Claim Denied Issued A Ssoc Supplemental Statement Of Case What Now ?

[mrmark1999]

ok i got my SSOC today im not shure wher i sit now .

EVIDENCE

it had a list of evidence

1 soc was sent dated sept 7 2011

2 report of telephone contact taken on sept 13 2011

3 vs form 9 receve October 11 2011

4 report of telephone contact jan 4 2012

5 treatment reords ABC Podiatry Dated from Aug 26 2010 to apr 14 2011

6 VA examination Columbus VA Outpatient Clinic Dated feb 14 2012

ADJUICATIVE ACTIONS :

09-07-2011 The veteran was furnshed a statement of case outlining actions taken on the claim

10-11-2011 Substanitve Apepeal Receved

DECISION:

Service Connection for bilateral Achellies Tendonitis remains denied.

REASON AND BASIS

since we issued our Statement of the case to you on September 7 2011 we received additional evidence in support of your appeal. Treatment records from ABC Podiatry not you have bilateral foot and ankle pain with diagnoses of Achilles tendonitis and plantar heel spurs. No relationship is shown between your current diagnosis of Achilles tendonitis and your military service.

You attended the VA examination at the Columbus VA Outpatient Clinic on February 14, 2012 to determine any relationship between your current Achilles tendonitis and your military service. After a physical examination and review of your claims file including your service treatment and private treatment records, the examiner opined that your current Achilles tendonitis is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner provided the following rationale: "Achilles tendonitis is documented in note dated November 15, 1995 in the service treatment records (STRs). Thereafter, there is no mention of this condition in the STRs. He had no ankle condition noted on physical exams on May 21, 1996 and July 24, 1997. Letters by Dr. Schilling dated February 23, 2011 documents that veteran saw this provider on August 26, 2010 with "increasing pain gradually over the month precding presentation on his left ankle". Based on review of the medical evidence, it appears more likely that veteran's current Achilles tendonitis is a result of his occupation as a mailman where he has to walk up to 16 miles per day. Plantar faciitis is not documented in the service treatment records. Per note by Dr. Gutheil dated January 11, 2011, onset of plantar faciitis had been 3 months earlier."

The evidence of record continues to show that your current Achilles tendonitis is not related to the one event of Achilles tendonitis while in service. Therefore, service connection for Achilles tendonitis remains denied.

on My first SOC it states

in the SOC it says

REASONS AND BASES:

We received your NOD and in additional evidence in support of your claim . this additional evidence indicated a current diagnosis of bilateral Acheilles tendononitis there for , a VA examination and opinion was scheduled for you to comply with the VA's Duty to Assist , you were notified of this appointment and the importance of attending this appointment .Youlive in Pickerington, Ohio and the VAMC Chillicothe is yourjurisdiction . you didnotreport to this examanation because you did not want to go to the VAMC Chillicothie. This cancellation reason is not considered "good cause".Examples of good cause include, but are not limited to the illness or hospitalization of the claimant ,death of an immeadate family member ,etc.

You were denied service connection for bilateral Acheilles tendononitis in the ratin desison dated december 3, 2009 because although there was evidence of this disability in service , we did not have current diagnosis of this disability."

it is not enough , for a grant of service connection that a disability has been sustained in service. in addition there must be residual disability attributable thereto. Your service treatment records show that you were diagnosed with bilateral Acheilles tendononitisn Augest 21,1995. These same records donot show evidence of a chronic disability. Tofulfill the requirements for chronicity, the claimed illness must have persisted for a period of 6 months. the 6 month period of chronicity is measured from the earliest date on witch all pertinent evidence establishes that the signs or symptoms of the disability first became manifest. at this time we do not have contemporaneous or objective evidence of a continuity of symptomatology since your discharge from the military. the first evidence we have that you have a diagnosis of bilateral Acheilles tendononitis is Augest 26,2010 from ABC podiatry. this is approximately 15 years post discharge from the military.

Regulations state when a claimant fails to report for an examination scheduled in conjunction with an original compensation clam ,the claim shall be rated based on the evidence of record. When the examination was schedule in conjunction with any other original claim, a reopened claim for benefit that was previously disallowed , or a claim for increase the claim shall be denied . You did not report to your Va examination : therefore ,your Claim for service connection for bilateral Acheilles tendononitis cannot be established and remains denied ."

by the way i did not miss my exam I had it re scheduled to a closer exam location (I know now that was a big mistake )the va assumed i misssed when it was being recheduled i got all of that worked out and got my c&p in febuary do not understand where they get the idea that my bilateral Acheilles tendononitis is not service connected i had it diagnosed in the millitary and was told the same thing here is som 800 mg motrin and to strech what can be my next step on fight ing this my current doctor gave me a IMO showing the connection to my millitary service and a continuing issues let me know what you think

thank you

mark

[mrmark1999]

I would like to give a copy of the c&p exam to achelies tendonitis to my doc is there a form i can get ?

[mrmark1999]

some new info from my doctor stating his medical opinion let me know what u think

ABC Podiatry/East

Patient: XXXXX Account No:XXXXXX Date 5/10/2012

Chief Complaint: Pt presents with longstanding foot and ankle pain. Pt has had foot and ankle pain for about 17 years and this is ongoing even through treatment. Pt was first diagnosed with Achilles tendonitis on August 21, 1995. Pt was in boot camp at Paris Island, SC at the time of diagnosis. Pt had been pain free prior to entering camp. Pt had been training and fell with large backpack and injured his right patella and had pain in knee. Pt was seen for this problem and was put in the medical rehab platoon and was there about 3 months. While in rehab, pt noticed tightness and pain in both legs. Pt was then sent for physical therapy and was given stretching instructions as well as ice for inflammation. Pt also had therapeutic ultrasound done for these problems. This was all in the spring and early summer of 1995.

Pt was running and walking during rehab for bilateral leg pain when he started to have tightness and pain in back of calves and heel areas. Pt was seen August 21, 1995 for pain in feet and shoe irritation as well as blister formation from all of the rehab exercise and diagnosed with Achilles tendonitis and was told to rest. September 26, 1995 pt returns to clinic and was given a diagnosis of shin splints a this time, and told to ice and stretch. In November, 1995 according to a medical review pt is still dealing with Achilles tendonitis and taking NSAID for treatment. Pt was seen on May 21, 1996 and July 24, 1997 and while he was still having problems with his Achilles, his knee pain was greater and this was the focus of the visits. However, his ankles were still painful swollen and documented by his marking the box of painful and swollen joints. This box was not specific to his knee or his ankle. Pt went to Marine Reserves and went back to school. Pt was limited in his activity and had increasing pain because of his Achilles tendonitis and subsequently was gaining weight. Pt got married and started a family and his pain never completely resolved. Pt has been and was at the time taking Ibuprofen regularly. Pt was see by his family doctor January 11, 2001 and was still complaining of heel pain esp in right. Pt has been seen at this office since August 26, 2010. Pt had been complaining of shooting pain and sharp pain in both legs and this was exacerbated by walking and standing. Pt had a long history of Achilles tendonitis. Pt was told about shoegear changes, given ¼ heel lifts, told to stretch and changed his NSAID. Pt returned February 11, 2011 for follow up and was cast for custom molded orthotics and told to continue to stretch. Pt picked up orthotics about 1 month later and also received an ankle foot orthosis for his right ankle and heel. Pt admits some minor improvement through the stretching activities given to him by our office. After usage of custom molded orthotics, pt did obtain increasing relief, however this will not be a permanent change and he will likely have continued pain throughout his lifetime.

Allergies: ERYTHOMYCIN

Medications: Fish Oil-capsule, Ibuprofen 800 mg tablet

Past Medical History: Admits Unremarkable.

Past Surgical History: Admits hernia repair.

Past family and Social History: Denies alcohol and tobacco use

Height: 69 inches Weight 273 pounds BMI 40.31 pulse: 74/min Sitting Blood Pressure: 125/90

• Vascular: Dorsalis pedis and posterior tibial pulses are graded at 2 with digital hair growth present bilateral. CFT with the leg elevated was less than 3 seconds at the distal hallux bilateral. There is no evidence of ischemic skin changes. Temperature was warm at anterior tibia to warm at the distal digits bilateral.
  
• Lymphatic: No popliteal lymphadenopathy noted
  
• Neurolgical: Pt oriented X3, with appropriate affect, no anxiety or depression. Coordination WNL to right and lefty lower extremity. Exam reveals epicritic sensation is intact along defined dermatones to protective threshod, symmetrical Achilles tendon and patellar deep tendon reflexes with a negative clonus and down going toes. Patient is able to heel and toe walk with ease. Normal sharp/dull, vibratory, proprioception, light touch sensation to right and left foot. DTR Achilles 2/4 right, 2/4 left.
  
• Dermatological: No edema, erythema, ecchymosis, open lesions, interdigital macerations or signs of infection evident at this time bilateral.
  
• Musculoskeletal: Good muscle strength to all prime movers of the foot and ankle with adequate muscle tone and symmetry bilateral. Decreased ht in medial long arch BL decrease with wt bear. Pain on palpation posterior heel at insertion of Achilles tendon BL. Decreased dorsiflexion in ankle BL with pain at end ROM.
  
• Xray analysis: Diagnostic lateral BL x rays show large, mature posterior heel spurs BL with possible fracture line in left posterior heel spur. Decreased caldaneal inclination angle BL with degeneration STJ BL. Plantar heel spur right.
  
  
  Impression:
  1. Equinus, BL
     
  2. Achilles tendonitis, BL-chronic. I believe that this is very likely to be connected to his time in the service by approximately 90% level of certainty. This is because before entering the military there was a health evaluation that made no mention of lower extremity pain or problems.
     
  3. 3. Early STJ DJD BL
     

  Plan:

  [*]Diag lateral BL x ray

  [*]Long discussion on eitiology, treatment and prevention of Achilles tendonitis.

  [*]Discuss treatment options for Achilles including physical therapy, home stretching, shoe and insert changes and ultimately surgery either to lengthen Achilles or to inject with platelet rich plasma or use of radiofrequency conlsyion

  [*]I believe that the examiner from February 14, 2012 failed to understand the chronicity of the injury and the fact that he never fully recovered from the initial pain. Pt had other problems from his service including patellar injury at about the same time which were higher priorities at the times of exam in the mid/late 90s therefore his heel pain, even though stil present was not mentioned in the exams. In Aubust, 2010 it was documented that he had gradually gotten worse over the previous month or so, but this condition is intermittently worse at certain times and can be aggrevated by activity or weight as well. However, without the first episode and without full resolution of symptomatology, this would not have been an ongoing issue to this date.

  [*]Pt to return as needed for follow up

  [*]Pt to continue stretching and orthotics/good shoegear

[cooter]

mrmark,

The Dr needs to state " I have reviewed Mr xxxxx service medical records, c;file (if you have the copy), private medical records." and any other records you brought to him. This is very important that he states this, otherwise his IMO will not be credited.

The part where your Dr mentioned about the box with swollen and painful joints. He needs to mention the form he's talking about, etc, exiting exam, service medical record, or other. This is one way the raters will know your Dr actually read the service records or what ever records he reviewed.

The part where he mentioned "very likely and 90% certainty". He should use the exact VA language...is due to (100% sure)...or...more likely than not (greater than 50%) service connected.

The last item I noticed is it could be shorten quite a bit. There are some unnecessary quotes he can eliminate to shorten it up some more. He should just mention the important facts only.

If nothing else, just make sure he mentions the "I have reviewed the records" and use the VA language.

Coot

[Berta]

The full criteria for an IMO is in the IMO forum here.

It certainly helps to have a copy of the C & P to provide to an IMO doctor as well as any SOC denials from the VA.

I assume( but could be wrong) that perhaps VA questioned the documentation of treatment for continuity of symptoms here since you left the Military.

It is a factor the IMO doctor might need to consider and opine on.

You can certainly add an addendum or a cover letter referring the BVA to more evidence,as soon as you get a BVA docket number if you cannot respond to the 30 deadline with a strong IMO- which may or may not even be considered at the RO level at this point.

Edited May 17, 2012 by Berta

[mrmark1999]

so im kinda of lost what im doing now so iit loks like i ned to ask the doctor to add a few things to the IMO directly refer to my medical records millitary cillivian and to opine exactly as the va wants do i need to sumit a response i have all ready enterd a apeal for the original statement of case do i have to enter one for the SSOC too my va adviocate says they have it all taken care of not shure it i should trust any one lol so if you have any sugestions please let me know

[mrmark1999]

ok i sent in my IMO from my doc now i called and the y are sending it to be rated not to the BVAcan they rate it fromn just this?