free_spirit_etc

In our area, you fill out an application for an ADA card - show them a copy of a Social Security award letter (I am not sure about veterans) and they give you a ADA card. With that you can get tickets and passes for half price. If a doctor signs that you need a NONfixed route service (door to door) at least SOMETIMES - (i.e. like to go to a doctor in the city) - you get a paratransit card - and with that you can ride the FIXED routes for free. Odd that you are required to show that you can't always ride the fixed route bus - in order to get to ride it for free. Free

Thanks cowgirl! I didn't know about the organizational charts. These were IRIS. I was considering asking a Congressman to do an inquiry. I am running into the SAME run-around with my request for an extension of time to submit evidence (due to them taking so long to send me the file). I asked over and over. Finally got a reponse that they were sending my string of emails to the raters to have them check the regulations - to see if a request could be granted. However, I did not hear back from them - and my one year deadline from the date they requested the evidence was June 7. I sent evidence by certified mail June 6. The letter I sent - AND the follow up IRIS - again indicated I had been ASKING for an extension, but had not been informed if it had been granted. The extension is needed for the IMO - as I didn't get the medical records. But I DID send in evidence within the one year deadline. Then they just responded that I MENTIONED a request for an extension of time (As if I hadn't even mentioned it before), told me I need to let them know what claim I am submitting evidence for - and informed me that the only OPEN claim was for my burial benefits. I HOPE they consider the burial claim open - since they lost the claim forms. But regardless of if they gave me an extension or not - I DID submit evidence WITHIN the one year granted after receiving the VCAA letter. So that claim SHOULD still be pending. So I was thinking of asking for a Congressional Inquiry - and explain to the Congressman that I had requested extensions because the VA took almost a year to send me the copy of the file, but also let him / her know I DID submit evidence. Maybe that way I could get an answer in writing - acknowledging my open claim - so they can't act like it isn't open. I can also have them inquire as the the rest of the medical report - and the discharge physical. Below - the IRIS on the extension requests: 05/09/2008 I am following up on previous inquiries Inquiry: xxxx and Inquiry: xxxx I was following up on my previous requests for: 1. A copy of my husband's C-file 2. A copy of the medical opinion referenced in the November 2007 denial. We first requested the C-file in August 10, 2006. However, we did not receive it prior to my husband's February 5, 2007 death. I requested a copy again on June 14, 2007. I submitted a limited request early this year for a copy of the medical opinion. Could you inform me when I might expect to receive these? Also, I am requesting an extension beyond the one year time frame to submit evidence in support of my claim, as I have been waiting for close to a year to recieve the requested medical records from the VA. Thank you, Response (Department of Veterans Affairs) 05/09/2008 Dear Mrs. xxx: We mailed you a copy of your husband's entire claims file on 3-03-08, all 4 volumes, based on a request we received 2-29-08. If you did not receive these records, please let us know and be sure to verify the address that you want them mailed to. 05/09/2008 I did not receive any package or letter from the Department of Veteran's Affairs in respect to the C-file. I sent an IRIS follow up to my request on Feb. 26, 2008 - and received a response on 2-29-2008 that I would receive the physical first and that there would be a delay in getting the rest of the C-file. But at this point, I have not received either. The last thing I have received from the VA in the mail was the letter informing me there would be a delay in processing my request for burial benefits. Response (Department of Veterans Affairs) 05/13/2008 Dear Mrs. xxx The Privacy Officer will send you another copy of the file. 05/21/2008 Could you tell me approximately when they intend to send the file? I have been needing copies of the file in order to obtain an Independent Medical Opinion for the claims. And again, I am requesting an extension beyond the one year time frame to submit evidence in support of my claim, due to the length of time it is taking for me to get a copy of his file,in order that I might submit such evidence. 05/22/2008 Ma'am, I wanted to let you know I received the copy of the C-file in the mail today (May 22, 2008). Thank you very much. However, again, it will be very difficult for me to be able to obtain a medical opinion by the one year deadline at this point, and I request an extension of time to submit evidence in support of my claim. Response (Department of Veterans Affairs) 05/27/2008 Dear Mrs. xxx: We printed out your email string and sent to the claims department showing your request for an extension of your time to submit evidence. The claims department will review the regulations to see if an extension can be granted. 06/08/2008 I sent a copy of the VAF 119 that looks like the medical opinion the denial letter is referring to. I sent it by certified mail receipt number xxxx on June 6, 2008. ... I additionally sent addditional evidence in support of my claim, including .... I additionally sent evidence the VA requested regarding my son - including his Birth Certificate and statements from physcians indicating that he was disabled prior to the age of 18, and continues to be so. I received a call from the VA Friday informing me that the claim for burial benefits I submitted cannot be found, and asking me to re-submit my burial claim. I will be resubmitting the claim in the near future. I have not received any notification in regard to whether my request for an extension of time to submit additional evidence will be granted. I am in the process of obtaining an Independent Medical Opinion in support of my claim. As the medical records were neccessary to submit to a doctor, in order for him to issue such an opinion - I had to wait until I received the records before seeking an IMO. Response (Department of Veterans Affairs) 06/16/2008 Dear Mrs. xxx With regard to your request for copies of records, we must hve this request over you written signature. You mentioned a request to have additional time to submit evidence. Please clarify what claim you are submitting evidence for. At this time, the only claim we have pending is your burial claim. If you plan to file an appeal, your Notice of Disagreement must be received in our office within one year of the date of notification of the decision you are appealing. You don't have to submit all evidence at that time you submit your NOD, but you must submit the Notice of Disagreement.

05/28/2008 Thank you for checking on that and thank you for sending me a Copy of my husband’s C-file. I previously requested a copy of the Medical Opinion dated October 19, 2007 that the Rating Decision dated October 22, 2007 indicates was evidence reviewed in making the decision. I am not finding a copy of such Opinion in my husband’s C-file. The closest thing I can find is a Medical Opinion that is written on a Report of Contact (Form 119). However, the copy of the report I received does not indicate the date it was written. The date MAY be on the second page, as the page I DID receive has (Over) written on the bottom. As I only received a copy of the first page of this report, would it be possible for me to receive a copy of the remainder of this report? Also, is it possible that the report the October 22, 2007 decision refers to was actually written in October 2007, rather than October 19, 2006? The partial report I did receive appears that it was written in response to the Request for a Medical Opinion indicated in the file. This form also does not have a date, but the fact that it is asking for an opinion in regard to entitlement for benefits due to the veteran at the time of death would indicate the opinion was requested AFTER my husband’s February 2007 death. I would like to request to be sent the remainder of the report, as I only received the first page of the report. I would also like to find out if this is the report the October 22, 2007 decision is referring to. If not, I would still like to receive a copy of the Medical Opinion dated October 19, 2007 that the VA used as evidence in deciding my claim. 06/03/2008 01:31 PM We have provided all information from Mr. Xxx claim file. Could you forward a copy of the VAF 119 that you currently have and we might be able to do further research. 06/08/2008 03:37 PM I sent a copy of the VAF 119 that looks like the medical opinion the denial letter is referring to. I sent it by certified mail receipt number xxxx on June 6, 2008. 06/16/2008 09:23 AM With regard to your request for copies of records, we must hve this request over you written signature. 06/16/2008 12:06 PM Could you tell me if you did find the other side of the doctor opinion letter that was written on the other side of the VAF 119? I indicated that I did not get the second page to that in the copy of the C-file I received on the 05/28/2008 post on this thread, and you asked me to forward a copy of the report to help with your research. I would like to know if the second page of the report was located. If I am required to submit another written signed request to get the second page of the report, I will do so. However, I would like to know if the second page has been located (or actually, as the page I received said “over” at the bottom of the page, it is most likely the back page of that report, rather than a second page of the original). I would additionally like to know if this is the October 16, 2006 medical opinion the adjudicator was referring to in the October 22, 2007 notice. 06/20/2008 10:14 AM To be able to have someone review the file for that particular VAF119, Please provide us with the date on the VAF119 and we will someone review the file for the back page. AAAAAAAAAAAGGGGGGGGGGGGGGGGGGGGGHHHHHHHHHHHHHHHHHHHHH!!!! Free

But would his records even BE at the National Record Center? Is still think it is horrid that the Record Center sends the orginals to the VA, as much as they lose things. We tried to get copies of my husband's records from the NRC - and got a response that the were in the possession of the VA. Free

Yeah.. I sure agree with you. I sure don't have high frequency hearing loss. I can hear dog whistles. I didn't know people aren't supposed to hear them. I blew on one - and OUCH -- what a horrid squealing sound they make... Seems like tinnitus would be higher than zero percent. I fail to understand how a person can have ringing, buzzing, or anything else going on in their head - and it NOT affect them. I also think my husband's neck injury should have been granted and rated at AT LEAST zero percent - since he had an in service injury, complaint of pain, and a finding of something on the disk plates in the x-ray that correlated with where he was complaining about the pain. Of course, the first C&P stated he had an injury in the SMR's - but that the x-ray showed no problem. The second C&P said they found a SLIGHT problem on the x-ray - but THAT examiner didn't find the injury documented in the SMR's. So each one missed the connection - one by not finding a current disability - and the next one by finding the current disability , but not finding the injury in the SMR. Seems like he could have just READ the first C&P and noted that the FIRST C&P had FOUND it in the SMR -- or maybe even READ the SMR's until he FOUND it. Anyway - it was probably a CUE - but as a widow I don't think I can raise that as a CUE, as he had not raised it in his lifetime. I STILL think that an inferred claim for an INCREASED rating could come into play with it though. He WAS granted SC for arthritis. Though that claim was for the lower back - the fact that he had continuously ALSO complained of pain in his NECK, and the fact that the headache C&P indicated some of his headaches were caused by the arthritis in his NECK - and the fact that the doctor included an X_RAY of his neck and CIRCLED the PLACE that was CAUSING the pain - which was the same dang place they said had a SLIGHT problem in 2001 - and the same dang place he told them hurt when he RETIRED in 1998 (though they couldn't find a "current" disability on the x-ray) - I think that might be able to be considered an INFERRED claim for an INCREASED rating for ARTHRITIS - in that it was now affecting ANOTHER joint that had an IN SERVICE injury. I will still have to check that out a bit - for the accrued benefits part of my claim -- and I think I will claim it - if for no other reason than, even if it gets denied -- I will still get to state "He kept TELLING you his neck HURT!!! And here is x-ray PROOF that it DID hurt!" Even if they deny me on some legal technical thing on inferred claims - at least I will be able to stand up for him, and stand up for his integrity - and say "He told you his neck hurt. He is not a liar." He did not really have much cancer pain, but boy did his neck hurt. At least with the cancer he was able to get morphine to take - which he took for his neck. It just ticks me off that even when he was dying of cancer, his complaint was how much his neck hurt - and the VA had never acknowledged it as a SC injury. Free

Thanks Cowgirl. My husband got a discharge physical. He actually does have a note in his chronological record of care that one was done and the form was completed. But the actual physical and form is missing. The dental care link is also interesting. My husband filed for his one time treatment - for dental CARE - at the time he retired. The RO denied. Said he had no dental injuries. My husband appealed - said he wasn't applying for compensation - he was applying for TREATMENT. Waited and waited. His claim finally got to the BVA - but his file was missing the DD-214. So the BVA remanded - Didn't consider his claim until the RO put the DD214 in his file. Went back to the BVA - the BVA said - he isn't asking for compensation - he is asking for TREATMENT - so they remanded it again. The RO had a dental exam done - said they referred him for dental treatment - and sends back to BVA. BVA decided it looked like he might have an INJURY - so remanded back to the RO to see if he has a compensable claim. Meanwhile - he gets a letter from whomever the RO passed the buck to on the dental treatment - that tells him he is not eligible for it because he has no compensable dental condition. The letter was just from a dental clinic or something - NO "decision" was made by RO or BVA (except the RO's denials). Gets BACK to the BVA -- (by now it was 2004 - SIX YEARS past his retirement). The BVA denies the compensation that my husband never applied for - and said their decision does NOT bar him from treatment - Yet they STILL didn't make a DECISION to grant or deny treatment. With 28 years in the military - most of his conditions either started or worsened in the military. He retired in 1998 - applied for his one time dental treatment on retirement. He died in 2007 and a decision had still NOT been made as to whether he got the treatment or not - though his claim for it bounced back and forth between the RO and BVA for YEARS. Free

Yes. Thanks alot! I got quite a bit out of the other thread also. I had been trying to understand how my husband got a zero percent rating for some conditions - because they existed, but were not disabling - but yet was denied service connection for another because it was not considered a "current disability." Still trying to make sense out of some of that stuff. But I do understand this part a lot better. Free

Under 3.157 is a claim that is disallowed / denied for the reason that the disability was not compensable in degree... - does that mean service connection was denied because they couldn't find a "current" disability? Or does that mean that the vet was GRANTED SC - but at zero percent - and thus the claim was granted, but compensation denied? Free

I have several vets records in my husband's C-file. If I run across any discharge physicals from 1988 with an enlarged heart - I will let you know. I IRISed the RO and asked them what I should do with the medical records of OTHER vets that were in my husband's C-file. They didn't respond to that question. Free

No. Not yet. But I think I will need to - especially since I kept asking for an extension to send evidence - and they never denied or granted it - just said they would check their regulations - and so I sent what I had ON TIME - and now they have no idea why I sent evidence - as they say my claim is not pending. Trying to get Social Security tamed a bit first - and then will have the 67 hours a day it takes to keep up with the VA. --Oh..and thanks Wings - for the link -- gonna read up on that. Free

That's interesting. My husband's lung cancer was found (slow growing tumor - 3.1 cm) a little less than 2 years post retirement. The only TWO things I really needed from his C-file were his discharge physical and the copy of the medical opinion. There is no discharge physical - and only 1/2 the medical opinion. Geez. It also didn't make sense to me that his neck claim and his right shoulder claim were denied - back when he first filed. The SMRs showed cervical injury - but the VA couldn't find anything significantly wrong with his neck on the x-rays. The x-rays on the appeal showed a slight problem - but they didn't give him zero percent -they denied SC on the basis he didn't have a current disability. But then when they evaluated him for headaches - the C&P doctor gave the headaches two causes. 1. Chronic sinutitis - which the doctor indicated had been diagnosed in service - both through recurrent treatment and x-rays. 2. Cervical problem - which the doctor indicated he was treated for the strain in his smr's - and the doctor took x-rays - which showed significant problems in the SAME disks that had shown a slight problem (therefore not a current disability - according to the VA) as before. To me it was clear that the x-rays finally showed the pain he kept reporting. The VA denied the claim as his headaches were not an undiagnosed illness. And I couldn't understand the shoulder claim. He filled out the claim BEFORE retirement. So I would imagine as he was claiming for his shoulder - he would make sure it was addressed in the discharge physical. But the VA said there was NOTHING in his SMR's - and though they admitted his shoulder was injured - they said it couldn't be determined when it happened - like tons of time had passed or something. No - he claimed it AT discharge. If he spent over 28 years in the service and he claimed his shoulder hurt AT discharge - to both the VA - and I would assume on the discharge physical - where do they THINK he hurt his shoulder? I am not sure the cancer would have been detected at discharge. But those missing discharge physicals let them deny lots of claims. Free

I am not sure of the C&P question. I think it should be, but I would imagine it would not be - because they are not "treating" you, they are merely examining you and writing an opinion. But then, again, if they misdiagnose you - and cause you to not seek medical care or treatment for conditions they say you don't have - that could very well fall within the realm of negligence. Except for the lung cancer C&P - I would have to say many of the C&Ps my husband got were pretty thorough and pretty intense. From the reports it looks like he did have some pretty good doctors on them sometimes. However, the RO didn't go by the C&P's on some of them. The doctor clearly stated, he doesn't have ___, but his symptoms are caused by ___. And then they would cite his SMR's - to SHOW that it started in service. The SOC would just tell my husband - the doctor reported you did not have ___(a) - and didn't even mention B. I read a C&P guideline that said the doctors were not supposed to state their opinion on whether it was more likely than not connected to the service. It is more like they are supposed to use some secret code - so the RO will know they THOUGHT that - but they aren't supposed to come right out a SAY it - because, of course, lay people with little knowledge of medical conditions are supposed to determine that - NOT the doctors with a specialty in the field. I can imagine that filing for PTSD would be a horrid experience. It would cause you to take all the stuff that happened, all the feelings, all the experiences, all the affects, into one coherent "whole" - that could be pretty overwhelming. To have to do that - and then have the VA blow it off with an "Oh well...." or suggest that you are lying, or disregard what you have said --that would be totally horrid. Somewhat similar to women not reporting rape because of what they are put through when they report it...being victimized over and over and over again. The VA likes to act like everyone just tries to claim PTSD - and that many of the claims shouldn't be taken seriously. However, I think it takes a very strong person to go through what they have to go through to claim it. I wonder how many walking wounded are out there - carrying the burden of the invisible wounds with them every day. The VA, of all people, needs to learn how to "see" the invisible wounds. Free

Nope. I can't request a smoker friendly doctor. They don't "shop" opinions. They send your file to one of their doctors and request an opinion. I would think that most often, if you are paying $2,900 for an opinion, you are seeking an opinion in SUPPORT of your position. I would not ask that a doctor write an opinion that was not in line with what they truely believe. But I would also have a problem with paying a doctor $2,900 to write an opinion AGAINST my claim, or to even fail to write an opinion, because of the smoking. I do know that many doctors DO still consider other factors, especially asbestos exposure - along with smoking. However, other doctors, once they see smoking - that's it. Sole cause. Nothing else. Case closed. I do not want to risk $2,900 on the chance that I might get a doctor who will at least CONSIDER contributing factors - or at least CONSIDER when the cancer most likely started - even though my husband smoked. Free

When I didn't get the copy of the C-file I requested last June by this May - I followed up and also asked for an extension of time to submit evidence - as the one year delay in getting the C-file affected my ability to submit evidence (especially an IMO). I was sent the C-file immeditately - and they did say they had also mailed a copy in March (that I did not receive). It surprised me if they HAD mailed it in March, that they would mail it out AGAIN within a couple days of my asking. I did get the C-file, but I kept asking AGAIN through IRIS for an extension of time to submit evidence, as again, it would be hard to meet the one year deadline (June 7 VCAA notice). The IRIS reponse said they had printed out the email string and submitted it to claims - to check the regulation to see if I could be granted an extension. I never heard from them. I also am STILL trying to get the second page to the medical opinion they used to deny the claim in November. (The first page says "Over" at the bottom - so I am assuming it is on the BACK of that page). They asked me to send them a copy of what I DID have (as far as that medical report)to help them research what I am looking for. On June 6 (one day before the June 7 deadline) I sent in some evidence, sent the copy of the medical report I am trying to get the rest of, and notified them that I had NOT heard a response to my request for an extension. I also IRISed them and told them I had sent the evidence, etc - gave the certified mail receipt number, and again asked about the extension for an IMO. (and the REST of the medical report). I received a response today: "With regard to your request for copies of records, we must have this request over you written signature. You mentioned a request to have additional time to submit evidence. Please clarify what claim you are submitting evidence for. At this time, the only claim we have pending is your burial claim. If you plan to file an appeal, your Notice of Disagreement must be received in our office within one year of the date of notification of the decision you are appealing. You don't have to submit all evidence at that time you submit your NOD, but you must submit the Notice of Disagreement." So I have to SIGN ANOTHER request to get a copy of the SECOND page of the medical opinion that they have not even verified they have yet. Also - they are saying I do not have a pending DIC claim. The only claim pending is the burial claim (which they have lost the form and I have to resubmit). At this point they are telling me to submit an NOD on the DIC. I filed May 2007. Received a denial November 2007. But if they decide it before the one year I have to submit evidence is up, don't they have to readjudicate it if I submit evidence within that year? If I sent evidence by certified mail June 6, 2008 in response to the June 7, 2007 VCAA letter - isn't that within the one year? Does anyone know about any regulations about extending deadlines for submitting evidence if you are waiting on the medical records from the VA? I guess I could just move into the next phase with an NOD - and get my statement of case. I think Chicago said it takes about a year to get an SOC after filing an NOD. So maybe I should start moving in that direction, rather than to ask for another original decision, based on new evidence being sent in one year. But it seems like once you get an SOC, no one at the RO reads beyond that. So the inital SOC controls the Supplemental SOC (i.e. they are the same thing with a few extra lines). I also don't want to get all the way to the BVA - and have them decide I didn't get my claim readjudicated though I submitted additional evidence within the one year, so I missed a step in the due process - and have them remand it to start ALL OVER - to grant me all the steps of the due process (and add about 5 years). Any ideas? Free

I kind of got what Carlie was saying (I think) that no matter what the VA does to you - that can't be considered a "stressor" that "caused" anything. However, I sometimes wonder how much they hold the veteran's own functioning ability with THEM against the veteran in psych claims. For instance, they may think if you build a good case, or create a strong argument -that means you can function well at work. Or if you are that smart, you must not be disabled. That is a common misconception with many mental disorders, people think they HAVE to affect your intelligence to be considered "disabling." Not so. You CAN be extremely intelligent AND have a disabling mental condition. Free

Since the VA went back to 1992 on your effective date - because of SMR's not being in your file in 1992 - it would look like they should go back to pre-1983. I am not clear on why they are not going back to the date you filed the claim, where they found you were eligible for the non-service connected pension. That should now be considered a claim also for compensation for the anxiety / headaches (and the SMR's that weren't available in 1992 - weren't available back then either. §3.151 Claims for disability benefits. (a) General. A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by VA. (38 U.S.C. 5101(a)). A claim by a veteran for compensation may be considered to be a claim for pension; and a claim by a veteran for pension may be considered to be a claim for compensation. The greater benefit will be awarded, unless the claimant specifically elects the lesser benefit.

I found this -- about the Privacy Act and Psych Records - I can't really see how the VA can keep the psych reports from patients - except maybe in being a government agency - they might be exempt from the rules that apply to mere mortals http://pn.psychiatryonline.org/cgi/content/full/43/8/24 Psychiatr News April 18, 2008 Volume 43, Number 8, page 24 © 2008 American Psychiatric Association Psychiatric Practice & Managed Care Do Patients Have Access to Therapy or Personal Notes? Donna Vanderpool, M.B.A., J.D. Donna Vanderpool, M.B.A., J.D., is the assistant vice president for risk management at PRMS Inc. The HIPAA Privacy Rule and state law govern whether patients have access to psychotherapy notes. But understanding which one takes precedence and when is important to avoid falling into a legal morass. The Privacy Rule under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was created to provide standards for protecting the confidentiality of patients' individually identifiable health information. While the Privacy Rule gives patients a right to access their medical records, it permits psychiatrists who are covered by HIPAA to deny patients access to strictly defined psychotherapy notes. It's important to note, however, that under HIPAA psychiatrists are obligated to release these same notes to a third party if the patient requests that this be done. Moreover, laws in some states may allow patients firsthand access to those same psychotherapy notes, and such state laws continue to apply, notwithstanding HIPAA. Many Fine Points to Consider HIPAA's Privacy Rule permits covered psychiatrists who choose to keep psychotherapy notes to deny patients access to those notes. The Privacy Rule definition of psychotherapy notes is "notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's record." The following information is considered part of the medical record and is excluded from the definition of psychotherapy notes: medication prescribing and monitoring; counseling session start and stop times; modalities and frequencies of treatment furnished; results of clinical tests; and any summary of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date. According to the Department of Health and Human Services (HHS), the agency that enforces the Privacy Rule, psychotherapy notes are limited to information that psychiatrists keep separate for their own purpose and that contains sensitive information relevant to no one else. HHS equates psychotherapy notes with process notes. It is important to keep in mind, however, that although the Privacy Rule allows psychiatrists to deny patients access to psychotherapy notes, it also states that patients may authorize the release of their psychotherapy notes to a third party such as an attorney, another provider, or even a friend, and that psychiatrists must comply with this authorization. State laws differ regarding patient access to their medical records. In some states, patients have access to the entire record; other states prevent patients from accessing therapists' "personal notes" (or similar term). Additionally, some state laws may have other requirements for restrictions on the use and disclosure of these "personal notes." The issue of which law to follow (state or federal) will ultimately be determined by the courts. Until this issue has been resolved, the following provides a starting point for analyzing questions about patient access to psychotherapy notes. Because this is a complex and developing area of the law, an attorney should be consulted for specific legal advice. Patients may be entitled to access psychotherapy notes as defined by the Privacy Rule and/or personal notes (or similar term) as defined under state law The legal concept of preemption basically means that the federal Privacy Rule preempts (trumps) a contrary state law and must be followed, unless the state law is "more stringent." More stringent state laws have been defined to include those that grant patients greater rights of access to the record. So, state laws granting greater rights of access to records (including psychotherapy notes, as defined by the Privacy Rule), will not be preempted and are to be followed. In other words, if state law does not deny patients access to the notes, state law provides greater rights of access to the patient, and state law will apply. This is true even if a psychiatrist covered by HIPAA keeps separate psychotherapy notes that fit the Privacy Rule's definition, because patients have access to those notes under state law, regardless of the Privacy Rule's restrictions. In contrast, if state law does deny or restrict patients from accessing personal notes, but those notes do not fit the Privacy Rule's definition of psychotherapy notes (that is, the notes are not kept separate from the rest of the medical record or the notes are kept separate but contain information relevant to other providers), then the Privacy Rule's provision requiring release of the entire record to the patient applies. That is, the exception under the Privacy Rule whereby patients may be denied access to their psychotherapy notes does not apply because the notes are not "psychotherapy notes" as defined by the Privacy Rule. State law restricting patients from accessing notes does not apply because the Privacy Rule's provisions provide greater rights of access for the patient. However, if the personal notes do fit the definition of psychotherapy notes under the Privacy Rule, then patient access to the notes can be denied, since the state and federal laws are consistent in terms of restricting patient access.

I was looking for some of the information - because I looked it up after the VA had to read my husband's psychological evaluation before deciding if he could have it. I thought that was horrid. But they were saying. "Well..they read it and get upset..." I thought - Well, YEAH..if you write a bunch of crap I bet they do.." Anyway - I looked up some stuff because I thought it was a definate violation of patient rights, but apparently psych patients don't have the SAME rights as other patients. Now I could see if someone was in there totally violent and beating on people and all. And maybe that is why they passed the law / regulation - whatever it is. But that gives the VA a lot of power to not give the reports to ANY patient, and act like they are acting in the person's best interest. So there is no telling what they give you and what they keep just to themselves - all in the pretense of protecting you from knowing about yourself. Geez... and then they wonder why people get paranoid.. I don't think it is just the VA - Not sure - there seems to be a different standard for psych patients and psych records... Come to think of it - my husband was NOT a psych patient. He had ONE psych evaluation as part of his workup for the Fatigue C&P. And they still had to read the dang thing to see if he could have it. Had it said anything they thought MIGHT upset him - they could have kept it from him. And actually - had we NOT asked - Is this EVERYTHING?- we wouldn't have even known about it. Anyway - Here is the reference for the SOC - on how the VA doesn't have to tell YOU every reason they deny you - if they can justify that they are "protecting" you from things you should not know. It does not specifically mention psych claims - so it is even broader than that - but psych claims can certainly fall into this in a system where they have to read your psych eval before deciding if you can SEE it. I remember I read this when Betty was having so many problems - and I kept asking her - are you SURE they are giving you the REAL SOC??? I thought maybe they were just giving her part of it - because so much wasn't making sense. Here is the part from M-21-1MR M21-1MR, Part I, Chapter 5, Section D d. Matters Not to Be Disclosed in an SOC Do not include matters in an SOC of a sensitive nature that would be injurious to the physical or mental health of the appellant, including · matters considered by responsible medical authority to be injurious to the appellant’s health · references to · a prognosis of “poor” or “terminal,” or · conditions of misconduct, unless the specific misconduct is relevant to the issue, or · discussions of evidence in a way that might provoke feelings of hostility, resentment, or rejection on the part of the appellant or his/her family. e. Disclosing Information to the Appellant’s Representative All matters can be disclosed to the appellant’s designated representative unless disclosure to the representative would be as harmful as if made to the appellant. Therefore, in some cases, two different versions of the SOC may be prepared when it is permissible to furnish full information to the representative. Use the table below when disclosing information to the appellant’s representative. · If the appellant … has a representative And the … matters omitted from the appellant’s SOC may be released to his/her representative Then … prepare a separate SOC for the appellant and omit matters not to be disclosed · furnish copies of the edited SOC to both the representative and the appellant, and · annotate the representative’s copy and the original SOC (full statement) to show what portions were deleted from the copy sent to the appellant. Note: Annotate the statements to the effect that the material omitted from the appellant’s SOC is not to be revealed to him/her. · If the appellant … has a representative And the …matters omitted from the appellant’s SOC may not be released to his/her representative, because the information might provoke feelings of hostility, resentment, or rejection on the part of the representative Then … prepare a modified statement omitting these matters · furnish copies of the edited SOC to the appellant and his/her representative, and annotate the original SOC to show that matters not to be disclosed to the appellant or his/her representative were omitted from their copies. · If the appellant does not have a representative And the …SOC contains matters not to be disclosed to the appellant Then … eliminate those specific references from the SOC that will be furnished to the appellant, and annotate the original SOC (full statement) to show what portions were deleted from the copy sent to the appellant.

Even medical records - they have more records than those that are in your records. It seems like they have records and records... One example - We went to the VA to get my husbands records. He was never treated at the VA - but he got his C&Ps there. I was looking for his C&P for lung cancer. Didn't make sense. My husband kept swearing he NEVER HAD a C&P for lung cancer. But the SOC went on and on - "you told the examiner this. You told the examiner that.." It was there. So I told him - you DID have a C&P for it. But then, looked - it is written on an EXAM form - LOOKS like an EXAM, but there was nothing on the report that was NOT in what my husband had WRITTEN to the VA - and it said the doctor was supposed to give an opinion after reviewing the record. That's all. They made it kind of sorta LOOK like an exam - but the doctor NEVER examined him. Now surely they who have more forms than they know what to do with - could certainly come up with a FORM for a MEDICAL OPINION - so it would be CLEAR that it was NOT an exam. The RO TOOK it as an exam (you told the doctor blahblahblah - NOPE - didn't SEE the guy). Anyway - back to the point. When my husband ASKED - "Is this ALL my records?" A little bit of "well..uhmmm.." started. Well - uhm... there is a psychological exam..but we don't usually GIVE those to the patients - because it COULD upset them... What??????????? Yes. People might get upset if they read their psychological exams..so they don't usually give them to them. He asked for his. They actually had to have someone come and READ it - and make sure there was nothing on it they thought might upset him before he was ALLOWED to have it. I read more about that. It seems like psychological records CAN be kept FROM the patient under the guise of it being "for their own good." I was even reading somewhere that with psych diagnosis they CAN make TWO SOC's - one REAL one - and one they give the vet (that doesn't mention some of the stuff that might "upset" them. Well - how in the WORLD are you supposed to defend your claim - when they are giving you a DIFFERENT SOC than the one they are playing by. I am not sure how often this happens. And your vet rep is supposed to get a REAL copy. But hey! How about providing a FREE ATTORNEY to everyone who has their psych records withheld from them - make sure their rigths are protected - if you take away their right to protect themselves <<<< my idea, not theirs...lol AND - we went to the base to get his post service medical records..signed the papers ... got a stack. But it was just all those little computerized CLIFF NOTES type med records. These are what the military and VA LIKE to use now. It is all computerized. Everyone can just pull it up on a screen. BUT it is mostly check off list kind of stuff.. with a scant bit of "notes. I couldn't believe it. I said "Gee - you had a SURGERY - and it is reduced to A PARAGRAPH!! An ENTIRE surgery!! And all they have documented is ONE PARAGRAPH??? So he went out to the Base - and said - is his most endearing way - "What's this crap???" LOLOLOLOLOL They said - "Oh - we have OTHER records -- like doctors notes - these are just your MEDICAL records -- If you want your DOCTOR NOTES - we will have to get those from the DOCTORS. Well..YEAH.. we really wanted them - because the doctor who had written about the asbestos exposure - who the base attorney said couldn't write us an opinion - told us to come and get HIS NOTES - and maybe they would help. So - my point being - When you ask for ALL your medical records - you THINK you are getting ALL your medical records - but they can have all kinds of OTHER records that they don't CONSIDER your "medical records" (like doctor notes). And here is another scary thing - when the VA requests your records - they most likely request your MEDICAL records - but that doesn't mean they will get doctor notes, etc. But the vet THINKS they got everything. I think THEY should be responsible for KNOWING what is stored where - and getting it all. Had we not been so shocked about the scant crap they gave us - we never would have known there were still other medical records that aren't considered your medical record. And most of our evidence is within THOSE records - NOT on their little Cliff Notes of Medical Care. It just isn't right... Free

My mother got a notice from Social Security telling her that she is dead. Would that qualify you for disability? LOL No. Really. She got a notice to the Estate of ### She said her name and address were stuck OVER the someone else with the same name in a different state. But my mother has lived at the same address for 60 years. It seems like Social Security - of all agencies - should go by you SS nummber - and NOT just the name. Anyway - she is trying to get her NON death straigtened out so they won't stop he check or keep her from getting her medicine. Free

I certainly am not sure about the ratings. The Cardiovascular System top § 4.100 Application of the evaluation criteria for diagnostic codes 7000–7007, 7011, and 7015–7020. top (a) Whether or not cardiac hypertrophy or dilatation (documented by electrocardiogram, echocardiogram, or X-ray) is present and whether or not there is a need for continuous medication must be ascertained in all cases. (<_< Even if the requirement for a 10% (based on the need for continuous medication) or 30% (based on the presence of cardiac hypertrophy or dilatation) evaluation is met, METs testing is required in all cases except: (1) When there is a medical contraindication. (2) When the left ventricular ejection fraction has been measured and is 50% or less. (3) When chronic congestive heart failure is present or there has been more than one episode of congestive heart failure within the past year. (4) When a 100% evaluation can be assigned on another basis. © If left ventricular ejection fraction (LVEF) testing is not of record, evaluate based on the alternative criteria unless the examiner states that the LVEF test is needed in a particular case because the available medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability. [71 FR 52460, Sept. 6, 2006] Diseases of the Heart Rating Note (1): Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it. Note (2): One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 7000 Valvular heart disease (including rheumatic heart disease): During active infection with valvular heart damage and for three months following cessation of therapy for the active infection 100 Thereafter, with valvular heart disease (documented by findings on physical examination and either echocardiogram, Doppler echocardiogram, or cardiac catheterization) resulting in: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electro-cardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 7001 Endocarditis: For three months following cessation of therapy for active infection with cardiac involvement 100 Thereafter, with endocarditis (documented by findings on physical examination and either echocardiogram, Doppler echocardiogram, or cardiac catheterization) resulting in: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 7002 Pericarditis: For three months following cessation of therapy for active infection with cardiac involvement 100 Thereafter, with documented pericarditis resulting in: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electro-cardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 7003 Pericardial adhesions: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electro-cardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 7004 Syphilitic heart disease: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 Note: Evaluate syphilitic aortic aneurysms under DC 7110 (aortic aneurysm). 7005 Arteriosclerotic heart disease (Coronary artery disease): With documented coronary artery disease resulting in: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 Note: If nonservice-connected arteriosclerotic heart disease is superimposed on service-connected valvular or other non-arteriosclerotic heart disease, request a medical opinion as to which condition is causing the current signs and symptoms. 7006 Myocardial infarction: During and for three months following myocardial infarction, documented by laboratory tests 100 Thereafter: With history of documented myocardial infarction, resulting in: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 7007 Hypertensive heart disease: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 7008 Hyperthyroid heart disease: Include as part of the overall evaluation for hyperthyroidism under DC 7900. However, when atrial fibrillation is present, hyperthyroidism may be evaluated either under DC 7900 or under DC 7010 (supraventricular arrhythmia), whichever results in a higher evaluation. 7010 Supraventricular arrhythmias: Paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor 30 Permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor 10 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 Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 Note: A rating of 100 percent shall be assigned from the date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia or for ventricular aneurysmectomy. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. 7015 Atrioventricular block: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication or a pacemaker required 10 Note: Unusual cases of arrhythmia such as atrioventricular block associated with a supraventricular arrhythmia or pathological bradycardia should be submitted to the Director, Compensation and Pension Service. Simple delayed P-R conduction time, in the absence of other evidence of cardiac disease, is not a disability. 7016 Heart valve replacement (prosthesis): For indefinite period following date of hospital admission for valve replacement 100 Thereafter: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 Note: A rating of 100 percent shall be assigned as of the date of hospital admission for valve replacement. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. 7017 Coronary bypass surgery: For three months following hospital admission for surgery 100 Thereafter: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 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. 7019 Cardiac transplantation: For an indefinite period from date of hospital admission for cardiac transplantation 100 Thereafter: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Minimum 30 Note: A rating of 100 percent shall be assigned as of the date of hospital admission for cardiac transplantation. One year following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. 7020 Cardiomyopathy: Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100 More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60 Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30 Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10 Diseases of the Arteries and Veins 7101 Hypertensive vascular disease (hypertension and isolated systolic hypertension): Diastolic pressure predominantly 130 or more 60 Diastolic pressure predominantly 120 or more 40 Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more 20 Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control 10 Note (1): Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. Note (2): Evaluate hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation. Note (3): Evaluate hypertension separately from hypertensive heart disease and other types of heart disease. 7110 Aortic aneurysm: If five centimeters or larger in diameter, or; if symptomatic, or; for indefinite period from date of hospital admission for surgical correction (including any type of graft insertion) 100 Precluding exertion 60 Evaluate residuals of surgical correction according to organ systems affected. Note: A rating of 100 percent shall be assigned as of the date of admission for surgical correction. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. 7111 Aneurysm, any large artery: If symptomatic, or; for indefinite period from date of hospital admission for surgical correction 100 Following surgery: Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of 0.4 or less 100 Claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; persistent coldness of the extremity, one or more deep ischemic ulcers, or ankle/brachial index of 0.5 or less 60 Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less 40 Claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachial index of 0.9 or less 20 Note (1): The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater. Note (2): These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under §4.25), using the bilateral factor, if applicable. Note (3): A rating of 100 percent shall be assigned as of the date of hospital admission for surgical correction. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. 7112 Aneurysm, any small artery: Asymptomatic 0 Note: If symptomatic, evaluate according to body system affected. Following surgery, evaluate residuals under the body system affected. 7113 Arteriovenous fistula, traumatic: With high output heart failure 100 Without heart failure but with enlarged heart, wide pulse pressure, and tachycardia 60 Without cardiac involvement but with edema, stasis dermatitis, and either ulceration or cellulitis: Lower extremity 50 Upper extremity 40 With edema or stasis dermatitis: Lower extremity 30 Upper extremity 20 7114 Arteriosclerosis obliterans: Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of 0.4 or less 100 Claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; either persistent coldness of the extremity or ankle/brachial index of 0.5 or less 60 Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less 40 Claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachial index of 0.9 or less 20 Note (1): The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater. Note (2): Evaluate residuals of aortic and large arterial bypass surgery or arterial graft as arteriosclerosis obliterans. Note (3): These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable. 7115 Thrombo-angiitis obliterans (Buerger's Disease): Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of 0.4 or less 100 Claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; either persistent coldness of the extremity or ankle/brachial index of 0.5 or less 60 Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less 40 Claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachial index of 0.9 or less 20 Note (1): The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater. Note (2): These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable. 7117 Raynaud's syndrome: With two or more digital ulcers plus autoamputation of one or more digits and history of characteristic attacks 100 With two or more digital ulcers and history of characteristic attacks 60 Characteristic attacks occurring at least daily 40 Characteristic attacks occurring four to six times a week 20 Characteristic attacks occurring one to three times a week 10 Note: For purposes of this section, characteristic attacks consist of sequential color changes of the digits of one or more extremities lasting minutes to hours, sometimes with pain and paresthesias, and precipitated by exposure to cold or by emotional upsets. These evaluations are for the disease as a whole, regardless of the number of extremities involved or whether the nose and ears are involved. 7118 Angioneurotic edema: Attacks without laryngeal involvement lasting one to seven days or longer and occurring more than eight times a year, or; attacks with laryngeal involvement of any duration occurring more than twice a year 40 Attacks without laryngeal involvement lasting one to seven days and occurring five to eight times a year, or; attacks with laryngeal involvement of any duration occurring once or twice a year 20 Attacks without laryngeal involvement lasting one to seven days and occurring two to four times a year 10 7119 Erythromelalgia: Characteristic attacks that occur more than once a day, last an average of more than two hours each, respond poorly to treatment, and that restrict most routine daily activities 100 Characteristic attacks that occur more than once a day, last an average of more than two hours each, and respond poorly to treatment, but that do not restrict most routine daily activities 60 Characteristic attacks that occur daily or more often but that respond to treatment 30 Characteristic attacks that occur less than daily but at least three times a week and that respond to treatment 10 Note: For purposes of this section, a characteristic attack of erythromelalgia consists of burning pain in the hands, feet, or both, usually bilateral and symmetrical, with increased skin temperature and redness, occurring at warm ambient temperatures. These evaluations are for the disease as a whole, regardless of the number of extremities involved. 7120 Varicose veins: With the following findings attributed to the effects of varicose veins: Massive board-like edema with constant pain at rest 100 Persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration 60 Persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration 40 Persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema 20 Intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery 10 Asymptomatic palpable or visible varicose veins 0 Note: These evaluations are for involvement of a single extremity. If more than one extremity is involved, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable. 7121 Post-phlebitic syndrome of any etiology: With the following findings attributed to venous disease: Massive board-like edema with constant pain at rest 100 Persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration 60 Persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration 40 Persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema 20 Intermittent edema of extremity or aching and fatigue in leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery 10 Asymptomatic palpable or visible varicose veins 0 Note: These evaluations are for involvement of a single extremity. If more than one extremity is involved, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable. 7122 Cold injury residuals: With the following in affected parts: Arthralgia or other pain, numbness, or cold sensitivity plus two or more of the following: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis) 30 Arthralgia or other pain, numbness, or cold sensitivity plus tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punched out lesions, or osteoarthritis) 20 Arthralgia or other pain, numbness, or cold sensitivity 10 Note (1): Separately evaluate amputations of fingers or toes, and complications such as squamous cell carcinoma at the site of a cold injury scar or peripheral neuropathy, under other diagnostic codes. Separately evaluate other disabilities that have been diagnosed as the residual effects of cold injury, such as Raynaud's phenomenon, muscle atrophy, etc., unless they are used to support an evaluation under diagnostic code 7122. Note (2): Evaluate each affected part (e.g., hand, foot, ear, nose) separately and combine the ratings in accordance with §§4.25 and 4.26. 7123 Soft tissue sarcoma (of vascular origin) 100 Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals. (Authority: 38 U.S.C. 1155) [62 FR 65219, Dec. 11, 1997, as amended at 63 FR 37779, July 14, 1998; 71 FR52460, Sept. 6, 2006]

I don't think I have ever met anyone with cancer who the cancer did not in some way affect their mental condition. Free

Nope. They just tell me I already have everything that is in hs file. Heck! I am STILL trying to get the second page of a medical opinion that was used to deny my claim. The opinion I got is just written on a Report of Contact VA form. No name. No date. Says (Over) at the bottom - but there is NO page 2 in the records. I am begining to think the discharge physical was NEVER in his file. The C&P's mention that my HUSBAND states he reported such and such at his discharge physical -but they don't DIRECTLY report anything that was on the discharge physical. The ONLY doctor that refers directly to the discharge physical is the doctor on the lung cancer claim. This is the same doctor who also said my husband had no unique conditions that can be attributed to asbestos (though his post service records mention Interstitial Lung Disease in AT LEAST 30 records, including the pathology report that diagnosed it - this doctor didn't notice ANY of THOSE 30 records - but focused on the emphasematous changes that was reported ONE time - to say his cancer was caused by smoking) and the same doctor who said my husband had NO residuals of his cancer (though he didn't even EXAMINE my husband, and the medical records showed had a one lobe of his lung removed, and 11 inch scar from his scapula to under his arm, and REDUCED PFTs at the VA hospital THE SAME DAY the doctor wrote the opinion.) So though this doctor mentioned the discharge physical - you can't really go by what he said. The written notes of chronological care show he GOT a discharge physical - and indicate the form it is on. But the actual physical DISAPPEARED! So yeah..there were SEVERAL things my husband's SMRs didn't show on his claims - because the SMR that might have shown them disappeared. Oh.. and the one person I talked to at the RO indicated that my HUSBAND might not have SENT them his discharge physical! How could he? He tried to get a copy from the record center - they don't have it because they sent it to the VA. If the VA is the "holder" of your service records - then you CAN"T get a copy to SEND them. I wish they would pass a law that the VA only got COPIES of your records from the record center. Why in the world do they get the ORIGINALs - when they lose so many papers? I DID get copies of medical records of OTHER vets that were in my husband's C-file. I thought of offering to trade THOSE for a copy of the discharge physcial. Free

I have thought of that. Not quite sure yet. It might be less costly to get an IMO or 2. And then, with a lawyer, I still might need to get an IMO or 2. I was hoping that ONE IMO would do. As far as the asbestos exposure - If I can get an IMO that says if my husband was exposed to asbestos that it is more likely than not the asbestos exposure CONTRIBUTED to the development of his cancer - his medical records should SUPPORT that opinion. So far the VA has an opinion that my husband's cancer was caused by his smoking - and that asbestos exposure isn't a contribting factor. However, he based that opinion on HIS belief that my husband was NOT exposed to asbestos. He said that though my husband worked as an electrician for 13 years, he was not part of any occupational screening or medical survillience programs. So he ruled out asbestos as a contributing factor because he ruled out asbestos exposure. We have already submitted evidence to rebut his assumption that the lack of any records of involvement in any occupational safety programs proves my husband wasn't exposed to asbestos. We submitted the INITIAL Air Force regulation on Asbestos Safety programs - which shows those programs STARTED in 1988. My husband was an electrician from 1970 - 1983. So he was an electrician for THIRTEEN YEARS - in a period that was five years BEFORE the Air Force has ANY safety programs in place. We also submitted evidence that Interior Electricians (the field my husband was in) NOW are required to wear respiratory protection for some of their work. So basically, the people that NOW do the work my husband USED TO do - ARE part of those programs. So - we pointed out that the LACK of involvement in the programs show that my husband was EXPOSED to asbestos WITHOUT any safety measures being taken by the Air Force, more than they show that he was NOT exposed. My husband also turned in copies of work records, his own statement of things he did to expose him to asbestos. I submitted buddy statements from four people my husband worked with that all support my husband's reports of the type of work they did, the bad shape the asbestos was in in many of the buildings, that no safety measures were in place until the late 80's, etc. I also submitted a report we got from the last Air Force base where my husband worked as an electrician - which showed the base had SIGNIFICANT problems with crumbling asbestos in MANY of the buildings surveyed. His Medical Records at the AIR FORCE BASE. (These are POST Service - but they are written by the Air Force doctors - the SAME doctors whose reports in SMRS are taken to be FACTS) include: Written Notes in Chronological Record of Medical Care 10/3/2001 – Dr. XXX pulmonologist (In Medical Records from XXXAir Force Base) state: “CXR rpt seen > Upper Lobe Scarring & 3 cm Left Lung SPN Also likely asbestos exposure as electrician 1969 – 1982N.B. – Chart & Consult & pt. Is in Error & pt. Is Non-Small Cell CA & Not Small Cell. Important Differences explained to pt. e. g. Poss. Adeno CA unk 1 ° ? “ (Note - this was also the examination in which Dr. XXX wrote the statement of doubling times and relative risk asbestos exposure, which my husband turned in with his previous claim package) which states: Former Smoker – Best is 1.4 Times Current smoker 10 Asbestos 8 Together – 80 > Now New Patient Note 10/10/2001 – XXXX,, MD – Oncologist (In Medical Records from XXX Air Force Base) states: “The patient’s past history is somewhat remarkable in that he worked as an electrician in the air force and was exposed to asbestos.” Written Notes in Chronological Record of Medical Care 11/5/2003 - Dr. XXXX pulmonologist - (In Medical Records from XXX Air Force Base) in which he states: Hx of Lung Cancer. S/P resection at SLU September 00 3 cm & LLL-ectomy. Adeno CA. Smoker & Asbestos Exposure. Impr. – 1. Poss Adeno CA Stump Recurr 2. 1st CA 2000 3. Exposure Cigs & Asbestos > 80 x’s Risk I also turned in A copy of a part of an asbestos education training program from the US Army Medical Center and School Portal, which shows the relevant risks of developing lung cancer from asbestos exposure alone, smoking alone, and a combination of the two (being 80 X’s the risk) – which should support the pulmonologist's notations of the 80's risk. To me, though these doctors did not come right out and say "it is more likely than not" - the notations of asbestos exposure in BOTH the oncologist and the pulmonogist at the AIR FORCE BASE, indicate they THOUGHT the asbestos exposure was relevant to his cancer - or they wouldn't have mentioned it in their notes. Additionally - the pulmonologists NOTES SHOWING the 80 times increased risk - within his medical notes on my husband are SAYING "it is my opinion that this man's exposure to asbestos greatly increased his risk of getting cancer" though he doesn't come right out and say it in an official IMO kind of way. He doesn't give reasons and basis to support his statement of the risk factor - but WE have submitted medical Treatises that support it - including the info from the US Army Medical Center and School Portal - which also shows the 80 x's risk. Even the VA M-21 manual shows that smokers who ae exposed to asbestos have a much greater risk of developing cancer. So to me - if I can get ONE IMO - the combination of THAT AND the Air Force Base medical records should TRUMP the one VA medical opinion that merely states my husband wasn't even exposed to asbestos - If the VA decides to get ANOTHER opinion from one of THEIR doctors - I will consider that a fishing expedition to try to defeat the claim. As the synergetic effects of smoking and asbestos exposure is not only not far-fetched, it is COMMON medical knowledge. If I turn in an IMO and all the doctor notes that are based on COMMON medical knowledge that is even reported in the VA M-21 manual - and they try to find someone that will just say it is their opinion my husband's cancer was caused from smoking even IF it is shown he was exposed to asbestos - that is a fishing expedition to defeat the claim. And of course, I wouldn't let them get by with relying on that opinion without the doctor giving their reasons and bases that they are throwing ALL KNOWN knowledge of the interaction of asbestos and smoking out the window to totally rule out asbestos as a CONTRIBUTING factor - to determine his cancer was caused by smoking alone. Free

Teac, Does the VA seem to consider med records or notes or opinions from the military physicians as more "credible" than private physicians? I hope so - because these are the SAME physicians - that had they made ONE note in a SMR would be believed for whatever they said. And my husband DOES have documentation of asbestos exposure by his treating pulmonogist on base - AND by an oncologist (before the base moved that unit off base and into Tri_care) Free