diabetes Nod & Cue?

[atlb685]

Hello all!

I am in the process of filing a NOD for my finace. He has been rated for Diabetes Insipidus (DI) secondary to a head injury he obtained in service. As I have been researching his disease, all the research has shown that DI presents itself almost immediately after the injury (within 3-5 weeks). He was in service for more than a year after the accident (which occurred in 2002) and the DI diagnosis was not awarded to him until 2008--when we requested that he be formally evaluated for it. He was not back-dated for it. Since the disease is directly related to the head trauma (by their own admission) and it would have presented itself within weeks of the accident, could this qualify as a CUE? I even have lab results from 6 months after the accident showing that he was clinically dehydrated, yet the military never followed up on this. He should have been diagnosed while he was in-service.

Is it appropriate for me to point all of this out in his NOD, or is there a completely different process that I have to go through? I don't want to put the cart in front of the horse if it is going to hurt him...

Thanks in advance for your help!

Jami

[atlb685]

Carlie,

He is not directly rated for his head injury... Below is his original award (granted in 2003 upon discharge):

Left upper extremity weakness due to herniated disc, cervical spine, with radiculitis-- 10%

Post-concussive Syndrome with chronic headaches, cognitive disorder, and mild dysthymia-- 10%

Plantar fasciitis, right foot-- 0%

Nuralgia, right sural nerve-- 0%

Now, here is his current rating (as of Feb 2008):

Diabetes Insipidus-- 20%

Dysthymic Disorder due to post-concussive syndrome/cognitive disorder-- 50%

Degenerative disc disease with cervical spondylosis C4-C7-- 10%

Plantar fasciitis-- 10%

Neuralgia, right sural nerve-- 10%

Left upper extremity weakness-- 10%

Migraine headaches-- 50%

We are filing a NOD because we disagree with the 20% rating for DI. In order to qualify for 40%, he had to show 1 occurence of dehydration within the past year. We provided 4 labs that showed dehydration.

What I don't understand is why they do not have to compensate him for something they completely missed. They should have caught the DI early on, and because they didn't, he suffered for almost 6 years before he finally went to the doctor and got diagnosed. Now it has progressed to the point that he has to take 4 times the normal dose of DDAVP and he still urinates at least once every 30 minutes (including during the night). Why can't the VA be held accountable for missing this diagnosis?

To answer Berta's questions: He is not currently working. His head injury has affected him quite a bit. He has almost zero concentration, and because of his DI he is constantly in the bathroom. His problem is not with the pituitary, but with the hypothalamus (which a PET scan documented damage to). I have encouraged him to request to be rated for TBI as well, but I am not sure if that is the right course to take.

Oh and Carlie, in reference to your last post, glucose has nothing to do with DI. He has "water diabetes" and not "sugar diabetes". The only causes of DI are congenital, brain tumor and head trauma. They have acknowledged that the head injury caused the DI. but the onset would have been almost immediate. If he was in the military over the year after the accident, it certainly would have presented itself in that time. He complained of frequent thirst, not being able to sleep due to urination, etc, and they still missed it. It just breaks my heart for him because now he cannot live a normal life. He is grateful for the 90% he got, but somehow it still doesn't seem fair. This could have been well controlled if caught early. But it will only get progressively worse from here.

Also, I'm sorry that I don't know all the vocab here. i don't know anything about diagnostic codes, etc, so I hope this is enough info. I just want to help him...

[carlie]

jami,

Thanks for straightening out my thoughts on glucose and DI.

I would file the NOD for an increase in the DI and also request

TDIU and submit a TDIU form.

carlie

[broncovet]

Altb685

CUE is normally used IF YOU DID NOT FILE A TIMELY NOD. That is, if you waited more than a year after the decision date, you cant appeal without CUE. Since you did not wait more than a year, then you dont need to worry about CUE.

When you file your NOD, it is a good idea to specify whether you want a DRO REVIEW, a DRO HEARING, or skip DRO.

DRO has been discussed elsewhere, and there are differing opinions on this. Here is my take on it.

DRO Review..I recommend it. It is one more person to look at your claim, and, you only need ONE to approve it. It does have the drawback, tho, that it takes time.

DRO Hearing..This is where a Decision Review Officer sits down with you and you get to meet him and go over your evidence. If you think there are things relevant to your case that you can explain better in person than by paper, then by all means elect a DRO hearing even tho the drawback to a hearing is that they take EVEN MORE time than a DRO Review, because the DRO hearing officer has to schedule these and his time is limited.

SKIP DRO and go for BVA appeal. Many elect this step, because they think the DRO will just "carbon copy" the earlier decision. Since your appeal may well wind up at the BVA anyway, this may be the fastest method to get it there. Remember, tho, the DRO Rating specialists are usually the most experienced, and may well catch mistakes made in the original decision. At least one person swears by DRO..they claim the DRO fixed the mistakes and granted the benefits. I personally have had good luck with the BVA, and not good luck with DRO review. However, it is good to elect which one you want with your NOD.

[john999]

One of the main reasons for asking for a DRO Hearing is so that DRO can associate a face with your claim. You may have the same evidence but the DRO gets a look at you, and that is important to my mind. Also, you can have your spouse or some other significant other testify about how your disability affects you. Sometimes just talking directly to someone who has the power to decide your claim can iron out misunderstandings to your benefit. Other times it won't matter because of the amount of retro involved, or because the VA has decided to dig their heels in the dirt. I recommend the hearing. I have had good luck with both hearings and reviews.

[Ricky]

The VA does not deal in what should have been diagnosed. One of the elements of a disability claim is that the veteran must have a current diagnosis. Since he did not received such a diagnosis until 2008 that would be the earliest date the VA will use as an effective date - and that is if the claim was submitted at that time.

No CUE exists as until the diagnosis was issued there was no valid claim for disability. Sorry

[Berta]

The diagnostic code is on the rating part of the decision-it will be a four digit number.

I cant see how he could possibly work with this condition.

Is he receiving SSA disabiliy benefits for it?

If he cannot work due to this condition he should file for TDIU- Total Disability due to Unemployability -

Carlie- I got impression these were inservice medical notes.

Clinical dehydration is a serious illness and a medical etiology should have been determined at that time.

But if this happened in the Mil- the Feres Doctrine prevents them from sueing the Mil.

The VA did grant SC for the DI -

did you say he gets 90%?

What statement did the VA make as to why they did not consider him for TDIU?

(100% rate of comp)

Or did they state they have deferred the TDIU issue?