What Does "may Be Caused By" Mean Va Wise

[OnRiver]

I posted to long of a message before. Basically does anyone know what "Maybe caused by" really means in VA jargon?

Thanks

[john999]

What is the "maybe" in referrence to? Is it a statement about service connection. If so you need something stronger than "maybe".

[OnRiver]

Below is what he wrote after neurology also stated that the emg did not rule out neuropathies .

A/P Perephial neuropathy and history of cranial nueropathies(these are being compensated for and are listed as caused by diabetes).The periperhial neuropathies may be secondary to long-standing diabetes or small fiber painful type. I recommend that he continue neurotin as it is helping to relieve his painful symptoms. He should continue with physical activity and exercise as tolerated.

[Tower_Rat]

yeah its got to be stronger than that. There are many ways for them to say it but, if you can get them to say "at least as likely than not" or something close to that than your closer to winning. Thats what they said on my C&P that I had but, the actual regular doctors just stated that it was the cause of the disability. Funny how the main doctors you see can say it is 100 percent and the C&P doctor can say "at least as likely than not" which is probably 50 to 70 percent.

[Josephine]

Friends,

Here is another good one.

My first C&P - the Va Psychologist stated - More likely than not or a result of service

My second C&P - A board of two Va staff psychiatrist found that the veterans symptoms were primarily consistent with a personality disorder and that it did not appear she developed a chronic psychiatric disability while on active duty.

In my opinion the board of two aren't saying anything concrete.

What do you think?

Josephine

[OnRiver]

Have you ever come across the term or are you making a quess? How could my focal nueropathies be considered to be secondary while perephial are not? The main reason they denied it was because the EMG was used to knock it down...now the EMG can not knock it down as I have written VA comments to that affect, So maybe...maybe will win out.

[Josephine]

Below is what he wrote after neurology also stated that the emg did not rule out neuropathies .

A/P Perephial neuropathy and history of cranial nueropathies(these are being compensated for and are listed as caused by diabetes).The periperhial neuropathies may be secondary to long-standing diabetes or small fiber painful type. I recommend that he continue neurotin as it is helping to relieve his painful symptoms. He should continue with physical activity and exercise as tolerated.

OnRiver,

You need to direct your question to Berta. I have diabetes, but I am sorry, I cannot help you,

Just post again and place at the bottom for Berta.

Josephine

Edited December 5, 2006 by Josephine (see edit history)

[john999]

Onriver

If you have diabetes and PN then there is a much better than likely chance the two things are related. Get a real doctor to connect the dots for you. I have DMII and PN and it was service connected, but I had to fight for it. PN is a very common secondary condition to DMII. That doctor is just tap dancing around. There is no diagnosis that says "maybe". You can't win service connection with a "maybe". I am not being funny. You need something like "as likely as not" to get service connected.

[OnRiver]

Dear John

Thanks for your comments and input. I don't have the money to see a dr. for another opinion. I kind of read this as if their was only two reasons for the Perehial neuropathy ...a either or when he states...."The periperhial neuropathies may be secondary to long-standing diabetes or small fiber painful type." The va turned me down the first time because of the false assumption that EMG's ruled out diabetic neuropathies which it does not. That has been noted in my file. Al;so since I only claimed nueroptjies of the lower extremeties I can still claim upper ones as they have now been shown by examinations to be there.

[john999]

Onriver

I went through the same BS about my PN. The VA granted 10% for each lower extremity but denied the upper PN based on the same evidence. I appealed this and won and so can you, but you need a medical opinion!!!! The C&P doctor should have given you a physical exam to determine sensory loss. Not all PN shows up on an EMG, as you say. You should have the benefit of the doubt on this matter. For the doctor to make a statement like "maybe" is irresponsible. They know that PN is a major secondary condition of longstanding DMII. Ask the VA for another C&P exam to make a determination as to the fact of your PN being secondary to the DMII. You got an inadequate exam. Ask your primary care doctor to send you to the neurologist for an opinion.

[Hoppy]

It does not sound like the statement was written for the purpose of adjudication and was only a justification for his treatment plan. Take him the nexus form.

[Guest rickb54]

OnRiver,

Stated," "Maybe caused by" really means in VA jargon?"

It means the doctor is not sure if the problem was caused by....

For a va claim you will need a statement that reads;

it is more likely than not that the present condition is caused by ______ or;

it is as least as likely as not that the present condition is caused by______.

If your trying to get service connection for a new conditon, the doctor needs to indicate he has reviewed your active duty medical records, and he also needs to justify his opinion.

If your trying to get a condition service connected as a secondary issue, than it may not be necessary to review the active duty medical records. But the opinion still needs to be justified.

You don't need any special forms or letters for the va to accept the statement.

Your doctor can write this statement right in the medical record, it is eaiser for him to do this, and it is faster than having to dictate a letter, and then having it typed on letterhead. It is also cheaper and less time consumming for him to write it in the medical record.

Hope this helps...

Edited December 6, 2006 by rickb54 (see edit history)

[Guest jstacy]

Here is the examination criteria for DMII;

http://www.vba.va.gov/bln/21/Benefits/exams/disexm13.htm

I hope this helps.

[vaf]

Are you sure the person who administered the C & P was a real doctor, not a P.A. or a Nurse Practioner? If he was a bona fide physician, was he a specialist in the area being examined?

John999 has an excellent point. You need to be examined by a neurologist, and the phrasing of the opinion needs to following the structure of what has already been discussed here.

[Guest terrysturgis]

ONRIVER, after reading this post I have a couple queations. Is your DMII awarded because you are an in country Viet Nam vet? What percentage of compensation is the DMII at? If you have DMII you will get PN. When I had my C&P the PN testing consisted of a lot of range of motion testing. MY compensation is as follows:DMII 40%, PN right lower 40%, PN left lower 40%, PN right upper 30%, PN left upper 20%, add 10% for tinnitus equals 94.6% schedular paid TDIU 100%.

My private doctor wrote a letter and said my PN was caused by DMII. As you have probably read on this board, an IMO really helps the VA examiner get it right. Also, compare the C&P you had to the DMII exam posted by jstacy. A lot of good info there. Take care. Terry Sturgis

[Berta]

" As you have probably read on this board, an IMO really helps the VA examiner get it right"

Terry- glad you said that- even the VBM says that it is often difficult for one doctor to go against another doctor's opinion if the IMO opinion is strong and well supported.

An IMO doctor can often provide so much more medical support for the claim (because they actually read all of the records) that I agree that it can make the VA examiner's job easier.

The VA doc will have to not only conform to the VA criteria for an opinion but will have to attempt to break down an IMO and they usually can't do that successfully if the IMO opinion has full medical rationale and also some known medical references to support the opinion.

My second IMO broke down the VA opinion extremely well- the VA doc gave no rationale, nor any supporting medical references,or treatises , nor any rendition of their background as to be able to opine on my husband's conditions at death.

The records remained here 20 miles away at a local VAMC in Bath NY as this opinion was rendered over probably at least 100 miles away in Buffalo, whereas Dr. Bash had everything.

The opining VA doc did not have the autopsy , MRIs and ECHO results,FTCA medical findings and any other documentation that showed the VA could not diagnose multiple other conditions Rod had.She had 3-4 med recs faxed to her from Bath.

The VA doc , as my IMO said , relied on an "outdated" medical criteria for the medical assessment.

The VA opinion however did offer support for the claim.

I used a professional dictionary to define for VA clearly what the VA doctor stated that certainly was supportive.And it also did support the nexus as the VA doctor did state that Rod's confirmed exposure to AO in Nam was a risk factor for diabetes.

I focused on the support it offered in a response to the SSOC ,expanded on the autopy findings and Sec 1151 findings of 1998 that were not considered and the second IMO again supported direct SC death based on the med recs and other legal documents in the c file yet the fact that,this time, the VA opinion was knocked down -made the second IMO opinion neither redundant nor cummulative.

The expense of good IMos should be viewed as an investment because often without them, a claim will just continue to fail.

Edited December 6, 2006 by Berta (see edit history)

[OnRiver]

Thanks for all the comments.....they help.... I am a vietnam vetran with 30% rating...20% diabetes and 10% facial neuropathies bells palsy on one side....I can get 10% more for the left ...they just gave me the focal without asking but denied the perephial even though I have all kinds of backup stating I have neurologicl damage.......

I have sensory loss all over my records from neurology, pedotry and primary, even eye Doctors state so......The actually reading is "may be a secondary condition of long standing diabetes or small etc"....they all agree I have neurological damage but have like he stated "maybe secondary to diabetes or...." Which to me means its either diabetes or this other thing....he does state long standing diabetes which according to Diabetes Association most all develpe neuropathis over time...

...one service rep. says it will fly with the added extras as the CP examiner (a cardiologist) thought wrongly that a emg ruled out diabetic neuropathy....he even states " Certainly, all examinations shows perepherial neuropathies but the emg by Dr. ..... shows otherwise." Certainly means certain as far as examinations are concerned. So if you take away the emg he would be certain....We now have written into the record that EMG miss allot of neuopathies...

What exactly is a nexus statement....ALSO I am going to borrow some money to see a neurologist to review my records etc.

sorry about the writing but I can't see to well today...

[john999]

Nexus is the medical evidence that connects your injuries to your military service. In your case the nexus would be the evidence that connects the PN to your service connected DMII. What that means is a neurologist would state that your PN is a secondary condition to the DMII.

[LarryJ]

OnRiver,

Just thought I'd chime in here. Getting an "Independent Medical Opinion" an "IMO" will not help if the doctor that you choose does not know how to speak "VA".

In his opinion, he must state that your condition was "At Least As Likely As Not" ( in other words a 50% - 50% chance ) of having been caused by your military service, or having been caused by another condition that was caused by your military service.

Of course, it would be great if, instead of "at least as likely as not", that he could state difinitely that the military service caused, etc., etc.

I'll take my seat and keep quite now.

[Hoppy]

There used to be a form letter you could take to the doctor. I used one and it got me service connected. About a year ago there was a post stating that the letter I used had been incorporated into the documentation they use for a C&P exam. The same post included a copy of the exam report. I will try to find something. However it is a letter that gives the doctor the option of stating m"ost likely or not, "as likely" or "not likely" related to service.