hypertension Post C&p Information Request

[jalexand]

As I reported in another post a few days ago, I had my C&P exam on my AO IHD claim at the VARMC last week. At that time after answering the questions I was asked and providing the examiner with

copies of my latest test reports from my private cardiologist which showed diagnosis, mets, ejection fraction, etc. etc, and being asked to have the results of additional stress testing that I am scheduled for

next week be FAXED to the examining oficer I thought I had covered my bases. But..................apparently not!

Today I received what might be a normal letter on a claim (but new to me) asking me to provide additional information. I am a little stunned, to say the least. First thing they are asking for is:

"medical evidence that shows the diagnosis and earliest symtoms for each disabiity below that resulted from your exposure to herbicides (Agent Orange)

Ischemic Heart Disease"

"We need evidence showing that the following conditions(s) existed from militaty service to the present time:

Ischemic Heart Disease"

Well, to be truthful I have no evidence of the existence back to my military service because I did not have the onset of the disease until I was 37 and I retired at age 21. To make matters worse, all the records associated

with the onset of my disease at age 37 have been destroyed as my doctors office indicated to me that they only keep records 7 years. (I may have some records that go back almost that far, but have not been able to

locate them yet)

And as to the first request, I have no evidence other than what will become effective down the road with the initiation of the Presumptions that are forthcoming regarding the IHD and AO.

What really stuns me though is one of the things that comes next in this letter is:

"What have we received?"

Here they list the claim for benefits, VA FOrm 21-4142 (2), VA FOrm 21-256 (VONAPP). They make no mention of the medical evidence that I provided at my visit!

They follow this with "what have we done?" Here they list: VA Exam Cardiovascular Heart and Hypertension (if the C&P I had is supposed to be that, I'll eat my hat) and they go on to say: "We have requested

copies of treatment records or other evidence from: Dr. George B Bittar (my cardiologist) (again I state that I personally handed them these records, which now they don't even mention in this letter)

They also state that while they have asked for these records, it is up to ME to make sure they get them. I don't know what would be more effective than my having personally carried them to them, which as I say again

is not mentioned in this letter.

Then they state that they have asked the VA Medical facility nearest me to schedule me for an examination with the claim. They will notify me of the place and time. What would this be all about?

They have also included in this packet explanations on what I need to provide to prove the claim, etc., as well as a VCAA Notice Response that I am supposed to sign and return which gives me the option of

including the info now and asking to have my case decided immediately or ask for a 30 day extention of the time to respond.

So, I am totally confused about what is happening here. They give me a phone number to call if I want to contact them, should I try a phone call to see if I can get this cleared up?

I hope I can get some good advice on this, cause I don't know what to do at this point, especially regarding the evidence they are requesting.

Jim

[jbasser]

Remember the VA is not even considering IHD as a presumptive condition yet. That is why you got the wording in this letter.

They are asking you to prove the condition as it is rated under the current non presumptive criteria.

I beat this by connecting the HTN first as t he heart disease was secondary.

Just hang in there, eventually the reg will be updated. Just keep sending them what you have and make a trip to the RO to review your folder. You wouyld be surprised at the unopened cookies left in the jar.

J

[jalexand]

Remember the VA is not even considering IHD as a presumptive condition yet. That is why you got the wording in this letter.

They are asking you to prove the condition as it is rated under the current non presumptive criteria.

I beat this by connecting the HTN first as t he heart disease was secondary.

Just hang in there, eventually the reg will be updated. Just keep sending them what you have and make a trip to the RO to review your folder. You wouyld be surprised at the unopened cookies left in the jar.

J

As I stated, I assumed thismight be a pretty standard response letter to my claim. What I am most upset about is there complete lack of acknowledgement of the documents that I presented them with at my C&P.

I also figured that the reason for the request for the info back to my service period was because of the fact that the disease is not yet a presumptive condition. I guess I will just have to play the game? There should be absolutely no problem in establishing my IHD, that is a given, but of course I have no way to connect it to service as even I have only become aware of the nexus to AO in the last month or two.

So, am I to assume that what will happen here is that they will acknowledge my IHD, but deny my claim at this point because I cannot prove nexus to AO exposure? Since I am a 90%, service connected (combat wounds received at KHE SANH in '68) I do not have to go to the trouble of proving my Military service or should I fill out the form and list all this in my own words, ie. provide them a history of my service?

By the way I am not familiar with the term HTN?

Jim

[SgtAFMOB]

As I stated, I assumed thismight be a pretty standard response letter to my claim. What I am most upset about is there complete lack of acknowledgement of the documents that I presented them with at my C&P.

I also figured that the reason for the request for the info back to my service period was because of the fact that the disease is not yet a presumptive condition. I guess I will just have to play the game? There should be absolutely no problem in establishing my IHD, that is a given, but of course I have no way to connect it to service as even I have only become aware of the nexus to AO in the last month or two.

So, am I to assume that what will happen here is that they will acknowledge my IHD, but deny my claim at this point because I cannot prove nexus to AO exposure? Since I am a 90%, service connected (combat wounds received at KHE SANH in '68) I do not have to go to the trouble of proving my Military service or should I fill out the form and list all this in my own words, ie. provide them a history of my service?

By the way I am not familiar with the term HTN?

Jim

Jim: I have the same horse in the race and have a history of CAD/IHD, MI, Bypass surgery in 1994. I sent my medical information to the RO and provided a copy of my most recent Thallium Stress Test, past stress tests and private cardiologists letter indicating IHD. I also provided the same at my C&P in February. Sometimes there is a disconnect between the RO and the VAMC. I had an appointment last month for another purpose and the Counselor indicated that IHD was reflected on my record. I have the standard deferred till the rule is posted letter. All I can suggest is that you furnish the RO with the info you did at your C&P, many things go to who knows where.

[jalexand]

Jim: I have the same horse in the race and have a history of CAD/IHD, MI, Bypass surgery in 1994. I sent my medical information to the RO and provided a copy of my most recent Thallium Stress Test, past stress tests and private cardiologists letter indicating IHD. I also provided the same at my C&P in February. Sometimes there is a disconnect between the RO and the VAMC. I had an appointment last month for another purpose and the Counselor indicated that IHD was reflected on my record. I have the standard deferred till the rule is posted letter. All I can suggest is that you furnish the RO with the info you did at your C&P, many things go to who knows where.

Thanks, good information! Do you think it necessary for me to actually get a letter from my cardiologist stating the CAD/IHD, or is it enough that I let the records speak for themselves?

As I have suffered with CAD for over 25 years I actually have a file that is probably about 4 inches thick over at the medical facility where I have had almost all of my medical procedures done (St. Vincents Hospital, Indianapolis). In the last couple of years I was able to obtain the local services of a good cardiologist in my home town, so I stopped going to INDY for cardiology and I would think that just copies of my latest test reports would be enough to establish the claim and since they are not going to pay based upon when this disease began I would think it unnecessary to provide data that is up to 25 years old? But, if the consensus is to unload it all on them, I can and will.

Jim

[jbasser]

As I stated, I assumed thismight be a pretty standard response letter to my claim. What I am most upset about is there complete lack of acknowledgement of the documents that I presented them with at my C&P.

I also figured that the reason for the request for the info back to my service period was because of the fact that the disease is not yet a presumptive condition. I guess I will just have to play the game? There should be absolutely no problem in establishing my IHD, that is a given, but of course I have no way to connect it to service as even I have only become aware of the nexus to AO in the last month or two.

So, am I to assume that what will happen here is that they will acknowledge my IHD, but deny my claim at this point because I cannot prove nexus to AO exposure? Since I am a 90%, service connected (combat wounds received at KHE SANH in '68) I do not have to go to the trouble of proving my Military service or should I fill out the form and list all this in my own words, ie. provide them a history of my service?

By the way I am not familiar with the term HTN?

Jim

HTN is Hypertension.

J

[SgtAFMOB]

Thanks, good information! Do you think it necessary for me to actually get a letter from my cardiologist stating the CAD/IHD, or is it enough that I let the records speak for themselves?

As I have suffered with CAD for over 25 years I actually have a file that is probably about 4 inches thick over at the medical facility where I have had almost all of my medical procedures done (St. Vincents Hospital, Indianapolis). In the last couple of years I was able to obtain the local services of a good cardiologist in my home town, so I stopped going to INDY for cardiology and I would think that just copies of my latest test reports would be enough to establish the claim and since they are not going to pay based upon when this disease began I would think it unnecessary to provide data that is up to 25 years old? But, if the consensus is to unload it all on them, I can and will.

Jim

Jim: I filed for IHD July 2009, along with PTSD was granted PTSD April 16, 2010 effective back to Aug 1, 2009. My IHD C&P was in February 2010. I had changed to my previous cardiologist that same month and asked for a letter that specifically contained the word ischemic. His statement began I am reintroducing myself to Mr. ---- for cardiology evaluation and management of his chronic ischemic cardiomyopathy. I have known Mr. ---- for quite sometime and he has a history of myocardial infarction, ischemic dilated cardiomyopathy status post coronary artery bypass grafting in 1994, hypertension, hyperlipidemia, etc. etc. (the graft to the damaged heart muscle is completely occluded as of two months after the bypass) Farther down he again states "He is a Vietnam veteran with a history of exposure to Agent Orange, and at this point clinically he does carry a history of ischemic cardiomyopathy, which is one of the disabilities listed for Agent Orange exposure in combat soldiers. I made sure I included the copy of the most recent (within six months) Thallium Stress Test which showed a left ventricular ejection fraction of 39%. Since the bypass surgery it has never been above 45% and should according to the rating guidlines be compensable at 60%. I JUST DIDN'T TAKE ANY CHANCES, BETTER SAFE THAN SORRY, HOPE THIS HELPS.