Would These Count As Evidence In Support Of Claim?

[free_spirit_etc]

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.

[free_spirit_etc]

Yeah.. I think maybe our next step needs to be finding a VSO that will really help. My husband went to an agency in the area on his earlier claims and all they had him do on the appeal forms was check the box and state the claim...the one word diagnosis.

So the only help they gave was making sure the proper forms were turned in. And that the boxes were checked.

So he switched to another group - but we were under the impression the VSOs were just in name only most of the time.

So maybe we need to see about finding a good one.

You were very lucky to finally find out about your disease...and it's cause.

When my husband had his first cancer surgery, all the doctors told him for a year he had small cell lung cancer. After a year - someone finally read the lab report - and his pulmonolgist informed him he had nonsmall cell cancer - and because of the slow growth rate of that cancer - it probably started in the mid to late 80s. He retired in 1998. Thus - he wrote the letter to open his claim.

Free

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?

[Berta]

Free-

"Your claim has been decided - it is important that you read the letter you get..." stuff. But that is it?

I think I understand the one word diagnosis was on an I-9 formal appeal statement?

Did he get a VCAA Notice with two check boxes on it, prior to getting the I-9 form?

The first vet rep I had wrote one sentence on a short VA form and told me to sign it.

I was dumb in those days- 1982.

It should have been on a 21-534 but I dont recall that form-they didn't have a xerox machine so no copy-I did get an award letter- VA pension but my income limited that so no pension money-I had no idea what a VA claim really was then -a VAMC director told me to file it.I had no idea what a service connected death meant.(widowed twice-both vets)

On an I-9 if this is what you mean- I gave advice here as to how I did mine- because

1. NVLSP recommends that you preserve on appeal all errors the VA could make in deciding your claim (I stuck all that in the Number 9 box-)and

2. In the very first paragraph of your statement responding to Question # 10-

You have to immediatly get into four inches of type- exactly why they are wrong!

State it strong and refer to evidence right on that first page-

You can attach more pages and expand on your statement --- however

The VA R0s as well as the BVA are so backlogged that they are skimming our claims-

You have to call their attention right away to why their decision is wrong-

They see hundreds of 1-9s weekly at the BVA- make them read yours----

by immediatly attacking their decision---with reference to evidence--- on the first page-

if you never got a VCAA letter and if your medical evidence has been ignored tell the BVA on the first page of the I-9.

I hope you meant something else -when you said "one word diagnosis" and that this was expanded on.

As I mentioned before- I wrote my opening I-9 statement in Word-edited it until it fit into the # 10 I-9 box,

printed it ,cut it out and scotch taped it to the I-9 then copied it-all - as page one-

I expanded on additional pages-and attached my 2 IMOs also, which the RO never considered.

The VARO never even read it -because the SOC added a SMC claim that was withdrawn and turned into two CUE claims-

In spite of a letter from my RO VSM to correct this error-

and to take the SMC claim off appeal (they are working on this as 2 SMC CUE claims now at the RO-so duh- should NOT be in the appeal but they stuck it there-)

The RO did not read the I-9 nor any prior correspondence to and from the RO's VSM-who said,in her letter that, this was issue clarified -at a meeting with my vet rep present-

so my whole point is-they dont know what they are doing-at these VAROS -a GOOD vet rep is checking what they do-before a claim gets transferred to the BVA-

I hope more than a diagnosis appears at question # 10 on your I-9 form-

I am not sure what you actually mean- on what form this was.