How To File Additional Medical History

[Kray]

I was awarded 30% for CAD and Agent Orange/Vietnam in July 2012.In the last few months I have experienced three episodes of passing out, one Aug 31, 2012; one Feb 3, 2013; one Mar 11, 2013 when my heart stopped,blood pressure dropped, passed out and had to be transported to Hospital. On the second event a “Loop Recorder” was implanted and on Mar 11, 2013 when I passed out again the recorder indicated heart stoppage at more than one time period when I passed out. A Pace Maker was implanted on Mar 12, 2013

I need to report this to VA and am trying to figure out proper procedures. I feel I should get my Dr. to complete VA form 21-0960A-1 and Fax results to the VA. Is that the proper procedure to provide more information or must I appeal my previous award? Do I appeal or just provide additional medical history that occurs after the award? What form(s) do I need to use if not VA form 21-960A-1? Do I mail it to the local district office or upload to Fast Track or what?

Help; how should this be handled during the one year period after an award? Is there any chance that this opening of the claim for them to downgrade my award?

Thanking you in advance.

Ken

[jbasser]

Your rating is based on your Ejection fraction or Mets so dont worry about adversity. Get the results in asap as your issues may increase your rating depending on what has caused the need for the pacemaker.

J

[broncovet]

I agree with Basser. You want to file an increase, pronto. This can be done on a 21-4138. However, if there is evidence your condition was worse than actually rated, then you need to file a NOD disputing the percentage rate, and tell them why.

As Basser said, the ejection fraction is measured, and it is not something another rater would be able to say, "Oh, the last guy rated him too high, I am reducing it."

The VA can not reduce you, save for CUE, once the decision has been made, unless your condition has "actually improved".

[manning01]

I was awarded 30% for CAD and Agent Orange/Vietnam in July 2012.In the last few months I have experienced three episodes of passing out, one Aug 31, 2012; one Feb 3, 2013; one Mar 11, 2013 when my heart stopped,blood pressure dropped, passed out and had to be transported to Hospital. On the second event a “Loop Recorder” was implanted and on Mar 11, 2013 when I passed out again the recorder indicated heart stoppage at more than one time period when I passed out. A Pace Maker was implanted on Mar 12, 2013

I need to report this to VA and am trying to figure out proper procedures. I feel I should get my Dr. to complete VA form 21-0960A-1 and Fax results to the VA. Is that the proper procedure to provide more information or must I appeal my previous award? Do I appeal or just provide additional medical history that occurs after the award? What form(s) do I need to use if not VA form 21-960A-1? Do I mail it to the local district office or upload to Fast Track or what?

Help; how should this be handled during the one year period after an award? Is there any chance that this opening of the claim for them to downgrade my award?

Thanking you in advance.

Ken

Ken

Just my two cents worth if your going for an increase and your having the Dr fill out a DBQ why not use the FDC form VBA-21-526EZ for the increase. Submit everything up front i.e 21-4138, 21-0960A-1, buddy statements, new material medical records, surgery records/post op, tests etc since your claim was last decided for that condition. That way it will go through the FDC program and skip the gathering evidence phase since you submited everything up. But remember if you do this don't submit anything after submiting the FDC or they will get change it over to the slower normal claim process/duty to assist time waits etc in a heartbeat. I'm using this process for a single increase and things are moving much faster than the traditional route. John

See this link for the FDC process: http://benefits.va.gov/transformation/fastclaims/

FDC Fast Letter: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CEQQFjAD&url=http%3A%2F%2Fwww.vfwilserviceoffice.com%2Fupload%2FFL%252012-25%2520Fully%2520Developed%2520Claims.doc&ei=8BtGUdWrIMGM2gWe6oCQCQ&usg=AFQjCNEI_oxfxJ06Kw7_I7gcR1xhqi7rlA&bvm=bv.43828540,d.b2I&cad=rja

[Kray]

Many thanks to all that have reponsed to this thread.

Unless I am wrong, VA form 21-960A-1 must be Faxed to the VA by the Doctor. I guess you could attach a copy of the Faxed document. Reading page 3 of the instructions of VA forrm 526EZ leads you to think an amendment to your claim can indeed to submitted by the EZ form.

I feel with my latest heath setback that I must submit to increase my claim rating. Eveything you read about IHD talks about going from 30% to 60%. What happen to 40 and 50%.

I appreciate all your help. I have learned so much from this site. Thank You

[meghp0405]

if you submit additional documentation after you file a fully developed claim, your claim will no longer be a FDC and end up as a normal claim. Have all the documentation as described above and submit everything together.

If you feel that your condition is worsening, obtain an appointment with your doc, get your tests and submit them. I have seen veterans at the 60% for IHD (CAD), then they have surgery, have stents placed and after further testing, the VA sent out letters with a proposal to decrease the rating because the mets increased (they got better). Doesn't happen to all veterans, but like I said, I have seen a few around here that have experienced what i stated.

Consult with your doctor first!!!

[x020574]

Ken - this is the rating scheduled for CAD (aka Ischemic Heart Disease)

§ 4.104 Schedule of ratings—cardiovascular system. - Diseases of the Heart, there are other conditions that you may or may not be able to claim. I would print off the whole section 4.104 and bring it to your cardiologist so that he could mention all applicable situations. I am not positive but yoou may also be eligible for 100% for recovery for several months. - you can review the complete scheduling for 4.104 at this link :

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=036a0cf06d49a7c18f10ea8ce3e9c331&rgn=div8&view=text&node=38:1.0.1.1.5.2.103.49&idno=38

I read everthing I can on this subject since I have a pending claim for IHD. It is my understanding that if you have an EF > 50%, they do not consider the EF, they only consider METs. Read the criteria, you don't see any rating for an EF > 50%. Note the table does not have a rating for 30 or 40%. If you are unable to have a DREAD MILL TEST to measure METs or your doctor feels it is not advsiable, then have the doctor estimate it... the criteria for estimated METs in on the DBQ. Of course it is important for the doctor to note the 'results in dizzines, angina, etc. etc.' Good luck and keep us posted.

7005 Arteriosclerotic heart disease (Coronary artery disease):

With documented coronary artery disease resulting in:

Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100

More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60

Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30

Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10

Note: If nonservice-connected arteriosclerotic heart disease is superimposed on service-connected valvular or other non-arteriosclerotic heart disease, request a medical opinion as to which condition is causing the current signs and symptoms.

.

Edited March 18, 2013 by x020574