The VA may deny your claim for compensation for various reasons. A frequently used rationale to deny service connection for an orthopedic condition is that the Veteran’s disability was “caused by the natural aging process” and not related to an injury or event that occurred in service. This logic often discourages Veterans from pursuing their claim any further, and thus, validating the recurrent use of this language. An Independent Medical Evaluation (IME) or Opinion (IMO) is usually required when the Veteran has been denied compensation based on this reasoning.
This rationale is used by the VA to deny compensation for an injury that the Veteran sustained in service many years ago, but has progressively worsened over the years. As Gulf War Veterans age, this issue will become more and more prevalent for those who sustained musculoskeletal injuries more than twenty years ago. Because of the long stretch of time between the original injury and subsequent claim, an expert evaluation may be needed to link the injury to the Veteran’s diagnosis and symptoms. An IME is meant to support a service-connected nexus or provide an evaluation of the current severity of a condition(s).
More than 650,000 Service members served in Operation Desert Shield and Desert Storm from August 2, 1990 to July 31, 1991. However, the Gulf War period is still in effect, and anyone who served on active duty from August 2, 1990 to present is considered a Gulf War Veteran.
Gulf War Veterans are eligible to receive compensation benefits for certain illnesses and diseases “presumed” to be related to service in designated areas of Southwest Asia. These presumptive diseases include medically unexplained illnesses (popularly called “Gulf War Syndrome”), certain infectious diseases, and Amyotrophic lateral sclerosis (ALS).
However, Gulf War Veterans may also seek to establish service connection individually for other, “non-presumptive” diseases and illnesses related to service in the Gulf War.
According to Dr. Stephen Hunt, national director of the U.S. Department of Veterans Affairs Post Deployment Integrative Care Initiative, just over half of all veterans’ post-deployment health visits address lingering pain in their backs, necks, knees or shoulders. And according to a study in the Journal of Pain, about 100,000 veterans of the Gulf War nearly 20 years ago have reported chronic muscle pain.
Occupational activities such as lifting loads, working in constrained spaces, and training increase the risk of pain-related musculoskeletal disorders in military veterans.
Therefore, Veterans who sustained a musculoskeletal injury in service should be advised to continue treatment for any lingering pain symptomatology associated with that injury. It is well known in the medical community that an orthopedic condition can be caused by a precipitating event, such as an acute injury or secondary to chronic insults to the site. Typically, the individual is left with chronic pain that can vary from intermittent to daily complaints of pain. For example, a Veteran relates jumping off a Humvee with a full pack gear during training or during combat operations and sustaining an injury to his knee or his back. Although, the Veteran receives minimal care in service, the duration of pain is initially intermittent, and returns to regular duty. Eventually that injury will progressively worsen over the years. It could be that the demands of active duty service prevented the healing of his injury and the Veteran never truly recovers. Twenty plus years later, the VA says the Veteran’s orthopedic disability is “caused by the natural aging process” and denies the claim. This is when an IME is crucial.
Preferably, the Veteran should try to find a Board Certified Orthopedic physician who is familiar with the VA medical system used by the military. Otherwise, whenever possible, include with your request sections of the Clinician’s Guide (found at http://va.gov), as well as the diagnostic code(s), also referred as the rating schedule, involving the musculoskeletal system that you want the expert to evaluate. The expert must acknowledge review of the entire VA claims file (C file), to include all relevant Compensation & Pension Examinations, lay statements, and relevant treatment records. If your evaluation request includes an obscure or complex condition the use of relevant medical treatises are helpful and should be included with the report. The expert’s final report should be based on the objective medical data and the application of medical principles, and should not include hypothetical opinions.
The Veteran should disclose any intervening injuries or events that may have had an effect on the disability he/she is claiming compensation. This will allow the expert to provide an opinion of how this has affected, or not, the Veteran’s condition for which he/she is seeking compensation.
Although it is true that as we age our bodies decompensate, depending on many variables such as lifestyle and genetic disposition. Many of us have degenerative conditions that are asymptomatic. The key in these claims is that there was a precipitating event in service, and as such the Veterans are entitled to compensation.