[Appeal Certification]

Did the Cardio docs give a nexus statement?

This is critical to claims like yours.

A nexus statement can rule out any other cause or etiology but for in-service events as primary manifestations of this type of disability.

Did they refer to any medical texts, treatises or abstracts stating this type of heart disease can take years to develop and is consistent with reported inservice events?

Please read my posts here under IMO forum-"Getting an Independent Medical Opinion"

I assume the VA gave you a NSC rating.

What is their NSC rating percentage and what rating codes did they use?

That is where in my biggest obstacle lies. CAD was not addressed in my initial retirement exam. High cholesterol was not addressed. According to the rating subsection that covers high cholesterol, the Veteran must specfically address and request consideration for high cholesterol/lipd levels.

Again, I remind you...I was totally unaware of any elevated lipid levels or cholesterol problems until my first exam by a cardiologist. I never saw a cardiologist while on active duty inspite of my repeated (and rather vehement at times) requests for the same. I was called on the carpet by the hospital administrator for my repeated visits and requests for consult to cardio and informed that my continuing to "waste the time of his medical staff" would result in his requesting my CO take non-judicial action against me. Even recommended my seeing a shrink.

[Appeal Certification]

My original DIC claim started out as cardiology claim.That claim took over 3 years for award.

The VA was relentless in telling me that I was not competent enough to give lay medical testimony and evidence.

I did prove that case.

But these days it is usually too difficult for a vet to do this on their own-

I spent month after month studying cardiology and autopsied hearts etc-to get that claim resolved but I missed something-because I am not a doctor.

Similiar BVA cases make no difference to VAROs because the medical info is only specific to the BVA vet's claim.

What I missed in that older DIC claim was something I found at the very last minute.

I had re-opened for cause of death, had 3 IMOs and had just paid more money for a cardiology IMO-and found the most single overwhelming piece of evidence that I should have found sooner-

it was the only word in the autopsy I never looked up for over a decade-

My award came perhaps before the BVA even got this evidence-

although I sent it to them right away-

I hope you can get a good IMO here- because IMO docs know just how to take claims like this step by step and can determine chronicity.

Also they read the evidence carefully- this is one point the BVA made in my award letter- that the IMOs I had were based on careful study of all available med recs.This is what the VA means by having a full medical rationale.

When an IMO doc can give a full medical rationale that favors the claim -the VA usually has no way to combat the opinion.

I take it (Sorry but it's been over 16 years since I retired) "IMO" is Independent Medical Official, right? My cardiologist has given a medical opinion, as did two of the other civilian Cardiologist. All three stated it was their medical opinion that my cardiology problems were Mytral Valve Prolapse with Mytral and Tricuspid regurgitation. However, the "ejection fraction" is within normal, thus the VARO denied that part. I must add, theey accepted my "request to amend original rating from Cardiac Arythmia to MVP" was approved, but maintained at the original rating. Every BVA ruling I have researched (16) on MVP, CAD, Atheroscorlosis (sp), the verbiage for the diagnosis are very similar to my Cardiologist.

I never saw a Cardiologist my entire 22 years in service. Was never told I had any problems until I begin having chest pains and palpitations. Repeated trips to clinic resulted in "You're overweight and out of shape." Changed my diet to poultry, fish and veggies, started running and returned to Martial Arts. Maintained my weight as previously stated until my kness got worse.

My current appeal is already 3 years old and has sat in DRO office for almost 2 years (November 07) with no explanation. I've been to BVA before - took almost 5 years - and I am beginning to believe VA is waiting for me to die, thus my appeal becomes moot and my wife looses DIC because basis for my appeal, my CAD and MVP, are dropped due to my death.

You people on here are super and I really appreciate your help and support. Wann represent me at St Petersburg VARO? I'm ready to fire the stupid NSO I have.

[Appeal Certification]

You might have a problem proving chronicity-

"Long history (20 years) of palpitations, shortness of breath and chest pain." IS that documented in your med recs at all?

Or is there a treatment gap of many years?

You could still succeed on this claim but I think it will take a strong IMO.

"3rd cardiologist said YOU NEED STENTS or you will die in 3 to 5 years. Se cannot confirm how long I've had CAD, but based on degree, estimates while I was in service." If they could write that up to conform to the IMO criteria here-using "as likely as not" or "more than likely" the VA would have to give that type of opinion considerable weight -as it is from a Cardio doc.

You're right on the "likely to have occurred in service as not", Berta. I have two BVA rulings on that where two noted Cardiologist stated "CAD is a progressive disease that does not happen overnight, rather is a long term process if not properly treated. One of these Cardologist is Chief of VA Cardiology at VA facility in one of the Carolinas. Another noted specialist that said the same, is a Coronor who made the ruling as CAD was a contibuting cause of death in a Veteran and AGAIN, the Board ruled in favor of the VET. St Petersburg Regional is not know for being compassionate in their rullings but is known for being overruled by the BOARD on better that 64% of their cases.

[Appeal Certification]

"No mention of SMR showing Highly elevated Lipids an exam by physician having diagnosis of quote 'hypercholesterolemia and hyperlipdemia, overweight.' (5' 10" weighing 185#) I was never examined by a cardiologist or any other specialist. my basis for Bell v Derwinski."

OK I get it now-

you have this on appeal and have filed the I-9- your rep should have asked for reconsideration.

The CUE claim-is this a separate claim under CUE that you sent to the VARO which made the decision?

It is possible the DRO is considering the CUE allegation.

Do you have a medical statement from anyone that your present heart condition is directly stemming from the hyper cholestrol, hyperlipedemia in service?

Obviously the C & P doc could not render any opinion at all as he didnt have the SMRs.

These two conditions as they stand are not disabilities but doput a vet into a risk factor for developing diabetes and heart disease.

The connection to heart disease is medically strong but still the VA needs a medical nexus statement.

Do you see any private cardio doc?

The fact that this went back to the DRO might well be a good thing.

Do you have a copy of the C & P results that prove the CV & P doc didnt even have the records?

Sorry, Berta. My biggest problem...saying too much or not enough. From beginning (and short)

Long history (20 years) of palpitations, shortness of breath and chest pain. Al Primary care docs say exercise needed. My walking around weight since 1980 has been 155 to 170 depending on if my knees allow exercise. Not lately, need knee replacement.

Chest pains became more frequent, more intense until my wife took me to ER. They done a heart Cath and said to try meds first. 2nd cardiologiest said stents - I refused due to my research on mortality. 3rd cardiologist said YOU NEED STENTS or you will die in 3 to 5 years. Se cannot confirm how long I've had CAD, but based on degree, estimates while I was in service.

Between my retirement (93) and my ER visit (2006) no treatment by Primary care...just told exercise and diet.

Stents implanted Aug 08, talked with VSO and they had requested a Informal Conference...DRO never scheduled. The only time I can speak with anyone at RO is by submiting IRIS complaint and they call me with promises. I now have two letters going out today Cert mail to Regional Office Driector requesting the journal of my files since March 2007 claim filing and to my VSO REP for documentation of when they request Informal Conference. Told Director in letter I will file Writ of Mandamus if I am forced.

[Appeal Certification]

You had a claim that was denied in 4-5 months?

That is hardly time for them to send a VCAA letter.

It is Not unusual to have an appeal certified and then sit at the RO for a long time before the BVA calls for the files.I got 2 SSOCs,responded to them both with medical evidence,(2005)and then got letter that the claim would be transferred to the BVA.It did get there-in 2009- the BVA read my evidence and awarded.

Did you get a letter saying the claim was going to be transferred to the BVA?

Berta, timeline of my initial claim:

1. Submitted claim 3 times to DAV Rep - finally given to VA TRIAGE on 3/27/07

2. 4/5/07 received VCAA and Autorization for release of medical evidence - sent along with 21-4142. Sent in anyway.

3. 6/7/07 Claim Denied - no service connection evidence

4. 6/9/07 sent NOD with statement "Have additional medical evidence to submit."

5. 7/1/07 Received SOC from RO - No mention of SMR showing Highly elevated Lipids an exam by physician having diagnosis of quote 'hypercholesterolemia and hyperlipdemia, overweight.' (5' 10" weighing 185#) I was never examined by a cardiologist or any other specialist. my basis for Bell v Derwinski.

6. Inadequate exam reason was my VSO rep said my SMRs were not provided to the examiner and he didn't know why I was there.

7. 8/12/07 Received notice from DRO of upholding denial and providing me VA FORM 9 and my timeline to submit or I could provide further data.

8. Submitted FORM 9 with reason for appeal - CUE reason gave date of entry in SMR of diagnosis for Service Connection.

9. 11/27/07 Received letter of Substantiated Appeal and that "Case file would be gathered along with submitted evidence for scheduling with BVA." Then got SSOC that was a regurgitation of the original denial.

I'm about ready to fire the DAV here in St Petersburgdue to their attitude and lack of help. I guess it's that my disabilities are heart, knees and ears. I still have them but they don't work so well. I'm just trying to get what's due me and to take care of my wife when I kick the bucket in 3 - 5 years. Thanks people for your invaluable help!

[Appeal Certification]

My experience has been that the appeal "path" goes something like this:

1. RO issues decision

2. Vet files NOD.

3. Ro asks Vet to elect DRO review, DRO hearing, or BVA appeal.

(A DRO hearing request slows the process down immensely as DRO hearing officers are backed up, and you have to wait still more time after the hearing for a decision)

4. If the Veteran is satisfied with the results of the DRO Review/hearing, the case does not proceed to the BVA. However, If the Vet is still dissatisfied with the DRO decision, then he files a form 9, the substantive appeal, to proceed to the BVA.

5. The RO then "certifies" the appeal and it moves to the BVA.

You indicated that your claim is still at the DRO. You should check your old paperwork to see if you, in fact, elected a DRO "hearing" or a DRO "review". Ask your VSO if he/she can document your request for a hearing. If you have documention to support that you elected a DRO hearing, but were denied a hearing, then it would appear you should consider hiring a lawyer represent you at the BVA.

If you can not document your request for a DRO hearing, then you need to rattle the cage to get your claim moving to the BVA. I recommend you "rattle the cage" in this order:

1. Call your VSO and ask him to request status.

2. Send an IRIS email, and request status.

3. Call the 800 number, and ask them to request status.

4. Send a "Statement in Support of Claim" stating that your claim has not moved from the DRO in 2 years, and indicate an intent to file a Writ of Mandamus.

5. If no action, file a writ of mandamus.

You may be another "shredding" victim, also. Often the VA shreds your evidence, then delays your claim because they say they have " no record" of it. If this is the case, File a Special Handling request before Nov. 14, 2009.

Broncovet - Many thanks for your comment. I did file a NOD electing DRO option and stated in my NOD quote: "I have additional medical evidence to submit." I also alleged CUE under Bell v Derwinski (VCA 1985) and inadequate exam by the VA Medical(?) examiner.

Finally in the oder you stated above, I did the following (kept a journal of all actions)

1. Call St Petersburg Regional office for status - Still in DRO

2. Called my VSO - waiting scheduling for travel board hearing. - She hung up on me(?)

3. Sent a total of 6 IRIS emails related to my appeal and for when I head a heart attack - 3 answered.

Will send a 21-4142 requesting status in Cert Mail - Return Receipt. Not sure what a Writ of Mandamus is but will talked to my attorney. Difficult to find one locally (Tallahassee) that are versed in VA Law.

MANY MANY Thanks everyone

[Appeal Certification]

Thanks for your very QUICK replies, Pete53, Berta and Clown Man. My Claim recieved by VA 3/27/07, C&P Exam 4/30/07 - examiner had no idea why I was there; claim denied 5/14/09; I sent NOD 5/21/09 stating "I have additional medical evidence to submit." (Though that was sufficient for conference according to DRO process procedures - NOT.) Asked my VSO and he said he would request an "Informal Conference" with the DRO if I had everything together." I did, and waited.

8/7/07 (7 days before my birthday,) received letter from DRO upholding original denial and a VA FORM 9 for appeal to BVA. Sent off the completed Form 9 and got a SSOC from DRO that was regurgitation of original denial.

11/11/07 got letter of "Substantiated Appeal" and a Supplemental-Supplemental-Supplemental Statement of the Case (Yep, that;s right a trrfecta Statement of the case) from Regional with forms for election of type of hearing and notice of waiver of 60 day waiting for further evidence, signed and sent in Certified Mail. Signed for 11/22/07.

Like Red Buttons "Never got a dinner..." I never got an Informal Conference. Despite my insistents that I did not get an 'IC' their replies are "You never requested one." Seems my VSO cannot request one on my behalf.

I have two "2 gigabyte thumb drives containing ONLY the data from and a journal of telephone conversations with VA and my VSO. Just my opinion (PLEASE) St Petersburg DAV's NSO have an attitude in helping Vietnam era vets with no visible wounds/injuries.

[Appeal Certification]

First if you have proof of the request for a DRO hearing and they never gave you that opportunity then you or you VSO need to be screaming foul very loud as that meeting in particular is part of the due process rights during an appeal. If you scream loud enough you will get it and it will be held by a DRO other than the one who did the de novo review. Based upon the time line it appears that they were doing some closet cleaning in the appeals team area and yours was one that got cleaned out with a carbon copy denial. I have personally seen this happen to several vets. Start screaming quickly.

-Second once you reach the traditional appeals process your file receives a docket number but stays with the appeals team (DRO)until that particular docket number is called for by the BVA. This is evidenced by the fact that each time you have submitted new evidence it was reviewed and a new SSOC was issued.

If the 2007 date (vs 2009) is correct in your post you are just about at the time when the BVA should be asking for your file (24) months. Once they asked for it (which will be done 2-3 months in advance) the DRO will once again review your file to insure it is complete and they have rated it in accordance with the requirements of CFR 38 (yep right!) then he or she will "certify" it to the BVA. Once the certification is done you will be notified that your file was transferred to the BVA. The fact they said substaniated simply means that your appeal was proper (met all the required time lines).

Hope this helps a bit - I still do not know how a VSO can let the RO get away with not honoring a request for a hearing during an appeal. If this is the case I would be "writing him/her their last pay check (figure of speech since their help is free).

[Nod & De Novo Review Vs Reconsideration]

Since the DRO I had was the VARO rater that denied the claim. It simply got rubber stamped with the same SOC.

Allen, Me thinks I have been rubber-stamped as well. Almost verbatim on the de Novo Review decision as was in the original. Stinks, huh?

[Appeal Certification]

Filed claim in March 2009 - Denied; Submitted NOD electing de Novo review and had my DAV Rep request conference with DRO. Never got the conference and the original denial was upheld. Claim was for amendment of original rating of Cardiac Arythmia (PVC) to Mytral Valve Prolapse and service connection for Stenosis of 3 coronary arteries of 50 - 60 percent.

Submitted VA FORM 9 and received letter "Substantiating" my appeal in November 2007. Hasn't moved since. Meanwhile, submitted additional medical evidence of Stent implants (2) in Aug 2007, and received Supplemental Statement of the Case (total of 1 form original AO and two from DRO.)

No one can/will tell me why my case is still in DRO. AMC doesn't even know me, thus my appeal has not been sent there nor has the Board of Veteran Appeals received anything on my "Substantiated Appeal."

Any ideas/suggestions?