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Hip Arthritis Appeal

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bergin c/o

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recieved 10 percent for ptsd but they denied service connection for bilateral hip arthritis. one hip has beed replaced and the other is on the way. i began having hip pain while in desert storm but did not give it much thought. i discharged shortly after returning and it grew progressivly worse. i was 30 when i had my first hip replaced. v.a said in denial letter that my docters relied on speculation in the evidence letters i provided the va. words like possibly caused by service in the military and may have been caused by . also c-p exam stated a cause could not be assigned without resorting to speculation .even though my docters stated abnormal amount of degenerative arthritis in a young individual..got a letter today asking me to pick between traditional appeal or a decision review officer.were do i go from here to get more supporting evidence?

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thank you , i am waiting to hear from my vso later today . after i supplied all the medical documentation, i was curious about what more to give them and what i needed to say at the hearings . i discharged three months after returning from saudi , and the aches and pains grew worse i just went to my own dr. at home for treatment. they stated that i did not get seen by a dr. in servive they could not point to a cause of injury. they could only speculate.

have you filed for service connection under 1118. The presumption period doesn't end til Dec 31 2011 i think.

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I think you mean regulation:

http://www.hadit.com/forums/index.php?showtopic=25232

BTW all- the Gulf War is not declared as over so all GWV illnesses are also applicable to Iraq and Afganistan veterans if they also fit the criteria for service connection of these conditions found in the above reg.

ALSO I posted recently the additional 9 new presumptives that Sec Shenseki wants to be added to the list of GWV illnesses.

(Unless some 90 day wonder like Sen Webb wants to try to prevent these illnesses from becoming service connectable lke he is trying to do with the new AO regs)

I asked ths vet about having any infrectious disease while in the Gulf area during service as it could be a possible etiology inservice for his arthritic condition now.

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Larry posted this news here and we discussed this last week at SVR Radio show and will be doing so again this coming Wednesday.

I did some research on these conditions but can't find where I put it here at hadit- here it is again-

(The info I found was overwheleming and difficult to edit to a post)

Brucellosis

Brucellosis is an infectious disease caused by the bacteria of the genus Brucella. These bacteria are primarily passed among animals, and they cause disease in many different vertebrates. Various Brucella species affect sheep, goats, cattle, deer, elk, pigs, dogs, and several other animals. Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria. In humans brucellosis can cause a range of symptoms that are similar to the flu and may include fever, sweats, headaches, back pains, and physical weakness. Severe infections of the central nervous systems or lining of the heart may occur. Brucellosis can also cause long-lasting or chronic symptoms that include recurrent fevers, joint pain, and fatigue.

Source CDC

http://www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_g.htm#whatis

Campylobacter jejuni

A foodborne pathogen

http://www.cdc.gov/ncidod/eid/vol5no1/altekruse.htm

Coxiella burnetii (Q Fever)

“Only about one-half of all people infected with C. burnetii show signs of clinical illness. Most acute cases of Q fever begin with sudden onset of one or more of the following: high fevers (up to 104-105° F), severe headache, general malaise, myalgia, confusion, sore throat, chills, sweats, non-productive cough, nausea, vomiting, diarrhea, abdominal pain, and chest pain. Fever usually lasts for 1 to 2 weeks. Weight loss can occur and persist for some time. Thirty to fifty percent of patients with a symptomatic infection will develop pneumonia. Additionally, a majority of patients have abnormal results on liver function tests and some will develop hepatitis. In general, most patients will recover to good health within several months without any treatment. Only 1%-2% of people with acute Q fever die of the disease.

Chronic Q fever, characterized by infection that persists for more than 6 months is uncommon but is a much more serious disease. Patients who have had acute Q fever may develop the chronic form as soon as 1 year or as long as 20 years after initial infection. A serious complication of chronic Q fever is endocarditis, generally involving the aortic heart valves, less commonly the mitral valve. Most patients who develop chronic Q fever have pre-existing valvular heart disease or have a history of vascular graft. Transplant recipients, patients with cancer, and those with chronic kidney disease are also at risk of developing chronic Q fever. As many as 65% of persons with chronic Q fever may die of the disease. “

source:

http://www.cdc.gov/ncidod/dvrd/qfever/

Malaria

“Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. In 2008, an estimated 190 - 311 million cases of malaria occurred worldwide and 708,000 - 1,003,000 people died, most of them young children in sub-Saharan Africa. “

source:

http://www.cdc.gov/malaria/

Mycobacterium tuberculosis

“Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States. “

http://www.cdc.gov/tb/

Nontyphoid salmonella

“Salmonellosis is an infection with Salmonella bacteria. Most people who get infected with Salmonella develop diarrhea, fever, vomiting, and abdominal cramps, 8 to 72 hours after infection. In most cases, the illness lasts 4 to 7 days; most affected persons recover without treatment.[1] However, in some persons the diarrhea may be so severe that the patient becomes dangerously dehydrated, and must be taken to a hospital. At the hospital, the patients may receive intravenous fluids to treat their dehydration, and medications may be given to provide symptomatic relief, like fever reduction. In severe cases, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites, and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness. Some people afflicted with salmonellosis later experience reactive arthritis, which can have long-lasting, disabling effects. “

http://en.wikipedia.org/wiki/Salmonellosis

Shigella

“Any of the rod-shaped bacteria that make up the genus Shigella, which are normal inhabitants of the human intestinal tract and can cause dysentery, or shigellosis. Shigellae are gram-negative (see gram stain), non-spore-forming, stationary bacteria. S. dysenteriae, spread by contaminated water and food, causes the most severe dysentery because of its potent toxin, but other species may also be dysentery agents. “

http://encyclopedia2.thefreedictionary.com/Shigela

Visceral Leishmaniasis

“(also known as kala-azar) is a deadly disease transmitted via the bite of an infected sand fly. Visceral leishmaniasis (VL) is the most dangerous of the three manifestations of disease caused by the Leishmania parasite because the parasite migrates into the vital organs. VL is associated with fever, weight loss, enlargement of the spleen and liver, and anemia. If left untreated, VL is nearly always fatal.”

http://www.oneworldhealth.org/leishmaniasis

West Nile Virus

in general, the likely outcome of a mild West Nile virus infection is excellent.

“For patients with severe cases of West Nile virus infection, the outlook is more uncertain. West Nile encephalitis or meningitis may lead to brain damage and death. Approximately 10% of patients with brain inflammation do not survive.”

https://health.google.com/health/ref/West+Nile+virus

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Brucellosis could be a possible etiology for this veteran's arthritic condition.If he had any documented infectious type of disease in SW Asia

it could be a possible SC condition based on these proposed presumptives.

In my opinion many many vets who served in SW Asia came back with potential infectious diseases and I think the Sec based his request for presumption on some facts that appeared to show a commonality of these infections in SW Asia vets.I only wonder however- how the heck the Mil would really know what some of this stuff was and how an infection could be properly diagnosed and documented in an SMR.

Then you have to deal with C & P examiners who might not have a clue on these diseases either.

Chronic Coxiella burnetii (Q Fever)is deadly in many cases and it strikes me as odd that this was part of Project SHAD/112 tests and those vets are not compensated for any disabilty due to any exposure to it but the Sec wants it added as a Irag, Afganistan, Persian Gulf War disease.

Advocates need to look into these new presumptives carefully.Even a sand fly could kill you with a bite if infected with leichimaniasis.

Edited by Berta
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This case shows what I mean:

http://www4.va.gov/vetapp02/files03/0212223.txt

This case shows what I mean.

In Part:

“The veteran's service medical records are negative for

treatment for or a diagnosis of leishmaniasis. Medical

records do reflect that the veteran was seen by the service

department subsequent to his active service (as a reservist).

A provisional diagnosis of rule out leishmaniasis is noted on

a consultation report dated in October 1992, but the

impression on examination included suspected leishmaniasis

(visceral). It was noted that if the diagnosis was strongly

entertained, the veteran should be seen for bone marrow

biopsy and cultures. An infectious disease consultation was

also recommended, but it does not appear that this was

accomplished. The report of liver biopsies taken a few days

later in October 1992 at an Army Medical Center reflects a

preoperative diagnosis of "consider leishmaniasis" but a

postoperative diagnosis of hepatomegaly. On consultation (by

a private facility), a leishmaniasis panel in October 1992

revealed that antibodies were not detected. A stool sample

analyzed by this facility in April 1993 was found to be

negative for parasites.

In the report of a VA infectious disease consult of February

2000, the Chief of Infectious Disease indicated that he

reviewed the veteran's records and noted that the veteran

served Southwest Asia which is a region that is endemic for

cutaneous leishmaniasis and for sporadic cases of visceral

leishmaniasis. The examiner pointed out that the veteran did

not, however, have a history of skin lesions consistent with

cutaneous leishmaniasis. He noted that the veteran had

elevated liver function tests since 1982, and that serologic

tests for leishmaniasis were reported to be negative.

The examiner noted that he suspected that the question of

leishmaniasis had been raised initially because of abnormal

liver function tests and intermittent fevers, and that

testing for leishmaniasis was recommended for Gulf War

veterans with such signs. He noted that, however, these

symptoms were associated with other diagnoses, and pointed

out that the veteran did not have certain other symptoms

associated with leishmaniasis. Significantly, he noted that

there were few false negatives on testing of antibodies.

In concluding the report the examiner stated that the veteran

does not have the symptoms of chronic,

visceral leishmaniasis and does not have

the characteristic laboratory findings of

visceral leishmaniasis, has a negative

test for leishmanial antibodies, does not

have the characteristic pathologic

changes of hepatic leishmaniasis, and has

documentation of two diagnoses . . .

which adequately explain his intermittent

fevers, abnormal liver function tests,

and hepatomegaly. As an infectious

disease expert . . . I can state

definitively that [the veteran] does NOT

have visceral (or cutaneous)

leishmaniasis and that further clinical

evaluation and/or tests [to include bone

marrow biopsy] for this disease are NOT

indicated.

Taking into account all of relevant evidence, discussed

above, the Board finds that service connection is not

warranted for leishmaniasis. The Board noted that the

veteran was seen with suspected leishmaniasis just subsequent

to his active duty service, the weight of the evidence does

not indicate that the veteran currently suffers (or ever

suffered) from the disorder. Of particular significance, the

specialist who recently - and thoroughly - reviewed the

record, indicated that the veteran never suffered from

leishmaniasis.

The objective medical evidence of record does not show that

the veteran currently suffers from leishmaniasis or the

residuals of leishmaniasis. In fact, while it was indicated

as a possible diagnosis in the past, the disorder was never

actually diagnosed. It is pointed out that the existence of

a current disability is the cornerstone of a claim for VA

disability compensation. 38 U.S.C.A. §§ 1110, 1131 (West

1991 & Supp. 2001); see Degmetich v. Brown, 104 F.3d 1328

(1997).

Given the particular facts of this case, as well as the RO

(and the Board) having complied with the necessary obligation

to notify and assist the veteran, as mentioned above, the

Board finds that there is no reasonable possibility that any

further assistance would aid in substantiating the veteran's

claim. 38 U.S.C.A. § 5103A (West Supp. 2001); 66 Fed. Reg.

45,620 (Aug. 29, 2001) (to be codified at 38 C.F.R. §§ 3.102,

3.156(a), 3.159, 3.326(a)). Accordingly, the Board does not

find that this claim needs further development.

ORDER

The appeal is denied.”

-------------------------------------

A red flag here for me is the word hepatomegaly.

“VL is associated with fever, weight loss, enlargement of the spleen and liver, and anemia. If left untreated, VL is nearly always fatal.” I got this from the oneworldhealthorg link above.

Visceral Leishmaniasis (VL) can cause hepatomegaly-which is enlargement of the spleen and liver.

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thank you for your help, it is a very confusing process. i am still researching your posts but when i returned from sw asia i did have bad night sweats ,joint pain and irritable bowel. there is alot of information out there ,and i called my vso on my appeal and was told to gather more evidence.problem is one my evidence is redundent not new,also many of the docters i saw when i got out are no longer in practice. i had an old letter from one dated 2002 which said i had been treated for arthritic hips since my time in the service ( the va in the decisicion letter discounted this statement because they said it did not list what caused my condition and it appeared to them the doc was reliying on my statements as to when the pain started and not on medical record)..i returned to this doc for a follow up letter and was told since i was not longer his patient to see my new doc. i went to my current dr, who stated he i was not his patient when i was diagnosed he could not truthfully give a medicall opinion ,all he would write was a softball type letter based on what was in my medicall record. all other drs. have used this excuse when asked for a opinion.all are afraid to be pinned down by va.( you have bad arthritis deal with it ) i got out in 91 and the only other letter i have that is close to that time frame is a 1994 letter stating i i have bad hips due to military service( va threw that out because the docter never stated a cause) and that doc is no longer in practice. i went to get a letter for my ibs and was told by my docter that most of america has ibs and he would not give an opinion letter for such a common disease.all my other doc letters are from my current docs and all say about the same thing my condition was possibly caused by or made worse by military service. so when i go to get more evidence it is just more of the same not new and material, so thats where i am now kinda cunfused and stuck , i thank the forum for your help ,this is the only place i have found with any answers. thank you

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Have you obtained your SMRs yourself?

The VA can easily overlook probative information in SMRs.

I had local vet whose SMRs were extremely difficult to read.I spent days on decifering them and then looking up some of the medical terms.

He was able -with the SMRs decifered and the research to obtain an IMO that made his case succeed.

They owed him a decade of retro.

The VA and the BVA had said his SMRs were "silent" for any potential nexus of his current disability.

The fact was no rep he had nor his lawyers ever read them. The SMRs were loud and clear when I got done with them.

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