Secondary to Service Connected Issue

[ShuMan]

Is it true that for secondary issues you DO NOT need your in service medical records reviewed in order to obtain a Nexus letter?

And has anyone had any success in claiming secondary issues?

For example I am looking at putting in a claim for neck and hip pain secondary to my service connected lower back pain. I'm being treated for both neck and hip pain by my VA doctor. By treated I mean given Pain killers and muscle relaxers..lol

[flores97]

Shuman, keep in mind I am by no means an expert, but NO, you should not need your in service strs to prove a secondary condition that is caused/aggravated by a sc condition. You will need your VA or private medical treatment records of course, showing treatment and progression of the secondary conditions. Has your VA provider stated any causes for the hip/neck pain in your records? If not, you might need to obtain an IMO to submit along with your records. If the doc has stated that your back is causing these conditions, then VA might grant the secondaries but there is the risk of getting sent to c&p exams and having the examiner opine against you. If you include the IMO, it SHOULD lessen the risk of you being sent to a c&p. Have you tried asking your doc if he/she would be willing to complete a DBQ(Disability benefits quesionnaire), for the neck and hip issues? You can google the DBQ forms, find the ones for your specific disabilities, and print them out. I had no problem getting my VA PCP to complete mine, but alot of veterans do have trouble getting their VA docs to complete them.

[Vync]

Flores is correct!

Great advice!

[ShuMan]

Flores,

 Very detailed answer and I greatly appreciate the advice.

I'm going to have to go IME/IMO as of now. I was able to find a local doc that was once a C&P examiner to complete an exam on me on the 31st. I'm hoping to kill 2 birds with one stone here and have him complete the DBQs for my appeal and well as secondary conditions (and nexus letters were needed). So now I'm reading thru the DBQs and the regulations to see what percentage I could possibly qualify for.

Also I hired Valor to provide some needed nexus letters and to do a records review (Based off the great review you gave them). There's over 1000 pages in my C-File and I knew I couldn't look that over all myself. They've been really helpful in pointing me in the right direction and providing realistic advice. Just what they've pointed out so far has been pretty helpful and worth every penny.  

I'm really surprised that your VA PCP was open to completing a DBQ on you. I was always told that they like to shy away from that stuff. I'll have to message my PCP to see if they are open to it.

Again thank you for the advice!

[flores97]

Shulman, your welcome, I hope that helps! Its great that your getting an IMO and an IME as well, that is exactly what i am doing, using of course Valor for the IMO and Dr Ellis in OK for the IME. I am crossing my fingers about the trip to OK, as I have a really difficult time traveling, but I plan on posting both the IMO and the IME when I receive them. I'm glad Valor is working out for you, its rare to be able to find a practitioner willing to take monthly payments for a medical opinion, that is for sure. Best of luck on your claims, keep us updated!!

[Carl the Engineer]

I think secondary is where its at. 

Depending on the secondary claim, you will need a C&P if it involves calcutalting a percentage, i.e., range of motion, etc.

As you get older, more issues can be secondary to original service connected issues.  Especially if you are rated for arthritis. I dont think many vets think of this. Its just going to get worse with age.

Good luck,

Hamslice

 

 

 

[ShuMan]

16 hours ago, flores97 said:

Shulman, your welcome, I hope that helps! Its great that your getting an IMO and an IME as well, that is exactly what i am doing, using of course Valor for the IMO and Dr Ellis in OK for the IME. I am crossing my fingers about the trip to OK, as I have a really difficult time traveling, but I plan on posting both the IMO and the IME when I receive them. I'm glad Valor is working out for you, its rare to be able to find a practitioner willing to take monthly payments for a medical opinion, that is for sure. Best of luck on your claims, keep us updated!!

Best of luck to you on your travels Flores!

How have you been preparing for your IME?

The monthly payment plan is a huge plus and makes it more affordable for everyone.

[ShuMan]

16 hours ago, Hamslice said:

I think secondary is where its at. 

Depending on the secondary claim, you will need a C&P if it involves calcutalting a percentage, i.e., range of motion, etc.

As you get older, more issues can be secondary to original service connected issues.  Especially if you are rated for arthritis. I dont think many vets think of this. Its just going to get worse with age.

Good luck,

Hamslice

 

 

 

Hamslice,

In your experience what pieces of evidence encompasses a good secondary claim?

I've been told a note from a doctor linking the two conditions is key to winning these type of claims.

[flores97]

Shuman, I've already sent my records packet to Dr Ellis, as well I went ahead and paid for the visit up front, not that its required, just wanted to go ahead and take care of that. As far as other preparing, the past few weeks have been the worse health wise I have ever had. I realized yesterday that i have tachydaria(not sure if i spelled correctly), or abnormally fast heart rate. I went to urgent care for flu symptoms, pulse was 116 at rest. It has consistently been over 105, more like 111, for past six months every time i go to VA.  But getting back to preparations for IME, i will bring all of the urgent care/specialty clinic visits ive had since i sent the packet. There are quite a few. When do you have your IME appt? I would make copies of all relevant treatment records, put them in order with newest on top, going down by date to oldest. Highlight whatever you want the doc to pay attention to, I usually separate each visit with a paperclip and put sticky notes on front of each stating (for example)-urgent care visit 3/5/2016, for lupus flareup, abdominal pain, rashes, etc. It might also help to make a list of all pertinent evidence, with dates of treatment, symptoms and diagnosis(and which doc, facility), and include that as well.

[Buck52]

flores97

I suggest you see a Cardiologist before you make the Oklahoma Trip.

If your having severe pain that radiates from the front to  the back about bra line area...& with that fast of Heart Beat  you truly need to see a Heart specialist .

If they have you do a stress test and you fail  they may want to do a heart catheter test on you to check for blockages or heart disease.

This will make you think you have a Back-ach

I don't want to be scaring you but Heart Diseases is a silent killer in Women...because of the pain in the Back Area....you would never suspect the Heart.

This would tend that you might believe you just have a Back-Ache 

I hope and pray you will be ok.

 

..................Buck

[flores97]

Buck, thank you. I am not going to lie, the chest pain yesterday was bad. I can take joint pain, and I can take abdominal pain, but chest pain on top of that...the nurse pointed out to the doc three times, look at her heart rate, do you want to address that, and he just did a flu swab(i was also very congested), and said i have acute bronchitis. I believe the fast heart rate is possibly from anxiety, i do have trouble with that, and with pain on top of it my pulse once was up to 124. I also get dizziness with it at times. I will definitely be pushing my pcp to take a closer look, i thought it was severe heartburn. Thank you so much for your advice and support. 

[ShuMan]

1 hour ago, flores97 said:

Shuman, I've already sent my records packet to Dr Ellis, as well I went ahead and paid for the visit up front, not that its required, just wanted to go ahead and take care of that. As far as other preparing, the past few weeks have been the worse health wise I have ever had. I realized yesterday that i have tachydaria(not sure if i spelled correctly), or abnormally fast heart rate. I went to urgent care for flu symptoms, pulse was 116 at rest. It has consistently been over 105, more like 111, for past six months every time i go to VA.  But getting back to preparations for IME, i will bring all of the urgent care/specialty clinic visits ive had since i sent the packet. There are quite a few. When do you have your IME appt? I would make copies of all relevant treatment records, put them in order with newest on top, going down by date to oldest. Highlight whatever you want the doc to pay attention to, I usually separate each visit with a paperclip and put sticky notes on front of each stating (for example)-urgent care visit 3/5/2016, for lupus flareup, abdominal pain, rashes, etc. It might also help to make a list of all pertinent evidence, with dates of treatment, symptoms and diagnosis(and which doc, facility), and include that as well.

I have mine on the 31st. I sent him the package digitally so I can always send more. Good thought about bringing the records and organizing them. A lot of my issues have to do with ROM, so I've been making sure I understand the regs on that.

Thanks again!

[flores97]

Absolutely, I'm glad you are studying the regs on ROM, I'm sorry I didn't even think of that, duh. Very smart move, and I wish you the Best of Luck!! My IME is on April 19th. Im not sure when Valor will complete my IMO, im thinking two weeks, but they did state they would go ahead and send it to me when completed and I could keep making payments. 

[Vync]

Flores,
Do you happen to have acid reflux? I ask because it has landed me in the ER many times with chest pain and rapid pulse that resembles a heart attack. After the EKC and blood tests came back, they were able to determine it was reflux. I never would have imagined stomach acid could do that.

[flores97]

I do, Vync, I have gerd and a hiatal hernia as well. I figured the gerd was causing the chest pain, but its the racing heartbeat that really worries ne. The docs told me that longtime nsaid use was causing or aggravating the gerd and ibs.

[flores97]

Vync, I reread your post, I missed the racing heartbeat portion earlier. You are absolutely right, i had NO idea stomach acid could do that. Its gotten pretty bad, im taking the meds, but so far no improvement, ANYTHING i eat causes pretty moderate symptoms. This sucks, but i appreciate you sharing that, it does help, and i will also take Bucks advice and make sure the kicker is functioning correctly. 

[Vync]

Hey Flores,
It's amazing how reflux can feel so devastating. When I showed up at the ER with chest pain, they brought me back immediately. I wound up being admitted overnight for observation. When I was told it was caused by reflux, I was indeed surprised! I guess it was a better safe than sorry approach.

[Carl the Engineer]

ShuMan,

Most of my secondary's have been from SC'd arthritis, DDD and DJD.  Most evidence has been X-ray.  And the ratings have been ROM (Range of Motion).  Elbow second to Shoulder, arthritis ROM, xray.  Lumbar second to Cervical Spine, DDD, DJD, ROM, xray.

I also have secondary (rated at zero), scars from warts SC'd, and scars from facial acne SC'd.  As I said, both rated at zero, but if I die from acne, my wife gets DIC..

Just saying

Hamslice

 

[Andyman73]

Flores,

Have you had a sleep study done? Some of your symptoms are indicative of sleep apnea! Please please please get that checked, if you haven't already! It is a major player on the silent killer field. SA has been proven to cause a lot of heart related issues.

My chronic acid reflux was cut by 95%, within 2 days of starting using my CPAP. It still shows up, but the belly bonfire is just a smoldering ember now. I sure don't miss waking up in the middle of the night just as I'm about to aspirate acid into my lungs! Talk about scary!

Also my bp has dropped an additional 10 points since CPAP usage started.  It doesn't help with my other sleep issues much. 

[flores97]

Thanks Andyman, its funny you should mention that, about the same time the gerd symptoms got worse, I started waking up some nights gasping for air, always when I'm fi

[flores97]

Keyboard malfunction. Always when I'm first falling asleep, I stop breathing pretty frequently and wake up gasping. Haven't had a sleep study done yet, I have complained about it and was told my neck wasn't thick enough for me to have sleep apnea. Haha. Good 'Ol VA docs. Some good, some bad, some a@#$%!