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,

[ruby]

Ruby:

I hope that I am wrong since you already did it I was in your case. I guess I have to high a regard for Doctors.

Pete, there is nothing wrong with having a high regard for doctors, but you have to remember we are all human. While you may not like that I said no money honey, no papers it's a simple fact of life, if they did fill out RFC's and write letters in support they won't make any money.

Health care is not and never will be what it once was, its a business, while before the existence of HMO's and DRG's came into play, insurance companies were paying good money to the Doc's and they could charge for filling out forms, now they can't for most gov forms. In most offices they will say we charge 50.00 to fill out simple forms, and the office does those, that 50 is for him just to sign the form. RFC's are not simple.

If a Doc had just 10 patients a week to fill forms out he would be losing 5-10 hours of income per week, and he isn't going to do that-human nature. Doctor today have up to 500 patients esp if they are part of an HMO.

Just remember that doctors, nurses, tech's etc are people who work with people and they a no different then anyone else. Yes, they do say comments about people when they are out of sight and hearing distant of other patients, but they make them.--Human natu

I have kept my distance from them as a patient and I limit what I tell them. I am in the field and have been for 30 years. I prefer not to be the brunt of thier jokes or sick humor which you must have to work in health care.

If you have good working relationship with a physician that helps, if you do the work for them they will pretty much sign anything for you unless it is a direct contradiction.

While the most intelligent thing for anyone to do is to fill the forms and/or letter out and then put it on a disk, give it to them with instructions on what and why it must be in that format and should they feel the need to change it, they can. Then all they have to do is print and sign-your still taking a chance they will remember to do that.

To ensure that I get the paperwork, I do the work and ask them to sign it, right then and there. Unless they truly disagree with what you wrote, your are assured to get the paperwork you need to support what ever you may be doing.

I hope this can help others in how to the make the system work for them.

Thanks for your reply

[john999]

I have to admit I never had a doctor who would sign off on a letter I wrote. They at least want to pretend to be unbiased. If they were totally unbiased I would not pay them. They knew what to do since I had been seeing them for a while. However, I did have an IMO where I wish I could have had more direct involvement in how the report was written, but it turned out the doctor doing the IMO did a great job on her own, and added three new conditions to my SC file, and the VA accepted it. This is a toss up and as long as the doctor says it is all SC and backs it up with facts then I think it is OK. I see where Ruby and Pete are coming from on this. How is that for being a politician?

[cowgirl]

Ruby, seems both these gentlemen have shared advice that you have considerd. Glad you know what works for you. As a patient, my experieneces with health care providers rounds out so far; one needed help in the form of a statement to understand the legalize support statement because of probable transciptionist editing, others did just fine and I got the truth statements needed, only one missed the boat but somehow that balanced out. Pete and John999 are invaluable cohorts here. Best to ya'! cg

John,

I sure hope your right and Pete is wrong.

Thanks

Edited December 27, 2007 by cowgirl

[luvHIM]

I was dx'd in service with an infection that spurred on Reactive Arthritis. Condition worsened to bilateral sacroiliitis and now full blown Ankylosing Spondylitis. I was initially service connected in 1979 under lumbosacral strain at 0% disabling.

I filed for increase and was denied (with xray evidence-sacroiliac joints now fused bilaterally). I also did what you did and walked away for 17 years, which did go against me (in round one). I am now in appeal status on that filing. I have a new claim pending for service connection for the Bilateral Sacroiliitis/Ankylosing Spondylitis.

It is my prayer that you do not have to go through what I have gone through thus far. By the way, the claim for increase that is on appeal was filed back in 2003 and I'm still waiting for that to be finally adjudicated. I have received SSD already (which was based on my VAMR and VA rheumatologist report); but, of course, I'm still waiting on the VA.

I can tell you right now that the VA is going to require way more than the letter your doc signed to support your claim even for increase. But that is just my opinion based on the hoops I've had to jump through just for an increase.

One of the problems with a ReA diagnosis in service and no treatment for 20 years is that it makes the condition in service appear to be acute. As a nurse, you probably already know that ReA can run its course for about a year and then go into remission.

The idea of something such as an "infection" (even though, as I am, you might be HLA-B27 positive) "reactivating" an ReA flare-up would need to be supported by your SMR that the condition was already considered "chronic" and you are prone to flare-ups and incapacitating episodes as outlined by DC5002 Rheumatoid Arthritis (active condition).

It gets really tricky with the VARO's because the regs are written in such a way that if it is not in black and white they (VA) will deny the claim. No treatment for 20 years for an arthritic condition can be perceived by the VA as an "acute" condition in service. They (VA) might try to use the 20 years of no treatment against your claim. That is what they did to me. But I used the fact that they (VA) told me my condition was "merely" lumbosacral strain and I didn't see the need for continuous treatment for something as minor as a back strain.

I pointed out in my Statement that my condition was diagnosed by not one but three VA officials and that if they had not informed me I would still be self-medicating in an attempt to treat myself.

I would be surprised if they did not have you scheduled for a C&P exam, inspite of the letter signed by your doc. Also, I would go to the BVA archives to get a "feel" for even how the BVA looks at claims similar to your own.

My nexus is right there in my service medical records and I was considered to be "chronic" and I was still denied an increase in 2003. I have hung in there this time. I intend to fight it out to the end. Please do not "assume" anything with the VA. If you they don't have your medical records...get copies and send them through your SO.

It has taken a VA and 2 outside rheumatologists, not to mention three VA C&P's, which connected all the dots (without my involvement) and I believe it to be the reason why this time I will get a full grant of benefits.

I'm not trying to burst your bubble or make you feel hopeless. But I am suggesting that you need to be ready to fight for what you want this time. Unless your evidence is air-tight, or at least in equipose, the VA doesn't need much to deny a claim, especially when it comes to arthritic conditions. They have been giving vets a hard time with these type claims for a long time. Mainly because it takes more than an IMO from a primary care doctor.

When it comes to the seronegative spondyloarthropathies it also takes the involvement of a board certified practicing rheumatologist to make the diagnosis, along with the labs and radiographic evidence. If a rheumatologist hasn't made the diagnosis, the VA will usually set you up with a rheumatologist via a C&P exam.

I know my claim is a bit more complex than yours and it just gets too detailed to go into on this forum. Again, I hope all goes well for you. Best regards.

[ruby]

I hope I didn't offend anyone, my post wasn't meant to do that.

We are all human beings and to evaluate a situation you must look at human nature to see if your path coincedes with thiers, if not, don't be surprised that you won't get what you need, if thier needs are not met also.

More you make, the more you spend, the more you need. If you interfere with thier needs it's just human nature you needs won't be met.

I am pretty good at writing letters once I know what is needed. That letter I wrote wasn't the greatest but with the time I had, since I am going through a major flare up now, it stated the facts that are in my medical records with the wording needed for SSD to approve. I am doing most of this research to get SSD within the first 30 days.

If you keep your letters to the point and truthful most docs will sign them. My letter was originally designed for SSA and not the VA but I thought if I can kill 2 birds with one stone, let me see how I can word this that the VA will accept this letter as proof. It was suggested to me to write he reviewed my SMR and based upon what he reviewed more ikely then not this is service connected.

I didn't write he reviewed my entire file, as he didn't , nor would I ask him to, I already knew that answer, he already wrote in April 07 in his opinion I was P&T, this wasn't new, he then reinterated they could only inject my hands a couple of times, I had to stop repetitive motions and rest, basically quit work. My lab work and xrays support my condition, I didn't stretch the truth. He was comfortable signing what I wrote.

I already screwed up with the VA and now I am having to back track to get it right.

From what I have read about the VA they will send off for medical records or opinions, the doc has 60 days to respond, if he doesn't they send out a second request that gives them 30 days, SSD does the same thing.

If I have obtained this info for them, I just cut out 90 days waiting period. If they are going to request a RFC, if I obtain that for them at the onset I cut out 90 days response time, if I give them my xrays, labs, medical records, mri's etc again I cut down the waiting period. Then I do matrix's to show in great detail what I could do before I quit work and what I can do now, it shows them that I am not capable medically or mentally to obtain gainful employment.

I am going to copy and paste something that I got from an attorney regarding SSDI the steps your claim goes through and what they ask for. Perhaps if this is good enough someone will sticky it so others can see what they need to do to get it first go around within the 30 day window.

Here is a sample time frame taken from a case I tried a few years ago:

January 1, 2000 - Claimant files application by calling or writing

January 10, 2000 - Social Security acknowledges receipt of

application and schedules a phone or office interview.

January 25, 2000 - Social Security intake clerk takes down

information contained in formal Application for Benefits

Form SSA-16-F6).

February 1 - March 30, 2000 - DAS claims processor sends form

requests for medical records to all doctors and hospitals listed

on Form SSA-16-F6. The claims processor may also send you a

Disability Report (Form SSA-3368-BK) and a Work History Report

(Form SSA-3369-BK). ------DONT WAIT DO IT WITH THE APPLICATION THAT IS YOUR APP, MEDICAL RECORDS, WORK HISTORY, DISABILITY REPORT, MATRIX'S BEFORE, AFTER, CURRENT, WEEKENDS. LETTERS FROM DOCTORS, RESIDUAL FUNCTIONAL CAPACITY FORM, GET COPIES OF ALL LABS, XRAYS ETC THAT SUPPORTS YOUR DX

April 1 - 15, 2000 - DAS claims processor collects, organizes and

reviews medical records, Disability Report and Work History Report.

Adjudicator will also send your file to staff physician and/or

staff psychologist for review.

[if evidence supports a favorable decision, claimant is notified

and claim is sent for payment processing.]

April 25, 2000 - Claims processor issues a form based denial notice.

You have 60 days to appeal.

June 1, 2000 - you file your appeal (Request for Reconsideration

form SSA-561-U2 and Reconsideration Disability Report form

SSA-3441-F6).

June 10, 2000 - DAS acknowledges claim

June 15, 2000 - DAS claims processor reviews Reconsideration

Disability Report and sends out form requests for updated medical

information and records from any new physicians. If mental health

or physical consultative exams are called for, the claims processor

will schedule appointment and send you an appointment notice

letter.

June 20, 2000 - DAS claims processor sends you Daily Living

Questionnaire and will request statement from a person who

knows you.

August 1, 2000 - Claims processor organizes file, reviews it and takes

it to an in-house physician/psychologist for review.

[if evidence supports a favorable decision, claimant is notified

and claim is sent for payment processing.]

August 15, 2000 - Claims processor issues a form based reconsideration

denial notice. You have 60 days to appeal.

September 15, 2000 - you file Request for Hearing (form HA-501-U5)

and Claimant's Statement when Request for Hearing is Filed and

the Issue is Disability (form HA-4486).

September 30, 2000 - Social Security office issues confirmation of

receipt of hearing request.

November 1, 2000 - your claims file is physically moved from the

DAS to the Office of Hearings and Appeals (OHA).

June 15, 2000 - OHA personnel unpack file and begin to organize it.

August 1, 2001 - OHA finishes working up file and sends notice

to you (and your attorney) that file is ready to be reviewed.

September 1, 2001 - Case is assigned to a Judge and a hearing notice

is issued for hearing on October 15, 2002.

October 15, 2002 - case is called by Administrative Law Judge

March 1, 2002 - Judge issues decision.

That's over two years, if you were counting. And, unfortunately, this type of delay is more and more common.

What can you do about it? As a start, you need to do everything in your power to make sure that your file is kept up to date. That means you need to keep a current list of all of your doctors - with contact information and a current list of your medications.

Remember, Social Security speaks its own language. So, whether or not you order my book, remember to focus on the vocational (work) limitations that arise from your medical condition. Also remember to be very specific - a statement that I can't walk very far and my legs hurt a lot - means nothing. A statement where you report that 'I can walk no more than 30 yards before I have to sit down and my leg pain is a sharp shooting pain from my hip to my feet that feels like an 8 on a 10 point scale' does mean something to Social Security. THIS IS WHAT I CALL A MATRIX IF INTERESTED I WILL POST ONE WHEN I FINISH MINE

And finally, as a last resort, if you desperately need to have your case decided, call your Senator's office. Every U.S. Senator has an employee who spends most of her time helping constituents deal with the Social Security Administration. Many of the cases deal with retirement or missing check issues, but these Senate staffers can sometimes cut through the red tape to get you a quick hearing.

I hope this helps others it made me see that if I get everything they could possible ask for prior to asking for it, I just cut my waiting period down or I just sped up the appeal process.

I have no hard feelings toward anyone, nor do I wish for others to feel ill towards me. I appreciate everyone's opinions.

[ruby]

I was dx'd in service with an infection that spurred on Reactive Arthritis. Condition worsened to bilateral sacroiliitis and now full blown Ankylosing Spondylitis. I was initially service connected in 1979 under lumbosacral strain at 0% disabling.

I filed for increase and was denied (with xray evidence-sacroiliac joints now fused bilaterally). I also did what you did and walked away for 17 years, which did go against me (in round one). I am now in appeal status on that filing. I have a new claim pending for service connection for the Bilateral Sacroiliitis/Ankylosing Spondylitis.

It is my prayer that you do not have to go through what I have gone through thus far. By the way, the claim for increase that is on appeal was filed back in 2003 and I'm still waiting for that to be finally adjudicated. I have received SSD already (which was based on my VAMR and VA rheumatologist report); but, of course, I'm still waiting on the VA.

I can tell you right now that the VA is going to require way more than the letter your doc signed to support your claim even for increase. But that is just my opinion based on the hoops I've had to jump through just for an increase.

One of the problems with a ReA diagnosis in service and no treatment for 20 years is that it makes the condition in service appear to be acute. As a nurse, you probably already know that ReA can run its course for about a year and then go into remission.

The idea of something such as an "infection" (even though, as I am, you might be HLA-B27 positive) "reactivating" an ReA flare-up would need to be supported by your SMR that the condition was already considered "chronic" and you are prone to flare-ups and incapacitating episodes as outlined by DC5002 Rheumatoid Arthritis (active condition).

It gets really tricky with the VARO's because the regs are written in such a way that if it is not in black and white they (VA) will deny the claim. No treatment for 20 years for an arthritic condition can be perceived by the VA as an "acute" condition in service. They (VA) might try to use the 20 years of no treatment against your claim. That is what they did to me. But I used the fact that they (VA) told me my condition was "merely" lumbosacral strain and I didn't see the need for continuous treatment for something as minor as a back strain.

I pointed out in my Statement that my condition was diagnosed by not one but three VA officials and that if they had not informed me I would still be self-medicating in an attempt to treat myself.

I would be surprised if they did not have you scheduled for a C&P exam, inspite of the letter signed by your doc. Also, I would go to the BVA archives to get a "feel" for even how the BVA looks at claims similar to your own.

My nexus is right there in my service medical records and I was considered to be "chronic" and I was still denied an increase in 2003. I have hung in there this time. I intend to fight it out to the end. Please do not "assume" anything with the VA. If you they don't have your medical records...get copies and send them through your SO.

It has taken a VA and 2 outside rheumatologists, not to mention three VA C&P's, which connected all the dots (without my involvement) and I believe it to be the reason why this time I will get a full grant of benefits.

I'm not trying to burst your bubble or make you feel hopeless. But I am suggesting that you need to be ready to fight for what you want this time. Unless your evidence is air-tight, or at least in equipose, the VA doesn't need much to deny a claim, especially when it comes to arthritic conditions. They have been giving vets a hard time with these type claims for a long time. Mainly because it takes more than an IMO from a primary care doctor.

When it comes to the seronegative spondyloarthropathies it also takes the involvement of a board certified practicing rheumatologist to make the diagnosis, along with the labs and radiographic evidence. If a rheumatologist hasn't made the diagnosis, the VA will usually set you up with a rheumatologist via a C&P exam.

I know my claim is a bit more complex than yours and it just gets too detailed to go into on this forum. Again, I hope all goes well for you. Best regards.

/quote]

Thank you for your response.

I will fight them this time, as well, my SMR clearly show that I had SI involvement while on active duty, they never told me I had AS.

I can show in my SMR's that I had a "cyst" in my r groin that was treated in the service and I can also show where I was again treated for the same one at least once within 6 months after getting out of the service. Now, after 30 years they ask me if I ever had any cyst, boils etc in my groins/thighs or arm pits, yea I do and have for years, right now I have about 8 and showed them to the rheumatologist, he jumped for joy and said you have hidradidinitis that has been known to cause reactive arthritis, I also can show where I was dx with samonella which also causes reactive arthritis, and I am being tested for a pneumonia that causes reactive arthritis which I also had in the service.

I can show where I was treated for 6 years after I got out of the service for sciatica, uveitis, irititis, bilateral carpal tunnel and my SI's haven worsen 90% fused on the left and 75% on the right side.

From 78-83 I was misdiagnosed with back strain, until I had a gall bladder series done and the AS showed up in my SI joints, that's when they sent me to a rheumatologist.

Now I have bilateral heel spurs, ankylosis of 3 fingers and thumb-bilaterally, arthritis in my shoulders, elbows, ankles, feet and knees and IBS.

All of this is documented in my VAMR. The rheumatologist I am seeing is the dept head for the VA and the University associated with the VA.

I had letters from family, friends, neighbors and employers stating that I have worsen over the years and I eat motrin.

I am HLA-B27 positive and RA negative. We have slightly different problems while I have the xray evidence of sacroilitis in the service, I never complained of low back pain, just assumed it was to much pt, sitting, standing etc I had an episodes of severe pain but never got treated for it.

When I went for low back pain/sciatica in 86 it was remanded for further outside medical evidence that I didn't have to prove I didn't have a prior injury to my back. Which I should have stopped and thought, wait this is caused by a bacteria and not an injury. I was already upset about a couple of things and at that time it wasn't worth the effort to fight.

I had a prior myelogram for headaches since they couldn't find any other reason for my headaches, which turned out to be birth control that was causing the headaches. Since the myelogram shows up forever in your xrays when I had xrays taken of my cervical spine due to an accident they are trying to say its a pre existing condition. I pointed out in this request that if I had a prior back injury I would not have been able to complete boot camp and pass the PFT's while on active duty.

I also pointed out the 2nd myelogram I had done in 85 supports my claim, it was normal.

It never should have been remanded in 86 and if there is any way I can go for effective date of 86 I will.

Thank you for sharing your experience. If you can either email or sent a private msg and share your experience on how and why they are denying I would appreciate it, if you chose not to, I totally understand and really do appreciate your reply.