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Left Knee 10%, Left Hip and Left Foot Secondary Claim

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Hello, I am rated at 10% for my left knee service connected due to injury on active duty almost 20 years ago. Recently I filed for chronic pain and received 30% rating, so now at 40%. 

For the last five to six years I have steadily had left hip and left foot pain, and have seen orthopedic doctors and tried rehabilitation and chiropractor visits to get things better. Three doctors have told me I need a hip replacement and these three doctors have documented my issues with the hip as severe osteoarthritis and femoral acetabular impingement syndrome. Also I have three letter that create a nexus to the left knee that states the left hip issues and left foot issues are more likely than not a direct result of my left knee service connected injury. 

I have MRIs and X-rays with reports that state the issues of the left hip and left foot. I will be filing a claim for the left hip and left foot as secondary to left knee service connected, and I will include the three nexus letters and evaluations. But do I need to send the VA my MRI and X-ray CDs? 

Will they order new MRIs and X-rays at the C&P? I have been in so much pain for so long and now finally trying to get this taken care of. I am waiting to get the hip replacement until I can service connect the hip and left foot to the knee injury on active duty. 

What can the hip and foot be rated at if I can get them to connect the issues to my left knee? I have read so many articles about knee injuries causing hip and foot issues like I have but my concen is the VA has denied even my tinnitus rating a few years ago. And I was infantry in the Marines. 

Any help or advice greatly appreciated before I send off this claim. 

Thank you!

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You sound like you have the general idea.  There might be a couple things we can help with.  While there is a temptation to read up a few articles and gain some knowledge, then direct your rating specialst to your relatively new found knowledge, thus "apply for secondary" conditons.  

While its okay to file for secondaries, can you be sure your rating specialist wont view this as direct, or presumptive?  I cant accurately predict how my spouse will think, let alone someone I have never met.  For that reason, I dont burn bridges down.  Instead of "filing for secondary" to the exclusion of all other types of service connection, why not just let the rating specialist do his/her job, and file for service connection, both direct and secondary to already sc conditions?  One reason is that some people get offended when you try to tell them how to do their job such as "I want it rated secondary, not primary or presumptive".    I dont know about you but I dont really care whether my sc is secondary or what.  

You indicated you have "3 nexus letters".  This is awesome, but "ONE" Quality nexus letter may well be better than 10 of them that left something out.  So, what is a quality nexus letter, that will often result in a favorable rating?

Mostly, quality nexus letters have these things.

1.  Dr.  declaration of competency.  Example:  My name is Dr. Smith, I am an orthopedic surgeon, a graduate of harvard Medical school, with 10 years of diagnosiing and treating hip, foot and knee surgures.  (That is, the doctors cv, you need to demonstrate his competency as an expert witnesss).  It wont do much good if he has a phd in internal medicine, totally unrelated to your issue.  The VA wont assume the doc knows what he is talking about, unless you provide some background on the doctors qualifications to make his opinion statement.  The opinion of your six year old neighbor girl, wont carry much weight as a nexus.  


2.  The nexus needs to be in a format VA understands.  This means a statement similar to "Based on my examination of the Veteran, his recommended knee replacement is at least as likely as not due to his knee problem incurred during military service".  (Now he should provide a medical rationale as to why the doctor feels your hip problem is related to your knee problem.)


Your nexus statement should have all these things: demonstrate doctor competence (docs cv), wording VA understands.  For example, if your doc says, "your hip condtion COULD be caused by the knee condition"..thats a deal killer.  "Could" is speculative.  So is "may", or may be.   He needs to opine its at least as likely as not, that is greater than 50 percent chance that the 2 are related.  Not maybe. 

Of course, you are gonna need a current diagnosis of a hip condtion.  (What ever the doc calls it.  )

It boils down to the Caluza elements of 

current diagnosis, in service event, and nexus. 

Did I mention you need all 3 Caluza elements?  What was your "in service event"?  Did you jump out of airplanes and injure your knee?  I dont know, but the va will want to know what in service event caused your knee injury (you apparently have that, ) And they willl want a valid nexus.   

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