C&P Nexus of opinion inadequate?

[doc25]

Would this be an inadequate nexus of opinion?

The examiner clearly marked that it "at least as likely as not" incurred in service, but in the rationale just concurred with a previous C&P exam rationale.

Full 2nd C&P exam Nexus_Redacted.pdf

Edited May 12, 2019 by doc25

[GeekySquid]

10 minutes ago, doc25 said:

Would this be an inadequate nexus of opinion?

@doc25

this uploaded doc seems to have an alignment problem with the check boxes. at least in my pdf viewers.

can you look at the original unedited doc and see which pieces of evidence reviewed where checked?

In what I see it looks like they did not review some of the listed items in the DBQ.

please upload the 1st dbq and other documents, code sheets, award letter with evidence reviewed, request from VA for the C&P. redacted of course.

the conflict in opinion may be flowing from that original dbq and comments noted from that other doctor.

[doc25]

1 minute ago, GeekySquid said:

@doc25

this uploaded doc seems to have an alignment problem with the check boxes. at least in my pdf viewers.

can you look at the original unedited doc and see which pieces of evidence reviewed where checked?

In what I see it looks like they did not review some of the listed items in the DBQ.

please upload the 1st dbq and other documents, code sheets, award letter with evidence reviewed, request from VA for the C&P. redacted of course.

the conflict in opinion may be flowing from that original dbq and comments noted from that other doctor.

Yea for some reason my Adobe misaligned it. I will post everything I have with the exception of the 3rd c&p results. I had to request that from the intake center.

[GeekySquid]

1 minute ago, doc25 said:

I will post everything I have with the exception of the 3rd c&p results.

@doc25

Great!..I have that happen when I use Adobe. I get a better result from Nuance Power PDF,  but alignment issues do happen in some files.

 

[doc25]

9 minutes ago, GeekySquid said:

@doc25

this uploaded doc seems to have an alignment problem with the check boxes. at least in my pdf viewers.

can you look at the original unedited doc and see which pieces of evidence reviewed where checked?

In what I see it looks like they did not review some of the listed items in the DBQ.

please upload the 1st dbq and other documents, code sheets, award letter with evidence reviewed, request from VA for the C&P. redacted of course.

the conflict in opinion may be flowing from that original dbq and comments noted from that other doctor.

Yea for some reason my Adobe misaligned it. I will post everything I have with the exception of the 3rd c&p results. I had to request that from the intake center.

EntranceExam98.pdf In-serviceDxpg1.pdf In-service Dxpg2.pdf C&P 2007pg2_Redacted.pdf C&P 2007pg3_Redacted.pdf C&P 2007pg4_Redacted.pdf 2007DenialLetter1_Redacted.pdf 2007DenialLetter2_Redacted.pdf 2007DenialLetter3_Redacted.pdf 2017DenialLetter1.pdf 2017DenialLetter2.pdf Denial Letter 4-18-19.pdf Denial Letter 4-18-19p2.pdf

[GeekySquid]

25 minutes ago, doc25 said:

I will post everything I have with the exception of the 3rd c&p results

@doc25

I just read all the pages you post. Here is a list of things that jump out at me. Maybe others will see more stuff.

1) Entrance Exam page-cannot tell what the handwriting says just that you have an NORMAL ARCH is circled. Is there other stuff on this physical that indicates congenital flat feet?

2) DX pg 1 in service record shows complaint of foot problems-not congenital

3)  DX pg 2 in service record shows ROM problem with ankles(?) what is this about(?) does not mention congenital. gives a consult for DME orthoses (what is this and did you go?).

4) C&P 2007 pg 2 indicates you did not complain about serious problem with your feet. Is this correct?

5) C&P 2007 pg 3 indicates no feet problems. In section on left knee raises "mere speculation" issue. Not sure where that might go for you.

6) C&P 2007 pg 4 brings up first mention in these docs of "congenital". Why that diagnosis? if your feet were good at entrance in what looks like 1998 (that Normal Arch entry) then how is it in 2007 your problem is now called "congenital"? Congenital means "from birth" so where is the justification for that diagnosis?

7) 2007 Denial Letter pg 1 relies on the congenital statement. If this is a congenital issue, then your Entrance Exam info seems to be important. Further NSC conditions aggravated by a service connected nexus are rateable as SC. so their claim your service did not aggravate your flat feet seems questionable without further explanation or documentation of that word "congenital".  They further state additional medical evidence based on another exam which concurs with "congenital" statement without further supporting evidence it is congenital. The military accepted you on the entrance exam, so any harm service does or aggravates should be compensable. Maybe others will chime in on this part related to NSC's accepted at induction physical.

8 ) 2007 Denial Letter pg 2 indicates no evidence directly looking at congenital. This may or may not be relevant.

9) 2007 Denial Letter pg 3 says a congenital or developmental defect. This is a change in diagnosis. As far as I can tell from the regulations and laws raters cannot make spurious medical diagnostic claims  sua sponte or sua generis, meaning on their own. so why is developmental a stated likely cause? it is very different than congenital (from birth) and I don't remember seeing it in any C&P DBQ or medical note that you have posted. Their claim that orthotics fix your problem and allows the VA to deny service connection seems tenuous at best as orthotics don't cure anything, they just help alleviate the pain from the problem. The experts here might have a better idea how problematic that statement is.

10) 2017 Denial letter pg 1 relies on the congenital developmental claim from above. may be in error if you can fight that part of the record. It further states that there was a VA Letter 2016 that I don't see here. Was there one? can we see it? did I miss some date on one of the pieces  you uploaded above?

11) 2017 Denial Letter pg 2 Says they reviewed STR's from 99 to 2007 and they were received May 2016. What is with these dates? how could teh 2007 denial be done without those records "received 2016? it seems odd to include since they also say they did a complete review of claim file but does NOT mention a complete review of your service record. Isn't this supposed to be a De Novo review since you were granted a re-opening of your claim? if it is De Novo it means a complete review with fresh eyes are required. Mentions VA Letter 2007 is that your denial letter? or another one"? and it mentions the Harlingen VA treatment records. Did you upload them? what do they say? is this were congenital and developmental diagnosis get supported? I don't see an explicit buddy statement listed in the evidence. is there one? what about your statement of claim? where is it?

12) Denial Letter 4-18-19 pg 1 says denial remains because evidence submitted is not New and Material. As of Feb 19, 2019 the standard is New and Relevant replacing New and Material. The CFR has different language as does the USC. I would look into this as it seems they may be applying the law wrong as to what is New and Relevant.

13) Denial Letter 4-18-19 pg 2 says 5103 response received Dec 2018. By who and what did it say? Says lay evidence received Jan 31, 2019 and dated Feb 18, 2019. WTF is with the dates? how do you receive a letter before it is written? repeats New and Material denial. Claims lay evidence received is not credible. This needs to be investigated. what did that letter say and why would it not be credible. The VA is required by law to give broad latitude to lay evidence, so what made that letter incredible? The vet gets Benefit of the Doubt and any lay evidence is not expected to be on par with evidence written by a doc or lawyer.

@doc25 others may find more stuff, but at first read I see some missing pieces and questions that might need to be addressed. You may have that info and that would be great but what I asked about I don't see in the records you uploaded. To me it seems there are evidentiary problems, diagnostic claims not supported by medical evidence and a potentially invalid claim that your lay evidence is not credible. It seems you also have an IME/IMO type evidence from non-va providers that may contradict the VA doctors diagnosis.  I don't see them here so you may want to create a word-map showing the differences and contradictory diagnoses ( i think that is the proper plural of diagnosis?)

It reads like a fustercluck revolving around that claim of congenital and then the developmental declaration seems to make it more questionable.

I hope all that adds something to your thinking and planning.

 

 

 

[doc25]

4 hours ago, GeekySquid said:

@doc25

I just read all the pages you post. Here is a list of things that jump out at me. Maybe others will see more stuff.

1) Entrance Exam page-cannot tell what the handwriting says just that you have an NORMAL ARCH is circled. Is there other stuff on this physical that indicates congenital flat feet?

2) DX pg 1 in service record shows complaint of foot problems-not congenital

3)  DX pg 2 in service record shows ROM problem with ankles(?) what is this about(?) does not mention congenital. gives a consult for DME orthoses (what is this and did you go?).

4) C&P 2007 pg 2 indicates you did not complain about serious problem with your feet. Is this correct?

5) C&P 2007 pg 3 indicates no feet problems. In section on left knee raises "mere speculation" issue. Not sure where that might go for you.

6) C&P 2007 pg 4 brings up first mention in these docs of "congenital". Why that diagnosis? if your feet were good at entrance in what looks like 1998 (that Normal Arch entry) then how is it in 2007 your problem is now called "congenital"? Congenital means "from birth" so where is the justification for that diagnosis?

7) 2007 Denial Letter pg 1 relies on the congenital statement. If this is a congenital issue, then your Entrance Exam info seems to be important. Further NSC conditions aggravated by a service connected nexus are rateable as SC. so their claim your service did not aggravate your flat feet seems questionable without further explanation or documentation of that word "congenital".  They further state additional medical evidence based on another exam which concurs with "congenital" statement without further supporting evidence it is congenital. The military accepted you on the entrance exam, so any harm service does or aggravates should be compensable. Maybe others will chime in on this part related to NSC's accepted at induction physical.

8 ) 2007 Denial Letter pg 2 indicates no evidence directly looking at congenital. This may or may not be relevant.

9) 2007 Denial Letter pg 3 says a congenital or developmental defect. This is a change in diagnosis. As far as I can tell from the regulations and laws raters cannot make spurious medical diagnostic claims  sua sponte or sua generis, meaning on their own. so why is developmental a stated likely cause? it is very different than congenital (from birth) and I don't remember seeing it in any C&P DBQ or medical note that you have posted. Their claim that orthotics fix your problem and allows the VA to deny service connection seems tenuous at best as orthotics don't cure anything, they just help alleviate the pain from the problem. The experts here might have a better idea how problematic that statement is.

10) 2017 Denial letter pg 1 relies on the congenital developmental claim from above. may be in error if you can fight that part of the record. It further states that there was a VA Letter 2016 that I don't see here. Was there one? can we see it? did I miss some date on one of the pieces  you uploaded above?

11) 2017 Denial Letter pg 2 Says they reviewed STR's from 99 to 2007 and they were received May 2016. What is with these dates? how could teh 2007 denial be done without those records "received 2016? it seems odd to include since they also say they did a complete review of claim file but does NOT mention a complete review of your service record. Isn't this supposed to be a De Novo review since you were granted a re-opening of your claim? if it is De Novo it means a complete review with fresh eyes are required. Mentions VA Letter 2007 is that your denial letter? or another one"? and it mentions the Harlingen VA treatment records. Did you upload them? what do they say? is this were congenital and developmental diagnosis get supported? I don't see an explicit buddy statement listed in the evidence. is there one? what about your statement of claim? where is it?

12) Denial Letter 4-18-19 pg 1 says denial remains because evidence submitted is not New and Material. As of Feb 19, 2019 the standard is New and Relevant replacing New and Material. The CFR has different language as does the USC. I would look into this as it seems they may be applying the law wrong as to what is New and Relevant.

13) Denial Letter 4-18-19 pg 2 says 5103 response received Dec 2018. By who and what did it say? Says lay evidence received Jan 31, 2019 and dated Feb 18, 2019. WTF is with the dates? how do you receive a letter before it is written? repeats New and Material denial. Claims lay evidence received is not credible. This needs to be investigated. what did that letter say and why would it not be credible. The VA is required by law to give broad latitude to lay evidence, so what made that letter incredible? The vet gets Benefit of the Doubt and any lay evidence is not expected to be on par with evidence written by a doc or lawyer.

@doc25 others may find more stuff, but at first read I see some missing pieces and questions that might need to be addressed. You may have that info and that would be great but what I asked about I don't see in the records you uploaded. To me it seems there are evidentiary problems, diagnostic claims not supported by medical evidence and a potentially invalid claim that your lay evidence is not credible. It seems you also have an IME/IMO type evidence from non-va providers that may contradict the VA doctors diagnosis.  I don't see them here so you may want to create a word-map showing the differences and contradictory diagnoses ( i think that is the proper plural of diagnosis?)

It reads like a fustercluck revolving around that claim of congenital and then the developmental declaration seems to make it more questionable.

I hope all that adds something to your thinking and planning.

 

 

 

1). No nothing else documented in the entrance exam.

2.) Correct. 

3.) Equinus means tight achillies tendons. No mention of congenital. I was prescribed arch supports and yes I went. I even used the damn things for 5 years until there was just the heel and arch molding. All the padding had worn away.

4.) I did complain of foot pain in 2006. There was no injury whatsoever to my feet.  A navy podiatrist made the diagnosis pes plano valgus.  

5.) Same as above. The knee was SC 10%. The issue is my feet since 2006 to the present.

6.) For an exit C&P exam, is a Benefits Disability claim on Discharge. From my understanding, the examiner doesn't need a rationale. Basically, can diagnose what they want. I could be wrong. I'll follow up with the guidelines.

7.) That's why I'm still pushing for SC for flat feet. I strongly believe it was an injustice done to my claim. VBA ust saying that I had congenital flat feet without clear and unmistakeable evidence prior to entering service is wrong and unlawful. Otherwise, I'd leave the claim alone. But, the VBA is making up stories that medically are not true. 

8.) No such congenital or developmental evidence ever existed at anytime during my childhood or adolescence. 

9.) Hmmm...so the VBA continues to make up their own rules. Wonderful.

10.) I had submitted claims for other disabilities in 2016. Flat feet was not one of them because I didn't know I could reopen a finalized decision. I reopened the Flat feet claim in April 2017 and was denied July 2017. I appealed and submitted a NOD. I was provided the SOC. The problem was that I naively believed that my VA podiatrist would help me out by writing a nexus of opinion. I requested it numerous times and never got. I wasn't able to submit my I9 Form, after a year the appeal was closed.

11.) VA podiatrist made the same diagnosis as the Navy podiatrist did in 2006. How can two experts in their specialty make the same diagnosis 10 years apart without ever consulting with one another? See the 9-17-16 note below. I had been treated for a year and did physical therapy. PPV= Pes Planus Valgus (Flat Feet).

12.) Strange how one word can change things. Ha ha.

13.) I don't even know what a 5103 is. Flub my luck. 

 

Chadburn Note9-17-16.pdf