Please Help-I Need Guidance And Reassurance!

[nicki]

I came across this website as kinda a fluke, but IM SO GLAD I DID! I guess god really does give you what you need at the right time!

My name is Nicki, I spent 11 yrs AD Navy. My husband Wade spent 20 years and was an AD1 (jet mech) from 1983-2004. He retired in 2004. august 2012 he was diagnosed with a rare form of bladder cancer (adenocarcinoma-lipid variant). At that time, our oncologist at University of Colorado said she truly believe it was from exposure to chemicals while in the navy (specifically benzene, but there were all sorts of crap he was exposed to) and advised me to file a VA claim and wrote a letter on our behalf stating no family history, non smoker, probably environmental related, etc. I met with an American Legion rep who started the process.

Since that time, he has undergone chemo, had his bladder, prostate and appendix removed. We went to MD Anderson in Jan 13 where he was diagnosed with plasmacytoid urethral carcinoma. The cancer has spread to the liver, colon, pancreas and adrenal glands.

He has about 9-18 months. He will be 49 years old on 6/13. He was in the best shape of his life.

The doctor is now adamant he was exposed to something in the Navy that is the cause.

He was also stationed at NAS JRB Willow Grove for 4 years, 1996-2000,which is a EPA Superfund Site (you would not believe all the people with cancer from there!).

I have kept the VA and our rep with the most up to date records. I have been getting letters stating they have the claim.

Wade was discharged with a 0% disability rating.

Am I doing this right? What am I missing? Please advise

[Berta]

Benzene exposure can certainly be a cause of cancer:

“The Department of Health and Human Services (DHHS) has determined that benzene causes cancer in humans. Long-term exposure to high levels of benzene in the air can cause leukemia, cancer of the blood-forming organs. “

http://www.bt.cdc.gov/agent/benzene/basics/facts.asp

In this DIC claim from a widow at the BVA it states:

“The evidence shows that the Veteran was exposed to an identified carcinogen, benzene, on regular basis in performing his duties for nearly 14 years of active service. It is specifically established by the record that benzene is implicated in the development of the type of cancer that the Veteran developed and caused his death. “

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp10/Files1/1008013.txt

The widow was granted DIC

However these claims are often difficult to succeed in.

This January 2012 post is by Dr. Craig C Bash, a former VA doctor, and NeuroRadioloist, who has prepared hundreds of IMOs for veterans or their survivors, with VA claims.

He has also done many SVR radio shows here, available via your PC media player ,in our SVR archives.

However ,you do have a doctor who seems very willing to support the claim.

Did the American Legion provide any IMO template for this doctor?

Years ago, in 2009 after I had obtained 2 IMOs from Dr. Bash I posted this info here as to how they were prepared and what key issues Dr. Bach had covered. I won that claim.

VA is often quick to reject any IMO or IME that does not have these keys points in it.

In my 2009 post here this is what I developed for a valid IMO,solely using my IMOs from Dr. Bash as VA provided no forms or guidance on what an IMO should contain:

Independent Medical Opinions can often be the only way a veteran or widow can succeed on a VA claim.



Opinions obtained from private treating doctors are often free yet most independent medical opinions are needed from doctors with full expertise in the field of the disability can be very costly.



However an award can easily absorb this cost with a few comp checks or the increases in comp that the claimant might never obtain without an IMO.



A Valid IMO must contain the following:



The doctor must have all medical records available and refer to them directly in the opinion.

In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs.



Also the doc needs to have all prior SOC decisions from VA particularly those referencing any VA medical opinions or a copy of the actual C & P results.



The doctor should define their medical expertise as to how their background makes their opinion valid.



In other words a psychiatrist cannot really opine on a cardiovascular disease.

An internist cannot really opine on a depression claim.



The doctor must have some valid medical expertise that makes his/her IMO valid.



The doctor should state their opinion in terms of “as least as likely as not”, or “More than likely” as to the present disability and the nexus to the veteran’s service medical records or other SC disabilities, if the medical evidence warrants them to agree with the claim.



They should then refer to specific medical evidence to support their conclusion.



They should rule out any other potential etiology if they can-but for service as causing the disability.



They should briefly quote from and cite any established medical principles or treatises that support their opinion.



They should point out any discrepancies in any VA examiner’s opinion-such as the VA doctor not considering pertinent evidence of record in the veteran’s SMRs or Clinical record.



They should fully provide medical rationale to rebutt anything that is not medically sound nor relevant or appropriate in the VA doctor’s opinion.



They should attach a full Curriculum Vitae if possible or list their expertise within the opinion and tell VA of any special medical background they have that also makes their opinion valid. (For example, how long they have treated patients with the same disability, any articles they have written, or symposiums attended etc,)



It helps considerably to identify pertinent documents in your SMRs and medical records with easily seen labels as well as to list and identify these specific documents in a cover letter that requests the medical opinion.



A good IMO doctor reads everything you send but this makes it a little easier for them to prepare the IMO as to referencing specific records.



Send the VA and your vet rep copies of the signed IMO.



And make sure your rep sends them a 21-4138 in support of it- you also- can send this form (available at the VA web site) as a cover letter highlighting this evidence.



PS- Mental disabilities- make sure the doctor states that you are competent to handle your own funds- otherwise, if a big retro award is due-the VA might attempt to declare you incompetent and it takes times to find and have the VA approve of a payee.
--------------------------

The key wording that VA is familiar with , such as “as likely as not” mentioned in Dr. Bash's topic here,

needs to also be followed by a strong medical rationale.

Also although I had sent Dr. Bash print outs from medical abstracts that supported my claim, he was able to use a citation from a very prominent cardiology text ,that I could not access or print from, via the internet.

An IMO does not have to lengthy , mine were each only 2 pages long. Dr. Bash's CV however was about ten pages long and the background of the VA doctor who had been opining against my claim, in no way compared to Dr. Bash's background.

Many doctors who are willing to provide IMOs are not familiar with the VA's criteria for what an IMO should contain.

The DAV and the AL I am, sure, would have some sort of template as guidance for the IMO you need.

This concerns me:

“At that time, our oncologist at University of Colorado said she truly believe it was from exposure to chemicals while in the navy (specifically benzene, but there were all sorts of crap he was exposed to) and advised me to file a VA claim and wrote a letter on our behalf stating no family history, non smoker, probably environmental related, etc. I met with an American Legion rep who started the process. “

Although it is great that she stated there was no other known etiology, for his cancer, but for benzene exposure,

the VA will not accept “probably” , or statements like “truly believed”
in an IMO.

They need a statement that it is as likely as not that his inservice benzene exposure caused his specific type of cancer, ,that there is no other known etiology for his cancer, but for the benzene exposure, and then add any additional medical rationale ,such as length of time his MOS exposed him etc.

Also, hopefully he had no other post service occupations that exposed him to benzene and she should make that point as well. and also she should cite either the printouts I posted link to here, or any other strong, legitimate medical sources that fully supports her medical rationale.

Exposure claims can succeed but,in my experience, the VA will want the exact chemical exposures identified,and verified via the veteran's MOS , and proof of no other etiology for the disability, as well as a strong IMO to support this type of claim.

You stated:

"Wade was discharged with a 0% disability rating."

I assume you mean a SC "0" rating? What was that for?

[nicki]

Thank you so much Berta for your reply. I left tis in the hands of my VFW rep, and was told NOTHING of any of this. I just submitted the wih no evidece except the letter and medical records. OBVIUSLY I need to get my "stuff" together.

Im not familar with alot of the acronyms you used, so Im guessing here. SC is Service Connected correct? His SC Rating of 0 was for "bilatera wrist, left punctured ar drum, right ear hearing loss, status post right patella fracture, claimed as right knee injury and righ knee".

In April I rceived packet frm the VA with "What we still need from you" letter. It also had enclosed VA Form 21-4138, 21-4142, VCAA, and "what the Evidence Must Show". When I called my VFW rep, he told me not to worry and just have the hubby sign the VCAA notice and email it back to him.

By reading the packet info, I klnow realize I have alot of work to do.

How do I get a IMO? I need guidance on this. Where would I find a hysican to support his claim? Is there a netwok or forum that people can post who they have used an reccomend? Do they do ti with visiting with patient in conjuction with his or by medical records from both his military service and current medical records. Or can you just send the records and they can give their opinion that way?

I am hesitant to ask my husbands oncologist, becasue the initial letter. I hink adhreing to the guidelines that you outline previously would be something she would not agree to, for the main reason she is the head of the urology oncology departmentand all the politics involved with that. Her initial letter stated the following:

Mr Wade Woxland is currently aplying for Veterans benefits related to his bladder cancer, andI am writing thi letter in support of his application.

Mr. Woxland was diagnosied with bladder cancer in 8/12 and is currently under my care. Mr Woxland was employed by the Navy for 20 years, and believes his bladder cancer may be related to possible occupatonal exposures. The curent literature estimtes the 5-25% of all bladder cancers result from occupational risk factors. To my nowledge, Mr Woxland is a never smoker, has negitve family history of bladder cancer, does not hve history of urinary tract disease and does not have any exposure to drugs such as phenacetin.

thank you for your consideration.

(Along ith this letter was 2 pages of enclosures backing up othe claim of occupational exposure-with studies )

So, what I think I need to do now, is get a timeline together of each of his duty stations and all the chemicals he used at each one. And an IMO. Should I get letters from his shipmates stating that he did indeed use these chemicals?

Also, should I call he VA to make sure they have all his medical records? Is there anything else?

The AL rep advisedme to 21-4138 and state "Wade Woxland currently hs saage 4 cancer which is terminal. His life expectinect is 9-18 monts. We request you expidite this claim quickly."

I hope that doesnt bite me in the butt!

Im so mad right now, at myself and at the American Legion rep. He told me NOTHNG of any of these thing Im learning here. . And under different circumstances, I probably would have done this myself (the claim) and not used the VFW, but I was told "they should do everything for you-they are there to help you"

I feel like Im going to blow this for Wade if I dont get it together soon.

Sorry for the vent-thanks for the help!

Sorry about the typos previously. Need a new keyboard.

[Stretch]

Read as much as you can. You have to become pro-active. Here is a med advisor.

http://www.veteransmedadvisor.com/

[Notorious Kelly]

Nicki,

I can't add anything to the previous and don't stress out- it can be a long process. You have time to read and gather evidence.

I also wouldn't trust that a VSO has everything under control.

Good luck!

[Berta]

I advise using the IRIS system , to get VA to confirm if they have ALL of his medical records:

http://www.va.gov/landing2_contact.htm

This link will direct you automatically to the Contact Us form. Describe exactly what private and VA records they should have.

I always advise asking VA for an email hard copy response.

It would be a good idea to see if you can do that timeline to narrow down what chemicals he was exposed to, but the benzene might be the best bet, since this is a know carcinogenic.

If any other chemical he was exposed to was a known carcinogenic, I would try to google that as well for some medical literature on that.

Personally I would focus solely on the benzene and getting some 'buddy statements' would also be helpful.

You asked “How do I get a IMO? I need guidance on this. Where would I find a hysican to support his claim? Is there a netwok or forum that people can post who they have used an reccomend?”

Hopefully if anyone has an IMO doctor to suggest along with Dr. Bash, they will answer that here for you.

“Do they do ti with visiting with patient in conjuction with his or by medical records from both his military service and current medical records. “

Sometimes Dr.Bash and other IMO doctors want to personally examine the veteran and then prepare an IME.

“Or can you just send the records and they can give their opinion that way? “

That was my experience with Dr. Bash because the veteran was dead.

I prepared a cover letter highlighting specific records and documents that supported my claim,(for a AO disability he had never been diagnosed with or treated for....so you can imagine that wasn't easy)

and then, along with all of the records he needed, I put tabs on the specific ones that were critical.

In my case he did not need my husband's SMRs., just proof of my husband's Vietnam service.

Here is the link to Dr. Bash's SVR shows here:

http://www.svr-radio.com/archives.html

In Sept or Oct 2012 I did one or both of the shows with him on IMOs along with Jerrel Cook, Jbasser,Jon Brown, and John Dorley.

(He is the Medical advisor in the link Stretch gave you-Stretch is the SVR technician and makes these shows run smoothly)

He can be emailed with a brief rundown of the type of opinion you need.Tell him the exact diagnosis of your husband and what the oncologist stated in the letter she prepared.

Dr. Bash is very user friendly,in my opinion, and in my case he not only emailed me back within days,after my first email to him in 2005, he also discussed my claim by phone with me and gave me the fee amount right away.

Although he is a NeuroRadiologist, I am sure he could opine on your claim, or otherwise could recommend an Oncologist who would.

IMOs are costly and need to be viewed as an investment into a claim that might never succeed without an IMO. MY IMO fees were easily absorbed ,in my case, by the award of ancillary benefits I would have never gotten without these IMOs.

Dont forget to tell him of the Oncologist's letter... It can be a corroboration of his opinion.

As I mentioned, I had a 2 sentence email form a former VA neuro who treated my husband and Dr. Bash loved it, because as brief as it was, it corroborated his IMOs and the BVA gave the former VA Neuro's opinion much weight along with Dr. Bash's IMOs.I am sure he would view the onocologist's letter you have the same positive way.

It doesn't fit the proper IMO criteria, but neither did my email from a Neuro, but it corroborated what Dr. Bash prepared and thus,it became probative evidence.

Notorious Kelly made a good point here that many of us hard core claimants learned long ago....

No one cares about our claims as much as we do and we are the ones who have to do the legwork to get them resolved.

“His SC Rating of 0 was for "bilatera wrist, left punctured ar drum, right ear hearing loss, status post right patella fracture, claimed as right knee injury and righ knee". “

If there is medical evidence that any of these disabilities have gotten worse, he should also file for a higher rating for them.

An IMO doctor might be able to incorporate that potential into his/her IMO as well.

[meghp0405]

Your VSO should of told you what Berta did. If he/she didn't get rid of them! He/she will hurt you more than help!