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Just Wondering About This.....


Michellee

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If a person was medically boarded out after injuries sustain as a result of an accident . When they entered the VA system say they filed claim for Traumatic arthritis why would they (VARO) deny it then turn around and rate them with 5003 DDD then couple of years later the local VA Doctor still turn around and diagnose them with Traumatic arthritis to the same area but the VARO denied you for that. I think they (VARO) does this to low ball claims. Its amazing when the doctor tells you there is no way you should have these type of injury so young unless you injured your back at some point and so on.....mellow.gif

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Sometimes the rating specialist is stuck with what the doctor diagnoses.

In a perfect world, a servicemember who sustains injuries in service and subsequently develops traumatic arthritis would be diagnosed with exactly that; traumatic arthritis of the (whatever joint). If it's soon after the release from active duty, we can go ahead and "connect the dots" ourselves; "Hmm, this vet injured his back in service, he has traumatic arthritis now in his back, granted." If it's been a few years, though, we have to ask if the complaints now are as likely as not related to the complaints in service. I've seen more than one claim where the vet had just a few complaints of back pain in service, but 20 years after their discharge they got into a bad car wreck or a workplace accident, and now are trying to claim service connection for their back condition.

Note: DDD is NOT presumptive. DJD is. But either can be service connected if the examiner makes a nexus. Furthermore, true degenerative joint disease under DC5003 if granted in one joint, anywhere else it manifests also gets service connected because it's considered a systemic disease. We have to be real careful when we use DC5003.

My guess as to what happened is that for whatever reason, there was no arthritis diagnosed (confirmed by x-ray) in service or within one year, despite the injuries. That pretty much prevents the use of the 5003 diagnostic code (actually, I would write it 5003-5237 using hyphenated codes). This would pretty much be a denial as it stands. If it were my case to work, and I saw injuries in service, and maybe no arthritis confirmed by x-ray within one year (maybe it's a couple of years out now), but if I *did* have a diagnosis from the VAMC or private doctor of degenerative disc disease, hey, I'm using THAT. I'd see to it that the file got sent to the hospital for a C&P exam, tab the service medical records that showed treatment for the injuries, tab any private treatment records subsequent to getting out that show continuity of treatment for SOME sort of back condition, and ask the examiner if it's as least as likely as not that the current diagnosis, whatever it is, is related to the complaints in service. The examiner connects the dots for me, gives me a nexus opinion, and bam, I get to service connect Degenerative Disc Disease, and the veteran gets the same compensation as if he were granted for traumatic or degenerative arthritis (they use the same rating criteria after all). I may not be able to give the same effective date, but then again, maybe I can depending on when the vet refiled. It's ugly, it doesn't quite match reality, but it matches what the doctor says and it gets the job done; the vet gets compensation for his back.

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Sometimes the rating specialist is stuck with what the doctor diagnoses.

In a perfect world, a servicemember who sustains injuries in service and subsequently develops traumatic arthritis would be diagnosed with exactly that; traumatic arthritis of the (whatever joint). If it's soon after the release from active duty, we can go ahead and "connect the dots" ourselves; "Hmm, this vet injured his back in service, he has traumatic arthritis now in his back, granted." If it's been a few years, though, we have to ask if the complaints now are as likely as not related to the complaints in service. I've seen more than one claim where the vet had just a few complaints of back pain in service, but 20 years after their discharge they got into a bad car wreck or a workplace accident, and now are trying to claim service connection for their back condition.

Note: DDD is NOT presumptive. DJD is. But either can be service connected if the examiner makes a nexus. Furthermore, true degenerative joint disease under DC5003 if granted in one joint, anywhere else it manifests also gets service connected because it's considered a systemic disease. We have to be real careful when we use DC5003.

My guess as to what happened is that for whatever reason, there was no arthritis diagnosed (confirmed by x-ray) in service or within one year, despite the injuries. That pretty much prevents the use of the 5003 diagnostic code (actually, I would write it 5003-5237 using hyphenated codes). This would pretty much be a denial as it stands. If it were my case to work, and I saw injuries in service, and maybe no arthritis confirmed by x-ray within one year (maybe it's a couple of years out now), but if I *did* have a diagnosis from the VAMC or private doctor of degenerative disc disease, hey, I'm using THAT. I'd see to it that the file got sent to the hospital for a C&P exam, tab the service medical records that showed treatment for the injuries, tab any private treatment records subsequent to getting out that show continuity of treatment for SOME sort of back condition, and ask the examiner if it's as least as likely as not that the current diagnosis, whatever it is, is related to the complaints in service. The examiner connects the dots for me, gives me a nexus opinion, and bam, I get to service connect Degenerative Disc Disease, and the veteran gets the same compensation as if he were granted for traumatic or degenerative arthritis (they use the same rating criteria after all). I may not be able to give the same effective date, but then again, maybe I can depending on when the vet refiled. It's ugly, it doesn't quite match reality, but it matches what the doctor says and it gets the job done; the vet gets compensation for his back.

Seems very complicated. I just thought the connection would automatically be made if you were medically boarded out for it. I understand your explanation cause thats about how it went down. Their heads must get to spinning after dealing with so many claims. Thank you. I wish I could get your opinion on the best route for my husband to take. We have hit a rock although he has been trying to research the best way to file his claim. I had him studying hadit an the other yuku site. Still cant figure it out. I am going to start a new thread and explain shortly. Thanks again.

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