Appeal Certification

[Lee_USAF]

Filed claim in March 2009 - Denied; Submitted NOD electing de Novo review and had my DAV Rep request conference with DRO. Never got the conference and the original denial was upheld. Claim was for amendment of original rating of Cardiac Arythmia (PVC) to Mytral Valve Prolapse and service connection for Stenosis of 3 coronary arteries of 50 - 60 percent.

Submitted VA FORM 9 and received letter "Substantiating" my appeal in November 2007. Hasn't moved since. Meanwhile, submitted additional medical evidence of Stent implants (2) in Aug 2007, and received Supplemental Statement of the Case (total of 1 form original AO and two from DRO.)

No one can/will tell me why my case is still in DRO. AMC doesn't even know me, thus my appeal has not been sent there nor has the Board of Veteran Appeals received anything on my "Substantiated Appeal."

Any ideas/suggestions?

[Lee_USAF]

You had a claim that was denied in 4-5 months?

That is hardly time for them to send a VCAA letter.

It is Not unusual to have an appeal certified and then sit at the RO for a long time before the BVA calls for the files.I got 2 SSOCs,responded to them both with medical evidence,(2005)and then got letter that the claim would be transferred to the BVA.It did get there-in 2009- the BVA read my evidence and awarded.

Did you get a letter saying the claim was going to be transferred to the BVA?

Berta, timeline of my initial claim:

1. Submitted claim 3 times to DAV Rep - finally given to VA TRIAGE on 3/27/07

2. 4/5/07 received VCAA and Autorization for release of medical evidence - sent along with 21-4142. Sent in anyway.

3. 6/7/07 Claim Denied - no service connection evidence

4. 6/9/07 sent NOD with statement "Have additional medical evidence to submit."

5. 7/1/07 Received SOC from RO - No mention of SMR showing Highly elevated Lipids an exam by physician having diagnosis of quote 'hypercholesterolemia and hyperlipdemia, overweight.' (5' 10" weighing 185#) I was never examined by a cardiologist or any other specialist. my basis for Bell v Derwinski.

6. Inadequate exam reason was my VSO rep said my SMRs were not provided to the examiner and he didn't know why I was there.

7. 8/12/07 Received notice from DRO of upholding denial and providing me VA FORM 9 and my timeline to submit or I could provide further data.

8. Submitted FORM 9 with reason for appeal - CUE reason gave date of entry in SMR of diagnosis for Service Connection.

9. 11/27/07 Received letter of Substantiated Appeal and that "Case file would be gathered along with submitted evidence for scheduling with BVA." Then got SSOC that was a regurgitation of the original denial.

I'm about ready to fire the DAV here in St Petersburgdue to their attitude and lack of help. I guess it's that my disabilities are heart, knees and ears. I still have them but they don't work so well. I'm just trying to get what's due me and to take care of my wife when I kick the bucket in 3 - 5 years. Thanks people for your invaluable help!

[Berta]

"No mention of SMR showing Highly elevated Lipids an exam by physician having diagnosis of quote 'hypercholesterolemia and hyperlipdemia, overweight.' (5' 10" weighing 185#) I was never examined by a cardiologist or any other specialist. my basis for Bell v Derwinski."

OK I get it now-

you have this on appeal and have filed the I-9- your rep should have asked for reconsideration.

The CUE claim-is this a separate claim under CUE that you sent to the VARO which made the decision?

It is possible the DRO is considering the CUE allegation.

Do you have a medical statement from anyone that your present heart condition is directly stemming from the hyper cholestrol, hyperlipedemia in service?

Obviously the C & P doc could not render any opinion at all as he didnt have the SMRs.

These two conditions as they stand are not disabilities but doput a vet into a risk factor for developing diabetes and heart disease.

The connection to heart disease is medically strong but still the VA needs a medical nexus statement.

Do you see any private cardio doc?

The fact that this went back to the DRO might well be a good thing.

Do you have a copy of the C & P results that prove the CV & P doc didnt even have the records?

[Lee_USAF]

"No mention of SMR showing Highly elevated Lipids an exam by physician having diagnosis of quote 'hypercholesterolemia and hyperlipdemia, overweight.' (5' 10" weighing 185#) I was never examined by a cardiologist or any other specialist. my basis for Bell v Derwinski."

OK I get it now-

you have this on appeal and have filed the I-9- your rep should have asked for reconsideration.

The CUE claim-is this a separate claim under CUE that you sent to the VARO which made the decision?

It is possible the DRO is considering the CUE allegation.

Do you have a medical statement from anyone that your present heart condition is directly stemming from the hyper cholestrol, hyperlipedemia in service?

Obviously the C & P doc could not render any opinion at all as he didnt have the SMRs.

These two conditions as they stand are not disabilities but doput a vet into a risk factor for developing diabetes and heart disease.

The connection to heart disease is medically strong but still the VA needs a medical nexus statement.

Do you see any private cardio doc?

The fact that this went back to the DRO might well be a good thing.

Do you have a copy of the C & P results that prove the CV & P doc didnt even have the records?

Sorry, Berta. My biggest problem...saying too much or not enough. From beginning (and short)

Long history (20 years) of palpitations, shortness of breath and chest pain. Al Primary care docs say exercise needed. My walking around weight since 1980 has been 155 to 170 depending on if my knees allow exercise. Not lately, need knee replacement.

Chest pains became more frequent, more intense until my wife took me to ER. They done a heart Cath and said to try meds first. 2nd cardiologiest said stents - I refused due to my research on mortality. 3rd cardiologist said YOU NEED STENTS or you will die in 3 to 5 years. Se cannot confirm how long I've had CAD, but based on degree, estimates while I was in service.

Between my retirement (93) and my ER visit (2006) no treatment by Primary care...just told exercise and diet.

Stents implanted Aug 08, talked with VSO and they had requested a Informal Conference...DRO never scheduled. The only time I can speak with anyone at RO is by submiting IRIS complaint and they call me with promises. I now have two letters going out today Cert mail to Regional Office Driector requesting the journal of my files since March 2007 claim filing and to my VSO REP for documentation of when they request Informal Conference. Told Director in letter I will file Writ of Mandamus if I am forced.

[Berta]

You might have a problem proving chronicity-

"Long history (20 years) of palpitations, shortness of breath and chest pain." IS that documented in your med recs at all?

Or is there a treatment gap of many years?

You could still succeed on this claim but I think it will take a strong IMO.

"3rd cardiologist said YOU NEED STENTS or you will die in 3 to 5 years. Se cannot confirm how long I've had CAD, but based on degree, estimates while I was in service." If they could write that up to conform to the IMO criteria here-using "as likely as not" or "more than likely" the VA would have to give that type of opinion considerable weight -as it is from a Cardio doc.

[Lee_USAF]

You might have a problem proving chronicity-

"Long history (20 years) of palpitations, shortness of breath and chest pain." IS that documented in your med recs at all?

Or is there a treatment gap of many years?

You could still succeed on this claim but I think it will take a strong IMO.

"3rd cardiologist said YOU NEED STENTS or you will die in 3 to 5 years. Se cannot confirm how long I've had CAD, but based on degree, estimates while I was in service." If they could write that up to conform to the IMO criteria here-using "as likely as not" or "more than likely" the VA would have to give that type of opinion considerable weight -as it is from a Cardio doc.

You're right on the "likely to have occurred in service as not", Berta. I have two BVA rulings on that where two noted Cardiologist stated "CAD is a progressive disease that does not happen overnight, rather is a long term process if not properly treated. One of these Cardologist is Chief of VA Cardiology at VA facility in one of the Carolinas. Another noted specialist that said the same, is a Coronor who made the ruling as CAD was a contibuting cause of death in a Veteran and AGAIN, the Board ruled in favor of the VET. St Petersburg Regional is not know for being compassionate in their rullings but is known for being overruled by the BOARD on better that 64% of their cases.

[Berta]

My original DIC claim started out as cardiology claim.That claim took over 3 years for award.

The VA was relentless in telling me that I was not competent enough to give lay medical testimony and evidence.

I did prove that case.

But these days it is usually too difficult for a vet to do this on their own-

I spent month after month studying cardiology and autopsied hearts etc-to get that claim resolved but I missed something-because I am not a doctor.

Similiar BVA cases make no difference to VAROs because the medical info is only specific to the BVA vet's claim.

What I missed in that older DIC claim was something I found at the very last minute.

I had re-opened for cause of death, had 3 IMOs and had just paid more money for a cardiology IMO-and found the most single overwhelming piece of evidence that I should have found sooner-

it was the only word in the autopsy I never looked up for over a decade-

My award came perhaps before the BVA even got this evidence-

although I sent it to them right away-

I hope you can get a good IMO here- because IMO docs know just how to take claims like this step by step and can determine chronicity.

Also they read the evidence carefully- this is one point the BVA made in my award letter- that the IMOs I had were based on careful study of all available med recs.This is what the VA means by having a full medical rationale.

When an IMO doc can give a full medical rationale that favors the claim -the VA usually has no way to combat the opinion.