Question About Some Claims

Tomahawk · June 30, 2010

Okay Ill try and keep this short so people with experience dont have to read a book to respond. The long of the short is that it took about 9 years for my to get my disability approved. Im currently rated at 30%. I was told and was under the impression this was for flat feet. My original claim was for left foot condition that at the time was not diagnosed properly. I was discharged medically due to "Hallux Vulgus" yet that was not the underlying condition. At any rate after 9 years they finally came back with the flat foot rating because I didnt have flat feet going in but do now. I actually have RSD in my foot/lower left calf. So I filed for an increase after talking to my pain managment doctor. All of my treatment is done at the VA

It is clearly documented that my foot condition is CRPS/RSD in my VA treatment records. And I have statements in my SMR that clearly indicate RSD back then.

1.) With my claim for the CRPS (granting they approve it) will they back date it to when I filed my original claim as I applied for the increase within 1 year of receiving my 30% decision?

2.) To prove something is service connected do I need the stated issue sited in my SMR or is having multiple "general" treatment for conditions good enough? For example I had an MRI in 2006 of my back that states " There is an apparent left pars defect of L5 suggestive of unilateral spondylolysis. Incidental note of Spina bifida Occult of L5. Sagittal images shows posterior disc bulge at T11-T12 which narrows the spinal canal at thsi level. Conus medullaris is displaced posteriorly. At l4-l5 there is hypertrophy of both facet joints causing mild bilateral beural foraminal narrowing. And in my SMR I have multiple low back strains as well as documented contusions in the T5 and T9 areas. However I never had an MRI when I was in the service.

3.) What is the best way to get a VA doctor to write a nexus? Do I just request a referral from my PCP for a specialist in that area specifically to be examined for the possibility of service connection? For example I have Sleep Apnea with documented sleep troubles while in service and a buddy statement saying I snored and occasionally woke up gasping. I am also on meds that are known to exacerbate OSA. So do I just request to be seen by the sleep lab people again and ask them to review my case or do I actually need to find a doc outside of the VA?

I have more but those are my main concerns for now. Its been over a year since my initial request for increase and due to logistical issues I still havent had my C&P exam so Im trying to get all my ducks in a row prior to going to the regional office.

Berta · June 30, 2010

1.) "With my claim for the CRPS (granting they approve it) will they back date it to when I filed my original claim as I applied for the increase within 1 year of receiving my 30% decision?"

They will use the actual date of filing the claim for CRPS for potential EED.

"It is clearly documented that my foot condition is CRPS/RSD in my VA treatment records. And I have statements in my SMR that clearly indicate RSD back then."

Do you mean a formal medical diagnosis of CRPS and RSD ?

What did the VCAA letter they sent to yo on this specifc claim say that you needed as evidence?

Tomahawk · June 30, 2010

"It is clearly documented that my foot condition is CRPS/RSD in my VA treatment records. And I have statements in my SMR that clearly indicate RSD back then."

Do you mean a formal medical diagnosis of CRPS and RSD ?

What did the VCAA letter they sent to yo on this specifc claim say that you needed as evidence?

Yes I have a formal medical diagnosis in my VA medical records for CRPS/RSD. However I do not have a formal diagnosis in my SMR. I do however have in my SMR being treated for many of the symptoms of it.

What the VA sent me says

"We need evidence showing that the following conditions exsisted from military service to the present time:"

And then it lists everything I am claiming "esophagitus with hiatal hernia, sleep apnea, left knee condition, low back condition........ And then continues saying I need to show proof the issues I claimed as secondary to service connection existed in service. Which I dont understand that part. Im not claiming those were SC Im claiming they are secondary to SC. And then it goes on to say I need to submit current medical records stating the conditions exist. Which again I dont understand as I thought if I was treated at the VA then I didnt need to submit anything. So does this mean I need to go to the VA and get copies of all my treatments and submit them?

And thank you in advance for your help.

Berta · July 1, 2010

You need to get a copy of your VA medical records.

"Yes I have a formal medical diagnosis in my VA medical records for CRPS/RSD. However I do not have a formal diagnosis in my SMR. I do however have in my SMR being treated for many of the symptoms of it."

I assume you do have copies of your SMRs.

In this case you certainly need to consider that only an independent medical opinion might be what is needed to connect the inservice documented symptoms to the actual diagnosis that you have now.

VA doesnt connect the dots- we usually have to do that or get an outside doctor to do it.

Perhaps a C & P doctor would connect the medical dots but that is often not the case at all.

These IMOs can be costly but if there is a nexus between the SMR documentation and your current conditions ( the IMO could also opine on any claimed secondaries) that a doctor with expertise in the field can opine on with a full medical rationale- then service connection can be established.

I assume you received the VCAA letter asking for evidence.Did they mention the CRPS and RSD in that letter?

Have you responded to the VCAA letter? Have you told them your VA medical records should be used to adjudicate the claim? DO you have any private medical records? They will need to obtain those or you could submit them.

The VA will not grant any secondary disability as SC until it grants the initial disability as SC and then they will need medical evidence that the prime SC condition has medically caused the additional disabilties.

There are cases for your claimed disability at the BVA web site.Many some of those cases would reveal some help as to what evidence they need.

But if the SMRs only reveal documented symptoms then it will take a doctor to assess the SMRs and your post service Medical records to opine on and establish the nexus-the linkage of the current diagnosis to your service.

Edited July 1, 2010 by Berta

jbasser · July 1, 2010

I have a question for you. This is a little fishing expedition.

Was your father a in country Viet Nam Vet.

J

Tomahawk · July 1, 2010

I assume you do have copies of your SMRs.

In this case you certainly need to consider that only an independent medical opinion might be what is needed to connect the inservice documented symptoms to the actual diagnosis that you have now.

VA doesnt connect the dots- we usually have to do that or get an outside doctor to do it.
Perhaps a C & P doctor would connect the medical dots but that is often not the case at all.
These IMOs can be costly but if there is a nexus between the SMR documentation and your current conditions ( the IMO could also opine on any claimed secondaries) that a doctor with expertise in the field can opine on with a full medical rationale- then service connection can be established.

I assume you received the VCAA letter asking for evidence.Did they mention the CRPS and RSD in that letter?

Have you responded to the VCAA letter? Have you told them your VA medical records should be used to adjudicate the claim? DO you have any private medical records? They will need to obtain those or you could submit them.

The VA will not grant any secondary disability as SC until it grants the initial disability as SC and then they will need medical evidence that the prime SC condition has medically caused the additional disabilties.

There are cases for your claimed disability at the BVA web site.Many some of those cases would reveal some help as to what evidence they need.

But if the SMRs only reveal documented symptoms then it will take a doctor to assess the SMRs and your post service Medical records to opine on and establish the nexus-the linkage of the current diagnosis to your service.

Yes I have 1 copy remaining of my SMR. I have already submitted 3 copies to the regional office as they have lost them twice.

Yes the VCAA letter states I need to provide evidence of a diagnosis of CRPS/RSD and also submit documents that it is service connected. Which I have in my SMR the symptoms, and it shouldnt be too hard to connect the dots as I was discharged due to the navy doc screwing up my surgery on my foot. I have letters from a private doctor back then stating what the navy doc did and what he should have done, along with letters from my CO and XO when I was trying to fight my medical discharge stating that they only agreed to it because the navy doc said it was not a repairable condition and they wanted me examined by someone else. Which they then sent me to Bethesda for an exam and the doc there again sited the symptoms of CRPS in his notes and stated "R/O RSD(Which Im not sure if this RSD actually means Reflex Sympathetic Dystrophy or not I was never explained anything about this I just saw it in my SMR long after I was already diagnosed with it) and scheduled me for a bone scan. Which after the bone scan came back they said there was nothing they could do for me.

I have not responded to this letter other than to do the online inquiry asking whether or not they had my file or if it was lost, as I was told 3 months ago they were working off of a rebuilt file. And I asked that if it was yet again lost whether or not I needed to resubmit my SMR or not. I do not have any private medical records other than the consult from when I was in service which I submitted initially with my claim.

Thanks again for the help and answering my questions. I have time next week Im going to go to the RO and ask to speak to someone about my file to see exactly what paperwork I need. Ive also requested a consult with my PCP to see a neuro doc. I already have an appointment for Physical Medicine as PT says Im too jacked up to benefit from therapy. My Pain Mgt doc has been on a LOA and the last guy I saw took 5 minutes to see me gave me blood pressure meds that supposedly help neuro conditions and sent me on my way with an RTC for 3 months out, so I had my PCP try and get me a different interim pain doc and cancel the stupid meds.