Claim Nightmare Going On Since 2007

[Tunaboat]

What a nightmare of a time I have had getting to the final disposition of my claim which started in 2007. It seems it is better to provide more info than less so this maybe a rather long post, I'll be brief when I can. My typing and sentence construction is difficult at times as I had a TIA in May of 2012.

In August 2012 I found out by accident that I could be “advanced on the docket” if certain conditions were met. My condition appeared to merit advancement as it was awarded. However, since being advanced on the docket, I have received notice that more medical information was necessary and the VA is still not able to make a determination in my case.

I was medically retired from the US Navy and granted 30% service connection for Coronary Artery Disease after a heart attack while onboard the USS New Jersey in 1989. In 2007 I made a request for increase in service connection as my medical condition was deteriorating due to ongoing and increased medical conditions related to my service connected condition. That increase was denied and it has been on appeal since that time. I did receive a 30% service connection for depression with anxiety secondary to heart attack, I was then given the combined rating of 50% SC.

I have used the VA as my provider of choice for many years, I came to the VA emergency department on the morning of January 8, 2012 as I was experiencing chest pain. While in the ER on that Sunday morning I had a massive heart attack and was admitted to the Birmingham VAMC. The next day during a heart catheterization it was determined that my coronary arteries were 95% blocked and triple bypass surgery was necessary. Bypass surgery was completed January 11, 2012 at the Birmingham VAMC.

I have been told to be patient and “wait your turn” as there are a number of claims ahead of you and “you can’t rush the VA when it is something this important.” While I appreciate the quality, care and attention I have received during this medical odyssey, I am very frustrated with the compensation & pension and appeals process and the ongoing wait for a decision regarding an increase in service connection of Coronary Artery Disease. My medical information lies within my VA chart as the heart attack and surgery happened at my local VAMC, the information necessary certainly must be on file or should have been collected by now, I have signed the necessary releases and continue to wait for an answer.

In April of 2012 I had a Trans-Ischemic Attack, (TIA) and I now have a stutter, problems with balance, difficulty with word finding, and my short-term memory continues to be a big problem in my day to day life. I have also put in a claim for this condition and have been initially denied SC as a secondary condition, I have appealed and am waiting to hear a determination on it as well. The increased stress exacerbates my ongoing depression, and increases problems with organization, word finding, and stuttering and makes it more difficult to continue in my job at the VA.

Due to my service connected condition and related health problems I can no longer work as a mental health therapist and social worker assisting veterans, work I have loved and found extremely satisfying for many years. Following the heart attack I did receive 3 months of 100% temp. SC during convalescence. A small amount of support considering I have missed the equivalent of nearly $30,000 since the beginning of 2012.

I am currently SC for Arteriosclerotic Heart Disease 30% (first SC and reason for military retirement in 1989) Major Depressive Disorder 30%, superficial scaring 20%, Tinnitus 10%, 3rd degree burns 10% & 3rd degree burns 0%. Still working, need to be medically retired and waiting for SC. So much info, I am considering hiring an attorney. What do you suggest???

To the HADIT family, in advance, thank you for your suggestions and assistance.

Dean A. Daniels, USN (retired)

[jbasser]

Dean, what is your last Ejection Fraction measurement?

You need a Bash IMO to beat this.

J

[Berta]

Lots here

“I was medically retired from the US Navy “

“combined rating of 50% SC. “

I am sure,but it pays to ask, that you have looked into CRSC and/or CRDP as I beieve the 50% might put you into CRDP criteria:

http://www.dfas.mil/retiredmilitary/disability/crdp.html

“triple bypass surgery was necessary. Bypass surgery was completed January 11, 2012 at the Birmingham VAMC. “ I am glad they handled the temp convalenscense claim fairly fast.

“In April of 2012 I had a Trans-Ischemic Attack, (TIA) and I now have a stutter, problems with balance, difficulty with word finding, and my short-term memory continues to be a big problem in my day to day life. “

This TIA ,in my lay opinion but based on TIA experience, is more than likely due to your heart disease.Also it sounds more like a CVA than a TIA. But I am not a doctor.

“Arteriosclerotic Heart Disease 30% “ This is also known as Ischemic heart disease and is known to cause ischemia (blockage) in the brain due to blood clots ( TIAs and full blown strokes (CVAs)

Are you also diagnosed with HBP?

If so, is that documented as due to the heart disease?

Are you treated for high cholesterol?

What did the MRI narrative state? Did you even get an MRI?

“The increased stress exacerbates my ongoing depression, and increases problems with organization, word finding, and stuttering and makes it more difficult to continue in my job at the VA.” Of course it does. TIAs often leave minor deficits,sometimes completely unnoticed by the patient. Other TIAs can be more disabling.

“makes it more difficult to continue in my job at the VA.” My husband was 100% SC P & T 3 years after his initial TIAs.100% for PTSD and then 100% under 1151 for a CVA that the untreated TIAs and CAD caused.

My husband had a heart attack while employed at the VA He had been seen also for multiple TIAs and then had a full blown stroke.

Others here have experience with FERS.I assume you have FERS at the VA, but I could be wrong.

It looks to me that you eventually might be unable to work at all, but that is a medical determination that a doctor must make.

“Still working, need to be medically retired and waiting for SC. So much info, I am considering hiring an attorney. What do you suggest??? “

The medical retirement and also applying for Social Security Disability benefits, sets the stage for TDIU.. We have a forum on TDIU, paid at the 100% rate to any veteran whose Scs prevent them from working.

You might well need a strong IMO (Independent Medical Opinion) for a doctor to connect the dots here.

Jbasser asked an important querstion, as he is thinkling of the potential CAD rating you might get.

Can you explain this:

“In August 2012 I found out by accident that I could be “advanced on the docket” if certain conditions were met. My condition appeared to merit advancement as it was awarded.” Did that decision come from the BVA?

That alone tells me that you should be getting either 100% or TDIU but then again, you are still employed. And by the VA itself.

“However, since being advanced on the docket, I have received notice that more medical information was necessary and the VA is still not able to make a determination in my case. “

That is where the IMO will be needed in my opinion. JBasser gave you a great IMO docs.name.

Dr BAsh has done many SVR radio shows here in our SVR archives up top.

As a NeuroRadiologist he prepared IMOs for my claim, that covered IHD,DMII, TIAs and CVA and other secondaries.

VA is using a different TDIU method then they used for years, asking the claimant to focus initially on the most disabling condition they have, that should warrant TDIU (to include any secondaries.) I am sure someone has posted that new TDIU info here by now.

What I see is that your CAD more than likely caused the TIA , causing in turn 'possible' ratable physical disabilities,.... not enough info here to know ….. but certainly the TIAs due to the IHD (CAD) (in my experienced lay medical opinion) has excerbated the SC MDD you have now.

This should be a TDIU no brainer but you cant file for TDIU until you are officially unemployed.

My neighbor worked at VA and an inservice back injury , which a VA doctor service connected for him , on paper, even before he filed a claim ,caused him to leave VA and use the FERS disability system and then he had to apply for and received SSDI and although he says those findings were solely for the back injury in service, he doesn't get it that the 10% SC VA gave him is crap and they owe him TDIU.....he isn't interested in applying. He also is 20 years Retired and it would set him up for CRDP but he isnt interested in that either. So maybe there was more to his disability picture then he told me.

In your case, others here have dealt with FERS. My husband was paying into it in 1988 at the VA so I assume you are covered by it.

It seemed to me that my neighbor had a very swift time getting his 10% SC from the VA,along with his FERS and SSDI.My claim ( death due to AO DMII ) had already been at this same VARO for years by then. His VA claim took 8 months. Then again all he got was 10% VA SC deducted from his Mil Ret. check every month.

Edited August 7, 2013 by Berta

[Berta]

Just to add one more point here that might help you or someone else out there.

TIAs are rated on residuals and often found to be non compensable.

However this is a very unusual case: because the BVA did not explain the jump in the vet's prior TIA rating:

"In a July 2007 rating decision, the RO granted service connection for residuals of transient ischemic attack (TIA) from lacunar infarct, rated noncompensable from November 23, 2006. The Veteran appealed for a higher rating. In a January 2008 rating decision, the RO granted a 100 percent rating for TIA, effective November 23, 2006, with a noncompensable evaluation effective June 1, 2007. Hence, this issue is as characterized on the first page of this decision."

And
"Finally, as to the claim for a higher rating for service-connected residuals of TIA, the Board notes that the Veteran has submitted several medical certificates from Cebu Doctors' University Hospital (CDUH), as well as reports of magnetic resonance imaging (MRI) scans, but the clinical records of such treatment are not on file and must be obtained. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159.

CDUH records reflect that in November 2006, the Veteran was diagnosed with an acute hypertensive attack, TIA, lacunar infarct. He was treated for additional TIAs in December 2006, February 2007, July 2007, May 2008, June 2008, and December 2010. A November 2008 VA medical opinion indicated that the hospitalizations after November 2006 were not for active cerebrovascular hemorrhage or active cerebral strokes, but rather were for TIA and acute hypertensive attack.

The most recent VA brain and spinal cord examination to evaluate the current residuals of TIA resulting from lacunar infarct was performed in July 2007. The examiner noted that the Veteran was being maintained on anti-hypertensive medication and treated conservatively. He stated that the Veteran had no overt residual motor symptoms. On examination, muscle strength was 5/5 (full) in the upper and lower extremities. Muscle tone was normal, and there was no atrophy. Deep tendon reflexes were 2+ throughout. There were no dysesthesias, no tremors or fasciculations, ataxia, incoordination or spasticity, no speech impairment, and no evidence of other autonomic nervous system problems. Gait and balance were normal. There was no bowel or bladder impairment, no cranial nerve impairment, no cognitive or psychiatric impairment, no loss of sense of taste or smell, no limitation of motion of joints. The examiner diagnosed lacunar infarct, old, and the problem associated with the diagnosis was TIA. The examiner indicated that the TIA resulted from the ischemic lacunar infarct, which in turn was due to the Veteran's uncontrolled hypertension. The examination noted that the Veteran's cognitive skills had remained intact."

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp11/Files3/1120514.txt

Unfortunately this claim was remanded and I believe the jump from “0” TIA rating to 100% TIA rating from Nov 2006 to June 2007,was due to a full blown stroke at that time (CVA) ratable at 6 months at 100%, then rated for residuals after that point.

I am guessing on that however ,based on personal experience with TIAs,CVA ratings etc.

[Tunaboat]

Thank you all for the great ideas. I have tried to respond on a couple occasions today but did not have the time. I hope to write an I depth response tomorrow.

Thanks,

Dean

[Testvet]

my fight with the VA for heart disease and TIA's and strokes took from Dec 2002 until June 2009 with the help of a lawyer to get my heart SC mind you I went from a stroke in April 1992 within a year of discharge from Desert Storm a roto rooter in Feb 94, triple bypass in 97 in Oct 2002 the VA did a heart cath and told me to put in for SSD and VA if it was SC my bypass failed and my ejection fraction was less than 30% SSD was approved in Apr 2003 with effective date of Dec 2002 since I quit working due to CHF in June 2002

I got an attorney in June 2007 when the law was changed and she knew what she was doing and within 2 years I got 60% for CAD. in Apr 2011,. I had a major heart attack the doctor told my wife I had a very low chance of leaving the hospital alive, I did and was transferred to MUSC in Charleston for a work up for a VLAD device or other options, heart and lung transplant, NO, VLAD, NO, heart transplant NO, another bypass NO, medications only and I was diagnosed with end stage congestive heart failure supposedly with six - 12 months.. In June the docs put me on oxygen 24/7 and I was now using a wheelchair and not leaving the house except for VA appointments or admissions to ER for bouts with CHF, I spent from Thanksgiving 2012 to Apr 2013 in and out of ICU having fluids drained off my lungs and IV lasix to take fluids off my legs and other places. I have been lucky this summer my last ICU was in Apr 13. We have learned better home care of lasix and a BIPAP machine to take off the carbon dioxide from the blood since my lungs are not doing it properly on their own. The docs put in a CRT pacemaker/defib since my EF was 15 as of Apr 2011.

I made it thru this because I was found disabled by SS and the VA rated me in 2006 at 100% for PTSD otherwise we would have been in serious financial trouble. yes they denied then they gave a low ball rating for PTSD in 2005 at 50% and kept denying heart issues, the VA gives you nothing but stress and thinking you have found a new way to skin that cat will leave you hurting you need a rep or a lawyer and let them handle the stress, the money will come when the evidence is right and seen by the right people until then you are the one going to pay health wise for it, you are not bothering anyone at the VA and they are not missing a meal let alone anything else they need their paychecks for.

[Tunaboat]

Dean, what is your last Ejection Fraction measurement?

It was done at the VA. Visual estimate between 50-60

“I was medically retired from the US Navy “

“combined rating of 50% SC. “

I am sure,but it pays to ask, that you have looked into CRSC and/or CRDP as I beieve the 50% might put you into CRDP criteria:

http://www.dfas.mil/...ility/crdp.html

I did look into CSRS and CRDP long ago. I refreshed my memory and came up with this: you are a disability retiree who earned entitlement to retired pay under any provision of law other than solely by disability, and you have a VA disability rating of 50 percent or greater. You might become eligible for CRDP at the time you would have become eligible for retired pay.

I am not a 20 year veteran.

“In April of 2012 I had a Trans-Ischemic Attack, (TIA) and I now have a stutter, problems with balance, difficulty with word finding, and my short-term memory continues to be a big problem in my day to day life. “

This TIA ,in my lay opinion but based on TIA experience, is more than likely due to your heart disease.Also it sounds more like a CVA than a TIA. But I am not a doctor. I am in full agreement, I think it is absolutely related to my heart disease.

“Arteriosclerotic Heart Disease 30% “ This is also known as Ischemic heart disease and is known to cause ischemia (blockage) in the brain due to blood clots ( TIAs and full blown strokes (CVAs)

Are you also diagnosed with HBP? yes, and it is controlled with continuous medication, my understanding that although it is controlled, it should and can be service connected, am I correct?

If so, is that documented as due to the heart disease? No, it is not

Are you treated for high cholesterol? Yes, and I have been on continuous medication since retirement in 1989.

What did the MRI narrative state? Did you even get an MRI? Are you speaking of MRI with contract to the head? Yes I have and there appears to be some micro-angiophraphic changes from an MRI from a few years earlier

“The increased stress exacerbates my ongoing depression, and increases problems with organization, word finding, and stuttering and makes it more difficult to continue in my job at the VA.” Of course it does. TIAs often leave minor deficits,sometimes completely unnoticed by the patient. Other TIAs can be more disabling.The depression, anxiety and problems associated with TIA have made my life hell.

“Still working, need to be medically retired and waiting for SC. So much info, I am considering hiring an attorney. What do you suggest??? “

The medical retirement and also applying for Social Security Disability benefits, sets the stage for TDIU.. We have a forum on TDIU, paid at the 100% rate to any veteran whose Scs prevent them from working. I applied for TDIU and my understanding is, it can be considered and will be AFTER other SC issues are settled if I have not met the threshold for 100%.

You might well need a strong IMO (Independent Medical Opinion) for a doctor to connect the dots here. Would you suggest Dr. Bash?

Jbasser asked an important querstion, as he is thinkling of the potential CAD rating you might get.

Can you explain this:

“In August 2012 I found out by accident that I could be “advanced on the docket” if certain conditions were met. My condition appeared to merit advancement as it was awarded.” Did that decision come from the BVA? Yes, BVA advanced me on their docket. Because of the heart attack and TIA they found it appropriate to have my hearing sooner rather than so much later.

That alone tells me that you should be getting either 100% or TDIU but then again, you are still employed. And by the VA itself. Yes I am employed by the VA. But no longer as a therapist. (I had asked for a reasonable accomodation, when it was granted this was the job they came up with. It was a real blow to my self esteem to begin with, I have grown use to the position over time). I work in the substance abuse clinic doing alcohol breathalzyer tests and one group per week. I am not capable of the thinking and organization that my former job required.

“However, since being advanced on the docket, I have received notice that more medical information was necessary and the VA is still not able to make a determination in my case. “ I have provided all the necessary new medical notes. All of my care has been done here. I did have an arteriogram at an outside hospital back in February, they have that information as well.

That is where the IMO will be needed in my opinion. JBasser gave you a great IMO docs.name.

Dr BAsh has done many SVR radio shows here in our SVR archives up top. I will sure check on the Dr. Bash possiblity, thanks for the info.

As a NeuroRadiologist he prepared IMOs for my claim, that covered IHD,DMII, TIAs and CVA and other secondaries.

VA is using a different TDIU method then they used for years, asking the claimant to focus initially on the most disabling condition they have, that should warrant TDIU (to include any secondaries.) I am sure someone has posted that new TDIU info here by now. When the temp 100% was awarded I had put in for the TIA's, & ED, I applied for TDIU and my understanding is, it can be considered and will be AFTER other SC issues are settled if I have not met the threshold for 100%.

What I see is that your CAD more than likely caused the TIA , causing in turn 'possible' ratable physical disabilities,.... not enough info here to know ….. but certainly the TIAs due to the IHD (CAD) (in my experienced lay medical opinion) has excerbated the SC MDD you have now. I agree

Thank you all for your replies, I never had a chance to reply yesterday, .