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

[free_spirit_etc]

I do plan on giving the information and studies to the Veteran to take over the the VAMC and leaving studies and information about this condition for the examiner. He can delever this through the patient advocate and they can deliver it to the doctor, who is a real dumb a** in my opinion. We never know what motivates others, until we have walked in their shoes, however, I will help to re-file this claim and give it one more chance rather than do an appeal. We could file an FDC claim and see what happens.-H

I hope you can still get the earlier effective date because he filed for the wrong condition because the VA misdiagnosed him. After all, it isn't a lay person's fault that the VA misdiagnosed him...several times...

[Berta]

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 by harleyman, 28 July 2013 - 10:07 AM.

“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 .”

Posted 28 July 2013 - 10:31 AM

This is the pre-op report of findings and assessment just before the emergency surgery.

“He was initially seen and evaluated and felt to have cellulitis. “

(That is not a confirmed diagnosis.)

(from an August 1 post)

“The veteran states he did not have a DVT but had cellulitis of the left

leg. He had surgery

for the debridement of the left leg secondary to the cellulitis. He

denies

any symptoms

related to the DVTs found on VA and private ultrasounds and for which he

was treated with

heparin and coumadin.

The veteran claims the cellulitis was due to his diabetes.”

Posted Yesterday, 10:12 AM

That is not a confirmed diagnosis.

“The claimed condition is less likely than not (less than 50 percent

probability) proximately due to or the result of the Veteran's

service connected condition.Rationale: The veteran's medical records indicate he had a DVT in

the left leg. The veteran vehemently denies he had a DVT and

states he was misdiagnosed. He states the left leg problem

was due to cellulitis which was treated with hospitalization,

surgery and IV antibiotics. He claims the cellulitis was due

to his diabetes.

There is no indication in the medical literature that

diabetes is a risk factor for cellulitis. It is also not a risk factor

for a DVT which is due to disruption of normal blood flow in

a vein or to other factors such as clotting factors. Therefore,

based on a review of the veteran's medical history, a

review of medical literature and clinical experience and expertise,

the veteran's peripheral vascular disease(or cellultis)

is less likely than not proximately due to service connected

diabetes, hypertension or coronary artery disease.”

from C & P posted yesterday.

This is the same type of BS I fought over for my AO DMII death claim.

It was a Section 1151 issue but I had to word the claim without that factor involved,because of my prior 1151 award letter.

The only way I overcame a statement from a VA Endocrinologist (who said their was no evidence at all of my husband having DMII) was with an IMO from Dr. Bash.

Has the veteran tried to contact Dr. Bash?

Have you or the veteran referred Dr. Bash to our posts here?

If you talk to Dr. Bash, let him know Berta Simmons from hadit,recommended the 1151 in additional to the secondary potential. Give him a link to this thread and he (or John Dorley) can email or call me on that if he wants to.

I am becoming very pressed for time these days ,am back in school, but I went over all of the thread here many times again.

My advise remains the same as months ago.

The veteran must formally claim negligence under a formal Section 1151 claim if he wants the VA to even remotely consider a negligence factor here.

However, the VA would rather deal with trying to make a secondary award then deal with an 1151 claim for the same issue.

But I feel in this type of case, file both ways, 2 separate claims.

My advise remains the same as I gave months ago here.

He needs a real doctor to assess all of his medical records and needs an accurate diagnosis and then a proper treatment plan.

The IMO doctor should be aware of how his initial claim was worded, and will need a copy of this C & P and the last SOC or SSOC the veteran got.

Then the IMO doctor can determine ,if and how,with a full medical rationale, this disability is secondary due his SC DMII. And the IMO doctor can also determine if this is an 1151 issue.

Maybe that would be the time to file the 1151,if the IMO agrees with the 1151 basis. No time limits at all on 1151 claims. In that case the IMO should be sent to support the pending claim and then sent again separately for or attached to the formal 1151 claim.

I appreciate the research that free spirit and you did here harleyman......I did plenty of research too for my DMII claim.

But it will take an IMO to overcome the C & P exam.

Even if a potential IMO doctor's rationale would be the same as what has been presented here, VA will continue to deny and say the claimant does not have any medical expertise to opine on a claim as complex as this issue, the internet printouts are not claimant -specific, and the veteran will not succeed, unless VA can justify an award ,(that would rebutt the C & P doc's opinion) because it is backed up by a valid IMO.

I think the C & P doc (who probably is not an endocrinolgist ,hematoplogist, or radiologist, maybe not even an MD at all, tried to cover the VA's butt here because I think he MUST have smelled malpractice in going through the med recs. It is the way he even worded his rationale to deny.

But that is just my opinion ,having received many many BS

C & Ps over the years too.

This veteran needs, more than anything, a proper diagnosis and viable treatment plan.He was given coumandin and heparin I believe....that tells me they expect a severe clot could form in his leg.

I certainly do agree with the medical statement below that the C & P doctor made. I don't have time to translate those clinical findings.

I believe this veteran needs some serious medical care and doubt if VA is making any attempt at all to provide “clinical correlation.” Are they?

That is how the VA killed my husband....with a utter lack of clinical correlation the very first time he presented at ER with a heart attack,with an EKG to prove it, and yet they instead told him he had a sinus condition that caused his collapse on the VA job and gave him sudafed for it. The VA is still paying for that.

Findings suspicious for partial occlusion of the distal superficial

femoral vein and popliteal veins. This is nonspecific, but could represent

acute or chronic deep venous thrombosis. Clinical correlation is suggested.

[harleyman]

Berta, The underlined part of the post was actually the statement made by the ultrasound technition in the report when they were trying to diagnosed the DVT. The tech was stating the findings were suspecious for occulsion but needed clinical correlation, such as an MRI or other testing. They decided to treat the vet for DVT without confiming the diagnosis. That is malpractice especially when the conditions of diabetic cellulitis or foot sore infection and DVT have similar symptoms. By not confirming the diagnosis the let an infection rage and diffinately caused permanent residuals as well as putting the Vet in danger of loosing his limb and possibly his life.

Your statement:

I certainly do agree with the medical statement below that the C & P doctor made. I don't have time to translate those clinical findings.

I believe this veteran needs some serious medical care and doubt if VA is making any attempt at all to provide “clinical correlation.” Are they?

That is how the VA killed my husband....with a utter lack of clinical correlation the very first time he presented at ER with a heart attack,with an EKG to prove it, and yet they instead told him he had a sinus condition that caused his collapse on the VA job and gave him sudafed for it. The VA is still paying for that.

Ultrasond report from VA tech:

Findings suspicious for partial occlusion of the distal superficial

femoral vein and popliteal veins. This is nonspecific, but could represent

acute or chronic deep venous thrombosis. Clinical correlation is suggested.

I appeciate your insight as usual. We will be filing an 1151 claim, reopening the claim for the residuals, as well as trying to find an attorney willing to take on a malpractice case against the 1st hospital, who had him in thier hospital for 5 days and in the emergency room on two occasions and still didn't get it correct.

The VA examiner just rubber stamped the treatment received bythe VA. He did give the diasnosis, which the VA says the veteran didn't have a diagnosis so I think this newest denial could be a CUE, as the examiner states the Veteran has a diangosis, but proclaimed it is not due to the veteran's S/C conditions. Then the RVSr did not list the exam as evidence when clearly the exam shows the veteran with a diadnosis. This whole case is messed up. It will take Dr. Bash to get in thier face to straighten it out. In he meantime we are proceding on with getting everything in order as an FDC claim.

[free_spirit_etc]

Something interesting about the Section 1151 claims is they can be based on:

The direct result of VA fault such as carelessness, negligence, lack of proper skill, or error in judgment, OR

Not a reasonably expected result or complication of the VA care or treatment.

So even if someone can't prove negligence (which I think you should be able to prove) - they could prove that the disability wasn't a reasonable expected result.

I just read a case the other night when I was looking up something else, and the widow was granted SC for the veteran's death because he died, and he wasn't reasonably expected to.

Of course, since they granted the claim on that basis - there was no reason to discuss negligence and carelessness.

I wonder how easy it is to prevail on a Section 1151 claim on the "reasonably expected" basis, if there wasn't negligence.

[free_spirit_etc]

"By not confirming the diagnosis the let an infection rage and definitely caused permanent residuals as well as putting the Vet in danger of loosing his limb and possibly his life."

I am not sure he is out of the woods on this yet, until that is TOTALLY healed up.

Findings suspicious for partial occlusion of the distal superficial

femoral vein and popliteal veins. This is nonspecific, but could represent

acute or chronic deep venous thrombosis. Clinical correlation is suggested.

It is so odd (if we are talking about a real doctor) for a doctor to so dismissively discuss what the veteran told him (about being misdiagnosed with DVT) when the report just says the findings were suspicious for __ and that it is nonspecific, but COULD represent ___"

Personally, I think the C&P exam should be able to be used as part of the evidence of the pattern of negligence with this veteran. He dismissed the veteran's statements, made a diagnosis that was based on a "suggested, possible, maybe" type report without ordering more testing, and made some off the wall statement about how cellulitis is not associated with diabetes (based on some non-existent search of medical literature). It is beyond ridiculous!

To care for him who shall have borne the battle ...