ptsd Question About Date Of Diagnosis And Secondary Conditons

[chr49]

Amended post - Hope this is easier to understand

I lived with PTSD for over 30 yrs before I was diagnosed in 2007. There was no such thing as PTSD in 1971, but I wouldn't have gone for help for several years anyway due to my state of mind. I didn't bother to see any doctors between 1971 and 1998 and when I went I did not talk about my Vietnam experience (I doubt I mentioned being a veteran)so my records don't say a thing, other than the fact that I was warned to stop smoking and have used multiple cessation programs since 1999 in an effort to quit.

I was recently denied a secondary claim for vascular disease. The denial states I have had an unhealthy lifstyle before and after "PTSD diagnosis in 2007." Smoking is 'the after diagnosis' unhealthy lifestyle and my addictions (in long term remission)are indicated as 'before diagnosis'.

When I initially filed for PTSD, it went thru easily. My 2008 PTSD C&P exam documents 'chronic PTSD'with classic symptoms since returning from combat(1971). The exam is standard form stuff but I'm thinking the statement "The veteran’s PTSD is the cause of the aforementioned changes in functional state and quality of life" may be of value, but I truly don't know.

My wife has found a couple cases and most important; a General Counsel’s Published Opinion (VAOPGCPRED 6-2003) which addresses whether a veteran’s tobacco-related disability or death may be service connected secondary to a service-connected mental disability, which caused the veteran to use tobacco. 38 U.S.C. §1103(a) prohibits a finding of service connection of a disability or death resulting from the veteran’s use of tobacco during the service. The General Counsel opinion, however, clarifies that service connection is permissible if the veteran’s disability or death is the result of his post-service use of tobacco, which is caused by a service-connected psychological disability.

I am considering using the materials we've found so far and getting another IMO that will support having PTSD prior to diagnosis, as well as the tobacco usage connection but we can't find any regulations specifically related to the "date of diagnosis" in regard to secondary conditions.

I'm concerned about fighting something that can't be won if there is a regulation that won't allow secondary based on the date of diagnosis.

Any help out there?? I really appreciate it. My wife does my research and paperwork (I'd most likely give up if she didn't) but I can't see stressing her over all of this if it's an impossible mission.

Thanks ahead to anybody that has advice to offer.

Edited August 6, 2010 by chr49

[Berta]

This link is one of dozens I used in some way to prove my AO death claim:

http://www.springerlink.com/content/472m54r3897844h6/

There is certainly a strong medical association between myocardial ischemia and atherosclerosis.

However-for claims involving IHD, I suggest any IHD vet read the regs over very carefully. They are posted here.

The VA will be using ECHO and EKG results as well as METS testing to see if the veteran's heart disease is ischematic in nature.

They will weight heavily on the Ejection Fraction- a measure made within ECHO results because an EJection Fraction of the heart reveals how much blockage (ischemia) the heart has.They will also look for any past ischemic heart attack.

An ischemic heart attack in a vet with any peripheral arterial disease or Peripheral Neuropathy sometimes can present itself as a 'silent' heart attack, revealed only by EKG.

The EKG could read "possible inferior ischemia".

One needs to reade their med recs carefully to find what the VA will be looking for.

For my claim I sent them copies of EKGs and an ECHO on my husband and copies of all records that revealed his undiagnosed heart disease was ischemic in nature.

VA never diagnosed IHD or treated him for this AO disability but in their FTCA med opinions they agreed with my findings.

It isn't easy to interpret medical records. I studied cardiology to succeed in that claim. I also had to study medical symbols and abbreviations.

Getting IM0s for my more recent claims made it easier to prove to VA that my husbands disabilities were due to AO.

If I were you- file the claim but ask your doctor if you do have ischemic heart disease and if he or she will document that in your med recs.

There are many forms of heart disease so this would definitively support your claim for IHD if you have IHD.

[john999]

Do you have DMII? I got SC'ed for heart disease as secondary to DMII. That is the easiest way to get SC'ed for vascular artery disease, CAD or PAD. The VA plays this game where if you get DX'ed with CAD or any vascular disease a year before the DMII DX they will say you can't claim the CAD as secondary to the DMII. I think a good IME or IMO could defeat that since getting the official DX of DMII from the VA is not always that easy. You can have high blood glucose readings for years and never get the DX from the VA. If you have fasting glucose level of 124 you do not have DMII, but if your glucose is 126 you do have it. That is arbitrary. The VA found the problems in my legs by accident after I got DX'ed for DMII. I was looking through the VBM and noticed that the problems that we have are almost presumptive for DMII, so I filed a claim and got 60%. I guess the VA way of thinking is that until one of those clots breaks off and lodges in your heart artery you don't have IHD. Do you have to wait to die for widow to collect? CAD is what leads directly to heart attacks which is definition of IHD.

[chr49]

Berta,

Thanks for the link to Springerlink.com and for your comments. I follow try to follow your posts because they are always informative and often related to issues that I'm dealing with. I have seen the AO IHD proposed regs so I have a fairly good idea on how that's going to work and from what I'm seeing in my records, there is little to no evidence other than the atherosclerosis that I've mentioned. My EKG s have been normal up to 2008 but I am due for another and I've had a couple worrisome episodes in the past year. That is one of the reasons I've hesitated on filing to this point.

I think your advice is spot on. I most likely will have to see a specialist to get proper diagnosis and documentation.

Thanks again.

[chr49]

Do you have DMII? I got SC'ed for heart disease as secondary to DMII. That is the easiest way to get SC'ed for vascular artery disease, CAD or PAD. The VA plays this game where if you get DX'ed with CAD or any vascular disease a year before the DMII DX they will say you can't claim the CAD as secondary to the DMII. I think a good IME or IMO could defeat that since getting the official DX of DMII from the VA is not always that easy. You can have high blood glucose readings for years and never get the DX from the VA. If you have fasting glucose level of 124 you do not have DMII, but if your glucose is 126 you do have it. That is arbitrary. The VA found the problems in my legs by accident after I got DX'ed for DMII. I was looking through the VBM and noticed that the problems that we have are almost presumptive for DMII, so I filed a claim and got 60%. I guess the VA way of thinking is that until one of those clots breaks off and lodges in your heart artery you don't have IHD. Do you have to wait to die for widow to collect? CAD is what leads directly to heart attacks which is definition of IHD.

John999

I'm considered 'pre-diabetic' at this point. I had one doctor diagnose me with DMII but his diagnosis does not meet the VA standard. My blood sugars are consistently elevated but they have stayed below 125.

Edited August 9, 2010 by chr49

[john999]

Did you ever claim DMII? Until you claim it you will be pre-diabetic for life. I was pre-diabetic right up to the day of my C&P exam. I also claimed PN. The VA never DX'ed my with PN but the C&P doctor did. I got SC'ed for CAD by filing for it. The VA would not DX me with it until I filed.

[chr49]

Did you ever claim DMII? Until you claim it you will be pre-diabetic for life. I was pre-diabetic right up to the day of my C&P exam. I also claimed PN. The VA never DX'ed my with PN but the C&P doctor did. I got SC'ed for CAD by filing for it. The VA would not DX me with it until I filed.

Hi John,

Haven't hit the point that I can file. I will file the day I receive a blood sugar result of 125 or higher, whether they give me a diagnosis or not. Just hasn't happened yet. I watch my lab results closely. I also have PN left foot(without diagnosis) and will file for that at the same time...whether the VA gives me a diagnosis or not.