Another Question Regarding A Va Claim

[DICK HILL]

Reference my post on 28 Feb 14 and 3 Mar 14 “More Questions Regarding VA Claim”

I finally received a copy of the Spine Doctor’s 3 Mar 14 report of my 3 Mar 14 visit.

Although as I reported on my 3 Mar 14 post that the doctor would not sign a NEXTUS or IMO, his report does include the following:

“He has hip osteoarthritis. In view of his records, the right hip arthritis or arthrosis in examination of the hip is very consistent to the issues he had while on active duty and deemed at that point to be service connected. Additionally, there are notations dating back during his active duty status he went and saw orthopedics there, saw a PA who diagnosed him with sciatica which is exactly what he has in the right lower extremity today. Therefore, again, I do think he is suffering from exacerbation of these conditions today that are service connected and should be covered under his VA benefits. It is very clear with the documentation of the hip arthritis that was diagnosed while on active duty and also his sciatica as again diagnosed on active duty. This supports his endeavors to try to get this become service connected and I tend to agree. Examination of his right hip today shows pain with FABER with significant groin pain which is consistent of the worsening condition that was previously diagnosed when he was on active duty. Now whether or not this is taken care of within the VA system or outside in the civilian sector still remains to be seen.”

My question now is: Do you think the VA will see the above comments as a NEXTUS between my pain and problems of today and the slipping on stairs injury I suffered in October 1987? Your comments will be greatly appreciated. Dick Hill

[Berta]

Forgot to add:this is the IMO/IME criteria VA needs:

I developed this from 2 IMos I got from Dr. Bash.

As a former VA doctor himself, he knows exactly what they VA needs to have in these opinions.

Also he mentioned an additional disability my husband had in my IMOs, never raised in any of the claims.

And he also will use abstracts and medical citations to bolster his opinion and this can be very persuasive when a doctor does that.

[DICK HILL]

24 Mar 14 answers to Berta’s second response:

Response to Berta’s questions

"If so why did they deny? Unknown"

A copy of the denial should be in your C file. When I retired in 1988 and was examined by the VA in 1989 and 1990, the only thing I received from the VA at that time was a letter stating that I had been service connected at 20% (10% heart and 10% degenerative arthritis for Thoracic and Lumbar Spine) with 0% for Plantar Fasciitis, 0% for hearing). Hearing was increased to 30% in 2011. I did not even receive a copy of the rating decisions back in 1989 and 1990. First time I saw them was several months ago when I finally received a copy of my VA C-file. There are no denial letters in my C-fie.

They should have sent it to you explaining their reasons and Bases and listing the evidence they used. I got nothing other than the letter I mentioned above.

John999 is right:

"1987 has been 25 years ago so you need a good IME/IMO in which your doctor connects all the dots."

Their might be something in that old denial that was legally wrong ( a potential CUE claim). There is no old denial letter that I know of.

But a CUE claim would rest on establishing SC first. I am in the process of trying to establish service connection for right hip and right sciatica.

"connecting the dots" can become very beneficial to a claimant, when done by an IMO doctor who can give a full medical rationale...

what I mean is this(but I am not a doctor)

You said "Do you already have any SC percent for this condition? No. I am SC for heart condition (10%), hearing (30%),

Degenerative Arthritis Thoracic and Lumbar Spine (10%), Plantar Fasccitis (0%), Migraines (0%). The right hip DJD and right sciatica problems are reflected on my original VA Form 21-526e and on both of the 1989 and 1990 VA examination sheets. Only mention by the VA exam is that I had full ROM in right hip. No mention of right sciatica pain."

The right hip DJD and right sciatica provblems could be possibly excerbated or caused by the SC Degenerative Arthritis Thoracic and Lumbar Spine (10%),

Did you formally claim an increase in that specific SC rating adding that the right hip and sciatica are secondary? letter or the VA already has direct access to evidence contained in my military service and post military service medical records (That is what I am in the process of doing now. This is what my DRAFT claim’s opening paragraph says: This claim letter is submitted to respectfully request VA consideration for increase to service connected Thoracic/Lumbosacral Spine Degenerative Arthritis/Spondylosis and service connected Plantar Fisciitis. Also to establish service connection for Right Sciatic Nerve pain/problem currently not service connected to include secondary to service connected Thoracic/Lumbosacral Spine Degenerative Arthritis/Spondylosis and to establish service connection for Pes Planus diagnosed during periodic military physical examination in November 1976 (see SF 88 dated 16 November 1976) currently not service connected to include secondary to service connected Planter Fasccitis. To my knowledge, I have either provided all medical evidence as enclosures to this claim referenced in paragraphs 1 and 2 below) or the VA already has direct access to my military service and post military service medical records. I recently was seen by a foot doctor who re-diagnosed Plantar Fasciitis and Pes Planus (flat foot) bilateral. Also, recently was seen by spine doctor who diagnosed right hip and right sciatica problems.

I Might not even have a clue here on what I am suggesting ....but a strong IMO can connect dots that can lead from one SC to another potential SC.

I assume you have had continuous treatment records since discharge. In addition to 15 documented active duty clinic visits regarding right hip, leg, knee and sciatica, there are another 17 documented post service visits from 1989 to today.

I am very surprised that the initial claim was denied and the Reasons and Bases for that denial might well contain some clues as to how to continue with this claim.

" I am SC for heart condition (10%), hearing (30%),

Degenerative Arthritis Thoracic and Lumbar Spine (10%), Plantar Fasccitis (0%), Migraines (0%"

How old are these ratings? All ratings were issued in 1989 and reissued in 1990 except the hearing rating which went from 0% to 30% in 2011.

Disabilities get worse in time. Does your medical evidence still match those ratings or should they be higher by now? I believe current medical evidence justifies an increase for the degenerative arthritis (10%) and Plantar Fasciitis (0%). I have recently been evaluated by a foot doctor and by a spine doctor.

You could go to our VA Schedule of Ratings topic here and look up your SCs by diagnostic code and see if the VA % still matches them or if you would fall into a higher rating category by now.

The VA cardio heart ratings for example were rated one way years ago but they changed...forget when...

And I bet the SC (0) plantar facilitis is making everything worse too or vice versa. Yes, I would not wish Plantar Fasciitis on even my worst enemy.

Are you able to work? I quit work almost nine years ago (age 60 at the time) because I had surgery on my left carotids artery in my neck and I was not sure how long the recovery time would be. The surgery had nothing to do with my military service.

Again thanks for your response.

[Berta]

"i am SC for heart condition (10%)"

" I quit work almost nine years ago (age 60 at the time) because I had surgery on my left carotids artery in my neck and I was not sure how long the recovery time would be. The surgery had nothing to do with my military service. "


Do you get SSDI and if so what is it for?

There could be a significant possible relationship between the carotid surgery you had and your SC IHD.

Possible. I am not a doctor but before I filed FTCA against VA ,I studied every medical abstract and text I could as to the relationship of his malpracticed IHD to his other conditions.This was prior to the internet as well know it now and in those days we,in the electronic vets community (late 1990s) never even thought of obtaining IMOs.

In 2004 Dr Bash agreed with my lay medical opinion based on documented medical evidence regarding another malpracticed condition.(DMII) VA concered in 2010.

And in 2012 VA awarded direct SC for my husband's IHD and 1151 SC for a Stroke he had.(a head VA cardio had supported my lay medical evidence on that years ago and VA finally read that specific evidence)

This is one of many articles and medical abstracts on the internet involving that possible relationship between IHD and the carotoid surgery (which I( assume was possibly for plaque build up in that artery):


http://www.sciencedirect.com/science/article/pii/S0002914997007017

http://www.sciencedirect.com/science/article/pii/014067369392123B

What did your Cardio or neuro doctor say about the carotoid surgery in relation to the IHD?

Perhaps he ruled out the IHD factor already..

But this is why we say a good IMO/IME will connect the dots.

I feel the heart rating you got in 1989.1990 would be too low now.

This is the VA's definition of IHD per the Nehmer decision:

In a posthumous award my husband's IHD was rated at 30%.(1988-1994)If he had lived long enough the rating would have been more favorable.


Although the definition limits IHD ,.it also allows for potential secondarys, if claimed, if there is medical evidence of the nexus betwen SC IHD and other disabilities that are claimed (and have a full medical rationale and nexus statement).

In any event,whether the cartoid problem had any relationship at all to the IHD I think you should ask for an increase in the IHD and have it rated under the more favorable IHD ratings that stemmed from the Nehmer decison..

"How old are these ratings? All ratings were issued in 1989 and reissued in 1990 except the hearing rating "



Do you have a service officer or vet rep?

Can you contact one of the moderators here (click on their name ) To have this thread moved to the Claims Research forum ?

More will see it there and add opinions.

[DICK HILL]

Response to Berta’s response on 25 March 2014

Do you get SSDI and if so what is it for? I did not apply for SSDI. No - I waited until age 62 and started collecting regular Social Security.

There could be a significant possible relationship between the carotid surgery you had and your SC IHD. In 2011, I was told by a VA C&P doctor that my service connected “cardiac Arrythmia had nothing to do with my high blood pressure or carotids problems. He said “more likely than not” my problems were caused by a history of smoking. I tried asking him a couple medical questions to which he did not respond. After that I suggested he walks and talks like a duck - he said his decision stands. Because of a piece of evidence I discovered when I received my C-File last year, I submitted a request to reopen the claim last June, but have not received anything on it yet.

This is one of many articles and medical abstracts on the internet involving that possible relationship between IHD and the carotoid surgery (which I( assume was possibly for plaque build up in that artery): Yes it was for plaque buildup in the left artery. The right artery is what they call “occluded” which means they can not do anything about it.

What did your Cardio or neuro doctor say about the carotoid surgery in relation to the IHD?

Perhaps he ruled out the IHD factor already.. I have been seeing a vascular doctor for annual follow-up on the carotids surgery, but I have never discussed it with him.

I feel the heart rating you got in 1989.1990 would be too low now. I just found out last Friday that I no longer have a VA primary care provider because it has been over a year since my last VA appointment. Now I have to go back through the process and request a primary care provider so I can get referrals to other VA clinics.

Do you have a service officer or vet rep? Yes - Texas Veterans Commission. However, last year I let the rep talk me into letting him send something to the VA instead of sending it via registered mail and it never got to the VA. So I have been thinking of looking for another rep.

Thanks again Berta

Dick Hill

[DICK HILL]

Had another follow-up with spine doctor on 9 May 14. I finally convinced him to provide me with a Nextus letter for current diagnosis for right hip osteoarthritis and sciatica pain in right lower extremity, both of which were also diagnosed while on active duty in 1987.

I want to thank all those who have responded to my different posts. You have given me valuable information. I would have been lost without your input.

Thanks Dick Hill