Hyperlipidemia

[stillhere]

Berta picked up on this a couple of years ago.

In my case for EED for heart disease I was diagnosed with hyperlipidemia that was noted in my SOC and my chest pains were denied as heart disease in 2003. I went on to have a heart attack in Oct.05 I then sent the VA the info of my hospital stay and surgery and was granted heart disease but only back to the date of my heart attack.

The case below states a law where if condition such as hyperlipidemia causes a disease it should be considered back to that date.

Will this help me if I refer to this law? Am i reading this right?

In this case, the Board notes the facts are not in dispute

and that the medical evidence of record includes findings of

hyperlipidemia. The Board notes, however, that

hyperlipidemia is not a disability for VA compensation

purposes. Nor is there any evidence of a chronic disability

having been incurred as a result of hyperlipidemia. The

Court has held that, in cases such as this, where the law is

dispositive, the claim should be denied because of the

absence of legal merit. See Sabonis v. Brown, 6 Vet. App.

426 (1994). Therefore, the Board finds entitlement to

service connection for hyperlipidemia must be denied as a

matter of law.

[jerrbilly]

I see what you're saying here John and there are other factors that could contribute to heart disease. I went ahead and made sure the VAMC documented in my records that my meds are causing my hyperlipidemia just in case something does happen down the road.

I have that part covered. The next step would be the connection between my hyperlipidemia and heart disease. As far as I know there isn't any history of heart disease in my family and the other factors aren't there so I guess that's where the famous phrase "at least as likely as not" comes into play.

I do take a statin though and it's working ok. Bad lipid are about 35% down and good lipids are up about 15%.

Thanks,

Jerr

Jerrbilly

I don't think I would want to bet that the VA is going to SC you for heart disease ten years from now because you have high cholesterol from meds for a SC condition. Too many other factors are in play including your own genetics, weight, blood pressure etc. I would be taking a drug to reduce the high cholesterol now. My brother has been living with hyperlipidemia for 20 years. At what point can you say that high cholesterol is going to do him in from a heart attack?

Edited January 7, 2010 by jerrbilly

[carlie]

As far as I know there isn't any history of heart disease in my family and the other factors aren't there so I guess that's where the famous phrase "at least as likely as not" comes into play.

Thanks,

Jerr

jerr,

The phrase doesn't have anything to do with your family history.

The phrase refers to medical statements regarding

possible Service Connection:

Is due to- 100%

More likely than not- Greater than 50%

At least as likely as not- 50% (Benefit of doubt goes to Vet)

Not at least as likely as not- Less than 50%

Is not due to- 0%

carlie

[jerrbilly]

Carly, I was more referring to if I developed heart disease and had to get an opinion that my hyperlipidemia contributed to the heart disease.

That's basically what I meant when I state "at least as likely as not." Better yet, I would rather have "is due to" or "more likely than not" instead.

Those would be even better.

Thanks, Jerr

jerr,

The phrase doesn't have anything to do with your family history.

The phrase refers to medical statements regarding

possible Service Connection:

Is due to- 100%

More likely than not- Greater than 50%

At least as likely as not- 50% (Benefit of doubt goes to Vet)

Not at least as likely as not- Less than 50%

Is not due to- 0%

carlie

[jerrbilly]

I forgot who it was but someone here on HADIT said they had hyperlipidemia during their service and wanted to seek service connection for CAD after service from their in-service hyperlipidemia.

Here is a case that might help or if someone here remembers who that was please let me know and I will post it in the proper place.

Here it is and to take up less room I didn't copy the whole thing:

http://www4.va.gov/vetapp09/files2/0911268.txt

Coronary Artery Disease

The Veteran contends that his STRs show numerous readings of

very high cholesterol and triglycerides, which he felt caused

his coronary artery disease and atherosclerotic heart

disease. During his August 2008 hearing, the Veteran stated

that the high cholesterol he experienced while in the

military was a contributing factor to his coronary artery

disease which was diagnosed in 2002.

The Veteran's service treatment records contain several

entries referencing high cholesterol (see January 1990, June

1990, March 1990, February 1992, August 1992, November 1992,

May 1992, September 1992, January 1993 entries), or

hyperlipidemia. See February 1991, December 1992, August

1992, and February 1993 entries).

The first diagnosis in the record of coronary artery disease

is a December 2002 record from Wheeling Hospital, noting that

the Veteran underwent a left heart catheterization with stent

placement. The Veteran underwent another stent placement in

February 2003. A September 2003 evaluation for a psychiatric

disability noted coronary artery disease, status post two

stents implantation and hypercholesterolemia. A September

2006 entry noted a past medical history of

hypertriglyceridemia, and coronary artery disease, and a

December 2006 record again noted hyperlipidemia with coronary

artery disease.

Regarding a nexus to military service, in a November 2007

statement, A.F., M.D., noted that the Veteran had been a

patient of his since January 2003. Dr. F. stated that the

presumption over the years was that the Veteran's

hyperlipidemia had contributed greatly to his coronary artery

disease, noting that medical records showed that the Veteran

had coronary artery disease for most of his adult life. At

the 2008 hearing, the Veteran submitted an additional

statement from Dr. F. which further clarified Dr. F.'s

opinion regarding the relationship between the in-service

notations of hyperlipidemia and current coronary artery

disease. Specifically, in the April 2008 letter, Dr. F.

noted that he wanted to make clear that he not only went over

his treatment records for the entire time that the Veteran

was his patient, but that he also reviewed the Veteran's

military service treatment records, and again opined that the

Veteran's hyperlipidemia had contributed greatly to his

currently diagnosed coronary artery disease. Dr. F.

explained that this was evident after reviewing service

treatment records which showed that the Veteran had

hyperlipidemia for most of his adult life, and he noted that

hyperlipidemia was an indicator which was known to cause CAD.

Therefore, Dr. F. opined that the Veteran's coronary artery

disease more likely than not started during his military

service, and had been contributed to by his hyperlipidemia.

In this case, the Veteran is currently diagnosed with

coronary artery disease. See medical records from Belmont

Urgent Care Center, Wheeling Hospital, and medical opinions

by Dr. F. Additionally, the Veteran's service treatment

records contain several references to hyperlipidemia (see

entries dated in February 1991, December 1992, August 1992,

and February 1993). Regarding continuity of symptomatology,

December 2002, approximately 7 years after discharge, is the

first documented post-service diagnosis of coronary artery

disease. As just discussed, in terms of a nexus between the

Veteran's currently diagnosed coronary artery disease and

military service, Dr. F. in two separate statements, noted

that he had reviewed the Veteran's service treatment records,

as well as his current treatment records, and opined that the

Veteran's in-service hyperlipidemia greatly contributed to

his current coronary artery disease, explaining that this was

evident after reviewing his STRs which showed that he had

hyperlipidemia for most of his adult life, and that

hyperlipidemia was an indicator which was known to cause CAD.

As such, Dr. F. stated that it was his professional opinion

that the Veteran's current coronary artery disease more

likely than not started during military service.

Therefore, because the Veteran has a current diagnosis of

coronary artery disease, and the STRs contain references to

hyperlipidemia, a known precursor or cause of CAD, and the

record contains a medical opinion by Dr. F. establishing a

nexus between his current disability (CAD) and the in-service

references to hyperlipidemia, the Board finds that service

connection for coronary artery disease is granted.

ORDER

Service connection for coronary artery disease, including

atherosclerotic heart disease, is granted.

[broncovet]

I agree with most of what has been posted, especially Berta who pointed out that to get an EED, you are going to have to prove CUE in a decision more than one year ago. When you are doing CUE claims be sure to base your CUE on errors of facts or law, not errors of judgement on the part of the rater. "I think he should have rated me 40% instead of 20%" wont pass the CUE test.

Dig deep. Find a loophole in your favor. Read these over several times each: Your medical records, The related CFR regulations, schedule of rating criteria, and the RO decision(s). Look carefully at the "reasons and basis" in your decisions. Look for any conflict between any two of those 4. I think Berta said she had an "Aha moment" after reading her stuff like 12 times, discovering the way that eventually won for her. A similar thing happened to me. Write down what each says on a piece of paper:

rating criteria; RO decision "R and B"; CFR; your medical records evidence

Then list them all of those applicable to you. draw lines connecting them together, kind of like they were states and state capitals, and maybe state birds.

One more thing..take it from "the captain" and NEVER GIVE UP.

Edited January 7, 2010 by broncovet

[Berta]

Great case Jerrbilly-

Although the VA doesnt want to consider BVA decisions for other vets and they say that is because the BVA cases are only specific to individual veterans disabilities - this is different and I have used BVA cases myself when the BVA makes a legal interpretation of the regs.

This case shows inservice manifestation of a symptom that led to a post service disability-

"numerous" high cholestrol readings which also included the high triglycerides in service were absolute proof of the hyperlip[edimia in service that was not just an isolated reading.

Broncovet is right - I also suggest to focus on the Blue rating sheet (if you dont have it your vet rep should have it- or any rating sheet at all with the decision that used the diagnostic codes.

say the VA gave you what you feel is the wrong % in a past denied decision you are filing CUE on-

If the medical evidence is established in the file and should have warranted a higher rating then the legal error VA made might well be in using the wrong diagnostic code and that would be valid CUE basis.

Medical evidence does come into play with CUE claims but it involves only the established clinical record-as Broncovet stated-

the examples of CUE under the CUE forum show what I mean.

"I think he should have rated me 40% instead of 20%" wont pass the CUE test.-Broncovet is right

BUT if the diagnostic code for the 20 was different than the one for the 40-and the established medical evidence warranted 40%- the diagnostic code was wrong (and manifestly altered the outcome) because the wrong DC caused a lower percentage to be awarded-to the veteran's financial detriment.

In a case like that the VA committed CUE in using the wrong diagnostic code from 38 CFR. A Legal Error.

Edited January 7, 2010 by Berta