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.

[bm6546]

Gee-I am more organized than I thought! I just found my cover letter to the cardio doctor I mentioned:

“Health Information Search, Inc, April 13, 2009

1514 Potomac Drive

Houston, Tx. 77057-1928 Re: IMO for VA claim

Dear Dr Campos,”

I found this Company and Dr Campos under a search for Forensic Medical Opinions.

This is their email addy:

http://www.legalmed1.com/

C.W. Pete de Boisblanc might remember me if you tell him I referred you. He needs to be contacted via their email addy first so he can seek the best doctor he can find for the specific opinion needed.

I need to contact him myself again if the VA does not do my AO IHD claim right as to the level of accrued SMC.

I had an unusual claim and prepared an extensive cover letter regarding my enclosed evidence as well as the type opinion I needed.

Mr. Boisblanc actually called me up when he got my packet- and asked me if I was a lawyer or health care professional.

He said the cover letter was so well prepared, they usually dont see stuff like that much and I think they deal with many lawyers and doctors.

His comments to me caused me to really realize that the efforts that we put into these IMO requests are well worth the time and research.

It pays to tell the IMO doctor exactly what type of opinion you are seeking and then refer them to some specific med recs or documents that support your position.

But an IMO no matter what it costs, cannot produce a miracle.

On the other hand , if the medical evidence warrants a SC award,because of a full medical rationale stated by an IMO doctor, the IMO has been well worth the cost and the efforts to prepare the cover letter.

A Cover letter can be brief but it should highlight some specifics if possible.

An IMO doctor (unlike these VA C & P docs and the raters) will review everything!

Make sure they have copies of any past denials and SOCs, SSOCs, etc as well as copies of past C & P exam results.

Include any corroborating medical opinions as well.If the inservice nexus is questioned , they will need the complete SMRS too.

My cover letter to Dr. Campos was not brief and was almost 11 pages long but directed him to not only the enclsoed exhibits he needed but also to numerous medical abstracts, also to my 3 previous IMOs and also to my FTCA internal VA documents. I believe we claimants cannot leave a single stone unturned.

Berta,

Thanks for all the help you are providing.

I am pretty sure I am going to need an IMO, preferably from a Cardiologist. I am going to e-mail CW Pete de Boisblanc at legalmed1.com and see if he can find a Cardiologist that would be interested in writing an IMO for me.

Do you know of any other Cardiologists that I could contact for an IMO.

Thanks in advance,

Brian

[Berta]

"Do you know of any other Cardiologists that I could contact for an IMO."

These sites contain a few cardiologist who do IMEs ( meaning they might well want to examine you themselves before preparing an IMO:

http://www.imenet.com/specialties/cardiology-cardiovascular-disease

http://www.jurispro.com/category/cardiology-s-446/

Also it might pay to just get out your phone book and check with any local cardio docs to see if they would do an IMO and what they would charge.

Oddly enough in 2003 the first doctor I contacted was a local dentist.For a DMII AO claim.

My husband presented a dental situation that was one of the first manifestations of DMII due to AO.It was noted in his VA dental records.In the VA's diabetes training letter, they mention this condition as due to uncontrolled glucose spilling into the saliva.

But the dentist wrote back to me that,although he was familiar with the condition,and I had presented a good potential medical rationale, he did not have the expertise I needed to opine.

Still- it pays to try local doctors first-

Also once in a while the BVA (if you search for a similiar claim as yours) will state the name and/or initials of an IMO doctor-whose opinion resolved the claim favorably.

If you take the time to try to find this same doctor on the internet, you might find someone who not only would be familiar with a similiar claim but also has dealt with the VA before and knows how to prepare the IMO.Sometimes the RO city also is a clue to where the IMO doctor could be found.

It takes time but is worth it.Even former VA docs you had in the past might help if any of them could support your claim.

It took me 8 months to find a former VA Neuro doctor and I emailed him. He asked to see the records he had noted when he worked at the VA and the blood work as to glucose.

The copy I had, he could not read well as when VA printing it ,they managed to obliterate most of the blood work test symbols.

It took me 3 or 4 more months to get a better copy from VA.

He emailed me back a brief statement.Dr. Bash loved it and called him asking him to put the statement on his letterhead.

He did.

As brief as it was, the BVA gave it as much weight as everything else I had because the email statement corroborated all the other evidence and IMOs.

I was charged $1750 in 2010 for the IMO from Dr. Campos.They refunded part of that when I called Pete and told him I had won my claim prior to it being prepared.

I have no idea what they (Health Information Search) or any other IMO doc would charge you as these fees are based on many factors.

Edited November 17, 2011 by Berta

[bm6546]

Dr. Craig C Bash can be contacted through his web site:

http://www.veteransmedadvisor.com/

He recently did a SVR radio here at hadit that is in the SVR archives.

He is a NeuroRadiologist and although my claims involved heart disease, they also involved neurological conditions and he was able to prepare 2 separate IMOs for me.

IMOs are expensive. You might want to contact a cardiologist instead of a NeuroRadiologist but then again his IMOs ,in my case, regarded diabetes and heart disease as well as cerebral vascular disability.

He used Braunwald -(the top cardio text in the USA) as one of the references he gave.VA uses Harrison's for heart disease as to defining IHD but Braunwald contributed to Harrison'a texts.

I have Braunwald on Cardiology -it is so large and heavy I cannot scan anything from it.

But every cardio doc would have it or be able to access it via the net.I think non professionals cannot access the text on the net and this is why my daughter gave this to me for Christmas last year.I thought it would help with AO IHD claims but so far I only needed to refer to it once or twice.

By all means you can send an email to Dr. Bash.Briefly describe the type of IMO you need.

And also try a cardio doctor as well.

The IMO must outweigh anything any VA doctor comes up with.I hope others will chime in here because

Dr. Bash is a NeuroRAdiologist and not a Cardiologist.

Then again he opined successfully over a VA Endodrinologist for my diabetes claim.

I need to add-

I presented him a very compelling claim.

I have done my medical homework and knew my IMO fees would be absorbed by an eventual award.

I sent along with the Med recs, and numerous other documents,

my assessment of what really caused my husband's death.

In that assessment I referred to specific enclosures that I had highlighted.

I did this for a cardio IMO I didnt need.

If I can find who that doctor was I will let you know-it is in a file somewhere here.

I contacted him via a Forensic firm on the net.

His charge was cheaper than Dr. Bash's but specific only to the cardio disability.

You have to determine who would be the best person to opine on your claim based on their expertise.

They must meet the IMO criteria here in our IMO forum.

Dr. Bash, as a former VA doctor,knows that criteria in and out and is familiar with SOCs etc.

If I find time I will see what I can find in the Braunwald text-

but I have a question-

did you experience anything that profoundly stressed you out in the military that could have been the cause of the PAT?

With SSDI for both the heart condition and the anxiety- what did SSDI attribute as the nexus for the Anxiety?

also:

"did file a claim for anxiety and depression second to my PAT. The RO denied my claim on both."

Could an in service situation have caused the anxiety as well as the PAT?

Berta, You asked whether "Could an in service situation have caused the anxiety as well as the PAT?"

As I was going thru my service records, I came across 2 entries in my records that said...

" Paroxysmal Atrial Tachycardia secondary to anxiety"

And another entry that states......

" Imp: Sinus tachycardia

Etiol - Anxiety "

Not sure if this helps but thought I would bring it up.

Brian

[Berta]

If you have proof of a documented anxiety -producing situation inservice-that could be consider as service connectable- then if that is claimed and awarded , the PAT could also be claimed as secondary to that when you claim the anxiety.

"The Social Security has diagnosed me with:

1. Primary Diagnosis - Anxiety Disorders

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

As a primary diagnosis, the anxiety could possibly become a strong claim with PAT as secondary but anxiety in service could come from many non service connected reasons-such as a death at home,while serving.

PTSD is an anxiety disorder but PTSD vets can pinpoint often to the hour of the day, the first anxiety producing event they experienced in service as a stressor.

Then again PAT with no known etiology can also produce anxiety.

I hope you find a good IMO doctor who can assess your medical situation.

What you found in your SMRs is interesting but contains no apparent documentation for the cause of the anxiety.

Others will chime in here I am sure.

I worked with PTSD vets at a vet center,married a PTSD vet, and most of my friends are PTSD vets locally.

I regret I am not able to understand anxiety disorders other then PTSD very well without a specific inservice cause for the anxiety but others here can help with that.

Your prime focus however, is the pending claim for an association of the PAT to the IHD you now have.

The reduction of the PAT % might well have been a CUE.That could be claimed as CUE when you current claim is resolved.

You could mention these SMR notes to any opining doctor.They might agree with your past denied claim- that the PAT ,in fact, caused the anxiety.

Edited November 19, 2011 by Berta

[bm6546]

If you have proof of a documented anxiety -producing situation inservice-that could be consider as service connectable- then if that is claimed and awarded , the PAT could also be claimed as secondary to that when you claim the anxiety.

"The Social Security has diagnosed me with:

1. Primary Diagnosis - Anxiety Disorders

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

As a primary diagnosis, the anxiety could possibly become a strong claim with PAT as secondary but anxiety in service could come from many non service connected reasons-such as a death at home,while serving.

PTSD is an anxiety disorder but PTSD vets can pinpoint often to the hour of the day, the first anxiety producing event they experienced in service as a stressor.

Then again PAT with no known etiology can also produce anxiety.

I hope you find a good IMO doctor who can assess your medical situation.

What you found in your SMRs is interesting but contains no apparent documentation for the cause of the anxiety.

Others will chime in here I am sure.

I worked with PTSD vets at a vet center,married a PTSD vet, and most of my friends are PTSD vets locally.

I regret I am not able to understand anxiety disorders other then PTSD very well without a specific inservice cause for the anxiety but others here can help with that.

Your prime focus however, is the pending claim for an association of the PAT to the IHD you now have.

The reduction of the PAT % might well have been a CUE.That could be claimed as CUE when you current claim is resolved.

You could mention these SMR notes to any opining doctor.They might agree with your past denied claim- that the PAT ,in fact, caused the anxiety.

While I was in the service, I was in and out of sick bay many times with my PAT. I have copies of all the different times doctors examined me. The problem is, I can't read half the stuff they wrote or the paper work is either blurry or too light to read it.

After my heart attack in 2006, I was diagnosed with Anxiety and PTSD by the VA Social worker, psycholgists and psychiatrists. I was prescribed medication for my anxiety and PTSD.

Not sure if tis helps, but there it is.

Brian

[Philip Rogers]

Brian - are you a VN in-country vet? And if so, have you filed for IHD, yet?

pr