diabetes Appeal Vs. Tdiu

[SEJones]

Well all I finally heard form the VA. The good news is they increased the rating the bad is I don't understand this 25 page letter. So I applied for ONE condition (SHML) and was awarded s/c. Then the problems started because there is no rating for the disorder. So a 2 year fight over what to call it that did have a rating. I thought since it is one disease that I would get the benefit of regular math not VA math. I was wrong. So here is how they broke it out to follow. They also denied several manisfistations of the disease. So should I appeal or just fill out the TDIU form. They did comment that they know that I have been on SSDI for same condtion since 2001. The SSDI award letter was part of my original claim in 2003. They said they could process the TDIU quickly. Should it go back to 2003 orignal claim date?

Thyroid 30

diabetes Inspidus 20

pulmonary fibrosis 10

surgery scar 10

Total 60% for 2003

Migraines 50 as of 2005

Total 80%

It seems that even if I win I will never get to 100% the way the math works eventhough they acknowledeged that this is one disease.

All comments welcome and needed

Thanks

SE

;)

[SEJones]

John

No there is no metion of a denial of tdiu. Just a note at the end of the SOC stating that I could apply and if I submit evidence of the last day I worked it would be processed more quickly. Oh and that I had a year from the date of the letter. The SO said they were holding my file waiting for the form.

SE

[Guest Berta]

Well all I finally heard form the VA. The good news is they increased the rating the bad is I don't understand this 25 page letter. So I applied for ONE condition (SHML) and was awarded s/c. Then the problems started because there is no rating for the disorder. So a 2 year fight over what to call it that did have a rating. I thought since it is one disease that I would get the benefit of regular math not VA math. I was wrong. So here is how they broke it out to follow. They also denied several manisfistations of the disease. So should I appeal or just fill out the TDIU form. They did comment that they know that I have been on SSDI for same condtion since 2001. The SSDI award letter was part of my original claim in 2003. They said they could process the TDIU quickly. Should it go back to 2003 orignal claim date?

Thyroid 30

diabetes Inspidus 20

pulmonary fibrosis 10

surgery scar 10

Total 60% for 2003

Migraines 50 as of 2005

Total 80%

It seems that even if I win I will never get to 100% the way the math works eventhough they acknowledeged that this is one disease.

All comments welcome and needed

Thanks

SE

;)

SE-reading over the statements from the SOC- if TDIU is granted-I feel they will award the TDIU back to the day they receive the form-I would not hesitate to file it if I were you-

They could go back to the 2005 migraine date- but it is hard to determine-

If your SSA is for SC conditions- they will consider that in the award-

which might change the retro TDIU date-

what do you get the SSA for?

[SEJones]

Berta and John

I met I went from 10% to 80% WITHOUT adding new evidence. My file is with the DRO This is why the SO thinks that I could get 100% back to 2003. Is this possible? Berta yes the SSDI is for the same (only one) condtion. The problem is the condtion is not in the regs. So I got caught up in them trying to rate its symptoms. My private doc is willing to wirte a letter to get some of the other symptoms s/c. I just need to know what format he should use. The VA has never treated or seen anyone with my condtion. The C&P examiner just googled my diagnosis during the meeting so ALOT was missed.

SE

[Guest Berta]

Berta and John

I met I went from 10% to 80% WITHOUT adding new evidence. My file is with the DRO This is why the SO thinks that I could get 100% back to 2003. Is this possible? Berta yes the SSDI is for the same (only one) condtion. The problem is the condtion is not in the regs. So I got caught up in them trying to rate its symptoms. My private doc is willing to wirte a letter to get some of the other symptoms s/c. I just need to know what format he should use. The VA has never treated or seen anyone with my condtion. The C&P examiner just googled my diagnosis during the meeting so ALOT was missed.

SE

OK_ now I see the SO's point-the medical evidence was there all along for higher rating-

it is just (my VA paranoia) you can't predict anything the VA might do-

On the IMO SE- make sure that the doctor states there could be no other know medical reason that these secondary conditions are not due to the SC one-

and makes sure he or she states their rationale-

their experience in medicine that would lend to their opinion.

I have noticed that some IMOS doctors reference treatises and other known medical principles-

Dr. Bash did that in the IMO I got-

He quoted from Brunwald, a highly respected medical publication as to the veteran's documented peripheral arteriolsclerotic disease as more than likely known medical condition that is due to diabetes, with no other known cause or etiology in the veteran's medical profile.

His IMO_ I mentioned under another topic here today

1. ruled out any other etiology for his opinion as to the veteran's disability(presumptive AO exposure)

2. he provided his expertise (about 10 pages of credentials)

and his experience with reading thousands of X rays and MRIs of diabetics and could refer to the clinical record as to the type of brain damage Rod had, as consistent with diabetic vascular disease of brain

-his bonafide rationale.

3. he referenced prior SOCs , VACO reports, autopsy, etc, and subsequent award letters I had sent him,along with the medical records, incorporating those findings into the opinion.

4. He added quote from a well known medical reference to support his opinion

5.He referred to the brief recent IMO I had received in email from a former treating VA neurologist.

6. He called the doctor to get the IMO on the doctor's letterhead for VA purposes.The two IMOS supported each other and the other doctor -in spite of such a short IMO- stated ,with the Bash IMO, the actual undebatable crux of the claim.

7. He also briefly referenced the subsequent decision that awarded Sec 1151. The VA had caused "multiple deviations" in standard medical care that led to the demise of the veteran (FTCA settlement and Sec 1151 award.)

I had proved heart disease, stroke, and improper medication were some of the deviations. VA never stated all of them and the VACO determined the care was substandard and undefensible.(documented)

Part of my claim was that- the undianosed diabetes was clearly- per the med recs- one of these deviations and- since the VA could not properly diagnose heart disease and strokes, they more then likely could not diagnose the veteran's diabetes -that caused the heart disease and strokes-whoch caused his death.

I am stating all this as to why a good IMO has to cover these specifics:

Medical Rationale for the opinion,

etiology factor ,

expertise and/or medical experience of the doctor,

in many cases , known medical literature that supports the opinion,

specific reference to the veteran's med recs,

and in my case to prior SOC statements,by a VA expert doctor, VACO reports ,autopsy etc.

And a second opinion right from the git go can help tremendously too.

8..I had sent considerable additional medical evidence from VA records that I mentioned to him-not in the opinion- but certainly the VA has it all , and it all presents an overwhelming picture of DMII.

I always say- surround the enemy- what I mean is send the VA any evidence whatsoever that helps prove your claim.

Edited November 8, 2005 by Berta