ptsd When Should New Evidence Be Submitted?

[handler]

I would like some advice and opinions on when I should submit some new evidence.

To fill you in a little, I submitted claims for IHD, PTSD, and other claims. Received my decision letter and was given a total rating of 60%. IHD 30%, PTSD 30% and a couple 10%. One claim deferred.

I also submitted the form 21-8940 for TDIU which was denied.

I have submitted a NOD (to the DRO) for the PTSD and IU issues and the process is now in the development stage. I did not submit a NOD for the IHD.

Recently I have obtained a great IMO from my cardiologist confirming that I am totally and permanently disable due to my IHD. I also have had some further medical problems and it will reinforce what the doc has written. (I should state at this point SSDI has deemed me permanent/total solely for IHD since 1990 but apparently the VA didn't agree)

My main question is when can/should I submit the new doctor evidence and supporting documents? Now, while the NOD is in the development stage or wait until I am sent the SOC.

Thanks for any advice

handler

[Berta]

Handler asked:

"And while I am bothering you with questions, is there a specific or suggested format for the Reconsideration letter? "

No bother at all- this is what we are here for.

I checked for the Reconsideration template that DAV appears to use and Rakkwarrior had posted here a few months ago and now I see he has deleted many of his posts.

Any service org probably would have a template for this type of request.

I did it this way:

I used the Attention to stuff and then typed in BOLD Caps RECONSIDERATION REQUEST

and then I stated that I wanted the VA to reconsider their decision of (Date) because they failed to acknowledge and consider probative evidence that was mailed to VA via USPS multiple times but has yet to be considered or acknowledged at all.

I then stated I was again enclosing this evidence and listed it.

(They did not act on this request and I filed a NOD in time. It is now under Nehmer))

In your case tell them of the SSA award that they listed but did not refer to at all in the decision narrative ,which is probative evidence of your unemployability due to service disability and then cite

Murincsak v. Derwinski, 2 Vet. App. 363, 366, 370 (1992) (stating that an SSA decision that the veteran is unemployable is relevant to his claim of entitlement to a total disability rating based on unemployability)

and then tell them you have enclosed additional probative evidence from Dr XXXXX dated XXXX that also supports your pending claim for TDIU.

Mail it with proof of mailing but it would be great to try to get a POA to support this and they might suggest wording it a different way.

You have new and material evidence from the doctor as well as evidence they have received but have not properly addressed.

I usually say here to cite Washington V Derwinski as this was the old COVA case that stated basically what Murincsak does-

and I won my first claim in 1997 using Washington as VA failed to address my husbands SSA records.

In those days I had to call COVA,give them Docket number if I had it, and promise them to send them a few bucks for each decision and then they wold fax the decision to me.I attached the entire WAshington V Derwinski decision to my response to an SOC along with some other medical stuff they had ignoredand a few months later that claim was awarded.

It is hard to find ANYTHING on Washington V Derwinski these days on the net but still is in my old VBMs.

[Chuck75]

Handler

"New York Heart Association functional class is III to IV. On the basis of the above, you are unable to work and permanently disabled."

Class 3 to 4 is too broad. The doctor should have been able to assign the class and a sub category in the class(more specific symptoms).

A quick internet look did not list the subclasses, as my states handicapped permit application does(or did a couple of years ago).

This is likely one of the reasons the VA used to arrive at the 30%.

In my state, class 3 at the higher sub categories is enough to qualify for a Handicapped tag.

It might be advantageous to get a physician to fill out a copy of VA form 21-0960A-1, and send it to the VA, along with an NOD as to the percentage.

30% for IHD is certainly possible, but, based upon your remarks, may be too low.

There are various tests, including a chemical stress test, that are fairly definitive, and may show more damage than the doctor's opinion.

While PAD, HBP, etc. is not part of IHD, it can be secondary, especially when diabetes is also present. The medical reasoning concerning high blood pressure (HBP) has to do with

the demands for blood flow needed to help sustain the heart. When medical records show blood pressure decreasing as a result of heart related medical intervention,

such as stints, bi-passes, balloon angioplasty, etc., A cardiologist can then opinion that the high blood pressure is related to IHD and CAD. A recent Nehmer decision

accepted the treating cardiologist's opinion relating HBP to CAD and IHD, overruling a C&P examiner's opinion of "essential" HBP.

Since the "essential" opinion translates to we don't know, or more literally, of itself, it does not refute the cardiologist's opinion.

In a way, the sad part is that IHD is a result, rather than a cause. The cause is thought to be a metabolic disorder, and is gaining more recognition as the culprit.

If the VA were to recognize metabolic disorders as related to A.O. a Pandora's Box would have it's lid torn off.

Extracted from the VA form 21-0960A-1 (for use by a Physician)

VA FORM MAY 2010

21-0960A-1

SECTION I - DIAGNOSIS

Note: IHD includes, but is not limited to, acute, sub-acute and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina. IHD does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of ischemic heart disease. IHD encompasses any atherosclerotic heart disease resulting in clinically significant ischemia or requiring coronary revascularization.

Edited May 2, 2011 by Chuck75

[handler]

Carlie, Berta and Chuck

Thanks so much for all your help and information.

I have all the information I need and will put it together and file soon. I sure appreciate all the effort everyone puts into this site.

I will be sure to post the results.

handler