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from my appeal (block 10 of form 9)

Heart Disease

I disagree with the effective date. I believe that if DR XXXXXXX would have had my SMR and reviewed it prior to my C&P Exam on 03/24/05 she would have seen:

- Years and years of high cholesterol readings.

- Feb of 1990 Where I was instructed inn the prevention of hypercholesterolemia

- April of 1992 I was diagnosed with hyperlipidemia and referred to a Dietician

- I went to a Emergency room in May of 1994 with chest pains

- May of 2000 a stress test from which documented Intermittent Claudication during the

test which is suggestive of Peripheral Vascular Disease.

- Nov 2000 I was taken off zocor and put on baycol.

- April of 03 cholesterol of 247.

- Documented family history of premature CHD.

All of the above would have alerted a M.D. to suspect Heart Disease, and it would have been her duty to look and check for heart disease. The general medical exam worksheet

http://www.vba.va.gov/bln/21/Benefits/exams/disexm23.htm states “This is a comprehensive base-line or screening examination for all body systems, not just specific conditions claimed by the veteran. It is often the initial post-discharge examination of a veteran requested by the Compensation and Pension Service for disability compensation purposes. As a screening examination, it is not meant to elicit the detailed information about specific conditions that is necessary for rating purposes. Therefore, all claimed conditions, and any found or suspected conditions that were not claimed, should be addressed by referring to and following all appropriate worksheets, in addition to this one, to assure that the examination for each condition provides information adequate for rating purposes.”

THE REQUIREMENTS OF THE VCAA ARE SET OUT IN 38 USC 5103, AND ARE EXPANDED upon in 38 CFR § 3.159. In general, VA has a duty to assist a claimant in obtaining all relevant records, to provide medical examinations, and where appropriate for compensation claims, to obtain medical opinions. It is my opinion that under the VCAA DR XXXXXX had a obligation to provide the best possible medical examination possible, and by completing the examination on 03/24/05 without reviewing my SMR she failed to comply with the VCAA. Her report states that my SMR was not present during the examination, she further stated that the veteran brought copies of his SMR and she reviewed them. This is un true, my SMR is over 600 pages long and She did not complete the physical and review the copy I brought with and left with in the 45 minutes I spent with her.

From my Ann Arbor VAMC Record 04/20/2007, “I reviewed the patients cardiac catherization performed on 6/1/06, which shows 2 vessel coronary artery disease with successful stenting of the mid LAD and an occluded, very well collateralized RCA. Based on the robust nature of the collateral vessels seen on this film, I would judge the pt’s RCA infraction to have occurred in the more remote (i.e. greater than 1 year ago) past. It is impossible to ascertain precisely when the RCA closed, and indeed closure of the vessel could have occurred silently without a noticeable myocardial infraction. Certainly, given the appearance of the vessel, it did not close recently. I also reviewed the patients service records at this time.”

Signed XXXXXXX XXXXXXXXXXX MD, Attending Physician Cardiology

My Cardiologist is stating that the vessel had been closed greater than a year when it was found. Thus my point is that I had this heart disease for sometime, it did not just appear after I retired from the service.

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Jim- that is prepared very well- you took them step by step-

those hyperlipedimia reading etc----etc- good for you-

This what it takes- understanding the med recs and any chemistry or blood work reports-

This could even be the basis of a Section 1151 claim- hard to say---

But the better EED is what you want and this is how to get it-

telling the VA step by step what the evidence revealed.

VA will not rate hyperlipedimia or high cholestrol- as disabilities -however they would have to rate the results of these disabilities if they cause heart disease and stroke.

Whether SC or not- for Vietnam vets and any vet potentially exposed to Agent Orange-

if you have heart disease make sure that it is listed in any claim for direct SC-on any other basis-

this way you will get a NSC rating for the CAD -but if CAD ever goes on the AO presumtive list- your EED ,under the Nehmer Stipulation-will be the date of the decision that held the NSC rating- and that would be the retro date.

Nehmer Retroactives are explained in the VBM and at the NVLSP website.

Edited by Berta (see edit history)
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They didn't give me a C&P exam either. I don't think it would've helped my case though, as it's hard enough for the Rheumatologists to figure out and they're supposed to be the experts. But that regulation also says they can obtain a medical opinion, so I wondered why the veteran couldn't request an IMO thru the VA?

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  • HadIt.com Elder

If the VARO reviews medical records of Service Connected Veterans to reduce or lower ratings would that not put them on the hook to increase ratings when justified being non adversarial and all?

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