desertshield

Dear Berta and broncovet, Thank you for the excellent advice. Like a VA doctor told me years ago...if it ( i.e. a medical condition ) was first discovered on active duty, it should be considered service-connected.

If at a RO hearing, the hearing officer determined that a Veteran's previously unknown medical condition, i.e. heart arrhythmia or hypertension, was found so soon after entry, ( about 2 weeks ), onto active duty that in their opinion it couldn't have started in military and therefore denied the claim on that basis, have they in essence made a medical opinion and therefore something that could be contested as a CUE?

We all have heard the rumors, however, has any P&T 100%er personally been reduced when they put in a new claim? How did that happen?

Shane, You indicate your 2nd sleep showed CSA. It's not at all unusual it didn't show up on your first sleep study which you indicate only showed OSA because that's how it is with the brain. Sometimes they catch it the problem on the first study, sometimes they don't. I don't know anything about CHF causing CSA, however, I think a TBI could cause it.

The navy veteran in this case filed for a mental health condition with a sleep disorder. It is on the psych C&P that the term "chronic sleep impairment" is indicated. It is also included in the 38 C.F.R. § 4.130, DC 9411 General Rating Formula for Mental Disorders rating decision narrative he received as follows: "Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), CHRONIC SLEEP IMPAIRMENT, mild memory loss (such as forgetting names, directions, recent events) 30" Therefore, if the veteran gets a 30% or more mental health disorder rating decision which includes the "chronic sleep impairment" clause as above, could that form the basis for making a sleep apnea as a secondary condition claim as a logical extension?

I'm asking for help on behalf of another veteran who just got SC'd for adjustment disorder with mixed anxiety and depressed mood at the 50% rate based, in part on, "chronic sleep impairment". He already has had for years non-service connected obstructive sleep apnea (OSA) and uses a CPAP machine. The question is: can his non-service connected obstructive sleep apnea, (a respiratory condition), be aggravated by the "chronic sleep impairment" from his SC'd mental health condition...thereby getting his OSA SC'd?

Could be talking out of Uranus...on the other hand: https://www.earthfiles.com/news.php?ID=2284&category=Science

Wonder if he needed an independent alien medical opinion to win it? See article: http://www.mirror.co.uk/news/technology-science/science/british-ufo-encounter-gave-heart-5266589

As I understand it, if you are service connected for a respiratory condition and it requires home oxygen, that is supposedly* an automatic 100% rating. See the rating: "episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy 100". This 100% rating does not mean someone is P&T by itself as the need for home oxygen therapy may be only temporary, say because someone later received a lung transplant and then didn't need supplemental O2. How the need for home oxygen is determined by your the doctor, be it based on a PFT, Arterial Blood Gas or Pulse Oximeter reading of SpO2 below 90%, isn't all that important...just that the need can be documented by a means acceptable to the VA that outpatient home O2 therapy is needed.

Regarding the education benefits of Chapter 35, on VA Form 22-5490 SECTION II - ELECTION (CHILD APPLICANTS ONLY) it states: "You may not receive payments of Dependency and Indemnity Compensation (DIC) or Pension and you may not be claimed as a dependent in a compensation claim while receiving Survivors' and Dependents' Educational Assistance (DEA)." Here's my question: As the Chapter 35 payments are only made for the months a student is actually attending school or college, what happens during say the summer months when a student may not be attending school or college? Does the Veteran parent then get additional funds in the his/her compensation claim checks for those intervening months when their dependent isn't attending school or college? Please help!

The communicative and information processing disorders due to TBI may come from an ( central ) auditory processing disorder. See VA link: http://www.afaslp.or.../Gallun2008.pdf on this. Sometimes called CAP or APD. Anyone SC'd for TBI tested or rated for a CAP or APD claim?

Might it meet the "separate and distinct" criteria in that OBD/OBS can cause, for example, seizures or tremors etc. from physical damage to the brain without the psychiatric component that depression and/or PTSD might have and vice-versa? OBS and PTSD are etiologically very different and these conditions may manifest themselves in markedly different ways.

Organic Brain Syndromes (OBS) are "a heterogenous class of conditions caused by brain tissue dysfunction due to abnormalities of brain structure or secondary to alterations of brain neurophysiology or neurochemistry. In all cases, there is a failure of normal metabolic processes in the brain leading to a cognizant loss characterized by impairment of four major areas: 1) orientation; 2) memory; 3) intellectual functions (comprehension, calculation, learning); and 4) judgment. According to the Diagnostic and Statistical Manual of Mental Disorders, Third edition-Revised (DSM-III-R), the essential feature of all organic mental disorders is a psychological or behavioral abnormality associated with transient or permanent dysfunction of the brain. In some cases, the origin of the dysfunction is readily identified with diagnostic tools such as computed tomography (CAT) scanning of the brain, magnetic resonance imaging (MRI) of the brain, or electroencephalography (EEG) which reveals the electrical brain wave patterns. In other cases, it is impossible to identify the underlying abnormality in brain structure or function accounting for the behavioral changes, but an organic cause can be inferred from characteristic physical findings." 5 Robert K. Ausman, M.D., and Dean E. Snyder, J.D., Ausman & Snyder's Medical Library Lawyers Edition § 8:49, at 431-32 (1990). Tinnitus: A sound in one ear or both ears, such as buzzing, ringing, or whistling, occurring without an external stimulus and usually caused by a specific condition, such as an ear infection, the use of certain drugs, a blocked auditory tube or canal, or a head injury. See The American Heritage Dictionary of the English Language 1879 (3rd ed. 1992); see also Stedman's Medical Dictionary 1816 (26th ed. 1995). Posttraumatic Stress Disorder: The essential feature of the disorder is "the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate...The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event, persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, and persistent symptoms of increased arousal....Stimuli associated with the trauma are persistently avoided....The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. These symptoms may include difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived, hypervigilance, and exaggerated startle response. Some individuals report irritability or outbursts of anger or difficulty concentrating or completing tasks." See American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 309.81, at 424-25 (1994).

OBS / OBD useful link: http://books.google.com/books?id=ZRI7AAAAIAAJ&pg=PA289&lpg=PA289&dq=organic+brain+syndrome+veteran&source=bl&ots=BVlKhKq1Vo&sig=opEHl0rve7M9vM5Ya_c50Ykfeng&hl=en&sa=X&ei=265wUPfLA8Xf0gHWnYCYBA&ved=0CBwQ6AEwADgU#v=onepage&q=organic%20brain%20syndrome%20veteran&f=false

I heard that if you are on blood thinner, like coumadin, and it makes your gums bleed from brushing etc. you may be able to get into dental as the bleeding may promote as a seconday condition, ( to the reason you are on blood thinner ), tooth decay or gum disease.

BTW, There's a ton of stuff on hypertension as a cause of cardiac arrhythmias. Just put in a search engine : "hypertension cardiac arrhythmias" and you can see that is the case. ex: Hypertension and cardiac arrhythmias: a review of the epidemiology, pathophysiology and clinical implications. Yiu KH, Tse HF. Source Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. Abstract Hypertension is commonly associated with cardiac arrhythmias in patients with and without concomitant cardiovascular disease. Experimental and epidemiological studies have demonstrated potential links between hypertension and atrial and ventricular arrhythmias, although the underlying pathophysiological mechanism remains unclear. Nonetheless, the importance of hypertension as a cause of atrial and ventricular arrhythmias is not well recognized. In particular, the occurrence of left ventricular hypertrophy is a strong predictor for the development of AF, ventricular ectopy and sudden cardiac death. Recent prospective clinical trials reveal that antihypertensive therapy may delay or prevent the occurrence of cardiac arrhythmias and sudden cardiac death in patients with hypertension. Although antihypertensive agents that block the renin-angiotensin-aldosterone system appear to protect against cardiac arrhythmias, this needs to be confirmed by current ongoing clinical trials.

That's what I thought...and apparently so did the C&P doctor, however, the VA didn't. Question: Having no prior heart problems and after being cleared for active duty my cardiac arrhythmias were discovered while on active duty. If the VA didn't acknowledge that fact and denied the claim, would that constitute a CUE?

I see where your going with that. I also think that when the C&P examiner physician learned that the arrhythmia was first discovered while I was on active duty, he indicated it would be SC'd on that basis alone as I had no prior known history of it. Does that make any difference? VA didn't think so and denied the claim.

Carlie, Thank you for taking the time to better explain it. True, I'm not real clear on what is needed for a CUE....kinda murky. The statement "as likely as not due to CAD" being a 50/50 statement would seem to leave open the door for the possibility that some other condition was equally, ( i.e. 50% ), as likely as not to also be a cause of my cardiac arrhythmias and tacking on the "and not related to hypertension" clause indicates what that other condition is that the doctor had in mind. I don't have CAD which the C&P physician would have found out if he read my medical file he had in his possession, nor was he even asked by the RO anything about CAD. This doctor was also not a cardiologist. Hard to sort the logic of how this doctor worded this opinion out.

Super thanks for the replies. I recognize the value of the IMO, however, as you indicate the doctor's statement is not a CUE, could you please explain why? The way I see it is that since he wrote "as likely as not" that's only a 50/50 statement and one that has nothing to do with my medical condition since I do not have CAD. In any case, doesn't the "as likely as not" CAD statement also allow for hypertension being equally as likely?

"If Chapter 35 isn't being paid during breaks, could we then get the child over 18 payment? Seems the VA is setting themselves up for 3 additional claims from every 100% veteran with college age children each year." That's an very interesting concept worthy of more discussion: If the VA isn't paying out Chapter 35 funds during school breaks, why shouldn't the Veteran sponsor get monthly compensation switched back on for the dependent school age child during those breaks? After all, once Chapter 35 funds stop coming in the Veteran or the school age child isn't getting both. In fact, during the school breaks neither the Veteran or the eligible child is getting anything!

Help! I submitted a comp claim for “cardiac arrhythmias” as a secondary condition which was denied after a C&P exam. Need some help interpreting a C&P MD examiner’s statement upon which the denial is based: “Cardiac condition is AS LIKELY AS NOT due to CAD and not due to hypertension.” I read this as a 50/50 statement in which case shouldn't the veteran been given the benefit of the doubt and won the claim? CAD = coronary artery disease. Interestingly enough, my angiogram test results, ( which were available in my medical file and available to the examiner ), done months after the arrhythmia claim was filed showed absolutely no CAD. Obviously, the C&P physician never read my angiography test results! Any thoughts on the examiner’s statement? He was asked to offer a medical opinion on if there was a causal relationship between the arrhythmias and hypertension, ( i.e., high BP which I am SC'd for ), but instead made one based on CAD which I do not have. What the what? Is this enough for a CUE?

Link to see types of ID cards: http://www.cac.mil/uniformed-services-id-card/

Link below has what the ID Card codes mean: http://www.cac.mil/d...nstructions.pdf