diabetes My Diabetes Claim Was Denied With No C&p Exam

[brentakar]

I come to Hadit for advise since I am fairly new here and try and obtain some great advise with fellow Veterans.I was rated 50% service connected when I retired. I just filed my first claims since I have been out of the military. I claimed an increase in my HBP from 0% service connected to 10% service connected.I was awarded 10% for this. I retired in 2005 and was diagnosed 2 years ago with Diabetes 2. I was diagnosed through the VA Hospital here in Florida, and no, they did not mention why they thought why I have Diabetes 2. I kept 2 full packet copies of my medical records before I retired from the military. Once I was diagnosed with Diabetes 2 at the VA hospital, I took my records while on active duty to the diabetic clinic at the VA and had the nurse who gave the 4 hour orientation on Diabetes look at my records to see if I had any high blood sugar numbers. The nurse had highlighted about 10 different dates while on active duty and suggested I file a claim. Claim was denied and on top of that, NO questions or exam during my C&P.I made copies of my sugar readings that were highlighted from the Diabetic clinic, and submitted them with my claim. A physician conducted my C&P exam and only questioned my High blood pressure>Please advise.After I found out my rating for my HBP, I called the VA and requested a copy of my C-File like you had mentioned earlier right after I joined HadIt.com. I need some advise on what steps I need to take.Do I file a NOD now or wait till I get my C-file in the mail.I am going to the Diabetic clinic Tuesday to talk to a Diabetic nurse to go over my blood sugar readings again to verify they were high and then I need to request a nother C&P i assume.Please advise. Thank you again.

[carlie]

Did you have a specific claim for Diabetes ?

Was a claim for Diabetes considered by VBA in this last rating decision ?

Was Diabetes denied ?

If yes, What does it state in the Reasons and Bases Section regarding Diabetes ?

[brentakar]

Good afternoon carlie,

I filed 2 claims in Nov 2011, one claim was new for Diabetes 2,the other was for an increase for my HPB was approved from 0% to 10%.I was diagnosed 2 years ago through the VA Hospital that I have DIabetes 2. I kept copies of my military records while I was on active duty and I had a nuse from the diabetic clic review them .She went through my records and highlighted approximently 10 dofferent dates throughout my army career that my sugar count was high.The diabetic nurse advised me that I should file a claim for Diabetes with the VA.I asked her and my Doctor from the VA if they could provided a letter on my behalf connecting my High sugar readings, HBP, and cholesterol all together saying this was connected.The nurse said no one from the VA can or will do that. During my C&P exam I was scheduled for and attended in Nov 2011, the only thing the physician asked me was about my HBP.I wore my Diabetic shoes and socks to the exam that I was issued from the VA , and was not asked one question about my Diabetes.My Diabetes was denied saying it didi not occur while on active duty and I did not file qwithin one year of getting out if the military.Well carlie let me tell you this, I was and am irate to say the least.I included my high sugar readings that the Diabetic nurse highlighted while I was on active duty and submitted them with my claim.So I need help here.After I received my claim notice, I called the VA and requested a copy of my C-file, which I learned through this web site.I am waiting on my C-file from the VA, do not know how long that will take and trying to figure out how to approach this disagreement on my denial for Diabetes.I am going to the Diabetic clinic next week to sit down with one of the nurses or doctors there and verify my high sugar readings once again before I file a disagreement.Thank you for your help.

[john999]

What were your fasting glucose levels? There are levels that are considered high and then there are levels that are considered DX for DMII. If you have fasting glucose of 120 that is high, and probably means you will get DMII. If you have glucose of 200 that is diabetes if you get that kind of level more than once or twice. Is there anything in your SMR's that says pre-diabetic or "at risk for diabetes"?

[carlie]

I filed 2 claims in Nov 2011, one claim was new for Diabetes 2,the other was for an increase for my HPB was approved from 0% to 10%.

I was diagnosed 2 years ago through the VA Hospital that I have DIabetes 2. I kept copies of my military records while I was on active duty and I had a nuse from the diabetic clic review them .

She went through my records and highlighted approximently 10 dofferent dates throughout my army career that my sugar count was high.The diabetic nurse advised me that I should file a claim for Diabetes with the VA.

Did you submit these SMR's to the VARO along with your claim for Diabetes ?

If no - did you point these out to the VARO ?

I asked her and my Doctor from the VA if they could provided a letter on my behalf connecting my High sugar readings, HBP, and cholesterol all together saying this was connected.The nurse said no one from the VA can or will do that.

During my C&P exam I was scheduled for and attended in Nov 2011, the only thing the physician asked me was about my HBP.I wore my Diabetic shoes and socks to the exam that I was issued from the VA , and was not asked one question about my Diabetes.

Have you gone to ROI at your VAMC and requested a copy of this C&P exam ?

If yes - does it state what the exam is for and does it state ANYTHING in relationship to Diabetes ?

My Diabetes was denied saying it didi not occur while on active duty and I did not file qwithin one year of getting out if the military.

Does the denial mention any of the evidence shown in the SMR's or VAMC ?

Does the evidence section mention anything about the SMR's ?

Well carlie let me tell you this, I was and am irate to say the least.I included my high sugar readings that the Diabetic nurse highlighted while I was on active duty and submitted them with my claim.

So I need help here.After I received my claim notice, I called the VA and requested a copy of my C-file, which I learned through this web site.I am waiting on my C-file from the VA, do not know how long that will take and trying to figure out how to approach this disagreement on my denial for Diabetes.

I am going to the Diabetic clinic next week to sit down with one of the nurses or doctors there and verify my high sugar readings once again before I file a disagreement.Thank you for your help.

I would ask the clinic for them to put info about this into my progress notes and any possible

relationship to what is shown in my SMR's and if the doc feels these are related.

Here's a link that supports they can and should do this due to your requesting them to do so.

Remember you have up to one year to NOD their denial - so there is time to get all of your little

duckies line up : -)

JMHO - carlie

[brentakar]

Thank you for replying back carlie,

yes, I did submit a copy of my lab results while I was on active duty to the American Legion Rep when he filed my claim that showed I had high sugar readings while on active duty. I also had him read the reading then he faxed everything over to the VA. yes, I did go the the ROI the same day I had my C&P exam, and they were mailed out and recived 2 weeks ago.There is no mention what so ever about Diabetes period. I know I submitted a new claim and is on E-benefits as a (new) claim for

Diabetes. As mentioned earlier, there was not one single question ref: Diabetes during my C&P exam. I felt something wrong as I was leaving the C&P exam about this but waitied till I saw the rating as was suggested to me by others. I did not see anything talking about evidence on the letter period You mentioned that I should ask the clinic to put information about this situation and progress notes as well as to any possible relationship to what is shown in my SMR records. I remenber like it was yesterday when I first learned I had Diabetes 2, I was stunned and in shock. I was very active person in the army and always states in shape.I distinkly asking the doctor if he could write a letter on my behalf he said he could not.I told him I do not understand why since I been going to the VA and it occured there and he was my doctor.Th e doctor asked me to talk to the diabetic clinic and she referred me back to my VA doctor who said again, he could not provided me with a letter. I will do what you suggest, what happens if I get the run around again and the clinic says they cannot or will not do any of the things you suggested? What is my recourse if any.Please reply back.

I

[carlie]

Thank you for replying back carlie,

yes, I did submit a copy of my lab results while I was on active duty to the American Legion Rep when he filed my claim that showed I had high sugar readings while on active duty. I also had him read the reading then he faxed everything over to the VA. yes, I did go the the ROI the same day I had my C&P exam, and they were mailed out and recived 2 weeks ago.There is no mention what so ever about Diabetes period. I know I submitted a new claim and is on E-benefits as a (new) claim for

Diabetes. As mentioned earlier, there was not one single question ref: Diabetes during my C&P exam. I felt something wrong as I was leaving the C&P exam about this but waitied till I saw the rating as was suggested to me by others. I did not see anything talking about evidence on the letter period

On your copy of the C&P exam - up at the top - what does it say the examination is for ?

If they denied Diabetes - then obviously a claim for Diabetes had been filed or at the very least inferred.

Does the evidence section of the denial show SMR's and if yes - is this broken down any ?

You mentioned that I should ask the clinic to put information about this situation and progress notes as well as to any possible relationship to what is shown in my SMR records. I remenber like it was yesterday when I first learned I had Diabetes 2, I was stunned and in shock. I was very active person in the army and always states in shape.I distinkly asking the doctor if he could write a letter on my behalf he said he could not.I told him I do not understand why since I been going to the VA and it occured there and he was my doctor.Th e doctor asked me to talk to the diabetic clinic and she referred me back to my VA doctor who said again, he could not provided me with a letter. I will do what you suggest, what happens if I get the run around again and the clinic says they cannot or will not do any of the things you suggested? What is my recourse if any.Please reply back.

The link I posted certainly supports that both your VA doc and the Diabetic Clinic can are and supposed to

at least -

"the clinician, if requested by the veteran, must place a descriptive statement in the veteran’s medical record regarding

the current status of the veteran’s existing medical condition, disease, or injury, including prognosis and degree of function.

This may then be requested by VBA for the purposes of making a claim determination."

Now if they won't bother to help you out by reviewing your SMR's and writing something in your progress notes

stating in their opinion your current Diabetes had it's initial onset during active duty as shown in SMR's dated

XX/XX/XXXX, XX/XX/XXXX, etc. . . - then I would go to a private doc for an IMO/IME to support this contention.

You might want to have a little meeting with your AL rep.

JMHO - carlie