What Is He Saying Here?

[free_spirit_etc]

This is actually from one of my IMOs

"The 100 or so pages of records that I have reviewed clearly show that he was separated from the US Air Force on 9/30/98 at a time when he manifested no symptoms from his left lower lobe lung cancer (although Ms XXXXX has indicated that he complained of fatigue at the time of his discharge which can be a prominent symptoms of lung cancer). A chest x-ray done on 6/24/96 was read as unremarkable. A physical exam performed at the time of his separation from the service cannot be found at this time."

Does it sound like he is saying that my husband's reported fatigue could be related to his cancer? I actually think that he is saying that he manifested no symptoms -- but that he reported fatigue and that could be a symptom. (i.e. he manifested no apparent symptoms expect for possibly fatigue).

But since he stated it the way he did -- especially with parenthesize - the VA could also take it to mean - He manifested no symptoms - and even though he reported fatigue, and fatigue is a prominent symptom of lung cancer (i.e. he did not manifest any symptoms)

I am wondering about that before I start finalizing my argument. I also wonder if I should write and ask him to clarify the statement -- and see about adding an addendum to his IMO that expands on the fatigue a bit.

[71M10]

To me the first line you quote from the physician at the top of this thread is a clear indication that the physician thought lung cancer was present. "clearly show that he was separated from the US Air Force on 9/30/98 at a time when he manifested no symptoms from his left lower lobe lung cancer" this is a declarative statement. If they are willing to follow up their opinion with the tumor doubling data that is supported by the size it was during the first definative identification (and work it back) you should have enough evidence. Tumor doubling is commonly used to determine when a cancer was established/started. I find the disappearance of the seperation physical telling. Mine disappeared also, I think they were just hiding/covering up heart disease. Every other scrap of paper (good and bad) that was done in the military on me is still around except for that last physical and the the x-rays. The only proof that I had one was an entry on my medical record indicating one was completed (they missed that page of records).

When you know who your judge is, i would start researching how they have ruled on similar issues (they are not held to it, but it might give you an Idea how they think)!

[free_spirit_etc]

Thanks 71M10,

I have attached the VA examiner's opinion -- and my 2 IMOs. The examiner that made that statement is IMO 2, but IMO 1 is much stronger as far as reasoning goes.

I was mostly revisiting the "manifest" portion in the presumptive regs. For some reason, the VA seems to like to jump to that (though the regs say direct service connection can be granted even if the disease wasn't considered manifest within the presumptive period).

I am sorry they lost your discharge physical too. My husband's case was the same.The SMRs note that a discharge physical was completed. What gets me is no one ever told him it was missing. But all the decisions don't mention a thing about his discharge physical. It is always just "Your SMRs didn't show..." I think it has most likely been missing since he retired. But they have never mentioned it.

VA examiner opinion_ onset.pdf

IMO_onset_1_redact.pdf

IMO_onset_ 2_redact.pdf

[free_spirit_etc]

I already had my hearing. But I have additional time to submit evidence. I have looked up quite a few of my judge's decisions. He has granted similar types of claims. But I have read that the attorneys are the ones who write the decisions. So it could make a difference on which attorney is assigned to my claim too.

[63SIERRA]

it seems like they could look at the xrays when he had the cancer and by its size, possibly determine how long it was there, at least an estimate? or other things like the typical time of progression of his particular type of cancer.

[63SIERRA]

also can u get ahold of any of his blood test records, there could be elevation or declination of something in the tests that could point to a cancer condition, like elevated white blood cells, or elevated antigen s. Or how abt the autopsy, any notes in there, ? just trying to be helpful ,hope im not being unsensitive.

also keep this in mind an xray could have EASILY missed a cancer spot in the lungs. My father had lung cancer and it started off as a tiny dot in his lung. It was so small they had to tattoo a corresponding dot under his armpit, to aim the radiation gun at, to try and blast the cancer. When they blasted it, all hell broke loose. He died abt 8 months later, of the lung cancer. Ive had xrays where they thought thought they saw something, and had me get re xrayed several times, before they dismissed it as not anything to worry abt. Xrays are not perfect science thats why theres now cat scan, mri, magnetic resonance , dye injections, ect. Xrays were invented to look at bones., the tissue was a bonus, but not that great. Maybe bring up the fact that they didnt do a mri , or cat scan.

to me it sound like the doctor is saying that the xray is not all that conclusive. If it were that conclusive, he would have just noted that, and basically been done. The fact that he acknolwedges the fatigue, and would have like to have seen the exit physical records, tells me he is someone inclined to believe that the cancer did start while in service.

Heres what I would do. I would call that doctor and ask him if its as least likely as not that it developed in service, if he says yes, go get it in writing , if he says no, hang up.

Edited October 30, 2013 by 63SIERRA

[free_spirit_etc]

Sierra,

Thanks. I actually did get the opinions in writing in regard to whether the cancer started in service. I attached them in post #9.

The part I put in the initial post was just a portion of the opinion, where he noted fatigue.

But both IMO doctors clearly stated it is more likely than not his cancer started in service.

I am sorry to hear about your father.

Edited October 30, 2013 by free_spirit_etc