diabetes Help! Va Sent For A Medical Opinion From Vamc 4times

[Lzjump]

I have a Claim for Cause of Veterans Death & TDIU. My husband was 90% SC at the time of his death in 2004. He had applied for TDIU & reopened claim for Hep C. but that claim was not decided until after his death and was denied. I refiled as the widow and was denied. I appealed the decision, had a BVA hearing in March 2008, in August 2008 was awarded the TDIU and claim for cause of veterans death was remanded. Remanded stated that they were to try to locate the STR from service and also get a medical opinion to opine if any of his SC conditions contributed to his death. I received a letter stating that they could not locate the Service Treatment Records from when he was hospitalized in Nam after trying 3 times. (Husband had Hep C and had a Liver Transplant in 2002). He was hospitalized for 6 weeks in Quin Hon and had blood transfusions. He was SC for PTSD, Diabetes Mellitus type II, PN, Gunshot wounds. He was boots on the ground vietnam vet with purple heart, air medal etc. His death certificate stated cause of death was Multi System Organ Failure and Sepsis. (he had chronic renal insufficiency secondary to DM in 11/03 he was on insulin & restricted diet) My claim was sent for a medical opinion in August 2009 and has been sent back 4X for medical opinions. the latest being Feb 24, 2010. Yesterday I went to the VAMC to get a copy of his medical records and the opinions and now I see where the problem is.

Medical Opinion Sept. 2009.

the relationship of the veteran's Hep C to his military service is speculative. Service connected disability listed. the only one that could be considered as contributing to the veteran's death is his diabetes mellitus.

Nov 2009

see exams 9-09 with explanation/rationale and cfile reviewed.

Feb 2010

the degree of contribution of his diabetes mellitus to his death is speculative.

Feb 2010

Claim Back again for heart condition.(he had a AMI with left branch bundle block before he passed away) so now I guess they want his opinion on that.

My question, Does the Doctor have to give a rationale for his opinion?

Should I get another medical opinion and submit to AMC with more rationale?

I have 3 medical opinions from his Physicians who treated him for over 8 years. stating that the Diabetes did contribute to his death and one stated that all though diabetes was not listed on the death certificate it is well document thru out his treatments. I have hospital ICU records showing his blood sugars some over 300 and all over 180. Also have a Veterans Affairs study stating that even mild hyperglycemia was associated with as much as a 15-fold increased risk of death in study of ICU patients and a correlation between hyperglycemia and renal failure and sepsis. This study was done at VA medical centers.

Thanks for any help.

[Berta]

"I feel that those instructions are very clear, to the point and hopefully will assist me in this claim. What do you think about the remand?

Thanks for any assistance".

I feel it is certainly concise and to the point. But that means nothing to the VARO sometimes.

What did the BVA say as to the 3 IMOs you had sent in?

Did those opinions fully comply with the IMO criteria I posted here under the IMO forum?

I feel a claimant should try to comply with a remand themselves.

This is why I obtained a forensic cardio specialist when my remand called for a Cardio opinion.

As I mentioned- the PA opinion was easy to knock down and the BVA gave my IMOs enough weight to award the claim before my cardio doc had chance to prepare the IMO.

In your case:

"I have 3 medical opinions from his Physicians who treated him for over 8 years. stating that the Diabetes did contribute to his death and one stated that all though diabetes was not listed on the death certificate it is wel" etc etc

Has the VA ignored these opinions or have they rejected them?

Would any of the IMOs docs be able to prepare an additional opinion that reflects the remand word for word?

They must follow the IMO format here and it is best if they include excerpts from established medical texts or treatices -in additional to their full medical rationale( VA usually ignores when we do that but cannot ignore these references when an IMO doctor uses them) and they should list their Curriculum Vitae or their expertise in order to support their conclusions.

[Lzjump]

"I feel that those instructions are very clear, to the point and hopefully will assist me in this claim. What do you think about the remand?

Thanks for any assistance".

I feel it is certainly concise and to the point. But that means nothing to the VARO sometimes.

What did the BVA say as to the 3 IMOs you had sent in?

* No mention of the IMO's in my remand.

Did those opinions fully comply with the IMO criteria I posted here under the IMO forum?

*Not really:

I feel a claimant should try to comply with a remand themselves.

* I have package ready for Dr. with copy of the remand, I thought that myself and worked on that this weekend.

This is why I obtained a forensic cardio specialist when my remand called for a Cardio opinion.

As I mentioned- the PA opinion was easy to knock down and the BVA gave my IMOs enough weight to award the claim before my cardio doc had chance to prepare the IMO.

* The PA opinion on all of my claims are speculative, with no rationale. Were your PA opinions from the VA more clear and did they have a rationale? Did you receive a SSOC from the AMC? Did the AMC send your claim back to the BVA? (Hope I'am asking this quesion correctly) it is my understanding, if the AMC denies my claim, the claim will be sent back to the BVA for a final decision.

In your case:

"I have 3 medical opinions from his Physicians who treated him for over 8 years. stating that the Diabetes did contribute to his death and one stated that all though diabetes was not listed on the death certificate it is wel" etc etc

Has the VA ignored these opinions or have they rejected them?

*Not sure to be honest, all I really know is that the AMC is requesting a medical opinion from the VAMC. All I have received was a notice back in August 2009 that states they were unable to locate the medical records from hospitalization in Nam. Spoke to someone in his unit and he pointed me to a article that states that medical records from that hospital were lost/destroyed when a ship with these records on them was sunk in Danang Harbor by enemy fire. I have that article and I will submit it with my claim. My husband had tried to get his hospitalization records back in 1997 from VA and they were unable to locate them. In 2001 VARO tried to get them and now AMC has tried to locate them. (this is for the Hep C claim).

Would any of the IMOs docs be able to prepare an additional opinion that reflects the remand word for word?

* That is what I started on last week, I have given a copy of the Remand to the Dr's so they can see exactly what the BVA is looking for:

They must follow the IMO format here and it is best if they include excerpts from established medical texts or treatices -in additional to their full medical rationale( VA usually ignores when we do that but cannot ignore these references when an IMO doctor uses them) and they should list their Curriculum Vitae or their expertise in order to support their conclusions.

Thanks Berta for your time I really appreciate it. I have been searching for the VA Worksheets on Diabetes. can you point me in the right direction? Also do they have a work sheet for Chronic Renal Failure, are these in 38CFR?

[Berta]

This is the diabetes worksheet which seems to include renal disease:

http://www.vba.va.gov/bln/21/Benefits/exams/disexm13.htm

But C & P Exams are done differently for deceased veterans.They should involve exactly what the BVA remand called for and be done by a doctor who has the expertise to opine.

Here is the VA diabetes training letter:

http://www.hadit.com/forums/index.php?show...aded&start=

"The PA opinion on all of my claims are speculative, with no rationale. Were your PA opinions from the VA more clear and did they have a rationale?"

No-I received in 2005 an opinion from a VA Endocrinologist that denied my claim and I obtained an IMO to knock that down.She gave no probative rationale at all for her opinion and never considered the evidence.

In 2009 the AMC sent the claim,per the BVA remand, to a Physicians assistant. He gave no medical rationale whatsoever and he really didnt give an opinion by saying anything he stated would be speculative.I rebutted his entire C & P myself.

By then I had 2 IMOs from a NeuroRadiologist ( due to his ability to interpret MRIs of diabetics with brain trauma and the ECHO in the med recs )and also I had a powerful 2 sentence statement from his former treating Neurologist which the BVA gave equal weight to.

"Did you receive a SSOC from the AMC?"

Yes, this was when I rebutted the PA opinion and they sent it (outsourced it)to Seattle VARO (I am in NY) for a decision.

It was denied again.

" Did the AMC send your claim back to the BVA? (Hope I'am asking this quesion correctly) it is my understanding, if the AMC denies my claim, the claim will be sent back to the BVA for a final decision."

Yes after AMC denied again (still my evidence remained unread by the Seattle VA and the AMC )-they sent it all back to the BVA and within a very short time the BVA awarded the claim.

Almost 7 years had passed and this was the first time the VA ever acknowledged my medical evidence.

I made sure (since VA had removed and destroyed evidence regarding my past claims that the BVA also had copies of everything.

I kept in contact with the BVA via their phone number and ombudsman to make sure that if things were missing -as I had experienced before- that I could replace it before they made a decision.

If you go to the BVA web site (via the VA.gov main site) you can search for claims and decisions that are similiar to yours.

But the problem is that we both based DIC claims on disabilities that are not on the death certificate.

But I dont feel you will have the same problems I had.My huisband's DMII and CAD were not even diagnosed by the VA.

My claim was a re-open of a successful malpractice claim I won against the VA.

It involved AO diabetes as contributing to death but diabetes never appears in my husband's medical records or autopsy.

He died of cardiovascular disease (also undiagnosed and untreated) and cerebralvascular disease -all of which the VA admitted to malpracticing on-and thereby caused his death.

When I re-opened for death caused by an AO condition-diabetes-that I proved was also malpracticed on-the VA knew if I succeeded-then right off the bat they would have to pay me a very large offset amount that was offset to my DIC over a decade ago.

I think this was one obvious reason they continually ignored my IMOs.

I got the offset money a few weeks ago.My award came in April 2009 but I had to fight them for 10 months over this money-and I had to go over their head on it-they didnt want to pay it and now I believe that was why they ignored my evidence.

You must make sure that they not only acknowledge everything you send to them-in their decisions- but also that you maintain proof of mailing.

I had very little time -from the BVA remand requesting a cardio doc -to when the claim was returned back to the BVA from the AMC.

I contacted the forensic firm right away when I read the remand ,sent them the money and the records as fast as I could and found the BVA decision in my mailbox much sooner that I expected.The cardio opinion had not even been prepared yet.

It pays to obtain an IMO as soon as possible.Make sure that if the claim is still at the AMC-to send the opinion to the AMC, the BVA, and even the original VARO as it seems these IMOs often get lost or misplaced by VA and of course they are usually the most critical evidence we have.

[Lzjump]

This is the diabetes worksheet which seems to include renal disease:

http://www.vba.va.gov/bln/21/Benefits/exams/disexm13.htm

But C & P Exams are done differently for deceased veterans.They should involve exactly what the BVA remand called for and be done by a doctor who has the expertise to opine.

Here is the VA diabetes training letter:

http://www.hadit.com/forums/index.php?show...aded&start=

"The PA opinion on all of my claims are speculative, with no rationale. Were your PA opinions from the VA more clear and did they have a rationale?"

No-I received in 2005 an opinion from a VA Endocrinologist that denied my claim and I obtained an IMO to knock that down.She gave no probative rationale at all for her opinion and never considered the evidence.

In 2009 the AMC sent the claim,per the BVA remand, to a Physicians assistant. He gave no medical rationale whatsoever and he really didnt give an opinion by saying anything he stated would be speculative.I rebutted his entire C & P myself.

By then I had 2 IMOs from a NeuroRadiologist ( due to his ability to interpret MRIs of diabetics with brain trauma and the ECHO in the med recs )and also I had a powerful 2 sentence statement from his former treating Neurologist which the BVA gave equal weight to.

*May I ask what year you filed your original claim?

"Did you receive a SSOC from the AMC?"

Yes, this was when I rebutted the PA opinion and they sent it (outsourced it)to Seattle VARO (I am in NY) for a decision.

It was denied again.

" Did the AMC send your claim back to the BVA? (Hope I'am asking this quesion correctly) it is my understanding, if the AMC denies my claim, the claim will be sent back to the BVA for a final decision."

Yes after AMC denied again (still my evidence remained unread by the Seattle VA and the AMC )-they sent it all back to the BVA and within a very short time the BVA awarded the claim.

Almost 7 years had passed and this was the first time the VA ever acknowledged my medical evidence.

I made sure (since VA had removed and destroyed evidence regarding my past claims that the BVA also had copies of everything.

I kept in contact with the BVA via their phone number and ombudsman to make sure that if things were missing -as I had experienced before- that I could replace it before they made a decision.

If you go to the BVA web site (via the VA.gov main site) you can search for claims and decisions that are similiar to yours.

*I have been doing that also.

But the problem is that we both based DIC claims on disabilities that are not on the death certificate.

But I dont feel you will have the same problems I had.My huisband's DMII and CAD were not even diagnosed by the VA.

* VAMC has sent another medical opinion back to the AMC as of today. If I do receive a SSOC from the AMC will that show what information was used to deny the claim? Is that how you knew they had not read or considered your evidence? Until I receive a SSOC from the AMC it is kind of hard to figure out what they will use to deny the claim. Sorry again for all the questions but I'm learning from your experiences and this helps me understand the claims process.

My claim was a re-open of a successful malpractice claim I won against the VA.

It involved AO diabetes as contributing to death but diabetes never appears in my husband's medical records or autopsy.

He died of cardiovascular disease (also undiagnosed and untreated) and cerebralvascular disease -all of which the VA admitted to malpracticing on-and thereby caused his death.

When I re-opened for death caused by an AO condition-diabetes-that I proved was also malpracticed on-the VA knew if I succeeded-then right off the bat they would have to pay me a very large offset amount that was offset to my DIC over a decade ago.

I think this was one obvious reason they continually ignored my IMOs.

I got the offset money a few weeks ago.My award came in April 2009 but I had to fight them for 10 months over this money-and I had to go over their head on it-they didnt want to pay it and now I believe that was why they ignored my evidence.

You must make sure that they not only acknowledge everything you send to them-in their decisions- but also that you maintain proof of mailing.

* I have done that after reading hadit. Wish I knew back then what I know now!

I had very little time -from the BVA remand requesting a cardio doc -to when the claim was returned back to the BVA from the AMC.

I contacted the forensic firm right away when I read the remand ,sent them the money and the records as fast as I could and found the BVA decision in my mailbox much sooner that I expected.The cardio opinion had not even been prepared yet.

It pays to obtain an IMO as soon as possible.Make sure that if the claim is still at the AMC-to send the opinion to the AMC, the BVA, and even the original VARO as it seems these IMOs often get lost or misplaced by VA and of course they are usually the most critical evidence we have.