Carlie, Could You Please Take A Look At This

[bm6546]

Carlie,

I would appreciate it if you would please look at this and tell me what you think. I know you deal a lot with claims that involve a CUE.

I would like your take on this.

Thanks in advance,

Brian

[Hoppy]

Wings,

Good job that was very interesting. I am still working on CUE involving several issuse. It is typed up for the most part. However, I wont' finish until Thursday. Tomorrow is a play day for me.

[bm6546]

Hoppy,

Watta ya mean, tomorrow is a play day. I thought you worked every day...LOL Just kidding!! You deserve a day off.

Thanks for all the help.

Brian

PS I got 2 responses from doctors and they want me to call them in the morning. Maybe things are starting to work for me after all. I will let you know what they say.

B

Wings,

Good job that was very interesting. I am still working on CUE involving several issuse. It is typed up for the most part. However, I wont' finish until Thursday. Tomorrow is a play day for me.

[Wings]

Hoppy, Play is hard work! When writing for the VA, remember that BVA Remand was sent to the AMC. Although the BVA has a higher rate of actually reading a claim, the AMC seems not to be the sharpest tacks in the barn. We all need to write in "plain language" for the VA. Think kindergarden LOL ~Wings

In reference to the BVA Remand (2-9), See page 2:

The Board notes that the Veteran filed a claim for heart disease in September 2006 subsequent to a myocardial infarction (MI) in January 2006. In February 2007, the Veteran raised the issue of an increased compensable rating for his service connected Paroxysmal Atrial Tachycardia (PAT). When a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled [no citation provided]. As such the Board has recharacterized the issue of entitlement to an increased compensable evaluation for PAT to entitlement to an increased compensable evaluation for a heart disorder, to include PAT. See Clemons v. Shinseki, 23 Vet. App. I (2009).

And page 3:

The Veteran currently receives a non-compensable rating for Paroxysmal Atrial Tachycardia (PAT) under 38 C.F.R. Sec. 4.104, DC 7010, which is a rating code for supraventricular arrhythmias. A second Diagnostic Code is also available for ventricular arrhythmias under 38 C.F.R. Sec. 4.104, DC 7011.

DRAFTING ...

FACTS

The veteran's "disease of the heart" was service-connected (yr. 1966) for Paroxysmal Atrial Tachycardia (PAT) under 38 CFR 4.104, then Diagnostic Code (DC) 7013. Direct service-connection (38 CFR 3.304) thus presumed fitness for military service, and voided any doubts about pre-existing heart disease. The veteran's heart disease has been service-connected for more than 20 years; thus having special protections under 38 CFR 3.951, 3.952.

DRAFTING ...

Regulatory changes amended the VA Schedule for Rating Disabilities, 38 C.F.R. Part 4 (1997), including the criteria for evaluating cardiovascular diseases, effective January 12, 1998. See 62 Fed. Reg. 65207 through 65224 (December 11, 1997). In the instant case, the veteran's service-connected PAT is protected if the amended regulation would result in a lower evaluation; however, if the new criteria provides for a higher evaluation, grant the entitlement effective the change in regulation. 38 USC 1155; 38 CFR 3.114(a).

Edited December 7, 2011 by Wings

[Wings]

It won't be necessary to scan the reports at this time. I will work on a position paper based on what I have. If I say something that contradicts medical evidence then maybe you can show me what the reports actually say. My main concern was the establishment of accelerated heart rate while in the military. Back then they were looking for an accelerated heart rate when making the diagnosis of PAT. There was no specified manner in which the heart rate was documented. Thus, any static, treadmill or any other test is sufficient. I was afraid they were trying to say you never had any evidence of a compensatable condition.

Just for your information I have assisted on several cases where veterans had heart rate problems in the early seventies. They were diagnosed with an"asthenic personality disorder" and discharged without benefits.There were numerous diagnoses of hyperventilation episodes and subjective complaints of accelerated heart rate in their SMR's. They were not given halter monitor tests to confirm the symptoms. When they were examined their heart rate was normal. The fact that your heart rate was accelerated when you were examined is probably what got you the PAT diagnosis. I was able to obtain a change of diagnosis from the 'asthenic personality disorder" to an anxiety disorder and the veterans were service connected. However, these cases incurred delays and were difficult. The VA raters and C&P examiners did everything they could to subvert the claims.

The presumption that heart rate symptoms were caused by a mental condition was allowable under the DSM II. Currently, when the heart rate symptoms are not caused by a perceivable threat to a person's well being or a known medical condition they are not presumed to be caused by a mental condition. The official position by qualified examiners is that there is no preferred etiology that explains the cause o fthese changes in heart rate. However, without proper treatment such changes are very capable of inducing anxiety and long term disabling anxiety disorders and agoraphobia.

The PAT and anxiety appears to be intertwined dating all the way back to the military. I will be working on the CUE and also the anxiety claim. I have a question on the anxiety claim. Have you sought a nexus opinion by a clinician who reviewed the SMR and post service treatment reports or are you waiting on a C&P exam?

Hoppy, I believe as you do, that the current Anxiety and PAT date back to active-duty. Obviously, since the PAT has been SC for 20+ years. A good clinician could see both diagnoses as inextricably intertwined.

Seems to me, the BVA's game (or wisom) in their remand is to ask the veteran to evidence symptomoly of heart disease (by whatever name) from both the SC PAT and the much later MI. Those symptoms can also be considered "intertwined". Even though the etiology may be different (same organ, different parts), the symptoms of PAT can esculate to mimic MI, and visa versa. I am also concerned that this veteran's service-connection had been rated under the same DC for more than 20 years; isn't the veteran protected under the old rating schedule? Thinking about the diifficulty and wisdom of heart testing under the current DC's vs the old DC. The BVA said as much, that if the testing proved too much stress for the veteran's health, it was not necessary.

My thoughts are the veteran should be reporting on symptoms of heart disease; just because the vet did not ask for a SC PAT increase until after his MI< does not mean that he was ineligible for an increased rating. Maybe he wasn't motivated to file a claim for an increase in PAT say 10 years ago, because of the injustice of the first reduction. Appreciate your input ;-) ~Wings

[Hoppy]

Wings,

"My thoughts are the veteran should

be reporting on symptoms of heart disease; just because the vet did not ask for

a SC PAT increase until after his MI< does not mean that he was ineligible

for an increased rating. Maybe he wasn't motivated to file a claim for an

increase in PAT say 10 years ago, because of the injustice of the first

reduction. Appreciate your input ;-) ~Wings"

I totally agree and I am working onthis. I did not finish today. I shouldbe done Saturday. Friday is a work onthe car day. It needs breaks.

"Seems to me, the BVA's game (orwisom) in their remand is to ask the veteran to evidence symptomoly of heart disease (by whatever name) from both the SC PAT and the much later MI."

My impression on this is that theanxiety claim was previously denied and requires new and materialevidence. Thus the remand did not evenaddress the anxiety claim.

[bm6546]

Hoppy, I believe as you do, that the current Anxiety and PAT date back to active-duty. Obviously, since the PAT has been SC for 20+ years. A good clinician could see both diagnoses as inextricably intertwined.

Seems to me, the BVA's game (or wisom) in their remand is to ask the veteran to evidence symptomoly of heart disease (by whatever name) from both the SC PAT and the much later MI. Those symptoms can also be considered "intertwined". Even though the etiology may be different (same organ, different parts), the symptoms of PAT can esculate to mimic MI, and visa versa. I am also concerned that this veteran's service-connection had been rated under the same DC for more than 20 years; isn't the veteran protected under the old rating schedule? Thinking about the diifficulty and wisdom of heart testing under the current DC's vs the old DC. The BVA said as much, that if the testing proved too much stress for the veteran's health, it was not necessary.

My thoughts are the veteran should be reporting on symptoms of heart disease; just because the vet did not ask for a SC PAT increase until after his MI< does not mean that he was ineligible for an increased rating. Maybe he wasn't motivated to file a claim for an increase in PAT say 10 years ago, because of the injustice of the first reduction. Appreciate your input ;-) ~Wings

"My thoughts are the veteran should be reporting on symptoms of heart disease; just because the vet did not ask for a SC PAT increase until after his MI< does not mean that he was ineligible for an increased rating. Maybe he wasn't motivated to file a claim for an increase in PAT say 10 years ago, because of the injustice of the first reduction. Appreciate your input ;-) ~Wings"

Wings...you are correct on this issue. I did apply to the VA twice following my discharge and was denied twice. I just figured it was a losing battle, at that time, and didn't pursue it any farther. I did not know how the system worked back then and didn't bother with it any more.

I am sure there are a lot of veterans out there that also were denied several times and just gave up. I have just recently (almost 6 years ago) realized that I do have the right to pursue something that I believe in and deserve my fair justice with the VA. I feel that I am starting to learn a little (emphasise on the word little) about how the VA operates, in thanks mostly to the great people here on Hadit.

I am going to continue my fight until I prevail.