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Gulf War Burn Pit Rheumatoid Arthritis

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Grilla79

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I tired to research this here but I did not find this question so here goes.  I retired in 2011, i was diagnosed with Rheumatoid arthritis in 2019.  GW and burn pits 2006 and 2008.  On the Burn Pit registry.    I'll file a disability claim but will they just boot it since i'm filing almost 10 years after retirement? .  I've read a lot of material, some on VA.gov websites, and I'm not clear if RA/autoimmune diseases have an established presumptive cause with GW service/burn put exposure.  One article would make it sound like it was in the works, another like it was a done deal.  I can think back and recall joint pain over and above as far back as 2007 (my 50th birthday) but I chalked up to aging, wear and tear and an active lifestyle.  it started as occasional pain and stiffness in my hands, then progressed to my feet,  continued to progress to shoulders, knees and hips and the episodes of pain became more severe, lasted longer and happened more often.  By 2019 I complained to my civilian doctor saying this is not normal, referred t a Rheumatologist and diagnosed late 2019.  Unfortunately blew a lumbar disk, fusion in April 2020, so i just got back to the rheumatologist,  I've also read about the correlation of RA with PTSD and I've got a 70% rating for PTSD.

Do i file for RA as a new claim with the nexus as burn pit exposure or as RA secondary to PTS.  Multiple joints are affected but hands and feet without a doubt the worst.  I can't write a sentence longhand that someone could read and I can't pull the tabbed metal lid off a can of soup or walk down the stairs without two handrails because the achilles area of my heels are so tight.  IT loosens up with activity , but sit in a chair for 20 minutes and get up and its like i never loosened up. 

by the way, i mentioned to the Doc that I might be asking for a letter and shared that an important statement from a doctor might be something like it as more likely than not likely that my RA was caused buy my service/burn pit exposure and she was like, sure, no problem.  

 

Sorry for running on, 

 

grilla

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I guess I was reading this , when I asked about the meds- 

https://www.goodrx.com/blog/10-common-medications-that-cause-joint-pain-cholesterol-drugs-asthma-inhalers/

I found this award-there are MANY claim  for RA secondary to PTSD at the BVA.

https://www.va.gov/vetapp16/Files1/1605458.txt

In part:

"

The Veteran contends that she is entitled to service connection for rheumatoid arthritis as secondary to her PTSD.  The issue of direct service connection for rheumatoid arthritis is no longer before the Board as it was previously denied in the October 2014 Board decision, and the JMR was limited to the issue of service connection on a secondary basis.

A June 2013 VA examination indicated that the Veteran was diagnosed with rheumatoid arthritis in 1990.  The Veteran was previously granted service connection for PTSD.  See October 2014 Board Decision; see also December 2014 Rating Decision.  Finally, in January 2016 a medical opinion was obtained from a VA rheumatologist who opined that it was at least as likely as not that the Veteran's rheumatoid arthritis was caused by her service connected PTSD, citing several medical publications to support her opinion.  Therefore, the Board finds that the weight of the evidence indicates that the criteria for service connection for rheumatoid arthritis as secondary to PTSD have been met, and service connection is, hereby, granted.  See 38 C.F.R. § 3.310; see also Wallin.

 

ORDER

Service connection for rheumatoid arthritis as secondary to PTSD is granted.

Wow, I was surprised to find that fast- I just wonder what "medical publications" the VA rheumatologist used.
 

In this denied case, and within a few others I found, the VA C & P examiner used Wikipedia to dent the claim.

"n January 2014, the Veteran was scheduled for a VA examination for his rheumatoid arthritis, during which the examiner considered whether such disability was related to PTSD. The examiner opined negatively on a relationship between the two, and in doing so included a citation to Wikipedia.com. In this regard, medical articles appearing on Wikipedia are not, at present, formally recognized by VA to possess official controlling authority for the veracity of any medical information and facts purported in such articles to be true. Accordingly, such a citation diminishes the probative value of the examiner's opinion. Additionally, the examiner concluded that, as there was "no additional literature support for the Veteran's claim," she was "going no further with this claim and an examination is not needed." During the April 2014 hearing, the Veteran's representative stated that such a declaration seemed adversarial to the Veteran and questioned the adequacy of the opinion, and the Board agrees that the January 2014 evaluation was unsatisfactory."

Part of the remand was for another C & P exam on many issues to inlcude the RA and PTSD connection.

https://www.va.gov/vetapp17/files2/1706362.txt

It seems obvious to me that only a VA or Private rheumatologist could possibly provide an opinion that would include the most recent medical findings on this relationship- (PTSD as causing rheumatoid arthritis.) Any other VA  medical doctor or nurse probably would not have a clue.

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Wow. Wikipedia. That’s just.... special. They could have at least cited one of the source articles for the wiki entry or something. *smh* 

 

this is why I read the exams that come back so I can kick them back if they don’t actually answer the question. Private doctors do it too. Citing web md in an IMO didn’t look very good, either, 

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Good points-

I often search medical conditions to see what could cause them, as that could be a potential nexus for some vets here that the veteran might have overlooked.

For example I have a vet friend with what appears to be Raynauds syndrome.

I dont know what the VA has diagnosed him with- if anything for this severe disability.

He spent long periods of time in the service in Alaska and Korea. He thinks he might have been treated for frostbite in the military.

There are many things that can cause Raynauds syndrome but this BVA decision shows a higher rating granted for frostbite residuals, and is on remand to consider Raynauds, among other potential residuals.

https://www.va.gov/vetapp10/files6/1044110.txt

But my point is I use good Medical sites, such as John Hopkins, Mayo, etc for medical information and I know, if a C &P doctor using google as part of their exam results, they can find probably many sites that would not help to establish an inservice  nexus, but then again I bet they overlook the good medical sites that CAN help establish a strong inservice nexus.

I challenged A VA endocrinologist years ago when I found evidence that my dead husband had undiagnosed and untreated DMII from AO.

A VA doctor had put DVD into the record with no follow up care.

VA used Merck at that time ( and probably still do to assist VA doctors).

The VA Endo stated that I claimed the entry meant Diabetic Vascular Disease, but she said it meant the veteran had "denied having VD."

Say what? The veteran had VD in service and showed up as "0" NSC on all of his rating sheets.

My husband told me about the VD when I met him. He got it in Vietnam.

This was a small part of the claim evidence and it was awarded, as direct SC death.

This is a case whereby the Endo doctor surely knew what the medical abbreviation of DVD was for but she did all she could to deny the claim and made up some crap.

I think these C & P doctors use the internet more then we now to find anything that would medically go against a claim, without considering prominent web sites that could open the door to a potential inservice nexus and an "as likely as not" statement.

Besides some of them are opining on claims they have no expertise in ,so I bet they use the internet a lot.

My 1151 HBP claim was opined on a doctor, who was in charge of some sort of PTSD initial assessments. She knew nothing about HBP and even said it was an "in person exam"although my husband had been dead for over 20 year by then.

She never considered my evidence, from the VA Central Office.I cued the denial immediately and they reversed and awarded in 3 weeks.

I had called the 800# about something else but the Peggy person said the 1151 HBP claim was denied...then said  what is this, they awarded it recently- there must be a mistake n the computer.

I LOLed and said 'no that info is correct.'

If we do not challenge erroneous C & P exams, that means we are accepting their errors....errors that can follow a claim into light years on the Hamster wheel.

C & P Exams as far as I know, cost the VA $800 each.It might even be higher than that and often the only way to combat a lousy C & P exam is to make a good argument with VA right away ( or with the provider) to get a better one.

Otherwise down the road the veteran might need to come up with a lot of cash to hire a Good IMO/IME doctor.

 

 

 

 

 

 

 

 

 

 

Edited by Berta
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I know. I was agreeing with you. The last few months, though, the only exams ive had to kick back or that got unfavorable ratings due specifically to the credibility of the exam opinion were those that were gorten from private doctors, usually not in the state where the veteran lived, saying they had access to the Veteran's file (which they didn't), rendering vague opinions of SC for conditions based on things like Web MD citations, or their own theory and opinion with nothing cited to support it- basically from a few of the gunslinger IMO doctors that will write whatever you want if you pay them enough. 

It happens with VA doctors, Va examiners, and private, but I see more of them when its private doctors that A. don't know how to write a good opinion, or B. write opinions that are 20 pages long full of unsupported guess's that never even saw the veteran in the first place, and when you google them you see that they get paid for for writing IMOs.

Edited by brokensoldier244th
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Yes , I have seen that as well-in BVA decisions as well as here at hadit.

If an IMO/IME doctor does not follow the criteria here at hadit- the VA will reject their opinion.

If the opinion involves a inservice nexus, they must have the SMRs and refer to them specifically,in the opinion, give a full medical rationale for the nexus.

I have also seen veterans who think an IMO/IME will be favorable, because they expect a miracle.

IMO/IME doctors are easy to find these days. I had to FTCA the VA without an IMO ,decades ago, and do all of the medical work myself to prove malpractice.

But they are easier to find because many doctors have found IMO/IMEs to be lucrative, rather than appropriate to the veteran's issues. I bet many never even get a copy of the C & P exam,from the veteran ,that denied the claim....something a good IMO/IME doctor would relish to have.

I am sure that, if I had not done a concise cover letter for my IMO doctor years ago- the fee could have been much higher.

I had proven the claim to myself before I acquired this doctor.

Brokensoldier, your posts here are very valuable-and it is the C & P exam that causes the VA to deny so many  claims.

But some claims will never receive an award...even with a IMO/IME. 

Unfortunately the BVA only uses doctor's initials in their decisions. It would help if we knew their names and then could see what type of effort they have put into their IMO/IMEs.

But most of us know who the best ones are- by their experiences posted here.

 

 

 

 

 

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I went to the BVA and searched IMO nexus denied and one of  the first recent decisions that popped up revealed that this veteran had multiple independent medical opinions yet non of them advanced his claim.

https://www.va.gov/vetapp19/files9/19173282.txt

The next case is from a widow :

 

"The Board affords great probative weight to the VA examiner’s September 2018 opinion as he considered all of the pertinent evidence of record, as well as relevant medical literature, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion...must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). The Board observes that, in his November 2018 Appellant’s Post-Remand Brief, the appellant’s representative argued that, if the Board was unable to grant service connection for the cause of the Veteran’s death, it was requested that the Board exercise its authority under 38 C.F.R. §§ 3.328 and 20.901(d) to request an independent medical opinion (IMO) from an expert outside of the VA as the evidence is in conflict as to whether the Veteran suffered from a mental health disability that caused him to commit suicide. In this regard, the provisions of 38 C.F.R. §§ 3.328 and 20.901(d) provide for an IMO when the issue under consideration poses a medical problem of such obscurity or complexity, or has generated such controversy in the medical community at large, as to justify solicitation of an IMO. In the instant case, the Board finds that an IMO is not necessary as the evidence is not in conflict as to whether the Veteran suffered from a mental health disability that caused him to commit suicide. Specifically, as noted previously, VA regulations presume that an individual who commits suicide is mentally unsound. 38 C.F.R. § 3.302. Furthermore, such is not the relevant inquiry in the instant matter. Rather, the question before the" etc etc

https://www.va.gov/vetapp19/files1/19103671.txt

I dont know who represented this widow but obviously she might have needed a strong IMO from a non VA MH professional. But there were factors here we don;t really know-

 

Above BVA case in part:

"Finally, to the extent that the Veteran had a problem with alcohol in service, or subsequently had an alcohol use disorder as a result of service, the Board notes that, for claims filed after October 31, 1990, as is the case here, service connection may not be granted for substance abuse on the basis of service incurrence or aggravation. 38 U.S.C. §§ 105, 1110; 38 C.F.R. § 3.301(a); VAOPGCPREC 2-98.  Further, as service connection for an acquired psychiatric disorder has not been established, secondary service connection for an alcohol use disorder is likewise not warranted.

Therefore, based on the foregoing, the Board finds that a disability of service origin did not cause or contribute to the Veteran’s death.  Consequently, service connection for the cause of the Veteran’s death is not warranted.  In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine.  However, the preponderance of the evidence is against the appellant’s claim of service connection for the cause of the Veteran’s death.  As such, that doctrine is not applicable in the instant appeal, and her claim must be denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra.

 

We had a widow here not too long ago who did prove her husband's fatal motorcycle accident was a suicidal act and she won her claim for DIC, as well as a neighbor I have whose husband committed suicide in service. The sucide regulations are here under a search.

Also there are some great veteran lawyers out there for sure- but even a lawyer cannot perform a miracle. Veterans often must do the legwork themselves to succeed.

 

 

 

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