Chuck75

"Secretary may reimburse" Leaves the decision to the VA. It's a very poor phrase to put in an entitlement law, since it does not require the VA to do anything.

If you have had and paid the insurance for 25 years, why stop it now? It's doubtful that you could go out and buy a replacement policy for the same money. Additional insurance thru the VA may be useful if you can qualify.

I probably would not go there unless there was something about the radiation treatment that violated good medical practice. This is a bag of worms not to open unless you really have a reason. "Do I need to look into a malpractice suit?"

A past acquaintance was retired AF and had private company group insurance from our common employer as well as Tricare.. He usually obtained medical care from the local AF base clinic. The AF clinic billed the private group insurance, and collected some sort of minimal basic payment from him, since he was retired and not active duty. One older AF contract we worked under overseas had a provision that the AF would provide medical care. When all was said and done, The AF hospital (in Germany) billed the group insurance. They paid the claim, and forwarded an accounting to our employer. In turn,the employer added a management fee, and billed the contract. When the AF paid under the contract, the insurance company was repaid by our employer. Only the government can think of such a screwy way to do business. About the same time, also in Germany, we had our second child. The base hospital was undergoing renovation and OB/Gyn was for all intents closed. As a result, my wife had to make prior arrangements with the German doctors and hospital. The group insurance complained about having to figure out how to pay a hospital bill in German Marks. On top of that, the hospital kept sending the bill to an incorrect address, and a very distant German relative who was quite elderly, as was his wife.

"Should I pay for my own stress test?" Yes, at least what Tricare or your insurance does not pay. You may find that your Left Ventricle Efficiency (LVEF) is such that you are entitled to a higher rating than that based upon the MET alone. Bradycardia & a pacemaker make me think that using the appropriate scheduler table with LVEF <30% may get you to 100%. There are different types of stress tests. I usually take one that is chemical based, and uses a computer controlled sonic scanner. This can be used to establish LVEF or overall EF. The first treadmill stress test years ago almost did me in. The Dr. did not listen when I told him that I was in trouble. Lesson: Never take a treadmill test unless you have a "kill switch" in hand, and test to make sure that it works.

I would have asked the lawyer to find out what additional evidence was needed to avoid the waver of a year & 1/2. In otherwords what reasoning is behind the "offer". After all, that's a fair amount of change.

Carvedilol 6.25 MG Tab NDC#00007414020 from Carl Vinson VAMC Dublin GA My non VA Cardiologist writes the prescription, and the local VA vet center OKs it. I've been taking it since 2001. Hardly a "new" drug.

Chances are that the VA regs concerning notification timeframe and insurance stand.

"doc but that she was trying to get a "more longitudinal view" of the disability.. whatever that means." The doc is trying to decide how long your disability (for SSA purposes) has existed. Thinking like a pessimist-- If you were employed (based upon records) during the time that the disability existed, you may be currently employable (by SSA standards). Thinking like an Optimist-- The doc is trying to determine the effective date of the disability for "award" start date purposes.

The VA seems to have decided that Plavix is too expensive for us lowly vets. That aside, I've been taking it since 2001, mostly thru the VA. Most recently, I filed a copy of the new plavix prescription from my cardiologist with the VA. I also take another drug, simvastatin(Zocor) This is a drug of some concern as there is a big flap about it going on in Britain. Seems that the NHS there is trying to change patients from Lipitor to simvastatin. The uproar is because symvistatin is less effective than Lipitor, and there are statistics that show a 30% increae in death rate among patients that were switched from Lipitor to symvastatin. My cardiologist originally called for Lipitor, which was not in the VA formulary. It seems that symvastatin can sort of hold things in check, and Lipitor can actually improve matters.

The main part of the job seems to be to optimize the funds available for use on politician's pet projects. "Protect taxpayers" HAH!

To me, this is just a fancy way of saying that the examiner did not wish to say that diabetes caused or aggravated the hypertension. This flies in the face of current medical thinking. "ESSENTIAL IN NATURE"

Given the hasle you are having, I would suggest that you get both. This may be a little difficult, unless you can get a Vet Rep, politician, or lawyer involved. "Should I get a copy of the claims file at the VARO as well as the one at AMC. What will the difference be?"

It is my understanding that SSA can go back one year from the last application. If you did not file an appeal to the denials in a "timely" manner, they are past history.

First, most Vietnam Vets don't reach full SSA retirement age until 66-67. I'm also sure that the politicians interested in "saving money" regardless of other considerations have already thought about the veterans & retirees "double dipping" from the military pension, VA compensation, and SSA & SSDI. I'd also bet that the subject comes up again after the next round of elections, regardless of who wins what. There is too long a history of whittling away at military and veteran's benefits, not to mention using a cost of living index for all that is not realistic. Some of the more notable losses "Free" Medical care for retirees and dependents. VA Medical care has a very long way to go as received before it in fact uniformly meets the current care standards on the private side. (And it's been that way since I can remember. It was so bad when I returned from Vietnam (1968) that my family doctors treated the Vietnam related medical problems at no cost or for what the insurance companies would pay, without copay or deductible, rather than have me use the VA. (This included some corrective surgery.) The 1/2 compensation payment by the VA Very low VA mileage compensation. Medicaid & Medicare drug formulary vs the VA & military formularies. The influx of foreign trained "doctors" in VA employment. Some/Many? are not considered to be qualified to practice in the state that they are employed by the VA. SSA disability payments were changed to be taxable under certain circumstances.

What I would do is call the nurse back and ask her to call a local pharmacy or give you a written prescription for up to two weeks so that you can maintain dosage while the VA screws around. If I wanted to really raise cain, then I'd call the VMAC patient affairs and administrator, and bitch about it some more. Finally, I'd suggest that the VA should pay for the drugs from the local pharmacy. If they resist, I'd consider filing malpractice. (Unnecessary Pain and Agony) My local VMAC is a 120 mile round trip, so I'd likely go the private doctor local pharmacy route for a short period of time. One of my major complaints is that the VA is not setup to provide drugs to a veteran on short notice, unless the vet can go to the VMAC. An amendment to the veteran's drug benefit law allows the VA to get away with this, and also did not stop "pill splitting" and the resultant double "copay" when it applies.

Won't happen-- The government has already used the money you paid in. Naturally, if the "lump sum" idea catches on, it will likely end up being an amount tied to one or two years of your income. Possibly average income for some period of time. In my case, what would happen is that the years chosen based upon current SSA rules would be a lower average than normal. due to loss of income due to disability.

Those who are not involved with SSA or SDI or the other "welfare" programs consider the whole package to be welfare or "on the dole". Many also believe that those "on the dole" are there somehow by their own fault. Politicians have a major fiscal problem now, and it will just get worse. It seems that as the "babyboomers" retire, the cost of all the "welfare" programs climbs to levels that threaten the governments ability to: Fund "Pork Barrel Programs/projects" Borrow money from the SS funds. (And NOT repay it, as is the current policy.) There is no current viable fiscal policy, just "Rob Peter to Pay Paul" The only way to "pay" for the current war is to print more money. This was done to pay for the Vietnam war, and resulted in massive inflation. The recent bridge collapse is just a minor example showing that the government has been spending money in other than the places that really need it. SSA has been redefined as a TAX by the politicians. This allows them to "borrow" from the SSA fund without repayment. The SSA pension payments then become an "unfunded" entitlement obligation of the government. "SSA is earned by work credits for retirement-to include military service- and VA comp is due to SC sacrifice- I cannot imagine why this is even an issue but apparently it is now---"

How is the FOIA and obstacle? It helps you to obtain information in a "timely" manner. Admittedly, there are enough loopholes to drive an aircraft carrier through. A request letter citing the FOIA is actually enough. Seems that bureaucrats like forms that ask for lots of inapplicable information and have boxes to check that allow them to quibble and avoid making a real decision.

The pictures show pipe "lagging" (insulation) in good condition. Unfortunately, they do not really show anything other than that. Many of the older ships underwent asbestos removal in the 1960's and 1970's. The lagging shown may have fiberglass insulation instead of asbestos. One clue is the diameter relationship of the pipe and lagging. Replacement with fiberglass insulation usually resulted in a larger lagging diameter. The other thing shown is that the outer layer of the lagging seems to be painted or coated. This helps to prevent the insulation fibers and possible dust from getting into the surroundings. I was assigned to two ships that went through the removal process in 1967-1968. A real problem with one was the "shock" that was a result of firing a 5" gun. This shook loose any dust particles and caused them to become airborne. Any asbestos particles present were then circulated by air handlers. The air filters were not very effective. The concussion and shock from the 5" was great enough to crack "frames" that are structural parts of the ship.

The SSA award letter should follow in short order. If it does not, you can call or go to the local SSA office and request a copy of the letter. This gives you something to compare against the amount you received by check. Obviously, the QRB was completed favorably.

You will need to request a copy of your records from the VA regional office. Cite "duty to assist" and the "FOIA". Ask for service records and all medical treatment records. The VA generally refers to the records as your "C" file. You may also request VA medical records in writing from the treating VA facility or the appropriate VAMC if the treating facility is something like a satellite veteran's center. I suspect that the VA doctors said that you had medical conditions, and then deliberately did not include language that might be used to substantiate service connection. You may need to go back to them and request a statement to the effect that in their opinion, the conditions are related to service. They may not want to do this, or may, because of internal VA pressures, say something other than what you need them to say. They are required to give this opinion if asked, but remember that they would rather not. There is a VA form that can be used, although I don't remember the form number.

My SSA claim went thru the QRB, and I'm told the process is just to make sure that the i's are dotted and the T's are crossed. Once a doctor has stated "creditable" in the medical review, things go fairly fast thru the process. You are lucky in that they decided to award previous to your claim (as the law allows). In my case, they obviously picked a date that allows them to avoid paying retro pay. I had to ask for reconsideration, citing the medical evidence that the doctor said was creditable, and re-request the original date that I had applied for. I have no idea when this process will complete. I'm told that it may take up to three years. At issue is up to about 20k. It would take something really unusual to deny your claim at this point. I got two letters from the SSA during the initial claim process. The first stated that the medical requirements had been met, and the other eligibility criteria were being verified. The second was the award notice. The reason I went thru the SSA disability process was simply that I'm 62, and the additional $508 above what I would have received with SSA "early" retirement is a significant amount of money. Not to mention that the SSA disability medical review cites the very conditions that I'm either currently SC'd for, or have applied for SC for. I also obtained a full copy of my SSA file on CD, (FOIA) and noticed that the award letter in the file did not have a prepaired date, where the actual letter I received did. There were two pages (filled out forms) that were appropriate to send to the VA in support of my current claim. Both together were the SSA equivilent of an IMO based upon medical record review by a currently licensed doctor. The VA will have a hard time trying to discount the information and opinion stated on the forms.

I believe the VA will seize on the word limited as an excuse to continue the current practice of denying SC for HBP. From my personal experience, the issue is that there is a difference between "higher than normal" BP and diagnosed HBP. I had higher than normal blood presure after returning from Vietnam to civilian life. Proving it is another matter, since it was not high enough (with the numbers used at that time) to require treatment. Indeed I had to get a doctors statement for one employer in the middle 70's, to the effect that the ratio of rest to after excercise BP was wide enough to ignore the higher than normal rest BP. Since I also carried an FAA medical certificate appropriate for an ATR (airline transport rating) it was obvious that the definition of HBP was not very cut and dried. In addition, I believe that the numbers used to diagnose HBP may have dropped in recent years. HBP is associated with Diabetes. Unfortunately it "may" occur as a preliminary symptom of diabetes, well before any diagnosis of diabetes is made. Thus an opening exists for the VA to say that HBP is not directly related to diabetes, and is from other non SC causes. The significance of the "limited association" is that it provides a direct tie between AO and HBP. "I wonder if the VA will even pick up on the "limited" association " ---

The difficulty you (and I) face is that heart, circulatory, and blood pressure problems often occur without diagnosis of diabetes. When these conditions occur before a diagnosis of diabetes, the best that can be said is that diabetes can (and does) aggravate them. Proving to the VA that Diabetes is a likely cause is a hard road to go down. It really depends on the availablity of old medical records that show higher than normal blood sugar levels. With this information, and a good IMO from a qualified specialist, you (and I) have a fair chance of success in getting SC for them. The VA will likely try to offset by having an in house "medical professional" say that Diabetes has a small contributing factor, and so forth. the saving factor is if the total disability with everything is 100%. This can easily happen if left Ventricle Efficiency is less than 30%. I have had a heck of a time finding useful records. Seems that the local hospital threw them out when they aged out at ten years. Many of the doctors that treated me in critical time frames are no longer alive, let alone in practice. One light in the long tunnel is that the medical profession and the NIH has said in print that there is such a condition as "prediabetes" and that heart, blood pressure, and circulatory problems may be the first sign of diabetes in patients with higher than normal blood sugar levels that are well below the levels used to confirm diabetes.