Looking For Opinions And Guidance

[carlie]

Warning - this is a long read and I appreciate your guidance and opinions.

Due to remand instructions from BVA, I have a C&P for a Heart Disorder next week.

*** The examiner is to determine the etiology and current level of disability.

*** Also, in the BVA Remand instructions the BVA Judge wrote,

"Moreover, in light of the action granting service connection for asthma

and bronchitis, further discussion of the Veteran's claim of service connection for a

Heart disorder to include on a secondary basis is required.

FYI - to add for consideration - I am service connected for Chronic Suppurative Otitis Media,

(draining infection), this will relate to one of my PCP letters of support you will read further down

in this same post.

The medical evidence I have of record that shows support for SC of Heart disorder is as follows :

June 2, 2000

From my PCP to DVA.

XXX has been a patient since 1998.

She has multiple,severe medical conditions which are more likely than not related to her military service.

2. Congestive Heart Failure - she did have congenital heart abnormality of endocardial fibroelastosis which

was treated at age 8 months at XXX Children's Hospital.

Currently has severe shortness of breath on exertion with 36 percent Ejection Fraction, which was

presumed to be normal when she went into service.

She is currently unable to work due to her Cardiac condition

3. Asthma and emphysema requiring multiple visits to our clinic, missed work, multiple medications.

There is evidence that she was having respiratory problems while in the military.

January 12, 2001

From my PCP to DVA - Memorandum - XXXXXX - Veteran's Service Center Manager

2. Congenital heart condition was severely aggravated this year requiring frequent Cardiology visits

and side effects from medications.

I feel that her lung disease is aggravating this condition. I feel that her heart condition existed

while in the military.

3. Asthma - I feel her recurrent episodes of Bronchitis in the military were highly related

to her Asthma.

January 12, 2001

From my PCP to DVA - Memorandum - XXXXXX - Veteran's Service Center Manager

Patient XXX was seen today for Congestive Heart Failure, Asthma and Depression.

I feel she is permanently disabled. If any questions please call XXX-XXXX.

January 18, 2001

The RO's - VSCM sent a Memorandum back to my PCP with these questions (and others).

2. What is the etiology of the veteran's current Heart condition ?

Reply from my PCP

She had endocardial fibroelastosis as a child.

Currently she has improved ejection fraction of 40 percent, but in 1999 before medication and

Cardiology titration of medication her ejection fraction was 36 percent with dilated Cardiomyopathy.

This type of Cardiomyopathy is very unusual for a woman this age (43 yrs old).

I feel it is related to her Congenital Heart disease.

I do not feel that recurrent bouts of bronchitis / asthma has helped this condition.

I feel that depression and smoking has worsened this condition.

3. What respiratory problem in service has resulted in her current asthma ?

Reply from my PCP

9/1/77 URI, treated with XXX antibiotics, 11/14/77 URI with shortness of breath,

1/12/78 URI with cough, 2/21/78 TMC 3 shortness of breath when running with chronic cough.

In view of her current diagnosis of asthma and chronic respiratory SX's since the military,

I feel that her respiratory downward spiral started in the military.

Asthma is a chronic process that is aggravated by stress, smoking and recurrent infections in the ears/sinus.

Soooooooooooo . . . .

Keeping in mind that the BVA did grant service connection for asthma and bronchitis in the

Order Section of this adjudicated appeal and I am service connected for

Chronic Suppurative Otitis Media (draining infection).

I know quite a bit will depend on what this C&P examiner states.

I am going to take copies of the above and try to get the examiner to accept them.

What's your opinion ?

Yes - I know - Stop smoking is one : )

[john999]

If you have a chronic infection that could aggravate heart issues. Dentists at the VA say if you even have gum disease it can harm your heart because the infection gets into the blood stream and the blood is pumped through the heart. How much worse if you have a severe draining infection that is chronic? Knowing the VA they will try to blame everything on pre-existing heart problem and smoking. Have you ever tried to claim depression due to general medical condition.

[carlie]

John,

This same BVA Order / Remand has instructions for SC of Depression

as secondary to SC'd seizures.

[shag]

Hey Carlie,,,sorry to hear about your issues. Glad you got at least a REAL look from the BVA. However, the reason for this reply has to do with the smoking issue. Up until 1992, I think, smoke addiction was a compensable issue. Even now, I think it can be secondary. Now,,,,,,to rant a little,,,,,,don't you chew on me now: My rant is that back in the 60's when I was in vietnam, the military issued cigarettes in the rations. What gets me about that is that many guys, and gals, did not smoke on entry to the service. It was implied that somehow smoking might help with the anxiety of the conditions (war). Now, I don't want you to actually answer this,,,but the question looms,,,How can the VA then say that smoking and the associated problems are now considered willful misconduct?

Edited October 21, 2010 by shag

[carlie]

Thanks.

Still keeping an eye out for all additional help and opinions.

[halos2]

Carlie, Look up the illiness and diagnoses on the internet. Find researches that were done that linked them together, statical data and medical journals specifying this too. I brought all of these to my last C&P and highlighted the most important quantifying info...also I had spoke with the examiner on a few occasions telling her I would be bringing her these medical studies and the relationship of these disease processes to my diagnoses and medical issues..

.She used these all(22 pages worth) in her evidence rebuttal in this exam. Also I requested she include these sentences in her summary:

regarding the veterans illiness and chronic condition It is most likely noted a relationship exists between the veterans current medical condition and the diagnosed medical conditions and illiness's she was treated for in-service. These conditions are chronic in nature and are irreversible to establishing normalcy.(I did put it my diagnosis but I generalized the statements here for you to put in yours.)

I won my last 2 C&P's with this.(sometimes they are reluctant to say most likely, or more than likely) but I tweeked it a bit by using ...a relationship exists...and it worked!

Good luck with this one, I know they have jacked you around for years. More than my 7...

[retiredat44]

My Father, who was a US Navy Vet, got VA disability for emphysema.. he smoked Pall Mall Red for 40 years.. he never saw a doctor in his life.. but they gave him the VA disability, and he only went to one c&p exam..

I did not smoke and, nor did any other self inflicted wounds, spent 20 years sick in bed, in the hospital for operations, some hospital stays up to 6 months in a hospital bed fighting for my life every moment..

yet they have fought me every frakkin inch of the way to appeals..

To me it looks like if you smoke and drink yourself to death, they pay up, but if you be a good boy, and mind your own business, they tell you to F-Off..

sorry, I am just angry.. everything is bass ackwards..