Could Use Your Suggestions

[Lou_1980]

Please bear with me, as this is long.

Hi all:

First off, I am 10 percent SC for my left knee. My knee constantly hurts and cannot do certain activities (run, walk for 5+ minutes, squat, sit for 10+ minutes, lift heavy items). While I was in the service, I went to the clinic for bilateral feet pain around three times and once for right knee pain. However, I would mainly go for my left knee pain as I thought it was the most important one. I received a discharged from the Marines due to my left knee in 2002. I was 18 when I was diagnosed with my left knee disability. I am 30 now and weigh 185 pounds compare to the 145 pounds I weighed when I was 18. I served 39 months in the Marines, which 37 months of that I spent in pain due to all the running/humping/mountain climbers, etc...

Fast forward 9 years to early March of this year. I tried to pick something from the floor, I carefully squatted down and when I came up, my left knee felt as if it was going to break or the knee cap was going to pop out. I felt an extremely sharp pain, one I would feel while I was in the service. I ended up falling backwards, twisted my right foot and fractured it (I'm still walking with crutches). I had a feeling of my knee popping out, but I do not think it physically "popped out," but rather a sensation that my knee cap was going to pop out.

This fracture is what caused me to go back to the VA and put in the claims for my right knee, bilateral feet pain, and an increase for my left knee.

As a note: When my original claim for my left knee was done, someone put a claim for my bilateral feet pain as well. The problem here comes that they put my feet claim as pes planus. In my service records, it only states I had tendonitis on both feet. It was eventually denied because I also could not make it to the examination since I was stationed in Georgia and did not have a way to get to Jacksonville, Fl. And to be perfectly honest, since the final exam in JAX was near my termination date, I did not go since I just wanted to get home (I know, big mistake). The denial decision for my feet claim is final according to the letter I received for this new claim I am trying to put in.

However, now that I have seen a VA doctor, she diagnosed me with plantar fasciitis (not sure how to spell that) and knee pain with sciatia (again not sure how to spell it). She also allowed me to do two MRI's of my knees, which surprisingly stated that I had no ligament issues on my left knee (the one I am SC for). But, on my right knee it showed an "abnormal signal" in the medial meniscal posterior horn, "consitent with degenerative" wear. I have always claimed that I lean to my right to relieve left knee stress, hence my right knee and right foot pain.

My questions are these:

1- Do you ladies/gents think I made a mistake by trying to file a new claim for an increase of my left knee, right knee issues secondary to my left knee SC disability, and bilateral feet issues secondary to my knee as well. Especially when I am just beginning to gather medical information? All I have is my right foot fracture MRI, bilateral knee MRI's, service record health records showing my visits for my left knee, 3 visits for my feet and 2 other notes by doctors stating I had a chronic foot issue, 1 visit for my right knee, and all the new notes from March on with the VA hospital stating my new diagnosis for my feet and right knee. I reviewed the progress notes for these new VA visits I am doing and they have noted me walking with an abnormal gait due to pain. But, I also noticed on one occasion they wrote I have full Range of Motion on my knees, which I think is b.s. since my jknees and feet are always hurting and I pretty much suck it up.

2- Do I have a case on the denied case for pes planus since the examiner did not list all the dates I went to sick bay to get treated for my feet? In other words, in the letter the VA sent me to justify my denial, they listed two dates I went to sick bay and noted that it was not chronic. However, there are two occasions on my health record that clearly states I have "chronic" foot pain. The denial letter also did not list a third visit I made for bilateral feet pain. Also, considering that this new doctor diagnosed me with plantar fascitiis and not "tendonitis" as claimed in my service record. I pretty much have the same type of pain, but two diagnosis.

3- Any advice on how to ask a VA or private doctor to create a nexus for me using the limited amount of paper trail? Especially since I have not received treatment since I left the Marines in 2002? Will this hurt my case since there is a 9 year gap? My excuse and reason for this is lack of money and insurance as well as not knowing I could go to a VA hospital and get limited amount of treatment at a discount rate (If I had to pay).

4- How do I link my right foot fracture with this fall I had. I am not overweight nor was drunk when I fell.

Thank you for any feedback given. I am really lost and hope I have a strong enough case for disability.

[Pete53]

Welcome to Hadit. Because of the system many Veterans make mistakes. I know that I did but the main thing is to get the proper rating than look and see if there is a back door to get the proper effective date.

Hadit can help.

Good Luck

[Berta]

"The denial decision for my feet claim is final according to the letter I received for this new claim I am trying to put in."

You will need new and material evidence to re-open that claim and I am glad you are willing to consider an IMO right off the bat as the VA will not be willing to establish any paper trial as far as nexus goes.

Make sure you file a NOD and briefly tell them why each part of the denial is wrong.

Then go to our IMO form here to get an idea of what the IMO doctor needs.

The IMO doc could surely link the fall to the SC knee.It sounds like they could also make a strong case for inservice foot problems that would get worse in time.

I assume you have a copy of the C & P exam and this is something the IMO doctor will need as well as any other info you mentioned here.

There are bound to be similiar cases at the BVA web site under a search for the same disabilities and this might give you an idea of the best approach to the IMO.

The IMO doc will need your SMRs too.

"Any advice on how to ask a VA or private doctor to create a nexus for me using the limited amount of paper trail? Especially since I have not received treatment since I left the Marines in 2002? Will this hurt my case since there is a 9 year gap? My excuse and reason for this is lack of money and insurance as well as not knowing I could go to a VA hospital and get limited amount of treatment at a discount rate (If I had to pay).

4- How do I link my right foot fracture with this fall I had. I am not overweight nor was drunk when I fell."

Did this ever create any problems in employment? Can you get buddy statements if needed to prove this was chronic?

This claim is possible but definitely will need all of the medical factors tied up well in a strong IMO in my opinion.

Edited June 15, 2011 by Berta

[Lou_1980]

hi Berta, thank you very much for your suggestion. However, would I need one IMO or two from two different specialists (one for my feet and one for my knees to tie it to my knee)? Thanks once again.

"The denial decision for my feet claim is final according to the letter I received for this new claim I am trying to put in."

You will need new and material evidence to re-open that claim and I am glad you are willing to consider an IMO right off the bat as the VA will not be willing to establish any paper trial as far as nexus goes.

Make sure you file a NOD and briefly tell them why each part of the denial is wrong.

Then go to our IMO form here to get an idea of what the IMO doctor needs.

The IMO doc could surely link the fall to the SC knee.It sounds like they could also make a strong case for inservice foot problems that would get worse in time.

I assume you have a copy of the C & P exam and this is something the IMO doctor will need as well as any other info you mentioned here.

There are bound to be similiar cases at the BVA web site under a search for the same disabilities and this might give you an idea of the best approach to the IMO.

The IMO doc will need your SMRs too.

"Any advice on how to ask a VA or private doctor to create a nexus for me using the limited amount of paper trail? Especially since I have not received treatment since I left the Marines in 2002? Will this hurt my case since there is a 9 year gap? My excuse and reason for this is lack of money and insurance as well as not knowing I could go to a VA hospital and get limited amount of treatment at a discount rate (If I had to pay).

4- How do I link my right foot fracture with this fall I had. I am not overweight nor was drunk when I fell."

Did this ever create any problems in employment? Can you get buddy statements if needed to prove this was chronic?

This claim is possible but definitely will need all of the medical factors tied up well in a strong IMO in my opinion.

[Berta]

I would think a specialist in orthopedics (not sure if that is right area of expertise here)

would be able to cover all of the bases here.

IMOs can be very expensive so best to shop around on that.

[broncovet]

I will add my 2 cents. I think the VA term, "chronic" , pertains to symptoms, not necessarily to treatment. I think you can appreciate that the VA does not pay for a broken bone, for example, that has healed up and causes no problems. You have to have a chronic condition for it to be compensable. That being said, many people have "chronic" conditions that there is no treatment for, or that the treatment is rather temporary. Arthritis, sometimes due to a bone fracture, is an example. Lots of times there is not a real good treatment for arthritis....the doc just gives you pain meds, usually NSAID's, to treat it and you deal with it forever, with the symptoms sometimes waxing and waning. So, if you had arthritis, but did not take your NSAID's for a couple years does not mean you did not have chronic arthritis..it just means you elected, for whatever reason, not to treat it with NSAID's for time.

Of course, the trouble with self medicating your arthritis or other conditions is that the VA wants documentation of the (chronic) symptoms. You may be able to get this, if your doc says something like this, in his report:

"The Veteran has experienced chronic knee pain since the (fracture during military service). He self medicated with Over the counter NSAID's....etc...etc...and has sought treatment as he reports the NSAID's are no longer effective".....something along that line.

Of course, you need to remember to tell the doc about the times, for example, when you did not go hiking because your knee hurt, or was unable to play basketball, soccer, work in a warehouse, etc., etc. I will never suggest you lie to the Doc or to the VA, but some Vets have a tendency when the Doc says, "how are you" to say "fine"...and then forget to tell the doc you spent the last week in bed because your knee hurt so bad. The doc wont read your mind, and if you tell him "fine"..then he is going to assume you are "fine". If you tell the doc you are "fine" then dont be suprised when your claim is denied as the doc cant find a disability. Instead, when the Doc asks how you are, tell him that for the past week you could not walk on your inflamed knee..had to call off work, and your wife and kids had to bring you everything. Dont tell him you are "fine" but tell him how, just the other day, you went to Walmart and asked for the power scooter as your knee hurt that bad.

Berta is right..that most VA docs are trained to deny you benefits, so often VA docs just "wont" write a nexus statement. You could walk into the docs office with two stubs for legs, blown off in a bomb in Iraq, and the Doc could say..."Gee, I am not going to 'speculate' that the wheel chair you are in is caused from a bomb in military service...it could have also been caused by an auto accident, or you might have even taken a chain saw to your legs just to try to get benefits." This exaggeration is not always all that far fetched...VA docs remember who sign's their paychecks, and it is not the Veteran. This is often why you need an IMO/IME.

[Lou_1980]

thank you very much for your insight. It is well noted. I have always worried how I would tie all of these issues I have. I am in the process of "shopping" around for doctors who would be willing to do an IMO/IME for me. I'll post with any new information I come across. Thank you all very much.

I will add my 2 cents. I think the VA term, "chronic" , pertains to symptoms, not necessarily to treatment. I think you can appreciate that the VA does not pay for a broken bone, for example, that has healed up and causes no problems. You have to have a chronic condition for it to be compensable. That being said, many people have "chronic" conditions that there is no treatment for, or that the treatment is rather temporary. Arthritis, sometimes due to a bone fracture, is an example. Lots of times there is not a real good treatment for arthritis....the doc just gives you pain meds, usually NSAID's, to treat it and you deal with it forever, with the symptoms sometimes waxing and waning. So, if you had arthritis, but did not take your NSAID's for a couple years does not mean you did not have chronic arthritis..it just means you elected, for whatever reason, not to treat it with NSAID's for time.

Of course, the trouble with self medicating your arthritis or other conditions is that the VA wants documentation of the (chronic) symptoms. You may be able to get this, if your doc says something like this, in his report:

"The Veteran has experienced chronic knee pain since the (fracture during military service). He self medicated with Over the counter NSAID's....etc...etc...and has sought treatment as he reports the NSAID's are no longer effective".....something along that line.

Of course, you need to remember to tell the doc about the times, for example, when you did not go hiking because your knee hurt, or was unable to play basketball, soccer, work in a warehouse, etc., etc. I will never suggest you lie to the Doc or to the VA, but some Vets have a tendency when the Doc says, "how are you" to say "fine"...and then forget to tell the doc you spent the last week in bed because your knee hurt so bad. The doc wont read your mind, and if you tell him "fine"..then he is going to assume you are "fine". If you tell the doc you are "fine" then dont be suprised when your claim is denied as the doc cant find a disability. Instead, when the Doc asks how you are, tell him that for the past week you could not walk on your inflamed knee..had to call off work, and your wife and kids had to bring you everything. Dont tell him you are "fine" but tell him how, just the other day, you went to Walmart and asked for the power scooter as your knee hurt that bad.

Berta is right..that most VA docs are trained to deny you benefits, so often VA docs just "wont" write a nexus statement. You could walk into the docs office with two stubs for legs, blown off in a bomb in Iraq, and the Doc could say..."Gee, I am not going to 'speculate' that the wheel chair you are in is caused from a bomb in military service...it could have also been caused by an auto accident, or you might have even taken a chain saw to your legs just to try to get benefits." This exaggeration is not always all that far fetched...VA docs remember who sign's their paychecks, and it is not the Veteran. This is often why you need an IMO/IME.