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Would These Count As Evidence In Support Of Claim?


free_spirit_etc

Question

We sent quite a few medical articles about cancer in support of our calim. When I was researching cancer and BVA I found quite a few claims that were granted along the same theory that we argued.

In my husband's case we argued.

1. He retired in Sept 1998.

2. His cancer was detected at 3.1 cm. in August 2000.

3. Pulmonary adenocarcinoma has a medically established doubling time of 180 days.

4. It takes approx 35 doublings for a tumor to reach 3 cm.

180 days times 35 times is WAY more than 2 years. -- And it is more likely than not that my husband's cancer did not grow to the size that typically takes 17 years to develop in the two years after service.

Though applied to different types of cancers - these same principles were used to grant service connection for cancer.

Two were supported by the Armed Forces Institute of Pathology applying the standards - and one by the BVA.

Would it be useful to send these claim to the RO to show that this same argument has been used to grant service connection many times? And also to add backing to OUR evidence (that it takes about 35 doublings to reach 3 cm - that a tumor is rarely detected on a chest x-ray until it is 2 cm. --thus it was not detected sooner...etc)

http://www.va.gov/vetapp93/files2/9315426.txt

Received in March 1993 was an opinion by the Armed Forces

Institute of Pathology, issued by the Chairman of the

Department of Environmental and Toxicologic Pathology, who

reported that agreement was obtained on the diagnosis of

adenoid cystic carcinoma in the veteran's case. He

indicated that, as a general rule, adenoid cystic carcinomas

are very slowly growing tumors. He pointed out that this

tumor's volume doubling time has been estimated at about

two years. (See Mayo Clinic Proceedings 68:297-306, March

1993.) He further reported that the Department of

Otolaryngic Pathology stated that it was their opinion that

the adenoid cystic carcinoma in the veteran existed as a

microscopic lesion during his period of service. He also

noted the following:

It is possible that the lesion existed

(as a tiny or microscopic lesion) prior

to the beginning of service. However,

this would be less confidently stated

than the statement about existence during

the period of service.

In summary, it was noted that the Armed Forces Institute of

Pathology staff concurred in the diagnosis of adenoid cystic

carcinoma in this case and that the probable duration of

this tumor was such that it was present during the veteran's

service. We concur. Thus, a grant of service connection

for the cause of death is warranted.

ORDER

Service connection for the cause of the veteran's death is

granted.

http://www.va.gov/vetapp93/files3/9320249.txt

Pursuant to the Board's request of May 1993, the Chief Medical

Director of the VA submitted this case to the Armed Forces Institute

of Pathology. After a review of all the evidence, including

pathological materials, the examiner replied, in pertinent part, as

follows:

Theoretically a tumor will have passed through 30 doublings before a single cell becomes a detectable tumor mass of 1.0 to 2.0 centimeters

in diameter. If it is unlikely that a patient can survive much beyond 40 doublings because of a very rapid increase in tumor size, then it can be appreciated that such a tumor has already been in a subclinical existence for almost ¾ of its natural history at the time of detectionand treatment. By extrapolating data on meandoubling time for squamous cell carcinoma, it is possible to arrive at a projected value for the time it takes for a tumor to attain a detectable size of 2.0 centimeters as 7.8-9.1 years (1, 2).

In Fraser and Pare's textbook Diagnosis of Diseases of the Chest, 3rd ed., W. B. Saunders Company, 1989, on page 1407, the authors state "The time required for a malignant pulmonary nodule to reach 1 centimeter in diameter ranges from about 2.5 to over 25 years." Since Mr. Brown's tumor measured 5 centimeters in maximum diameter three years after, it is reasonable to conclude that it had its inception prior to his discharge and more particularly during the years of his service.

In view of the above, it is apparent that the veteran's fatal carcinoma of the lungs with metastases to the brain had its inception during his 20 years of active duty and, therefore, service connection for the cause of the veteran's death is clearly warranted.

ORDER

Service connection for the cause of the veteran's death is granted.

This one does not have an opinion from AFIP, but uses much of the same reasoning.

http://www.va.gov/vetapp92/files2/9213359.txt

. The third period is when there is

clinically evident disease. The time required from malignant

transformation of a single cell to the appearance of a tumor

large enough to be clinically diagnosed depends on the rate

of cell division. Squamous cell carcinoma of the lung,

absent other factors, is relatively slow growing. Studies

have shown that the average time the tumor has been present

in the body before symptoms develop may be 7 to 8 years for

this histologic type. G. Baum, M.D., et al., Textbook of

Pulmonary Diseases, l060 (3rd ed. l983); A. Fishman, M.D., et

al., Pulmonary Disease and Disorders, l93l (2nd ed. l988).

Experimental studies suggest that early cancer growth occurs

at a constant exponential rate. Applying this to human

cancer of the lung, 20 doublings would be required to produce

a l mm. tumor containing l million cancer cells; 30 doublings

would be required to produce a l cm. tumor containing l

billion cells; while 35 doublings would be required to

produce a 3 cm. tumor containing l0 to l00 billion cells.

However, certain factors are known to limit these growth

patterns. The mean doubling time for squamous cell cancer of

the lung, absent other influences, is estimated at 88 days;

thus, from the time of malignant change until a 3 cm. mass

becomes chronically evident, the calculated time might be 8.2

years. Fishman, supra at l933. The veteran's 6 cm. tumor,

based on the above cited growth rates, can reasonably be

considered to have had its beginning during active service,

and service connection is warranted therefor.

In further granting benefits not only for the lung cancer,

from which he now has apparently specific postoperative

residuals including pain in the scar areas and dyspnea, but

also for other current respiratory problems, the Board notes

that the veteran now exhibits dyspnea with shortness of

breath and some right lung dysfunction with decreased

fremitus and loss of normal breath sounds. He has testified

that he has not smoked cigarettes since his surgery in l983.

He also has objectively demonstrated severe ventilitary as

well as obstructive defects in both lungs. One physician

diagnosed progressive chronic obstructive pulmonary disease

in March l990. Accordingly, service connection is also

reasonably warranted for the veteran's other chronic

respiratory problems as symptomatically indistinguishable

from his service-connected postoperative residuals of lung

cancer. 38 C.F.R. § 3.303.

ORDER

Service connection for postoperative cancer of the left lung

with chronic respiratory disorders is granted.

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  • HadIt.com Elder

The best way to support a claim is to have a treating physician write a nexus letter. Take the cases you found to a doctor and have him write any reports that are necessary. The RO is not good at intrepreting medical literature. The RO actually gets upset when you start sending the literature. I have seen numerous decision where they complained that the veteran was summitting medical literature.

This is my opinion. Get a service officer to help you and ask him the same question.

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Thanks Hoppy!

I have just recently realized that VSOs actually help people. I just thought they let you put their name on a case and pretend to represent you so the Va can pretend you were represented. I didn't realize they actaully DO represent people.

There are a few form letters from the VSO in my husband's file. "Your claim has been decided - it is important that you read the letter you get..." stuff. But that is it.

I thought the VSOs were just an illusion.

Free

The best way to support a claim is to have a treating physician write a nexus letter. Take the cases you found to a doctor and have him write any reports that are necessary. The RO is not good at intrepreting medical literature. The RO actually gets upset when you start sending the literature. I have seen numerous decision where they complained that the veteran was summitting medical literature.

This is my opinion. Get a service officer to help you and ask him the same question.

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Guest jangrin
Thanks Hoppy!

I have just recently realized that VSOs actually help people. I just thought they let you put their name on a case and pretend to represent you so the Va can pretend you were represented. I didn't realize they actaully DO represent people.

There are a few form letters from the VSO in my husband's file. "Your claim has been decided - it is important that you read the letter you get..." stuff. But that is it.

I thought the VSOs were just an illusion.

Free

Free,

It sounds like you got a copy of your husbands Cfile. How long did it take the RO to send it to you?

Jangrin :o

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I don't have a copy of it all. He has kept a copy of all of the letters, decisions. SOC, etc - so I have been going through those.

We got his VA medical records from going to the hospital and picking them up. He filled out a form one day and picked them up the next - FREE -

but you do have to ask if you have ALL the records) I was looking for his lung cancer C&P and didn't see it at first - so he asked if that was all the records. And - gues what - they weren't. She said they usually don't give people some of their C&P exams because they might upset them...especially the psych exams.

Say what????????? So he asked for a copy -- and she had to go back and READ it to see if there was anything in it that might upset him before she could give it to him.

Is this America or what?????

He was able to get his post service medical records (On Base) in a couple days... but they were not complete. The doctors have records that are not included in your official file.

He just got a bunch of digitalized records with very brief - clcik the diagosis type stuff... and very few notes.

I was real upset - because the VA wants documentation - and they had very little documentation of anything.

My husband had his appendix removed - and there was one page - just noting he had surgery and being released.

I said "they have reduced an entire surgery and hospital stay to SIX LINES?????????????"

So he went out and raised heck with them..and they said - oh -- we just gave you the official files. That other stuff would be in the doctors records. So he asked for those. It took a couple weeks to get them - but they had LOTS of useful information.

If the VA asks for records - they probably get the digital crap - that doesn't say much. But how is a veteran to know that when you say records - there are more than one set of records....

So claims are probably being decided a lot without the full medical records.

Not sure if they do the same thing with in service records.

He has ordered those - but they said it will take awhile to get them.

We have also sent in a request for his records at the VARO - but haven't heard a thing yet.

But when you ask for records - make sure you ask for ALL the records...and when you get them make sure you ask again.... because it has been our experience that they just give you a stack and have more in reserve...in other places...

Free

Free,

It sounds like you got a copy of your husbands Cfile. How long did it take the RO to send it to you?

Jangrin :o

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  • HadIt.com Elder

Free,

My first SO and his supervisor heard some of what I had to say and they threw me out of the office. The supervisor was screaming and yelling that I was wasting his time. This SO was a disabled Viet Nam veteran, He obviously got hit by some artillery or a land mine. He could barely walk. I have no idea what he did before he became an SO. I seriously questioned his ability and desire to help a non combat veteran with a vascular disease. I was transferred because my CO did not want to take me to VN with this weird ass disease. I was discharged after 20 months and told that it could not be service connected because the disease was hereditary. 26 years later I went on line and joined a support group for people with the hereditary form of the disease. They told me it did not sound like I had the hereditary form. I found out that I had an acquired life threatening form of the disease and tested negative for the hereditary form. The first SO threw me out of his office without me even getting to the point where I was going to tell him that I did not have the hereditary from. He just said that the VA will not service connect me because of some pre conceived ideas he had without listening to the specifics of my claim. That is when I found hadit and changed SO's.

The new SO was very interested in my claim and told me that he would take it all the way to the BVA. He told me if the BVA denied me to go to COVA. The new SO had a BS and masters degree in psych. He studied pre med in his lower division. He was a rating specialist for the VA for 20 years. He knew some basic principals of immunology. He read the SMR and knew that I got an incurable vascular disease while in the military.

It took some time because the VA did every thing they could to confuse the issues and delay the claim. However, in the end he called me and asked me if I was sitting down. Then he proceeded to tell me he got me 100%. I did a lot of the work with the stuff I learned here on hadit. I WAS SO FRUSTRATED WITH THE DELAYS AND BS THE VA THREW AT ME I WOULD HAVE SETTLED FOR 50%. He told me every time I went in his goal was to get me 100% and he did.

If your SO is motivated stay with him. If the claim is complex it would be nice if you could find some guy who went to medical school before he became an SO. But the VA and their system does not work that way.

I keep bringing up the qualifications of SO because I was a city employee and got injured in a car accident at work. The first person my union sent me to see was an MD/JD. The guy went to both medical school and law school. He was a total worker advocate and ran the insurance company around in circles. I got a very good settlement considering the injuries I had. Wouldn't it be nice if the service organizations had a bunch of these guys waiting around to help veterans?

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