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C-File, does RO's claims specialist opinion / interpretation of evidence, appear in C-File?

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MKAH

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Hi All, Hi Berta,

 

We received the decision package and how they made their determination. 
We "ONLY" submitted a DBQ on IHD!! 
 
Per the decision "Examiner reported your non service connected chronic obstructive pulmonary disease and your peripheral vascular disease limit the achievable effort for your METS level."
 
The examiner asked hubby if he had COPD....**But we had only submitted one disability at a time, per VSO. 
 
Yet the VA FORM 21-0960A-1 Titled: Ischemic Heart Disease DBQ clearly states (4B) Dyspnea, Fatigue, Angina, Dizziness, METS 1-3.
My hubby's CARDIOLOGIST put in his report of his METS, yet the examiner and rater elected not to look at the DBQ.  Apparently, the 15-minute C&P exam outweighed my hubby's ELEVEN years of examinations with a REAL DOCTOR.  
 
Damnation!!  I am mad as hell!! 
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Post a Redacted copy of both the C & P DBQ and the Denial Letter. s

Sometimes, things are much clearer than they first appear. Our Lay review of the C & P DBQ and the Rater's Denial Decision might might point you in the right direction.

Has your husband been DX'd with COPD? Age and being a Heavy smoker virtually guarantee  COPD symptoms and DX. COPD has a direct effect on METS.

Semper Fi

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Thanks for your help Gastone!!

I am posting the 2 page VA FORM 21-0960A-1 IHD filled out by hubby's cardiologist.  

The 2 pages of the decision letter.  

Has your husband been DX'd with COPD?  YES....but DAV VSO told us NOT to start a claim on that DX until after the IHD came through to which he said was a SURE 100% because of the METS 1-3.

Age HUBBY IS 70   and being a Heavy smoker ... YUP, got him to quit 4 years ago. virtually guarantee  COPD symptoms and DX. COPD has a direct effect on METS.....I just looked that up.  I have his pulmonary doctors notes in front of me....(that's not a GOOD report either)...OMG!!   

Any information you can help me (US) with ....Believe me.....IT IS GREATLY APPRECIATED. 

I only see the "EXAMINER's" opinion on this decision letter.  Never do they make mention of what all CARDIOLOGIST documents show on eBenefits.   

Page2RedactedVAform.JPG

RedactedVAForm210960A.JPG

RedactedDecision2.JPG

Page3ofDecisionLette2r.JPG

EvidenceConsideredsnip.JPG

Edited by ValpoVet
added Evidence Considered
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No COPD DX or Symptom treatment while on active duty or within the 1st 12 months after discharge? He's screwed as far as a COPD Direct SC and the "Heavy smoking" takes a Secondary SC off the table.

How are his Carotid Arteries? At 70, there should be significant occlusion if it hasn't already been treated. Has he been assessed for Stroke Risk?

Thanks for the get back on the 21-0960, I'll give it a read asap.   Semper Fi

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Was the stent  operation After the date they listed in the Evidence section, as to the private records they had?

They stated their had private records up to Feb 2017.

This might take a strong IME from a real doctor, and I feel the PAD , if documented in the medical records,should be claimed as due to the AO IHD.

An IME doc should consider opining on that potential .

Have you googled the Examiner's name to see if they are a real cardiologist?

The ECHO- was that date 9-16-2016?

Part of the "Lifeline" screening program I mentioned will cover a cartoid artery exam.They do it with a small scanner type of thing and can read the results on a screen (sort of like a CT scan) and it probably takes mere minutes to do.

Gastone is right. If his arteries are occluded that info will be found in the measurement data on the ECHO results. Unfortunately VA found that out After my husband has a major ischemic stroke due to his undiagnosed, untreated AO IHD.

 

 

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Just reviewed the Decision, CAD @ 10% sucks but is probably correct. Effective date back to your "Intent to File" is also apparently correct.

I gotta ask, WTF was the delay in filing the CAD Claim? That CAD DBQ indicates Medical Record Evidence of Heart problems back in 2004 and 2012. Just considering the CAD 10% SC, by not filing back in 10 or 11 when CAD was added to the AO Presumptive's, he missed out on about $7K in Retro.

He's 70 now, covered by Medicare A & B with a B Supplemental plan? Consider requesting a Heart Echo-Cardiogram from VMC or Private Cardiologist, whichever is cheapest and fastest. The Echo results would be considered New & Material Evidence and could get the CAD increased to 30%.

Doe's he snore, have a BMI North of 28%, have a 171/2+ neck, and a wide tongue? Not unusual for CAD Patients to develop a Secondary SC Condition of SA (Sleep Apnea), which would result in a SA Secondary SC of 50% if RX'd CPAP or BiPAP.  If he now has a Sleep Study done by the VA or a Non-VA Sleep Specialist, getting a Nexus to his SC CAD should not be a problem.

Go on his E-Ben account and start a New Claim for Hypertension as a Direct AO Claim, just don't hit the Submit Button yet. You have 12 months from the Start Date to complete the claim, but you've established the File Date for Retro. Right now, VA is still denying AO Hypertension Claims, could change in the near future.

Semper Fi

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