What Does This Mean? Good Or Bad?

[c&p man]

this is from a award letter from a c and p exam.. Service treatment records from june 7,1993 to 1996 show treatment for right ankle pain. VA examination dated march 31,2009 finds a current strain of the right ankle wiht flexion from 0 to 30 degrees. Examiner notes pian wiht plantar flexion. the examiners opinoion is that, due to lack of chronicity of treament, the current strain is less likely than not related to treatment in service. Service connection for right ankle strain is deniend since this condition neither occured or was cuased by service.

Ok happen in service and thier is a current strain? i do have a bone spur on my heel now...my left ankle and heel are sc... what does DUE TO LACK OF CHRONICTY OF TREATMENT MEAN? does this mena they think it might be like a acute sprian and if i show medical eveidence of treatment from now on that it will be sc?

[rgero311975]

remember you had a strain in service and a current strain..link them with the nexus letter... but i dont know if you can get a percentage for a strain unless it is a rom percentage of the ankle...i guess you could since i have a freind that has degerative ankle disease mild and he is connected...hoppy got a lot of good advice and info though he might be able to elaborate farther than me.

[c&p man]

this was sent to me by a member to post..it helped me and since some one else will need help in the future here it is ...is a bva case... a denail for a condition related to mine..

Citation Nr: 0818285 Decision Date: 06/03/08 Archive Date: 06/12/08DOCKET NO. 04-12 819 ) DATE ) )On appeal from theDepartment of Veterans Affairs Regional Office in Montgomery, AlabamaTHE ISSUEEntitlement to service connection for chronic residuals of a right ankle strain. REPRESENTATIONAppellant represented by: Alabama Department of Veterans AffairsWITNESS AT HEARING ON APPEALAppellantATTORNEY FOR THE BOARDJ. Rose, Counsel INTRODUCTIONThe veteran had active military service from November 1973 to October 1976 with subsequent reserve duty.This matter comes before the Board of Veterans' Appeals (Board) from a June 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The veteran subsequently perfected this appeal. In September 2005, the Board remanded this matter to the RO to schedule a Board hearing for the veteran. In April 2006, the veteran elected a local hearing before a Decision Review Officer (DRO) instead, and one was held in July 2006. In April 2007, the Board remanded for further development. Development was completed and the appeal was returned to the Board. FINDING OF FACTChronic right ankle strain did not have its onset in service, did not increase in severity in service, and is not otherwise related to active service. CONCLUSION OF LAWChronic right ankle strain was not incurred or aggravated in service. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2007).REASONS AND BASES FOR FINDING AND CONCLUSIONDuties to Notify and AssistIn correspondence dated March 2004 and May 2007, the RO satisfied its duty to notify the veteran under 38 U.S.C.A. § 5103(a) (West 2002) and 38 C.F.R. § 3.159(:D (2007). Specifically, the RO notified the veteran of: information and evidence necessary to substantiate the claim for service connection; information and evidence that VA would seek to provide; and information and evidence that the veteran was expected to provide. The veteran was instructed to submit any evidence in his possession that pertained to his claim.VA has done everything reasonably possible to assist the veteran with respect to his claim for benefits in accordance with 38 U.S.C.A. § 5103A (West 2002) and 38 C.F.R. § 3.159© (2007). Service medical records have been associated with the claims file. All identified and available treatment records have been secured. The veteran has been medically evaluated in conjunction with his claim, and an etiology opinion was provided in compliance with the April 2007 Board remand. The duties to notify and assist have been met.In light of the Board's denial of the veteran's claim, no additional disability ratings or effective dates will be assigned, so there can be no possibility of any prejudice to the veteran under the holding in Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). For the above reasons, it is not prejudicial to the veteran for the Board to proceed to finally decide the issues discussed in this decision. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Sutton v. Brown, 9 Vet. App. 553 (1996); Bernard v. Brown, 4 Vet. App. 384 (1993); see also 38 C.F.R. § 20.1102 (2007) (harmless error).Service ConnectionService connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110 (West 2002). Service connection may be also granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2007).For a showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then showing of continuity after discharge is required to support the claims. 38 C.F.R. § 3.303(B).An evaluation of the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the examiner's knowledge and skill in analyzing the data, and the medical conclusion reached. The credibility and weight to be attached to such opinions are within the province of the Board as adjudicators. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Greater weight may be placed on one physician's opinion over another depending on factors such as reasoning employed by the physicians and whether or not and the extent to which they reviewed prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994). The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert's qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. See Sklar v. Brown, 5 Vet. App. 140 (1993).Once the evidence has been assembled, it is the Board's responsibility to evaluate the record. 38 U.S.C.A. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54.The veteran is claiming service connection for chronic right ankle strain. Upon review, the evidence demonstrates a right ankle injury in service; however, this did not result in a chronic disability and is not related to his current chronic right ankle strain. Service medical records show that the veteran injured his right ankle in January 1975. The clinical note stated that he twisted his right ankle playing basketball. X-rays were negative. He was given crutches and Tylenol. No other complaints or treatment for right ankle strain is noted in the service medical records. Report of Medical Examination in August 1976 indicated that lower extremities and feet were evaluated as normal. In the report, the veteran signed a statement indicating that he did not have any known physical defects. Reports of Medical Examination during his reserve duty make no mention of right ankle problems. Examination reports in April 1980, May 1984, May 1988, August 1992, and March 1998 indicated that clinical findings of the lower extremities and feet were normal. The first post-service record noting treatment for the right ankle was dated in August 2001. Here, the veteran complained of chronic bilateral ankle strain. The veteran indicated that his ankles gave him problems over the past 10 to 11 years. VA treatment record in December 2001 diagnosed degenerative joint disease of the right ankle. VA examination in March 2002 indicated a diagnosis of chronic bilateral ankle pain with none to mild functional loss of range of motion. X-ray report in April 2002 revealed normal findings. No degenerative changes noted. Bilateral ankle braces were issued to the veteran in September 2002. VA examination report in April 2004 noted a diagnosis of ankle strain with no findings of rheumatoid arthritis or osteoarthritis. X-ray report in August 2004 indicated normal clinical findings. VA examination in August 2006 noted that the veteran has bilateral chronic ankle strain with pain secondary to the strain. The examiner indicated that there was no significant osseous, articular or soft tissue abnormality in either ankle. Based on these findings, and the lack of abnormal findings on x-ray studies, the examiner found no present medical diagnosis of arthritis of the ankles. In a November 2006 VA addendum, the examiner commented that there was no reference made as to which ankle was injured in January 1975. There was also no other treatment in service or following service for the right ankle. As such, the examiner indicated that the veteran's chronic right ankle strain could not be attributed to service without resorting to mere speculation. The Board remanded the appeal in April 2007, noting that the November 2006 VA examiner was incorrect in stating that the service medical records failed to reference which ankle was injured in January 1975. The service medical record in January 1975 clearly indicated that the right ankle was injured. A new VA etiological opinion was requested.In the May 2007 VA examination report, the examiner indicated that veteran's right ankle sprain is less likely as not to be related to service. The examiner states that the veteran's current chronic right ankle diagnosis is not related to his sprain in 1975. The strain is an acute condition that is self limiting and is not classified as a chronic condition. Upon review, the Board finds that the preponderance of the evidence is against a finding that the veteran's current chronic residuals of a right ankle strain are related to service. The VA etiological opinion from November 2006 was of little probative value as it was based on incorrect facts. There was clear evidence of a right ankle injury in 1975. However, the Board finds the VA etiological opinion from May 2007 to be probative evidence. The findings are based on a review of the record and is supported by the record. Service medical records are negative for chronic residuals resulting from the 1975 right ankle injury. There are also no abnormal findings involving the right ankle through 2001, approximately 16 years after his right ankle strain in service. There is no competent medical evidence in contradiction.The veteran is competent to state that he has had chronic right ankle problems since his right ankle injury in 1975. See Layno, supra; 38 C.F.R. § 3.159(a)(2). However, as a lay person, the appellant is not competent to diagnose any medical disability or render an opinion as to the cause or etiology of any current disability (i.e. that any current right ankle disability is related to service) because he does not the requisite medical expertise. See, e.g., See Routen v. Brown, 10 Vet. App. 183, 186 (1997); Espiritu v. Derwinski, 2 Vet.App. 492 (1992). The competent evidence outweighs the veteran's assertions. As noted above, separation examination in August 1976 indicates no abnormal findings involving the right ankle and the veteran stated at that time that he had no known physical defects. Numerous subsequent examinations from service through 1996 were negative for right ankle pathology. The only medical opinion proffered reflects that it is unlikely any current right ankle pathology is related to service. In conclusion, a preponderance of the evidence is against a finding that the veteran's chronic residuals of a right ankle strain is related to active service. Thus, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107(B); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990).ORDERThe appeal is denied. ____________________________________________THOMAS J. DANNAHERVeterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs

[pacmanx1]

This denial is not related to yours but if you want to give up that is your choice. The facts are similar I agree but totally different. Again you can "file a claim for right ankle pain/strain secondary to your already service connected left ankle and heel". The veteran that was denied did not have this option. Please do not confuse the facts, with filing a claim as secondary you do not need to show chronicity all you need is a medical doctors opinion that the two conditions are related based on his/her medical opinion and they will give VA a medical rational which is a nexus (a statement connecting the conditions) the doctor may also examine you, it may also help if you use a cane or braces. He/she will also check to see if you walk with a limp or abnormal. I hope this helps

[carlie]

remember you had a strain in service and a current strain..link them with the nexus letter... but i dont know if you can get a percentage for a strain unless it is a rom percentage of the ankle...i guess you could since i have a freind that has degerative ankle disease mild and he is connected...hoppy got a lot of good advice and info though he might be able to elaborate farther than me.

rgero,

For clarification.

He had right ankle pain in SMR's -- now he has right ankle strain.

carlie

[c&p man]

This denial is not related to yours but if you want to give up that is your choice. The facts are similar I agree but totally different. Again you can "file a claim for right ankle pain/strain secondary to your already service connected left ankle and heel". The veteran that was denied did not have this option. Please do not confuse the facts, with filing a claim as secondary you do not need to show chronicity all you need is a medical doctors opinion that the two conditions are related based on his/her medical opinion and they will give VA a medical rational which is a nexus (a statement connecting the conditions) the doctor may also examine you, it may also help if you use a cane or braces. He/she will also check to see if you walk with a limp or abnormal. I hope this helps

it does everyone has different views and experieince on here so no matter what i can take a little from everyone and use it...i read over the post and i agree with you that it the same kind of case but he did have a secondary reason.....i use a cane and a wheel chair ....thanks for your time....i think i will file secondary since it a good route if i get the imo if i dont i have to go down same road.

[broncovet]

My guess is that it "means" that you probably got stuck with a QTC C&P examiner who basically gets paid to get you denied. Heres how it works:

C&P exams are now very lucrative as they get $500 for usually less than an hours work. QTC does not require you are a doctor, but only a PA or nurse practicioner.

PA's and nurse practioners making more than $500 per hour is very lucrative. The catch is, that if you DONT offer evidence to deny, the VA wont hire you next time, so you are forced to say things that cause a denial, or loose this lucrative $500 per hour job.

It is very easy for the QTC quack to deny you if your medical records do not show ongoing treatment. They assume there is no such thing as "sucking up the pain" and that everyone will go to the doctor once every month or so to get pain meds.

However, the average Veteran probably "sucks up" the pain, and doesnt go to the doc except once every couple years, when something else happens.

Try to get a c and P exam from your Va doctor..and if you have been sucking up the pain, then tell your doc so, and explain you cant suck it up anymore.

Others can correct me, if this is not right, but you are trying to prove chronicity of SYMPTOMS and not necessarily chronicity of medical treatment. You may have to get an IMO, but dont give up, although this quacks c and p exam is a setback.

It is possible to work in your favor in this plausable senario:

The QTC PA or Nurse practitioner offers the medical opinion that you did not have chronicity of treatment so it was not likely related to military service. However, your VA DOCTOR, who has more training that the physicans assistant, says that you have been experienceing chronic pain, but that you self treated the pain, so, your condition is at least as likely as not related to military service, because you had chronicity of SYMPTOMS.

Edited June 27, 2009 by broncovet