Denied Again

[Deesulpwr]

Sorry for the length but this is from the AMC received on a Friday (way to ruin a weekend). They do not mention the muscle atrophy or the bilateral leg numbness from the original claim in this decision. I have 60 days before this goes to BVA again. HELP!!!!!! What do I do now? I am trying to connect the left and the right legs secondary to my left hip due to altered gait, now it looks like they are trying to make this a result of my back, I was going to go after the back secondary to the hip due to altered gait after this one is done. I have walked with a limp since my injury in service in 1991. I do have pain constantly and was medically retired from the fire service in 2003 because of this injury.

Decision:

• Entitlement to service connection for right leg disability, to include as secondary to service connected left hip capsulitis, is denied.
  
  
  
  • Entitlement to service connection for left leg disability, to include as secondary to service connected left hip capsulitis, is denied.
    

  [*]Entitlement to an increased evaluation for left hip capsulitis, currently evaluated as 10 percent disabling, is denied.

  Reasons and Bases:

  In accordance with the BVA remand instructions, we scheduled you for a comprehensive VA medical examination to determine the etiology of your claimed disabilities and to determine the current severity of your service connected left hip capsulitis. Examination findings show that hips were normal in appearance. You complained of some tenderness to palpitation in the left hip and the left sciatic notch areas. You do not have this on the right side. You were able to flex the hips on the torso to 115 degrees bilaterally. You complained of discomfort as you do this. You have more pain on the left side seemingly than the right. You were able to extend the back about 20 degrees, complaining of pain. Pain was more on the right side than on the left side. You can abduct either leg to 45 degrees. You complained of pain the final 10 degrees of the abduction and stops at that point because of the pain. You can adduct 30 degrees, again complaining of pain through the final about 15 degrees of adduction and stopping at that point because of the pain. Internal and external rotation was equally painful. You can externally rotate 60 degrees and internally rotate about 40 degrees, again complaining of pain bilaterally, equally and symmetrically.

  Motor and sensory examination revealed that you have a 1+ left knee jerk. You have an equivocal knee jerk on the right. You have equivocal ankle jerks bilaterally. On motor examination, you have decreased strength in the left leg when compared to the right leg. Your strength on the left at the knee, the hip and the ankle are approximately 3/5 when compared to that on the right. The extensor hallucis longus power was also rated as being decreased. The sensory examination was essentially normal , equal, and symmetrical except for a band laterally down the lateral aspect of the left lower extremity, from the knee down to the top of the left foot, where you complained of decreased perception of light touch. You have normal perception of light touch across the plantar surface of the foot. You complained of pain with any movement of either hip.

  Imaging studies showed degenerative changes in the spine. The magnetic resonance imaging scan of the hip and pelvis have shown no evidence of any bony disease in the hip. There was no evidence of malunion of the hip. The problems in the hip and on the left side and right side all seem to be muscle and nerve in nature rather than involving the bones. The magnetic resonance imaging scan has shown changes which initially were interpreted as being the result of avulsion injuries to the muscles, but now are thought to be more consistent with chronic inflammation of the hamstring muscles. An electromyelogram and peripheral nerve conduction study done several years ago indicated the absence of a response in the left perineal nerve, which is thought to be secondary to lumbrosacral spine disease, and not consistent with his diagnosis of left hip disability.

  The examiner's diagnoses were causalgia of the left and right hips, with residuals, also called capsulitis of the left hip and left perineal neuropathy, with residuals. There was no evidence of malunion of the hip. According to the examiner, your disability appears to involve just the muscles and the nerves, not really the joint. Based on a review of your claims file and examination findings, it was the opinion of the examiner that your hip and leg disabilities seem to date to your injury in 1991, and subsequently. According to the examiner, it was as likely as not that your left leg disability is the result of the injury in 1991. the examiner further noted that he could not state whether the right leg problems have been aggravated by the left leg problem without resorting to speculation.

[rentalguy1]

I hate to be the one to tell you this, but you just flat out don't meet any of the ratable criteria for the hips as set forth in 38 CFR 4.71a. If I were in your position, and this only me...so don't get mad, I would consider cutting my losses on this one. I would then file a claim for degenerative disc disease with perineal neuropathy secondary to the SC'd hip (I'm assuming the hip is SC'd from the 1991 accident). I feel like you could get at least 20% on your back and 10% on the peripheral nerve damage. Then you could file for the hips secondary to the newly SC'd spine. You could alo file a claim for muscle atrophy in the hips.

The only other thing you could do is to get a IMO showing greatly reduced hip ROM's. The problem here, is that it would look like you faked it to everyone, and you definately don't want that.

I'm sorry to point this out, and I truly hope someone comes along and proves me wrong. I'd love to eat crow in a case like this.

[Deesulpwr]

I appreciate you being straight up rental, I really believe that this is all connected though. My hip is 10% SC'd since discharge in '93. The part that confuses me is that they didn't refer to any of the SMR copies, VA treatment notes, lay statements or cover all of the symptoms that I am claiming. Walking with a limp (altered gait) due to the pain in my hip for almost 17 years now has done damage to both of my legs and my back. Plus I have SMR’s where I was treated for pain in my right leg and knee that was “a result of altered gait compensating for left hip pain”. It is as clear as mud, right hahaha. That is the one reason I am hesitant to let this appeal go, this claimed was originally filed in 2002. I did file for my back in 2004 (denied) and not sure what happened or why but I didn’t appeal, stupidity I guess.

it was the opinion of the examiner that your hip and leg disabilities seem to date to your injury in 1991, and subsequently. According to the examiner, it was as likely as not that your left leg disability is the result of the injury in 1991

Can anyone explain why these statements mean denial? It covers what I am claiming as left leg secondary to the left hip capsulitis doesn’t it?

[Pete53]

Sorry that you lost. Wish I could add something but I don't know ebough to do that.

Good Luck

You can still push your claim if you really believe you are right.

[rentalguy1]

Don't get me wrong. I'm not saying you don't have a disability, or that you're not in pain. I'm also as positive as you are that the altered gait has led to deterioration in the other areas, too. The problem lies in the rating criteria.

Can anyone explain why these statements mean denial? It covers what I am claiming as left leg secondary to the left hip capsulitis doesn't it?

There is nothing to SC. The x-rays and scans show no abnormalities or malunion. The ranges of motion in your hips are outside of the ratable rom's, per the regs. If there was a rating for painful motion, you would get it, but there isn't one for the hips. That's why they keep denying it.

5250 Hip, ankylosis of:

Unfavorable, extremely unfavorable ankylosis, the foot not \3\ 90

reaching ground, crutches necessitated.......................

Intermediate.................................................. 70

Favorable, in flexion at an angle between 20[deg] and 40[deg], 60

and slight adduction or abduction............................

5251 Thigh, limitation of extension of:

Extension limited to 5[deg]................................... 10

5252 Thigh, limitation of flexion of:

Flexion limited to 10[deg].................................... 40

Flexion limited to 20[deg].................................... 30

Flexion limited to 30[deg].................................... 20

Flexion limited to 45[deg].................................... 10

5253 Thigh, impairment of:

Limitation of abduction of, motion lost beyond 10[deg]........ 20

Limitation of adduction of, cannot cross legs................. 10

Limitation of rotation of, cannot toe-out more than 15[deg], 10

affected leg.................................................

5254 Hip, flail joint........................................... 80

5255 Femur, impairment of:

Fracture of shaft or anatomical neck of:

With nonunion, with loose motion (spiral or oblique 80

fracture)..................................................

With nonunion, without loose motion, weightbearing preserved 60

with aid of brace..........................................

Fracture of surgical neck of, with false joint................ 60

Malunion of:

With marked knee or hip disability.......................... 30

With moderate knee or hip disability........................ 20

With slight knee or hip disability.......................... 10

You should seriously reopen the claim for your back and for neuropathy. You have radiographic evidence and it would be an easy claim to win, if you get all of your evidence together and sent in.

The only other thing I can think of is to get an MRI of your hips and see if that shows something useful to the claim. And, you never know...it just might. They show much more than any of the other radiographic methods.

Edited January 19, 2008 by rentalguy1

[Deesulpwr]

I see what you are saying rental and agree. Believe it or not I have questioned the VA about my rating code 5255, I have repeatedly complained that there is nothing wrong with the femur. That the majority of my problems are muscle and nerve related. The only response I get is "that's the closest rating to your symptoms".

A friend of a family member says don't let it go and he agrees that the rom's played a huge part into the denial. He suggests IMO's and additional lay statements may help when it gets back to the board.

I guess what I was hoping for was that they would rate for the left peroneal nerve being completely gone, residuals of left knee menisectomy (that I paid for), the abscence of the EDB muscle on my left foot and the numbness in both legs

[Josephine]

I see what you are saying rental and agree. Believe it or not I have questioned the VA about my rating code 5255, I have repeatedly complained that there is nothing wrong with the femur. That the majority of my problems are muscle and nerve related. The only response I get is "that's the closest rating to your symptoms".

A friend of a family member says don't let it go and he agrees that the rom's played a huge part into the denial. He suggests IMO's and additional lay statements may help when it gets back to the board.

I guess what I was hoping for was that they would rate for the left peroneal nerve being completely gone, residuals of left knee menisectomy (that I paid for), the abscence of the EDB muscle on my left foot and the numbness in both legs

Deesulpwr

Just coming from the AMC with a SSOC did you receive the yellow sheet

of paper 60 days to respond.

Could you receive an IMO as Paul ( Hurryupnwait) and make contact

with Dr. Bash.

I felt that my SSOC was not correct and went to D. C to see a

Forensic Psychaitrist for an IME.

I received my SSOC dated December 6, 2007 and now my claims file is

back with the Judge at the BVA.

You have to act fast and make a decision.

Think about it, as you know your claim best.

Always,

Betty