Proving In Service Connection

[hayley3]

They say in the denial that I failed to relate the arthritis condition to the service connected condition.

How can I show them that it is connected? What concrete evidence are they looking for? It almost seems like they didn't read anything I said.

This is what I typed up:

Timeline of disease history:

Cervicitis (treated in service) Symptom of reactive arthritis

Hemorrhagic Cystitis (treated in service) Symptom of reactive arthritis

Salpingitis infection (PID) resulting from the cervicitis/cystitis: Symptom of reactive arthritis (treated in service and service connected)

Acute knee pain (treated in service) Symptom of reactive arthritis

Back pain (sacroiliac arthritis) Result of reactive arthritis or inflammatory bowel disease.

I don't have the symptoms of inflammatory bowel disease (IBD) nor did I have an intestinal infection prior to the arthritis which is what causes IBD.

But like I said, my Dr was a jerk. The resident said it was reactive arthritis but the Attending? said it could be either Reactive or (IBD). I had a colonoscopy which should have ruled out the inflammatory bowel disease(IBD) because they found nothing but a polyp.

Anyway, I just thought I'd pass this by someone who may have some ideas. I think they didn't do their job.

[carlie]

"Timeline of disease history:

Cervicitis (treated in service) Symptom of reactive arthritis

Did you provide information relating to SMR's -- copies of SMR's would be good.

Hemorrhagic Cystitis (treated in service) Symptom of reactive arthritis.

My same opinion goes here.

Salpingitis infection (PID) resulting from the cervicitis/cystitis: Symptom of reactive arthritis (treated in service and service connected)

What percentage of service connection did VA grant for this disability ?

Acute knee pain (treated in service) Symptom of reactive arthritis

Did you provide information relating to SMR's -- copies of SMR's would be good.

Back pain (sacroiliac arthritis) Result of reactive arthritis or inflammatory bowel disease.

Medical doctor will need to provide a nexus.

I don't have the symptoms of inflammatory bowel disease (IBD) nor did I have an intestinal infection prior to the arthritis which is what causes IBD."

Medical doctor will need to provide a nexus.

Research sites for you:

38 CFR - Part 3 - Adjudication

http://ecfr.gpoaccess.gov/cgi/t/text/text-...fr3_main_02.tpl

38 CFR - Part 4 - Schedule of Rating Disabilities

http://ecfr.gpoaccess.gov/cgi/t/text/text-...fr4_main_02.tpl

M21-1MR

http://www.warms.vba.va.gov/M21_1MR.html

Hope this helps a vet.

carlie

Edited May 15, 2007 by carlie (see edit history)

[Former Member]

"They say in the denial that I failed to relate the arthritis condition to the service connected condition.

How can I show them that it is connected? What concrete evidence are they looking for?"

You need to copy and highlight for them the SMRs that show:

Salpingitis infection (PID) resulting from the cervicitis/cystitis: Symptom of reactive arthritis

(treated in service and service connected)

They probably dont know exactly what reactive arthritis is:

http://www.medicinenet.com/reactive_arthritis/article.htm

Are you able to afford an Independent medical opinion?

In the underlined statement of the VCAA letter they sent you- what did they specifically ask for regarding the reactive arthritis claim?

Is this condition noted on your discharge physical also?

[Former Member]

"It almost seems like they didn't read anything I said."

Veteran I just went through 5 years of VA BS- all of the claims filed and all the stuff that went with them and all of the SOCs and denial letters (a copy of my C file)

I found right in the c file something the VA said they didnt have- yeah right-

I just said the very same thing to myself!

The VA in initial letters for each claim NEVER gave me the right decision and never read the evidence until I got tough.This involved DIC as well as Chapter 35 and other

stuff.

I won all of those claims ----still I have years and years of VA BS here- and some of the denials were extraordinary.and very creative.

and all were blatantly wrong.

I even filed for an Administrative Review in VA Central in DC at one point.

The VA lawyer called me up within days- he said they never get these requests -he only saw one before mine and it was from a VA employee-and he wondered why I filed it-

and I said because VACO has lawyers and lawyers know how to read.

I could not find anyone at the Buffalo RO who seemed to have that ability.

Well long story-I won that one too-

but I noticed that-in many submissions of my evidence on these older claims- someone at VA had highlighted part of the statement but failed to address the medical evidence it reffered to at all.

I knew the c file had what VA said recently wasnt there but I took the time to check it anyhow- and I hope this encourages someone-

denial after denial, fight after fight, considerable overwhelming evidence----

and years later the war of the words was over.

The evidence that they listed in the initial denials never changed-it was all in the veteran's medical records-

but it took them years to read it.

That is why Persistence as well as evidence is the name of the VA game.

Edited May 15, 2007 by Berta (see edit history)

[hayley3]

I have none of my service medical records. But they have copies.

What exactly do you mean the medical doctor will need to provide a nexus. I know that nexus means link. I'm assuming you're saying that, no matter what's in my records, if the Dr doesn't come out and say it, it means nothing.

Thanks

"Timeline of disease history:

Cervicitis (treated in service) Symptom of reactive arthritis

Did you provide information relating to SMR's -- copies of SMR's would be good.

Hemorrhagic Cystitis (treated in service) Symptom of reactive arthritis.

My same opinion goes here.

Salpingitis infection (PID) resulting from the cervicitis/cystitis: Symptom of reactive arthritis (treated in service and service connected)

What percentage of service connection did VA grant for this disability ?

Acute knee pain (treated in service) Symptom of reactive arthritis

Did you provide information relating to SMR's -- copies of SMR's would be good.

Back pain (sacroiliac arthritis) Result of reactive arthritis or inflammatory bowel disease.

Medical doctor will need to provide a nexus.

I don't have the symptoms of inflammatory bowel disease (IBD) nor did I have an intestinal infection prior to the arthritis which is what causes IBD."

Medical doctor will need to provide a nexus.

Research sites for you:

38 CFR - Part 3 - Adjudication

http://ecfr.gpoaccess.gov/cgi/t/text/text-...fr3_main_02.tpl

38 CFR - Part 4 - Schedule of Rating Disabilities

http://ecfr.gpoaccess.gov/cgi/t/text/text-...fr4_main_02.tpl

M21-1MR

http://www.warms.vba.va.gov/M21_1MR.html

Hope this helps a vet.

carlie

[hayley3]

I forgot to say I'm 50% sc for a hysterectomy because of the PID/cervicitis.

I sent them tons of information on reactive arthritis (maybe too much)

Rheumatologists are very expensive and this is an immune disorder and I don't have insurance. I was so sick in 2000 that I had to quit my job and I worked for the VA hospital! I am raising a child on very little money.

I don't know what a VCAA is. But the only thing I remember them asking for is the addresses and phone numbers of all the physicians I had seen when I had insurance. I wouldn't know if it is on my discharge physical. My discharge was in 1982 and that's why this is so hard for them because it's been so long since it started.

They also said that the MRI failed to provide a diagnosis but they did the MRI of the wrong area.

Thanks!

"They say in the denial that I failed to relate the arthritis condition to the service connected condition.

How can I show them that it is connected? What concrete evidence are they looking for?"

You need to copy and highlight for them the SMRs that show:

Salpingitis infection (PID) resulting from the cervicitis/cystitis: Symptom of reactive arthritis

(treated in service and service connected)

They probably dont know exactly what reactive arthritis is:

http://www.medicinenet.com/reactive_arthritis/article.htm

Are you able to afford an Independent medical opinion?

In the underlined statement of the VCAA letter they sent you- what did they specifically ask for regarding the reactive arthritis claim?

Is this condition noted on your discharge physical also?

[SLEDGE]

hayley3,

A doctor who specializes in your particular medical problem needs to examine you AND your inservice medical records so the doctor can establish, on paper, the most probable CAUSE of your medical condition and WHEN it was first treated and HOW the inservice medical condition is directly related to your present medical condition.

The inservice medical condition has to be connected to your present medical condition through the opinion of a true expert within that particular medical specialty.

The opinion should be as short as possible so the person reading it at the VA doesn't get bored.

It needs to spell out in plain language why the medical condition is directly connected to your service.

The doctor has to list his qualifications.

If you can supply supportive statements to back up your service connection contentions, from friends and/or relatives, be sure to have their signatures notorized and dated.

Then be prepared for a stupid denial that does not reflect the actual facts as they existed at the time that you submitted them to the VA.

sledge

[hayley3]

Thank you Berta! I used to say those same things, because they are true. But,

I lost the ability to fight like I used to. I always said that, you will win if you are right and persevere, but it is so hard. Keeping up with day to day is hard enough.

I have had to fight so many doctors to try and understand how sick I was, and no one would listen because the lab tests never showed anything and the whole time my back was disintegrating. And VA doctors are the worst. This last rheumatologist I saw, mentioned that he didn't like people getting diseases service connected and said something about veterans being there just for the money. And so I think he didn't give me a diagnosis for that reason.

Thanks for the uplifting talk. It really helps!

Susie

"It almost seems like they didn't read anything I said."

Veteran I just went through 5 years of VA BS- all of the claims filed and all the stuff that went with them and all of the SOCs and denial letters (a copy of my C file)

I found right in the c file something the VA said they didnt have- yeah right-

I just said the very same thing to myself!

The VA in initial letters for each claim NEVER gave me the right decision and never read the evidence until I got tough.This involved DIC as well as Chapter 35 and other

stuff.

I won all of those claims ----still I have years and years of VA BS here- and some of the denials were extraordinary.and very creative.

and all were blatantly wrong.

I even filed for an Administrative Review in VA Central in DC at one point.

The VA lawyer called me up within days- he said they never get these requests -he only saw one before mine and it was from a VA employee-and he wondered why I filed it-

and I said because VACO has lawyers and lawyers know how to read.

I could not find anyone at the Buffalo RO who seemed to have that ability.

Well long story-I won that one too-

but I noticed that-in many submissions of my evidence on these older claims- someone at VA had highlighted part of the statement but failed to address the medical evidence it reffered to at all.

I knew the c file had what VA said recently wasnt there but I took the time to check it anyhow- and I hope this encourages someone-

denial after denial, fight after fight, considerable overwhelming evidence----

and years later the war of the words was over.

The evidence that they listed in the initial denials never changed-it was all in the veteran's medical records-

but it took them years to read it.

That is why Persistence as well as evidence is the name of the VA game.

[hayley3]

How do you go about getting a different doctor? Unfortunately my primary care doctor is a friend of the rheumy's. How can you get a copy of your medical records from you military time?

hayley3,

A doctor who specializes in your particular medical problem needs to examine you AND your inservice medical records so the doctor can establish, on paper, the most probable CAUSE of your medical condition and WHEN it was first treated and HOW the inservice medical condition is directly related to your present medical condition.

The inservice medical condition has to be connected to your present medical condition through the opinion of a true expert within that particular medical specialty.

The opinion should be as short as possible so the person reading it at the VA doesn't get bored.

It needs to spell out in plain language why the medical condition is directly connected to your service.

The doctor has to list his qualifications.

If you can supply supportive statements to back up your service connection contentions, from friends and/or relatives, be sure to have their signatures notorized and dated.

Then be prepared for a stupid denial that does not reflect the actual facts as they existed at the time that you submitted them to the VA.

sledge

[carlie]

If you check out the recently posted topic --titled -- Questions, you will find quite a few answers to your current and upcoming questions.

Hope this helps a vet.

carlie

[LarryJ]

"How can you get a copy of your medical records from you military time?"

Write a letter to your local VA Regional Office, requesting copies of ALL your Service Medical Records, to include all doctor's and nurse's notes.

Then wait a little while and this big package will show up. Or, you could tell them to hang on to it and you'll be by to pick it up, for them to call you when they have it.

And, as far as your VA quacker making statements, or even acting like, you're there to bilk/milk the VA, then him doing so is strictly against VA Policy and Procedure and you should see your Patient Advocate and have a little visit with them concerning this quack's attitude, and request at that visit that they provide an unbiased primary care physician and an unbiased specialist. Put the above in writing. Turn it over to the Patient Advocate. Request an acknowledgement that you did, in fact, give the Patient Advocate such a document.

[Pete53]

I got my Service Military Records from St Louis. After filing my claim the second thing I did was ask for them.

When you are having problems with the VARO the only way to cure in my opinion is to get an MD Medical Opinion that establishes a diagnosis and links it to service.

Good Luck

[john999]

A good medical opinion can turn your claim around 180 degrees. It is worth every penny you pay for one if it does what it is supposed to do which is get you SC or an increase. My IMO's got me TDIU and then got me P&T and it cost me 500$.

[hayley3]

Thanks everyone and an update

Thanks Larry! I will request the records. I really should have got the doctor in trouble in the beginning when he said it. I'm afraid I waited too late.

Thanks Pete and John! I went back and looked at the VA outpatient records and in 3 different visits after the xrays, he says I probably have reactive arthritis. He says it could be reactive arthritis in another visit. And then in another visit, the resident says it's probably reactive arthritis and the attending agrees with him. Why is that not good enough????? What happened to that "benefit of the doubt"?

Also, I have decided that I would attempt to see a rheumatologist I had seen in the past, at my expense. (Now remember I have no money) I called them up and she said I could get an appt, (which is a miracle for a rheumatologist without waiting 3 to 6 months) The appt is scheduled for June 18. So I was excited and she says it will be about $300. I can handle that, until she tells me they only accept cash!!!!!!!!

I was going to use my credit card. If you get cash off your credit card the interest rate jumps to $25%. But I guess I'll do it, because August is my cutoff date for submitting new information. I have only asked the Rheumy for a second opinion visit. I am gathering all of my bloodwork and outpatient appts that are relevant including xrays and mri reports. If he won't give me a definite diagnosis, (which I doubt on only one visit) and will only suggest a mri for further evaluation, would that be enough to submit to the VARO to extend my date?

Thanks for any help!

[Vike17]

hayley3,

"I went back and looked at the VA outpatient records and in 3 different visits after the xrays, he says I probably have reactive arthritis. He says it could be reactive arthritis in another visit. And then in another visit, the resident says it's probably reactive arthritis and the attending agrees with him. Why is that not good enough????? What happened to that "benefit of the doubt"

Let me try to explain this for you. First, the "benefit of the doubt" is afforded to the veteran when all the evidence for the claim is weighed by the decision maker and that weight given to the evidence by that decision maker results in an equal balance of evidence for the claimant and against the claimant. When this happens the "tie goes to the runner" or the "benefit of the doubt goes to the veteran. So now this is where thoses phrases of "proabably, and "could be," comes into play. Well, actually they don't come into play. According to the CAVA,, not VA, they have determined that legally there should be the words "at least as likely as not," which means 50/50 possiblity, written when reasonable doubt comes into question. With this phrase the VA can legally resolve the benefit of the doubt in the claimants favor.

Vike 17

[spike]

Just my two cents when I have an IMO done. I ask them to state that it is more likely than not due to service connected injuries. Especially if state the reason. I.E. For my back, it was more likely than not that my lumbar disc disease (L4 and L5) are related to the injury occured in the U.S. Corps in April 2000. I usually bring a copy of the records for them to review....(treatments). My IU claim indicated the physician has reviewed my medical records and has been treating me since ( ) and it is more likely than not that I will not be able to obtain or sustain gainful employment due to my service connected disabilities (list them here).

When I have other vets ask me, I usually recommend a few physicians. Tell them to get a few treatments, then I hand them a prewritten form (basically what the CFR states for the rating schedule), have them bring the records from the VA (a free copy of your treatments can be obtained through correspondence...claiming freedom of information act), bring a COPY to the physican and have him review and make the statement on his or her official letterhead. I submit that with or after we make a claim. It usually helps speed the process along. What are your thoughts.

[hayley3]

Thanks Vike! Well, I think that's retarded, because probably technically means the same as "at least as likely as not". Only the VA..........

What is CAVA?

Let me try to explain this for you. First, the "benefit of the doubt" is afforded to the veteran when all the evidence for the claim is weighed by the decision maker and that weight given to the evidence by that decision maker results in an equal balance of evidence for the claimant and against the claimant. When this happens the "tie goes to the runner" or the "benefit of the doubt goes to the veteran. So now this is where thoses phrases of "proabably, and "could be," comes into play. Well, actually they don't come into play. According to the CAVA,, not VA, they have determined that legally there should be the words "at least as likely as not," which means 50/50 possiblity, written when reasonable doubt comes into question. With this phrase the VA can legally resolve the benefit of the doubt in the claimants favor.

Vike 17

[hayley3]

Ok Spike, are you saying you tell the doctor what to say and they do it?

I have never had any doctor agree with me. Maybe this could be the first.

Rheumatology is more art than science, so we'll see. And my arthritis has no specific, lab tests and fits more into a category. Hard to explain, which is why it's taken me so long to even get an xray.

Thanks for the ideas though. I need every idea I can get.

What do you mean about claiming information of freedom act? I'm getting ready to ask for my records, is there something else I need to include before I mail it to speed up the process?

Just my two cents when I have an IMO done. I ask them to state that it is more likely than not due to service connected injuries. Especially if state the reason. I.E. For my back, it was more likely than not that my lumbar disc disease (L4 and L5) are related to the injury occured in the U.S. Corps in April 2000. I usually bring a copy of the records for them to review....(treatments). My IU claim indicated the physician has reviewed my medical records and has been treating me since ( ) and it is more likely than not that I will not be able to obtain or sustain gainful employment due to my service connected disabilities (list them here).

When I have other vets ask me, I usually recommend a few physicians. Tell them to get a few treatments, then I hand them a prewritten form (basically what the CFR states for the rating schedule), have them bring the records from the VA (a free copy of your treatments can be obtained through correspondence...claiming freedom of information act), bring a COPY to the physican and have him review and make the statement on his or her official letterhead. I submit that with or after we make a claim. It usually helps speed the process along. What are your thoughts.

[Pete53]

Ok time out.

You are asking the Doc to use the language of the VA. The Doc's opinion is still their own. Its tough but its worse when you wait a couple of years and get denied and have to go back and do it again.

Good Luck

I would just say Doc the VA is anal and they have to have this phrase. Would you mind working it into the opinion letter it would really help me out. Thank you.

[Kirk]

Perhap I was lucky with my case, but I had a VA doc write "probably" and a civilain doc say "presumably" and both were weighed evenly by The BVA. On the other hand I was denied at the VARO first.

[Hoppy]

haley3,

If the doctors who you have been talking to have not reviewed your SMR then their opinion is not credible evidence whether they agree with you or not. If you keep reading appeal cases or adjudication law you will notice that a doctors report that is based on the veterans verbal statments and without review of the SMR can not be used as evidence.

The doctor needs to read the SMR and the post service medical reports and write an opinion that there is more likely than not a nexus. If the doctor were to write that there is at least as likely as not or a 50%, 50 chance that is when the benefit of the doubt rule would come into play.

Your SMR needs to show a chronic condition in the military or at least a diagnosis of symptoms in the military that through continuity of treatment after service can establish that you have a chronic condition currently that was due to military service. Merely having the same diagnosis in service and post service is not sufficient for service connection. However, it should have been sufficient to cause the RO to schedule a C&P exam to resolve the nexus isssue. If you get your SMR and post service reports with the same diagnosis take them to your SO. let us know on hadit and possibly take them to a senator and complain that you deserve a C&P to resolve this issue.

If you have an SO the SO was expecting the VA to see the obvious connection between your in service condition and your current condition. If you were denied then the nexus did not jump of the page and now you need to get a doctor to address the nexus issue.

It is not uncommon for the VA not to make the association of the nexus and cases are won when they are denied in the manner yours was denied. I also had a big problem with VA doctors not wanting to get involved and even lying about there ability to assist. You need to get the SMRs and take them with you and make the doctors put there opinion in writing in your file. Get your SO to help you get the nexus letter in the proper format for the VA.

The doctors who failed to help you probably did not even write it up. If they did, it could say you had no evidence of a medical condition in the military in your possesion. They just are not required to take your word for it. If you have a valid claim they are less likely to give you the run around if you make them put there opinion in writing whether they agree or disagree with you. Once they put something in writing that is bogus then you can file a complaint against their license. If they just verbally ignore you then complain to customer care at the VAMC that they are failing to get invloved. This worked for me and they sent me to a staff doctor who was willing to write a report. That report got me 100%. They ran me around for five years before I found hadit and got the nexus letter.