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Nod (Dro Hearing Request)



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I have requested a de novo DRO appeal, and received the USPS receipt that they have the NOD letter. I sent it to them and my VSO and to SSDI (I have since been awarded SSDI) April 12th. It has not shown up at eBenefits as an appeal, however. Here is a redacted copy of my NOD:

Department of Veteran Affairs

Regional Office

Oakland Federal Building

1301 Clay Street Room 1300 North

Oakland, CA 94612-5209

Dear Madame or Sirs:

This letter serves as a Notice ofDisagreement and a request for a de novo DRO review of my C-file #XXXX. I have three issues that I'd like to have reviewed:

  1. Peripheral Artery Disease (secondary to DMII) (Arteriosclerosis Obliterans)
  2. Ischemic Heart Disease
  3. Peripheral Neuropathy

The raters' decision on the PAD was inerror, I believe. The rater disregarded the ABI numbers entirely itwould seem, and stated that I claimed that I could walk 100-150before claudicating. That is simply not true and never was the case,and if I wrote that in any of the information that I contributed tomy claim, I was in error. I wrote in my claim cover letter (attached)that I couldn't walk beyond 50 yards before claudicating. Thatremains the case today, and that is supported by the VA-conducted ABIreadings of 0.5 bilaterally done in 2010. Title 38 of the ElectronicCode of Federal Regulations under section 7114 rates 0.5 ABIs asfollows:

Claudicationon walking less than 25 yards on a level grade at 2 miles per hour,and; either persistent coldness of the extremity or ankle/brachialindex of 0.5 or less

I meet the lasttwo criteria for a rating of 60%, and with bilaterals, it would be80%. This is important because it takes me from 86.56% = 90%currently to 95.52% = 100% Schedular in and of itself without theconsideration of items 2 and 3. This condition is by far my mostserious medical deficiency. I have extreme limitations in standing orwalking, and was forced to quit my dream job as a golf professionalbecause of it. I haven't played golf since mid December of 2010 dueto the PAD and neuropathy. Having had an ilio-femoral bypass with aDacron graft is indicative of how serious this is. That surgery mostlikely delayed a potential limb loss according to my vascularsurgeon, Dr. Peter Schubart.

At my C&Pexamination, Dr. Levin rated my IHD at 3 to 5 METs. I have 100%blockage of the LAD, and every EKG that I take notes a MyocardialInfarction, Undetermined Age. I was rated at 30% for IHD based uponthe estimated METs of >5 and an arbitrarily arrived at ejectionfraction of 59% by Dr. Sandeep Guntur at the VARO. The Title 38 ECFRunder section 7005 states that:

Morethan one episode of acute congestive heart failure in the past year,or; workload of greater than 3 METs but not greater than 5 METsresults in dyspnea, fatigue, angina, dizziness, or syncope, or; leftventricular dysfunction with an ejection fraction of 30 to 50 percent

I have since had aheart study echocardiogram prior to undergoing a recent surgicalprocedure to remove a benign schwannoma tumor at the base of mytongue. This was performed at the VA and was conducted by inducingmedicine to increase my heart rate, since I can't perform a stresstest due to my PAD claudication. These numbers would be available toyou via the VA internal website.

(LVEF 40%)

Lastly, there wasno consideration given to the bilateral peripheral neuropathy that Ihave in my hands. I mentioned this to my VA general practitioner, Dr.Albert Liang, and he thought it might be carpal tunnel. He did a testfor Carpal tunnel that proved negative, and I recall him putting thatin my progress notes. The condition exists to this day. I have hadbilateral ulnar nerve transposition surgeries to try to alleviate theneuropathy with only moderate success. I provided proof of thesesurgeries along with a neurological electrical study done pre-op tothe most recent of the surgeries, but it doesn't appear that therater considered any of it.

In closing, Iwould first like to commend the Oakland VARO and my rater for asurprisingly efficient and timely adjudication of my case. Iunderstand fully the enormous pressures that you are under with theNehmer class cases and the new Agent Orange presumptives, not tomention the returning OIF/OEF veterans' claims. This veteran wouldlike to offer all of you a snappy hand salute for your efforts thatare thankless and invisible to most. Please don't construe this NODas anything other than an attempt to get this case done within theVA's own published criteria. I'd hate for you to think that I wasnitpicking your efforts in any way at all. I considered letting thisgo since you approved the TDIU P&T, and that I'm beingcompensated at 100%, but I do believe this case deserves another lookbased on the VA's own numbers set forth above in this letter.

Thank you so muchfor all you do for veterans!!



cc DouglasNelson-VSO

County of SantaClara Veterans Service Office

68 NorthWinchester Boulevard

Santa Clara, CA95050-6701

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