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.

[boomer2]

John

Thanks for the advice, I am seeing a private doc for it now and he has told me he will write an IMO if needed.

[Doc904]

You can't go into the militarty if your a diabetic period. So when you get out and become diabetic it's most likely do to weight gain while in the military or after the military or stress during the military. Anyone who was in the military prior to 1997 the limit for blood glucose was 160 if you were near that they would call you "Borderline". You can ask any doctor today there is no such thing as borderline, your either a diabetic or your not a diabetic. Sleep apnea also could have caused your diabetes, did anyone in the service ever tell you that you snored to much? Bingo that's your answer then. Good luck.

Doc904

[indyman]

Chuck 75, you made an excellent point. When I got my DX for DMII, my VA doctor was very hesitant to even entertain the idea that I may have DMII. He posponed, delayed, ordered more labs, and anything he could come up with to delay making the DMII diagnosis. My last time under him I showed an A1c of 6.3 and fasting sugar of 128. When I went to the newly appointed doctor, and having dropped the other one, she immediately put me on oral meds, and now my A1c is 5.7 to 5.9 and my fasting sugar is 115 or so. I test pretty often, really have to watch my diet, and cut back on the coffee. And, I lost some weight. My point is the VA doctors come up with anything they can to delay an SC condition. When the lower PN started I had a hard time getting my doctor to finally order an EMG and confirm my suspicions. And you have a longer battle when you attempt to convince the VA that something has worsened. I will give my present doctor some credit, she has learned a little more english and does communicate a little better.

[x020574]

I am guessing here that the issue for the denial was that the claim for DM II was filed after 1 year of discharged. And there wasn't a specific diagnosis of DM II in his SMR (there was an inferred DX but it was never stated in the SMR as DM II).

That being said, you could resend your highlighted documentation with the NOD and ask that it be considered a infered claim, since your FPGs readings were already in your service medical records and the rater just did not pick up on it. And you think the fact that they didn't see it was unreasonable because there were many oppurtunities for them to do so. The raters are supposed to assist vets with their claims... which is one reason why some vets get awarded for things they didn't claim, but the rater found additional evidence in there c-file, SMR, etc..

Anybody have any thoughts on the infered claim idea???

[Berta]

I agree!

I helped a vet get direct SC for diabetes by carefully reading his SMRs, had to blow some of them up, and I ad to do a lopt pf research and finally his diabetes doc gave him, a great IMO. Diabetes can be symptomatic in service in many ways besides glucose readings.

Also I studied DMII intently when my daughter ,calling m,e while she was still in Mil, kept saying dad had diabetes from the AO.

It took me months to really pick up on what she meant...I had already won FTCA and DIC under 1151 and really didnt want to deal with the VA again.

But I started to carefully reviewed his VA med recs and then I studied and studied on how DMII can affect heart,brain, etc etc...and I prepared a claim and asked Dr. Bash for an IMO as soon as the VA denied it, and sent him all info and my extensive lay analusis and dignosis.

I won the claim. DMII due to AO.It changed my DIC and all my ancillary benefits Radically!

My daughter , now OIF OEF veteran, was RIGHT!!!!!!

The VA will not rate it at all or give a percentage and diagnostic code.

They never diagnosed it and could have caught it and treated it years before he died . I proved that critical entries, glucose reading and blood chem reports regarding all sort of other stuff plus I proved his brain and heart ischemia were consistent with undiagnosed and untreated diabetes.

Dr. Bash concurred and did the IMO within days after getting my stuff.

My point is that although diabetes itself doesnt kill anyone, it's complications can be fatal.

The HB1AC test is a very good indicator of diabetes ,robably ,uch better than a regular GTT but I hope the VA gets those HB1AC machines calibrated properly.

When I was researching DMII years ago for my DMII death claim, I read a startling article as to how many HB1AC test machines ,or whatever they are called, need maintenance which needs to be updated for calibration.It regarding HB1AC stuff in general, used in hospitals and not specifically the VA but that info sure concerned me.

As Pete said in this older thread:

"Although I am already 100% and don't really need to pursue this I am still very interested and fell that VA has mis diagnosed many Veterans who have had the same problems."

I would sure place money on that one Pete.

Old thread but Great and important discussion.

• A fasting blood glucose test. This test is performed after you have fasted (no food or liquids other than water) for eight hours. A normal fasting blood glucose level is less than 100 mg/dl. A diagnosis of diabetes is made if your blood glucose reading is 126 mg/dl or higher after two consecutive blood tests. (In 1997, the American Diabetes Association lowered the level at which diabetes is diagnosed to 126 mg/dl from 140 mg/dl.)
  

• A "random" blood glucose test taken at any time. A normal blood glucose range is in the low to mid 100s. A diagnosis of diabetes is made if your blood glucose reading is 200 mg/dl or higher and you have symptoms of disease such as fatigue, excessive urination, excessive thirst or unplanned weight loss.

• Another test called the oral glucose tolerance test may be performed instead. For this test, you will be asked, after fasting overnight, to drink a sugar-water solution. Your blood glucose levels will then be tested over several hours. In a person without diabetes, glucose levels rise and then fall quickly after drinking the solution. In a person with diabetes, blood glucose levels rise higher than normal and do not fall as quickly. A normal blood glucose reading two hours after drinking the solution is less than 140 mg/dl, and all readings between zero to two hours are less than 200 mg/dl. Diabetes is diagnosed if your blood glucose levels are 200 mg/dl or higher.

Source Virginia Mason Medical Center