diabetes Nexus In Smrs

[Berta]

This is one of my local vets.

I got him awarded about two years ago-

mega retro-----long time case------

His rep brought him to my home. I had limited info but had managed to access this BVA case and fortunately it was his because he forgot to bring all of his stuff-

http://www.va.gov/vetapp00/files3/0029422.txt

This was for SC of diabetes but not AO diabetes.

The Nexus is in the BVA decision-

one single word that no one bothered to even look up to see what it meant.

I couldn't wait until they left to delve into this word and what it meant-a few hours later ---

it meant service connection!

I will buy the VBM for the very first person here who posts that they have found the nexus word.

My point is that even with his SMRs the veteran himself nor his rep nor his attorneys at CAVC even read the SMRs carefully or used a medical dictionary to understand them.

Edited May 17, 2007 by Berta

[hayley3]

So, how do you get a specialist to read your claim? Or are you saying that the C&P doctor is the one that made your case? I'm confused on that point.

I actually thought that they showed the claims to a doctor. Well, that's not good.

How in the world do they decide a claim? They surely have to have some knowledge of the disease they are researching.

Susie,

The VA raters will have great difficulty with your claim. When my claim was first denied I suggested that VA raters not be allowed to process claims for systemic diseases unless they were MD's or immediately forwarded the claim to a specialist for review of the entire medical history priot to a decision.. It takes an MD to sort out the progression of symptoms and changing names of these diseases. Raters are just wasting everybodys time trying to figure it out.

I filed a claim for angioedema. The first decision was denied saying I was not treated in the service for this condition. Consider the following. Angioedema was considered a psychiatric condition for 150 years. It was called Angioneurotic Edema. It is the only disease I have heard of that had the word neurotic stuck right in the middle. It was listed in all of the DSM's up to the DSM IV.

With the development of modern medicine they figured out that it was not a psychiatric condition and dropped it from the DSM. They have since identified about five different forms of the disease. There is a hereditary form, allergic forms, non allergic forms, etc. Doctors call the disease Angioedema, allergic edema, urticaria, anaphylaxis. The symptoms can result in swelling of any portion of about 90% of the body. Skin, intestines, brain, mouth, nose, joints, etc. The form I have is considered an occupational illness under labor law.

Obviously I was treated in the military and the RO refused to schedule a C&P for five years. Eventually, I got one and only one report from the first specialist (head of immunology at the local VA) that read my file that was a slam dunk winner. It was just a question of symptoms and diagnostic terms that raters would never comprehend. Would you believe the rating schedule still calls it "Angioneurotic Edema"

[Hoppy]

Susie,

The laws have changed over the years. When I first started trying to get a VA doctor to help me the VA doctors were not required to help. In 2000 or 2001 the congress was a all over the VA for deniying claims without a C&P exam. The VA isssued a directive requiring primary care doctors to write a nexus letter when the veteran requested it. The directive instructed the veteran to take a medical record including SMR's and private doctors reports and any record of the current diagnosis to the prinary doctor for the doctors review and assessment as to whether it was more likely than not that the current condition has a nexus with the records form the time you were in the service.

I went to customer care and told them that their doctors had refused to help me for five years and now I have a directive. They called the head of immunology and he agreed to see me. This was actually better than seeing a primary doctor considering most primary doctors know little about the diagnostic terms used over a thirty year period. I filed my claim 26 years after my discharge. The head of immunology was board certified one year before my discharge. He had been the head of immunology at that hospital for over 25 years. He wrote a very favorable report and I was service connected without a C&P exam.

I am not sure what happened with that directive over the years. I think the VCAA which was passed several years later replaced it. As far as I know the RO is supposed to automatically schedule a C&P to determine if a nexus exists when the veteran has both an inservice diagnosis and post service diagnosis for the same condition. This provision could be verfied by finding the VCAA and reading it over. This is why I told you to tell you SO, hadit and a congressman if you can find a paper trail back to your time in service. Also consider that there are presumptive disorders that might be treated differently. Find out from your SO if you have a presumptive condition or not.

Now in a case where there are questions as to whether or not the doctors used different terms for the same condition would confuse the RO. That is why I suggested you make sure your SO is aware of any disparity or changes in medical terminology. The SO might be able to request a C&P for the purpose of resolving any disputed diagnoses.

Some people seek a report from a private doctor (IMO). If the VA doctors keep giving you the run around and the SO can not get a C&P consider a private doctor. If you need to go this route ask your SO for assistance on getting an IMO report written in a format accepted by the VA.

Keep asking questions here on hadit at all times.

Edited May 21, 2007 by Hoppy

[Hoppy]

To continue,

The VA raters have very little medical training. They are trained in connecting the dots as to adjudication laws. The doctors reports make and break a case. If the diagnoses terms changes over the years the RO will have problems connecting the dots. Thus, you need to connect the dots for them or they will not see the diagnostic picture.

[hayley3]

Thanks for explaining all that Hoppy!

I noticed there is a section in the regs that state that they will provide a medical exam or medical opinion if needed if it necessary to decide the case under section 3.159, if there is sufficient persistent or recurrent symptoms of disability. And I have that. I couldn't understand why they couldn't have sent me to see a specialist or have a C&P exam.

I am waiting for my service medical records. I hope I get them in time to take to the IMO. (does anyone know how long it normally takes to get those records)

But anyway, it's that question mark in front of my diagnosis that's in my way. I guess.

And the rater says they didn't see any evidence of the disability in service when I am 50% service connected for it.

I'll try and contact my SO. He is very hard to get a hold of.

Thanks again. You are sooooo helpful!

Susie,

The laws have changed over the years. When I first started trying to get a VA doctor to help me the VA doctors were not required to help. In 2000 or 2001 the congress was a all over the VA for deniying claims without a C&P exam. The VA isssued a directive requiring primary care doctors to write a nexus letter when the veteran requested it. The directive instructed the veteran to take a medical record including SMR's and private doctors reports and any record of the current diagnosis to the prinary doctor for the doctors review and assessment as to whether it was more likely than not that the current condition has a nexus with the records form the time you were in the service.

I went to customer care and told them that their doctors had refused to help me for five years and now I have a directive. They called the head of immunology and he agreed to see me. This was actually better than seeing a primary doctor considering most primary doctors know little about the diagnostic terms used over a thirty year period. I filed my claim 26 years after my discharge. The head of immunology was board certified one year before my discharge. He had been the head of immunology at that hospital for over 25 years. He wrote a very favorable report and I was service connected without a C&P exam.

I am not sure what happened with that directive over the years. I think the VCAA which was passed several years later replaced it. As far as I know the RO is supposed to automatically schedule a C&P to determine if a nexus exists when the veteran has both an inservice diagnosis and post service diagnosis for the same condition. This provision could be verfied by finding the VCAA and reading it over. This is why I told you to tell you SO, hadit and a congressman if you can find a paper trail back to your time in service. Also consider that there are presumptive disorders that might be treated differently. Find out from your SO if you have a presumptive condition or not.

Now in a case where there are questions as to whether or not the doctors used different terms for the same condition would confuse the RO. That is why I suggested you make sure your SO is aware of any disparity or changes in medical terminology. The SO might be able to request a C&P for the purpose of resolving any disputed diagnoses.

Some people seek a report from a private doctor (IMO). If the VA doctors keep giving you the run around and the SO can not get a C&P consider a private doctor. If you need to go this route ask your SO for assistance on getting an IMO report written in a format accepted by the VA.

Keep asking questions here on hadit at all times.