The denial was unconscionable and Jim took swift action at VACO!
This situation-I fear- will repeat itself all over the ROs because even vet org reps do not understand the regulations.
CAD (coronary artery disease) is most often IHD but sometimes it isn't.
Still the VA cannot arbitrarily deny any CAD claim based on what a rater -with no medical expertise- can assume is NOT IHD.
I keep repeating a mantra I have posted here since these regs came out on the new presumptives.
Either the clinical record must show ischemia of heart or there is a definitive diagnosis in the clinical record that would reflect the CAD medically as ischemic in nature.
Or the veteran might well need a medical statement from their doctor as to the ischemia diagnosis if the record contains instead other terms that reflect ischemia but are not specifically worded that way.
Cardiology has many medical terms to explain the type of heart disease someone has.But VA has focused solely on ischemic heart disease for the new AO presumptive.
I knew this was coming- if a rater doesn't see ischemia right off the bat in the record they could deny the claim-
but maybe no more- after this made news at VA WAtchdog Today!
Question
Berta
From VA Watchdog Today-Jim Strickland:
"11/30 We told you of the erroneous denial of IHD benefits
by the Pittsburgh Regional Office. The veteran has been notified 12/02/2010
that his award is now correct!
The Final Word
I'm told Pittsburgh RO will now be required to review and if needed,
readjudicate every Nehmer denial they have issued.
Once done all those are up for VACO review.
Done!"
Full story at VA Watchdog Today:
http://www.vawatchdogtoday.org/Recent_Headlines.html
The denial was unconscionable and Jim took swift action at VACO!
This situation-I fear- will repeat itself all over the ROs because even vet org reps do not understand the regulations.
CAD (coronary artery disease) is most often IHD but sometimes it isn't.
Still the VA cannot arbitrarily deny any CAD claim based on what a rater -with no medical expertise- can assume is NOT IHD.
I keep repeating a mantra I have posted here since these regs came out on the new presumptives.
Either the clinical record must show ischemia of heart or there is a definitive diagnosis in the clinical record that would reflect the CAD medically as ischemic in nature.
Or the veteran might well need a medical statement from their doctor as to the ischemia diagnosis if the record contains instead other terms that reflect ischemia but are not specifically worded that way.
Cardiology has many medical terms to explain the type of heart disease someone has.But VA has focused solely on ischemic heart disease for the new AO presumptive.
I knew this was coming- if a rater doesn't see ischemia right off the bat in the record they could deny the claim-
but maybe no more- after this made news at VA WAtchdog Today!
Link to comment
Share on other sites
Top Posters For This Question
1
1
1
Popular Days
Dec 6
2
Dec 5
1
Top Posters For This Question
Berta 1 post
Notorious Kelly 1 post
chr49 1 post
Popular Days
Dec 6 2010
2 posts
Dec 5 2010
1 post
2 answers to this question
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now