Dm Ii And Vascular Disease

[harleyman]

Does anyone have referenes or experience in getting vascular disease of the lower limbs service connected as secondary to DM II?

Veteran is s/c for DMII and PN with loss of use of one of the lower extremity ( 2 K awards one for loss and the other for ED),and also s/c for IHD. But recent claim for DVT (blood clot and infection in lower leg secondary to DMII ,VA has denied stating the leg condition is not related to the DMII.

Might the veteran get the DVT (clot and or infection)s/c as secondary to IHD?

Thanks!

Edited July 27, 2013 by harleyman

[Greg88]

Harley, yes DVT is not uncommon among Type 2 diabetics especially with PN, with the loss of one extremity, ambulation becomes more difficult leading to poor circulation, the PN further inhibits things by not signaling that their is problems. Diabetes main culprit is the attack on the vascular system- that's why so many secondary's to things like IHD.

[Berta]

I started this with info on arterial blood clots...might not apply at all to the vet you mentioned but always good info to have......

Blood clots can be a consequence of arterial Atherosclerosis associated with both IHD and DMII:

“Blood clots form more easily on arterial walls roughened by plaque deposits and may block one or more of the narrowed coronary arteries completely and cause a heart attack (see myocardial infarction for more information). Arteries may also narrow suddenly as a result of an arterial spasm. (Spasms are most commonly triggered by smoking.) “

:

source: http://www.hopkinsmedicine.org/heart_vascular_institute/conditions_treatments/conditions/coronary_artery.html

Diabetes. Diabetes increases the risk of plaque buildup in the arteries, which can cause dangerous blood clots. Nearly 80 percent of people who have diabetes will eventually die of clot-related causes. Many of these deaths are related to complications with the heart and blood vessels.

Source :http://www.nhlbi.nih.gov/health/health-topics/topics/ebc/causes.html

Also PAD (peripheral arterial disease...which VA rates separately from PN) can also be a consequence of IHD and/or DMII

.

http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/diabetes/diabetes_and_heart_disease_85,P00341/

The VA knows full well that arterial blood clots can be a major consequence of DMII or IHD or both...

A blood clot forming in my husband's heart (my etiology diagnosis not Vas) due to his undiagnosed and untreated IHD and DMII ( FTCA /1151 award) caused a totally disabling CVA (Stroke) and the MRI revealed other TIAs and brain damage consistent with brain ischemia (blockage due to clots).

But you mentioned DVT, deep vein thrombosis.......that is different......that type of clotting can be caused by inactivity due to many things (to include disabilities that prevent normal forms of exercise) this could be a potential approach by an IMO doctor on this claim.....

This vet at VBN is awaiting a decision on DVT due to IHD:

http://vets.yuku.com/topic/103737#.UfQLim04ns0

The discussion at that link is very good regarding the DVT ,which does not seem to have the strong association to IHD and DMII that an arterial plaque condition would.(causing PAD or any type of arterial clotting)

Your vet does have the PN and I wonder if he has PAD as a cause of the clots.

Was his DVT diagnosis from a VA doctor?

I think this claim could succeed as a secondary to either the IHD or the DMII but it might take a strong IMO.Or the DVT would need a strong association to the DMII or IHD as due to inactivity ...and I see he has a' loss of use of' for one extremity,so that might fit the bill right there.

Harleyman can you tell us the exact words VA used to deny? I guess the potential as due to IHD was not raised by the veteran in the claim and just DMII ??

Does the veteran have a copy of his entire VA med recs?

VA might be correct in their denial....but then again........a real doctor might see the condition differently and directly due to his DMII and/or IHD..

Infections arent good at all and prevalent sometimes in diabetics.

[Greg88]

Berta, yes the body hates stasis, which PN causes, I have noticed now that I'm 57 it's harder to get up when the pain starts in my feet, it was a lot easier when I was 40. I find it amazing how VA examiners nitpick about things that Dr.s in the real world see things much differently than the VA. but doesn't the VA do ultrasounds for diagnosing DVT, oh wait it's the VA.

[john999]

VA discovered calcification in my legs doing a CT scan and it was SC'ed with a good medical report. Artery disease and DMII go hand in hand.

[harleyman]

Thank you all for your responses;

Berta asks:

Your vet does have the PN and I wonder if he has PAD as a cause of the clots.

PAD has not been diagnosed, but IHD and arterialsclerosis has been for many years.

Was his DVT diagnosis from a VA doctor?

Yes, long story VA diagnosed DVT, but I think it was a miss disagnosis, as the Veteran ended up having to have emergency surgery at a private hospital on a Sunday evening as his leg exploded due to swelling caused by infection , and subsequently had two addtional surgeries by vascular surgeon and orthopedic surgeon. (thi all hppened over a period of 3 to 4 moths and the veteran ended up on a wound vac for many weeks. Started in Thanksgiving and the Veteran still needs to use a power chair for abulation if he needs to walk more than 50 yards.

I think this claim could suceed as a secondary to either the IHD or the DMII but it might take a strong IMO.Or the DVT would need a strong association to the DMII or IHD as due to inactivity ...and I see he has a' loss of use of' for one extremity,so that might fit the bill right there.

I agree with you, I sent and email to Dr. Bash and will see what he thinks should be done. He is a radiolgist as you know so he can do an IMO based on some of the tests the Veteran had. Ultrasound and MRI. I myself used Dr. Bash quite some time ago for my claim. He is expensive but in this case i think he will be in his field of expertise.

Harleyman can you tell us the exact words VA used to deny? I guess the potential as due to IHD was not raised by the veteran in the claim and just DMII ??

The C&P exam report has been requested by the Veteran, and he has not yet received it. We don't know for sure if he has been denied but the exam doctor did not touch the Veteran or do any of the ranges of motion. Without those objective findings from the doctor we are fairly positive this will be a denial. The VA doctor also did not have all of the medical records from the private doctors to reveiw he only had the VA reports, which had DVT, and did not address the 7 months of infections, the fat the Veteran went in walking and ended up in a power chair unable to walk and all the surgeries as well as the many weeks of IV antibiotics. The Veteran was in Scott and White for 11 days, and then in an acute care nursing facility for 2 weeks.

Does the veteran have a copy of his entire VA med recs? yes except most recent within last month

VA might be correct in their denial....but then again........a real doctor might see the condition differently and directly due to his DMII and/or IHD..

Infections arent good at all and prevalent sometimes in diabetics.-

The Veteran thinks this all started from a large blister on his toe from his diabetes, and the staff infection entered there but was diagnosed by VA as a DVT, when in fact it was infection in the leg thery were looking at and not blood clot. He is trying to get a copy of the scan on a disc to send to Dr. Bash of the good doctor is so inclined to take this on .

Berta, do you think this may fly as an 1151 claim? Or are the symtoms to close to one another that it is a common mistake made by doctors, and not really considered malpractice?

Edited July 28, 2013 by harleyman

[Berta]

I agree with you, I sent and email to Dr. Bash and will see what he thinks should be done. He is a radiolgist as you know so he can do an IMO based on some of the tests the Veteran had. Ultrasound and MRI. I myself used Dr. Bash quite some time ago for my claim. He is expensive but in this case i think he will be in his field of expertise.

Yes...in my case he completely understood the MRI results and even added PAD to my husband's 1151 disabilities,due to the 1151 stroke from the AO IHD and the AO DMII.

I haven't claimed the PAD yet.... no deadline for 1151 claims...I think once they resolve my 2 pending issues, I will not claim anything more....too rustrating but then again every claim I ever filed has helped me help others..the knowledge gained is really worth more then any accrued retro...

did not address the 7 months of infections, the fat the Veteran went in walking and ended up in a power chair unable to walk and all the surgeries as well as the many weeks of IV antibiotics. The Veteran was in Scott and White for 11 days, and then in an acute care nursing facility for 2 weeks.

Question :Do you mean he went into a VAMC 'walking' and came out in a wheel chair? If so that holds shades of 1151!

Dr. Bash ,in my case, had the proof of prior malpractice in my evidence from the OGC and VA Central

and the stuff I used to succeed with those claims,)

so ,although I had to very carefully word my DMII claim so it did not appear to be an actual 1151 death claim, (because VA had already awarded 1151 death) I found him to be extremely on point when we discussed my past 1151 /FTCA issues.

If this could be a 1151 issue as well as getting the proper SC award as secondary....Dr. Bash will incorporate that into his IMO....as well, but the vet would still have to formally file 1151 claim.

“The Veteran thinks this all started from a large blister on his toe from his diabetes, and the staff infection entered there but was diagnosed by VA as a DVT, when in fact it was infection in the leg thery were looking at and not blood clot. He is trying to get a copy of the scan on a disc to send to Dr. Bash of the good doctor is so inclined to take this on .”

Holy s___t!!!!!! Those med recs should reveal plenty on that!

Negligence and malpractice always has a paper trail.I had to learn many medical symbols and ancronyms when I prepared my 1151 issues. I also had overlooked an entry that a doctor had crossed out....until I figured what he had originally written....

I think I read my husband med recs literally dozens of times many years ago and every reading brought me more evidence of the initial misdiagnosis and then of the VA cover up of it, when they sent him to another VAMC.

Dr. Bash might want his associate John Dorley to look over this vets case.

I know John Dorley from SVR and maybe I could help him assess all this....at some point.

Jbasser posted John's email addy here just the other day...

I will await you answer to the questions here I have.... but so far this smells of 1151 all over the place.