Congenital Disease, How Are They Treated In A Claim?

[retiredat44]

Congenital disease, how are they treated in a claim? If you claim injury, condition, agrevation of disease, injury, how are conditions that the VA say are congenital handled..?

how can they prove it's congenital, how to they determine what? etc..

thanx..

[Pete53]

VA denies them routinely

[pacmanx1]

4.9 Congenital or developmental defects. Mere congenital or developmental defects, absent, displaced or supernumerary parts, refractive error of the eye, personality disorder and mental deficiency are not diseases or injuries in the meaning of applicable legislation for disability compensation purposes.

[Testvet]

it's not that they have to prove they are not SC rather you have to prove how they are SC if you can't prove service caused it then it will be denied

[john999]

It is like proving a negative. The VA can just say "NO" and you have to meet a burden that gets higher and higher. Thus the personality disorder that half of us have been DX'ed with at one time or another. You need an expert to disprove it.

[jbasser]

If the condition is diagnosed before entry to service then the onluy avenue for Comp is the Aggravation factor. If it is not diagnosed until after separation then the avenue changes for you are considered to be sound when you entered. ALso remember that a condition not diagnosed is not a condition until it is diagnosed.

I am seeing this in some IHD claims where the Vets have Aortic Stenosis. There are two tyoes of this issue. Congenital and Acquired. If it is not diagnosed until later in life then the only diagnosis would be acquired.

J

[acesup]

When I got my first copy of my C-file a few years ago, there was a Radiology Report (Two paragraphs describing X-ray results) from 1974, (during my C&P exam for my initial lumbar spine injury claim), that noted some wedging of T12-L1 vertebra, plus some broken bits of transverse process (those two little bones that stick out from the back of the vertebra). It was simple, kind of primitive X-ray technology back then, but after noting those findings the radiologist added that it was congenital.

I think only a VA C&P radiologist would have been smart enough to decide this all on his own, huh?

The same X-rays showed scoliosis in lumbar and T-spine areas. Nobody ever mentioned those to me, but I think they probably decided it was congenital too.

Now, I only recently learned about the scoliosis from my C-file, but after looking into it, I find that scoliosis CAN be caused by traumatic injury. If the VA docs knew that way back when, they kept it to themselves.

Then I found where before that date, a rater had received a diagnosis of lumbar compression fracture from my initial C&P exam, and he requested the C&P clinic to have an orthopedic specialist examine me. The ortho guy claimed X-rays found no evidence of any fractures, just chronic lumbar strain, and the initaially gave me SC 0%, then later 10% on appeal.

Now, a couple of months ago, I got another copy of my C-file, and found some more 1974 paperwork that had never been given to me before. Included was a Hospital Discharge Summary record from a 3 week stay in the VA hospital for hep B, during which time I had reported a lot of back pain, and the VA doctor had ordered X-rays, then reported that they displayed L1 compression fracture.

Go figure!

Unless you know yourself that something truly is congenital, it probably would be worth investigating to see if it might be otherwise. I guess I'm trying to say this; At least one half of medical professionals graduate in the bottom 50% of their class. I think the military and the VA attract those 50 percenters, they can be quite useful.