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Caluza Triangle defines what is necessary for service connection
Tbird posted a record in VA Claims and Benefits Information,
Caluza Triangle – Caluza vs Brown defined what is necessary for service connection. See COVA– CALUZA V. BROWN–TOTAL RECALL
This has to be MEDICALLY Documented in your records:
Current Diagnosis. (No diagnosis, no Service Connection.)
In-Service Event or Aggravation.
Nexus (link- cause and effect- connection) or Doctor’s Statement close to: “The Veteran’s (current diagnosis) is at least as likely due to x Event in military service”-
- 0 replies
Picked By
Tbird, -
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Post in ICD Codes and SCT CODES?WHAT THEY MEAN?
Timothy cawthorn posted an answer to a question,
Do the sct codes help or hurt my disability ratingPicked By
yellowrose, -
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Post in Chevron Deference overruled by Supreme Court
broncovet posted a post in a topic,
VA has gotten away with (mis) interpreting their ambigious, , vague regulations, then enforcing them willy nilly never in Veterans favor.
They justify all this to congress by calling themselves a "pro claimant Veteran friendly organization" who grants the benefit of the doubt to Veterans.
This is not true,
Proof:
About 80-90 percent of Veterans are initially denied by VA, pushing us into a massive backlog of appeals, or worse, sending impoverished Veterans "to the homeless streets" because when they cant work, they can not keep their home. I was one of those Veterans who they denied for a bogus reason: "Its been too long since military service". This is bogus because its not one of the criteria for service connection, but simply made up by VA. And, I was a homeless Vet, albeit a short time, mostly due to the kindness of strangers and friends.
Hadit would not be necessary if, indeed, VA gave Veterans the benefit of the doubt, and processed our claims efficiently and paid us promptly. The VA is broken.
A huge percentage (nearly 100 percent) of Veterans who do get 100 percent, do so only after lengthy appeals. I have answered questions for thousands of Veterans, and can only name ONE person who got their benefits correct on the first Regional Office decision. All of the rest of us pretty much had lengthy frustrating appeals, mostly having to appeal multiple multiple times like I did.
I wish I know how VA gets away with lying to congress about how "VA is a claimant friendly system, where the Veteran is given the benefit of the doubt". Then how come so many Veterans are homeless, and how come 22 Veterans take their life each day? Va likes to blame the Veterans, not their system.Picked By
Lemuel, -
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Post in Re-embursement for non VA Medical care.
broncovet posted an answer to a question,
Welcome to hadit!
There are certain rules about community care reimbursement, and I have no idea if you met them or not. Try reading this:
https://www.va.gov/resources/getting-emergency-care-at-non-va-facilities/
However, (and I have no idea of knowing whether or not you would likely succeed) Im unsure of why you seem to be so adamant against getting an increase in disability compensation.
When I buy stuff, say at Kroger, or pay bills, I have never had anyone say, "Wait! Is this money from disability compensation, or did you earn it working at a regular job?" Not once. Thus, if you did get an increase, likely you would have no trouble paying this with the increase compensation.
However, there are many false rumors out there that suggest if you apply for an increase, the VA will reduce your benefits instead.
That rumor is false but I do hear people tell Veterans that a lot. There are strict rules VA has to reduce you and, NOT ONE of those rules have anything to do with applying for an increase.
Yes, the VA can reduce your benefits, but generally only when your condition has "actually improved" under ordinary conditions of life.
Unless you contacted the VA within 72 hours of your medical treatment, you may not be eligible for reimbursement, or at least that is how I read the link, I posted above. Here are SOME of the rules the VA must comply with in order to reduce your compensation benefits:
https://www.law.cornell.edu/cfr/text/38/3.344
Picked By
Lemuel, -
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Post in What is the DIC timeline?
broncovet posted an answer to a question,
Good question.
Maybe I can clear it up.
The spouse is eligible for DIC if you die of a SC condition OR any condition if you are P and T for 10 years or more. (my paraphrase).
More here:
Source:
https://www.va.gov/disability/dependency-indemnity-compensation/
NOTE: TO PROVE CAUSE OF DEATH WILL LIKELY REQUIRE AN AUTOPSY. This means if you die of a SC condtion, your spouse would need to do an autopsy to prove cause of death to be from a SC condtiond. If you were P and T for 10 full years, then the cause of death may not matter so much.Picked By
Lemuel, -
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Question
Vetrequest
I’m in my 50’s. This is still foreign to me, however, learning something new every day through this forum.
Of course, when I was in and left the military no one told me anything the about VA or what an in-service event or aggravation, etc. meant or what I could do about it.
I have been able to acquire 60% disability so far on my own.
20% Left knee joint arthritis
50% Left knee osteoarthritis, limitation of extension
0% Left knee Scar
10% Bilateral Tinnitus
Hearing Loss – allowed one-year clock to expire without pursuing again -simply put, I didn’t know better at the time. I assumed if the VA says “no” then that was it)
Sort version of background information;
I injured my left knee when I was in the military in the early 1990’s. It was documented in my service medical records. So, for about fourteen years after I left the military my left knee got so bad, I had to have surgery. An orthopedic surgeon told me and wrote in my private medical records that my left knee was bone on bone. My left knee has been bone on bone for over two decades. My left knee was eventually service connected.
After limping (antalgic gait) as it has been described by my primary physician and physical therapist for over two decades, my opposite knee, right knee has finally showing signs of wear and tear from having to absorb my weight as I shifted everything to my right side.
My right knee has been diagnosed as:
Mild medial compartment osteoarthritis.
A degenerative enthesophyte at the quadriceps tendon attachment to the patella.
Tearing of the medial meniscal root with associated extrusion of the meniscal body.
Moderate-sized joint effusion and moderate synovitis.
Moderate-sized Baker’s cyst with distal leakage.
I initially filed a claim for my right knee as secondary to my service-connected left knee. I only submitted Xrays, MRI and orthopedic surgeon and private physician (a PA-C) notes which were in my private medical records.
My first right knee claim was denied.
Reason for Decision:
(First Denial)
quote:
Service connection for right knee arthritis with meniscal strain as secondary to the service-connected disability of knee joint osteoarthritis, left knee (claim as left knee condition).
Service connection may be granted for a disease or injury which resulted from a service-connected disability or was aggravated thereby. The evidence does not show that right knee arthritis with meniscal strain is related to the service-connected condition of knee joint osteoarthritis, left knee (claimed as left knee condition), nor is there any evidence of this disability during military service.
The medical opinion we received from the VA Medical Center was more persuasive than your private physician’s opinion because it was based on a thorough review of your relevant military and personal history and contained a more convincing rationale.
Rational
The veteran’s right knee condition is not due to or caused by left knee condition. Although there is a common misconception that injury to a weightbearing joints can somehow cause secondary injury to contralateral weightbearing joints there is no medical evidence that shows that this is the case and generally speaking injury to a weightbearing joints results in an overall reduction of weightbearing activity because the injured joint no longer tolerates it. Individuals may argue that because of pain in the injured joint the opposite joint is somehow overused by shifting weight from the injured side to the opposite side but again, there is no medical evidence that supports such concept and, in fact, reduce overall weightbearing often has a protective effect on other joints. In rare instances, extremely advanced or sever degenerative or severe degenerative joint disease of weightbearing joints may alter gait and weightbearing as to have an effect on other joints but this generally appears in the form of imbalance same side joints as the gait is altered to protect the injured side with reduced excursion (the antalgic gait) and associated secondary muscle contracture and use pain (but not specifically degenerative joint disease) of joints above/below the injured joint. Such is not the case in the veteran.
The veteran’s right knee condition is unrelated to the SC left knee condition and has occurred as a consequence of his weigh bearing activities over the course of his life.
So, after reading this forum, I knew I needed an IMO. So, I reached out to Dr. David Anaise who has been referenced many times throughout this forum. Dr. Anaise provided me with an IMO. I submitted a second claim for my right knee with Dr. Anaise IMO. My second right knee claim was denied.
Reason for Decision:
(Second Denial)
quote:
Service connection for right knee arthritis with meniscal strain as secondary to the service-connected disability of left knee joint osteoarthritis.
We previously denied your claim for right knee arthritis with meniscal strain as secondary to the left knee joint osteoarthritis as the evidence did not show your right knee arthritis was caused by your service-connected left knee. A claimant may file a supplemental claim by submitting or identifying new and relevant evidence. New evidence is evidence not previously part of the actual record before the adjudicators. Relevant evidence means evidence that tends to prove or disprove a matter at issue in a claim. (38 CFR 3.2501) In support of your claim, new relevant evidence has been received and your claim is now reconsidered.
We considered the evidence provided by Dr. Anaise, C. Brinton, you and your spouse. The medical opinion we received from the VA Medical Center was more persuasive than your private physician’s opinion because it was based on a thorough review of your relevant military and/or personal history and contained a more convincing rationale. (38 CFR 4.6)
Based on a review of all available evidence our prior decision is unchanged.
(Disclaimer: I simply cut & paste the VA examiner’s rational as written. Misspellings, punctuations, etc. are the VA examiners)
Rational
Dr David Anaise MD, JD E s advocacy for our veterans is appreciated.
Review of much of the literature quoted in Dr Anaise l s opinion reveals studies performed on various small animals involving transecting muscles affecting motor strength and movements and/or transect ion of knee ACLs and/or patella tendons which grossly affect the opposite extremity stability-wise as well as weightbearing biomechanics, and many of the study conclusions note that their findings can only be extrapolated to humans with speculation . The footnoted study by Bhargava et al was a small study (20 subj ects) that found that gaits in otherwise asymptomatic individuals at 6 months after hip replacement (THA) was not the same as "normal" (ie asymptomatic controls without recent TEA) . Although the prior animal studies are referenced, i t does not make the conclusion that gait changes from unilateral total hip replacement result in opposite limb DJD but rather makes recommendations Cc preserve the longevity of the prosthetic hip . The Morgenroth et al 2014 article (from which Dr Anaise appears to have reproduced his dynamic loading paragraph nearly word for word) is a study in which 28 generally asymptomatic subj ects (averge age 56, none with knee pain or other knee issues) had dynamic loading studies performed to analyze their otherwise normal gait/ weightbearing along with MRI imaging to assess for MRI changes consistent with otherwise undetectable DOD. Their study did indeed find an association between dynamic loading rate and degenerative changes in the medial knee joint, they go on to note that this demonstration of association between variables does not allow for definitive conclusions regarding causation and that they can not rule out that osteoarthritis subsequently found on MRI in the knee joint that they are testing isnt in fact causing the gait/dynamic load findings associated with that joint ie a chicken and egg scenario. Interestingly, that study included 14 subjects who had unilateral transfemoral amputations (average time of amputation 32 years prior to study) for the purpose of ensuring a range of degenerative changes based on the authors' impression that amputees are a population with a higher prevalence of knee osteoarthritis thought to be related primarily to mechanical causes. .however this study did not reveal significantly different biomechanical loading variable outcome measures between amputees and non-amputees, and amputee sub} ects in this study demonstrated a distribution of medial and lateral tibiofemoral degenerative changes similar to that exhibited in the general population which is not supportive of the contention of changes in one lower extremity causing arthritis in the other .
In contrast, from the American Medical Association (AMA)
AMA Guides to the Evaluation of Disease and Injury Causation, 2nd Edition; American Medical Association, 2014.
Chapter 33: Evaluating Causation of Favoring for the Opposite
757 :
"The assumption that injury to one limb (upper or lower) can result in overuse condition in the opposite limb is widespread but unproved, Lay people and some physicians believe that pain or impairment in one limb can stress the other and produce symptoms in the uninjured Iimb. This belief has led to the concept termed favoring. The impact of these speculative concepts is pervasive in spite of quality scientific investigations suggesting otherwise. It is important that popular conceptions (beliefs) of causation be kept in line with the best available scientific evidence. This Chapter provides expanded inversions of 2 articles published in the guides newsletter: (Evaluating Causation for the Opposite Lower Limb Il (May/June 2012) and "Evaluating Causation for the Opposite Upper Limb (July/Augustl' 2012)•
Page 769 "causation analysis should always be based on current scientific evidence and the facts of a specific case. However, certain beliefs have evolved that lack scientific basis . One unsupportable concept is that favoring one lower extremity will often result in injury or illness of the opposite lower I iimb. Il
"Review of the medical literature reve@ls no generally accepted studies that support such a causal relationship, nor is there any reasonable find scientific logic therefore . In fact, the literature available, most notably in editorial, " Can Favoring One Leg Damage the Other? , " by Ian Harrington ,
M.D. and Robert Harris M.D. refutes the reported cause and effect relationship . They explain : "Lay people, and many doctors as well, believe that pain or disability in one leg can stress the other one and produce symptoms and it.
We believe that there is no scientific basis for such reasoning. The mechanics of 1imping are poorly documented in the orthopedic literature and we have found few references to the effect of a limp on the other leg .
To clarify the position for lay adjudicators and the physicians who advise them we reviewed the mechanics of the 2 basic limps: Paralytic and antalgic . In the former the muscles of the weak leg are not strong enough to balance body weight and the patient walks with a characteristic lurching gait . The head and arm are displaced toward the affected side moving the body center of gravity directly over the weak leg and thereby reducing the muscle force required to balance body weight . In the antalgic gait the patient shortens the stance phase by adopting a similar Trendelenburg lurch .
It may seem logical that maneuvers designed to lessen the i cad on one leg must increase that on the other, but there is no evidence to support this .
Harrington and Harris reference gait studies using force plates cn patients with long-standing poliomyelitis who had a paralytic and short leg limp that confirmed the force transmitted in the affected lower extremity was reduced , but the force in the opposite limb was the same as in normal individuals . Similar findings were seen with an antalgic gait resulting from arthritis .
They also noted studies revealing that the magnitude of hip force in normal individuals varies with body weight, stride length and walking speed . Because someone with the lower limb pain typically walks slower than an asymptomatic person, shortens his her stride length, and reports the inj ury or illness of the originally of all lower limb resulted in a marked decrease in weightbearing activity (steps taken each day) , both the forces and number of loading cycles on the unaffected limb are likely to be less, not higher , than before the original illness or injury.
In 2005, Harrington provided a discussion paper titled l ' symptoms in the opposite or uninjured leg ll prepared for the workplace safety and insurance appeals Tribunal in the Province of Ontario, which concluded :
There is no clear evidence to suggest that an injury to one lcwer extremity would have any significant impact on the opposite uninjured limb unless the injury resulted in major muscle or nerve damage causing partial cr complete paralysis of the damaged leg, and/or shortening of the injured Icwer extremity resulting in a limb length discrepancy of more than 4 or 5 cm so that the individual gait pattern has been altered to the extent that clinically there is an obvious lurching type gait (a significant limp) .
In order for this type of gait to have impact on the opposite or uninjured leg , it is likely that the abnormal gait or limp would need to be present over an extended period of time-years . A temporary abnormality in gait, e.g. , a limp over a relatively short period of time of weeks or months is unlikely Cc have any effect on the opposite leg . The use of the cast, cane and crutches is also unlikely to have any major impact on the stress born by the uninj ured limb.)
The gait changes described on the AMA reference which would be required to result in an opposite limb condition are so severe as to preclude standing or walking more then short periods of time. Episodes of exacerbated left knee pain and issues are reported by veteran and buddy statements and are quite possible but a chronic severe lurching limp is not supported by either available medical observations or initial VAE examinations . Cn examination the veteran reported that he continued to play basketball and other sports up until 10 years ago ie age 4C or 41 (or nearly 15 years after one buddy letter reported first observing the veteran limping and putting weight "gingerly" on the left knee) These activities are likely associated with much more severe dynamic loading measures then the aforementioned biomechnancial gait studies .
It is this examiners medical opinion that the veteran right knee degenerative conditions are most likely related to genetic propensity, aging, and wear and tear from activities and not significantly caused oz- aggravated by his SC left knee condition.
My VSO told me this was the first time he had come across a VA examiner taking the time and putting so much effort into attacking an IMO. Reading the VA examiner’s first sentence (Dr. David Anaise MD, JD E s advocacy for our veterans is appreciated.”) I believe the VA examiner may have heard of or had dealt with Dr. Anaise IMO’s before and had a rebuttal ready for when his name crossed his desk.
I am still within my one-year time limit in regards to this claim.
Dr. Anaise agreed to write a rebuttal to the VA’s rational for denying my claim for my right knee arthritis with meniscal strain as secondary to my service-connected left knee.
My question(s):
1. Should I get a second IME/IMO to accompany Dr. Anaise’s rebuttal?
2. I believe there are favorable decisions issued by the BVA on this specific issue, just have to locate them. Are we allowed to submit those BVA decisions to show the BVA has decided this specific issue in the past? If anyone knows of any BVA decisions that address this point, please point them out to me.
3. Are we allowed to submit academic studies, research papers, etc. that support our claims?
4. What do I write when I submit this for a third time or submit any claim for that matter? I believe my VSO simply site the attached documents that are submitted. Should I site and point to specific areas or sections of my rebuttal documents (IME/IMO nexus letter(s), BVA decisions and studies, etc.?
As I’ve said before, I am an amateur compared to the experts in this forum who have been through the fire and came out the other end with a wealth of knowledge. I’m sure I’ve made mistakes in the past, however, I’m trying to get it right this time.
Any help and all suggestions are welcomed.
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