chr49

Congratulations Mik!

Excellent advice Larry. I was hoping you'd chime in. Cr has recently gotten the VARO fax number so we will be following thru in the manner you describe. I always mail C's stuff certified, return receipt ($$$$) but it's well worth it. Kathy Note: Talked to Cr at work. He sounded good and said the Vet Center sent him where he needed to go. We will talk more tonight. Thanks to all that have helped me thru this!!!

John & Pete, Thank you so much for your input on C's current situation. Cr left to go into the Vet Center for support and advice early this AM. I haven't heard from him yet but he was heading to work immediately following the appointment. Hopefully, they will help him clear his head and give him some direction. I think that your thoughts are something he needs to seriously think about. He did consider consulting with a lawyer when he received his decision letter. Thanks John, for explaining that he has to revoke their POA. I imagine he would have been told to do so by his new representation but it's nice to hear it here first. Pete, your decription of 'most' VSO's is exactly how it is in our situation. C has done all of his own work (I'm his secretary so I often use the word "we")on his claims but he's always consulted with his VSO. Essentially, the VSO has simply passed our papers along to the VARO. Actually, we didn't expect more than that, especially with the distance involved, but we did expect our paperwork to be sent along thru the channels properly. At this point it's hard to point a finger and say our VSO did us wrong. It's possible that the VARO misplaced the packet that he sent over but the fact remains... Somebody dropped the ball and we've learned a lesson the hard way! Kathy

This is chr49's wife. I help with C's claims so I feel a responsibility here. We live 2.5 hours from the VSO's location so that's been a problem. Cr went to his office to initiate a secondary claim back in January and was instructed to send everything thru him so he could make copies, see that they got to the VRO properly, and he could stay aware of what was going on, so we've complied with that request. Since January, Cr has received 2 letters from the VRO asking for information/evidence. Each time he phoned his VSO, asked his opinion and let him know that we would send him our packet when it was finished. C's never phoned him excessively or held him on the phone(phoned him exactly 3 times since January)and he's always been polite in his communications. CR's recently received a denial letter, so he phoned his VSO to set up an appointment to see him. When he got off the phone I asked him what was wrong and he said the guy was rude and wouldn't even allow him to give him his claim #, saying he needed to take his letter to a VSO a bit closer to our home. I told him the VSO must have misunderstood, most likely he gets tons of calls and wasn't aware that C's entire file is in his office but C's having a hard time trusting the situation and refused to call him back. Neither of us understand what's happening. But this isn't the end of the story...... When C received the denial letter I noticed that an entire packet of evidence wasn't included in the list of evidence used. The packet was sent in response to a VRO letter and was supposed to be submitted to the VRO by his VSO early in April. I want to believe it was sent because the VSO sent CR further paperwork for his files after receiving our packet. The VRO claims they never received the packet. So how does C handle this from this point on? Is it proper for C to look for another VSO or is that a no-no? If so, does he need to stay with the TN DVA? He really doesn't think this VSO wants to help him anymore. Kathy

This is so important! Thanks to N4XV & Berta for the latest information regarding AO IHD claims.

John, Well, my wife is in agreement with you. She said there is just too much evidence out there saying an A1C of 6 is too high. She has kept us both on diabetic, low fat/sodium diets since 2005. In honesty, I don't always understand where she's coming from but I know she's a smart gal. She tends to get a bit nutty about such things at times, but it's nice that she cares. BTW, Compensation isn't the reason I use the VA medical system.

retiredat44 This is my understanding: Blood sugar levels above normal but below 125 are considered 'pre-diabetic'. The DMII diagnosis comes into effect when your blood sugar rises above 125. Most often lower blood sugar levels are treated with diet &/or oral medication. Once your levels get consistently higher, insulin is brought into the picture. The VA also ran A1C levels on me annually until this year. I've been told that the A1C shows an average of your blood sugar over the past 3 months. My lab results say that 6.5 is considered diagnostic for diabetes. Mine was 6.2

Gotta laugh because I know a Pepsi or Coke will do the trick too. My wife had a soda prior to an appointment years ago. Obviously, she wasn't expecting any lab work. Set off bells and whistles when they saw her blood sugar level! I really don't want to be diagnosed for something I don't have...not smart me thinks!!!!

Hi John, Haven't hit the point that I can file. I will file the day I receive a blood sugar result of 125 or higher, whether they give me a diagnosis or not. Just hasn't happened yet. I watch my lab results closely. I also have PN left foot(without diagnosis) and will file for that at the same time...whether the VA gives me a diagnosis or not.

John999 I'm considered 'pre-diabetic' at this point. I had one doctor diagnose me with DMII but his diagnosis does not meet the VA standard. My blood sugars are consistently elevated but they have stayed below 125.

Berta, Thanks for the link to Springerlink.com and for your comments. I follow try to follow your posts because they are always informative and often related to issues that I'm dealing with. I have seen the AO IHD proposed regs so I have a fairly good idea on how that's going to work and from what I'm seeing in my records, there is little to no evidence other than the atherosclerosis that I've mentioned. My EKG s have been normal up to 2008 but I am due for another and I've had a couple worrisome episodes in the past year. That is one of the reasons I've hesitated on filing to this point. I think your advice is spot on. I most likely will have to see a specialist to get proper diagnosis and documentation. Thanks again.

Berta, Thank you so much for your reply. I will try to address your questions (to the best of my ability) within your post: "I was recently denied a secondary claim for vascular disease." Is the vascular disease due to ischemic heart disease? I have been diagnosed with Abdominal Aortic atherosclerosis. I also have atherosclerotic build up in the common carotid arteries, and kidney arteries. Are they considered part of the peripheral vascular system? They are outside the heart, yet within the body. Sometimes I feel very stupid where all of this is concerned. If so, are you an in-country Vietnam veteran? YES - 1970-71 If so- have you filed a claim under the new AO proposed presumptives? I recently found a claim (???)listed on the e-benefits site for heart problems dated back to 10/2009 which I never initiated. I have not have spoken to my VSO about this yet, but it is going to be addressed. In answer to your question: I am seriously considering filing a claim. I was waiting to see what happened with the PTSD claim. Can you be more specific as to the type of vascular disease you have? I have hypertension and peripheral vascular disease with occlusion in both legs (1 leg corrected per stent) and carotid occlusion ® and 50-60% in (L) carotid. Do your medical records show it is ischemic in nature , involving the cardiovascular system - If you were exposed to Agent Orange? My files are filled with "atherosclerotic" but little use of 'ischemic.' I have noticed that the VA was very careful not to use to use the 'ischemic' terminology. “For claims filed after June 9, 1998, the law prohibits service connection of a death or disability on the basis that it resulted from an injury or disease attributable to the use of tobacco products by a Veteran during active duty service. 38 U.S.C.A. § 1103; 38 C.F.R. § 3.300(a). Service connection, however, is not precluded where the disability or death resulted from a disease or injury that is otherwise shown to have been incurred or aggravated during service. 38 C.F.R. § 3.300(b)(1). For purposes of this section, "otherwise shown" means that the disability or death can be service-connected on some basis other than the Veteran's use of tobacco products during service. Id. VA's Office of General Counsel has held that the legal bar to service connection for a disability or death attributable to tobacco use does not bar a finding of secondary service connection for a disability or death related to the Veteran's use of tobacco products after the Veteran's service, where that disability or death is proximately due to or aggravated by a service-connected disability that is not service connected on the basis of being attributable to the Veteran's use of tobacco products during service. VAOPGCPREC 6-2003 (October 28, 2003). In other words, secondary service connection may be established for disability or death related to post-service tobacco use that is the result of or aggravated by a service-connected disability unrelated to tobacco use. See id. The opinion further held that VA adjudicators must resolve (1) whether the service-connected disability caused the Veteran to use tobacco products after service; (2) if so, whether the use of tobacco products as a result of the service-connected disability was a substantial factor in causing a secondary disability; and (3) whether the secondary disability would not have occurred but for the use of tobacco products caused by the service-connected disability. If these questions are answered in the affirmative, the secondary disability or death may be service-connected. See id. “ http://www4.va.gov/vetapp10/files1/1004021.txt This entire case shows how a widow proved her husband's nicotine dependency was due to his PTSD and how it contributed to his death. These claims are not easy but possible, if a service connected disability causes nicotine dependency and then directly causes a ratable disability. In the new proposed ischemic heart disease regs for incountry Vietnam vets, the VA certainly did not state that any vet with smoking history would be denied for heart disease under the new regs.That doesnt quarantee that some rater might use a smoking history to deny the claim. But the VA knows full well that cigarettes were in the C rats and many nicotine habits began in the military because of that. There are other claims at the BVA web site for nicotine dependency casing or contributing to addition disability.The denials contain as much good info as the awards. I am amazed with all of the information you have provided me. Your post has given me hope. I can not begin to thank you enough.

Skunk, Haven't had any problems using myhealthevet for my prescription refills. Another handy online source is the e-benefits site. I recently ordered my hearing aide batteries there and got them much faster than I would have by mailing my card in. Like others I'm waiting on the other services they've been talking about for a long time now.

Thanks so much for telling me you are up against a similar situation and have the same 'date of diagnosis' issue. I'm sure the probability of winning is low, but it's worth trying if a win could help somebody else in the future. Your comments make me feel better. Waiting to hear good news coming from your direction Pat!

Is it possible to have this moved to the appropriate forum?

johnjjr Thru the e-benefits site, I noticed a claim on my file for heart disease, dated Oct. 2009 that I have never filed for. Stillhere may have hit on the reason for these mysterious claims we are seeing.

I think I may have posted this topic in the wrong place. Could a moderator please move it to the proper location so I can receive comments? chr49

Amended post - Hope this is easier to understand I lived with PTSD for over 30 yrs before I was diagnosed in 2007. There was no such thing as PTSD in 1971, but I wouldn't have gone for help for several years anyway due to my state of mind. I didn't bother to see any doctors between 1971 and 1998 and when I went I did not talk about my Vietnam experience (I doubt I mentioned being a veteran)so my records don't say a thing, other than the fact that I was warned to stop smoking and have used multiple cessation programs since 1999 in an effort to quit. I was recently denied a secondary claim for vascular disease. The denial states I have had an unhealthy lifstyle before and after "PTSD diagnosis in 2007." Smoking is 'the after diagnosis' unhealthy lifestyle and my addictions (in long term remission)are indicated as 'before diagnosis'. When I initially filed for PTSD, it went thru easily. My 2008 PTSD C&P exam documents 'chronic PTSD'with classic symptoms since returning from combat(1971). The exam is standard form stuff but I'm thinking the statement "The veteran’s PTSD is the cause of the aforementioned changes in functional state and quality of life" may be of value, but I truly don't know. My wife has found a couple cases and most important; a General Counsel’s Published Opinion (VAOPGCPRED 6-2003) which addresses whether a veteran’s tobacco-related disability or death may be service connected secondary to a service-connected mental disability, which caused the veteran to use tobacco. 38 U.S.C. §1103(a) prohibits a finding of service connection of a disability or death resulting from the veteran’s use of tobacco during the service. The General Counsel opinion, however, clarifies that service connection is permissible if the veteran’s disability or death is the result of his post-service use of tobacco, which is caused by a service-connected psychological disability. I am considering using the materials we've found so far and getting another IMO that will support having PTSD prior to diagnosis, as well as the tobacco usage connection but we can't find any regulations specifically related to the "date of diagnosis" in regard to secondary conditions. I'm concerned about fighting something that can't be won if there is a regulation that won't allow secondary based on the date of diagnosis. Any help out there?? I really appreciate it. My wife does my research and paperwork (I'd most likely give up if she didn't) but I can't see stressing her over all of this if it's an impossible mission. Thanks ahead to anybody that has advice to offer.

I agree Pete. Looked up flat feet. Bilateral appears to be set in the ratings. Hope this helps you figure it out: Per VBA 38 CFR Book C: 5276 Flatfoot, acquired: Pronounced; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances: Bilateral 50 Unilateral 30 Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities: Bilateral 30 Unilateral 20 Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral 10 Mild: symptoms relieved by built-up shoe or arch support 0

Halos My personal opinion: #1 Before you accepted the offer you took the time to think it over and talk to people that could help you weigh the pros & cons, etc. #2 In the end, you most likely saved yourself several more years of waiting, wondering and fighting battles. #3 100% P&T, Chapter 35 and no future exams....not much to complain about with that! I'm sure I would have accepted this offer if I were in your shoes. I think it's very normal to feel uncertain, worried that you made a mistake, or even a bit depressed after going thru the process for so many years and then suddenly having it over with. Many Congratulations! You did GOOD!

Thank you Allan.

Thanks for posting the link to the form Allan posted. I had missed that one!

Don't know what they are supposed to do but they refused to take my list. The doctor was actually quite unhappy that I'd made a list, even though I told her it was because I forget what I need to tell them. She never documented any of my issues in my progress notes.

So good to hear that all has gone well for you! Congratulations!

While my wife and I were going thru my VA medical records we found multiple errors, especially in my primary care progress notes. There are several PTSD screens that were supposedly done by nursing staff showing a negative PTSD screen(I'm 50% SCed). The funny thing is, I've never been asked any of the listed questions by any nurse. We found several other errors, especially in my primary care progress notes. So....I'm assuming that this must be happening to everybody. If so, just how do you address the problem? Who do you see? If others have as many as I do, it seems like this could be a never ending source of problems. I haven't been in the VA medical system that long.