tdiu Tdiu Doctor's Opinion - Would This Work

[Charleese]

Hi All,

The vet I am helping orthropediac doctor wrote under History that: The patient is a 73-year old male who comes in primarily for pain in both knees and lower back. The patient had previous left knee surgery in 1954 service connected where he was injured. He has had progressive knee pain over the past years, which because of the way he has been walking has started to affect his other knee as well as his lower back. Physical Exam doctor states in part: Both knees have crepitus. The right knee has more crepitus and pain in the medial side. Varus knee deformity on the right is noted. Sensory examination is intact. Reflexes are trace gilaterally. Dorsalis pedis pulse is 2+. X-rays taken today shows severe patelloofemoral arthritis and milder femororotibial arthritis. He has also patellofemoral arthritis on the right knee and primarily medial joint arthritis on the right knee. Impression: The patient's pain is more severe in the left knee than the right. Treatment Plan: Is is felt that the patient has severe osteoarthritis, posttraumatically induced. I feel the right knee is probably within a reasonable degree of medical certainity related to the fact that he has been limping for the past 20 years and favoring the left side has caused an effect of producing arthritis on the right knee. The treatment options were discussed with him. At the present time, the patient is probably unemployable since ambulation for any long periods of time bother him and he cannot stand for a long period of time, anything longer than 20 minutes of the time and also, when he sits in one position for a while, his legs start to cramp up and bother him as well as pain in the lower back, so he has got to get up and move. We will see the patient back in the office as needed.

Questions: (1) Do you think these medical opinions by the doctor will get him secondary service connected for his rigt knee and lower back to his service connected left knee.

(2) Doctor stating: "At the present time, the patient is probably unemployable", get him TDIU.

Thanks in advance for your replies.

[carlie]

Hi All,

The vet I am helping orthropediac doctor wrote under History that: The patient is a 73-year old male who comes in primarily for pain in both knees and lower back. The patient had previous left knee surgery in 1954 service connected where he was injured. He has had progressive knee pain over the past years, which because of the way he has been walking has started to affect his other knee as well as his lower back. Physical Exam doctor states in part: Both knees have crepitus. The right knee has more crepitus and pain in the medial side. Varus knee deformity on the right is noted. Sensory examination is intact. Reflexes are trace gilaterally. Dorsalis pedis pulse is 2+. X-rays taken today shows severe patelloofemoral arthritis and milder femororotibial arthritis. He has also patellofemoral arthritis on the right knee and primarily medial joint arthritis on the right knee. Impression: The patient's pain is more severe in the left knee than the right. Treatment Plan: Is is felt that the patient has severe osteoarthritis, posttraumatically induced. I feel the right knee is probably within a reasonable degree of medical certainity related to the fact that he has been limping for the past 20 years and favoring the left side has caused an effect of producing arthritis on the right knee. The treatment options were discussed with him. At the present time, the patient is probably unemployable since ambulation for any long periods of time bother him and he cannot stand for a long period of time, anything longer than 20 minutes of the time and also, when he sits in one position for a while, his legs start to cramp up and bother him as well as pain in the lower back, so he has got to get up and move. We will see the patient back in the office as needed.

Questions: (1) Do you think these medical opinions by the doctor will get him secondary service connected for his rigt knee and lower back to his service connected left knee.

(2) Doctor stating: "At the present time, the patient is probably unemployable", get him TDIU.

Thanks in advance for your replies.

Charleese,

Answer (1) NO

Answer (2) NO

** This doesn't even read like this person is actually a doctor, just the word probably - will probably result in a quick denial.

Most of what the doc has written is by way of history. Crepitus is shown but no ROM measurements are shown. It maybe enough to get a

decision maker to order a C&P exam for the right knee as secondary to the SC'd left knee.

jmho

[Charleese]

He is an orthopedic surgeon who is board certified and specializes in Hip and knee replacement, hand/upper extremity surgery and orthopedic trauma. The word Probably means: insofar as seems reasonably true, factual, or to be expected without much doubt. The format is different than the way I typed it hear. The following format was used:

History of Present Illness - explanation;

Medications - list medicines he takes;

Allergies - patient has none

X-rays - explanation

Impression - explanation

Treatment Plan - explanation

I don't know what ROM is, matterfact I don't know what Reflexes are trace bilaterally, or Dorsalis pedis, pulse is 2+ mean. If you or anyone know pleasse tell me.

[Philip Rogers]

ROM = range of motion, reflexes trace bilaterally = reflexes on both sides but trace or diminished capacity, dorsalis pedis pulse is the pulse on the top of the foot and 2+ is normal.

pr

[LarryJ]

Heck, the vet is 73 years old. I have no idea how that age will fit into the claim concerning TDIU, but it should certainly become part and parcel for a good argument for TDIU. Has the veteran actually filed a claim for increase (a form 21-8940)?

[Charleese]

Yes he has filed TDIU application. VA does not recognize age.

[Berta]

There is considerable info in the IMO forum on how these IMOs must be prepared.

The lingo "as likely as not"

or a stronger statement "more than likely" is the key wording the VA looks for in these opinions and must be followed by medical rationale for the opinion .

If the doctor can bolster their opinion with brief excerts from highly regarded medical texts that supports their opinion,that too will help.

VA views the word "probably" as speculation.