diabetes Reason For Denial Need Help Finding Errors

[ruby]

The comp exam was done by a PA--my rheum was the chief of staff MD with 30 yrs. I had an IMO from a dermatologist MD for 30 yrs who provided the literature that connects the 2 and a statement more likely then not.

form 119 report of contact dated feb 5-needed to know what joints

your sc treatment records don't show trmt for reactive arthritis (actually the initial symptoms were there they were not together. had eye issue couldn't find why r/o diabetes-it was, cystitis unknow orgin this was the initial start.) the symptoms were never connected and the disease was most known by rheum docs only at that time.

a letter dated 2/9/08 was sent to you advising you of the vcaa and informing you of what evidence is required to complete processing your claim. This leter also furnished you information regarding disability ratings, factors affecting eval and how the va determines the eed.all reasonale efforts to assist you in pursuing your claim have been exhausted etc.

a review of virtual va records was conducted 4/27/09 the results of this review were negative results for medical records pertinent to your current claim.(it appears they missed records by another rheum doc on 8/08--10/08--2/09 he mentioned the reactive is due to the hs.)

Medical statement, Dr V dated 12/6 includeing progress note, and statement dated 1/15/2008 notes that he believes your recurring cyst is chronic condition called hidradenitis suppurative and that you have reactive arthritis due to hs. In the record dated 12/26/2007, he noted that you are unable to sustain gainful employmnet of any sort due to physical, mnetal, emotional and psychological limitations.

Va examiner addendum dated 4/809 was reviewed. the examiner noted a diagnossis of bilateral knww arthritis, the examiner opined that is less likely as not that your current reactive arthritis of the left knee is due to your sc hidradenitis. The examiner noted the rational is a review of the medical literature revealed that hs is a disease of the aprogra glnd bearing skin etc. The examiner noted that there was no medical evidence in the literature to indicate that hs causes reactive arthritis in myltiple joints. The examiner noted that xrays of the knees revealed early osteoarthritis which is normal for your age. It is the opinion of the examiner that you have multi joint osteoarthritis found on x-ray and no reactive arthriis related information found on medical literature, therefore, your claim of multi joint reactive arthritis is unrelated to and not aggravated or worsened by your hs.

although there is a positive opinion from Dr V that your reactive arthritis is due to hidradenitis suppurative, the examiner did not have access to your entire claims folder including complete service treatment records.

Thats the denial---they did not mention anything else.

In the evidence section they mention an IMO from the Derm doc but nothing about his statements or literature to support this opinion tat hs causes reactive arthritis.

The PA stated to me when I walked in "i see your trying to connect hs to reactive arthritis and your out of luck on that one, its not in my derm book" I ask him out old his book was but he never looked it up. I then ask him how much he knew about reactive and he said "very little"--this was my competent medical person who did a legal comp exam.

The VA takes the word of a PA over 3 MD's who doesn't know the difference from osteo from reactive. This where I might be able to get a new comp exam with a competent physician---This idiot doesn't realize that you can't determine the difference by xray. One of the hall marks of reactive is bone spurs on xray and reactive arthritis looks like osteo---osteo is given if your arthritis started after the age of 50. I have had mine for 30 yrs.

Any flay's with this denial

Since Dr R's notes are not listed in the evidence section and they missed them on there virtual review is that a cue.

they did not use the benefit of the doubt rule----

there rational for not giving any credence to the other md's appears they didn't have the complete file.

they had records that pertained to this issue and they documented those in there letters.

any help with errors would be great.

thanks ruby

[Berta]

They are playing word games here- I dont feel the IMO doc even needed the SMRs to give opinion on a secondary condition that is due to an established SC one-

I think they are wrong there.

You explained this well-how much time do you have left for response?

"he noted that you are unable to sustain gainful employmnet of any sort due to physical, mnetal, emotional and psychological limitations."

Did Dr. V give a full medical rationale for this statement ,referring to your established SC with this as seoondary?

[Berta]

"although there is a positive opinion from Dr V that your reactive arthritis is due to hidradenitis suppurative, the examiner did not have access to your entire claims folder including complete service treatment records"

I doubt if the PA even read them-maybe you could find out exactly what the PA did have- do you have copy of the actual opinion the PA did yet? O knocked a Endocrinologist down in 2005 for one reason-because she asked the local VA where they sent the records to -to fax only the blood Chem records to her-I called them up and found this out-

I raised the issue that 3 or 4 Blood Chem tests have little relationship to decades of medical care and the results are not a basis for any medical opinion at all when the clinical record revealed significant other tests that proved the claim.

(which of course this endocrinologist ignored)

Attack every statement in the actual C & P with common sense and medical evidence.

You made some excellent points here that you could use to do that.

[broncovet]

Ruby

Someone else can correct me if I am wrong on this, but I think you need only prove you had

SYMPTOMS of a disease suffered in the military and, not necessarily a diagnosis. A diagnosis by a doctor can come later.

An example may be when a military person gets shot. Symptoms of a gunshot wound would be bleeding, shock, etc. That Veteran may never be diagnosed by a doctor with a GSW..he may well die before he gets treatment/diagnosis. Or, it may not be serious enough that he even seeks medical attention. But, he still has symptoms of a GSW while in the military.

Just because a military doctor failed to diagnosis your conditions properly, does not necessarily mean you dont have any symptoms.

I mentioned this in another post. Cite Roberson vs Principii if you think you have evidence overlooked. http://www.ll.georgetown.edu/federal/judic...ns/00-7009.html

Everyone is always talking about CUE, if you filed a NOD within a year, you dont have to meet the strict CUE standard to win your claim so why make it harder for yourself?

Edited May 7, 2009 by broncovet

[ruby]

They are playing word games here- I dont feel the IMO doc even needed the SMRs to give opinion on a secondary condition that is due to an established SC one-

I think they are wrong there.

You explained this well-how much time do you have left for response?

"he noted that you are unable to sustain gainful employmnet of any sort due to physical, mnetal, emotional and psychological limitations."

Did Dr. V give a full medical rationale for this statement ,referring to your established SC with this as seoondary?

I just got the denial so I have a year to file a NOD but I think I want to file for reconsideration if its not decided within the year then file the NOD.

To complicate the issue I need to file another claim for radiculopathy secondary to a current sc disability.

The IMO was to show that the symptoms from the service was a disease process and to provide a statement that this disease proces was known to cause Reactive arthritis with medical rationale and literature to support this statement-the va ignored the literature they are claiming doesn't exist because an incompetent PA examiner said it didn't exist.

They listed his IMO, but never addressed it in the denial---NO, he did not need any files to make this statement in regards to the arthritis.

Dr V wrote this info for me to get SSDI I used it for my va claim also, SSD didn't need rationale for the opinion.

[ruby]

"although there is a positive opinion from Dr V that your reactive arthritis is due to hidradenitis suppurative, the examiner did not have access to your entire claims folder including complete service treatment records"

I doubt if the PA even read them-maybe you could find out exactly what the PA did have- do you have copy of the actual opinion the PA did yet? O knocked a Endocrinologist down in 2005 for one reason-because she asked the local VA where they sent the records to -to fax only the blood Chem records to her-I called them up and found this out-

I raised the issue that 3 or 4 Blood Chem tests have little relationship to decades of medical care and the results are not a basis for any medical opinion at all when the clinical record revealed significant other tests that proved the claim.

(which of course this endocrinologist ignored)

Attack every statement in the actual C & P with common sense and medical evidence.

You made some excellent points here that you could use to do that.

Yes, I have a copy of his opinion( I am not suppose to have this, the VA has decided not to give them out unless you put in a request in writing to the VARO, which I did 2 months ago), he never mentioned the C file or my medical records other than what I gave him, when he asked for dates I showed him my old service records and what Dr V said and I pointed out to him what Dr. R said.

The PA said I can't take that info unless its in the records they sent me, I said it was and here are the dates, but he refused to accept the medical literature, he said send it to the VARO.

In his opinion it says he reviewed the C file and medical records.

He wrote Rationale for opinion:

Review of medical literature revealed that HD is a " disease of the aprocrine gland bearing skin of the axillae and anogenital region". There were no medical evidence in the literature to indicate that HS causes reactive arthritis in multiple joints.

It is the opinion of the examiner that this veteran has normal aging multi-joint osteoarthritis found on xrays and no reactive arthritis related information found on medical literature, therefore her claim of multi-joint reactive arthritis is unrelated to and not aggravated by her hidradenitis suppurativa.

This examiner never looked for literature he looked at an old Derm book.

Berta, others say keep it simple don't go into great explanation, your saying knock every word down--personally I think every word should be knocked down especially since this PA is incompetent to make an opinion on this issue. I will try to do both not sure I can. Will post the draft version for comments.

Is the VARO required to consider the benefit of the doubt doctrine?

The denial says it reviewd my virtual records on 4-27-09 and no other medical records were found in reference to this claim---This is not true Dr R wrote 10/31/08:

spondyloarthropathy-has sacro-ilits has a history of hidrandenitis-is sc for same( I wasn't sc for HS, I was for cysts/scars) this most like is an associated if not a precipating factor.

On 2/06/09 Dr R stated:

Problem:

Spondylorthropathy

Has a lot of musculoskeletal problems--Most likely her Hidranitis-contributing to her problems.

Thanks

Ruby

[purple]

The thing that caught me was the fact that they did a "virutal review"....ugh. This is where you need to get ALL the paper copies of your records, SMRs, VA, civilian....anything and everything; highlight what the 3 Docs said was wrong, put it all together in a neat package and mail it in.

You have to put the proverbial dots extremely close together for the VA in order for them to connect them. You can't rely on them to look at the important aspects of your medical records...you have to shove it under their nose!!