Secondary/residuals Of Sc'd Conditions

[Chuck75]

Here's an interesting which way to jump situation!

SC'd Veteran has existing 100% SC for IHD(alone), CAD, High Blood pressure, DMII, etc.

Medical Records, both private and VA showed the presence of an Aortic Aneurism

at ~4.5cm. (5cm is usually considered as cause to consider surgery by medical references and advice.)

A/O presumption (Nehmer) was the basis for the existing IHD 100%, and other lesser ratings.

The VA RO and Nehemer failed to mention the Aneurism in the award, even though there were existing medical records showing

that it existed. The primary cause (from medical references) seems to be HBP. Naturally, the Aneurism existed

before the veterans initial claim for DMII was made, before the veteran's HBP was SC'd. and initially discovered based upon a sonogram. SC for HBP was added/increased by the Nehmer review with a later EDD for the increase. The Veteran experiences discomfort and other symptoms that can be related to the existence of the Aneurism, as well as IHD, CAD, and complications. These can cause movement restriction, discomfort, and pain in certain "bending" related positions and motions.

The Nehmer board ruling was made in early 2011 and retroactive for several years.

An additional claim may be filed for the Aneurism, with IMO's etc.

Or, can the fact that it was ignored when evidence was present in the veterans file be used as a cause for CUE, possibly entitling the veteran to additional retro?

I'm thinking that the claim should be filed, with supporting documents, then somehow, once awarded, show that the VA made an obvious error by previously ignoring existing medical records at the time of the 2011 decision. This would possibly result in a single additional rating of up to 60%, entitling the veteran to additional SMC money paid retroactively. A limited C&P was given for DMII and heart related problems. The Aneurism was not mentioned, and although the VA medical records were available to the examiner, not completely reviewed, based upon the C&P record. Overall the C&P results were favorable.

Any advice would be welcome.

Edited March 31, 2013 by Chuck75

[jbasser]

Hypertension is to be rated over and above heart disease separately. Vascular issues like AA's are a secondary issue to hypertension. All that is needed is a Doc to nexus the two and it is real easy.

Remember continuous high blood pressure causes excess pressure on the blood vessel walls and causes the walls to break down kind of like a water hose with too much pressure. It is the opposite of a stroke which is caused by the blood pressure being high and then dropping causing a piece of Plaque or blood clot to pass.

DMII actually worsens the scenario because the blood is stickier and the Plaque build up is greater. In worse case events the vessels become calcified and hard to work with.

The AAA is a BP issue and not related to the CAD. CAD is the actual Plaque inside of the vessels.

But remember, with the right Doc saying the right words, anything is possible.

J

[Chuck75]

The HBP is and was (by qualified medical opinions and Nehmer review) related to the causes of IHD in this particular case.

Has to do with various treatment records that I've looked at and the effects of heart and vascular related treatments on BP.

Anyway, it looks like the next step in preparing to deal with the claim is to obtain current lab test results documenting the present size of the Aneurism,

along with a cardiologist's and vascular surgeon's statements worded in a way that the VA accepts.

Edited April 1, 2013 by Chuck75

[jbasser]

Chuck also take this into account. What are the Docs telling him about his limitations with an AAA. Usually you cannot lift 5 lbs or strain yourself in any way. Those orders alone would justify a 60 percent rating for this Vet.

J

[john999]

If you want to know what kind of shape your blood vessals are in get a doctor to do a CT scan of your legs. It will show if there are blockages and calcification in and of the vessals. The first signs of heart disease often show up in your legs. If you have calcification in leg vessals you probably have it in your heart and brain as well. Some calcification is normal as we age. Nobody gets out of this life alive.

[Chuck75]

Chuck also take this into account. What are the Docs telling him about his limitations with an AAA. Usually you cannot lift 5 lbs or strain yourself in any way. Those orders alone would justify a 60 percent rating for this Vet.

J

As I understand it, heart conditions limit the physical ability of the Veteran. Nothing was said by him about a weight lift limit. His heart functions at about 25% of a normal heart, and he takes a "drug cocktail" of more than a dozen pills a day.

Edited April 2, 2013 by Chuck75

[jbasser]

What are they telling him about the aneurism? If his exertion is restricted it is 60 percent or if it is 5cm it is 100 percent and it is without a doubt secondary to service connected hypertension listed under vascular rating. It does relate to Nehmer CAD.

J