Your Opinion &thoughts -Sc Ankle And Shoulder Disability

[USMC2311]

1989-I was medically discharged for eczema and rated at 10% service connected.

1999 and 2000-The VA rated my ankle (5271-Moderate Ankle Limited Motion) at 10% and shoulder (5202-Dislocations) at 20% service connected. Total rating: 40%.

Oct 2012-I filed for reevaluation and increase for all three service connected disabilities.

Mar 2013-C & P Exam. Examiner stated that x-rays will be order. I was never contacted or afforded the opportunity to have x-rays done according to the examiner.

Aug 2013-Received VA Decision. No change in the three ratings, but received an increase of 10% for limited motion of the shoulder. Total rating: 40%.

Feb 2014-Seeked private medical appointment (overseas) and was referred for Ankle x-rays and shoulder MRI.

Right ANKLE FINDINGS:

Frontal, lateral and oblique views of the right ankle show no fracture or dislocation. Two screws are present in the distal right fibular metaphysis without evidence of loosening or fracture. The ankle mortise and other imaged joint spaces are maintained. Mild osseous sclerotic changes are present in the medial and lateral malleoli. Plantar enthesophyte is noted. There is no significant soft tissue swelling.

IMPRESSION: 1. No acute osseous abnormality. 2. Two screws in the distal right fibula without evidence of complication. 3. Mild degenerative changes in the ankle.

Right SHOULDER FINDINGS:

SUPRASPINATUS: The tendon is intact. There is heterogeneous fluid signal and thickening, consistent with tendinosis.

INFRASPINATUS: Chronic articular sided partial thickness tear with a large segment of scarring, measuring 1.5 ern, Some fibers remain intact, as the tendon does not appear retracted,

TERES MINOR: Intact.

SUBSCAPULARIS: Intact. There is heterogeneous fluid signal and thickening, consistent with tendinosis.

LONG HEAD OF THE BICEPS TENDON: Normal. MUSCLE VOLUME: Normal in signal and bulk. ROTATOR CUFF INTERVAL:

Unremarkable.

AXILLARY POUCH: Evaluation is limited given the relative absence of fluid in the glenohumeral joint space. No large bone fragments.

LABRUM: There is near complete circumferential degenerative tearing of the labrum. A small amount of anterior labrum maintained. Multiple para-labral cyst involving both the anterior inferior and posterior inferior labrum.

ACROMIOCLAVICULAR JOINT: Abnormal with hypertrophy of the capsule and fluid within the joint space. No widening of the joint space. Subchondral cystic and sclerotic changes.

ACROMION TYPE: II, small enthesophyte at the deltoid insertion. Undersurface osteophyte at the acromioclavicular joint. No downsloping.

BONES: There is extensive amount of subchondral sclerosis and cystic changes of the glenoid. Ring osteophyte of the humeral head.

SUBACROMIAL/SUBDELTOID BURSA: Small amount of fluid in the bursa. OTHER: Unremarkable.

IMPRESSION: 1. EXTENSIVE OSTEOARTHRITIC CHANGES OF THE GLENOHUMERAL JOINT.

2. PRIOR HIGH-GRADE PARTIAL-THICKNESS ARTICULAR SIDED TEAR OF THE INFRASPINATUS TENDON.

3. SUBSCAPULARIS AND SUPRASPINATUS TENDINOSIS.

4. ACROMIOCLAVICULAR JOINT ARTHROSIS.

Used this radiology report with NOD as medical evidence.

June 2014-Filed NOD for insufficient C&P Exam and noted that Right Ankle should be rated under (5262- Fibula Impairment with Moderate Ankle Disability) at 20% secondary to (5003- Painful Motion) at 10% vice the current (5271-Moderate Ankle Limited Motion) at 10% and Right Shoulder (5201-Arm Limitation and Painful Motion) at 20% secondary to my existing (5202-shoulder dislocation) at 20%..

July 2014-Seeked private medical appointment with Ortho Doc (stateside) for ankle and shoulder pain. Additional x-rays taken of ankle and shoulder. Prescribed ankle support brace and recommended brace fitting for shoulder. Ortho Doc also suggested in report for ankle a well-defined lucent lesion in the distal fibula and plantar calcaneal enthesophyte/spur. Also submitted this report as supporting medical evidence.

Your opinion and thoughts are appreciated.

Thank you.

[Berta]

Did the IMO docs come close to adhering to the IMO criteria here at hadit?



Did they make a full medical rationale as to how your disabilities fit into a higher rating criteria?

You did your homework! You researched the ratings and diagnostic codes.

We all must do that because VA often makes errors in that part of the rating.

"Used this radiology report with NOD as medical evidence.


June 2014-Filed NOD for insufficient C&P Exam"
Good for you.
July 2014-Seeked private medical appointment with Ortho Doc (stateside) for ankle and shoulder pain. Additional x-rays taken of ankle and shoulder."

Good on that as well. Have you sent that in to them ?

I always send anything to VA as Priority mail and pay a little extra for the tracking slip. This way I can track it on the USPS web site and print off proof they got it. ( They like to lose the good stuff)

This is why I recommend Dr Bash for most types of IMOs as he is a NeuroRadiologist and also familiar with the exact terms and wording etc etc, VA looks for in IMOs.
He is a former VA doctor as well and a disabled vet himself.

Sometimes however he needs to examine the patient personally to prepare an IME.

"1989-I was medically discharged for eczema and rated at 10% service connected."

Say what????? For some reason that seems odd to me....only at 10%.

There is some eczema rating info at VBN here:
http://vets.yuku.com/topic/80747#.VARpoGM08sY

And we have some SC eczema vets here.

Have you ever asked for increase in that rating?

[Gastone]

USMC2311: I agree with Berta.

It appears that you have the DXing covered, how do you compare to 38 CFR 4 rating schedual? You should be able to come fairly close to what your SC rating should be.

You filed a timely NOD, I procrastinated and did mine end of 11th month on my 1st claim. Did you ask for DRO with Personal Hearing? I just had my DRO Informal Hearing 6/27/14. 8 months of my 31/2 yr wait, due to my late NOD filing. The Face to Face with a Senior VA Rater worked out great for me. About 35 min of back and forth on my denied issues, all major issues from 2008 awarded. DRO said due to my decision to go with an "Informal Hearing" instead of the "Regular recorded and transcribed" hearing that I was scheduled for, we my as well take care of a 2nd NOD filed 09/2012. Walked out of hearing knowing what issues the DRO awarded from 08 claim nd TDIU award from 09/2012. Got a call from MCL VSO at 330 that same day, he already had an Official DRO Award on his desk addressing all issues, to include TDIU T&P.

Trust but Verify

Semper Fi

Gastone

[JR Reihs]

You may want to add ankle scar and Arthritis of both shoulder and ankle to your claim.

[Fat]

Good Information Berta.

[USMC2311]

Berta-

I am currently not contending the rating I have for my eczema of 10%, my flare-ups have been controlled by prescribed topical corticosteroids. I wish I knew about this information back in 1989.

Yes, I sent the private medical report from June 2014, as supporting medical evidence. This report also mentions the pain at surgical area.

Gaston-

I asked for a DRO review but not sure if those two go hand in hand or if I will be afforded the opportunity for a personal hearing when that time comes, I also currently work overseas.

JRReihs-

I have two scars running vertical on my tibula and fibula side of my ankle bone, but not long or wide enough to be rated. After looking through the CFR, I see that scars can be rated for pain. If I would have known this and had my C & P exam results to review I would have listed that also on my NOD because now that I have a copy, the C & P exam and recent medical evidence states that there is pain at the surgical area.

Is it too late to mention the pain at surgical scar area?

You folks are great!