diabetes Chances Of Being Reduced ?

[Greg88]

I have been SC for the last 37 years with the VA, right out of the service at 40% with Diabetes Mellitus Type 1. I'm also have been Brittle (meaning my blood varies from low to high- in my case mainly low), for the last 37 years, I used the VA health care for 21 years, in 1996 I was bumped up to 60% because of Neuropathy in both feet, Proteinurea, and generally poor control due being unaware that sugar was going low (I passed out at work and lost my job in late 1996), I put in for 100% in 1997, Nov. 1997 I had my C&P.

In Jan. 1998 I was granted 100%, my VA endocrinologist (who was my MD since the very beginning 21 years) retired from the VA, after 6 months of seeing Endo residents, I stopped using the VA system. I started the to see my private MD (I had been seeing him regularly for physicals and general medical for a year before my VA doctor retired. After being awarded the 100% the only time I heard from the VA was for COLA increase's, in 2012 I receive a letter from the VA saying they are setting me up for a physical because my Diabetes Mellitus in not considered Permanent.

Sept. 2012 I see my private MD and have him fill out the DBQ for diabetes and peripheral neuropathy, he also includes letters from opthamologist showing I have Diabetic Retinopathy, he also writes a Nexus type letter (I know I'm SCed, but with the VA you have to hit the over the head) saying this disabilty and it's complications are permanent (My MD is not a general practioner, he is the head of internal medicine for a large prestigous hospital in NY), I have my C&P, I get a copy 3 weeks later, the C&P results are a carbon copy of my Dr.s DBQ and note. A brief overview, I take 7 shots a day, test my BS 12 times a day, my blood pressure is high (common in diabetics, 4 medications to control) the neuropathy is so bad I cannot stand or sit for more than 10 minutes, I sleep 3-4 hours a night and need 20 mgs of Ambien and a muscle relaxant to do that, my vision is poor, I urinate 40-50 times a day. My diet is strictly controlled, low protein due to protein urea, low fat due hyperchlosteroemia, and of course now I have Erectile Dysfucntion

I called the 1-800 in Nov. and was told they reached a decision, actually nothing was decided, the farmed out part of my for an Admin Review, that was decided 3 weeks later. By 2013 no decisions, in March 2013 a new claim. a Rating Review, of course the compensation claim is still listed as Diabetes Mellitus (New). DAV who is my POA has been totally useless, when you do manage to get someone on the phone they give you the info, on March 15 I see my Comp claim go from Gathering to Preparation for Decision.

To the present day on Friday July 19th, I decide to go down to DAV and ask whats going on (In Sept it will be 1 year since the C&P and the VA may declare it invalid), 9:00 in the A.M. DAV tells me to come back 2 hours later, I go to the RO across the hall (there in the same Building) and talk the VSO thats their, he's also a Diabetic and he's wondering why I'm not P&T, he calls up the Rater upstairs and she tells him that they are looking at each complication seperatley. So looking at Ebenefits and the unsolicited items I submitted ( under the things the VA solicited were just the C&P exam) the VA showed the Dr.s letters and DBQ and that was basically it.

My question is if the VA looks at my Diabetes at the 60% rate and starts adding the peripheral neuropathy and others complications using VA math, it does not add up to 100% and I know that in 3.5 years I'm at my 20 year mark and theirs nothing they can do at that point, I just have a feeling they are going to try and lower it just to save money. Any input would be appreciated.

Edited July 21, 2013 by Greg88

[carlie]

Thanks Carlie, I'm thinking a lot of this could have been stopped if DAV took a more active role in it, I've spent the last hour and a half going over the C&P exam and my Dr.s note and DBQ, it should at least gone to IU in the least, actually it should have started there in 1997.

Unfortunately - we are all ULTIMATELY, responsible for all of our claim issues.

[harleyman]

Diffinately make sure you file for a hearing within 30 days. If after thirty days they can reduce you and talk about it later. Before 30 days they can't reduce you until the issue is resolved by a new rating decision..

In the mean time you need to have your private doctors fill out DBQ's for your Diabetes and all your secondary conditions. You also need to make sure you get copy of your VA records and make enough copies of those records to give to your private doctors. (even if you have very little treatment with VA). Your private doc's need to be able to say they reviewed all your VA records.

Make sure your private doctors state they have reviewed all your records both private and VA, and make a list of the records they reviewed on each DBQ.

With records by VA up against records submitted by the Veteran (as long as the private doc's have reviewed all the same evidene as the VA doc's you have a equipose situation. When the evidene is equally persuasive, the tie goes to the Veteran.

VA's justification for not honoring a situation of equipose is they state, "the private doctors do not have all the records therefore the VA doctor is better informed of the whole (big) picture. VA believes private doctors only review a small element of the available evidence. VA also uses this rationale for IMO's, thats why Dr. Bash has Veteran's fly in to see him, so he can do an examination of the patient not just a review of records.

IMO- opinion based on records review

IME- independent medical examination

IME/IMO- independent medical examination with independent medcal opinion

AME- agreed upon medical evaluation

AMO- Agreed upon medical opinion (usually a review of records and opinions from both parties and a compromise report). Siomewhat like arbitration.

I believe you will need an IME/IMO to stop from being reduced. But, you might be able to do stop the reduction, if you can get your private medicals doc's to do the DBQ's for DMII, bilateral upper and lower peripheral neuropathy, male genitourinary exam for ED, diabetic retinopathy, kidney if you have issues caused by your, heart, hypertension, any and all conditions secondary to DMII.

Edited July 23, 2013 by harleyman

[Greg88]

Harleyman, I gave them a DBQ on diabetes and Peripheral neuropathy and a letter from MD, before the C&P, I don't have DMII, I have Type 1 which is much more debilitating to the body, though I think you did hit on part of the problem. I think the raters are so used to DMII, that they are stacking me up next to the DMII claims and the disease has a much more brutal record the longer you have it, which is 37 years. By the CFR rules though, they have to show a sustained improvement over the last 5 years and I can guarantee that has not happened.

[harleyman]

Sorry, Diabetis type I, and yes it can be much more dibilitating than type two. But VA still looks at it as DM with known complications (type I or II) same rating schedues are used for both type 1 or II. The VA is not suppose to reduce your benefits unless you have had TWO consecqutive examinations wthin 5 years which show improvement. DM type I, is a permanent non-improving disability. I think you need to have a DRO review, they have a much more extensive medical backgrouind. Some of these newer raters don't have any medical background at all.

Have you had more than one exam in five years? Might this be a second time your DM has been evaluated by VA.

Secondary conditions are what will keep you at 100%. PN due to DM is usually much more severe for type 1 diabetics. Is your PN of the lower extremity severe enough that you can file for loss of use. Testing showing sensory loss, loss of dorsiflexion and/or extension is also partial loss of use. Just looking for things you may have due to your DM, but have not yet claimed.

Do everything you can do to keep your private doctors ahead of the VA doctor's or at least on an even playing field. Make sure to get those VA records so they can be reviewed by your doc's.

I wish you good luck, don't give up.

Edited July 23, 2013 by harleyman

[Greg88]

Harleyman,

The C&P I had in Sept. 2012 was the 1st since Nov. 1997, I see my private MD 4-6 times a year, the thing is I have been a Brittle diabetic for 37 years now, I have passed out in the Bronx VA hospital 15-20 times, at Dr.s appt.s waiting to be seen, it now has come to the point that I have no warning when my sugar will drop, at the C&P exam the examiner noted that my blood sugar was 48, I'm pretty sure the raters in 1997 looked at this info when they made me 100%, the raters today proably not. The problem is at this point in my life I cannot my blood sugar get to high, who know how much my kidneys have left. The C&P examiner said to me when I asked her why the VA had never classified my Diabetes Mellitus as permanent "because they really don't understand the medical ramifications of the disease" I know I have a Pre hearing before they actually do anything, who do I get to fight with me at this hearing- a VSO, an attorney, Congressmen, at this point I don't know where to start.

[harleyman]

How close are you to your doctor? Because if I was given a choice I'd take the doc. But that probably is not possible. If you have a "formal hearing" everyone is sworn in and it's all officially on the record. If you have an informal hearing it can be with a senior rater or a DRO, depending on if you have asked for a DRO review or not and it is very informal. The problem is they always over schedule these things as there are an incredible amount for no-shows by Veterans. So who ever you take or have there will be waiting around more than likely.

I think initially, you should have a statement with you from your primary Diabetic provider that outlines everything about why you are unable to "function in the work force" and why you are unable to be gainfully employed. Most employers will not deal with people who have insulin reactions, diabetic coma incidents, etc., confusion, outburst due to uncontrolled diabetes.

Secondly, I don't know who represensts you as your Representative, DAV, AL, VVA.. etc. but, I would go to the VA and ask questions and see if you can find the name of someone in your area that is top-notch. Heck, put the question of who best in my area on Hadit, the members will tell you who to contact and who is the best. When you find someone your comfortable with have them review this with you ahead of time, so when you go to the hearing you are ready. I think you will find the people at the hearing very understanding and they will listen to you. But they will not make a decision at the hearing they will notify you by mail.

Edited July 23, 2013 by harleyman