tdiu Bva Decision

[bm6546]

After 3 years at the BVA, I finally received an answer back. The BVA has remanded it back to my RO. The BVA wants the RO to determine if I am eligible for TDIU. I have been disabled since Jan 06 due to my heart attack. I am SC at 0%. I don’t understand this.

The BVA also wants me to have another stress test for my heart. Of course, they also say “under no circumstances should the health of the veteran be placed at peril to perform a test.” Six years ago the VA cardiologist prescribed medication to help control my heart problems. Do they want me to stop taking my medication so my heart problems will re-occur so I can fail the stress test. I don’t understand this at all.

The BVA is asking the RO to make a decision as to whether my Supraventicular Arrhythmia best characterizes the veteran’s service connected disability, and to address all manifestations of the veteran’s service connected heart disorder. (I had a heart attack in Jan 06). They are trying to determine whether the 2 heart conditions are related.

They also want to schedule me for a VA examination to evaluate my ability to secure gainful employment. (I am 65 years old). I haven’t been able to work for almost 6 years.

Not sure where to go with my claim.

[broncovet]

Right now, the "ball is in the RO court" and you simply need to wait until they hit it back, that is, with either C and P exams or a decision. As the BVA stated, you dont have to attend a C and P exam that could compromise your health. Dont stop taking your prescribed meds to fail any tests.

Let the remand run its course.

[Berta]

In Dec 2008 you posted:

“The VA paid me 10% back in 1966 for 1 year and stopped payment and said that I didn't need it anymore. Whatever that means. How would I find out if it was severed for reasons that violate VA rules. “

I believe that was for the Paroxysmal Atrial Tachycardia .

Did you appeal the reduction?

Also:

“After almost 3 years and 2 denials from the VA, I thought I had the answer from my private cardiologist. I had an appt with him approx 1 month ago and after listening to me and reading all my notes he indicated that he wanted to help me with a letter to the VA that would help me with my claim. Well he sent a letter to my VSO lady and basically said that I have 2 different heart conditions and that they are not related and that is why the VA has denied my claims. I was stunned and my VSO lady was also upset and couldn't believe it. I don't know which way to go now. “

This is not an adequate IMO for VA claims purposes. Years ago I posted the criteria for IMOs here at hadit and it is still available under a search.

This doctor is saying these heart conditions are not related and that is quite possible.

However perhaps the SC condition is aggravating the NSC condition now to the point that the SC condition is now at a ratable level.

It is possible a C & P could agree with what your private cardiologist said.

Can you get an IMO that could possibly look into the “aggravation” factor? Or possibly find an association medically between the past condition and the major heart condition you have now?

Maybe the same private doctor (with a print out of what an IMO should contain, would prepare something that might help ypou attain a rating higher than "0".

Within 38 CFR 3.310 (a) an "Increase in nonservice connected disability caused by aggravation from a service connected disability will also be service connected."

(Allen V Brown ,7 Vet App,4391995)

If you get SSDI solely for the main heart problem and VA finds it is due to your service (the main heart condition) than they will consider you for TDIU.

I assume they either have the letter the Private cardio sent to your VSO or have the same conclusions in your med recs.

What does the private doctor attribute your present heart disease to as to the cause of the heart attack you had?

Aside from your other "0" SC heart problems, do you have a valid nexus to your service for your present disabling heart?

condition?

I believe that a claimant on remand should try to do what the remand wants the VA to do.

In my case BVA remanded for a Cardio Opinion. I got a PA opinion.

But I had ordered a cardio opinion myself.

I mentioned before that the award came before the cardio doc had chance to write his opinion and was based on all the evidence the BVA already had.

I lost some money and could only get a partial refund on the cardio IMO fee ($1,750)because I called them as soon as I got the award to put it on hold.

But I sure was not going to allow the BVA to get some PA to do a cardio opinion when the remand called for a cardio.

I argued the PA C & P as soon as I got copy of it and sent it to the cardio IMO doc but the BVA disregarded it completely.

I hope the VA doesnt use the med recs and above statement from your private cardio doctor to deny the claim again.

[bm6546]

In Dec 2008 you posted:

“The VA paid me 10% back in 1966 for 1 year and stopped payment and said that I didn't need it anymore. Whatever that means. How would I find out if it was severed for reasons that violate VA rules. “

I believe that was for the Paroxysmal Atrial Tachycardia .

Did you appeal the reduction?

Also:

“After almost 3 years and 2 denials from the VA, I thought I had the answer from my private cardiologist. I had an appt with him approx 1 month ago and after listening to me and reading all my notes he indicated that he wanted to help me with a letter to the VA that would help me with my claim. Well he sent a letter to my VSO lady and basically said that I have 2 different heart conditions and that they are not related and that is why the VA has denied my claims. I was stunned and my VSO lady was also upset and couldn't believe it. I don't know which way to go now. “

This is not an adequate IMO for VA claims purposes. Years ago I posted the criteria for IMOs here at hadit and it is still available under a search.

This doctor is saying these heart conditions are not related and that is quite possible.

However perhaps the SC condition is aggravating the NSC condition now to the point that the SC condition is now at a ratable level.

It is possible a C & P could agree with what your private cardiologist said.

Can you get an IMO that could possibly look into the “aggravation” factor? Or possibly find an association medically between the past condition and the major heart condition you have now?

Maybe the same private doctor (with a print out of what an IMO should contain, would prepare something that might help ypou attain a rating higher than "0".

Within 38 CFR 3.310 (a) an "Increase in nonservice connected disability caused by aggravation from a service connected disability will also be service connected."

(Allen V Brown ,7 Vet App,4391995)

If you get SSDI solely for the main heart problem and VA finds it is due to your service (the main heart condition) than they will consider you for TDIU.

I assume they either have the letter the Private cardio sent to your VSO or have the same conclusions in your med recs.

What does the private doctor attribute your present heart disease to as to the cause of the heart attack you had?

Aside from your other "0" SC heart problems, do you have a valid nexus to your service for your present disabling heart?

condition?

I believe that a claimant on remand should try to do what the remand wants the VA to do.

In my case BVA remanded for a Cardio Opinion. I got a PA opinion.

But I had ordered a cardio opinion myself.

I mentioned before that the award came before the cardio doc had chance to write his opinion and was based on all the evidence the BVA already had.

I lost some money and could only get a partial refund on the cardio IMO fee ($1,750)because I called them as soon as I got the award to put it on hold.

But I sure was not going to allow the BVA to get some PA to do a cardio opinion when the remand called for a cardio.

I argued the PA C & P as soon as I got copy of it and sent it to the cardio IMO doc but the BVA disregarded it completely.

I hope the VA doesnt use the med recs and above statement from your private cardio doctor to deny the claim again.

Berta, You are right, they diagnosed me in 1966 with PAT (Paroxysmal Atrial Tachycardia). Now they have changed it to read "Supraventicular Arrhythmias" or "Paroxysmal Atrial Fibrillation". Now I'm not sure what it is that I have.

After they reduced my 10% down to 0%, I did not appeal the reduction at that time. After my MI in 2006 I did file a claim to increase my rating. It was denied twice.

I have had 2 C&P exams by the same Nurse Practitioner. She stated both times that my PAT was ok and was not due an increase in rating.

The Social Security has diagnosed me with:

1. Primary Diagnosis - Anxiety Disorders

2. Secondary Diagnosis - Chronic Ischemic Heart Disease with or w/o Angina

My VSO did not submit the letter to the VA from my private Cardiologist which states that my 2 heart conditions are not related. I do not know what my Cardiologist attributed the reason for my MI.

I am not sure what you mean by "do you have a valid nexus to your service for your present disabling heart condition".

As far as the TDIU is concerned. I am not sure how that will work for me. I am SC 0%. Don't you have to be somewhere around 60% or 70% SC in order to qualify for TDIU? Not sure how that would benefit me. In my remand from the the BVA, they mention TDIU several times. Its almost like they want me to file a claim for TDIU.

[bm6546]

Right now, the "ball is in the RO court" and you simply need to wait until they hit it back, that is, with either C and P exams or a decision. As the BVA stated, you dont have to attend a C and P exam that could compromise your health. Dont stop taking your prescribed meds to fail any tests.

Let the remand run its course.

It almost seems like I am going back to the end of the line with the RO. Does this mean that I have to wait another 3 to 5 years before I get some kind of answer back from them?

I am sure that the next C&P that they order for me will be with the same Nurse Practioner that I have seen twice already. If they want me to do a stress test I am pretty sure I will not be able to complete it. I get very short of breath just walking to the office. And I do not intend to stop taking any of my medication for any reason.

Thanks for your input.

[john999]

The true criteria for TDIU is that you not be able to work due solely to your SC condition/conditions.

[Berta]

John is right.

"As far as the TDIU is concerned. I am not sure how that will work for me. I am SC 0%. Don't you have to be somewhere around 60% or 70% SC in order to qualify for TDIU? Not sure how that would benefit me. In my remand from the the BVA, they mention TDIU several times. Its almost like they want me to file a claim for TDIU. "

The BVA is ,in my opinion without seeing the remand,insuring that if,in fact your heart condition is service connected by the RO, that they will then consider you for TDIU.

This is what I stated in the prior post I made:

"If you get SSDI solely for the main heart problem and VA finds it is due to your service (the main heart condition) than they will consider you for TDIU."

However you get it for both anxiety and heart problems so that will not help a TDIU claim.

"The Social Security has diagnosed me with:

1. Primary Diagnosis - Anxiety Disorders

2. Secondary Diagnosis - Chronic Ischemic Heart Disease with or w/o Angina

My VSO did not submit the letter to the VA from my private Cardiologist which states that my 2 heart conditions are not related. I do not know what my Cardiologist attributed the reason for my MI.

I am not sure what you mean by "do you have a valid nexus to your service for your present disabling heart condition".

What I meant was could your present heart condition possibly have a nexus to your service aside from the PAT.

But by now I am sure you would have fOund anything like that in your SMRs.

I am assuming you are not an incountry Vietnam veteran not exposed to Agent Orange elsewhere for a presumptive SC award.

Is the anxiety at all related to your service?

If so have you ever pursued that type of claim?

"Supraventicular Arrhythmias" This is different from the PAT diagnosis.

Do you still have this condition?

It is very possible that this condition (apparently diagnosed as PAT incorrectly before by VA?) would have the nexus you need to your current ischemic heart disease.

Have you ever used a Holter Monitor?

When was your last EKG and did that EKG or any other medical test reveal evidence of

Supraventicular Arrhythmias?

Are you able to get an Independent Medical Opinion from a different cardiologist?

Have you fully read over your med recs (VA and private records) to see if the PAT (which BVA has recharacterized) has any documented nexus or link to your ischemic heart disease?

You would need to explain to the IMO doctor exactly what you are seeking-

a clear diagnosis based on your SMRs and med recs of all of your heart related conditions and you seek to establish a nexus between the prior SC and the present IHD.

The full IMO criteria is here in our IMO forum.

One question- what was the Reasons and Bases for the VA to reduce the original PAT SC rating?

Can you scan and post that info here from the decision?

Also can you tell us what diagnostic code they used then for the PAT?

I really dont like to recommend IMOs because I know how expensive they can be.

IMOs bring no miracles and sometimes will not help a claim at all.

I had an IMO doc briefly assess my past claim via email.(Dr Bash)

I briefly told him what benefit I sought and a short list of what evidence I had.

His email reply was 'if you have that evidence, this is a good case.'

Then I sent him the money for the IMO and the records and evidence etc.

Perhaps an IMO doctor could assess your chances for a nexus via email before you would have to pay a fee.