Please Help Me With My Claim !

[bm6546]

I would like to ask the members on Hadit.com for some help. I am not sure which direction to go with my VA claim. I have been fighting with the VA for almost 3 years with my claims that go back over 40 years. In the last 3 years they have denied my claim twice and I am very frustrated and not sure what to do next. Someone on Hadit.com has a few ideas that they think might help me with my claim. They were nice enough to do some research and write up a "Statement In Support of Claim". I would like to briefly set this up and attach the comments that this person has sent me and I would like the Hadit members to let me know what they think. I apologize in advance for the length of this post but I don't know what else to do.

I was discharged from the US Navy back in 1966 with a heart condition called PAT (Paroxysmal Atrial Tachycardia) and was given 10% SC for approx. 1 year and then it was discontinued. (You can review my past posts for more detail info on this claim). I have been in and out of different hospitals over the last several years with this heart condition and 3 years ago I had a heart attack and I am now on SSDI because I am not able to work any more. I suffer from anxiety, depression and heart problems. And to top everything else I am going thru a divorce after 25 years of marriage. I have tried to connect my PAT and heart attack and the VA says they are not connected and denied my claim twice. I am currently on several medications thru the VA for depression, anxiety and my heart condition. I am trying to at least get my 10% back and am trying to get it raised to 30%. Here is the attachment:

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Statement In Support of Claim

THE ISSUES

1. Claim for Increase for Paroxysmal Atrial Tachycardia (PAT) currently rated 0 percent, under 38 C.F.R. Sec. 3.160(f) resumption of payments previously discontinued.

2. Entitlement to Service Connection for Anxiety Disorder, under 38 C.F.R. Sec. 3.310(a) Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.

INTRODUCTION

The veteran served the Vietnam Era, active duty in the US Navy from November 10, 1964 through November 25, 1966.

While active-duty, veteran reported heart palpitations, shortness of breath, aching chest pain, dizziness, fainting and syncope. An active-duty diagnosis of Tachycardia necessitated Holter Monitoring for approximately three weeks duration, which objectively confirmed the diagnosis Paroxysmal Atrial Tachycardia (PAT), and was positively evaluated under Sec. 4.104, Diagnostic Code (DC) 7013.

On 11-26-66, active-duty member was granted service-connection for PAT under (DC) 7013, and awarded 10% compensation rating.

Following an incomplete VA Compensation and Pension Examination, 12-12-67, the veteran’s 10% compensation was reduced to a non-compensatible 0% rating.

The veteran herein challenges that VA Rating Decision of 2-5-68, by claiming Clear and Unmistakable Error (CUE), 38 USC 5109A.

In that 12-12-67 C&P Examination, the VA Examiner noted:

"... while in service he had episodes of palpitation following inspection, with fainting and ended up in sick bay. He then began to have palpitation with some pains in mid sternal area following exertion, drills, and at times even when resting. The spells of palpitation may last from 5 to 20 minutes now, and in recent months has had 6 episodes, the last one 3 - 4 days ago. He has learned to lean forward with head between knees, and take deep breaths and this at times shortens the interval and length of attack. He is working now, gets the episodes at work, but continues working, [only] after they subside." Emphasis in italics.

By the examiner’s own admission then, the veteran’s symptomology clearly met then existing DC 7103 rating criteria for frequent attacks of PAT with impaired occupational functioning, whereby his “attacks” were “at times” manageable; and by default, other times not.

Proving that 1967 C&P Re-examination of PAT was incomplete, is the Federal Regulation which provides that, “Examinations less full and complete than those on which payments were authorized or continued will not be used as a basis of reduction“, Sec. 3.344 Stabilization of disability evaluations. A Holter monitor provided positive objective evidence of an active-duty diagnosis of PAT; therefore, that 1967 C&P Re-examination of PAT was less full and complete without reference to the Holtor Monitor criteria.

Under then existing diagnostic criteria, the active-duty member’s medical condition was evaluated under (DC) 7013, “Tachycardia, paroxysmal”, which provided for 10 percent evaluation when there were infrequent attacks, and 30 percent evaluation when there were severe, frequent attacks. The words "slight," "moderate" and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the VA must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 CFR 4.6 (2004). See also 38 CFR Sec. 4.7 providing that, “Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating.”

New regulations for rating service-connected cardiovascular disorders became effective January 12, 1998, 62 Fed. Reg. 65207- 65224 (December 11, 1997). These revised regulations no longer contain criteria applicable specifically to PAT; but rather rate PAT by analogy to Supraventricular Arrhythmias under Diagnostic Code 7010.

Under DC 7010, a 10 percent evaluation is warranted for supraventricular arrhythmias with permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by electrocardiogram or Halter monitor. A 30 percent evaluation is warranted for supraventricular arrhythmias with paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by electrogram or Holter monitor. 38 C.F.R. § 4.104, DC 7010 (2004).

Significant is the application of Section 4.100 Application of the evaluation criteria for diagnostic codes 7000–7007, 7011, and 7015–7020.

(a) Whether or not cardiac hypertrophy or dilatation (documented by electrocardiogram, echocardiogram, or X-ray) is present and whether or not there is a need for continuous medication must be ascertained in all cases.

(B) Even if the requirement for a 10% (based on the need for continuous medication), or 30% (based on the presence of cardiac hypertrophy or dilatation) evaluation is met, METs testing is required in all cases except:

(1) When there is a medical contraindication.

(2) When the left ventricular ejection fraction has been measured and is 50% or less.

(3) When chronic congestive heart failure is present or there has been more than one episode of congestive heart failure within the past year.

(4) When a 100% evaluation can be assigned on another basis.

© If left ventricular ejection fraction (LVEF) testing is not of record, evaluate based on the alternative criteria unless the examiner states that the LVEF test is needed in a particular case because the available medical information does not sufficiently reflect the severity of the veteran’s cardiovascular disability. [71 FR 52460, Sept. 6, 2006]

VAMC Reno Cardiologist prescribed the Metoprolol Tartrate (date). Veteran has Heart Disease.

CLAIM FOR GENERALIZED ANXIETY DISORDER

Where separate and distinct manifestations have arisen from the same injury, separate disability ratings may be assigned where none of the symptomatology of the conditions overlaps. See Esteban v. Brown, 6 Vet. App. 259 (1994). Under the circumstances in this case, the veteran should be provided with VA heart and psychiatric examinations in order to obtain current information to evaluate his generalized anxiety disorder and PAT under the appropriate regulatory criteria. Massey v. Brown, 7 Vet. App. 204 (1994).

Sec. 3.102 Reasonable doubt. It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant.

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I took the attached "Statement In Support of Claim" to my VSO and she liked it very much and she submitted it to the VA in it's entirety. My PAT claim is still pending and it has been almost 1 year to the date.

I am reaching out to the members on Hadit.com and asking anyone for any help you can give me. I would appreciate ANY suggestions and would be happy to answer your questions.

Thanks in advance. Brian

[Hoppy]

Larger universities might have a Bio-Med library. They should have copies of the DSM II and the DSM IV. You could see the differences in the way things were diagnosed.

If you want a lesson in the way things were changed type "anti-psychiatrists" into google. Check out the difference between psycho dynamic diagnostic system used in the 70's and the medical model diagnosic system used currently.

[Wings]

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I suggested this veteran file a Claim for "Entitlement to Service Connection for Anxiety Disorder, under 38 C.F.R. Sec. 3.310(a) Disabilities that are proximately due to, or aggravated by, service-connected disease or injury."

That Anxiety is proximately due to, or aggravated by, his service-connected PAT (DC 7010; formally 7013). ~Wings

[Hoppy]

wings,

It can be filed the way you suggested. The filing should result in a C&P. I got reports from VA shrinks that supported my claim prior to the C&P. That is what my SO told me to do. The SO did not want to rely only on a C&P. There is a code in the DSM IV for anxiety disorder due to a medical condition. The shrinks can call it what they want. If the shrinks take the time to read the SMR they could re-diagnosis it based on more current diagnostic criteria or they could simply call it anxiety disorder due to the original PAT. It would be a decision made by the clinician.

I got a statement from a clinician who reviewed the entire record that the inservice diagnosis was made in error and that my current anxiety is secondary to the re-diagnosed medical condition that was occuring while in the military and has been chronic since discharge.

Edited February 10, 2009 by Hoppy

[Wings]

wings,

It can be filed the way you suggested. The filing should result in a C&P.

Hoppy, I agree. AT the very least, his filing should trigger the VCAA Letter, which will address several issues, and give the veteran time to gather an IMO that may or may not provide a nexus statement from the SC PAT, to the Anxiety D/O.

I got reports from VA shrinks that supported my claim prior to the C&P. That is what my SO told me to do. The SO did not want to rely only on a C&P.

Exactly!

There is a code in the DSM IV for anxiety disorder due to a medical condition.

Haven't seen that Code, and thanks!

The shrinks can call it what they want. If the shrinks take the time to read the SMR they could re-diagnosis it based on more current diagnostic criteria or they could simply call it anxiety disorder due to the original PAT. It would be a decision made by the clinician.

I got a statement from a clinician who reviewed the entire record that the inservice diagnosis was made in error, and that my current anxiety is secondary to the re-diagnosed medical condition that was occuring while in the military and has been chronic since discharge.

Can we send this veteran to your "clinician"? Seriously, what vets need more of, is doctor's that are worth visiting! ~Wings

[bm6546]

wings,

It can be filed the way you suggested. The filing should result in a C&P. I got reports from VA shrinks that supported my claim prior to the C&P. That is what my SO told me to do. The SO did not want to rely only on a C&P. There is a code in the DSM IV for anxiety disorder due to a medical condition. The shrinks can call it what they want. If the shrinks take the time to read the SMR they could re-diagnosis it based on more current diagnostic criteria or they could simply call it anxiety disorder due to the original PAT. It would be a decision made by the clinician.

I got a statement from a clinician who reviewed the entire record that the inservice diagnosis was made in error and that my current anxiety is secondary to the re-diagnosed medical condition that was occuring while in the military and has been chronic since discharge.

Wings and Hoppy,

You both are providing some excellant information that I am trying to absorb and understand. I am keeping all the information that you two are posting and will take this information to my VSO when the VA responds to my NOD. I sent an IRIS e-mail a few days ago and got this response:

"Our records indicate that your appeal for increase and service connection due to supraventicular arrhythmia is open and in process at the Oakland Regional Office. We are unable to determine whether your documentation has been added to your claim folder. We are only able to access your electronic files through our inquiry system."

It appears they have now changed my diagnosis from PAT (Paroxysmal Atrial Tachycardia) that I have been SC for over 40 years and changed it to Supraventicular Arrhythmia. Not sure what this means or if it will help or hurt my claim. This whole VA process is very confusing and frustrating. It's enough to give anyone an anxiety disorder or depression or at the very least, Supraventicular Arrythmias.

Thanks for your help. Brian