free_spirit_etc

"THIS REGULATION ABOUT ONE MEDICAL REPORTS OUT WEIGHTS ANOTHER REPORT IS VERY CONFUSSING. ANYONE HAVE KNOWLEDGE OF THAT RULE?" randylan2, It isn't so much that there is a rule where one medical report outweighs the other one, as that the VA gets to decide whether they consider a report to be probative. If they consider the evidence in favor of granting to be greater than the evidence against granting, the veteran wins. If they consider the evidence to be equally balanced, the veteran gets the benefit of the doubt. If they consider the evidence against the claim to be greater, the veteran is denied. Would it be possible for you to post: 1. Your IMO from your doctor. 2. The opinion from the VA examiner. 3. The last Statement of Case you received. 4. The BVA decision (that includes the remand). If you scan them - be sure to remove personal information. The BVA decision should tell you a lot about what they took into consideration. Did they give any reason they did not consider the private doctor's opinion probative enough to grant the claim? What did they say about his opinion? The denials and remands often give you the keys to winning - once you are able to show them what they say wasn't shown.

Did you say something?

Reporting symptomology might help. But did your doctor write a strong IMO with reasons for his opinion and cite any medical studies? That might help strengthen your claim. Also - did they deny your initial claim for hearing loss (the claim in which you were granted SC for tinnitus)?

Don't panic! You haven't lost yet! In fact, it sounds like you have a very good case. But welcome to the world of "VA-ness" in which they don't always play by the rules that are printed on the box top.

Yes. You should also be given a copy of the new and improved opinion issued by the VA examiner, and so that you can have your private doctor refute anything that is ridiculous. But the aggravating thing is that if the VA opinion is adequate and the private opinion is inadequate - they deny, but if the private opinion is adequate and the VA opinion is inadequate they often remand to give the VA examiner another chance to write a more adequate opinion. It seems basically unfair and adds lots and lots of time to resolving the claim.

I am sure others will come along and give you lots of great advice -- hopefully if she writes a sucky report you will be able to get the exam considered inadequate. But I do want to say I am SO sorry this happened to you. You do not deserve to be treated that way!

I am always amazed that when the private opinion is more probative than the VA opinion, they remand the claim and ask the VA examiner to polish his denial opinion.

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I am heading to the home page now....

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"Filed Claim 4/2011. IHD with ICD , first time ever filed. ...9/2013 DM2 approved 20% presumptive for Herbicide/AO Thailand,DM2 retro back to file date 10/2013 Appeal closed approved at 30% retro to 8/2010 which I think is the correct effective date for Thailand guys and per my 2 years studying this topic." So there rhetoric about how you did not ask for a review until a year after the change is law had nothing whatsoever to do with the effective date of the claim.(Besides the fact that it wasn't even true). Why didn't they just say "The law changed ___. You filed your claim within one year of the change in law. Your effective date ___, the date of the change in law." instead of writing it to sound like you were somehow "at fault" for your effective date....

My husband did a lot of research on veteran's benefits for his Thesis for his Master's in Sociology. For one thing, veteran's benefits are "back-loaded." In essence, the pay is not good, but the promise to take care of you if you are injured is thrown in. So yes, they are earned benefits. For another thing, the VA benefits are responsible for creating a large middle-class in the United States. The VA home loans and the GI bill made college education and home ownership possible for many people for whom those would not have been possible - creating a large middle class. AND a study showed that VA benefits actually help the economy. I remember the study showed that for every dollar that was paid out in VA benefits, three dollars were returned to the economy. So, in essence, VA benefits help more than just veterans.

There is an interesting article on effective dates for IHD here: http://www.attiglawfirm.com/blog/va-benefits/va-disability-benefits-how-to-compute-effective-dates-for-ischemic-heart-disease-and-other-agent-orange-presumptive-conditionsunder-nehmer/

I am not clear on the effective date either. They say in one place that you were diagnosed with IHD in 2001 and had an AICD placed in 2007. But later they said the law was changed August 31, 2010 and that you were diagnosed with the condition in August 2009. It says that since you did not ask for a review until October 2011 - which was more than one year after the change in law, that you are only granted benefits back to August 2010 - when the law changed. But it looks like you had a PENDING CLAIM when the law changed. The claim was filed April 2011 (within one year of the change in law). And the review you asked for (that they said was more than a year after the change in law) was actually a timely filed NOD on the October 2011 decision on a PENDING CLAIM. So I am not getting the part where they said you asked for a review a year past the change in law. Your claim was pending at that time. Since they went back to the date the law changed (August 2010) though they said you filed your claim in April 2011, I am thinking you probably claimed for this condition before and was denied? And you reopened the claim in April 2011?

I like the way this one states it: http://www.va.gov/vetapp12/Files4/1227862.txt "A 100 percent rating requires an automatic implantable cardioverter-defibrillator (AICD) be in place; chronic congestive heart failure; a workload of 3 METs or less resulting in dyspnea, fatigue, angina, or syncope; left ventricular dysfunction with an ejection fraction less than 30 percent; or hospitalization for evaluation and medical therapy for sustained ventricular arrhythmia or for ventricular aneurysmectomy. 38 C.F.R. § 4.118, Diagnostic Code 7011 (2011)."

http://www.va.gov/vetapp11/Files1/1107194.txt "Diagnostic Code 7011 is used for evaluating ventricular arrhythmias and provides that a 100 percent rating is to be assigned for an indefinite period from the date of hospitalization for initial evaluation and medical treatment for sustained ventricular arrhythmias, or following ventricular aneurysmectomy, or following insertion of an automatic implantable cardioverter/defibrillator (AICD). The record shows that the rating for the Veteran's heart disability was increased to 100 percent, effective June 12, 2008, based primarily on the implantation of an AICD. Therefore, the issue on appeal concerns entitlement to a rating for the disability greater than 60 percent prior to June 12, 2008."

http://www.va.gov/vetapp13/Files3/1325327.txt "Diagnostic Code 7011 is used for evaluating ventricular arrhythmias and provides that a 100 percent rating is to be assigned for an indefinite period from the date of hospitalization for initial evaluation and medical treatment for sustained ventricular arrhythmias, or following ventricular aneurysmectomy, or following insertion of an automatic implantable cardioverter/defibrillator (AICD). The record shows that the rating for the Veteran's heart disability was increased to 100 percent, effective June 12, 2008, based primarily on the implantation of an AICD. The Board finds that the criteria for a 100 percent rating are met as of April 11, 2006. ..... In light of the June 2008 implantation of an AICD, the Board has also considered rating the disability under DC 7016 (sustained ventricular arrhythmias). However, prior to April 11, 2006, the evidence does not show that the Veteran was hospitalized for evaluation and treatment of sustained ventricular arrhythmias, as required for a 100 percent rating under this diagnostic code. Therefore, an earlier effective date is not warranted on this basis.... ....ORDER An effective date of April 11, 2006, and no earlier, for the 100 percent rating for service-connected residuals of rheumatic fever with myocarditis, to include coronary artery disease, status post coronary artery bypass, status post AICD implantation with congestive heart failure, is granted, subject to the laws and regulations governing the award of monetary benefits."

I thought they said they went back to 2010 because that was the time there was a change in law (Re: AO Thailand - adding Ischemic Heart Disease as an AO presumtpive condition). And the cardiac pacemakers (rated under 7018) says 100% two months, but the AICD (rated under 7011) says 100% indefinitely.

Victor, I know the feeling. I feel my case is very strong - and it would be if the VA plays fair. But they don't always. So I vacillate between thinking I have a strong case, and then worrying about if there is one sentence in my IMOs that the VA will pick out and distort and act like that is the whole issue. They make us worry about tiny little details that shouldn't matter. And I have not been through anything NEAR the crap you have. So the VA has totally earned your distrust. But it sounds like you have a VERY strong case, and your attorney will be able to expose the C&P opinion for what it was - complete and total nonsense. And having an attorney is sending a very strong message to the VA that you are not going away this time. They will know that they can just give you some BS denial and send you on your way now. And the BVA will actually look at your medical board records. As far as the redacted statement - I would be more worried about it if that was the reason your claim was denied. But if not, it might be best to let sleeping dogs lie. As far as VA examiners who specialize in whipping up BS to deny veteran's claims -- I am appalled by the practice. It would be one thing if they honestly believed what they wrote. But I am convinced that many times they don't. They know full well that the veteran is entitled to benefits, but they have sold their soul to write opinions to deny them.

I answered in the other thread... The decision clearly says you are granted service connection for IHD. And it clearly says the IHD DBQ shows you AICD. So it is odd that they didn't follow 7018 Implantable cardiac pacemakers: Note: Evaluate implantable Cardioverter-Defibrillators (AICD’s) under DC 7011. 7011 Ventricular arrhythmias (sustained): For indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for indefinite period from date of hospital admission for ventricular aneurysmectomy, or; with an automatic implantable Cardioverter- Defibrillator (AICD) in place........................................................................... 100

I wonder if they missed this part: 7018 Implantable cardiac pacemakers: For two months following hospital admission for implantation or reimplantation................................................................................................... 100 Thereafter: Evaluate as supraventricular arrhythmias (DC 7010), ventricular arrhythmias (DC 7011), or atrioventricular block (DC 7015). Minimum............................................................................................................. 10 Note: Evaluate implantable Cardioverter-Defibrillators (AICD’s) under DC 7011.

7011 Ventricular arrhythmias (sustained): For indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for indefinite period from date of hospital admission for ventricular aneurysmectomy, or; with an automatic implantable Cardioverter- Defibrillator (AICD) in place........................................................................... 100

Big hug!!!!!

It is up to 118 signatures now.