diabetes Medical Evidence

[Papa]

My Doctor has written a letter on my behalf, and I would appreciate some feedback.

Papa is morbidly obese. He has diagnosed and confirmed PTSD from Vietnam. Before he left the military he began overeating to comfort his emotions. This pattern has continued to present. A lap band procedure was performed to help minimize this but it has not been as successful as we had hoped. He currentlt see Dr. X at the VAH for his PTSD. It is likely that his PTSD led to his obesity. His obesity has led to his other medical problems (sleep apnea, diabetes, etc.). Please evaluate him for service connected benefits that apply.

Dr. Y

[jim n ok]

in my opinion it needs a lot . cases are won with strong evidence. this does not represent even basic medical evidence. he needs to state that he has viewed your medical history and records and links all this togeher in medical terminology that the va wants. he needs to state more than likely caused by.xyz secondary to etc etc.

[akwidow]

I agree with Jim. The letter needs to include "as least likely as not" for the ptsd to be a causal reason for the overeating... and the nexus needs to be connected dot by dot by a psych doctor diagnosing the ptsd. Which sympton of ptsd could cause the overeating? Denial? Avoidance? See what I mean?

Hope this helps,

Akwidow

[Berta]

If you have the proven nexus for the PTSD ( is that the rating you get now?) there are many studies on the net associating PTSD and eating Disorders.

http://www.ncbi.nlm.nih.gov/pubmed/17997727

In part:

"OBJECTIVE: Obesity is a significant public health problem in the United States, particularly among military veterans with multiple risk factors. Heretofore, posttraumatic stress disorder (PTSD) has not clearly been identified as a risk factor for this condition. METHOD: We accessed both a national and local database of PTSD veterans. RESULTS: Body mass index (BMI) was greater (P < 0.0001) among male military veterans (n = 1819) with PTSD (29.28 +/- 6.09 kg/m(2)) than those veterans (n = 44 959) without PTSD (27.61 +/- 5.99 kg/m(2)) in a sample of randomly selected veterans from the national database. In the local database of male military veterans with PTSD, mean BMI was in the obese range (30.00 +/- 5.65) and did not vary by decade of life (P = 0.242). CONCLUSION: Posttraumatic stress disorder may be a risk factor for overweight and obesity among male military veterans.

PMID: 17997727 [PubMed - indexed for MEDLINE]"

The doc needs to follow the proper wording as suggested here-and to provide ample medical rationale- the rationale can come from any very good studies or asbtracts such as above to enhance the opinion.

He/she must have your clinical medical records as well and refer to them specifically to make the opinion valid.

It isn't bad- but most IMO dfocs do not know the IMO criteria which is here at hadit.

Also he needs to give his area of expertise to make this opinion valid.

If you already had a C & P exam on this which VA used to deny the claim-the IMO doc needs the C & P results too- so he/she can punch holes in VA's rationale.

If he is a GP or internist and not a psychiatrist ( which would be best bet for this type of IMO) but if the C & P examiner was a NP or PA,he should raise that point as well as that would lend to his MD being greater weight then the VA examiner's.

[Papa]

Thanks for all the comments. They are about what I expected, and agree with. I saw my doctor today, and it took all my strength not to throw him out of his six story office window. He is not like my doctor before him that was in Vietnam himself. I was informed that even non-military people have PTSD and that I need to get over it. That San Antonio is noted for obesity and diabeses, so why should I be any different. That he was not an expert in AO, PTSD, etc. He told me that I need to go to the VA and be evaluated for service connection. How is this done? I hate to admit it, but the VA medical scares the day lights out of me.

papa

[LarryJ]

Papa, all in all, this is probably about all you are gonna be able to get, especially from this doctor (hmmmm, sixth floor, huh? wow, that woulda been dramatic!).

Psychiatrist would be good, Internist, also.

Bound to be someone around San Antonio that you could get to get a good Independant Medical Opinion. Surely one of the local Service Organizations knows of someone, a doc, that'll shoot it straight? Wish I knew someone, a VSO.

The "opinion" that you have is not really all that bad (or that good). It'll work, if you cannot get someone else to opine.

Have you your service medical records, do they indicate any treatment or notations about you weight or problems you were having. I know you said that your PTSD is service connected, anything else that is mentioned along with that service connection?

Berta's link is a very good one, always quote and indicate links such as this in your claim with the VA.

I'm still thinking....................

[Pete53]

I think that you should search BVA for someplace that awarded for PTSD and obesity.

If you walk around the VA you might notice that almost all the Veterans are over weight.My diabetic Doc who is telling me what I need to do is probably north of 300 lbs.

I have lost 39 lbs in about 2 years

[poolguy11550]

The approach to this type of obesity claim, would not be to claim obesity but rather the secondary conditions related to obesity. VBA thinking is that obesity is not a medical condition but rather a symptom of over-eating.

Key to this claim is the reason for the over-eating and it seems likely for you papa. However, how long have you been considered obese? One tactic the VBA can use is that you have become obese many years after leaving service and that you are simply obese just the same as other persons your age in the general population with-out military service. Hence, the remedy to this would be to establish that the obesity has been a long-term stuggle for you.

[Papa]

Poolguy,

I can estabish without a doubt that my eating problem did not just happen. I believe that I can document it from the time I left the service to present. Truthfuly, no one gets a rearend this big overnight ;)

Papa

[LarryJ]

I concur with poolguy. You need to concentrate on the OTHER problems that you have and not on your obesity. Your sleep apnea, your diabetes (any sign of high blood pressure or PN, anything such as that?).

These are things that will fairly easy to connect as secondary to PTSD.

Otherwise, they are gonna tell ya that you're fat, so what?

[Pete53]

Say while you are in the Military and have a problem with weight. Enough that it is in your records. Would that not establish a connection to a problem that started in Military.Compare your weight to when you entered and when you left?

[john999]

I think the VA will blame everything on your current weight unless you have SMR's that show problems in-service. A friend of mine who was in Vietnam with me and has DMII is having a hard time getting the VA to SC his CAD because they say it is because he is fat. He has severe congestive heart disease and DMII and the VA says it is just because he is fat. That is their mentality. He got the DMII SC'ed but not the secondary heart condition.

[retiredat44]

please don't take thois as a criticsm.. just an observation..

I recently spent 6 months in a VA hospital bed and had to many roomates to count them all..

They had so many medical problems I cann't remember them all, plus I wasn't privy to private information. But being a roomate of them I saw and heard to much information..

I saw and lived with lot of overweight people there..

Some were very, very large..

ok, now since I read this forum, and see some converstaions about weight,, and I was reading about sleep apnea and overweight relating to sleep disorders.. I lso had a recent sleep test..

Note, I am very skinny because of my health issues, and the most overweight I had been was maybe 2--lbs, when my ideal weghtt at that time was probably 160 lbs. So, I have never been overweight much, but now I am severaly underweight.. so at least I want to clear that info up before I continue..

I worry about those that are very over weight because of what I saw when I had the very huge overweight roomates in the hospital.

I saw a few that actually had to have special hoists used to lift and move them. The hospital has these hoists built into a few rooms that are on they steel rails mounted to the ceilings with electrical controls and cables with slings to wrap around and under patients that are too large to be moved by nurses and staff. The hoists are rated at around 425 lbs, but can also be rated up to 600 lbs.

I saw that some of the big patients were sick with other problems including infections that were threatening their limbs. One patient that was at least 400 lbs, was freaked out that the doctors were going to have to remove one of the guys leg if this guy would not let them treat his leg and the infection that the obesity was making very difficult to treat his problem.

The stress the weight puts on the body is really really bad and some of the issues and problems I saw would have to make people think about getting rid of some weight... about what it does to the body...

to top that off the sleep apnea problem which can help make sleeping a life and death problem with overweight issues.. and the stress on the organs, and diabetes, and the leg problems..

I am just saying, for people sake that need to get some weight off, I wish you well, after seeing this firsthand, and living with some people with these problems.. please, try and get help,, you don't want to be in such bad condition. You might end up in the hospital for any reason and have the problem be much worse because of the extra weight..

[deltaj]

please don't take thois as a criticsm.. just an observation..

I recently spent 6 months in a VA hospital bed and had to many roomates to count them all..

They had so many medical problems I cann't remember them all, plus I wasn't privy to private information. But being a roomate of them I saw and heard to much information..

I saw and lived with lot of overweight people there..

Some were very, very large..

ok, now since I read this forum, and see some converstaions about weight,, and I was reading about sleep apnea and overweight relating to sleep disorders.. I lso had a recent sleep test..

Note, I am very skinny because of my health issues, and the most overweight I had been was maybe 2--lbs, when my ideal weghtt at that time was probably 160 lbs. So, I have never been overweight much, but now I am severaly underweight.. so at least I want to clear that info up before I continue..

I worry about those that are very over weight because of what I saw when I had the very huge overweight roomates in the hospital.

I saw a few that actually had to have special hoists used to lift and move them. The hospital has these hoists built into a few rooms that are on they steel rails mounted to the ceilings with electrical controls and cables with slings to wrap around and under patients that are too large to be moved by nurses and staff. The hoists are rated at around 425 lbs, but can also be rated up to 600 lbs.

I saw that some of the big patients were sick with other problems including infections that were threatening their limbs. One patient that was at least 400 lbs, was freaked out that the doctors were going to have to remove one of the guys leg if this guy would not let them treat his leg and the infection that the obesity was making very difficult to treat his problem.

The stress the weight puts on the body is really really bad and some of the issues and problems I saw would have to make people think about getting rid of some weight... about what it does to the body...

to top that off the sleep apnea problem which can help make sleeping a life and death problem with overweight issues.. and the stress on the organs, and diabetes, and the leg problems..

I am just saying, for people sake that need to get some weight off, I wish you well, after seeing this firsthand, and living with some people with these problems.. please, try and get help,, you don't want to be in such bad condition. You might end up in the hospital for any reason and have the problem be much worse because of the extra weight..

I am about 80 pounds overweight and have gone on phase 2 of the Atkins diet and it is working for me. Last week I lost a pound and a half and I finally have my carbohydrate cravings under better control. (I would have lost more last week but I went out to lunch with my husband and over lunch I drank half a milkshake and had some sweet potato fries.) After I'd been on the diet about a week and my 15-year-old daughter sat right by me eating a brownie and I had no desire for the brownie. (That was really strange because brownies have always been one of my weaknesses.) On the diet I'm not eating bread, rice, cornmeal, cereal, sugar, potatoes, yams, sweet potatoes, etc. Atkins allows brown rice and whole grains in phase 2 but I rarely allow this indulgence because these foods are not allowed in the induction phase and the induction phase can run up to 6 months if the dieter is really overweight. I got my understanding of the diet from the book Dr. Atkins' New Life Diet Revolution but I'm not using any of Dr. Atkins' products from the store. Three meals a day I have about 6 ounces of lean cooked poultry and fish along with salad and either lightly steamed fresh vegetables or uncooked fresh vegetables. I'm not doing the full fat version of Atkins with cheese, bacon, and sausage because I fear clogging my arteries. If I'm still hungry after a meal, I am supposed to eat more protein to fill up and I'm careful to eat lean protein cooked in a small amount of olive oil. I just recently started eating a small quantity of fresh fruit and raw unsalted nuts and I will have to see how that affects my weight and my appetite. I'm also doing 3 miles on the treadmill and one mile on the elliptical machine at the gym several times a week. I keep a wide variety of vegetables in my refrigerator and keep varying the colors of vegetables at every meal to avoid boredom. At various meals we have brocolli, carrots, celery, snap peas, green beans, cabbage, salad mix, spinach, tomatoes, brussel sprouts, yellow crookneck squash, zucchini etc. In the freezer we keep turkey burgers, salmon fillets, meatballs that do not have breadcrumbs in them, salmon fillets, ground turkey, italian sausage made with ground turkey, and buffalo burgers. I've started reading labels and have eliminated foods with sugar or corn syrup in them. We keep various kinds of salsa and mustard in the refrigerator that have no sugar in them. Last night I cut up a spaghetti squash, removed the seeds, and baked the pieces along with water in a baking pan for 45 minutes at 375 degrees. After the squash was cooked, I then removed the skin and placed each skinned piece on a plate and spooned spaghetti sauce over it. I had prepared the spaghetti sauce while the spaghetti squash was baking. To make the spaghetti sauce, I had browned 1 1/4 pounds of ground turkey (a 20 ounce package) in a small amount of olive oil in a deep cast iron skillet and then added a small amount of eggplant cut up in cubes, a bell pepper chopped, 1/2 of a medium onion chopped, 2 carrots grated, and 2 stalks of celery sliced. Anyway when the meat the lightly browned, I added the vegetables to the skillet and put the lid back on the skillet to steam the vegetables. When the vegetables got tender but not browned, I added one jar of spaghetti sauce which did not contain sugar. I know this because I checked the label. My daughter came through the kitchen and reseasoned the sauce using a combination of Italian seasoning, Mrs. Dash garlic and herb blend, Kirkland No Salt Seasoning from Costco, and a little lemon pepper seasoning. My husband has hypertension and diabetes so she had to lightly season with the lemon pepper, which has salt. Anyway, I thought dinner came out well. My daughter had already eaten before we got home but I could have microwaved some spaghetti from the freezer to serve her spaghetti sauce over if she had chosen to eat dinner with us. Those family members, who are not on the Atkins diet, can also be served the same main dish at each mealtime along with a starch. The Atkins diet is really a lifestyle change. Eating healthier and exercising really changes a person's health and that person's mental attitude. It provides hope for the future to those who felt hopeless before.

Edited October 20, 2009 by deltaj (see edit history)

[deltaj]

I think the VA will blame everything on your current weight unless you have SMR's that show problems in-service. A friend of mine who was in Vietnam with me and has DMII is having a hard time getting the VA to SC his CAD because they say it is because he is fat. He has severe congestive heart disease and DMII and the VA says it is just because he is fat. That is their mentality. He got the DMII SC'ed but not the secondary heart condition.

It is interesting that V.A. is doing this considering that all the extra glucose in the blood stream causes a person to be constantly hungry and that is the main reason the diabetic gets obese.

[deltaj]

I concur with poolguy. You need to concentrate on the OTHER problems that you have and not on your obesity. Your sleep apnea, your diabetes (any sign of high blood pressure or PN, anything such as that?).

These are things that will fairly easy to connect as secondary to PTSD.

Otherwise, they are gonna tell ya that you're fat, so what?

My husband is diabetic and his civilian doctor outside the V.A. recently told both of us that diabetes often causes diabetics to have heart attacks. He strongly advised my husband to lose weight.

[deltaj]

My Doctor has written a letter on my behalf, and I would appreciate some feedback.

Papa is morbidly obese. He has diagnosed and confirmed PTSD from Vietnam. Before he left the military he began overeating to comfort his emotions. This pattern has continued to present. A lap band procedure was performed to help minimize this but it has not been as successful as we had hoped. He currentlt see Dr. X at the VAH for his PTSD. It is likely that his PTSD led to his obesity. His obesity has led to his other medical problems (sleep apnea, diabetes, etc.). Please evaluate him for service connected benefits that apply.

Dr. Y

I have seen the phrase more likely than not used. One sentence should possibly read: It is more likely than not that his PTSD led to his obesity. I think this phrasing is used in nexus letters because of benefit of the doubt. I do think, however, that your doctor has provided an Independent Medical Opinion which appears favorable. Have you sent a claim for service connection of obesity secondary to service connected PTSD? If not, perhaps you should send this claim to V.A. with the nexus letter from the doctor attached to it. Also, since you were in Vietnam have you filed a claim for compensation on service-connected Diabetes Mellitus? Diabetes is presumptive for veterans who were in Vietnam [see 38 CFR 3.309 (e). In that regulation the word herbicide is used instead of the term Agent Orange.]

Edited October 17, 2009 by deltaj (see edit history)

[Pete53]

The main reason for a diabetic to gain weight is a goal that most have. When you get control of your sugar you add weight. Simple when out of control you urinate or pass through 2000 calories plus a day. When you get some kind of control you have to adjust your calories appropriately.