1151 Denial

[LeroyJohnson]

After years of waiting I finally got a denial on my 1151 claim today. The denial was based on the fact that I had a cataract that caused loss of vision prior to surgery and the fact that I am now permanently blind in that eye they said there was no increase in disability since I had no vision because of the cataract prior to its removal and no vision now therefor no increase. I almost laughed at their reasoning. A cataract is not a permanent eye condition but what I have now at their hands is. Oh well what else is new with them. Have a NOD written and will send it in Monday. This is one fight I will not let go of. I know there are BVA cases where veterans have had cataract surgery and became blind from the surgery and won guess I will have to look them up again .

can someone tell me what wording I should use when sending in BVA cases as part of my evidence want to make sure I do it right.

Thanks Leroy

[Pete53]

Good luck the decision sucks

[otey2171]

Leroy: Did you ever file a ftca claim against the VA for malpractice?

[Berta]

Leroy - this is what I meant the other day here about how they manipulate the evidence.

Their medical position is ludicrous-

I think you should NOD this and point out exactly how their rationale is faulty.

Did they refer to some C & P doc or VA 'expert in this decision?

Do you have a copy of the exact med opinion they used?

I would ask for a de novo review too with a DRO-

Leroy -the VARO fought me for years on my reopen of my husband's 1151 claim-

the evidence I had was overwhelming.

Even when I signed a settlement with OGC, the VA STILL denied my 1151 claim-

Here the US of A said Rod's death was wrongful due to VA malpractice and the VARO STILL denied the 1151-

That got squared away real fast however-

my point is this- they will fight over a Section 1151 the same way -and even maybe harder ,than they fight over a regular claim-as long as you have the medical evidence you will succeed.

Did you file a FTCA-I forget and also did you get an IMO that supported this claim?

BVA decisions might help you but they are not binding on the BVA. A CAVC decision would be better-

I dont know if there are any on that-but will check that later-

In any event dont give up!!!!-----

that is their goal- to try to get the vet to give up-especially on 1151 issues.

Tell them in the NOD that you fully intend to continue to appeal this decision until the benefits you seek under Sec 1151 have been granted.

[Berta]

PS to my post-

How did they refer to this in your decision on the 1151?

"This doctor is already in the record as stating that the surgery that the VA did on my eye caused a retinal detachment which cause me to go blind he also said the glucoma I have was more than likely the result of so much haveing been done to the eye. "

That was in a Nov post you made-

Have you sent them the actual record of this?

I would think this is bonafide proof of your claim-

The Discharge surgical notes should show retinal detachment occurred-

VA almost got out of this one- Sec 1151 eye surgery -retinal involvement-

but they didnt :

http://www.va.gov/vetapp02/files02/0205116.txt

[LeroyJohnson]

Thanks for your replies . Berta, yes,they refereed to the C&P doctor who was by the way the same doctor who said that I had incurred a retinal detachment from the surgery. He is also the one who diagnosed the glaucoma.Now as far as the retinal detachment it is not mentioned in the denial. What is said is those famous words unknown etiology.(which at the time of the C&P I did not realize were going to cause so much problem)and which I found to be funny as he had just one month prior to the C&P put in the record that I had a detached retina from the surgery apparently he does not know that a detached retina can cause blindness. No mention of the glaucoma either in the denial.

The statement about the glaucoma came from DR. Bash, he also wrote that my blindness in my right eye should be considered service connect because the usual result of cataract removal is not blindness. It took by the way three years before the eye went completely blind. After surgery I had 20/30 vision in my eye. the next day after surgery I began seeing things floating in the eye. (this is in the record) That is a indication of a detached retina they did nothing about it.(detached retina is not in the record until it is diagnosed last year) The wrong lens was implanted into the eye (again this is in the record) it began giving me all sorts of vision problems their answer to this was laser surgeries to make the eye conform to the lens, result , really messed up eye. when I was dismissed from their clinic I had 20/80 vision in my right eye with eye pressure. I was dismissed and no further prescriptions for eye pressure were given.

I have sent them everything I have said here and more.

They said that since I had light perception vision prior to surgery (caused by the cataract) and light perception vision now no increase in disability occurred. Amazing rational .

A cataract blocking one's vision should not be considered as a permanent condition as eye sight can be restored to its original or near original condition prior to the formation of the cataract simply by removing the cataract and implanting the correct lens needed for sight. the eye condition I have now is not reversible. to me that is a definite increase in disability. Their own surgery to remove the cataract proved that I did indeed have vision in that eye 20/30 if their reasoning was correct then I should have had no vision except light perception in my eye after surgery to have incurred no increase in disability don't you think?

Thanks Leroy

Edited April 30, 2006 by LeroyJohnson

[Berta]

I understand what you mean-

did they challenge what Dr. Bash said?

"Now as far as the retinal detachment it is not mentioned in the denial."

of course not- that is their way out-this evidence has to be spoon fed to them-

"What is said is those famous words unknown etiology".

Another standard VA phrase meaning- "let's hope the vet buys this one"

Leroy- unfortunately you will have to do what did- treat them like they are 12 years ago and rebutt every thing they said in the denial statement-

Piece by piece-

It sounds to me like there are many avenues of attack on their denial-

The C & P- that also might have occurred before many of these problems were fully manifested-

Dr. Bash might well have used more recent records- he is very thorough-

That unknown "etiology" crap (written by a non -doctor) can be combated by telling them what the C & P doctor stated as to:

"yes,they refereed to the C&P doctor who was by the way the same doctor who said that I had incurred a retinal detachment from the surgery. He is also the one who diagnosed the glaucoma."

Leroy- sometimes sending them evidence and stating it isn't enough-

It often has to be restated , explained and even re-sent many times-until they get it.

Also when they make these 'medical' statements -it pays to fully question their rationale when they have failed to mention, in the decision, pertinent medical information.

I think you are getting SSA benefits?

Is there anything in those records that could help with this claim?

Another thing- this might help-

Attach to your NOS an actual diagraph of the eye and it's parts and explain what you are dealing with by referring to the diagram. somethig like this:

http://www.nei.nih.gov/health/glaucoma/glaucoma_facts.asp

I took the time months ago to beef up Dr. Bash's IMO I got-

They ignored it in two SOCs so far but I think I really brought it to their attention in January-

His IMO correlated my husband's MRI of brain (and autopsy results)with numerous strokes present to the diabetic brains he had

studied MRIs of which -he added his experience(NeuroRadiologist) involved "thousands" of brains of diabetics with cerebral ischemia due to diabetes.

So they would fully comprehend that, I printed a diagram of two brain hemispheres, pinpointed my husband's points of trauma and lesions, explained how each of these types of lesions had association in the known medical community as to diabetes- supplied many downloads of supportive medical treatices etc-

and explained in simple terms the medical association of these types of strokes to diabetes, adding even more hyperlinks.Not all strokes and brain trauma is due to diabetes -so I had to explain the etiology

in my husband's case.

Also I did this with a gruesome picture of an autopsied heart-diabetes affects the heart in specific ways-

My husband's heart disease was never diagnosed by VA, it was diagnosed by me-

I studied everything I could find regarding cardiology when I filed my 1151 claim in 1995. I was able recently to associate the medical info in Rod's records and his autopsy with overwhelming proof that his heart disease was from his undiagnosed diabetes.The picture I used was a LVH heart-

Left ventricular hypertrophy is a prominent sign of diabetic heart diease-

I also found numerous medical treatices and abstracts that explained and support my position and I again referred to specifics in the results of the few ECGs the VA had taken.The ECHO results I explained in great detail, so they would get that.

I also was quite surprised doing all this work as even though the VA agreed long ago they killed him with lousy medical care-this time I found the actual cover up in the medical records ,when they (the VA cardiologist) realised he had heart disease and that another VAMC had failed to diagnose it.

It takes work to succeed in claims like this-

the person deciding this claim you have is not a doctor- they need medical information that would back up an award for 1151 disability-these adjudicators are quick to use any negative C & P opinion or even just the negative part of a fairly supportive C & P because they are afraid to make a decision favoring 1151 -

unless they understand the medical information and have enough rationale themselves -as well as the evidence-to back up their decision.

Edited April 30, 2006 by Berta