Ao

[hawkfire27]

I wish we could delete our posts

Edited January 30, 2018 by hawkfire27

[sharon]

It would help if you listed the reason for his denial. It is listed on the rating decision.

[Philip Rogers]

Is your husband rated 100% strictly for PTSD?? If so, did they decide or discuss eligibility for A&A/housebound in their original award letter??? As for the diabetes, submit copies of his prescriptions and the original diagnosis. They were right to deny the diabetes w/o a recorded diagnosis. Never assume the VA has all the VA records from their medical centers.

pr

Hi Everyone,

I was wondering if you could help us out a bit????

My husband is currently 100% SC'ed with PTSD (took over 15 years whew!)

We were trying to add A&A because he is needing my help so much and I am going to have to stop working soon. The VA basically said he can't get A&A for PTSD and he needs to be more disabled, and the VSO suggested getting his other conditions service connected as well to help our chances.. Something we never bothered with because he was already SC'ed 100%.

So we have submitted a claim for a bunch of things, two of which we have been previously denied for. So we got our letter asking for evidence for the following:

Tinnitus

Bilateral Hearing Loss

Migraine Headached

Coronary Artery Disease (Denied 01/16/2002)

Peripheral Neuropathy

Ischemic Heart Disease

Back Pain

Sleep Apnea

Diabetes Mellitus, Type II (Denied 09/06/2002)

Enlarged prostate

Breathing Prolems

Abdominal Pain

Sooooooooo, what I was hoping you can help with is the previous denials. My husband served three tours on the ground in vietnam and basic bathed in Agent Orange! and was denied SC for Diabetes II in 2006. Wasn't this made presumptive in 2001? We need to provide additional evidence because this claim has been closed, but they already have all the evidence and it is presumptive to AO so I don't know what to do about this....Any ideas????

With the Coronary Artery Disease, do you know if this is the same as Ischemic Heart Disease?

My husband's Tinnitus and hearing loss was just diagnosed this year after I convinced him to get it checked because I was sick of yelling at him so he could hear me. The only other hearing tests done were in the millitary, so I don't know how we are going to service connect this, even though he has had it for years and the VA just gave him hearing aids.

I am kind of floundering with this claim because of the previous denials.

Thanks heaps,

Felicity Lynchard

Edited December 5, 2009 by Philip Rogers

[Berta]

It looks to me that the DMII possibly caused his heart disease-but that depends on the medical evidence that his CAD has generated.

You need to dig out his older denials.

Philip is Right- you need to also go over the Evidence list they used to deny to see what was missing.

WHat is the status of this denial? I mean have you formally re-opened yet?

I suggest that you re-open on a 21-4138 form and refer to and attach proof of the DMII diagnosis and meds as Philip said.

Raise the issue that his heart disease is due to the diabetes.

Is there medical evidence that his heart disease pre- dated the DMII diagnosis? If so they will deny CAD due to DMII.

However if it is Ischemic heart disease they would still have to award when the new presumptive for IHD is in the Federal register so raise this as service connected due to the AO DMII and/or Ischemic Heart Disease under the regs proposed by Secretary Shinseki.Raise both issues.

I had similiar claim.My husband died from DMII causing CAD and strokes-ischemic in nature-neither DMII nor Heart disease was diagnosed by the VA.DMII never appeared in his Med recs at all and the CAD was covered up and both were left untreated.My FTCA award for malpractice was 1997.

My award for his direct service connected death for DMII causing and contributing was April 2009.

I confirmed this week with the General Counsel and NVLSP that my EED retro for DIC is Oct ,1994.A lot of the Nehmer cases (AO) depend on past denials in order to get a more favorable EED.

Because of Beverly Nehmer AO widow- and the Court Order that lawyers at NVLSP won years ago.

I am bringing this all up here because you need to do what I did- scour the med recs as carefully as possible to find a DMII diagnosis date, get his Glucose readings and dates too, and then associate that to his heart disease.

ANd then determine if in fact this is ischemic heart disease too- this way you will be well prepared to battle on 2 fronts-

And if there is Nehmer Retro and they dont pay him- I have contacts in DC for how to handle that.

There is potential here for possibly a very favorable EED based on the past denials.

However I am jumping ahead of this-the claim must be re-opened and they will send you a VCAA letter-

However with proof of DMII diagnosis, they could award for that right off the bat-

List his disabilities with DMII first and then the heart disease and PN , and then the rest-on the 21-4138

(You can write them a letter instead of using this form but this form is what they are familiar with)

"With the Coronary Artery Disease, do you know if this is the same as Ischemic Heart Disease?"

Many advocates are concerned about how this will be defined in the new regs-hopefully the regulation will appear soon in the Federal Register4 and we can comment on it-

Was an ECHO done on his heart?

The measurements of an ECHO as well as an ejection fraction and other medical records invoving his CAD can reveal it to be ischemic- in most cases. But not all-

Does he have high lipid profile?

Does he have any diagnosis of atherosclerosis or periphal arterial disease?

Do you have copy of his complete medical records?

As Philip asked- why did they deny him SMC?

Edited December 5, 2009 by Berta

[Philip Rogers]

Hi "F,"

When your husband was awarded 100%, solely due to PTSD, the VA had the duty to decide if he qualified for A&A or Housebound(HB), "as an inferred issue." That failure, to do so, means that claim for A&A/HB remains open and can go back to the original claim/award date. You should pursue that claim vigorously. It's roughly $300 additional a month.

pr

Hi Philip,

Thanks for your reply...

Yes my husband is connected only for PTSD at 100%, they made no mention of A&A in his decision papers/award letter. We will definately include all the Dianosis and prescription info in this new claim!

Thanks,

F Lynchard

[Berta]

Philip is right-

I suggest that you definitely claim Ischemic heart disease under the proposed new regulations.

Perhaps an independent endocrinologist would see something in his med recs that was symptomatic of diabetes prior to the CAD.

Also the ECHO could be interpreted as to whether this shows heart disease of ischemic nature- most heart disease is,in fact, ischemia.

The ECHO has percentages that reveal narrowed arterial pressure due to atherosclerosis.

And well as the Ejection Fraction.

I mentioned my situation because I proved my husband was symptomatic of diabetes from 1988 to 1994-as VA patient yet VA never diagnosed him with DMII nor the subsequent IHD the untreated DMII caused.

An Endocrinologist could pick up on these symptoms-

For example the word 'Hyperlipedimia' appeared for the first time during a post death C & P review in a SSOC I got in 1996.

I studied this condition and it became very probative evidence for my undiagnosed DMII claim.

A VA dentist noted odd patches in my husband's mouth 1988-

this was also noted in 1992 hospital records and a diagnosis and treatment of what caused the patches-

This -after I studied this condition for months and months was also probative evidence for my AO death claim.

My husband had odd visual disturbance (on top of daily flashbacks) well documented in an EEOC case he had against the VA.

The VA EEOC testimony said he couldnt read the information correctly to do the job and made many mistakes.

This all because also VERY probative evidence of diabetic involvement to his eyesight.

In 1988 my husband had a heart attack while at the VA that they said was sinus infection-however I proved this heart attack was directly due to DMII which could have been diafgnosed -that day if they had followed up on other tests they never did.

A heart attack is often the very first sign of diabetes.

On the SMC Philip mentioned - check out the Bradley V Peake decision here in Claims Research.

[john999]

You know one of the first places artery disease shows up is in the legs. If you have DMII as a SC condition and you complain about pain in your legs the VA might do a CT scan of your legs. This will show artery disease possibly and if it is in your legs it is probably in your brain and heart as well. I had a lump on my leg and the VA did a CT scan. I was SC for DMII at the time. The CT scan revealed artery disease. I got this SC'ed as secondary to the DMII and they DX'ed it as CAD. This is sort of a back door approach.