C&P doc claims that I am already SCd?????

[LindaDP]

I was med boarded out in 1984 for 1. Recurrent right subclavian vein thrombosis (principal cause- combined rating w/diagnosis two-10%)

                                                         2. Right first rib resection performed 10 Apr. 84 for treatment of a possible thoracic outlet syndrome

I recently had a C&P exam for Service Connection for Thoracic Outlet Syndrome (I'll try to keep this short)

[X] In -person examination

Evidence reviewed

[X] VA e-folder(VBMS or Virtual VA)

[X] CPRS

1. Diagnosis

Does the Veteran now have or has he/she ever had a vascular disease(arterial or venous)?

[X]Yes

Diagnosis #1: Recurrent right subclavian vein thrombosis

ICD code(s):xxxx

Date of diagnosis:SC

Diagnosis #2: Thoracic outlet syndrome s/p First rib resection

ICD code(s):xxxx

Date of diagnosis:SC

2. Medical history

a. Describe the cause /onset of the Veteran's current vascular condition(s) (brief summary)

The Veteran chronically occluded right subclavian vein had multiple RUE DVT's, on Xarelto. She had upper rib resection in 1980. She c/o stable pain to RUE- constant numbness/tingling and shooting pains from armpit to hand and neck. She works as a housekeeper in the OR and reports being able to do her job w/out terrible discomfort. She also reports edema to right arm at end of the day, decreased by morning. She reports taking Tylenol for relief of pain.

UPPER EXTREMITY VENOUS DUPLEX- showing THE DISTAL SUBCLAVIAN AND PROXIMAL/MID AXILLARY VEINS WERE CHRONICALLY OCCLUDED WITH MANY COLLATERAL VESSELS

b. Type of vascular disease condition (check all that apply)

No response provided

No to all questions c-d

11.Other pertinent physical findings, complications, conditions ,signs, symptoms and scars

a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to the conditions listed in the Diagnosis Section above?

[X] No

b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above?

[X] Yes

12.Diagnostic testing

a. Has ankle/brachial index testing been performed?

[X]No

b. Are there any other significant diagnostic test findings and /or results? If yes, provide type of test or procedure, date and results (brief summary):

[X] Yes

UPPER EXTREMITY VENOUS DUPLEX (08/19/15): RIGHT INTERNAL JUGULAR VEIN : Vein is patent, Pulsatile, Phasic W/Augment

Subclavian vein: Vein not located

Proximal/Mid Axillary Vein: Vein not located

Distal Axillary Vein: Vein is patent, continuous w/augment

Brachial Vein: Vein is patent , phasic with w/augment

IMPRESSION: This study reals no evidence of DVT in the imaged veins. However, the Distal Subclavian and Proximal / Mid Axillary veins were not located with many collateral vessels imaged in this region, suggesting history of subclavian vein and Axillary vein DVT. The Distal Axillary vein was imaged with continuous waveform suggesting proximal obstruction.

The right Ulnar and Radial arteries were imaged with a high bifurcation at the mid upper arm.

13. Functional impact

Does the Veteran's vascular condition(s) impact his or her ability to work?

[X] Yes

Effect on usual occupation: Pain at the end of the day with repeated activity of the right upper extremity.

Problems with lifting and carrying, pain

Are there effects of the problem on the usual daily activities: Yes    

Chores: Mild

Shopping: Mild

Exercise: Mild

Driving: Mild

MEDICAL OPINION

[X] In person examination

EVIDENCE REVIEW

Was the Veterans VA claims file reviewed? Yes

MEDICAL OPINION SUMMARY

Opinion requested: Secondary Service Connection

Is the Veteran"s claimed Thoracic Outlet Syndrome at least as likely as not (50% or greater probability) proximately due to or the result of her service connected recurrent right shoulder subclavian vein thrombosis: with right first rib resection which is currently evaluated at 10%

Type of Medical opinion provided [MEDICAL OPINION FOR DIRECT SERVICE CONNECTION]

a. The condition claimed was at least as likely as not (50% 0r greater probability) incurred in or caused by the claimed in-service injury, event or illness.

c. Rationale: The Veteran is already serviced connected to Thoracic Outlet Syndrome with first rib resection which is the treatment for that condition. The recurrent right shoulder subclavian vein thrombosis is the result of Thoracic Outlet Syndrome.

My question is how can it already be serviced connected when they clearly state POSSIBLE THORACIC OUTLET SYNDROME, also, this was an exam that was half ass at best, she looked at my arms, chest and did not want to discuss the blood clots, she didn't even know what a Drill Sgt. is. Any and all opinions and suggestions are welcomed at this point.

 

 

                                                        

Edited December 11, 2015 by LindaDP

[Andyman73]

You were med boarded out, and only got 10% for it?  Would seem to me that if it was something serious enough to get med boarded for, then it certainly should be rated a lot higher.  But of course I haven't a clue to what I'm talking about, mostly thinking out loud.

[Gastone]

The C & P examiner (with or without a military background) is only supposed to address those issues designated by the VA Rater that requested the C & P Exam. You'll know soon enough, if you filed an FDC. Awards/Denial Decisions for FDC's have been rendered in as little as 4 months after the C&P.

Don't wait for the Decision, start planning your NOD. What possible N & M Evidence could you or should you have supplied?

Semper Fi

[Vync]

I'm not too knowledgeable about circulatory system claims, but I'll try to help. Perhaps others might be able to help, too.

 

The examiner might have avoided discussing the blood clots because she relied on the results of the vein image study instead.

c. Rationale: The Veteran is already serviced connected to Thoracic Outlet Syndrome with first rib resection which is the treatment for that condition. The recurrent right shoulder subclavian vein thrombosis is the result of Thoracic Outlet Syndrome.

Even though the word "possible" is present, the fact is that you had the rib removed as treatment for TOS. Back in 1980, they did not have technology like we have today, so the surgery was performed to identify the "possible" condition, which was confirmed, the rib resection was performed to treat the TOS.

The C&P doc confirmed you were already SC for TOS and states you did receive what they thought was the appropriate treatment (rib resection) for it.

The C&P doc also opined "recurrent right shoulder subclavian vein thrombosis is the result of Thoracic Outlet Syndrome". I'm not sure if "subclavian vein thrombosis" would be rated separately though. It could either be a case where the doctor is saying these are the same thing or they could be saying SVT is caused by TOS and is a new secondary claim. I'm sorry, but I am just not familiar enough to offer an opinion on it.

However, I did search BVA claims and found this which might be similar to your situation:

http://www.va.gov/vetapp07/Files3/0721570.txt

 

I hope this helps!

[pwrslm]

Check the med board %.  IF the VA rated you to low, you might be able to reopen the old rating if you can show an error. 

 

Have you requested your C File yet?

[LindaDP]

Thank you all for the advice! I will find out how to get my C file and gather any evidence I can get my hands on. Thanks again for the advice.

[Gastone]

Any chance of "Pyramiding" here? What is your current DX code? System, Coronary or Thoracic?

C&P rules out any type of Extra-Scheduler IU possibility, due to apparent ability to do Sedentary work and earn in excess of the VA SGI ($12,400.00 per yr).

Exactly what do you think your rating should be?

Semper Fi