Questionable Diagnosis

[burkhm]

Team,

Since I filed my claim in 2002, I have been bewildered by the decisions of the VA concerning my case. BRIEF HISTORY: During my 26 years on active duty, I was periodically seen for various joint conditions and pain. All of the conditions can be contributed to years of physical abuse of the body, parachuting, rucksacking, etc. It all started with my left foot being injured after a parachute jump. Initially diagnosed as a sprain, several years later and numerous tests, it was determined that I had an auto-immune disease going on and the foot was fusing on its own. Eventually after waiting for a couple of years for the foot to fully fuse, a decision was made to attempt to speed up the fusion process surgically. Over a ten year period, I had three surgeries on the left foot and during the last surgery, a nerve was clipped and I lost feeling on the left side of the foot. Additionally, the middle toe was operated on to remove bone growth and also fuses the toe. As you know, problems with the feet contribute to other joint problems. I eventually had to have two surgeries on my cervical spine to fuse C4-C5 which left me with extreme limited range of motion in my neck. I’m also experiencing tingling and numbness in arms and occasionally in legs. A compression fracture was also diagnosed at T-12, although I refused any surgerical treatment for this. All my other major joints, shoulders, hips, and knees were diagnosed as degenerative joint disease and the rheumatologist provided numerous anti-inflammatory medications for the pain and swelling. My initial claim identified all of these joints as there was plenty of evidence, both medical records active duty and post active duty and also diagnostic tests to support. I also filed for scars from surgery, GERD, anal fissure and conjunctivitis of the eyes. VA DECISIONS: Originally in 2002, I was rated at 50%, given 40% for Rheumatoid Arthritis and 10% for the compression fracture of the spine. I non-concurred with this decision and in 2004 was given an additional 20% for neck condition, now total disability is up to 60%. I appealed this decision in September 2004 by submitting a VA Form 9 and continue today awaiting a decision. So as I understand it, all my original issues are under appeal. I believe the evidence I presented supports my claim for approving a disability for all of the affected joints. Bone scans and X-Rays don't lie. I continue to be seen by Rheumatology and Orthopedics for these conditions. ADVISE: What do you think? I believe the VA didn’t want to rate me for all the affect joints and assigned me a 40% rating for Rheumatoid Arthritis. I believe they’re attempting to rate the nerve damage as part of Rheumatoid Arthritis. Thanks!!!!!

[Berta]

burkhm- you submitted an I-9 in Sept 2004?

What is the status of that-

HAs the VA transferred your claim to the BVA?

Have they acknowledged receipt of the I-9?

At some point they must have given you a C & P prior to them sending the I-9 to you-

do you have a copy of the actual C & P results (not what the VA said they were in an SOC but the actual report)

It is very concerning to me that so much time has passed regarding this I-9.

[burkhm]

Berta,

It is refreshing to know that someone is concerned about my on-going appeal since September 2004 and I appreciate your insight and advice. ADDITIONAL INFORMATION: The last C&P I had was in 2003. I do not have a copy of that. Since I submitted my appeal, I have continued to be been seen by VA doctors (Primary Physician, Orthopedics, Neurosurgeon), and private doctors for conditions mentioned earlier. I keep the VA informed by sending them medical documentation of these visits and also have given them permission in late 2005 to attain medical records from private doctors not releaseable to myself. I have inquired numerous times reference my appeal by contacting my Veteran Service Officer (DAV) and the VA 800 number. You may already know this, but it seems each time I call, I get a different response. My VSO informed me in Sep 2006 that my appeal was at the BVA and instructed me to call them for a status. When I called the BVA, they informed me they had no record of me on file. Contacted my VSO again and he said that’s impossible and he was sure my file was at the BVA. In December 2006, I received a letter from the VA indicating they were in receipt of my appeal dated September 2004 and did I want to use a DRO. I selected yes. Maybe because I send them information after each doctor visit, it is holding up my case. If this is not the case, I believe someone may have dropped the ball. If I learned one thing from this experience, it was to maintain a log of all phone correspondence you have with the VA, VSO, etc.

[Berta]

OK-

"In December 2006, I received a letter from the VA indicating they were in receipt of my appeal dated September 2004 and did I want to use a DRO. I selected yes." This will take some time-

The DRO job description is posted here at hadit-let me know if it becomes necessary for you to have it-

but at this point-have they contacted your private doctor?

Can you get an IMO from your private doctor? There is also criteria here for what this IMO should cover.

You are SO right- keeping a phone log can be very helpful and important-

getting conflicting info from reps and the VA ----tell me about it-

I deal only in hard copy wth my reps and the VA-

last phone call info from my vet rep about my DRO review was bullcrap.

I cant go by what a vet rep 'says' I go by what the VA states in documentation-

I am assuming this- your appeal is not at the BVA at all and is still set for DRO review-

good-

in the VCAA notice you received (if you received one) the VA specifically stated what you needed-

If I were you I would get copies of the private records myself if you can -or at least make sure the VA attempted to get and receive them-

it sure would not hurt to try to get the IMO I mentioned from your private doc-

and submit prior to the DRO review.

Send everything Certified or Priority to VA (copies only -no originals) and pay a little extra for the tracking slip-this way you can get hard copy proof from the USPS web site when the VA gets your evidence.

But it sounds to me you already do that now-and are being very proactive in your claim.

Evidence can 'hold up' a claim but they probably have not yet even set this for an imminent review-

in my opinion- better to send them all you can get- rather than get another denial-

evidence can be submitted right up to the review from the DRO- even presented to the DRO upon review, and then there is even more time after that to present more-

With a strong IMO that knocks down their C & P results (an IMO doc should have their actual C & P results) the VA has to weigh under Benefit of doubt- if the evidence has equal merit the vet succeeeds.

The vet does not have to send a preponderance only equal evidence- if the C & P result is medically wrong.

You can ask the VAMC where the C & P was done for a copy of the results. Put your c# file on the request. This way you have good idea what to expect from VA and you have time to combat a negative C & P report with additional medical evidence.

[burkhm]

OK-

"In December 2006, I received a letter from the VA indicating they were in receipt of my appeal dated September 2004 and did I want to use a DRO. I selected yes." This will take some time-

The DRO job description is posted here at hadit-let me know if it becomes necessary for you to have it-

but at this point-have they contacted your private doctor?

Can you get an IMO from your private doctor? There is also criteria here for what this IMO should cover.

You are SO right- keeping a phone log can be very helpful and important-

getting conflicting info from reps and the VA ----tell me about it-

I deal only in hard copy wth my reps and the VA-

last phone call info from my vet rep about my DRO review was bullcrap.

I cant go by what a vet rep 'says' I go by what the VA states in documentation-

I am assuming this- your appeal is not at the BVA at all and is still set for DRO review-

good-

in the VCAA notice you received (if you received one) the VA specifically stated what you needed-

If I were you I would get copies of the private records myself if you can -or at least make sure the VA attempted to get and receive them-

it sure would not hurt to try to get the IMO I mentioned from your private doc-

and submit prior to the DRO review.

Send everything Certified or Priority to VA (copies only -no originals) and pay a little extra for the tracking slip-this way you can get hard copy proof from the USPS web site when the VA gets your evidence.

But it sounds to me you already do that now-and are being very proactive in your claim.

Evidence can 'hold up' a claim but they probably have not yet even set this for an imminent review-

in my opinion- better to send them all you can get- rather than get another denial-

evidence can be submitted right up to the review from the DRO- even presented to the DRO upon review, and then there is even more time after that to present more-

With a strong IMO that knocks down their C & P results (an IMO doc should have their actual C & P results) the VA has to weigh under Benefit of doubt- if the evidence has equal merit the vet succeeeds.

The vet does not have to send a preponderance only equal evidence- if the C & P result is medically wrong.

You can ask the VAMC where the C & P was done for a copy of the results. Put your c# file on the request. This way you have good idea what to expect from VA and you have time to combat a negative C & P report with additional medical evidence.

[burkhm]

Berta,

Appreciate all the advise which I will heed. I was told the VA had received my medical records from my private doctor although I do not have this in writing. I will follow up and also request a copy of my last C&P examination. Unfortunately, my civilian doctor has not seen the results, so I was being treated for symptoms I complained about. I will ensure he gets a copy so future entries in my medical records can either collaberate what the VA determines or not. Any idea how long this DRO process will last?

[Pete53]

burkhm:

Welcome to Hadit. Berta is a great help to many Veterans who have thorny problems here. Her advice is top notch.

You should get a copy of your C&P next time you go to your VAMC.

You should also consider filing a Writ of Mandamus to make the VA do its job. Over 2 years with no results is unacceptable.

Good Luck to you.