Opinions On Ltr To Support Claim

[ruby]

Trying to make this usable for both SSA and VA any opinions would be nice, do you think it covers both service connect (active 75-78) and depression due to condition.

I am writing this letter on behalf of my patient xxxxx. I first saw xxxx in 1983-1986, then from 2005 to present.

Ms xxxx symptoms have been steadily increasing in magnitude since 1977 when it was noted she had reactive arthritis in her sacroiliac joints, xxxx has progressively worsen over the past 2 years. It is my opinion the arthritis in all joints Ms xxxx suffers from is related. I would consider her to be permanently and totally disabled due to her arthritis as dictated in my notes.

Due to the magnitude, scope and complexity of this patient’s condition it is unreasonable at this time to expect that she will be able to work at any time in the near or distant future. At best, medication can only decrease the rate of progression in this chronic arthritic disease. In my opinion, this patient would be a liability to any employer, and would be unable to sustain gainful employment of any sort, due to her physical, mental emotional and psychological limitations.

I have included a residual functional capacity form to help further assist you in your evaluation of her claim

Sincerley,

[Ricky]

Ruby just my opinions: First you said that you were trying to service connect you arthritis. This letter will need to be beefed up in order to do that. First you must mention something about him reviewing your pertenant service records. The letter mentions that he treated you from 1983-1986 then 2005 to present. Then it goes into him speaking of the increase of your symptoms from 1977 - from that date, as written all of that time period is based solely upon your statements to him about your disability. This is not good as they will simply come back and say that his entire opinion concerning your service connection is based entirely upon what you have told the doc. This is not good and goes back to a statement that is needed by him saying that he either reviewed your service medical records or at least the pertinent service medical records.

"It is my opinion the arthritis in all joints Ms xxxx suffers from is related" - what is this statement based upon? Once again a much needed review of the service records is needed here. Also he will have to provide a rational of his opinion. It can not simply state that it is my opinion that her current disability is related to her service. Some how you are going to have to provide proof of continued treatment or something which would lead a normal person to have a rational belief in this opinion.

Remember IMO's must be able to provide a clear cut relationship to your current disability and your service along with a very good rational to back up the opinion. Please tell us what happened between 1977 and 1983 and maybe we can be of more help.

[ruby]

Thanks Ricky

I was dx with reactive arthritis in 1977 while on active duty by xrays and it is documented in my records- but no one told me. I was service connected for degenerative in the neck, wrist and foot. I didn't know I had reactive arthritis until 1983 when it was dx by this same doctor.

I just went through my records and it showed xray are worsening of the SI joints in 5/79.

I was seen for back and leg pain on several occasions in 79. I was DC 9/78.

If I had minimal changes noted in 77 and 16 months later its much worse according to xray report, it would appear to me if I had this before I went it I could not have passed the PFT and I would have sought trmt for low back and leg pain, which I didn't

At that time 1985/86 I applied for an increase they remanded it for more medical evidence--I didn't have anymore evidence to give them so I walked away and said the heck with it.

From 86-2005 I didn't see a doctor for this, I took 2400 mg of motrin for the past 20 years it helped most of the time.

If I screwed up by not doing anything in 86 regarding this REMAND, then I lose everything, except my orginial 10% they gave me, its been 20 years.

In my ltr of support I pointed out to the rater that I was dx with this 2 yrs after I went into the service and I managed to pass my PFT's the entire time, if in fact I had this prior to the service it would appear to me I would not have been able to pass the PFT.

I also pointed out that I had 3 entrance exams due to the delayed entry program all 3 said no problems. I admitted being hospitalized for headaches and that I had childhood asthma, why would I lie about this, it makes no sense.

I really need help on how to write this for both the VA and SSD.

I will re do and ask for help on the new one. I have an appointment with the rheumatologist on 12/26 I was hoping to have this done by then so he could sign it.

[Ricky]

Ruby - thanks for the update. If I understand correctly you are service connected already for the condition, therefore, the question of service connection is mute.

I also understand that you are now trying to get an increased rating with an EED back to 1985. Is this correct?

I also understand that in 1985 the board remanded your claim back to the RO for additional evidence which you did not supply therefore, the claim for increase was denied. Is this correct?

If all of my assumptions above are correct then why are you preparing a letter as you have which indicates that you are trying to obtain service connection on a condition that is already service connected?

If I were you, I would make my appointment with the doc. And put in a claim for an increase. Without being able to review your claims folder it is hard to determine exactly what is going on. Not your fault just that your claim is fairly complex since you did not comply with the remand in 86. I first thought would be that if you did not comply with the remand then the claim issue was denied and closed. Therefore, outside of a CUE I am afraid you have lost all of that time. Berta or one of the others more familiar with CUE will be able to help you with that.

From what I see the only hope is that the doc you are going to see can review your records and find medical evidence and justify a higher rating prior to the current time.

If based upon his current medical findings your condition is worse, which will allow you to reopen the claim, and he can find previous medical evidence which provides that the condition WAS worse on xxxxx date and he provides you with a medical opinion you may have a chance for an earlier effective date. Maybe some of the others will chime in today sometimes and give you some better advice. However, as I said it is hard to provide advice without being able to review your folder. Do you have a Service Officer? If not I would think seriously about getting one for I think they would be able to properly assist your with this claim.

From what I have read it does not appear you will have a problem with SSDI if you meet all of the administrative requirements.

God bless, have a merry Christmas and good luck with your claim.

Edited December 24, 2007 by Ricky

[john999]

Ruby

I would still want a doctor to say that all these conditions are service connected and explain why. As long as the doctor says you are totally disabled from all work for at least one year that is what you need for SSDI. The VA is a different animal. There the main thing is service connection. If you don't have a medical opinion to support SC the VA may find some way to wriggle out of giving you a higher rating such as IU. You cannot expect them to connect any of the dots. They just see this as an opportunity to deny. It is always safer for a VA rater to deny a claim than to connect it. Get the highest rating possible and then worry about your CUE.

[ruby]

I have been reeading a lot of stuff on this site and I thank all you have contributed to myself and others.

I went the VA doc today and ask if he would sign my papers and and RFC (residual functional )

He did. I didn't read everything and just found where it said I should have state with a doubt, instead of more likely than not--I hope that doesn't hurt me. Here is his note, that he suggested I get today and the letter I wrote that he signed.

What is your opinion on how the rater will respond?

57 yo WF nurse with reatice arthritis since 1977. Shas radiographic sacroilitis bilaterally. Now she reports hydradinitis in groin for 30 yrs. Now she has axillary pustules as well. Her thumb has been become swollen over the past 4 wks eam sausage right thumb 1+ ankles, right knee, laet axilla and right groin active pustules

IMP: reactive arthritis (supected due to hydradidinitis supportiva) spondyolarthropathy.

Plan:

depo medrol injection 40 mg along flexor tendon sheath.

Pt is completely physically disabled permanently

Try doxycycline for pustules 100 mg bid

rc 3 mos

This a rare form of arthritis that is supported in my SMR that I had a "cyst" right groin in 76 and have a 0% rating for scar. I was also seen in the VA shortly after DC for a flare up. I also have lab work that supports another form of arthritis that can be connected to the service. It is thought that I was exposed to 2 possible 3 bacteria's that caused different infection while in the service.

In 30 yrs no one has ever ask about this infected sweat glands that occur primarily in the groin and axilla, so it was never investigated. He also wrote completley and permanently disable in July of 07

Here's the letter I wrote and he read and signed.

To Who It May Concern:

I am writing this letter on behalf of my patient xxxx. I first saw Ms. xxxx in 1983-1986, then from 2005 to present.

I have reviewed parts of Ms xxx service medical records, specifically her enlistment physicals dated December 24, 1974, April 02, 1975 and September 24, 1975 and VCUG note on August 3, 1977 noting irregularity in the sacroiliac joints.

It is my opinion that more likely then not the patients arthritis is service connected based on the information I reviewed.

Ms xxxx symptoms have been steadily increasing in magnitude since 1977 when it was noted she had reactive arthritis in her sacroiliac joints, Ms xxxxx has progressively worsen over the past 2 years. It is my opinion the arthritis in all joints Ms xxxxx suffers from is related. I would consider her to be permanently and totally disabled due to her arthritis as dictated in my notes.

Due to the magnitude, scope and complexity of this patient’s condition it is unreasonable at this time to expect that she will be able to work at any time in the near or distant future. At best, medication can only decrease the rate of progression in this chronic arthritic disease. In my opinion, this patient would be a liability to any employer, and would be unable to sustain gainful employment of any sort, due to her physical, mental, emotional and psychological limitations.

Sincerely,

I don't know if this helps any but he is the director of the department.

Thoughts anyone, I really hope this good enough. I would like to get it mailed tomorrow to the VA rater if it looks like it will help me.

Should I send copies of my smr showing when I was treated for the cyst in the groin?

[ruby]

I don't know how to correct spelling errors (edit my post).

It should read. More likely than not the patients arthritis is service connected based on the information I reviewed.

I don't care if it goes back to 79, 86 or 05, or today I just don't know if I lost my rights since I walked away from the VA in 86 and never responded to thier request. To the best of my knowledge I never recieved any denial of claims, but that was 20 odd yrs ago.

My arthritis is reactive which means I carry a gene and when exposed to the right bacteria at the right time my body will react and cause other problems and not due to any type of injury.