How's This For An Idependent Medical Opinion?

[LarryJ]

Chief Compliant: Intense Ankle Pain and Immobility

History of Present Illness: The patient presents today with left ankle pain in relation to a broken ankle when he jumped off the porch when he was 14 years old. He also subsequently had an injury within the service. He brings his service records in with him as well as notes from the doctors during the service. He subsequently developed end-stage ankle degenerative joint disease and comes in for a medical opinion with regards to his left ankle and potential treatment options. He is currently a 61-year-old male who is not diabetic. He takes only Synthroid and Welbutrin at this point. He does not smoke.

Physical Exam: This is a very pleasant 61-year-old male in acute pain, awake, alert and oriented X 3. Examination of the left lower extremity reveals minimal range of motion. He has tenderness to palpation anteromedially and anterolaterally. His is grossly neurologically and vascularly intact. He has 5/5 strength despite pain 7/8 on a scale of 10.

X-rays: X-rays brought in by the patient show evidence of significant end-stage ankle degenerative joint disease with significant anterior spurring. These were taken on 07/25/06.

Plan: I have discussed with him the potential for AFO bracing versus potential for ankle fusion which will likely be necessary to completely address his symptoms. Analgesics and stronger medications are no longer effective and are no longer possible due to adverse drug reactions. With regards to the causes of his injury, certainly it can be said that his injury and current status of end-stage ankle degenerative joint disease could be aggravated or even caused as much by the second injury in 1964 in the Marine Corps as related to his broken ankle when he was 14 years old, but there is no way to absolutely determine which one has led to more of this significant degeneration which is now at end-stage. I advised the patient and his family member here today that certainly it can be said that either injury could cause this type of ramification and that this is likely as not to have occurred in 1964. I want to see him back in three months' to evaluate the possiblity of surgery or the use of orthotics for some degree of pain relief.

This doctor is the orthopedic contulting surgeon for World Cup Soccer, BTW.

Edited March 4, 2007 by LarryJ

[Guest rickb54]

Larry,

the term, "is likely as not to have occurred in 1964", is not the best statement you could have received, however for service connection and rating purposes it should do the trick.

Best of luck

[LarryJ]

I'm sorry, but I thought that "as likely as not" was what we were all looking for?

Am I wrong?

[carlie]

Larry,

This is only my opinion:

"current status of end-stage ankle degenerative joint disease could be aggravated or even caused as much by the second injury in 1964 in the Marine Corps as related to his broken ankle when he was 14 years old, but there is no way to absolutely determine which one has led to more of this significant degeneration "

This part of the doctors statement seems a bit shakey, VA may say it is speculation.

Here's how they are supposed to evaluate the evidence

http://www.warms.vba.va.gov/admin21/m21_1/...v/ch05/ch05.doc

You may want to read this also as it would pertain to your claim.

§ 3.306 Aggravation of preservice disability

http://ecfr.gpoaccess.gov/cgi/t/text/text-...113&idno=38

I sure hope you get some good results.

carlie

[john999]

Larry

This is where the benefit of doubt serves you. If there is doubt it should be resolved in the vet's favor.....well that is supposed to happen. Get the greasy thumb of the VA off the scale by getting a super strong statement of service connection.

[LarryJ]

No doctor that is worth his salt is going to sit down and make a flat out statement that what happened to me in the Marine Corps is definitely what caused all my ankle problems. So, so much for your "super strong statement of service connection". Ain't happening and if it did, then, if I were the VA I'd tear such a statement to shreds. Matter-of-fact, I would have to consider that statement "speculation".

He wasn't there in 1964.

This is all I can hope for, this "at least as likely as not" and I was all excited to have even gotten that. That and the fact that he states that he had my SMRs to consult.

So much for me getting excited.

I'm going back to bed.

[Guest rickb54]

I'm sorry, but I thought that "as likely as not" was what we were all looking for?

Am I wrong?

Larry,

This is a good statement, I just ment that too bad he didn't make it more likely than not. Either way it is a good statement and makes it likely you will be awarded service connection.