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    • New Va Pain Medication Policy
      I've responded on this thread in the past, and would like to update.  After 7 years of successful pain management; I took some advice from the message board and reached out to various "up the chain" types...and thought the Director of Pain Management at VA Palo Alto, CA had actually re authorized me back into Veteran's Choice program where I was being treated for my pain for 3 subsequent visits, was on the road for treatment for a procedure that VAHC had not even mentioned, (all of this after VA had "red flagged me as DRUG SEEKER")understand I have never deviated from requesting increase, missed appointments. Nothing.  Today, I get call from same Director of Pain Management, since I have not heard from Vet Choice about the reauthorization, that I was mistaken, he could offer me nothing but traveling the 40 miles to his clinic and of course that would be NO Opioids. I cannot travel the normal transportation route, and he assured me he had listed me, as Undue Travel Burden, but he would still not reauthorize. Have a nice Day! So, you tell me- how with all these qualifiers; and my Severe Pain that the Spine Specialist in my Community has agreed to treat Veterans, is only 3 miles from my home; has more compassion than those treating Veterans? Did I mention, that my Opioid meds has not changed in 7 years? Is anyone in Washington listening? Honorable Dr. DavidJ. Shulkin, your New Veteran's Choice guidelines don't mean anything to these people that have to care for us Veterans.  I was a Medical Officer for 9 years caring for thousands of brave Men and Women who served this Wonderful Country and I am appalled at the service and the way I am spoken to by the staff at the VAHC and told if you want Narcotics "Go Buy a Health Care Plan."  I say to them- without my Service to this Great Nation they would not have a job, and now they are talking to us like we are their BURDEN? If not for us, willing to Wear the Uniforms and guarantee their freedoms, they couldn't get a job except working at a County Teaching Hospital. 
    • Choice Program
      I've responded on this thread in the past, and would like to update.  After 7 years of successful pain management; I took some advice from the message board and reached out to various "up the chain" types...and thought the Director of Pain Management at VA Palo Alto, CA had actually re authorized me back into Veteran's Choice program where I was being treated for my pain for 3 subsequent visits, was on the road for treatment for a procedure that VAHC had not even mentioned, (all of this after VA had "red flagged me as DRUG SEEKER")understand I have never deviated from requesting increase, missed appointments. Nothing.  Today, I get call from same Director of Pain Management, since I have not heard from Vet Choice about the reauthorization, that I was mistaken, he could offer me nothing but traveling the 40 miles to his clinic and of course that would be NO Opioids. I cannot travel the normal transportation route, and he assured me he had listed me, as Undue Travel Burden, but he would still not reauthorize. Have a nice Day! So, you tell me- how with all these qualifiers; and my Severe Pain that the Spine Specialist in my Community has agreed to treat Veterans, is only 3 miles from my home; has more compassion than those treating Veterans? Did I mention, that my Opioid meds has not changed in 7 years? Is anyone in Washington listening? Honorable Dr. DavidJ. Shulkin, your New Veteran's Choice guidelines don't mean anything to these people that have to care for us Veterans.  I was a Medical Officer for 9 years caring for thousands of brave Men and Women who served this Wonderful Country and I am appalled at the service and the way I am spoken to by the staff at the VAHC and told if you want Narcotics "Go Buy a Health Care Plan."  I say to them- without my Service to this Great Nation they would not have a job, and now they are talking to us like we are their BURDEN? If not for us, willing to Wear the Uniforms and guarantee their freedoms, they couldn't get a job except working at a County Teaching Hospital. 
    • getting run-around by dental clinic
      In part, I agree, and in part do not! Turns out that the VA has a mantra about least cost when it comes to treating veterans. Private providers do have a profit goal to attain. It comes down to what the patient prefers, and what is the best for the patient. (Not the VA, provider, etc.)  
    • PTSD with questions
      I was actually thinking the sleep apenea and fibro secondary  to the back, I can't sleep but about 3 to 4  hours  a night my pain increases.  I know it is from being overweight  that once I hurt my back in the AF I was not able to exercise and the weight joined me so with the sleep apenea and fibro has made life almost miserable an then two months ago I was diagnosed with type 1 diabetes. Can the c-file be requested from ebenefits? Thank you for your quick response.  
    • PTSD with questions
      Rita, Welcome to hadit. You are at the right place.  There are NO dumb questions other than questions about how to succeed with a false/fraudulent claim. PTSD due to MST is covered by several knowledgeable veterans here.  They will chime in shortly. The evidence requirements are different than combat PTSD.  I don't believe they are any easier or harder, but they are different.  If you are suffering from PTSD resulting from events that occurred during your military service, file a claim for it.  I have never even heard of SA or fibro being secondary to PTSD. I am not certain if either could be an adequate stressor for PTSD.  Increased chronic pain from a SC condition can certainly be the basis for an increased rating. I did not claim PTSD until 40 years after I left active duty.  I was "boots on the ground" in Vietnam with combat awards, so my claim was really a walk in the park for me.  The 30% award did nothing to my monthly compensation, but I wanted all of my bases covered so that my wife will have no problems with DIC when I croak. C-File is your DVA claim folder.  It would be wise to request a copy right away because it takes a while for the VA to provide c-file copies.  Your military records may well contain evidence in the manner of behavioral changes after the event regardless of whether or not you reported it.
    • Aortic valve /ihd
      He also has an appeal in for increase in diabetes ,. He is on Lantus solar star pen and humalog quick pen.  Private dr filled out DBQ and wrote a prescription for restricted diet and activity.  Also filled for renal failure third stage secondary to diabetes.  Private nephrologist filled out DBQ with a diagnosis of diabetic renal failure type2. And diabetic nephrology.  Both were denied.  I don't think they read anything .  They said they did not feel his diabetes had progressed that much.  His aid 8.1.  They said renal failure was denied because he had no proteinuria in his urine sample.   And you had to have proteinuria in your urine to be renal failure.  I was reading online kidney foundation, that you do not always drop proteinuria.  And we were reading over the cp file again and it ask if the veteran had diabetes on it and they did not even check it. And on one spot on it it said his bun was 19 and said it was high.  Then on another spot it said bun was 19 and said it was normal.  It did have gfr at 40 and said low.  But it is like the gfr was just kind of over looked or ignored completely.  And that is the number one way, according to national kidney foundation,  to check if kidneys are dysfunctioning.  They said there was NO dysfunction of the kidneys.  Now on the DBQ from private dr says there is kidney dysfunction.    I picked up all his labs since he has had renal failure, and all the gfr are to low.  Some as low as 34.  Thanks everyone .  And Berta I'm so sorry you had to go thru all that stuff with the va..  And sorry for your loss.
    • Knee Condition
      Can the va refuse to increase my rating since my issue has worsened outside of the military? I am in a profession which requires carrying equipment and a vest. So without a doubt the weight has had an effect on my knee. I reported the injury to my work as well. Not sure if this can effect my claim. I'm thinking about revoking my claim through my employer. Since it is cared through from the VA. At the time I wasn't sure if it was related to my previous patellar injury. 
    • Aortic valve /ihd
      Berta he was seeing a private cardio.  And I kept asking him if he had ihd and he kept saying no.  And after the surgery I saw on his one piece of paper said cad, so I ask if it was the same, and he said yes.  You are right he did not get to 60 overnight.  But maybe his mets were lower because of the valve problem .  I know the surgeon told me and our daughter his heart was enlarged.    Now I think it was in 2009 he had lung embolism, and they could not say where the clot came from.  I'm suspecting it came from the heart.  He only goes to va for cp exams.  We have tricare and Medicare?  
    • PTSD with questions
      I have been going to mental health care at my local VA, I have been out of the service for 20 or more years and he recommended that I file for PTSD, based on what I have told him. I do not have anything in my medical records from active duty to confirm this nor witnesses since I did not report being raped. How in the world do I file for this? I am also service connected for my back and am seeking an increase due to excessive pain and wanting to include sleep apenea and fibro as secondary conditions would that go with my back or would I list as secondary to the PTSD. Dumb question but what exactly is a c-file is that my military health file?   Thank you all in advance for your help.
    • C&P Re-Exam - REPHRASED
      Your ok   Good news is coming

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stillhere

New Form For Dr's To Fill Out For Ihd Claims

13 posts in this topic





THANKS stillhere-

I understood months ago that this form woud be sent to most AO IHD claimants who have private medical care for their IHD and filed AO IHD claims.

The form mentions right up top that if the private doctor charges a fee for filling this out, the VA will not reimburse.

for reference:

Dyspnea means shortness of breathe

angina-chest pain defined within http://www.nlm.nih.gov/medlineplus/angina.html

Syncope fainting or loss of consciousness as defined in http://my.clevelandclinic.org/heart/disorders/electric/syncope.aspx

I wonder if I should fill this form out myself. I am the one who diagnosed and proved my husband's heart disease for FTCA case. :wacko:

This is an interesting form because it says that ECHO is only necessary when EKG and chest X ray reveal IHD.

An EKG can often state ischemia right on top of the strip yet the VA will also accept a "limited" ECHO to determine "left ventricular dimension,wall thickness and ejection fraction."

This form seems very concise on VA's part-I just hope the C & P docs also will use a similiar format.

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The actual regs and the form stillhere posted seem to rule out other secondary conditions such as stroke and HBP as potentially due to the IHD:

According to Harrison's Principles of Internal Medicine (Harrison's

Online, Chapter 237, Ischemic Heart Disease, 2008), IHD is a condition

in which there is an inadequate supply of blood and oxygen to a portion

of the myocardium; it typically occurs when there is an imbalance

between myocardial oxygen supply and demand. Therefore, for purposes of

this regulation, the term ``IHD'' includes, but is not limited to,

acute, subacute, and old myocardial infarction; atherosclerotic

cardiovascular disease including coronary artery disease (including

coronary spasm) and coronary bypass surgery; and stable, unstable and

Prinzmetal's angina. Since the term refers only to heart disease, it

does not include hypertension or peripheral manifestations of

arteriosclerosis such as peripheral vascular disease or stroke.

http://www.regulations.gov/search/Regs/home.html#docketDetail?R=VA-2010-VBA-0005

However-wit clear ct medical evidence there are secondarys that should be claimed such as:

Embolic ischaemic stroke is more frequent in patients with atrial fibrillation (80%), myocardial infarction, prosthetic valves, rheumatic heart disease and larger artery atheroma (artery-artery embolus). Most emboli are of atherosclerotic origin, and may partially or temporally obstruct cerebral arteries causing TIAs.5 Embolisms tend to be multifocal and may produce small haemorrhages around the obstruction.

archives.who.int/prioritymeds/report/.../stroke.doc

I was quite surprised this AM to see how many POWs with IHD (who were service connected for it) subsequent developed strokes and the VA denied the stroke as secondary to their SC IHD. These were old claims and there is more info on the net these days as to the relationships of IHD to stroke.

Embolic strokes are strokes from clots that form usuaully in the heart, and if the Pt has IHD, then atherosclerosis has most likely compromised the arteries ,casng a clot to form (emboli) that can go to the brain and then cause CVA.

Not all CVAs are embolic and not all are due to IHD. I see that claimants who do claim IHD with stroke as secondary will need a strong medical opinion to support the nexus.

Maybe this info will help someone.

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Is this form to be filled out by IHD vets who have filed their claims already, and had their c/p's ?

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I'm wondering the same thing about Vet's who have already filed claims for IHD/AO. My husband did not receive this form from Seattle RO, but he filed last NOV09' and it looks like the form didn't come out until May2010. He had a C & P and was sent for an Echo in lieu of a stress test so they already have this information.

I absolutely do NOT agree with the statement refuting hypertension, strokes, peripheral vascular disease not being related to IHD! VA has been adamant about hypertension not being a AO presumptive so feel they are protecting that decision with this statement.

I like the form for its brevity and concisemness. If the treating cardiologist is willing to state that the Vet has IHD and they've served time in VietNam it SHOULD be a done deal, then the rating will all depend on the severity of the disease determined by the Mets level, ejection fraction,presence of history of CHF, etc. Will save reviewers/raters lots of time if the cardiologists are willing to fill this out. They won't be having to search through years of clinical visit notes for documentation.

I'm curious as to whether the section that states "Provide only diagnoses that pertain to IHD" doesn't provide the format to include such things as Hypertension, CVA(stroke), etc.? if the doctor states these other diagnoses are caused from IHD?

This could get very interesting.

Lorraine

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I'm wondering the same thing about Vet's who have already filed claims for IHD/AO. My husband did not receive this form from Seattle RO, but he filed last NOV09' and it looks like the form didn't come out until May2010. He had a C & P and was sent for an Echo in lieu of a stress test so they already have this information.

I absolutely do NOT agree with the statement refuting hypertension, strokes, peripheral vascular disease not being related to IHD! VA has been adamant about hypertension not being a AO presumptive so feel they are protecting that decision with this statement.

I like the form for its brevity and concisemness. If the treating cardiologist is willing to state that the Vet has IHD and they've served time in VietNam it SHOULD be a done deal, then the rating will all depend on the severity of the disease determined by the Mets level, ejection fraction,presence of history of CHF, etc. Will save reviewers/raters lots of time if the cardiologists are willing to fill this out. They won't be having to search through years of clinical visit notes for documentation.

I'm curious as to whether the section that states "Provide only diagnoses that pertain to IHD" doesn't provide the format to include such things as Hypertension, CVA(stroke), etc.? if the doctor states these other diagnoses are caused from IHD?

This could get very interesting.

Lorraine

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The form is for IHD vets, who have private cardiac care, to have their private doctors fill out.

I would think if the vet formally claims secondary disabilties directly due to the AO IHD that should be stated on the form as such by the doctor and then the doctor might need to give a medical rationale at some point so maybe they should do that on the form too as to the association of the veteran's IHD to any secondary conditions.

Question for anyone:

IHD can cause embolisms (clots) that form in the heart and travel to the brain causing cerebral vascular stroke.However there are many other reasons for stroke so a CVA claimed as secondary to IHD will need strong medical evidence of the type of CVA it is and the etiology-

On my husband's ECHO the doctor states "there were no clots seen on this study" , and the ECHO was done 3 weeks after he had a catastrophic embolic stroke.

Does the VA make this sort of statement on every ECHO as to whether any clots were seen?

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Echos are actually an ultrasonic procedure that requires a separate reading by a Doctor. These tests are really an educated guess compared to an actual angiogram or Cardiac Catherization.

The strip of echo films are permanent record and if you have access to them, you can have another Doc read them and the results may be different.

Stuff gets missed constantly.

For example, a CT scan will not show a recent event like a stroke on the day it happens but a few days down the road it shows it.

They told my buddy he has a congenital disease that caused his aortic stenosis. I told him to conceed it but to also let them know that when they repaired the Aorta, they also bypassed 2 other arteries so he is eligible for service connection for IHD.

If anyone has or thinks they have IHD, you need to get the OR reports as it is a play by play of what is going on through an actual looksee at your insides. No test can do this and the VA can never dispute this record.

J

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The form is for IHD vets, who have private cardiac care, to have their private doctors fill out.

I would think if the vet formally claims secondary disabilties directly due to the AO IHD that should be stated on the form as such by the doctor and then the doctor might need to give a medical rationale at some point so maybe they should do that on the form too as to the association of the veteran's IHD to any secondary conditions.

Question for anyone:

IHD can cause embolisms (clots) that form in the heart and travel to the brain causing cerebral vascular stroke.However there are many other reasons for stroke so a CVA claimed as secondary to IHD will need strong medical evidence of the type of CVA it is and the etiology-

Berta

My husband's recent Echo thru QTC made no mention of embolisms(clots)

Lorraine

On my husband's ECHO the doctor states "there were no clots seen on this study" , and the ECHO was done 3 weeks after he had a catastrophic embolic stroke.

Does the VA make this sort of statement on every ECHO as to whether any clots were seen?

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Again...does this form apply to vets who have filed for IHD only, and have completed their c/p back in Feburary?

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Again...does this form apply to vets who have filed for IHD only, and have completed their c/p back in Feburary?

This form is for private cardio doctors to fill out. It helps them provide the information that the VA is looking for to support a claim for IHD.

Of course the doctors notes and DX will still be a part of your official medical records but this was created by the VA to help the doctors and vets relay the requirements that the VA in particular is looking for.

Nothing more nothing less.

If you have private care I would make this part of your package. If you have already filed and your claim is deemed ready to rate then depending on your decision I would use this for a reconsideration if denied and a higher rating if you are low balled by the VA.

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"If you have private care I would make this part of your package. If you have already filed and your claim is deemed ready to rate then depending on your decision I would use this for a reconsideration if denied and a higher rating if you are low balled by the VA."

That is an Excellent point stillhere and this form also could be used if a vet with VA health care needs to use an IMO doctor to support his/her claim for AO IHD if VA low balls or denies.

With VA Watchdog closing it's hyperspace doors in February and without the continued extraordinary work of Larry Scott (Tbird posted this info here today)

I don't know how we advocates and vets/widows will get a pulse on the AO IHD claims processing situation.Let alone anything else that goes on in inner VA circles.

It is quite possible Jim Strickland will post any info he has as to how these claims get going after the CRA 60 day waiting period.

Larry Scott has consistently given us the nitty gritty of the VA-always giving us information that he thoroughly checks out first.

Jim's excellent work will continue. Tbird posted the links to Jim Strickland's claims sites.

This is sad news for the vast veteran's community on the internet because we have lost an Icon and advocate of the hghest merit!!!!!

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Thank you Berta I do like to help our vets stay on top of these issues as much as possible.

I also just posted a link to another new website that is coming to help with these 3 conditions.

Unfortunately or fortunately depending on how your perspective is. The web and many veterans are becoming more and more comfortable dealing with issues and our government.

Sites like VA Watch dog and yes even Hadit may take a look at what they bring to the table and if there is still a need.

it seems this happens more and more in our society replacing our I think needed helping each other and replaced by a generic help all site!

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