As for a HLR? or no?

[Ranmic]

Last Nov I filled two claims, one for an increase in my current SC knees and then I filed a second one for my hips as a secondary to my knees.  The VA combined my two claims and then I got C&P exams for my knees and my hips.  I got an increase for my knees but they said my hips were not service connected.  I'm unsure if I file a higher level review for my hips if they will review my knees also.  All I want is for them to re-evaluate my hips, and not my knees as they are maxed out for instability and knee strain and I don't want that touched.  Below is what I filed for.  Again, I did get my knees increased and now they are maxed out.  I just want to challenge my hips.  Any advice?

• knee condition bilateral (Increase)
• hip condition bilateral (Secondary)

 

[Ranmic]

2 hours ago, Rattler767 said:

I just went through this same thing with a crap C & P Exam the VA sent me to.  The IHO the did stated; "One's R knee and L knee are anatomically discontiguous and physiologically unrelated. An injury to one's knee will not result in any chronic pathology of the contralateral joint." You should see the looks I get from other medical professionals when I quote the above statement. Than I go into the knee bone is connected to the leg bone, the leg bone is connected to the hip bone etc.

I found a real good orthopedic surgeon in Atlanta GA that I went to on the 21st to rebut the above with an IMO and DBQ's

Wow!  Good luck brother.  Rooting for you.

[jamescripps2]

I have had good results asking my VA doctors to enter into my medical records whatever it is that I need to support a claim. Be direct with your doctor and tell them exactly what you need and why it is that you need it. I usually ask with an instant message to the doctor using E benefits messenger. I have also asked face to face with the doctor and I have always gotten what I needed. Just be up front and Honest with your request.

 

The following was my actual request for a nexus letter from my VA Cardiologist.

10/02/2020                                                             James M. Cripps,  last four ----

Dr. -------, I remember in SICU, a doctor, most probably Dr.-------------, told me that the Fournier’s Gangrene was caused by a perfect storm resultant of my Diabetes, Chloracne, and the medication, Jardiance, that was prescribed for my Diabetes and heart disease. I understand that when Jardiance was prescribed, risk vs benefit was most probably considered. In my case, as you know, it didn’t work out so well. I ended up with Fournier’s Gangrene, a well known side effect of Jardiance.  As a result my life has changed and my abilities are now greatly diminished.

I now find myself needing to ask for your help. I need to show the etiology of the Fournier’s Gangrene. When I file a claim with the VA for service connection for Fournier’s as secondary to Diabetes, Chloracne, heart disease, and the prescribed medication, Jardiance, I am required by the VA to support the claim with a medical opinion as to the etiology.

I know that you are not a letter writer, but I am asking you to please consider writing this one, therefore enabling me to obtain my service connected benefits.

Thank you for your consideration.

[jamescripps2]

The letter in the above post produced the nexus letter that allowed me to be granted the Fournier's Gangrene claim. Like I said, ask for exactly what it is that you need and state why you need it. Make your request in writing whether it is an email, instant message or hand carried. If your request is not in writing the doctor will forget what it was that you asked for. Remember, your doctor sees many patients in a day.

[brokensoldier244th]

Worst case, if its in your notes, even without a letter, especially if you discuss it multiple times (like, appt followups for the same thing if you are trying to narrow it down) it is considered a ''nexus". A misunderstanding sometimes found on the internet in general is that you specifically need a 'nexus' letter, like, special separate thing for the doctor to write. Some doctors do, some don't- not all of them want to get involved in disability he said/she said (between doctors), and some people have stripped the header and footer off such letters and applied them to other letters typed by who knows who- which is actually pretty easy to see if the notes say X and the letter suddenly says Y.

So, you don't specifically need a letter/memo to support these things, but it does need to be broached to your doctor, a doctor, whomever you go to see. Some doctors will charge for the extra time as a visit, especially if you are not a long time current patient- or they won't write one at all- because they have little care history with you. If you approach it as a conversation rather than "please write me a letter..." which they hear a lot from any disability seeker- then at least it gets entered into the notes as a patient concern that they have to address, and not like a "im only seeing you because.....". If you are approaching a doctor specifically for an IMO/IME, be up front about it, and possibly pay a doctor visit fee or 2 for the time, but just be prepared that some might say no. 

I like letters, on one hand- they are easy to find, easy to read, get right to the point, and save me several hundreds of pages of reading sometimes. How they are received by the raters? I don't know what their opinions are on them. Probably similar to mine, as they save a lot of work in digging around for info and, if supported by the medical notes, easy to point to for justifying a rating (or granting an exam, or a rework of an exam). But, on the other, the lack of one isn't a mine crater to your claim, either. 

 

Dustoff has had a lot of success over the years with doctors opinions/thoughts being written in the notes rather than having a specific letter for a particular claim. You can search on his name and see a lot. 

[blahsaysme2u]

Great advice here...I wish I had been given this years ago or knew this when I first started seeing my doctors...I now tell young vets this same thing- talk about anything wrong with your docs any time possible- you need history in your records...

Now we have msgs that you can send direct to va docs and goes directly to your c-file....this can make big impacts...

Have migraines and can't get it documented by your doctor, msg the. Eveytime you have a debilitating headache and it's documented in your file....do this for 6-12 months and you have better evidence than a letter or even a lay statement from yourself

 

 

[jamescripps2]

16 hours ago, blahsaysme2u said:

 

Now we have msgs that you can send direct to va docs and goes directly to your c-file....this can make big impacts...

 

 

 

A message sent to your VA doctor will never make it to your C-file, however, it might make it into your VHA medical records, but only if the responder chooses to include the message in your medical records. The VBA and the VHA are two different entities' and they do not communicate well with each other.