ptsd Ecfr 7111 -- Aneurysm, Any Large Artery

[godeep]

Good afternoon, veterans!

I filed my very first VA claim on 8/18/10 for five SC issues...four of which are AO presumptive, and the last two secondary to DMII. All but the IHD claim are in decision phase, and IHD remains in development, probably pending another C&P once a rater gets to my C-file. I've also filed for TDIU.

1. PTSD 2. IHD 3. DMII 4. PN 5. PAD

My question to the experts here concerns the lower extremities as a body system, and how the VA rates the various maladies. I had a left ilio femoral bypass in 2004 to relieve an aneurysm. My reading of the ECFR is that the issue is dealt with on a single extremity basis and that all but one of the various ratings are post-surgery. I have blockage of the right ilio femoral artery as well, and numerous occlusions in the popliteal region and below bilaterally that have not had surgical intervention. I have no claim in for 7111. My post surgical ABI on the left is 0.53, 0.56 on the non-surgical right. In your expert opinion, will the rater pick up on this without filing a claim, and if so, how would the right leg blockage be dealt with if at all? I do understand that my PN and PAD claims will be dealt with as bilaterals, but would the 7111 issue be separate from the PAD claim?

Thanks in advance for your comments!

[Berta]

PAD is NOT part of the IHD regs.

That could be linked to your DMII as well as the PN.

"In your expert opinion, will the rater pick up on this without filing a claim"

In my opinion after 20 years of VAOLA- my answer is No.

Then again if the C & P has a statement on it -my answer is maybe-

But then again- if you did not formally claim it- the rater 'as likely as not" will not 'pick up on' it at all.

Edited February 3, 2011 by Berta

[Berta]

to add- was the aneurysm directed due to either DMII diabetic cardiomyopathy or directly due to the Ischemic heart disease?

[godeep]

Thanks, Berta!

Yes, I'm aware that PAD is secondary to DMII, but it is a stand alone claim due to the iliofemoral bypass. My reading of the ECFR is that a bypass graft surgery rates 40% for my numbers. Does anyone here have experience with with 7114...Arteriosclerosis Obliterans? Again, my ABIs are 0.53 LT and 0.56 RT. The bypass was on the LT. What I'm really asking is whether the PAD will be rated simply as secondary to DMII with the typical 10%, or are the raters dialed in to post surgical conditions? And if not, would that be a means for a bona fide NOD?

7114 Arteriosclerosis obliterans:Ischemic limb pain at rest, and; either deep ischemic ulcers or ankle/brachial index of 0.4 or less100Claudication on walking less than 25 yards on a level grade at 2 miles per hour, and; either persistent coldness of the extremity or ankle/brachial index of 0.5 or less60Claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, and; trophic changes (thin skin, absence of hair, dystrophic nails) or ankle/brachial index of 0.7 or less40Claudication on walking more than 100 yards, and; diminished peripheral pulses or ankle/brachial index of 0.9 or less20Note (1): The ankle/brachial index is the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure. The normal index is 1.0 or greater.Note (2): Evaluate residuals of aortic and large arterial bypass surgery or arterial graft as arteriosclerosis obliterans.Note (3): These evaluations are for involvement of a single extremity. If more than one extremity is affected, evaluate each extremity separately and combine (under §4.25), using the bilateral factor (§4.26), if applicable.

[godeep]

to add- was the aneurysm directed due to either DMII diabetic cardiomyopathy or directly due to the Ischemic heart disease?

I think I misspoke on that, Berta. It's not really an aneurysm, but rather a blockage of the aortic iliofemoral artery. None of my doctors has stated on the record the nexus of the PAD causation. I do know that the preponderance of VA claims have PAD secondary to DMII. I was just curious if anyone here had seen a claim in for Arteriosclerosis Obliterans independent of a DMII diagnosis, and whether or not the VA raters or DRO's were sharp enough to recognize a PAD claim secondary to DMII with surgical intervention with a graft and how they might rate it.

Thanks again for your response.

[Berta]

Thanks for clarification-I hope others here chime in-

"and whether or not the VA raters or DRO's were sharp enough to recognize a PAD claim secondary to DMII with surgical intervention with a graft and how they might rate it."

I am repeating my past opinion to you-I have decades of VAOLA experience.

They aren't sharp enough.

I have only seen a handful of claims in over a decade where the VA actually identified and awarded SC for something the vet did not specifically claim.

Raters and DROs are not doctors and depend on the C & P report.

If something isn't specifically claimed it is highly unlikely the C & P doc will take note of it-and state enough in the C & P opinion that would cause the VA to rate something.

It could happen but I sure would not depend on VA to " recognize a PAD claim secondary to DMII" unless it was specifically claimed.