Arthritis

[free_spirit_etc]

So, I am wondering…since arthritis is one of the chronic conditions under 3.309 and 3..303 says that when a chronic disease has been shown within service or within the presumptive period so as to permit a finding of service connection, that subsequent manifestations of the same disease at a later date, however remote, are service connected, unless clearly attributable to intercurrent causes ---- If you have a diagnosis of arthritis in service, or within the presumptive period – would subsequent manifestations of arthritis be service connected, though the manifestations are in other joints?

I am not talking about a service connected injury in one joint causing an injury in another joint – or the possibility that the arthritis in one joint “caused” arthritis in another joint.

I am talking about with arthritis being a chronic disease, if you had a diagnosis of arthritis within the presumptive period (with a 10% or more rating) could subsequent manifestations in other joints be an increase in disability of arthritis under 3.303 (unless they could be attributed to intercurrent causes)?

§ 3.307

Presumptive service connection for chronic, tropical or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents; wartime and service on or after January 1, 1947.

(a) General. A chronic, tropical, prisoner of war related disease, or a disease associated with exposure to certain herbicide agents listed in § 3.309 will be considered to have been incurred in or aggravated by service under the circumstances outlined in this section even though there is no evidence of such disease during the period of service. No condition other than one listed in § 3.309(a) will be considered chronic.

(3) Chronic disease. The disease must have become manifest to a degree of 10 percent or more within 1 year (for Hansen's disease (leprosy) and tuberculosis, within 3 years; multiple sclerosis, within 7 years) from the date of separation from service as specified in paragraph (a)(2) of this section.

§ 3.309

Disease subject to presumptive service connection.

(a) Chronic diseases. The following diseases shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under § 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of § 3.307 are also satisfied.

Arthritis

3.303 - Principles relating to service connection.

(b) Chronicity and continuity. With chronic disease shown as such in service (or within the presumptive period under ? 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clearcut clinical entity, at some later date. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word ?Chronic.? When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim.

[harleyman]

VA used to rate Arthritis solely under code 5003 no matter where it was located. They do not do that anymore for the exact reason behind your post. They used look at arthritis as a disease process affecting the entire body. Then Veteran would be granted lets say an elbow under 5003 and then based on the disease process ask for a shoulder even though there was no evidence of a shoulder event while in service. With the original S/C being based on the 5003 grant for elbow as a systemic process throughout the entire body they would then get a grant for the shoulder.

It doesn't happen that way anymore, A veteran must have a diagnosis of rheumatoid arthritis before other body parts will be considered for S/C.

Now days, if you have arthritis, there must have been an event in service for an injury or chronic conditions for the specific body part or joint and there must be chronicity of treatment and arthritis must be confirmed by x-ray and then an opinion by the examiner.

Also you will see hyphenated rating decisions such as 5003-5260 or (what are called analogous coding) so to identify the exact area of the arthritis so the issues you reference in your post do not occur anymore. Once an increase of a 5003 condition is reopened the VA will change the coding upon a new rating decision to an analogous code. The first four number 5003 reflect arthritis - the last four will reflect the area.- H

Edited October 5, 2013 by harleyman

[free_spirit_etc]

Thanks harleyman.

That is what I have seemed to notice, but I was wondering if that was people granted later SC. So, for instance, if my husband was granted SC for arthritis of his lumbar spine several years after service, I could get that -- as the arthritis didn't manifest to a degree of 10% or more within one year.

But I was wondering if, since arthritis did manifest to a degree of 10% or more within one year, if it could be handled differently as a chronic condition under 3.309 - and whether subsequent manifestations would be connected under 3.303.

I wonder why, if they only grant SC for service connection of arthritis if a joint is injured, why do they have it listed under 3.309 under chronic diseases. With arthritis caused by trauma - it would be granted SC anyway, without the presumption.

I have read quite a few cases where the VA examiners stated that someone's arthritis was NOT caused by service, even though they had an injury, because their arthritis was bilateral. If only one knee was injured, and the arthritis was in both knees, they opined it was not caused by the injury.

But then, it seemed like the reverse could also be true. Since my husband had bilateral arthritis in both shoulders, (but the right more than the left) and both knees, and his cervical spine - then it the bilateral condition looks like he had primary arthritis (as opposed to or in addition to) traumatic arthritis. And if his arthritis had manifested to the degree of 10% within the presumptive period (under 3.307 and 3.309) then it seemed like service connection could be granted under 3.303 regardless of whether the arthritis was primary or traumatic.

3.309 doesn't differentiate between rheumatoid arthritis and other types of arthritis. It just indicates that arthritis is a chronic disease that is subject to service connection if it manifests to a degree of 10% within one year of discharge. So it is puzzling that the VA would require trauma.

I was just wondering because since the VA kind of railroaded my husband on some of these conditions, but many of them are most likely final -- I thought maybe the claimed could be advanced on the increased rating theory.

Trauma-wise, I think he should have been SCed for his neck and his shoulders. But it is probably too late to do anything about it on the injury basis at this point.

I think they adjudicated his claims very poorly. I am wondering how true this was for lots of retirees because:

1. They were well-trained to accept (on some level) what the government told them.

2. Until 2004, they lost retirement pay dollar for dollar for the disability benefits they received - so fighting hard for 10% was not a huge priority.

[Pete53]

For whatever reasons the VA does not rate nor treat arthritis very well.