hypertension Help With A Claim Upgrade Please!

[Navy ELT to EMT-P]

Hi all,

First of all I am so glad I found this forum. This call for help is for my wife's case, that I am helping with. Here is the background. She served from 1997-1999 in the navy active duty. While in boot she came down with mono. During 18 months of A school her symptoms persisted. She was seen dozens of times at sick call by corpsmen and each time had a pregnancy test and sent back to work. When she finally passed out at work and was taken to see an internal medicine doc, they found she was still positive for mono. In her report the doc stated that her current condition was caused by the poor care she received which was below the standard of care for any military or civilian health care. Nice huh? She was quickly found unfit for duty placed on TDRL to PDRL and got a VA rating. 20% sc CFS, and some ortho stuff that put her at 50 percent total.

Now 13 years later her symptoms have worsened, to where she cant work, is home bound 50 percent of the time and often is too exhausted to eat, shower or brush her hair. Before she got sicker she was a respected high school math teacher and this has been hard. Additionally she has been diagnosed with fibromialgia, depression secondary to CFS, her ortho has worsened requiring surgery in both shoulders, hypertension, sleep disturbances, hyperlipidemia. She has only seen civilian docs since leaving the service.

She submitted a claim to have her rating increased, she used the local Texas Vet commission VSO and they did a pretty crappy job. Specifically they only put her CFS, hypertension and one shoulder on her claim. Paperwork was lost, ext ect ect. Now it has been filed and she just got her C/P exam scheduled for June. So here are my questions:

1. VSO, we need help with the paperwork, she is to tired and forgetful because of her illness and I am working 60+ hours a week and taking care of 4 kids. Does anybody have a recommendation for a good advocate in the central texas area? We aren't very involved with the vet community. We have had a recommendation for the Jewish War Vets rep in Dallas and are willing to drive, but this recommendation was not based on knowing his record only because we are friends with the JWV Austin post commander. We will drive to Waco, Dallas, San Antonio for somebody that will do a good job.

2. Should she at this time add the additional claims? Fibro, the left shoulder? We have been waiting for 18 months and money is critical. We don't want to add them now if its going to push this all back another year.

3. Looking at the rating guide she really looks like a 60 or 100 percent for CFS, from what I'm saying what are your WAGs?

4. IMO, I think its worth it. Espically to nexus the depression and hypertension, the literature supports this. Who do you all like? Dr Bash, or is there anybody good in texas? What should this cost? Also should we do this before of after the C/P. Also if we don't add the additional claims should the IMO only cover whats on the current claim or everything so it can be used for the next claim as well?

I think thats it for now. Any other help you guys ave would be most appreaciated.

[Navy ELT to EMT-P]

I found the BDQs. My thoughts were to have her private MD fill these out as she is not very familiar with the verbage the VA needs and then to have a secondary IMO or IME (not sure yet) to tie it up in a bundle. What do you all think?

[Commander Bob]

I found the BDQs. My thoughts were to have her private MD fill these out as she is not very familiar with the verbage the VA needs and then to have a secondary IMO or IME (not sure yet) to tie it up in a bundle. What do you all think?

Do you have copies of her C-file, VAMC records, and her mliitary med. records?

JMHO, Without copies of her records, her private MD, or a secondary IMO report is worthless at the VA...

Best Wishes,

Cmdr.Bob

[Navy ELT to EMT-P]

Cmdr Bob thanks for the reply. We have her records. The point of the BDQ from her md was to explain the current level of symptoms (should be 100) as it is already sc at 40 percent. Would this not help?

[Berta]

Unfortunately I had assumed (like an
-ss) that her CFS was due to GW service as it is a presumptive
condition to those veterans. I am sorry I ran with that.

You have gotten excellent advise here.

It pays to try to build off any
secondarys to what she has already established as service connected
and /or identifying an inservice nexus to disabilities, that might be found in
her SMRs.

Also you stated in your initial post:

“20% sc CFS, and some ortho
stuff that put her at 50 percent total. “ and then you mentioned

“Additionally she has been
diagnosed with fibromialgia, depression secondary to CFS, “ the VA
needs to have the diagnoses on that with a full medical rationale. If
she has that from private doctors, there might be no need for a
lavish IMO, if they simply give their full medical rationale for
that, their expertise as to make their opinion valid, and an abstract
or 2 from a good medical source.

Also you stated: “her ortho has
worsened requiring surgery in both shoulders, “If the VA has Sced
her ortho problems as bilateral or if a doc can state the SC
shoulder has aggravated or excerbated the right NSC ? shoulder, then
the shoulder SC rating can be biult on.

Also she needs to consider the
temporary 100%convalescent ratings when this surgery is done, as it
involves what I assume is one SC shoulder as well as the other
shoulder.

Someone mentioned having private docs
fill out the DBQs...I forget if it was in this thread or yesterday
in another thread.

In the most recent SVR Radio show we
did with Dr Bash ,found here:

. http://www.hadit.com/svr.html

(just click on the icon to the left of
that show and it takes a few minutes or seconds to download and then
will pop up in your PC media player)

Dr. Bash and his 2 assistants went over
the problematic DBQs in detail during the show.

These DBQs really dont cover all of the
nuances of a proper opinion...maybe in some cut and dry cases they
do....but often they dont.

I sure suggest that you listen to that
show if you are considering using the blank DBQ forms for an IMO.

also:

"In her report the doc stated that her current condition was caused by
the poor care she received which was below the standard of care for any
military or civilian health care. Nice huh? She was quickly found
unfit for duty placed on TDRL to PDRL and got a VA rating. 20% sc CFS,
and some ortho stuff that put her at 50 percent total."

Due to the Feres Doctrine the military is not accountable for medical f--- ups.

I think when you find a good VSO, they might want to consider going over those initial VA ratings carefully.

In that decision the VA might have parsed or manipulated the actual doctor's report on how bad her care had been and the diagnostic codes on the rating sheet might have been wrong ,setting up basis or what we call a possible CUE (clear and unmistakable error) in that older decision.

It took the VA 16 years to actually rate and code one of my husband's AO disabilities and then properly alter via CUE, a rating decision made in 1998,posthumously, which was to my detriment as the surviving spouse, due to the wrong diagnostic codes.

As I Mentioned here before, I have 2 more issues pending before the VA, to make sure they get it right.

They got close but they are still wrong.

When the VA makes a DC error (diagnostic code error) on a rating sheet and they use the wrong DC code, or forget to even give the disability a DC, assuming the VA has full knowledge of the disability, in the established medical evidence, the VA has committed a CUE ,if that error meant VA saved cash that should have gone to the veteran as valid SC compensation.

The fact of SC for that specific disability could come way down the road and it might appear as NSC in a old rating sheet.

I can only give my personal example:

VA stated on a 1997 and 1998 rating sheet ,among other things:

My husand died in 1994 with aonlya 30% PTSD SC rating. I reopened 2 pending claims he had, one for higher PTSD rating and one for 1151 disabilities which he predicted in his claim, would cause his death if the VA didnt start to give him proper PTSD care.

My husband was rated posth8umously at 80% for severe extremity weakness coupled with residual cognitive problems due to a CVA (stroke)

He also had a posthumous 100% P & T rating for PTSD

And a few other things I have cued.

My point is that in those 1997 and 1998 rating decisions, his 1151 CVA was not assessed to be 100% when the medical and legal evidence (from FTCA case ) warranted that.

As a matter of fact the VA conveniently and completely disregarded this catastrophic CVA as caused by VA medical care.But they had the medical proof of that.

Last year the VA finally properly SCed the CVA under 1151 with a 100% rating but only paid me 100% 6 months retro and then they also paid me SMC S retro.

They completely overlooked significant legal and medical info in my C file ,some coming from VA Central itself and the former head of the VBA, that he was 100% P & T from the CVA until he died.

They owe me about 40 thou more for this error.

My long oint here is a repeat of this point I made many times oer the years at hadit.

Some of the old decisions we have received contain CUEs because there were legal errors on the rating sheets.,errors so detrimental that the VA saved cash.

Any VBM by NVLSP also contains a chapter on adjudication errors that VA makes. It think the chapter's focus is on BVA errors but many of them start right at the regional level.

A good Service officer or rep,in my opinion, will always look for 3 things,in addition to the basis and proven nexus of the claim:

1. does the claim possibly fall into any of the chronic presumptives, or any other presumptives such as AO etc, and

2. any potential CUEs in past decision and

3. any potential for 1151.

sorry for this long post ,so repetitive of stuff I have said here many times before.

We all must have our ducks in a row as soon as we file a claim or appeal a decision , and those ducks have to be well armed with evidence and the ducks better be willing to consider any tactic at all to succeed.

We are truly on a paper battlefield .

Edited March 3, 2013 by Berta