr. there is good to me and conscientious as far as patient care goes, but he won't stretch far enough to flat say my arthritis is caused by my service connected conditions.

[2ndary Conditions Denied, Va Altering Claim]

People don't take methadone for mild pain. It is the number two drug that people OD on, oxycontin being number one I thing. Do you go to the pain clinic? I would make an appointment with the psychiatrist and tell them how depressed you are about this miserable pain you are in for the SC conditions. This could be a good claim. Being in chronic pain sure depresses the heck out of me and I am on wellbutrin and prozac.

I don't know about any pain clinic though I have discussed "pain management" with my Dr.

Depressed? darn right! In my case, I'd say there was something wrong if I wasn't! I'm a recovering alcoholic (20+ years sobriety) and these things scare the the feces out of me (or would if they weren't so constipating). By the same token, I find the thought of taking depression meds more depressing than dealing with life as is!

I just got an SSOC today.

"Entitlement to Individual unemployability remains denied."

"It is noted on the --- VAMC report severe debilitating arthritis; however, service connection for arthritis has not been established. Review of the claim file does not show that you meet the requirements for entitlement to individual unemployability as cited in 4.16."

I've read that thing with bi focals and I can argue that point, especially if you read 4.17.

But it's clear I have to connedt the arthritis to the ankle & feet. At least one of my studies does that. They all connect joint degeneration to flat feet as well as ankle or knee injuries. Again, I think I can argue that. The pain meds are for arthritis and are not worth didly if I can't connect arthur.

[2ndary Conditions Denied, Va Altering Claim]

Here's the VA reg http://www.warms.vba.va.gov/bookc.html#c (from the official website.)

§4.16 Total disability ratings for compensation based on unemployability of the individual.

(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided, That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability:

(1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable,

(2) Disabilities resulting from common etiology or a single accident,

(3) Disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric,

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

There's more but that sums it up for my case anyway.

There are percentage specifications. The help as I see it is in allowance for combinations of connected ratings to meet the criteria. I'm still short and 10% of my 40% would be excluded from combination since it comes from my hearing/tinnitus loss.

I have to get those secondary conditions. They would tie to the single ocurrence and or the flat feet which are bilateral.

[2ndary Conditions Denied, Va Altering Claim]

Need to have Romberg Test for gait problems to see if you are positive!

Never heard of it so I looked it up.

Found this interesting little thing... The Precise Neurological Exam-Coordination, Gait and Romberg Test

They have put me through most, if not all, of those. But I am not sure of the 'Romburg Test.' I have a copy of the progress reports. I'll have to go back through them to see if I can find any reference to it.

[2ndary Conditions Denied, Va Altering Claim]

JayQ,

I'd really like to see what you have as far as medical documentation of the problems an antalgic gait can cause.

If you could just tell me where to find this info on the 'net, that'd help.

"Clinical Assessment of Human gait" http://www.oandp.org/jpo/library/1993_02_039.asp

"Sagittal Plane Blockage of the Foot, Ankle, and Hallux and foot Alignment- Prevalence and Association With Low Back Pain" This is only available on-line as an abstract unless you're a subscriber. But you can get a full copy through the Library...

Journal of Chiropractic Medicine Vol. 5, Issue 4, Winter 2006, pages 123-127

This next isn't a study but a letter from a Physical therapy establishment. Called "As the Ankle Turns." I dn't have the link but you shouldd be able to punch it up. Can't say if this would help either but I got it.

Punch in "Altered Gait" and you'll get a ton of stuff. There are many VA and WorkeMan's Comp case and appeal reports. They may do to establish precedent. Don't know, I haven't tried it yet.

[2ndary Conditions Denied, Va Altering Claim]

My question to you is what has/does the medical evidence in your claim show? Do you have current medical evidence that states you gait is the cause of the knees and back. They can be secondary to bad gaits but has your doc said so?

No. They've avoided making any statement about that like the plague. :P

Seperate question.

What's "VA OGC" VA Office ? ?"

[2ndary Conditions Denied, Va Altering Claim]

The way for you to win this at this point is going to be one issue at a time. I'm not real sure of what all has happened here, so let me ask a few questions.

1. What is the documented medical diagnosis on your back, and what was used to prove this?

2. Have you filed a claim for SC for your back, or did you file it as secondary to something else?

3. If you have filed a claim for your back, has it been at least a year since you were denied?

4. Is there a record of the incident of falling out of the 2 1/2T? Medical, or otherwise?

This should be the staring point. You're going to have to get all of this information together and file the claim in VA language. Then, once you have the back SC move on the the next item. BTW...welcome to Hadit!

Thanks for the welcome and thanks for all the replies. I'll have to print these out so I can study them in detail.

I believe you're right about one issue at a time. I sort of started that with going at the flat feet. I honestly believe combined bilateral 10% is an accurate assignment though I'd like to see 10% each. But that ain't gonna happen.

The records show that my ankle is max @ 20% so there's nothing more to do there.

My biggest target now is the issue of secondary condition. I figure if I can break their line there, I can defeat them in detail on the rest. :P

The biggest link I see to that is the issue of "altered gait." Yes?

To answer in detail...

1. What is the documented medical diagnosis on your back, and what was used to prove this?

That's the bad thing. There is no "diagnosis." It's my weakest claim. I saw chiropractors back in the 1980s & 90s. One is retired and has expunged those old records. Another expunges his after 5 years. The one I saw in the 90s is out of practice and gone Lord knows where so no help there.

Then in the machine shops, if you want to keep working, a "back ache" is one thing you never have. I actually reported off one week with the flu when I was down in my back. I have a few doctor's reports, mainly for muscle relaxers for back pain. I have been solely a patient of VA since 2004 and have their treatment records for periodic back pain. I fear as I stand right now I'm technically "intermittant" and not "chronic." Their X-ray studies indicate "mild degeneration of..." I'd have to look to see exactly what.

2. Have you filed a claim for SC for your back, or did you file it as secondary to something else?

(herein my lie my problem) I first made a claim in 2004. I had to get a letter for entry into service for a trick knee. I was accepted as the examining physician found nothing serious enough to prevent service. My VSO claimed the knees as an aggravation of prior condition and back as secondary to them.

We were flying on a wing and a prayer as my medical records were lost in service and unseen since 1980. I was denied since VA couldn't find them either.

The missing records showed up from NARA in 2005 and we filed a new claim. The records showed the diagnosis of flat feet (which I had known about but couldn't prove exsisted in service) The new claim requests "service connected disability as secondary condition for left knee, right knee, and lower back due to stress and strain placed on them taking up the slack for the L ankle." I grant it could have been worded better but still it's in there. I have also since filed a couple of 21-4138 as well as plain old fashioned letters explaining the difference citing and providing copies of this claim. They are dating everything from this '05 claim not the 04 so there should be no confusion.

3. If you have filed a claim for your back, has it been at least a year since you were denied?

No

4. Is there a record of the incident of falling out of the 2 1/2T? Medical, or otherwise?

Well documented in fact. It was noted in my medical records since the cast had to be checked as it was thought to have cracked. I have a support letter from my former Battery Commander (artillery) that mentions that particular event and I have the letters I wrote home to my parents at the time describing it. That enough? Though adding to my pain quotient, no particular injury from it was noted.

[2ndary Conditions Denied, Va Altering Claim]

That sounds like some good advice. I have not as yet applied for SSI. I figure one battle at a time. I guess maybe it's getting to be the time. But what about this? As I understand it, if I get VA SC disabilityfirst, then SSI, I can keep both. But if I get SSI and then VA dis. VA will deduct my SSI from that total rather like concurrent receipt. On that basis I have been living lean (very lean!) trying to win my VA before taking the SSI. Too, many of my years of employment were low pay so I don't have that bloody much to draw on and am only 52.

"TDIU"? I expect the IU= "Individual Unemployability." Don't know the 'TD' part. Actually we had filed for that. But as I understand it, you have to have a total rating of 70% or a combined rating of 80% to get that. The IU was denied and is still in the claim. I just haven't made a focus of it for now, fighting this other.

As for the internet reference, many "journals" are now posted on line, some solely so. I had submitted some such with my worn boot pictures and those were sighted as evidence in changing my ff rating from 0% to 10%. So I figure it wouldn't hurt to go it again. At least somebody looked at them.

Another factor for IU is my background. I was a truck driver, construction worker and factory worker even before becoming a machinist. I have no education for more sedentary employment (barely graduated from high sch. and sustained physical labor is beyond me now. And yes, the meds are a contributing factor. I also have 'restless leg syndrome.' I am not claiming that but am medicated for it too. As it happens, I have been unemployed since 2004 and VA is my primary care (read only) provider.

Unfortunately my last employer laid me off for "economic reasons." But my condition had deteriorated by that time where I couldn't get work in my line especially. I have 10 pages of job searches. Even Walmart, Lowes and Home depot turned me down.

VA has thoroughly avoided the issue of altered gait. In fact, my first C&P exam, the doctor slammed me. Stated "gait normal." Then later stated "cannot raise on heels sufficiently to test gait." ?! :P I can walk alright so am not sure what that means. I use a cane mainly because I am prone to stumble and fall. Also my ankles turn easily and knee will buckle. If not supported, I go down. But the Phy Therapist that prescibed the knee brace said I "roll like a sailor." In the denials, they are silent on the altered gait issue.

I have written senator and congressman. They write VA, VA sends them a letter saying everyrthing is as it should be, and the sena/essman forward a copy back to me. But my file was pulled from the rater's office and sent to congressional. No telling how long before it gets back or where in order it goes. I have let that go since then.

I'll look up that article about getting an IMO. I have considered that but money is so tight, I have to have specific direction before I go that route. Every $ spent is taken from something else. I also have a wife & kids under 17. Yes I draw for them too. So every cent (we have paid bills with rolled pennies.) has to be watched.

A good source for medical and midicine info is WebMD. A long known and trusted pharmacist recommended it.

I hope this additional info helps. It has been and remains a long and rocky road.

[2ndary Conditions Denied, Va Altering Claim]

Hi everybody. First post here. I have tried searching but have not found much particular to my case. I am not used to this format and it's slow on rural dial up.

I am 40% overall, 10% hearing/tinnitus SC, 20% L ankle SC, Flat feet 10% SC.

I know this is going to sound trivial. Heck it does to me! :( But I'm a physical wreck now.

I sprained an ankle in service.(1974/81 US Army) While in cast we had an alert and I fell off the back of a deuce & a half. Hurt like blazes but they said it didn't hurt anything. Then had the cast off two weeks later and returned to duty. I was also diagnosed with flat feet in my second hitch.

Now both ankles, knees, hips & lower back are bad with peripheral neuropathy (I am not diabetic) thrown in. I am described in records as having "debilitating arthritis" and walk with a cane. I wear a rigid, authorized by VA, knee brace. I was a machinist but can no way work it now. Am on methadone and other "as needed for pain" meds. As noted above, I'm granted SC for feet & ankles. My records note me as having "altered gait/transferring."

But I am repeatedly denied any consideration for secondary conditions. They describe my conditions as "mild" with pain being the greatest limiting factor.

One infuriating thing is that they are rewording my claim and denying items on that basis. I claimed my bilateral knee, hip, and lower back condition with neuropathey as secondary to SC ankle & feet. But they say I claim my knees as SC (I did not) and since there's (naturally! :P ) no record of complaint in service, they're denied.

Then they say I claimed my back as secondary to my SC knee claim (not so!). Since the knees are denied, the back can't be connected! I have sent in copies of my original claim a number of times and they keep coming back to this. These claims were prepared with a well experience VSO.

VA also denied my shoulder but that's okay because I never claimed it. I expect it did add useless wait time to the process now that I think of it, however.

I've been going r'round and 'round with this since the summer of '04. I got flat feet upgraded from 0 to 10% when I sent in pictures of worn boots and got another exam. (I unfortunately wore my seldom worn dress shoes to C&P exam.)

Now I have amassed a pile of documentation, i.e., other similar cases, VA & workman's comp, granted, medical journal papers, all linking the above mentioned conditions and arthritis too, to flat feet and ankle problems. Think that will have any effect???

Sorry this is so long but this hasn't happened overnight either. I have had initial claim result, NOD denied, and am on the list for the traveling board but VA has granted the FF increase as noted above when I sent in new evidence. I am preparing another NOD including the information I mentioned.

BUT! How do I get them to straighten my claim and quit altering it?!