Appeal Video Conference, S/c Back Secondary To S/c Knees

[USAFvet13]

Hello all, unfortuantely my first post must be one asking for help as I do not know what to do from here.

I have service connections for the following:

Right knee degen joint disease w/ slight subluxation 10%

Right knee patellofemoral syndrome with chondromalacia 10%

Left knee patellofemoral syndrome with chondromalacia 10%

My knee symptoms and pain started during my service in the USAF. I have a lot of medical records to prove this so getting s/c for my knees wasn't extremely difficult. My knee s/c disablities began in 2004. I had surgery on my right knee with a private doctor in 2005 and since then I have had back pain and problems. I have continuous medical records from different chiropractors to show my back problems.

Problem is I never had any of them connect my knee problems to developing a back problem until I decided to try to get s/c back secondary to knees. I was able to get an IMO recently from one chiro saying "........ I have reviewed xxxx SMR's and it is my professional opinion that his altered gait due to his bilateral knee complaints has contributed to his low-back pain."

Here is where the difficulty began. I failed to get all my chiro records and this letter to the VA before they made a decision on back secondary to my knees. So I was denied. I filed a NOD and during this time my chiro records and my IMO made it to the VA. Well, they denied me again. This time they are saying there is significant documentation in support of a back problem, but I am lacking evidence of an altered gait with the exception of one VA note, and the IMO I submitted. So I have now requested a board of vet appeal video conference hearing.

I just today came from an appointment with the physical therapy / rehab doc at the VA in hopes that she would back up the altered gait developing a back problem, but she wouldn't write me an IMO and didn't agree with me that its a possiblity my knee conditions contributed to my back condition... WTF? She said she has plenty of patients with knee/ankle problems that do not develope back conditions...

So now I'm not sure what to do. The DAV is helping me, and he even said it's common medical knowledge that if you ankle or knee get messed up it will have a chain reaction and eventually mess up your back.

Sorry for the long rant, I look forward to hearing some advice on what to do. Hopefully I have enough time to figure something out before my appeal.

[Berta]

Whether for an IMO or to support an existing claim-an Evidence list is always a good idea.

For an existing claim you can use the 21-4138 form.

Maybe what I sent recently to VA will help you as to the format.

I stated what the claim was for and what award I expected .(Rating of AO IHD and CVA for accrued SMC)

I stated the accrued regs , the SMC regs (I used as source NVLSP VBM Page 333 on that)and some other brief VA case law and reminded VA of dates of 2 past denials for IHD I had received (which they needed to know due to Nehmer)and also reminded them my husband's AO exposure was confirmed by VA.

That was page one of the 4138 and then I referred them to page 2 thus:

Evidence List page 2 name address XC XX XXX XXX

The following medical evidence in VA's possession at time of Rod's death and subsequent other documents enclosed -documents based solely on the medical evidence in VA's possession at time of death, warrant a proper rating of the veteran's AO IHD and secondary CVA and also SMC as an accrued award under Nehmer.

Exhibit A VA ER Certifcate 8-13-88 one page

Exhibit B VA STAT 8-15-88 one page

Exhibit C VA EKG 8-13-88 2 pages

Exhibit D VA EKG August 1992 1 page

Exhibit E VA Syracuse ECHO EF 40% 8/31/92 1 page

Exhibit F Peer Review Report confirmed as sent by Dr. XXXX XXXXXXXXX VA Bath by Fax to Regional Counsel XXXX XXXXXX (confirmed received by Mr. XXXXXX, May 1995 and verified by Office of Medical/Legal VA) 6 pages

Exhibit G VARO award letter DIC under Section 1151, 38 USC Jan 1998 1 page

Exhibit H VARO Rating decision 6/17/96 2 pages

Exhibit I VARO Rating decision 7/9/97 2 pages

Exhibit J Death Certificate 1 page

Exhibit K Independent Medical Opinion Dr. Craig C Bash Nov 22, 2004 2 pages

Exhibit L Independent Medical Opinion Dr. Crag C. Bash August 21, 2006 2 pages

I have more evidence from OGC etc for this claim but I don't think they will need it.

I use colored blank labels or bright yard sale stickers to put on each piece of evidence and write EX A, Or EX B, etc.

and always put how many pages and then count and total the enclosures.

The VA is asking for evidence and even supposed to be sending a blank medical document to many AO IHD vets to have their doctors fill out as they say as soon as they have the evidence of IHD and AO exposure they can start to process those claims until the final reg is published.

I sent above claim and evidence on Aug 2 2010 and they said it already went to a head Nehmer Coordinator in Philadelphia on Aug 16th .

An Evidence list can make a claim move faster in my opinion in many cases.It also highlights what they must have their attention called to.My husband's VA records are "voluminous" per the BVA in a past decision I got and we cannot expect them to search through stacks of SMRs or med recs to find medical evidence.Better if we do that ourselves and send them the list and copies of the pertinent stuff.

They can then check any copies of our med recs that we send to them- with the actual clinical record.

Edited August 26, 2010 by Berta

[USAFvet13]

Finished my C&P and got a copy. Not looking good. Doctor states "less likely as not" back pain secondary to knees..... I did submit 2 chiro IMOs that say otherwise, and 2 other IMOs one from a physical therapist and one from an Ortho that says "as likely as not" or "is due to" so I'm not sure what to think at this point.... I don't think it's looking good though.

[JR Reihs]

Finished my C&P and got a copy. Not looking good. Doctor states "less likely as not" back pain secondary to knees..... I did submit 2 chiro IMOs that say otherwise, and 2 other IMOs one from a physical therapist and one from an Ortho that says "as likely as not" or "is due to" so I'm not sure what to think at this point.... I don't think it's looking good though.

Did the C&P doc look at you IMO's, if he or she did, it should be mentioned in exam notes as to how their assessment is inferior to the C&P docs. If they are not mentioned you should file to have the C&P exam thrown out and request a new one that will include the IMO's.

You should key in to the Ortho's IMO, this is the one that will get you over the hump.

[USAFvet13]

Did the C&P doc look at you IMO's, if he or she did, it should be mentioned in exam notes as to how their assessment is inferior to the C&P docs. If they are not mentioned you should file to have the C&P exam thrown out and request a new one that will include the IMO's.

You should key in to the Ortho's IMO, this is the one that will get you over the hump.

I'll have to look later tonight at the notes to see if he mentioned the IMOs. One key thing he is saying against my claim in his conclusion was that if the back pain was caused by knee issues then recent xrays of the knees prior would show abnormalities. He refers to xrays from 2009 which I have no idea what he is talking about. BUT, he fails to mention just this year in 2010 I had ANOTHER C&P for a knee increase and that C&P doc found degen arthritis and slight subluxation and my knees were given another 10%. NOt to mention the recent orho doc this month did xrays and found patella tilt in both knees (this is the doc that wrote my IMO). I included all this information with my appeal.

[USAFvet13]

Did the C&P doc look at you IMO's, if he or she did, it should be mentioned in exam notes as to how their assessment is inferior to the C&P docs. If they are not mentioned you should file to have the C&P exam thrown out and request a new one that will include the IMO's.

You should key in to the Ortho's IMO, this is the one that will get you over the hump.

The C&P doc did not mention my IMO's from my other docs individually but instead made a broad generalized statement addressing all of them at the same time in one sentence. I will post the exact wording later tonight. Two questions:

1. Should I wait and see how this will play out from here and see what is decided? I was told it's possible the DRO may decide in my favor and it not need to go to the video conference (not looking good though since the C&P doc gave me a Less likely than not statement) Or should I file now to have the exam thrown out?

2. How do I file to have this C&P thrown out and request another one? I don't remember ever reading about this process in my research.

Thanks for all the help so far, its truely appreciated.

[USAFvet13]

Ok so after rereading his conclusion he is claiming x-rays of my knees taken in 2009 were normal. And says the structural abnormalities described by the D.C.'s are unrelated to the knee conditions. He then says gait abnormality significant enough to result in back pain would result in anatomic knee abnormalities prior to back pain. He also claims my gait was normal, when in fact I had a slight limp that day because my knee was acting up.

No mention of my orthopedic IMO that states "At this time for my professional opinion, I do feel that his back pain is secondary to his knee pain." My Ortho also states that during this visit (visit was 1 month ago) x-rays were taken of my knees and they still reveal lateral translation with patella tilt in both knees.

No mention of my recent increase of knee disability from a C&P exam earlier this year where the examiner found arthritis and noted a slight subluxation /instability.

Not sure where to go from here....