OldDave

I have a buddy who lives in Westwego, La which is a burb of N.O. He had a quintuple heart by-pass some time before he filed an AO claim for DMII a couple of years ago. He was granted 20% for the DMII but was not referred for treatment. The poor man has been paying his own medical expenses for DMII which is getting up there since he was put on insulin. Not to mention the fact that he has severe heart problems and has not filled an AO claim for that problem. He has contacted me for help with getting his DMII drugs paid for. I told him to go the the VAMC in the area. He has been dealing with a local VSO who apparently either doesn't care or doesn't know anything. He needs someone to get him into the VAMC system and help with a claim for AO IHD. I live 130 miles away and am not sure I have the experience to give him the help he needs. If anyone knows of a good VSO in the New Orleans area please let me know. If all else fails I'll make a trip and spend a couple of days banging on doors with him. Thanks, Dave

Thanks to all of you for the excellent advice. I'll get the process started..

Hi to all. Appreciate all the good work the veterans here at Hadit are doing. I’m considering putting in a claim for depression. I’m wondering if I need to try to get a psych consult before filing a claim. Do I do this through my PCP? I am currently SC for DMII - 20%, IHD - 60% , PN - 4 X 10%, ED - SMC-K. So far nothing the Va has tried has helped my ED. My eGFR is at about 40 so kidney problems are probably not far off. That along with the pain, frustration and side effects of the meds has me down. Also, let me say I was diagnosed with DMII in the late 1980’s and had a heart attack in 1998. I’ve been dealing with this for quite a while. Does the prescribing of anti depressants and anti anxiety medications imply a diagnoses of those disorders? I am currently on 50 mg of Trazodone at betime and 1mg of Clonazepam twice a day. Any advice would be greatly appreciated. Dave

Thanks for that memory, Berta. I was one of those Marines in Danang in '68. I treated myself on ONE shave while I was having a hair cut. I don't know what he dipped the razor in but it felt like I was being shaved with a rusty fender from a '53 Chevy. Never had another. And, you don't complain to someone who has a razor to your throat.

Hi to all. I was rated 3 years ago at 10% for each limb for peripheral neuropathy. I understand this is considered MILD incomplete paralysis of the nerve. To go to 20% it would have to be considered MODERATE. Does anyone know what the criteria are for a classification of moderate? My symptoms are a lot worse now but I don’t know if I should file for an increase. Any information would be appreciated. Thanks, Dave

Thanks to all for the good information. That would be good news if a 40% rating for DMII would boost my overall to 90%. My IHD and PN are both secondary to DMII. My PN exam was 3 years ago during my C%P. Back then, I wasn't having any symptoms. Now I do and am on gabapentin. I still work a little part time. I think when I do file, I'll file for increases for DMII and PN and file for TDIU. Thanks Again. Dave

Yes, I know. The criteria says that you also be cautioned about physical activity. I'm on insulin aspart 3 times a day and must eat within 10 minutes of injection Every insert that comes with the insulin has a warning that physical activity can change your need for insulin. I thought I used VA math to calculate what a new rating would be. If I am wrong, could you please tell me what the correct rating would be. I am reluctant to file a claim because I don't think it would make a difference in my compensation. Thanks. Appreciate the input from everyone. Dave

I am currently rated : IHD=60, DMII=20 and PN=40 (4X10). VA math puts that at 80%. I was put on insulin last month which can increase the DMII from 20% to 40%. The way I calculate the VA math that would put me at 84.25%. This I am sure the VA would round down to 80%. If I end up with the same 80% I have now, does it make any sense to file for an increase at this time? Or, should I wait until there may be something else for which I could file? Any suggestions would be appreciated. Thanks, Dave

Yes. In my opinion you have IHD. My numbers are a little better than yours and I'm rated at 60% for IHD. I think your rating should be 60 or possibly 100%. Maybe someone else would know if the C%P exam is enough for you to get the rating or if you should submit a claim. Good Luck. Dave

Thanks for the input J. I'm on the 60mg Imdur. The imdur is dosed so that it is out of your system before the next dose. Otherwise, you develop a tolerance to it and it stops working. The Levitra warnings say not to take any nitrates within 24 hrs of taking the Levitra. I'm still in the research phase. I don't know if I will try it or not. Thanks again for the info. Dave

My PCP suggested I try Levitra to help with my ED problem. When I told him I'm on isosorbide mononitrate once a day, he said I could skip my dose for the day that I use the Levitra. The VA will send me two 20mg tablets of Levitra that I can cut into 10mg doses. I usually forget to take my meds a morning or two a month anyway. Does anyone have any experience skipping a daily dose of a nitrate med in order to take an ED med? The research I've done on the meds indicate that both drugs pretty much clear your system within 24 hrs.

Almost 2 years ago I had a C&P exam for an AO claim I filed for DM2 with IHD secondary. They gave me an echo on the day of the C&P and scheduled me for a stress test the following Monday. They called me to cancel the stress test. The echo showed an EF of 40% and that gave me a rating of 60% for the IHD. I believe I read somewhere that the procedures state that the C & P for IHD should start with an echo and only go to a stress test if the EF is below 60%. I don't know what they would do if they had both results and they conflicted. Good Luck, Dave

Glad to hear that you got rid of the iron. I have some scare tissue on my arm from the needles, but nothing that prevents another stick. Sorry about your problems. My biggest problem was getting diagnosed. You would of thought I was asking for radiation or chem o instead of a needle stick. I joined the same group and bought the book. There was a chapter titled something like 'The Sacrificial Sibling". That was my brother. His death brought me a longer life. I spent most of his last 3 weeks with him in the hospital. Believe me, liver failure is not a pleasant way to exit this world. I wouldn't think after these years and your iron under control, the VA could point a finger at hemochromotosis as the cause for arthritis. But, you can't count on the VA to do what seems logical. Good luck with your claim. Dave

Cooter, Have you unloaded the excess iron? I lost my brother in '91 due to liver failure brought on by hemochromotosis. Because of that, I was diagnosed in '92 and started treatment. They took a unit of blood every week for 6 months. Then every other week. I did a lot of research. The iron is stored all over the body. It can have deadly effects on the liver and heart. I would think that if you had enough iron to damage your joints there would be other complications. Are you being treated? I hope so. Good Luck, Dave

Good luck with your struggle. I'm reminded of the scene in "Catch 22" when Doc is trying to convince everone he is not dead when his name was clearly on the manifest of a bomber that crashed. Even his wife denied him because she had already been paid his GI insurance an got a new boy friend. I've got small problems with errounous progress notes. It seems once some thing is set in the record it automatically becomes fact. Why is it so hard for the VA to admit they messed up? Dave

Saints Won and I'm not even dead yet. Thought I'd never see it in my life time. The parade they had for the Saints Tuesday night drew an estimate 800K to 1 million people. The players were rockin'. I heard the Colts had 11 fans meet them at the airport on their arrival. The parade for the Saints would have rolled even if they had lost. As for music, I don't care what band is playing so long as the song is "When the Saints go marching in" Dave

Thanks to all of you for your feed back. I'm not in pain any more so I think I'm going to see if it will resolve on it's own. At least for now. I don't have a problem with teaching hospitals. I had a heart attack over 11 yrs ago and was treated in the Louisiana charity hospital system(I didn't have insurance). Including the placement of a steent. The hospital was training doctors for the LSU and Tulane medical schools. My steent is still working and not another heart attack (Knock on Wood). Dave

10thFO, keep us posted on the surgery. Hope it goes well for you. Allan, did that surprise you? You were only in for evaluation. If you were in for a procedure, would you have gotten a little worried? My dad used to say the best hospitals were teaching hospitals. Fresh inquesative minds with experienced teacher supervisors. Of course, dad was never in a VA hospital.

10thFO, thanks for your response. I'm not service connected for my back. I'm at 80% though, so the VA should cover the treatment. My first visit to my VA PCP was last Feb. and it just so happened I was having back trouble at the time. He prescribed muscle relaxers and pain pills and I recovered nicely in a week or two. That was the first time in recent years that I've had trouble. I'm 64 so all in all I guess I shouldn't complain. If the worse it gets is two episodes within 8 months I can deal with that. The problem is, if I should have the surgery, the private option probably won't be there next year. Although, after October 2010, I'll be eligble for Medicare. But, between January and October, the VA will probably be my primary care provider. Have you had the surgery already or are you working on it? I hope it gives you relief and good results. Good Luck.

I’ve been in the VA Health System less than a year. About 4 weeks ago, I went to my pvt doctor complaining of back pain (I still have pvt insurance). He sent me for X-rays and an MRI and gave me a muscle relaxer and some pain meds. The MRI results say I have multiple bulging discs in the lower spin. Pvt doc wants to refer me to a neurosurgeon. I have my deductible met but my 20% would still be about $3000. I’m not sure I want surgery in any event. I’m feeling a lot better than I was 4 weeks ago. I know that if I do nothing, I’ll end up in pain and flat on my back again. And, I probably won’t be able to afford the pvt insurance next year. Should I take my X-rays and MRI results to the VA clinic and try for a referral to neurology or orthopedics? I didn’t go there first because I was in pain and not moving around very well. I figured a referral would probably take a few weeks at a minimum. Any advice would be appreciated Thanks, OldDave.

Thanks dizzyvet. I should have been more patient. The leg pain went away and the actos is doing a great job on my blood sugar. Thanks Again - Dave

My PCP put me on Actos the end of June to bring my blood sugar down. Got the Meds in the mail last week. Started it Friday. I have PN and the pain in my feet is a lot worse since then. Also, I'm having pain in my calfs that keep me from getting a good nights sleep. Sometimes I can hardly walk. I've seen at WebMD that this might be a side effect of the Actos. Anyone have a similar problem? Does the pain go away? Any info would be welcome. Thanks, Dave

DMII is 10% if controlled through diet and exercise, 20% if on oral meds, and 40% if on insulin and regulation of activities. Above that gets more complicated. I also got 10% for each limb for DN as my symtoms are mild.

I was diagnosed with DMII in the late 1980's. Had a heart attack in 1998. I filed with the VA in July 2008 with a decision in December. Got 20% for DMII and 60% for CAD with another 40 for PN. My VSO didn't want me to file for CAD. She said I would have to prove a nexus directly between AO and CAD. She was wrong. I didn't have any problems mainly because I have pages of medical records showing treatment for DMII for 10yrs before my heart attack. Do you think these VSO's get bad marks in their file when they assist a vet with a claim that fails? When were you diagnosed with DMI? I think you need more medical evidence linking the two. There is also evidence out there linking pre-diabetes to heart disease. Damage is done before the DMII diagnosis is made. If your DMII diagnosis and stent were in the same year you may have a fight on your hands. Good luck.

Thanks John999. I think I'll follow your advice. Hopefully, I'll be able to keep insurance until I qualify for Medicare. It just seems a shame that it has to be that way. Dave