ptsd Undiagnosed Arrhythmia

[m5a9c4]

I could go on and on of all the ins and outs of my fight (DIC) with the VA about my husband sudden death from cardiac arrhythmia. (I do understand all about service connection) The VA has sent me many denials, one specifically says he was never treated for cardiac arrhythmia and there is no evidence of it. I tried many time to get his complete records from the VA (he was 100% treated through the VA) and they said they sent me everything. I had given up until the 5 year anniversary of his death sparked me to try again. I decided to try directly through the sleep clinic to see if they had any information other than what the VA had sent me. To my surprise I received a CD with an ECG on it. They have typed, “Irregular heart rate and PVC’s” on the accompanying documents, some places it looks like scribbling instead of an ECG.
My question, if I get these verified that there is cardiac arrhythmia, is that grounds for an 1151 claim for not diagnosing and treating? His death certificate says: Primary: cardiac arrhythmia, Secondary: PTSD and sleep apnea. He also had hyperlipidemia. I did not have an autopsy; I was in such shock from trying to revive my husband that when they said there was no need for an autopsy, I didn’t question it.
I appreciate any thoughts.

[Berta]

"My question, if I get these verified that there is cardiac arrhythmia, is that grounds for an 1151 claim for not diagnosing and treating? His death certificate says: Primary: cardiac arrhythmia, Secondary: PTSD and sleep apnea. He also had hyperlipidemia."

Arrhythmias can be minor bumps in the cardiac electrolyte road or often Far more serious if they indicate heart disease.

"To my surprise I received a CD with an ECG on it. They have typed, “Irregular heart rate and PVC’s” on the accompanying documents, some places it looks like scribbling instead of an ECG." How soon before he died is that dated?

An EKG was one of the first pieces of evidence I used to succeed in a wrongful death claim.

The EKG ( they put a lot of into usually at the top right) said it was an abnormal EKG due to possible inferior ischemia.)
Also on the ER certificate the same day (my husband had collapsed on his Job at VA and was rushed to their ER) the cert said WU/CAD, and RO/CAD. ( VA never told him and never did WU or RO CAD.)
And an ECHO in his lifetime revealed more of his undiagnosed and untreated heart disease.

Even without the considerable additional evidence I had ,those three documents alone proved VA had failed to timely diagnose and treat my husband ,causing his "untimely death" per my DIC award letter. They admitted to the cardiac misdiagnosis and the Stroke he had also due to misdiagnosis.



They diagnosed him however with a sinus problem and sent him home with Sudafed.His death certificate confirmed the heart disease. So did his autopsy. I know it is such a terrible time to be thinking of an autopsy. My husband was an organ donor so they autopsied him right away.

As VA fought me back on my FTCA and 1151, I realized that the autopsy was critical but they (VA)'lost' it 12 times.

They will go as low as they can go sometimes when FTCA cases are filed.


Did they ever do an ECHO on your husband?

Hyperlipidemia is part of a trilogy of medical symptoms that can also contribute to heart disease

"His death certificate says: Primary: cardiac arrhythmia," Obviously this was not a case of any minor cardiac arrythymic event.
"Secondary: PTSD and sleep apnea. He also had hyperlipidemia."

Do I understand that the Death certificate stated these conditions were contributing to his death?

Listed under the primary cause.

What VA rating did he have for the PTSD,the SA and/or any rating regarding the Hyperlipedimia...I dont think they rated that because it is only a symptom but can contribute significantly to heart disease. Was he on any cholestrol lowering meds?

High Lipids means high cholestrol, high cholestrol can mean atherosclerosis of the heart and brain.(It causes plaque),if not controlled by meds and diet.My husband had that too. Never prescribed a statin drug at all.

You need to carefully go through his medical records, to include his blood chem reports, and his medication list.

But best of all, if you feel he was undiagnosed or misdiagnosed, get a real doctor to do an IMO on his condition at death.

They will need all med records and the death certificate as well as all past denials.

Do you have the results of all C & P exams he had? To include the posthumous one.(s)


"he was 100% treated through the VA"

Do you mean 100% service connected? This is why I asked the rating info.

I am not a doctor. I am a widow of a veteran the VA killed with lousy health care.

We have considerable info here in our FTCA/1151 forum on 1151 claims.

Did the VA make any statements in their past denials as to his PTSD as a contributing factor????

Was the DIC claim filed to reflect that his PTSD, SA, or hyperlipidemia contributed to the potential cause of death ,if the heart disease was deemed NSC by VA?

Was he a Vietnam Vet, incountry?

If so look for the word ischemia, or CAD (coronary artery disease in his records....or any findings of atherosclerosis.) *

He also could have had diabetes mellitus. Did the VA rule that out or ever diagnose him with DMII?

I proved the VA also misdiagnosed my husband's DMII, 18 years after his death.Nothing is impossible.

*The ECHO wont state these words usually, but the ECHO can reveal a very good indication of what type of heart disease he had.

"The VA has sent me many denials, one specifically"......

Can you tell us verbatim what the other DIC denials were based on?

I am sorry for your loss.I have been widowed for 20 years and the bast.....opps ,excuse me, the VA

is still paying for what they did to my husband.

Everything I know about 1151 is in our FTCA/1151 forum and that is a GOOD result of his death because it was not in vain.

His death has helped other veterans with 1151 issues (and their surviving spouses)

I didnt have Google or the internet when I fought them and spent many long hours in medical libraries.

IMO docs are costly but can save a claimant plenty of time and it is VERY difficult these days to succeed in this type of DIC claim without an IMO..

Google has made it so much easier these days to understand medical acronyms and conditions.

Dont give up on this but I am thinking you need to re=open with new and material evidence or are you still within an appeal timeframe? When was their last denial letter?

Edited November 7, 2014 by Berta

[m5a9c4]

Thank you for resonding.

I will do my best to answer without running on.

Death Certificate:Part 1 Only shows cardiac arrhythmia. Part 2 significant conditions, but not resulting in the underlying cause: PTSD and Sleep Apnea.

I was able to get my husband 100% disabled due to PTSD after he died. His one and only C&P showed PTSD and hearing loss.

My husband was a helicopter pilot in Vietnam.

After many years of issues, we found out about PTSD in late 2007.

He started all his medical needs through the VA in january 2008.

The ECG's were part of 3 seperate sleep studies, for his severe sleep apnea. So all I have are the monitored vitals EEG,EMG,EOG etc... The words were typed on a copy of his sleep study from an outside clinic the VA had do the studies. Those are dated August of this year when the sleep clinic finally sent me the file. The tests were done 9/2008, 11/2008, & 3/2009. My husband passed away in August 2009.

My husband was treated at clinics in one state and his 3 months of inpatient treatment for PTSD in another state.

My husband's records show he was on Simvastatin, then off in one state and then back on from the other state. He was on 80mg prozac, 20mg Simvastatin(?), 1mg clonazepam(3x).

They did 2 chest xrays that say heart within normal limits

While inpatient my husband after complaints of not feeling well, his file says set up for EKG. No other information or appointments are in the file after that. They even hand wrote on one of my requests for copies, "There are no EKG's at this site".

No diabetes, and occasional higher BP readings.

So basically no problems by their records.

My first letter to the VA was regarding sentences I saw in the records. It was from the doctor ordering his last sleep study it said " do not disturb patient due to his severe post traumatic sleep apnea" and PMH: severe PTSD and as in Vietnam.

So based my first letter on that, denied.

Based my second letter on more than 10 years of trouble, denied. Did that one trying to keep the file open.

The last one was based on finding out about Ischemic Heart disease and related it back to all his symptoms. denied. It has been more than a year from that one.

So asking and getting the monitored vitals from the sleep clinic was trying a new avenue to get additional information.

I thought originally that if I got the vitals (if they kept that kind of information) maybe they would show a sign of Ischemic heart disease, did not expect to see anything about an irregular heart rate.

The sleep reports I received from the VA showed alot of numbers that meant nothing to me and at the bottom of each report from the sleep clinic a sentence, "Clinical correlation and followup regarding these findings is necessary". Other than getting a Vpap there is not much in his medical records about sleep apnea.

Please forgive me if this makes no sense. I get really flustered when trying to explain any of this.

Thanks again!

Edited November 8, 2014 by m5a9c4

[Berta]

"Death Certificate:Part 1 Only shows cardiac arrhythmia. Part 2 significant conditions, but not resulting in the underlying cause: PTSD and Sleep Apnea."

Would you be willing to approach the coroner to see if the statement could be changed to 'contributing conditions'?

That might not be possible.But worth a try. 2 widows here (maybe more) were able to get a death certificate validly re-worded in order to succeed in DIC.

Was the coroner a MD or a PA? Or did a VA doc prepare this death certificate?

"I was able to get my husband 100% disabled due to PTSD after he died. His one and only C&P showed PTSD and hearing loss."
Good !!! that was I assume an accrued benefit claim, established by evidence VA had at th time of his death, regarding his pending claim at death.

Simvastatin.... they were treated the cholestrol problem (hyperlipidemia)but maybe not well enough

clonazepam and prozac...these meds are often given together usually for shot term use. I found no serious consequences of any contraindications when used together.

"They did 2 chest xrays that say heart within normal limits"

They did one on my husband and said the same thing. I proved he had an enlarged heart.


"My first letter to the VA was regarding sentences I saw in the records. It was from the doctor ordering his last sleep study it said " do not disturb patient due to his severe post traumatic sleep apnea" and PMH: severe PTSD and as in Vietnam."

So based my first letter on that, denied.

I assume (I am not a doctor) that by PMH they meant past medical history. It is quite possible the sleep study providers knew much more about his condition then his VA PCP did.

"The last one was based on finding out about Ischemic Heart disease and related it back to all his symptoms. denied. It has been more than a year from that one."

Do you mean you have not appealed that denial within the NOD time frame?

In any of his rating sheets from VA did they ever state NSC CAD or IHD or anything regarding a potential heart condition?

Was there any NSC HBP rating on any rating sheet??

"The sleep reports I received from the VA showed alot of numbers that meant nothing to me and at the bottom of each report from the sleep clinic a sentence, "Clinical correlation and followup regarding these findings is necessary".

That might be the key to discovering whether VA malpracticed on him or not.

Was this sleep study done by the VA or contracted out to some other hospital?

Are you able to scan and attach here a copy of the VARO's Ischemic heart disease denial and the evidence list they used?

Are you able to scan and attach also that page regarding the above entry from the sleep study?

Please cover his C file number and his name/address prior to scanning it.

If you file a Section 1151 claim and succeed, they should go back to the date of his death for any retro.

There is no time limit on Section 1151 but they will need some significant evidence of the 1151 potential.

I always advise getting an Independent medical opinion for 1151 issues.

So far what I see is that this might be the potential smoking gun:

"Clinical correlation and followup regarding these findings is necessary".

Thank you for answering my questions.

I would not want any claimant to get a costly IMO that might not reveal any support for their claim.

But an IMO doctor, who is familar with VA regulations and DIC, is the only entity who will take the time to read all of the medical evidence and be able to prepare an adequate opinion.

There are things here that are very concerning to me.

Did the VA give him any post death C & P exams. They did probably 5 or 6 on my husband.I had multiple claims.

Can you scan and post here the results of the last C & P exam they did for the IHD claim?????

If they did one......and if they didn't , that would really concern me as well.

[Berta]

forgot to ask

"I was able to get my husband 100% disabled due to PTSD after he died"

Did they award you CHAMPVA and Chapter DEA educational benefits?

Have you checked with your property tax office to see if you are eligible for any tax exemptions as widow of a 100% P & T SC veteran?

Did they give you a favorable EED on that accrued award?

My accrued award said the EED was 3 years prior to my husband's death (the same date SSA determined he was 100% due to PTSD.)The EED was for my Chap 35 and CHAMPVA as well as the retro.

My accrued award for AO IHD however was determined by a date of a PTSD exam, whereby the doctor had noted something

regarding his undiagnosed heart disease.( I never got a copy of this C & P when I ordered a copy of his med recs and my C file in 2003....I dont even recall him having this exam as he was working at VA as well as in college at the time )

and I felt it should have been 2-3 months prior because that was the date of the ER Certificate and initial EKG but I did not appeal that after talking to my lawyer at NVLSP.

I need to make a point here to all....and I sure hope our vets here are reading your posts because this stuff could happen to their spouses after they die.....and the spouse questions why they died and has a hard time getting DIC.

When a vet with a 100% SC disability dies, they are then rated as 100 % P & T, if the surviving spouse files for accrued benefits on a claim they had pending at death because the disability obviously was permanent and total in their lifetime.

The accrued claim must be filed filed within one year after death and the spouse can substitute themselves as the claimant.

As I have said MANY times ( and within our radio shows here) make sure the spouse can use a PC and the internet.

Many of you have death files and hopefully we will be doing another Death show at blog radio. soon.

A death file is simply a file the spouse is aware of,(and where it is) that contains your DD214, and other pertinent VA award letters.It should also contain a 21-534 application.

It can become quite large.

I feared if I died during my Nehmer claim that my daughter, a veteran, would have to continue to pursue the claim so I kept that file up to date on my evidence that VA had.

But it also contains photos of how my PC and TVs DVDs, etc , are set up , all of my internet passwords -dont forget HADIT. COM Password!, and and how the water pump and the Australian High tensile fence works ,

instruction pamphlets for everything, insurance policies,my will, my car title, deeds,to my properties, husband's DD214-215, marriage license, name and address of a potential serious buyer for my farm,when I die, and lots of stuff like that.

By all means tell the spouse now when you are alive that you want an autopsy done. It wont hurt a bit and they will remember your wishes because an autopsy can be critical to a DIC claim and often grief stricken spouses don't want to consider it or even think to ask for one to be done.

Edited November 8, 2014 by Berta

[m5a9c4]

You are an angel.

First let me jump on your band wagon about autopsy's and add I have told family members active in the military to ask for their medical records often and read through them.

The situation at the time of my husband's death, besides the horror, was once the attending EMT found out about PTSD we counted all his medications to verify nothing was missing before the coroner arrived. I absolutely reacted to the situation and not common sense.

I was awarded accrued benefits to his first visit in 2008, educational and no to CHAMPVA. I do use the exemptions.

There was only one C&P (that I have) and I looked at it and there was only the part for PTSD and hearing. There is nothing in his file saying anything was wrong. Nothing about check for IHD, only hyperlipidemia,PTSD,sleep apnea,ed.

I believe I have attached the sleep clinic page, there were outsourced by the VA.

(I have done this twice and lost it)

Let me say I have tried numerous times to have the local and state VSO help me and no one ever called me back or contacted me.

So to say the least my last attempt was trying to grasp at straws.

The evidence was sending them pages of his medical records showing his complaints of dizziness and nausea at different times, one entry showing that he requested a stress test and they said there were no indications for him to have one. I also sent an EKG from 3 years prior by someone else. They would not accept because there was no heart diagnosis, or signature by Doctor, only consider left atria enlargement and his name didn't show on second page.

Of course it was closed unless I came up with new material.

Once the VA told my Congress person there was no other information, I felt I should try contacting the sleep clinic on my own.

So here I am...

Please understand, I made a promise to myself and his memory, that I would try absolutely every avenue till there were no more.

Every service member deserves that.

I

[Berta]

"Let me say I have tried numerous times to have the local and state VSO help me and no one ever called me back or contacted me."

If you mean the State of New York, Division of Veterans Affairs, let me know what county of NY you live in, and what state VSOs didnt help you , by name. and I can contact their attorney and raise hell..

.".Of course it was closed unless I came up with new material."

But then again maybe that is why the VSOs didn't help ???

Once the VA told my Congress person there was no other information, I felt I should try contacting the sleep clinic on my own.

So here I am... "

Yes, and I think the sleep clinic records might be critical.

"Please understand, I made a promise to myself and his memory, that I would try absolutely every avenue till there were no more.

Every service member deserves that."

You bet! After my husband called the 800# one Chilly fall morning 2 decades ago...only to find his claims had not moved in many months, he made me promise ( one claim was his original 1151 claim) that if they killed him I should go after them for anything I could get.I said Oh Honey the VA isnt going to kill anyone.

A few hours later we walked out to our barn (I have a farm and raised livestock) as the sun had come out and it was warmer.Suddenly he collapsed and died as I gave him CPR.

He was right.Death by VA.

Undiagnosed IHD with 1151 strokes contributing to death.
The FTCA/ 1151 took 3 years.
In 2003 my daughter wanted me to re open for undiagnosed Diabetes from AO. I didnt want to deal with them and he had no diagnosis of diabetes either.
She pressured me for many months, bringing up symptoms he had that indicated DMII which she knew had gone on the AO presumptive list.After she returned from oversea AD (USAF) I told her I finally filed the claim. And 6 years later I got an award for direct SC death due to AO, (She was right) and then I got the IHD directly SC under Nehmer. 2012

In 2012 they finally paid 1151 accrued for his 1151 stroke under a CUE claim I won . But They owe me 16-18 months more at 100% and that claim has been pending for over 2 years.

I need to make a point.....you have a very good handle on how the VA can be.

You also experienced the crappy way some of us widows are treated by VSOs.

But you also will need some probative evidence to file the 1151 claim and to get their support and hopefully a better decision from the VA.

Now I am thinking that this is why the VSOs could not help you.....

I also suggest you file a IHD AO death claim under the Nehmer Court Order. I cannot determine here if your husband had ischemic heart disease.

The dizziness and nausea can indicate TIAs (Transcient Ischemic attacks) as well as heart problems and even other things not related to brain and heart.

I proved my husband had multiple TIAs ( same symptoms)that VA said was due to a hole in his eardrum and a major hearling loss . yeah right...He had no hole in his ear drums.

And no hearing loss.

For my DMII claim in 2003, I knew I would have a hard time with the VA because I settled with the USA under FTCA and they knew it, so I got 3 Independent medical opinions to reveal the diabetes was malpracticed on.

I had done extensive work and medical research already for my claim,in the 2 years after filing it, when I got a ridiculous C & P opinion, and my IMO fees ($4,000 for 2) and one freeby would have been much much higher, if the IMO doctor had to do it all , I am sure. I know you will need an IMO for the 1151 claim and that also can be used for the AO IHD claim if the IMO reveals Ischemia of heart.

I am not a doctor but after my daughter insisted I claim DMII in 2003, I studied cardiology and neurology and certainly feel there is something wrong in the treatment or lack of it ,that VA was involved in here regarding your husband..

But to be sure of that would take a complete review of all available medical records. Everything.

And that is what IMO doctors do.

"I believe I have attached the sleep clinic page, there were outsourced by the VA."

(I have done this twice and lost it)

I assume that all of his other medical treatment came directly from the VA.and were not outsourced And that 1151 would cover all of that direct VA treatment.

I contacted Dr. Craig Bash for my IMOs and we have done many radio shows here with him.

I always recommend him because I have had experience with his IMOs. He is a NeuroRadiologist but was able to state his extensive expertise at reading CTs and MRIs of thousands of diabetics, in order to opine on my DMII claim.

His right hand man John Dorly is a member here as well and once you get all available medical records, Dr Bash could give you a fee estimate, unless you have another IMO doctor in mind.

The 1151 criteria for wrongful death claims has 2 criteria that must be fulfilled :

1.Absolute proof of malpractice/negligence, on VA's part and

2. Absolute proof that this malpractice/negligence caused or substantially contributed to the veteran's death.

If you have that evidence (# 1 comes from the medical records, ...in my original FTCA case some of it involved a hidden cover up at one VAMC, over the negligence that a different VAMC here in NY had caused) and # 2 these days almost always requires a strong IMO with a full medical rationale ) I did # 1 and #2 myself for my 1151.FTCA issues.1997-1998

But as I said I had to study cardiology and neurology to do that along with extensive FTCA case law and I do not recommend that at all for any claimant filing under 1151..

I also was in a Military School for the next 4 years,after I opened my 2003 DMII claim ( AMU) CHAP 35 DEA, and that also is why I hired Dr. Bash..... and still dont know how I did all that,because I found more evidence of malpractice the entire time my claim was in progress, and even after I got my award letter..

I have an additional new 1151 claim pending now....filed 20 years after my husband died.

Do I understand they awarded you DEA (Chap 35) but NOT CHAMPVA?

It is possible but unusual.







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