Need Help! Fast! Opinions!?

[krbkwb02]

I am service connected for right knee patellar femoral pain syndrome with degenrative arthritis(%20). I recently had a total right hip replacement. My left hip will need it soon. I reopened my case claiming hips as secondary and my depression(rated 10%) has gotten worse. The depression has and is causing me to miss work. My other ratings are Tinnutis 10%, Chronic Left Shoulder Bursitis 10%...overall 40%

I recently (yesterday) recieved an IMO from my surgeon who performed the hip replacement here were his words; ""(name) is a 45 year old male with end- stage arthrosis of his right hip. I performed a right total hip arthroplasty on him 10/14/2011. He is doing well and has returned to work. He also has mild to moderate degenerative changes on his left side.

I understand he served approximately 8 years of active duty for the United States Army. Pertaining to the question of whether or not his hips are directly related to his service is not possible. However, given his underlying hip morphology,certainly his condition could have been exacerbated by the demands of his military duties. As a result, it is my opinion that his hip condition is as likely as not related to his time of service."

As of 2-19-2012 I have done the following;

1. Submitted several releases for all records to the VA, including MRI's and XRAYS

2. Submitted a copy of my work attendance for 2011-missed 18 days

Should I?

1. Submit the IMO from the Doctor that I recieved yesterday?

2, Should I submit evidence that my Doctor now has me on Prozac for the Depression?

Please be candid in your opinion, Me Personall? I think it has a fair to decent chance...there is absolutely no doubt in my mind that my hips are connected to my time in service, but my opion doesnt matter...yours does...please help!!!!!!! Thanks All!

[Hoppy]

The report should have shown that he was more knowledgable as to what you did in the military if he gave consideration to the entire eight years. If you went to boot camp and became a clerk that would not say much for chronic injuries to your hips. On the other hand if you were jumping out of airplanes that could definately be a consideration for hip replacements at the age of 45. I think you should have had the doctor rule out your post service employment as being a factor. His letter should get you a C&P exam in which they will do a complete investigation. They will look at your MOS and they will also look for post service accidents and injuries as a factor. Without his letter they could easily deny the claim without a C&P exam so definately submit his letter.

[Hoppy]

I am not sure about the depression. You should file a claim and see how it goes. The doctor might feel the depression will be resolved with the surgeries. The people I know who have had hip replacement are playing golf and doing fine.

[krbkwb02]

Thanks a lot Hoppy, will get it submitted ASAP!

Some quick facts for any additional thoughts;

1. Military Police

2. AASLT Qualified, many missions

3. Traumatic Injury to Right knee while in Panama

4. 2 Recorded Incidents of 'falls" but their record talks about the fall, but wasnt real specific as to each body part that was injured. I wrote a letter clearing those two incidents up

Whats your "ballpark" idea? Winner/Loser/ Too many variables to make an assumption?

Thanks Again

[krbkwb02]

Problem is.....right service connected knee has gotten to a point that now I can hardly walk on it at times, since the surgery for the hip replacement...when it acts up...the knee that is!

the surgeon basically said that my orthopedic problems were made worse and sped up by my military service. he also said that I had abnormally small hips....could that be viewed as "aggravated by military service vs secondary condition that I filed it under?

so many questions....uggg

[Hoppy]

the surgeon basically said that my orthopedic problems were made worse and sped up by my military service. he also said that I had abnormally small hips....could that be viewed as "aggravated by military service vs secondary condition that I filed it under?

I really think his statement that the orthopedic problems were sped up will be viewed as a bare conclusion (see below). That is why the VA will need to do a complete evaluation. The hips secondary to the knee is the strongest way to go. Unfortunately his report is more directed at the military without any statement that he reviewed any militray records. The VA usually does not require a lot of evidence prior to scheduling a C&P for a claimed secondary condition. I am assuming that he was aware that your knee was injured in the military and his very generalized statement is inclusive of your knee problems. If they do not give you a C&P get the IMO to specifically address a relationship between the knee and the hips. Most doctors do not know how to write an IMO and at this point the C&P will be the key to your claim. There are doctors who specialize writing IMO's for VA purposes. They charge a lot of money. I think you have enough evidence to get a C&P. Then if you get a negative C&P put an effort into finding a doctor who knows how to write IMO's for VA purposes.

A bare conclusion, even when reached by a health care professional is not probative without a factual predicate in the record. Miler v. West, 11 Vet. App. 345, 348 (1998).

The fact that you have abnormally small hips is not an issue unless there is an opinion that that somehow is a significant factor causing the need fo surgery..

Edited February 20, 2012 by Hoppy