georgiapapa

Berta and others, Today I obtained copies of some of my medical records from my cardiologist's office including the records for my July 2012 diagnostic tests and September 2012 records of my recent heart cath and stent placement. I have an appointment this Thursday September 20th with my cardiologist where I will have a lot of questions. Below is some of the comments found in the various reports: July 10, 2012 Reports: MYOCARDIAL SCAN (Lexican/Thalium stress test) "There are no areas of ischemia or scar tissue seen." IMPRESSION: "Normal myocardial scan. No change from the prior exam of 11/09/10." EJECTION FRACTION: "The ejection fraction is calculated at 74%." LEFT VENTRICULAR WALL MOTION: "Left ventricular wall contractility is noted to be normal with no areas of hypokinesis or akinesis. There is no paradoxical wall motion seen to suggest left ventricular wall aneurysm.." IMPRESSION: "Normal left ventricular wall motion." NOTE: This report is signed by a local radiologist. LEXISCAN WORKSHEET (Screening for IHD) CLINICAL INFORMATION: "Patient with DOE/Fatigue and history of hypertension, hyperlipidemia." INTERPRETATION: "Resting electrocardiogram reveals sinus bradycardia at 51 bpm with a resting blood pressure of 128/64 mmHg. The patient received IV Lexiscan per protocol. Maximum increase in heart rate to approximately 100 bpm. There was quite a bit of artifact during the completion of the Lexiscan. Minimum drop in systolic blood pressure was to 90/60 mmHg. No significant ST changes were noted above the baseline abnormality when adjusting for the artifact intervening. No chest pain was experienced." CONCLUSION: "Nondiagnostic electrocardiographic response to IV Lexiscan." "Pharmacologic effect achieved." "Isotope study to follow." NOTE: This worksheet is signed by my cardiologist. ECHOCARDIOGRAM - INDICATION: " sob, cp, htn, dizziness." LEFT VENTRICULAR STRUCTURE: "Normal in size and shape." LEFT VENTRICULAR FUNCTION: "Ejection fraction is estimated at 60-65%. No regional wall motion abnormalities were noted." LV DIASTOLIC FUNCTION: "Abnormal diastolic function with impaired relaxation." RV STRUCTURE & FUNCTION: "Size and function are normal." LA STRUCTURE: "Left atrium is mildly enlarged." RA STRUCTURE: "Right atrium is mildly enlarged." INTERATRIAL SEPTUM STRUCTURE: "Not well visualized." MV STRUCTURE & FUNCTION: "Mitral valve is mildly thickened." "Mild regurgitation." AV STRUCTURE & FUNCTION: "Aortic Valve is a tri-leaflet structure." "Aortic valve leaflets are thickened." TV STRUCTURE & FUNCTION: "Triscupid valve is structurally normal." "Mild tricuspid regurgitation." "Estimated right ventricular systolic pressure is 32mmHg." PV STRUCTURE & FUNCTION: "Pulmonic valve is structurally normally without stenosis or regurgitation." AORTA STRUCTURE: "Aortic root is normal." PERICARDIUM: "Percardium is normal." MISC. ITEMS: "Inferior vena cava is not well visualized." CONCLUSIONS: "Technically good, valvular sclerosis, mild triscupid and mitral regurgitation, diastolic dysfunction, biatrial enlargement." NOTE: This report is signed by my cardiologist. September 13-15, 2012 Reports Regarding Placement of Stents: PROCEDURE: "Left heart catheterization, selective coronary angiography, left ventriculogram, drug-eluting stent x 2 to the LAD, intercoronary nitroglycerin complex." ANGIOGRAPHY: "Left main coronary arter has ostial 20% disease." "Left anterior descending artery has a medially located moderate diagonal branch that has ostial 20% disease." "At this level the LAD has a very complex lesion that is 95-99% stenosed with what appears to be some thrombus." "The lesion is approximately 18-19 mm in length." "There is then a second diagnonal that is small to moderate size with a more tubular eccentric 70-80% stenoses in the distal LAD that is approximately 11 mm in size." "There is TIMI 2 flow." The circumflex is a large dominant system." There is a small first and second marginal." There is 20% luminal irregularities in the AV groove." There is a large distal posterolateral marginal and then there is 40% to 50% disease in the proximal segment of a large PDA>" "The right coronary artery is small and dominal." "There is proximal 20% disease." LEFT VENTRICULOGRAM: "Left ventriculogram in the RAO projection." "Three aortic valve cusps are present." Left ventricular systolic function is normal." "Ejection fraction estimated at 55%." "The apex is sluggish with some jypokinesis." CONCLUSION: "Three-vessel coronary artery disease is significant in the LAD distribution representing the culprit." "Successful drug-eluting stent to proximal portion of distal LAD and mid LAD restoring TIMI 3 flow." "Preserved left ventricular systolic function with segmental abnormality." NOTE: This report is signed by my cardiologist. PATIENT HISTORY: "Hypertension, mitral valve prolapse, dyslipidemia, chronic fatigue, obstructive sleep apnea with CPAP, elevated cholesterol, elevated triglycerides, elevated LFTs, elevated bilirubin, plasma cell dyscrasia, GERD, Gastric polyps, iron deficiency anemia, testosterone deficiency, colon polyps. Question: If the VA relies on METS & ejection fraction so much in their rating criteria, is there any chance I will be rated above 0% with my latest ejection fraction at 55%? I will ask my cardiologist on Thursday about a METS score. Please give me your thoughts and input as to what my reports indicate, especially the reports from September 2012 and your thoughts on a possible disability rating for IHD. Thanks...Georgiapapa

Still here, My old claim is still showing a status of gathering evidence but my RO is slow in updating Ebenefits. I filed my old claim in October 2011, provided all evidence to RO via certified mail in 2011, hand delivered evidence in May 2012 after my RO could not find evidence, had my C & P on September 12th which I think went well but you never can tell. The NP who conducted the C & P accepted all of my documents and after reviewing the documents she said "it looks like your doctors have already conducted the same tests we were going to do so I think this is all I need for my report to the RO." She also said, "you should hear something in about 90 days" which I will believe when it happens. Georgiapapa...

I asked some of these questions on another post but I am still unsure as to how to proceed. I currently have a claim pending and I had my C & P for the claim September 12th. Since I am past the C & P process, I do not want to delay this claim. I recently learned I have IHD and would like to file a new claim for the IHD through the Fast Track process as soon as possible so I can establish the earliest effective date possible. However, before I file my new claim I need some advice from others who have been in this same situation. Is there anyway to file for IHD now through the Fast Track process and not delay my pending claim? If it would delay my current claim, is there a way I can file for IHD after my current claim is decided and still establish the earliest effective date for my IHD claim? I don't mind waiting to file my IHD claim but I want to protect the earliest effective date possible for the IHD claim. Is it possible for a veteran to file a claim (fast track or normal process) to establish an effective date but ask the VA not to process the new claim until completion of the currently pending claim? I hope these questions make sense because I am not sure how to proceed with my IHD claim at this point. Your input would be appreciated. Georgiapapa...

My thanks to all of you for your informative replies. I need some additional guidance from all of you in regards to filing my claim for AO IHD considering the fact that I have a current claim pending for AO Multiple Myeloma and Peripheral Neuropathy secondary to my Multiple Myeloma. I had my C & P for MM and PN on September 12th. Since I am past the C & P process, I do not want to do anything to delay my current claim but I also want to establish the earliest possible effective date on my IHD claim. I planned to ask my cardiologist to complete a DBQ during my follow up visit with her on September 20th. I am also considering filing my AO IHD claim through the fast track process. Question: Do you think filing my AO IHD claim before resolution of my MM & PN claim will delay my claim for MM & PN? Question: If you believe it may delay my claim, how do I protect myself as to the earliest effective date for my AO IHD claim? Question: How is the earliest effective date established in an IHD claim? (Is it based on the date claim received, date symptoms recorded in medical records, date my stents were installed or what?) Question: As to the fast track process, are there any drawbacks to using this process? Question: If I use the fast track process, how is the DBQ submitted? All info provided is sincerely appreciated. Georgiapapa...

Berta, I talked with my cardiologist and asked why there was no indication of blockages during my diagnostic tests in July. She seemed truly concerned and said she was going to look into the matter because there should have been some red flags. Apparently, her cardiology group has someone who reviews the tests for the cardiologists and prepares reports of their findings for them. I am not sure of the professional background of the person performing the reviews. I advised my cardiologist that I was concerned about the reliability of the echo and ECG versus the cath procedure. She told me that an ECG and echo have an important role in diagnosing cardiac problems but are not as reliable as other diagnostic tests in situations such as mine. My cardiologist characterized my blocked artery symptoms as "atypical" because the only symptom I experienced on the night I went to the emergency room was a sharp stabbing pain in the center of my chest. I did not have any pain radiating to other parts of my body, no profuse sweating, no crushing feeling in the center of my chest, etc. Due to my lack of the standard symptoms, my cardiologist instructed me to contact her immediately if I experience any severe chest pains in the future and she will call the hospital and schedule me for a cath procedure upon my arrival in the emergency room. Georgiapapa...

Still here, Believe me I have learned my lesson. In the future I will seek emergency attention anytime I start having the chest pains. As I stated in my original message, I did have a cath this week which revealed my blockages. I don't think I will ever trust an ECG or an echo in the future. The cath seems to be the most reliable test to detect blockages based on what I have been told so far. Thanks for your input. Georgiapapa...

Berta, I have been going to this cardiologist for over twenty years for mitral valve prolapse and hypertension. Over that period of time, my cardiologist has performed different tests on me including stress test on a treadmill with IV, stress test sitting with IV, echo of heart, ECG, doppler procedures, chest x-rays, etc. The IVs used during the stress tests included some type of nuclear medicine. I have never been told I had a problem with blocked arteries prior to this week. I am going to ask for copies of all of my medical records at my cardiologist's office for as far back as they are available. The notification I received from the cardiologist's office regarding the results of my July cardio tests actually came from my cardiologist's PA via telephone. I had an appointment previously scheduled with my cardiologist for September 20, 2012 during which she was going to go over my July test results as well as the results of a Doppler procedure of my legs I had in August. I am waiting for my cardiologist to come and discharge me. I will ask why the previous cardio tests from July did not reveal the blockages. I will let you know what she tells me. Georgiapapa...

Up until a couple of days ago, I never thought I had any heart problems other than a mitral valve prolapse. Earlier this week I had been to my private primary care doctor for a cough and intermittent chest pain. I had undergone a stress test and an echo of my heart in July by my cardiologist and was told everything looked fine so I did not think my recent chest pains were caused by heart problems. My pcp did a chest x-ray and EKG and said it wasn't my heart and he diagnosed me with pleurisy and bronchitis. Wednesday night of this week I started experiencing severe chest pains and my wife called 911. I took an ambulance trip to the emergency room. After running some blood tests, I was told my cardiac enzymes were elevated and the cardiologist performed a heart cath. After the heart cath, the cardiologist informed me she had placed two stents in my heart due to a 99% blockage in one part of my LCD and 80% blockage in another part of my LCD. I believe the LCD she was referring to is the left anterior descending artery of my heart. My cardiologist advised that I did not have a heart attack but she said I was on the verge of a serious heart attack prior to placement of the stents. I am currently in the heart unit of my local hospital but I hope to be discharged this morning. I am totally lost as to what I need to do in regards to a claim for AO related IHD. I am a boots on the ground Vietnam veteran so I think I would qualify under the AO presumptive policy. Any guidance anyone can give as to what is needed and how to proceed at this point in time would be appreciated. Even if I would be rated at 0% service connected (since I did not experience a heart attack), at least this would make benefits available to my wife in the event I later had a fatal heart attack. Your thoughts ans suggestions would be appreciated. Georgiapapa...

Reddit & Notorius Kelly, Thanks for the input. Reddit, I am going to the VAMC in Dublin, Ga for my C & P. I also had a problem with the Atlanta VARO not being able to find my complete evidence package mailed to them in 2011 even though I had proof they received the evidence. I finally had to hand deliver another complete package to them on May 1st of this year. On ebenefits they show receiving my evidence on August 13, 2012. Good luck with your C & P. Notorius Kelly, Sorry to hear about your disability claim denial with social security. The only positive thing I see with the VA using a NP for my C & P for my cancer and neuropathy claims is my IMOs from my private oncologist and neurologist should carry more weight with the BVA if my claims are denied. I am going to take copies of my IMOs to my C & P and hope that the NP will agree with their conclusions so I don't have to go the BVA route. I hope I have a positive experience with the NP and thanks for your encouragement. Georgiapapa

USMC5811, Thanks for the info. I was beginning to think I was not going to get any replies. I should have known that a fellow jarhead would take the time to give me some good info. Semper Fi, Georgiapapa

I received notification today that I am scheduled for a "C&P Exam-General" for September 12, 2012. I looked up the name of the person performing the exam and she is listed as a primary care nurse practitioner. I have a pending claim for multiple myeloma caused by agent orange exposure in Vietnam and severe bilateral neuropathy of the lower extremities secondary to multiple myeloma. In addition to medical test results and other medical evidence I submitted an IMO from my oncologist verifying my multiple myeloma diagnosis and another IMO from my neurologist stating my neuropathy is "more likely than not" secondary to my multiple myeloma. I also provided EMG and Nerve Conduction study test results. I anticipated a C & P exam from an oncologist for the multiple myeloma claim and a C & P exam from a neurologist for my neuropathy claim. Question: Is it normal to have a general C & P exam for these type of claims? Question: Will I receive other C & P exams for these specific conditions? Question: Will I be examined at anytime by a VA oncologist and VA neurologist? I do not see how a primary care NP can conduct a competent exam of my two claimed conditions, especially the multiple myeloma which is a rare blood cancer in the bone marrow. Any input would be appreciated. Georgiapapa

USMC 5811, What about a claim for tinnitus. You did not mention this in your message. I can not imagine anyone who was in artillery not having tinnitus (constant ringing in the ears). This is 10% if claim is approved. I was only in artillery for 4 years and had no problem having a claim approved for tinnitus. I also went to a private audiologist and had the private audiologist prepare an IMO letter which stated my hearing loss and tinnitus were "as likely as not" caused by my exposure to artillery being fired while in the Marine Corps. I enclosed this letter when filing my claim. My VA C&P examiner used the same language about "being speculative" about service connection but the IMO from my private audiologist tipped the scales in my favor. I am service connected for hearing loss and tinnitus, 10% for each. Georgiapapa...

Mil T I currently have a pending claim with VA for smoldering multiple myeloma. I filed my claim in October 2011. I was diagnosed with MGUS in August 2009 and then I was diagnosed with smoldering multiple myeloma in September 2010 after I had a bone marrow biopsy which indicated a plasma cell percentage of 12%. My last bone marrow results indicated 22% plasma cell percentage. At first, I was not going to file a claim for smoldering multiple myeloma since it is considered asymptomatic but input with others on this forum convinced me to do otherwise. Berta, who is one of the moderators on this forum, provided me with a BVA decision where the veteran was successful with a smoldering multiple myeloma claim. However, I have not heard of anyone who was successful with a MGUS claim. According to my oncologists, some people with MGUS never develop multiple myeloma but people with multiple myeloma more than likely had MGUS first. Keep your fingers crossed that your MGUS will never develop into multiple myeloma. If you have any other questions, let me know. Georgiapapa...

Carlie, If a veteran moves to another state, does their pending claim transfer to the VARO in their new state or remain with the VARO in their old state? Georgiapapa

Spent, Check out the following link: www.opm.gov/insure/health/eligibility/tricare.asp According to info on this link, FEHB coverage can be suspended rather than cancelled. By suspending FEHB coverage you could avoid paying FEHB premiums but still be able to restart FEHB coverage in future if Champva coverage is lost. This link pertains to Tricare, Champva, Medicare, etc. Hope this helps. Georgiapapa...

rentalguy, I currently go to a private gastroenterologist and have had several endoscopy procedures monitoring my GERD and they are painless if you receive anesthesia such as propofol. I definitely would not have one without anesthesia. After the situation with the cross contamination during endoscopic procedures at the Augusta VAMC in Georgia, I would not even think about allowing the VA to give me a endoscopy. Your GERD sounds more serious than mine. I have been on Nexium 40 mg twice a day for about 20 years. I have been on Zanatac 150 mg twice a day for 3 years. I am also on Carafate liquid two teaspoons 4 times a day. I have a chronic cough from the GERD, especially right after eating. Last year my doctor recommended I have a Nissen Fundoplication surgical procedure at the Mayo Cllinic in Jacksonville, Florida. The doctor said he would not recommend allowing any doctor to perform this surgical procedure unless they have successfully performed the procedure many times. I am still procrastinating about having this procedure. Check it out on the internet and you will see it is a complex surgery and sometimes has complications. Has your doctor recommended this procedure for you? I also have problems with hyperplastic stomach polyps. During my last endoscopy procedure on the 7th of this month, my doctor removed 48 large polyps and stated I still had some small ones which he would check again in a few months. I am waiting for the pathologist report. You should definitely have the endoscopy procedure because of the potential of developing stomach cancer. Hopefully you will never have it, but better to catch it early if you do have it. Good luck to you... Georgiapapa

First let me say I appreciate the guidance from Broncovet, Berta and 71M10. The Atlanta VARO employee did date stamp my 3 page table of contents/evidence list which provided a detailed itemized list of all documents contained in my evidence package provided to the Atlanta VARO yesterday. All pages of my package were numbered (e.g.- 1 of 87, 2 of 87, etc.) in red ink. However, I made a mistake in that I did not get the last page (page 87 of 87 date stamped). My evidence package had 18 tabbed sections. On the actual tab page of each section I listed the tab number and underneath the tab number I put the following information: "This tab section contains pages _-87 through _-87 of this evidence package") Each tab page listed what pages were in each section. I tried to prepare my package so it was easy to reassemble if was mixed up, dropped, etc. Also, every page of my package has my VA claim number stamped on it at the top of the page in red ink. For whatever it is worth, I sent a message to IRIS this morning making them aware that the Atlanta VARO would not date stamp all of the documents provided to them. IRIS was already aware of the loss of my original package by the Atlanta VARO. I just wanted to create an additional record of this problem in the event the Atlanta VARO loses all or part of my documents delivered to them yesterday. Berta, as to the POA, my VA records show American Legion as my POA but I do not recall ever designating them as my POA. If I did, it was during my first claim in 1970. However, I have tried to contacting the American Legion rep in Atlanta since March of this year without success. I left several messages and even talked with a person there who said they would have someone call me back. The person also told me they were extremely busy so it might be awhile. I have also reached out to the state veterans rep who apparently must be extremely busy because he has not returned my phone calls or e-mails. Based on the lack of response, I just do not have much faith in POAs. I might change my mind but at this time I feel like I am better off relying on the hadit forum and getting advice from knowledgeable people such as yourself. I have been extremely satisfied with the advice you and others on this site have given me on other issues. Again, thanks to all of you for your advice. Georgiapapa...

UPDATE: In my last response from IRIS they advised the Atlanta VARO still could not find the documentary evidence I mailed to them in 2011 via certified mail return receipt requested. My due date on my VCAA notice is May 6, 2012 and I wanted to make sure the VA had all of my evidence before they started the review process of my claim so today I went to the Atlanta VARO and hand delivered copies of the same documentary evidence I had mailed to them. I told the lady at the desk that the VARO had lost all of my original documents and I wanted to provide her with copies of all of the lost documents. She asked, "are these the original documents?" I told her no because your agency lost the original documents. She said, "well we are supposed to get the original documents." I said, "if you can find them you can have them, but until you do these copies will have to do." She reached for the documents and I told her I wanted each and every page date stamped and I wanted copies of the date stamped documents. The VARO employee told me that per VA policy she could only date stamp two pages. After talking with her a few minutes, she did agree to go ahead and date stamp my two page cover letter, three pages of table of contents/evidence list and my signed VCAA notice form. I only ended up with copies of six pages date stamped out of the 88 pages I provided to her but this was the only thing I could do with the VA's policy of limiting the number of pages that could be date stamped. My table of contents/evidence list is a detailed itemized list of every document I provided to her but I wish I could have had all of the documents copied and date stamped. I hope they don't lose the documents I gave them today. Has anyone else ever been told by a VARO that they could only date stamp two pages or is this only Atlanta VARO's policy? Georgiapapa...

Berta & John, Thanks again for your input. I will start working on your suggestions tomorrow. I would start today but I am tired of being on this computer. Both of you have been a big help. Georgiapapa...

Berta, My neurologist and oncologists are all private doctors. All of them have been in practice for over twenty years and they have great credentials. The only specialists I use at the VA are for my mental health issues. On September 19, 2010, you cited the same BVA case to me in a reply to a question I had about filing a claim for smoldering multiple myeloma. This is a great case and I actually submitted a copy of the case as part of my evidence in my recent claim for multiple myeloma and peripheral neuropathy. I thought the facts in this case were similar to my situation. Do you think I need to make any changes in my current claim or leave it like it is? I am still not clear on this. I know you are one of the most knowledgeable members on this web site and when you speak I listen. However, my scrambled brain doesn't always properly process the information I receive. At times I have problems concentrating and staying focused on what I am doing. Your expertise is appreciated. Thanks...Georgiapapa

Berta, Forgive me for being a little slow but it just hit me as to what you and John are trying to tell me. To make sure I am now clear on this, are you and John saying that my claim for peripheral neuropathy will not even be considered along with my multiple myeloma claim? It sounds like I will have to wait until my multiple myeloma claim is approved and then file another claim for peripheral neuropathy secondary to multiple myeloma. Is this correct? If so, should I withdraw my claim for peripheral neuropathy at this time and refile later? NOTE: For what it is worth, my oncologist considers my peripheral neuropathy as a symptom caused by my multiple myeloma and has reclassified me from asymptomatic multiple myeloma to symptomatic multiple myeloma. How can I clean this mess up? Georgiapapa...

Berta, My claim for peripheral neuropathy is claimed only as secondary to my multiple myeloma. I have had neuropathy in my toes for several years. In 2009, the neuropathy began spreading into the rest of my feet. My neurologist conducted EMG tests, Nerve Conduction Studies and several blood tests. At that time my neuropathy was considered moderate. The same neurologist also discovered myeloma protein in my blood and referred me to a oncologist who discovered my myeloma. In the fall of 2011, my neuropathy began progressing up into my legs. My neuropathy pain also increased and I started taking gabapentin. I had additional EMG tests, Nerve Conduction Studies and CT myelogram tests in 2011. My neuropathy was then considered severe in my feet and legs. At first, my neurologist and orthopaedic doctor thought the neuropathy was caused by spinal stenosis but the CT myelogram indicated I did not have any significant stenosis. After reviewing all of the diagnostic tests and my other medical records from my orthopaedic doctors, oncologist and primary care doctor and doing some research of the medical literature available; my neurologist concluded that my neuropathy was caused by my multiple myeloma disease. One of my two oncologists also agreed with my neurologist's conclusion. I asked my neurologist if he would put his conclusion in writing and follow a format necessary for a successful claim with the VA. He agreed and I provided him with the information provided on the hadit website for IMOs. He provided me with a detailed IMO which concluded with the following sentence: "Considering every possible sound medical etiology/principle, to at least the 50% level of probability, I am of the opinion that the patient's symmetrical distal polyneuropathy of his lower extremities is more likely than not secondary to his currently diagnosed dysproteinemia/smoldering multiple myeloma disease." As to the bad water at Camp Lejeune, I am currently researching to see if any of my other issues may have been caused by the bad water. My unit was housed in the area where water was provided by the Hadnot Point water treatment plant. I have found info on veterans who have filed claims for multiple myeloma and peripheral neuropathy due to exposure to the contaminated water but since I am already pursuing claims on these issues as a result of my agent orange exposure, I don't think I need to file a duplicate claim for these issues. Berta, any additional thoughts or suggestions or you have would be appreciated. Thanks Georgiapapa...

Sharon & Donna, I appreciate your suggestions. If anyone else has any thoughts on the effective date issues brought up by Donna, please let me know. Georgiapapa.

John, I did see combat in an artillery unit. Our unit participated in several combat operations which are well documented in my service records. I also have the Vietnam combat ribbon and Vietnam service ribbon. Our unit was subjected to mortar attacks on a regular basis. I had fellow marines in my unit who were KIA or WIA while I was with them in Vietnam. However, I don't think I have PTSD from what I experienced in Vietnam. I have never been evaluated for PTSD. I have had thorough physical exams and have other health problems including obstructive sleep apnea, mitral valve prolapse, GERD, neuropathy of all extremities, hypertension, hand tremors, frequent headaches, gastritis, bilateral hearing loss, tinnitus, arthritis and multiple myeloma. I am service connected for hearing loss (10%), tinnitus (10%) and shoulder injury from Vietnam (10%). Other than my multiple myeloma, neuropathy and anxiety disorder, I don't think I have anything else that I could service connect unless it is conditions related to the contaminated water at Camp Lejeune when I was there in 68, 69 and 70. Thanks for your input. If you have any other suggestions, let me know. Georgiapapa...

John I was boots on the ground in vietnam in 1967 & 1968. Multiple myeloma is on the AO presumptive list. At this time I really don't expect a 100% rating for my multiple myeloma because I am in early stage. My oncologist seems concerned that my neuropathy is getting worse and is considering stem cell transplant. If I have the stem cell transplant I may qualify for a temporary rating of 100%. I am very satisfied with my VA psychologist and NP and I think they would give me a letter if they are permitted to do so by the VA. The NP is the one who entered the comment about my anxiety disorder being secondary to multiple myeloma. If necessary, I will try to get a strong IMO from an outside psychologist or psychiatrist. I will try to get my ducks in a row before I do anything. I appreciate your advice. georgiapapa