diabetes Imo Doctors In Oklahoma?

[Guest morgan]

I am helping a veteran who has diabetes, with complications that have caused him to be unable to have heart stents "due to diabetes narrowing of his arteries." He told me that he had high blood sugar in service about 22 years ago, so I told him he needed to get a copy of his C-file. He tried to get his medical records, but various delays from his file floating around from place to place (for two years) kept him from getting them. Finally, a few weeks ago he got his SMRs and the file shows that he was sent to a dietitian and the doctor made a comment about possible diabetes. His SMR labs showed his A1C above 8.0, at least once. Due to a recent move, he hasn't looked closer to see if other labs showed it as high at other times. He said he always had symptoms that he now realizes were diabetes related, but until his 60% heart blockage in three arteries showed up, he didn't know he needed treatment. Since diabetes is incurable, I believe he likely can get service connection for diabetes and his cardio problems based on his SMRs and his current diagnosis and treatment. But how would his having no treatment for 18 years play out? He just got a certificate at the VA for completing a diabetes clinic. His sugar is hard to control. Byetta (sp?) from a private doctor was helping control it, but the VA won't provide it, so he has plenty of VA labs showing high sugar levels. He will be able to get the Byetta now that he has a new job in Oklahoma, but he simply had to take what he could get at the VA for a while.

Can someone here advise me how to go about helping his claim? Will he need an outside IMO?

He moved to Oklahoma from South Carolina recently. He has an active claim in South Carolina seeking a higher rating for his hearing. He should get word soon, so he's not sure whether to have his file sent to Oklahoma or wait until after that decision.

I remember seeing somewhere on hadit.com that there are doctors in Oklahoma who have started helping veterans with IMOs and exams. Can someone give me that information again? I tried to find it with the hadit search feature but didn't find it.

Thanks,

Morgan

[LarryJ]

Dr Ellis

Ellis Clinic

Oklahoma City

I don't have his contact info handy, just google them.

[Guest morgan]

Thank you!

[Pete53]

http://www.ellisclinic.com/

[jim n ok]

elis is good,but slow. 300 bucks for an opinion though is not bad.

[Shark]

Was he in Vietnam? If so, DM2 is presumptive.

[Berta]

"His SMR labs showed his A1C above 8.0, at least once."

That documentation could be critical to proving his diabetes was evident inservice.

If he is not a AO Vietnam veteran-his SMRs need to be thoroughly checked for any of the multiple symptoms that diabetes can cause.

Morgan it was symptoms of diabetes that helped me win my claim in April.

Rod was an AO vet but the words diabetes never once appeared in his SMRS or any med recs.

I proved he had been misdiagosed as to other conditions that caused his death 14 years ago and then after filing a new AO diabetes claim 6 years ago-I proved that untreated and undiagnosed diabetes is what led to his death. VA agreed.

Also I had vet who needed to prove diabetes in service. That too took a long time- but his SMRs (when we finally decifered them) revealed many documented medical symptoms of diabetes. His local endocrinologist agreed and he won his claim.

The symptomatology of diabetes for any vet not under the AO presumptive regs-if documented in their SMRs- could be the way to an award and it sure helps to submit an IMO from a real doctor-otherwise VA says we are not competent medically to opine on this stuff.

The local vet- I actually proved that his many inservice diagnoses of venereal disease were in fact manifestations of an unusual diabetic manifestation, and that he had documented symptoms urinary problems, and even fainting spells that the Mil considered malingering and did not treat.

This was a difficult case but after twelve years he won.

By then he had developed cataracts and CAD from the diabetes.

There is a wealth of info on diabetes on the web-I used Mayo Clinic , Joslin, the ADA and Diabetologica web sites- as well as the VA's own diabetes training letter for both this vet's claim and mine.

Oddly enough (since I researched for my claim for the full 6 years it took VA to award it) much of the original information had changed a little becaue the medical community continues to study and learn more about diabetes.

3 weeks before the BVA decided my claim I had ordered my 4th IMO from a Cardiologist and then reviewed again my husband's autopsy.

There was one word in it that I considered not really probative and I never looked it up until 3 weeks before the BVA decision-

It was absolute bonafide prime facie evidence that proved my claim!

I whipped this evidence off to the BVA (The autopsy page it was on and the internet printout) and I got an award letter 3 weeks later.

The Award rested heavily on my IMos but still- this single word -which my IMOs didnt even mention-could have been the sole undebatable argument for my claim and awarded it- so it just goes to show that we can do lots of research but we cannot overlook a single thing.

Hopefully we are going to do a show soon on diabetes at SVR radio-

Diabetes is one of the most underdiagnosed and undertreated diseases in America.

It doesnt kill anyone- it's complications however can be deadly.

The IAC reading this vet got-I hesitate to reply on my memory but I think an IAC reading is indicative somehow of prior months of potential high glucose.

If I can find more on that I will post it here.

[Berta]

gee -I found this already-

the HBIAC can show high glucose as to hemoglobin over a 2-3 month period:

http://www.diabetesincontrol.com/index.php...cle&id=1286

This is a good site for basic overview of diabetes type one and type 2-

with the HBIAC reading he got- I cannot imagine how VA could rule out diabetes etiology in service.

That is critical evidence-

a good IMO doc will need copies of his complete SMRS (that record can be highlighted , and all of his clinical civilian med recs.

It is good idea to prepare a cover letter for the IMO doctor telling them exactly what type of opinion the veterans needs and lisrted all of the enclosed evidence.

My topic here is under Getting an Independent Medical Opinion.

Even if an IMO doc is unfamiliar with the VA -as long as they follow this criteria and make the important 'as likely as not" or "more than likely" statement with a full medical rationale-I think this vet has good chance to succeed on direct SC claim.

Was he in Vietnam or Korea?

All Vietnsm vets are presumed exposed to AO and some Korean vets were as well.

[Guest morgan]

Thanks, Berta, for all of this information. Congratulations on winning your husband's claim. That must give you slight satisfaction for what happened to him. Thank you, too, for your guidance with the case I'm working with.

He wasn't in Vietnam or Korea; he was in Germany mostly.

I also found hypertension evidence in his SMRs. Several diastolic readings over 100 during a five-day test for BP because of headaches. Systolic was high, too, up to 180. A medical note said "1/3 of 30 readings above normal." He got no treatment. He has CHD noted in his civilian record, and I'm assuming that is the same as CAD. Do you know? He had angioplasty but the doctor said his diabetes-narrowed vessels didn't allow stents to be placed. Three arteries are 60% blocked. His discharge physical made no mention of diabetes or hypertension, but said the vet said "no other problems except legs." A profile concerning his knee read that he could not stand more than two hours per day for work. First, he was rejected for a job because of the profile the employer checked about a vet hiring preference. The next time, he didn't tell anyone he was a vet. He said he needed a job to support his family so he forced himself to ignore his leg and knee pain. Typical, and admirable, military attitude.

Isn't hypertension one of the conditions considered chronic? If he has clear evidence of hypertension in service and has a current diagnosis, will he have to prove continuity of treatment? Nexus? How should he approach an effective date? Could he possibly get retro back to his discharge date?

I had him to send an email online to find out why he couldn't get his medical records for two years and to tell them he intends to file a claim for service connection for his diabetes, as he thought it started in service when a 24-hour sugar test was done. One SMR comment says that labs showed his fasting glucose at 97-124, and added "this is clearly normal." I think now prediabetic is about 100, fasting. He was "overweight within 20 pounds." That's when he went to the dietitian and when the 24-hour sugar test was done with A1C at 8.5. No treatment for diabetes either. His civilian doctor told him he wouldn't be in the shape he's in if he had been treated then.

I will see if he has the lab result you mentioned in his record. It's hard to read the handwritten SMRs, but I'm sure an IMO doctor will help with that. He is going to call the Ellis Clinic for an appointment.

[Berta]

CHD means congenital heart disease.This would have to be closely determined if this diagnosis is correct,

Or if he could raise the issue of it as being a pre existing condition- which was aggravated by his service.That would be his best argument if the VA said his heart disease does not stem from his diabetes and was congenital in origin.

CAD means Coronary artery disease - usually a complication of diabetes-if diabetes is diagnosed.

"Isn't hypertension one of the conditions considered chronic? If he has clear evidence of hypertension in service and has a current diagnosis, will he have to prove continuity of treatment? Nexus? How should he approach an effective date? Could he possibly get retro back to his discharge date?"

Only if it due to cardiovascular renal disease, (38 CFR 3.303)

diabetes meelitus is one of the chronic conditions in that regulation as well as arteriosclerosis -which he has now but comes under Chronic regs- only if documented in the SMRs.

NVLSP recommends that other disabilities not on the chronic presumptive list can often succeed with a strong independent medical opinion.The IMO doctor would have to give full medical rationale based on the SMRs and the clinical record.

His earliest effective date is the date he filed this claim-and that is the retro date.

If he succeeds on this claim and had been denied in the past in an unappealed decision -for the exact same condition-he could possibly raise CUE issue for a better retro.

"His SMR labs showed his A1C above 8.0, at least once" The military should have considered that and ruled in or out diabetes.

I think that is good evidence for inservice diabetes with the current CAD as secondary to it.

"His civilian doctor told him he wouldn't be in the shape he's in if he had been treated then. "

You bet- would this civilian doctor be willing to prepare an IMO for him? It sounds to me that this doctor has recognized his inservice nexus and could strongly opine on that.

Edited August 26, 2009 by Berta (see edit history)