diabetes Diabetes And Complications.

[Chuck75]

I'm trying to find a reference to a statement made is some sort of VA document that starts out--

(more or less)

It has long been the position of the C&P Department?/Division? that various Cardio and vascular conditions are caused/aggravated by Diabetes (and so on). I have a copy of the statement somewhere and have lost the index to it. Worse, I never found an actual copy of the source document.

Can anyone supply any useful help in finding a reference to the document?

I've got to go to the city that also has my area VARO later this week, and might as well file an NOD in person.

[Berta]

Chuck-the VA's Diabetes Training Letter (attached here) might help you- it doesn't state strongly what you have stated here-I dont know what document that could be.

Also this might help you- These are extracts from my response to the AMC-

They might seem out of context for a regular DMII claim but that is because I had to prove my husband's med recs and autopsy revealed undiagnosed and untreated DMII (sort of like doing a claim backwards):

“The scientific evidence regarding the link between type 2 diabetes and atherosclerosis and cataracts is so strong that a provision in M21-1 requires the VA to service connect these conditions as secondary to Type 2 diabetes” unless other proven etiology.”

National Veterans Legal Services Program, VBM Edition 2005, page 176. (enclosed as EXhibit )

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autopsy and the CT scan as well as his ECHO (heart) reveals the significant athersclerosis he had- in heart and brain-

(PS all of these are under Exhibits P and the ECHO, EKGs, etc under Exhibit J.)

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In BVA decision http://www.va.gov/vetapp06/files4/0620890

A VA doctor states that:

“long standing diabetes mellitus hastens atherosclerosis which may give rise to hypertension.”

This is an established medical fact.

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VA’s own diabetes mellitus training letter (# 00-06) supports that :

Page 6 of 17 VA DMII Training Letter July 2000 (enclosed Exhibit M)

"The veteran, dead at age 47, had no other possible etiology for his advanced atherosclerosis but for his undiagnosed and untreated diabetes mellitus."

The “endothelial function” of “ accelerated atherosclerosis” as found in diabetics “may favor coronary thrombosis.”

Diabetic Medicine July 1990 issue pages 285-291

By Drs Giles and Sander Exhibit N

The highly significant association of LVH to diabetes is supported by pages one and two of “Left Ventricular Mass in Diabetic Patients,” Drs M Hashemi and Sartaj and in

“The Epidemiology of left ventricular hypertrophy in type 2 diabetes Mellitus” by Drs. Dawson, Morris, and Struthers

Diabetologia Allemagne Springer, Berlin:

As “We conclude that left ventricular abnormalities are common in type 2 diabetic patients.” Enclosed under Exhibits P.

Again the VBM from NVLSP , page 176, 2005 Edition reflects the “link between type 2 diabetes and atherosclerosis is so strong” etc-and per Merck, a VA reference, atherosclerosis is associated with a lipid hypothesis,diagnosed as hyperlipedemia by VA doctor Paul Binette (SSOC 1996 as enclosed Exhibit K .)

The Joslin Clinic, and the Framington Study as well as the ADA and the VA itself has recognized the significant factor of hyperlipedimia in diabetes,causing some VA doctors to check off or highlight in some way these factors in the Rod’s clinical records when Rod’s glucose was not in normal limits per VA’s criteria at time of those records.

"Diabetes mellitus is associated with increased cardiovascular (CV) morbidity and mortality and with greater ECG left ventricular hypertrophy (LVH); however, it is unclear whether diabetes attenuates regression of hypertensive LVH"

http://cat.inist.fr/?aModele=afficheN&cpsidt=17665115

Exhibit R

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These are strong medical texts I used to associate my husband's clinical record and autopsy with medical facts known in the standard medical community.

Diabetologica is also an excellent reference for DMII abtracts and info.

These were only regarding one facet of the claim-(CAD)I had plenty of other evidence too- but

my point here is that

atherosclerosis and also LVH (left Ventricular Hypertrophy)

-both are revealed in an ECHO report,

are highly indicative of heart disease with a probable diabetic etiology.

I had 3 IMOs and even got another VA doctor to concur with it (he couldnt give me an IMO but agreed with my claim)

The evidence I had was so significant it could have been awarded without an IMO in my opinion (I have plenty of additional evidence)

but I felt that a strong IMO would stave off the endless SSOCS I got in the past before the VA would accept my lay evidence.They finally did -but I used Dr. Bash this time as he had expertise in reading MRI reports as a NeuroRadiologist and made a powerful statement that no one at VA could make.

A CAD or Stroke can often be the first manifestation of diabetes.DMII should be suspected as the possible etiology of any heart attack or stroke, and can only be ruled out by testing for presense of diabetes.

This is the newer version of VA's DMII Training Letter- I am pretty sure the 17 page one-I posted here quite some time ago.

DMII_VA_Training_Letter.doc

[john999]

In the 2006 VBM the connection between artery disease and cataracts and DMII was stated as being strong, but not presumptive anymore. There was a change in the Regs. The M-21 still says it is presumptive. Knowing the VA I would bet you still need a doctor's opinion to connect these secondary conditions to DMII. Getting the medical opinions would save years of arguing with the VA over presumption. I got a secondary connection between artery disease and DMII based on a medical opinion from my VA PCP. Now I have cataracts. I am just waiting for my CUE claim to be decided.

[Chuck75]

To answer my own question--

The M21 has been revised and renumbered since the case, so the m-21 reference has changed, and I have not found the reference in the current renumbered M-21. It may have been deleted.

I found the reference as part of

Docket # 93-110 (BVA)

Flynn VS Brown

Secondary Service Connection 6/3/94

Service Analysis

The heart of the overall problem is that the VA has historically used the date of diabetes formal diagnosis EED? EOD? as a basis for everything else. Since many of the serious complications of Diabetes can occur years before the formal diagnosis is made, the VA has used this to deny many secondary condition claims.

The logic to counter is based upon many references and at least one va document that acknowledges that the "secondary conditions" often? occur on the average of ten years before formal diagnosis is made. After all a formal diabetes diagnosis is an after the fact diagnosis.

Seems to me that this would place the secondary conditions in at least the 50/50 if not the "more likely than not" category. There is other language that says that "presumptive" diseases, etc. "issue" from the military service. In the case of diabetes, you might make the case that the effects of diabetes started before formal diagnosis, and the limiting dates are between the dates of service and the formal diagnosis.

Since this is going to fly in the face of some previous VA decisions, and some decide this way/that way M-21 examples, I suppose it's gonna be a fight.

I'm trying to find a reference to a statement made is some sort of VA document that starts out--

(more or less)

It has long been the position of the C&P Department?/Division? that various Cardio and vascular conditions are caused/aggravated by Diabetes (and so on). I have a copy of the statement somewhere and have lost the index to it. Worse, I never found an actual copy of the source document.

Can anyone supply any useful help in finding a reference to the document?

I've got to go to the city that also has my area VARO later this week, and might as well file an NOD in person.