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.

[JT24usn]

You might want to check your strs from service and look at you hga1c readings. This is a more accurate glucose reading. It is an average of three MOS rather than a snapshot glucose reading. If the hga1c was high then it was a steady high. I the other way. I am arguing that mine was too low. They said it was normal readings, but my hga1c has been around 3.7 which is well below thelow avg of 4.2. If you were diagnosed within a year of separation you may even be able to argue 3.309(a). Chronic disease. Jmho. Good luck

[john999]

T8r

If the vet had a hga1c of at least 6.5 that would indicate a DX of diabetes. The military and VA often will put off a DX of DMII until you hit that magic number of 126 fasting glucose or the 6.5 for hga1c. You could have readings just a point below those magic numbers and they will say pre-diabetes. I think this is arbitrary and really makes no sense except for those who have to compensate vets. Do doctor regulary ask for hga1c unless they suspect DMII? A high fasting glucose reading would indicate possible DMII and the hga1c would confirm it. Then there is the test where you drink or eat a meal and they take before and after blood after 2 hours, but they usually have to suspect DMII.

[JT24usn]

Isn't the hga1c part of standard labs? Inknow it is in every one of my lab requests from the Va. The pre diabetes is the kicker I was just thinking if the rater knew what they were doing and using the more liberalized examination requirements would five an exam and leave it to a doctor

[brentakar]

Hello carlie,

up at the top the only thing it says is Hypertension. Only thing I see on the evidence section is SM filed past one year after he got out of the army, diabetes claim denied. I will try and talk to the doctor or nurse and explain the situation.carlie, I am a fighter like you are, I do not give up easily.If I honestly felt that this was not a possiblity of being service connected , beleive me I would not have ever filed a claim.I just feel I was not given an adequate exam or asked any questions about my Diabetes, I am still very surprised by this.I served in the army 20 years plus, I thought I knew what to expect but I suppose this is different with claims. If all else fails, should I still submit a NOD and explain the reason is that I was not given an C&P exam, or the evidence I provided was either overlooked or not considered? I wonder how long my C-file takes till I get a copy of that?I probibly should not file a NOD untill I receive my C-file is this correct or has no bearing either way?Please reply back.Thank you again for helping me out, I sure need it.

[myround0]

In most cases, you first response is going to be a denial. You have to re-read your info, and submit an NOD= Notice of Disagreement. After doing that, the process could take years, to include several visits to a regional medical center, to first, make sure you have the disorder you are claiming, and secondly to determine how sever the disorder is or may be. I have been waiting for four years, five calendar years, for a resolution. My case started with two denials, and now it has progressed to "a complex case that has to be sent to DC for review". So stay the course, however congrats on being 50%. And Thanks for your service...

[boomer2]

brentakar

Since you are retired you have tricare insurance I would suggest that you find you a private doc. that specializes in Diabetes and take all of your SMR's showing the high readings and ask him to write you an IMO. The VA is notorious for telling vets they don't have DM II when they are so borderline they probaly have it. I myself was told by the VA that I don't have it and my A1C is 6.2 and my blood sugar is 120. I am VN vet as well. John999 hit it dead on. Your A1C has to be above 6.5 and your blood sugar above 126 for them to rate you. Also, the VA does not like to do the glucose tolerance test, I think because it takes 2 hours and it will prove you have DM II. My doc says the A1C is the most reliable test. As Carlie says get all of your ducks lined up (dress right dress) and then hit them with a NOD.