tdiu Tdiu Quiz (Level: Expert)

[Byte187]

I've had quite a few people disagree with me on this particular question, so I want to ask here and see what the consensus is.

Consider this hypothetical veteran:

The veteran suffered a lower-back injury on active duty back in the 1980s. He received hospital treatment at the time so, years later, with his SMR, service connection was an easy matter. The VA attributes the veterans current lower back disability to his documented injury in the 1980s.

The veteran also suffers bilateral radiculopathy (legs), and the VA connected that, secondary to the SC back condition. The verterans current rating is as follows:

40% - lower back

20% - right leg

10% - left leg

60% - total

Question: Is this veteran qualified to be considered for TDIU? Why? or Why not?

[carlie]

Byte187,

Anytime a claimant signs a POA to a VSO or lawyer / law firm - they are giving them

full authority to do or not do - whatever - whenever - with their claim issues and

they need no further signature from the claimant on anything.

There are good and bad apples everywhere.

There are some good VSO's and there are some crummy VSO's.

IMO - if a VSO is not familiar with or does not have a clear understanding of

"common etiology" and how this is applied to 4.16a, for a combined 60%

to meet the criteria for IU - then I suggest to NOT use that VSO.

Whether you want to see it or not, your question has been answered many times in this topic,

irregardless of whether this "hypothetical scenario" relates to you or not.

BTW - FWIW - this is not a new question or theory for IU.

This issue has been beat to death.

[GatorNavy]

I don't agree BV because the legs have already been found to be secondary to the back. Some medical opinion has already been rendered that indicates so.

For purposes of calculating the percentage requirements of one 60 percent disability, or one 40

percent disability, the VA has devised rules for determining what satisfies the term

“

one

disability.

”

The following are considered to be one disability:

“

(1) disabilities of one or both

upper extremities, or of one or both lower extremities, including the bilateral factor. . . ,

(2) disabilities resulting from a common etiology or a single accident, (3) disabilities affecting a

single body system,

e.g

., orthopedic, digestive, respiratory, cardiovascular-renal,

neuropsychiatric, (4) multiple injuries incurred in a

ction, or (5) multiple disabilities incurred as a

prisoner of war.

”

23

Therefore, if a veteran suffers from several service-connected heart disabilities

such as congestive heart failure and hypertension, the rating for these disabilities need only

combine to a 60 percent evaluation in order for the veteran to qualify for TDIU under 4.16(a).

If the veteran meets the percentage requirements, set forth above, the VA proceeds to the

second step of the TDIU analysis. The VA determines whether the individual veteran is prevented

from securing or following a

“

substantially gainful occupation

”

because of the service-connected

disabilities.

[broncovet]

You dont have to agree. Time and time again, it is not about what "GatorNavy" thinks, nor is it about what Broncovet thinks. Its about what the doctor says in his report.

Rating specialists have been very anal about what they accept as docs opinions. There are many many topics on IME/s IMO's and C and P opinions.

The rating specialist looks for words very similar to:

"The Veterans xxx condition is at least as likely as not due to yyy event in military service". The rating specialist wants words like this. He wont accept:

"The Veterans xxx condition COULD be a result of military service." or

"The Veterans xxx condtion MAY be a result of military service" or

"Its possible the Vets condition may be a result of miltary service.

These last 3 are considered "speculative" and the VA does not award benefits on maybes.

In a similar way, you would want a docs opinion similar to:

"It is at least as likely as not the veterans back and legs share a common etiology".

You can fight it until the cows come home, but Vets benefits turn on MEDICAL OPINIONS, not our opinions.

The doc can use, as his medical opinion rationale just what you stated...but our opinion that the "legs are secondary to the back" is not probative.

I expect any claim lacking a great medical nexus to be denied, and that is usually what happens. The docs opinions have to be very specific, precise, and not vague. Forget benefit of the doubt, here. It is up to the claimant to provide a favorable medical opinion. Without a favorable medical opinion, you rarely get benefits. OUR logic, and OUR opinions do not count. It must be the doctors.

Edited September 7, 2014 by broncovet

[RUREADY]

heart disease is another story but your back is this,,, cervical, thoracic , and lumbar that's your back

do any of this refer to the legs as part of the back. Different rating (common nothing).

Edited September 7, 2014 by RUREADY

[RUREADY]

You dont have to agree. Time and time again, it is not about what "GatorNavy" thinks, nor is it about what Broncovet thinks. Its about what the doctor says in his report.

Rating specialists have been very anal about what they accept as docs opinions. There are many many topics on IME/s IMO's and C and P opinions.

The rating specialist looks for words very similar to:

"The Veterans xxx condition is at least as likely as not due to yyy event in military service". The rating specialist wants words like this. He wont accept:

"The Veterans xxx condition COULD be a result of military service." or

"The Veterans xxx condtion MAY be a result of military service" or

"Its possible the Vets condition may be a result of miltary service.

These last 3 are considered "speculative" and the VA does not award benefits on maybes.

In a similar way, you would want a docs opinion similar to:

"It is at least as likely as not the veterans back and legs share a common etiology".

You can fight it until the cows come home, but Vets benefits turn on MEDICAL OPINIONS, not our opinions.

The doc can use, as his medical opinion rationale just what you stated...but our opinion that the "legs are secondary to the back" is not probative.

I expect any claim lacking a great medical nexus to be denied, and that is usually what happens. The docs opinions have to be very specific, precise, and not vague. Forget benefit of the doubt, here. It is up to the claimant to provide a favorable medical opinion. Without a favorable medical opinion, you rarely get benefits. OUR logic, and OUR opinions do not count. It must be the doctors.

broncovet I have to agree with you on this. jmho

[Byte187]

broncovet, that was, by far, the best rationale offered yet, in opposition to my contention. I'm not above being corrected, but I'm still not convinced. I see flaws in your rationale.

For example, you say "it's possible to 'connect the dots'" but I say, in this scenario, the dots have already been connected, and connected by the VA, not just the veteran's opinion.

> Rating specialists have been very anal about what they accept as docs opinions.

Do they accept their own opinions? In order to SC the radiculopathy in the first place, the VA rater had to determine that the cause was related to something in-service. If they're going to connect it, there is only one possible event to connect it to -- the same event the back is connected to. I see common etiology already determined by the VA raters.

> Again, "common etiology" is a medical determination.

Okay, but what additional medical determination could there be beyond that which already exists? Ie. the veteran has service connected back disability, with a documented injury determined to be the cause. The veteran's peripheral neuropathy is not a separate injury, but an additional painful symptom of the same injury. The pain in the back and the pain radiating from the back, down the legs, is all caused by one injury. Single injury, common etiology.

Assuming that it's possible to have leg pain without a back injury, that's not the case in this scenario, and the VA has already made that medical determination when they granted SC for radiculopathy, secondary to the SC back condition. Even though the radiculopathy is rated separately from the back, as they are a separate body parts, they are still caused by the same event/injury. Common etiology.

I think this is the very definition of "common etiology" and the VA has already made that medical determination when they granted service connection.

What possible rationale could be given to determine that common etiology does not exist in this case, after the VA has already connected the leg pain to the same cause as the back pain?

NOTE: I am using details from my own condition/rating to make this argument but seriously, this is not about me. I don't have an IU claim and don't anticipate one. I've discussed this many other ways with other people and I could make this case a thousand other ways, I just happen to fall into this category that I'm talking about and it's just easier to remember my own details.