Bi-lateral Quad Rupture Caused By Medication

[Bossman]

In_October_2005_Both_Quadricep_Tendons_snapped_while_walking_down_some_steps.doc

[Berta]

This looks to me like a clear cut case of TDIU!

Why did they deny the TDIU?

Did they mention TDIU in the decision that raised you to 70%?

You have very good medical evidence here-did they list the evidence in the denial and then refer to it in the narrative of the decision?

Your medical opinions on the surgery as well as the corticosteroids is certainly excellent support- but did the docs have a format they used that was acceptable to the VA? or did the VA just ignore their IMOs and never consider them?

Unfortunately your problems with Atlanta VA are just like the problems many of us around the country are having with our ROs.

You did good so far in my opinion- by getting the convalescence and then getting up to 70%-

do you have a vet rep?

There is a topic here available under Search called Getting an Independent Medical Opinion-

did your docs cover all the bases in the topic?

You should be getting TDIU P & T- do you have copy of what the surgeon wrote in the release letter? Does VA have that?

This is clearly more one case of the VA failing to read and consider prime medical evidence.

You could file a Section 1151 claim as well claiming their medication caused a contributing condition-as you stated it in the attachhment and claim it as secondary too-

Did the VA state this in your med recs?

Do you have all of your med recs?

What is the status of your claim at this point-did you NOD the 70% decision? is this the DRO hearing you anticipated?

Do you receive SSA disability and is it for the same problems?

If so -does VA know this and have they obtained your SSA records?

Bizarre-Your surgeon said this was permanent and you cannot work.

I dont understand this part- you requested a DRO AND a BVA hearing?

"likely cause of the rupture" by the ortho is great evidence-so is what the surgeon said-

have they ever opined on at all or listed these opinions as evidence?

I even wonder if they should have extended the convalescence payment.

Edited July 10, 2008 by Berta (see edit history)

[Bossman]

Thank you Berta for your response.

This looks to me like a clear cut case of TDIU!

Why did they deny the TDIU?

Entitlement to individual unemployability is denied because the claimant has not been found unable to secure or follow a substantially gainful occupation as a result of SC disabilities. SC disabilities currently evaluated at 70% do not meet the schedular requirements for entitlement to individual unemployability, 38 CFR 4.16 provides that individual unemployability may be granted where there is one disability evaluated as 60% disabling, or two or more disabilities, one of which is 40% with a combined evaluation of 70% or more. These percentage standards are set aside only when the evidence clearly and factually shows the veteran has been rendered unemployable solely due to SC disabilities regardless of their individual and combined percentages. Such cases are submitted to the Director of the compensation and Pension Service for extra-schedular consideration. This case has not been submitted for extra-schedular consideration because the evidence fails to show the veteran is unemployable due to SC disabilities (38 CFR 4.16).

They blurred section (a) and (b) together. What section b actually say is: (b) It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation and Pension Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service-connected disabilities, history, educational and vocational attainment and all other factors having a bearing on the issue.

I think that the key phrase is SUBSTANTIALLY GAINFUL OCCUPATION. My doctor wrote that I should not work more than 6 hours, no more than 1/3 of the time standing and no more than 2/3 of the time sitting. I must be able to change position as needed. Also there is no lifting of more than 20 lbs, no stair climbing, squatting, kneeling, crawling or balancing. Before the injury I worked 8 hours per day for pretty good pay.

I can not make as much as I did before my accident working part-time. I qualified with my company for ADA and UPS could not find any positions that I qualify for. I have a very diverse college background with 2 Bachelor degrees.

Also I am taking Hydrocodone for pain in addition to other medications. I do have to use a cane and on occasion crutches. All issued by VA including medication.

They have the surgery summary report from both surgeries and a copy of the paperwork sent to SSA concerning what I can and can not do.

Did they mention TDIU in the decision that raised you to 70%?

See above.

You have very good medical evidence here-did they list the evidence in the denial and then refer to it in the narrative of the decision?

Parts of it they did but they left some of it out in the narrative.

Your medical opinions on the surgery as well as the corticosteroids is certainly excellent support- but did the docs have a format they used that was acceptable to the VA? or did the VA just ignore their IMOs and never consider them?

The Corticosteriods that they had me on (Triamcinolone Acetonide, Fluocinonide and Hydrocortisone) have not been submitted to them yet because I am still trying to put all necessary information together. I should be finished next week. I want to file my 1151 within a day or so of giving this info.

They do know about the statement that EMG at VA made about systemic absorption, there is a copy in my C-file. They do not know about the private Orthopaetic opinion. No mention was made about a format for submission.

Unfortunately your problems with Atlanta VA are just like the problems many of us around the country are having with our ROs.

You did good so far in my opinion- by getting the convalescence and then getting up to 70%-

do you have a vet rep?

There is a topic here available under Search called Getting an Independent Medical Opinion-

did your docs cover all the bases in the topic?

I received error messages on this search but the doctor did explain in writing that I had knee surgery and not Quad surgery as VA wants me to claim. I am service connected for both knees.

You should be getting TDIU P & T- do you have copy of what the surgeon wrote in the release letter? Does VA have that?

Yes they do.

This is clearly more one case of the VA failing to read and consider prime medical evidence.

You could file a Section 1151 claim as well claiming their medication caused a contributing condition-as you stated it in the attachhment and claim it as secondary too-

Did the VA state this in your med recs?

Yes, all meds prescribed by VA.

Do you have all of your med recs?

Yes.

What is the status of your claim at this point-did you NOD the 70% decision? is this the DRO hearing you anticipated?

I don’t know the status and no one can tell me. I was supposed to have a DRO for continuance of the temporary 100% in the early spring of 2008 to challenge the discontinued compensation without a schedular exam.

The BVA is for the appeal that I entered in 2004 and filed the form 9 in 2006.

Do you receive SSA disability and is it for the same problems?

No. SSA is scheduling a hearing for me now. I expect that to happen in 2-3 years. lol

If so -does VA know this and have they obtained your SSA records?

Bizarre-Your surgeon said this was permanent and you cannot work.

He said that I could work up to 6 hours per day.

I dont understand this part- you requested a DRO AND a BVA hearing?

"likely cause of the rupture" by the ortho is great evidence-so is what the surgeon said-

have they ever opined on at all or listed these opinions as evidence?

Part of it as explained above. I want to have as much information as I can when I submit it. I have come across several studies that suggest that there are several cases where Corticosteriods causes simultaneous Tendon Rupture.

I even wonder if they should have extended the convalescence payment.

That is what the DRO hearing was setup for but I can’t even get to that.