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

[Vync]

Gastone,
I was thinking about the same thing.

I was also wondering if the numbness/tingling impairments to the arm and hand might qualify for secondary disability via radiculopathy/nerve impairment.

[LindaDP]

In 1983 I was in the last week of drill sgt. school, my arm swelled up and I later learned that I had a blood clot in the right subclavian vein. Ten months and five blood clots later, they sent me to Walter Reed Army hospital, after about a month there and lots of testing, they asked if I would accept a surgery to open up my ribcage for a possible thoracic outlet. I agreed and had the surgery. A few months later I had more blood clots and they med boarded me out. They had my diagnosis at the time as  1.4538  Recurrent right subclavian vein thrombosis

2.7383 Right first rib resection for treatment of a possible thoracic outlet syndrome

My VA doc says I have Paget-Schroetters disease, Factor five Leiden, Thoracic Outlet Syndrome, and I am hypercoagulable. I have been on blood thinners for the last thirty years. If nothing else, I would at least like to be compensated fairly. This cost me my job at the post office a couple of years ago because I started getting blood clots , have had over twenty five blood clots in my right shoulder, I guess time will tell. Thanks again for your help.

PS. I tried to find the code 7383 with no luck, does anyone have any info if that code means just a rib resection or what?

 

[broncovet]

Linda, 

   Getting a C and P exam for an already SC issue is not "always" bad.  One possibility is that your symptoms have worsened and you deserve an increase.  

This is likely the case in your example.  Why?  You indicated you lost your job due to blood clots, that started in the military!

While I wont specualate and guess you can not get another job, VA compensation is designed to replace average "lost earnings" due to the injury or condition.  

If you are not working, then you should consider applying for TDIU, if you/a doctor thinks you are unemployable due to SC conditions (such as blood clots).  

Your case "shouts" to me that you should apply for an increase/TDIU, but, of course, I dont know if you are unemployable or not, but the fact that you stated you lost your job to SC conditions is a very big start.  

Of course, if you are still employable, but your blood clots have worsened since you were rated, by all means apply for an increase there, also.

Dont forget about secondary conditions, either.  Blood clots can cause all kinds of problems by restricting blood flow to organs and apendages.    Further, the treatment (blood thinners) can cause more problems such as internal bleeding.  

Also remember your spouse can get DIC if you die to a SC condtion, and a blood clot can certainly be in that category.  

Edited December 13, 2015 by broncovet

[iceturkee]

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.

i was med boarded out and only got 10 percent for my back and almost $32,000 in cash.

[Andyman73]

i was med boarded out and only got 10 percent for my back and almost $32,000 in cash.

I knew a young Marine that was med boarded out after 2 years.  He only got 10G$, and when he got his SC of 30%, back dated to his med board date, he had to wait till the VA comp equaled his payoff before he started getting any money.  I thought he was getting screwed big time, but he didn't even want to think about it, just wanted to move on with his life at the time..

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.

Linda, if you are close enough to your VAMC you can go in and speak with the benefits counselor, they will file the request for your C-file.  And they can/will request your service record and service medical record at the same time.  That's what I did.

Andyman

[iceturkee]

andy,

 

if the marine got 30 percent from the military, he would have been considered military retired. you only got compensation, if you were found to be 10 or 20 percent.

and, yes, i had to go through the same thing when i got my va service connected disability. took a long time for the va to recoup that too.