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Blessedmom

Please Help -Widow Applying For Dic-Imo Question

Question

Good Morning

Please let me know your opinion. The doctor pretty much followed Ms. Berta's outline for IMOs'. I just have a few questions. Here is some of the IMO. I think he did pretty good--I am just concerned with the below.

Mr. _____ was in a prothrombotic state at the time of his death. The laboratory evaluation revealed a diagnosis of one of the antiphospholipid antibody syndromes, "as likely as not" due to his inservice treatment with (INH) as a treatment for a conversion to a positive TB skin test. This would be classified as an acquired hypercoagulable state. It is possible that the veteran also had an occult hereditary thrombophilia. It is my opinion that "as likely as not," Mr. Bassett experienced his morbdty and ultimate morality secondary to an acquired prothrombotic state superimposed on some undiagnosed primary hereditary thrombophilia.

Question

Will the part in italized mess me up?

It is a 12 page IMO with articles he has attached with in the IMO for support.

Does he have to mentioned he read the c-file? I did not request one from the VA, but I had all the info already.

He says The purpose of this report is to review the medical records including miltary and post-discharge records to determine whether his widow is entitled to DIC.

After that he list his qualifications--reference both military and VA records, he puts some articles to support his conclusion and the discussion

"As likely as not" Mr. ______ death was secondary to a hypercoagulable state that originated from a service-related disease. The veteran was treated with INH for 6 months while in the service disease, due to the conversion of his TB skin test to positive. It is well established that INH has been related to the development of antiphospholipid antibody syndromes which is associated wth an increased tendency for blood to clot in both veins and arteries.

(He continues with more, but just wanted to give you a brief overview.)

Question:

First, what do you think?

Also since he has input articles within the body, do I still need to sendy any.

Thanks again

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5 answers to this question

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"It is my opinion that "as likely as not," Mr. Bassett experienced his morbdty and ultimate morality secondary to an acquired prothrombotic state superimposed on some undiagnosed primary hereditary thrombophilia."

That could be considered as aggravated of a pre -existing condition, by his service.

could be....

But this clarifies it more:

"as likely as not" due to his inservice treatment with (INH) as a treatment for a conversion to a positive TB skin test. This would be classified as an acquired hypercoagulable state.

INH definitely has to be monitored:

http://emedicine.medscape.com/article/180554-overview

Did he give a full medical rationale for his statements that support the claim?

In other words did he give medical reasons why or medical citations why ?

after he made these statements?

I feel this is an opinion that is very positive for the claim.

"occult hereditary thrombophilia".... he was enlisted into the service as in good health-so this may not be a problem.

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http://www.cafamily.org.uk/medicalinformation/conditions/azlistings/h41_4.html

\

It says certain Genes are at a higher risk for the condition. How this will effect your claim is the question since they VA can say this was a genetic issue.

However, presumption of soundness may over ride tis issue as he was presumed to be sound when he enlisted.

J

Edited by jbasser

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These excerpts and the BVA case link might help you combat any negative opinion the VA might come up with:

"A veteran is presumed to be in sound condition when examined

and accepted into the service except for defects or disorders

noted when examined and accepted for service. 38 U.S.C.A. §

1111 (West 2002). Only such conditions as are recorded in

examination reports are to be considered as noted. 38 C.F.R.

§ 3.304(b). The presumption is rebutted where clear and

unmistakable evidence demonstrates that the injury or disease

existed before acceptance and enrollment and was not

aggravated by such service. Id

The VA Office of General Counsel and the appellate courts

have issued clarifying precedent decisions regarding

application of the presumption of sound condition upon entry

into service. Under this guidance, to rebut the presumption

of sound condition under 38 U.S.C.A. § 1111, VA must show by

clear and unmistakable evidence both that the disease or

injury existed prior to service and that the disease or

injury was not aggravated by service. The claimant is not

required to show that the disease or injury increased in

severity during service before VA's duty under the second

prong of this rebuttal standard attaches. VAOPGCPREC 3-2003;

see also Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004).

The law further provides that, if a preexisting disorder is

noted upon entry into service, the veteran cannot bring a

claim for service incurrence for that disorder, but the

veteran may bring a claim for service-connected aggravation

of that disorder. Paulson v. Brown, 7 Vet. App. 466, 468

(1995). In that case, the provisions of 38 U.S.C.A § 1153

and 38 C.F.R. § 3.306 apply. Jensen v. Brown, 19 F.3d 1413,

1417 (Fed. Cir. 1994). If a presumption of aggravation under

section 1153 arises, due to an increase in a disability in

service, the burden shifts to the government to show a lack

of aggravation by establishing by clear and unmistakable

evidence "that the increase in disability is due to the

natural progress of the disease." 38 U.S.C.A.

§ 1153; 38 C.F.R. § 3.306; Jensen, 19 F.3d at 1417; Wagner v.

Principi, 370 F. 3d 1089, 1096 (Fed. Cir. 2004).

VA's General Counsel has held that the provisions of

38 C.F.R. § 3.306(b), providing that aggravation may not be

conceded unless the pre-existing condition increased in

severity during service, are not inconsistent with

38 U.S.C.A. § 1111. Section 3.306(b) properly implements

38 U.S.C.A. § 1153, which provides that a pre-existing injury

or disease will be presumed to have been aggravated in

service in cases where there was an increase in disability

during service. The requirement of an increase in disability

in 38 C.F.R. § 3.306(b) applies only to determinations

concerning the presumption of aggravation under 38 U.S.C.A.

§ 1153 and does not apply to determinations concerning the

presumption of sound condition under 38 U.S.C.A. § 1111. 38

U.S.C.A. § 1111 requires VA to bear the burden of showing the

absence of aggravation. VAOPGCPREC 3-2003; see also Wagner

v. Principi, 370 F.3d 1089 (Fed. Cir. 2004).

Service connection may be granted for hereditary diseases,

such as retinitis pigmentosa, that either first manifest

themselves during service or which pre-exist service and

progress at an abnormally high rate during service.

VAOPGCPREC 67-90 (July 18, 1990) published at 55 Fed. Reg.

43253 (1990) (a reissue of General Counsel opinion 008-88

(September 27, 1988). Where during service a congenital or

developmental defect is subject to a superimposed injury or

disease, service connection may be warranted. VAOPGCPREC 82-

90 (July 18, 1990), published at 56 Fed. Reg. 45,711 (1990)

(a reissue of General Counsel opinion 01-85 (March 5, 1985).

Clear and unmistakable evidence is required to rebut the

presumption of aggravation where the pre-service disability

underwent an increase in severity during service. This

includes medical facts and principles which may be considered

to determine whether the increase is due to the natural

progress of the condition. Aggravation may not be con......"

Source:

http://www4.va.gov/vetapp10/files1/1011835.txt

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Thanks everyone. I am just a little nervous. Yes, he did provide reasons for his conclusions. He put medical inserts from Cecil Medicine, 23rd. He took abstracts from many other different sources explaining exactly what it (the APLS) is and placed it within the IMO. He also put a diagram.

+TB skin test in service+treatment with isoniazid+yields Antiphospholipid (anticardiolipin antibody syndrome yields hypercagulable state yields Mesenteric vein thrombosis, thrombocytopenia and pulmonary embolus yields Death (the word yield is actually arrows on the IMO--I did not know how to do the arrow) Sorry

He also put in the discussion (this ending)

The blood work is consistent with an antiphosphlipid antibody syndrome of the anticardiolipin variety. It is not unusual for the development of APLS to be asymptomatic for an extended time period, in fact many susch patients never develop thrombotic manifestations. The clotting abnormalities associated with an INH-induced APLS may revert to normal within a few weeks of discontinuing the offending drug, but he was required to take it for an extended period of time. Therefore, it is my opinion, some of the APLS antibodies had persisted to the point of still being able to cause thrombosis.

Berta, Do I need to send VA a copy of the law you mentioned above.

Is there anything else I can do except pray it goes through?

Thanks

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Blessedmom-he did a GREAT Job in the IMO-for the rationale etc

Cecil Medicine is an excellent source that he cited.

I feel yo should submit this to the VA ( Keep copy) and send it USPS with a tracking slip to prove you mailed it to them and then wait to see what the VA does next.

Hold onto those excerpts just in case you need them but I hope the VA grants this claim without them!

The VA will surely try to get a VA doctor to opine on the claim and come up with something that goes against the claim.

I went through many years of that.They wasted their time.

The Benefit of Doubt rules apply to widows as well as to veterans. (It is called Relative Equipoise)

When a claimant has medical evidence to support a claim and VA has medical evidence to deny the same claim-they must -if they find the weight of the evidence is equally for and against -will award the claim under Benefit of Doubt.

They own the scales that Blind Justice holds and I think they kick her in the knee sometimes to tip the scales in their favor.

However the expertise and medical rationale of a good IMO doctor can usually outweigh anything the VA can come up with.

I dont foresee the VA will find any doctor who can opine against this claim with any real expertise as your doctor did.

I fully believe that PRAYERS helps!!!!!

I prayed that someone at the VA would read my evidence.I prayed that prayer for 7 years. Finally someone read it.

One of the biggest problems I had was a vet rep outfit that seemed determined to see my claim fail.The vet org has paid for their

unconscionable treatment of me and hopefully will think twice before they treat any other widow like that.

You are smart enough and proactive enough not to need a vet rep at this point.

Edited by Berta

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