Just a question

[dapilgrim]

Do you think this will get approved i am confused between  the two statements below?

Request for Medical Opinion RESTATEMENT OF REQUESTED OPINION: 
a. Opinion from general remarks: Is the veteran's left hallux valgus, left 1st MTP degenerative changes at least as likely as not (50 percent or greater probability) proximately due to or the result of bilateral foot condition with 

b. Indicate type of exam for which opinion has been requested: Foot

TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ]
b. The condition claimed is less likely than not (less than 50% probability) proximately due to or the result of the Veteran's service connected condition.
 
c. Rationale: The veteran's current diagnosis of left hallux valgus and left 1st MTP degenerative changes are not related to the bilateral foot condition with pain during service. The veterans available str and mtr is silent for complaints of foot pain and the veteran denies medical evaluations for foot conditions. Hallux valgus exact causes is unknown but factors that can lead to hallux valgus include inherited foot type, foot injuries or deformities present at birth or can be caused by degenerative arthritis. Arthritis in the great toe can be caused by previous trauma, fractured or sprained toe. 

[broncovet]

No.  The statement you posted is a "negative" nexus.  (See sec. b, where it says your condition was not related to service).  This will, with 99 percent certaintly, result in a denial, that is, unless you have or get medical evidence to refute it. 

To get approved, you will need medical evidence to refute this exam.  That is, you need a doc's opinion that your condition is related to service and is not genetic.   

[dapilgrim]

This ia a MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION... I don't know what it is secondary too. i suspect 

pes planus  which i also claim. but it has not been approved as far as i know.

[Buck52]

 How could it be a secondary claim if you don't have a original S,C, condition ? unless I missed something?

broncovet is correct  this statement kills the deal

'' Rationale: The veteran's current diagnosis of left hallux valgus and left 1st MTP degenerativechanges are not related to the bilateral foot condition with pain during service.

You will need a specialist to re flute this statment and show in detail why

Using s specialist in this filed   WILL BE IN YOUR BEST INTEREST.

[broncovet]

I agree its confusing. However, this statement by your doc seems to clarify:

Quote

The veteran's current diagnosis of left hallux valgus and left 1st MTP degenerative changes are not related to the bilateral foot condition with pain during service. The veterans available str and mtr is silent for complaints of foot pain and the veteran denies medical evaluations for foot conditions

According to this doc, you did not have an "in service event" for foot pain in service.  Did you get treated for foot conditions in service??  Do you have missing records that document it??  

    Did the doc state, "he reviewed your records"?  Imho, because of what I quoted, above, this wont fly.  

    Its my opinion you will likely need additional evidence for SC, based on this c and p alone, it would be denied.  

[broncovet]

BUT, here is the deal:

Did you complain of foot pain (foot issues) on your exit exam???  Was that documented?  

If you had no foot issues on your entrance exam, and you had them upon exit from service, then service caused your foot issues.  

I think I may know what happened.  The military often makes you carry exceptionally heavy backpacks, sometimes 100 pounds or more.  Then they make you go on a hike.  

This can damage your feet!  But you have to have documentation.  

[broncovet]

However, "absence of evidence" is not the same as "evidence of absence".  

Let me explain:

Your doc listed "absence of evidence".  Ok, so where is this evidence?  We dont know.  It could be that the evidence got lost, was never recorded, or VA shredded it, or deleted it.  Its not an opinion that your condition WAS NOT caused in service, its an opinion there is no documentation of same.

However, "evidence of absence" is quite another thing.  This means that a doctor examined you, probably with an xray or mri, and stated, "No.  There is no sign of any foot disorders."  

You appeal these differently.  If there is "absence of evidence", well you submit your service records which show, yep, he was treated for foot pain.  

However, to refute "evidence of absence" you need another doctor to opine a refutation, such as:

"I examined the Veteran's feet and xrays, as well as the entrance and exit physicals.  Prior to service there were no foot conditions noted, but his exit physical showed damage.  Currently, I took xrays and mri's and they show...xy conditions.  Therefore, its at least as likely as not this is due to an in service event."