Post on 01-Jan-2016
description
Secondary Service Connected Conditions & Medical Opinions
Paula Taylor / Abdullah Shamsid-Deen
Fall Conference, 2009
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SECONDARY SERVICE CONNECTED CONDITIONS
WELL-GROUNDED CLAIMS
SERVICE-CONNECTED
NONSERVICE-CONNECTED
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SECONDARY SERVICE CONNECTED CONDITIONS
WAYS TO ESTABLISH SERVICE-CONNECTED CLAIMS
DIRECT SERVICE-CONNECTION
AGGRAVATED PRE-EXISTING CONDITION
PRESUMPTIVE SERVICE-CONNECTION
1151 CLAIMS
SECONDARY SERVICE-CONNECTION 3
SECONDARY SERVICE CONNECTED CONDITIONS
SECONDARY SERVICE CONNECTION
REFERENCE: 38 CFR 3.310
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SECONDARY SERVICE CONNECTED CONDITIONS 38 CFR 3.310 States:
• I. Disabilities caused by a service-connected
disability will be service connected on that basis• II. Also, Non-service connected disabilities made • worse by a service-connected disability, IF ...
a. Medical evidence that pre-dates the worsening
establishes the baseline level of the disability
b. Current severity is worse than the baseline,
which is to be deducted from the overall rating• c. Current medical evidence cannot establish the
baseline 5
SECONDARY SERVICE CONNECTED CONDITIONS
EXAMPLES OF SECONDARY CONDITIONS
Right Knee, Secondary to Left Knee
Lower Back, Secondary to Knee(s)
Lower Back, Secondary to Pes Planus
Sexual Dysfunction, Secondary to PTSD
Depression, Secondary to Occipital Nerve Injury6
SECONDARY SERVICE CONNECTED CONDITIONS
EXAMPLES OF SECONDARY CONDITIONS (CONT’D)
Kidney Failure, Secondary to Hypertension
Other Secondary Hypertension Conditions?
Glaucoma, Secondary to Diabetes Mellitus
Other Secondary Diabetes Conditions ?
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SECONDARY SERVICE CONNECTED CONDITIONS
ESTABLISHING SECONDARY SERVICE-CONNECTION REQUIRES:
Sufficient evidence that a current disability was
caused or aggravated by a “service-connected”
disability Since this is a question of Medical Causation,
competent individuals possessing specialized training and knowledge must to render a “Medical Opinion”
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MEDICAL OPINIONS
MEDICAL OPINIONS 38 CFR 3.159
COMPETENT MEDICAL EVIDENCE MEANS EVIDENCE PROVIDED BY A PERSON WHO IS QUALIFIED THROUGH EDUCATION, TRAINING,OR EXPERIENCE TO OFFER MEDICAL DIAGNOSES, STATEMENTS, OR OPINIONS. COMPETENT MEDICAL EVIDENCE MAY ALSO MEAN STATEMENTS CONVEYING SOUND MEDICAL PRINCIPLES FOUND IN MEDICAL TREATISES. IT WOULD ALSO INCLUDE STATEMENTS CONTAINED IN AUTHORITATIVE WRITINGS SUCH AS MEDICAL AND SCIENTIFIC ARTICLES AND RESEARCH REPORTS OR ANALYSES.
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MEDICAL OPINIONS
COMPETENT MEDICAL EVIDENCE EDUCATION, TRAINING, OR
EXPERIENCE
DIAGNOSES, STATEMENTS, OR
OPINIONS
MEDICAL AND SCIENTIFIC ARTICLES
RESEARCH REPORTS OR ANALYSES 10
MEDICAL OPINIONS
WHEN WILL VA REQUEST A MEDICAL OPINIONTHE RECORD DOES NOT CONTAIN SUFFICIENT COMPETENT MEDICAL
EVIDENCE BUT:
CONTAINS COMPETENT EVIDENCE OF A CURRENT
DIAGNOSED DISABILITY OR PERSISTENT OR RECURRENT
SYMPTOMS OF DISABILITY
ESTABLISHES THAT THE VETERAN SUFFERED AN EVENT,
INJURY OR DISEASE IN SERVICE OR HAS A DISEASE OR
SYMPTOMS OF A DISEASE LISTED IN 38 CFR 3.309, 3.313, 3.316,
AND 3.317
INDICATES THAT THE CLAIMED DISABILITY OR SYMPTOMS
MAY BE ASSOCIATED WITH THE ESTABLISHED EVENT,
INJURY, OR DISEASE IN SERVICE OR WITH ANOTHER
SERVICE -CONNECTED DISABILITY 11
MEDICAL OPINIONS
WHY WOULD VA REQUIRE A MEDICAL OPINION
TO RECONCILE DIAGNOSES
TO DETERMINE THE RELATIONSHIP BETWEEN CONDITIONS
TO DETERMINE THE ETIOLOGY OR NEXUS TO SERVICE-INCURRED DISEASE OR INJURY
TO DETERMINE WHETHER AND TO WHAT EXTENT A SERVICE-CONNECTED DISABILITY HAS AGGRAVATED A NONSERVICE CONNECTED CONDITION
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SECONDARY SERVICE CONNECTION &MEDICAL OPINIONS
REQUEST FOR MEDICAL OPINIONISSUES:
CONTENTION:
AVAILABLE PERTINENT EVIDENCE:
SERVICE MEDICAL RECORDS:
PRIVATE MEDICALRECORDS:
VA RECORDS
OTHER:
REQUESTED OPINION:
NOTE TO EXAMINER-IN YOUR RESPONSE PLEASE:
1. IDENTIFY THE SPECIFIC EVIDENCE YOU REVIEWED AND CONSIDER IN FORMING YOUR OPINION.
2. PLEASE PROVIDE A RATIONALE (EXPLANATION/BASIS) FOR THE OPINION PRESENTED
3. STATE YOUR CONCLUSIONS USING ONE OF THE FOLLOWING LEGALLY RECONGNIZED PHRASES:
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MEDICAL OPINIONS
LEGALLY RECOGNIZED PHRASES Is Caused By Or A Result Of__________
Is Most Likely Caused By Or A Result Of__________
Is At Least As Likely As Not(50/50 Probability) Caused By Or A Result Of__________
Is Less Likely As Not (Less Than 50/50 Probability) Caused By Or A Result Of__________
Is Not Caused By Or A Result Of__________
I Cannot Resolve This Issue Without Resorting To Mere Speculation
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MEDICAL OPINIONS
MEDICAL RATIONALE
IT IS ESSENTIALLY AN EXPLANATION OF HOW THE PHYSICIAN ARRIVED AT HIS OR HER MEDICAL OPINION AND SHOULD CONTAIN, AS A MINIMUM, AN EXPLANATION OF THE PATHOLOGICAL OR OTHER MEDICAL RELATIONSHIP BETWEEN THE CURRENT DIAGNOSES AND THE INJURY IN SERVICE OR CURRENT DIAGNOSIS AND THE SERVICE CONNECTED DISABILITY
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MEDICAL OPINIONS
EXAMPLEISSUE: ENTITLEMENT TO SERVICE CONNECTION FOR
CARDIAC DISORDER, ORIGINALLY CLAIMED AS MYOCARDIAL INFRACTION, SECONDARY TO THE SERVICE-CONNECTED DISABILITY OF ANXIETY DISORDER: OR, IN THE ALTERNATIVE, SECONDARY TO A TOBACCO USE DISORDER, ORIGINALLY CLAIMED AS CIGARETTE SMOKING, SECONDARY TO THE SERVICE-CONNECTED DISABILITY OF ANXIETY.
FACTS: VA AND PRIVATE MEDICAL EVIDENCE OR RECORDS SHOWS THAT THE VETERAN HAD A MYOCARDIAL INFARCTION IN 1995 AND HAS A CURRENT DIAGNOSIS OF ATHEROSCLEROTIC CORONARY ARTERY DISEASE. 16
MEDICAL OPINIONS
EXAMPLE CONT:July 2002-VA Comp And Pen Examiner Opined Less Likely
Caused Or Aggravated By the Service Connected Anxiety
July 2002-VA Psychologist Opined As Likely As Not That The Veteran’s Heart Problems Are Aggravated By His Anxiety
August 2002-VA Psychologist Explained That the Limitation Of Life That Affected The Veteran Because Of The Heart Disease Felt Worse To The Veteran Because Of His Anxiety Disorder. (The Physician Based The Opinion On A Publication By The American Psychological Association That It Was Possible That Heart Problems Are Aggravated By Anxiety)
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MEDICAL OPINIONS
EXAMPLE CONT:
2004: PRIVATE PHYSICIAN DIAGNOSED THE VETERAN WITH CORONARY ARTERY DISEASE. HE NOTED THAT STRESS AND ANXIETY AS A CONTRIBUTING FACTOR TO CORONARY ARTERY DISEASE WAS CERTAINLY A POSSIBILITY, BUT IT WAS NOT ENTIRELY CLEAR, AS IT WAS DIFFICULT TO DOCUMENT
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MEDICAL OPINIONS
WHAT DID THE BOARD DECIDE
CONCLUSION OF LAW:
A CARDIC DISABILITY WAS AGGRAVATED BY A SERVICE CONNECTED DISABILITY
ORDER:
ENTITLEMENT TO SERVICE CONNECTION FOR CARDIAC DISORDER, ORIGINALLY CLAIMED ASMYOCARDIAL INFRACTION, SECONDARY TO THESERVICE-CONNECTED DISABILITY OF ANXIETY DISORDER IS GRANTED
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MEDICAL OPINIONS
PRACTICAL EXERCISE OUTLINE
ISSUES:
REASONS AND BASES FOR FINDINGS AND CONCLUSION:
(MEDICAL OPINIONS)
DETERMINE THE DECISION:
DETERMINE THE ORDER:20
SECONDARY SERVICE CONNECTION &MEDICAL OPINIONS
QUESTIONS
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SECONDARY SERVICE CONNECTION &MEDICAL OPINIONS
SUMMARY
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