Widow Needs Help With Dic

[Blessedmom]

Hi Everyone

I posted this somewhere else and did not get any responds--not sure if I posted in the right place. Please forgive me if I have not posted this in the right place or I am posting wrong. I have been lurking for quite a while and join a few weeks or month ago. If it is in the wrong place, please be so kindly and let me know. I really need help.

I am a recent widow with 4 small children ranging in the ages of 11 years old to 1 years old. My husband passed away last year at the age of 33 years old. His death was sudden. There are many questions unanswered. Here is his background.

He served in the military from August 1994-August 2004. He was a dental tech and had never been deployed. He does not really have anything in his military records except for a few stomach complains (2 times), latent tb, allergic reaction to amoixicillian, and cyst on his eye. He was really never sick. For 10 years, he only has 156 medical pages.

As mentioned he was discharged from the military in August 2004. He received a VA physcial in May 2005 which is 8-9 months after discharged. His blood work was abnormal. His hematocrit was slightly elevated and he had a low white blood count. His kidneys had a creatintine level of 1.4 and eGFR of 77. In 2008, he was diagnosed with chronic stage 2 kidney disease. His blood levels mentioned above stayed the same in 2005, 2007, 2008, and 2009. He was never on any medication for blood disorders. In 2009, he began to complain about stomach pain. He went numberous times to the VA hospital and they kept sending him back home telling him that nothing was wrong. When they finally admitted him into the hospital a day or so later, he had to be rushed into the emergency room. They found 2 feet of his intestines was dead. He was placed into a coma induced state by the doctors. Upon waking him up a week later,he had passed away. Listed on his death certificate is

1. Immediate cause Pulmonary Embolism

2. Hypercoaguable state (btw on set and death) is listed as years. Meaning he had the hyperocoaguable state (blood clotting disorder for years)

3. Superior Mesenteric Venous Throbolism.

4. Ischemic bowel.

Listed on the autopsy also is infarct of kidneys and cardiomegaly.

In summary, he died 4 years and 9 months of getting out of the military.

Questions:

1. Isn't there a way I can connect his blood disorder to the abnormal blood work which was conducted 8-9 months after service?

2. What about the kidneys?

3. Also in his autopsy, his spleen weighed 430 grams which is double the size.

I know all what happen to him did not happen over night. Please help me.

Thanks

[Pete53]

BlessedMom

First my condolences for your loss and my prayers for you and your children. Hopefully a Doctor can explain to you if the problems your husband had started with with abnormal blood work. Its fairly simple and be sure to explain to your Doctor is all you really need to show is a diagnosis of a medical problem during or 1 year after service. The fact that it progressed is not the key its the diagnosis linked to his service.

Berta has given you a blueprint to act on and hopefully you can take the steps needed.

If there is anything we can do please continue this thread.

Pete

[Berta]

Pete said "The fact that it progressed is not the key its the diagnosis linked to his service."

Blessedmom- Pete is on to something there-

he means if the claim can fit into the Chronic presumptive regulations for possible award of direct service connection and death de to service connected disability.

This is why SMRS need to be carefully considered by any IMO doctor.

.

“The law provides that a veteran who

has 90 days or more of service may be entitled to presumptive

service connection of a chronic disease that becomes manifest

to a degree of 10 percent or more within one year from

service. 38 U.S.C.A. §§ 1112, 1137 (West 2002); 38 C.F.R. §

3.307 (2003). Diabetes mellitus is one of the chronic

diseases for which such presumptive service connection may be

granted. 38 C.F.R. § 3.309(a).

With chronic disease shown as such in service or within the

presumptive period so as to permit a finding of service

connection, subsequent manifestations of the same chronic

disease at any later date are service connected, unless

clearly attributable to intercurrent causes. 38 C.F.R. §

3.303(b).

The law further provides that no presumptions may be invoked

on the basis of advancement of the disease when first

definitely diagnosed for the purpose of showing its existence

to a degree of 10 percent within the applicable period. This

will not be interpreted as requiring that the disease be

diagnosed in the presumptive period, but only that there be

then shown by acceptable medical or lay evidence

characteristic manifestations of the disease to the required

degree, followed without unreasonable time lapse by definite

diagnosis. Symptomatology shown in the prescribed period may

have no particular significance when first observed, but in

the light of subsequent developments it may gain considerable

significance. Cases in which a chronic condition is shown to

exist within a short time following the applicable

presumptive period, but without evidence of manifestations

within the period, should be developed to determine whether

there was symptomatology which in retrospect may be

identified and evaluated as manifestation of the chronic

disease to the required 10-percent degree. 38 C.F.R. §

3.307©."

Yo stated:

"As mentioned he was discharged from the military in August 2004. He received a VA physcial in May 2005 which is 8-9 months after discharged. His blood work was abnormal. His hematocrit was slightly elevated and he had a low white blood count. His kidneys had a creatintine level of 1.4 and eGFR of 77. In 2008, he was diagnosed with chronic stage 2 kidney disease. His blood levels mentioned above stayed the same in 2005, 2007, 2008, and 2009. He was never on any medication for blood."

I am not sure what disability he would have had during the year after service that had risen to 10% disabling.I cannot determne even by looking at the autopsy info you gave us- iodf the disability was solely the blood clotting problem or if he already had kidney disease.

Pete sees something here I don't see but this is another possibly way to request both direct SC death and 1151 death DIC.They will only award one however.

We can raise every possible cause for service connection or 1151 DIC or direct DIC as we want if we have some evidence that it is plausible.

"In 2008, he was diagnosed with chronic stage 2 kidney disease. His blood levels mentioned above stayed the same in 2005, 2007, 2008, and 2009. He was never on any ...." etc

The blood levels etc might have Nothing to do with this:

Autopsy

1. Immediate cause Pulmonary Embolism

2. Hypercoaguable state (btw on set and death) is listed as years. Meaning he had the hyperocoaguable state (blood clotting disorder for years)

3. Superior Mesenteric Venous Throbolism.

4. Ischemic bowel.

Listed on the autopsy also is infarct of kidneys and cardiomegaly.

I had to study my husband's autopsy for weeks with medical texts to understand it. I was able to provide the General COunsel with enough info that they wanted to settle with me in a matter of 4 months after getting my SF 95.

There is a lot here to these autopsy findings and pf course there is m,uch more in the actual narrative that medical examiners do.

Do you have the complete autopsy itself or is this what was listed on the death certificate?

When I re opened my claim for direct SC death in 2003 I realized that I had to read the autopsy and med recs in a completlely different light to prove my husband had a AO disability that never appeared once in his med recs, and of course he had no treatment for it and it contributed to his death.

There was one word I had never looked up in the heart slide narrative when I filed my pother claims.

I looked up the word and it was Prime Facie evidence of what I was trying to prove in the new claim.

This time I got 3 IMOs and they awarded direct SC death-my point is that no one here is a medical professional who can opine on these issues.

We have the expertise however to know something is wrong here.If his kidney doctor was a VA doctor- that doc probably wont go against the VA with an opinion if you ask for it.

Months after recipt of my SF 95 the VA counsel asked for a Peer Review from a VA doctor who fully supported tha malpractice and wrongful death charges I made. The report had a complete medical ratioanle and the VA lawyer called me up to start negotiations.

Then the report , the doctor and the VA lawyer left the VA.

VA said the Peer report was basically a figment of my imagination as it did not exist.A few years ago I fopund it in my c file and used it for my present claim.

In 1151 and FTCA matters, the VA will stoop as low as they can go.In many SSOCs they blamed my husbands death on anything they could and did not give the VACO OGC doctors the complete medical files nor the autopsy.You need a strong IMO as well as a good lawyer.

If the IMO can follow Pete's suggestions to fit into the chronic presumptive regs, it should also consider any malpractice possibilities as well that contributed to your husband's death.

There is also the possibilty that NO negligence whatsoever occurred on the VA's part here.

I don't think they could have foreseen the fatal embolism at all but it is the other contributing conditions on the autopsy that concern me and a good IMO expert will be fully able to opine on them.

Edited August 22, 2010 by Berta

[Blessedmom]

Thank you Pete and Berta for your kind words and help.

Last year I requested a penison claim --I don't remember the form, but I put that I was not requesting service connection-only pension based on monthly income, but the VA regional office put me in for DIC also. They are requesting proof for service connection. I guess they thought something had to happen. So that is why I am trying to dig up as much info, but kinda stuck since he did not complain or have any problems. The extensions in which I mention was for additional 30 days. The first time it was due on August 6, but I was still waiting on the doctor. So I called again and asked for another 30 days. Now I have a doctor looking at the records (IMO) and he told me to ask for another additional 30 days. I didn't know if this was the right move or did not. Just thought I had to try and do something. I just check his other numbers for his lab results and they are all within normal range.

[Blessedmom]

Oh, I forgot to mention. I was trying to dig up all I can and I found an article (I don't know if it holds water or not because I gave it to the doctor and he did not mention anything about it) that the medicine he had taken for tb can cause kidney disease. It was a reputable article from Merek website.

[Blessedmom]

I just look at his records as far as the kidneys they said (in 08) his gfr is low 85 ml with the left kidney contributing approximately 64 ml/min and the right kidney contributing approximately 21 ml/min. They also mentioned that is renal function is abnormal with the left contributing 75 % and the righ 25%. Slightly smaller kidney most consistent with medical renal disease. However stable kidney function (at least for past 4 years). I hope the last 4 years did not messed anything up.....

[Berta]

One other thought- the spenomegaly (enlarged spleen) concerns me-

Was your husband an incountry SouthWest Asia veteran?

If so -his SMRs should be carefully considered to see if he had any infections in SW Asia or treatment for any sand flea bites.

Any conditon listed on a death certificate as Contributing to death could lead to a service connected death if their is a nexus to the veteran's service.

2 of the new GWV presumtives could cause splenomegaly. (kala-azar, and brucellosis.)

Even malaria can cause this condition.

I posted the IMO criteria here in our IMO forum.

Before I requested my IMOs for my DMII death claim- I added a cover page to the medical records and tabbed the records that supported my claim.

I then went step by step as to specific med recs from 1988 to 1994 contained negligence.

It was a case of "omissions" of acts that would have occurred in the standard medical community.

I highlighted with magic markers on some copies (leaving the oreiginal 'copies' from the VA intact, where the notations, etc symbols etc and the CHem reports showed a lack of follow up care and proper diagnosis.

I told the IM0 doctor exactly what the medical evidence revealed to me-

and ,after reading all the records (he had also many SOCs I got and other stuff to consider,autopsy etc, he concurred and also gave his own medical rationale and a statement of his expertise as specific to the disability claimed and a ten page Curriculum Vitae.

IMOs can be quite costly so it pays to make sure that the doctor has ALL info available

and that they fully adhere to the IMO format for giving a complete medical rationale.

And that they understand the exact basis of the claim.

I read a vet's IMO the other day that was pathetic.

The VA will give it no weight at all.

He thinks it is a winner and wont consider the IMO format here.

Edited August 22, 2010 by Berta