Have A Few Ratings Over The Years, All Basically The Same?

[MartyL16]

All the way back to 1987. Usually with the same denials. Never did they ever go back to the active duty records to "confirm" what I was telling them.

Rating usually stated "...is continued at %". or "remains denied" and you know what. I was too depressed and sick, and ignorant of how to proceed, how to fight for me, until lately!

My questions: Since they referenced no "codes", never explained why, and even when I stated extreme pain, on movement, did the wincing, refused to go past my "pain point", the ratings always said "mild pain". Since 2009 they stated they had no access to my records on the computer, so the only info that they had was my verbal answers to their questions.

Have to mention that I have NEVER seen "them" use a worksheet from the VA. Always saw them scribble a word or two on a regular tablet. Also never had an exam that went more than about 15 minutes.

I am thinking maybe since the info does not actually reflect what is in my "actual" records(that are only) referenced by "clinic name" but no specifics confirming my claims, shouldn't I have other appeal or legal rights?

Maybe their failure, over at least 4 separate ratings, to give me my rights of "due process", or whatever.

Since they always failed to describe the details, or use codes, maybe I can submit as "reopened claims" based on facts that they "missed"? Afterall, they now at least "mention" records that they have and should have had since 1967 and beyond.

For the record, I have an SC 0 from active duty, DM II from 2004 with a marginal SC % presumptive to AO from 'Nam and Thailand.

Thanks

[free_spirit_etc]

Here are some of the rating tables:

http://www.benefits.va.gov/warms/bookc.asp

7907 Cushing’s syndrome

As active, progressive disease including loss of muscle strength, areas

of osteoporosis, hypertension, weakness, and enlargement of

pituitary or adrenal gland ................................................................................. 100

Loss of muscle strength and enlargement of pituitary or adrenal gland .................. 60

With striae, obesity, moon face, glucose intolerance, and

vascular fragility ................................................................................................ 30

Note: With recovery or control, evaluate as residuals of adrenal insufficiency or cardiovascular, psychiatric, skin, or skeletal complications under appropriate diagnostic code.

7913 Diabetes mellitus

Requiring more than one daily injection of insulin, restricted diet,

and regulation of activities (avoidance of strenuous occupational

and recreational activities) with episodes of ketoacidosis or

hypoglycemic reactions requiring at least three hospitalizations per

year or weekly visits to a diabetic care provider, plus either

progressive loss of weight and strength or complications that

would be compensable if separately evaluated ................................................ 100

Requiring insulin, restricted diet, and regulation of activities with

episodes of ketoacidosis or hypoglycemic reactions requiring one

or two hospitalizations per year or twice a month visits to a diabetic

care provider, plus complications that would not be compensable

if separately evaluated ....................................................................................... 60

Requiring insulin, restricted diet, and regulation of activities ................................. 40

Requiring insulin and restricted diet, or; oral hypoglycemic agent

and restricted diet .............................................................................................. 20

Manageable by restricted diet only .......................................................................... 10

Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913.

6846 Sarcoidosis:

Cor pulmonale, or; cardiac involvement with congestive heart failure,

or; progressive pulmonary disease with fever, night sweats, and

weight loss despite treatment .......................................................................... 100

Pulmonary involvement requiring systemic high dose (therapeutic)

corticosteroids for control................................................................................... 60

Pulmonary involvement with persistent symptoms requiring chronic

low dose (maintenance) or intermittent corticosteroids ..................................... 30

Chronic hilar adenopathy or stable lung infiltrates without symptoms

or physiologic impairment..................................................................................... 0

Or rate active disease or residuals as chronic bronchitis (DC 6600) and extra-

pulmonary involvement under specific body system involved

7005 Arteriosclerotic heart disease (Coronary artery disease):

With documented coronary artery disease resulting in:

Chronic congestive heart failure, or; workload of 3 METs or less results

in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular

dysfunction with an ejection fraction of less than 30 percent.......................... 100

More than one episode of acute congestive heart failure in the past year,

or; workload of greater than 3 METs but not greater than 5 METs

results in dyspnea, fatigue, angina, dizziness, or syncope, or; left

ventricular dysfunction with an ejection fraction of 30 to 50 percent............... 60

Workload of greater than 5 METs but not greater than 7 METs results

in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of

cardiac hypertrophy or dilatation on electrocardiogram,

echocardiogram, or X-ray................................................................................... 30

Workload of greater than 7 METs but not greater than 10 METs results

in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous

medication required............................................................................................ 10

Note: If nonservice-connected arteriosclerotic heart disease is superimposed on service-connected valvular or other non-arteriosclerotic heart disease, request a medical opinion as to which condition is causing the current signs and symptoms.

[Berta]

Sorry for delayed reply...... I was concerned about the Nehmer decision .Thanks for posting it.

There appears to be no diagnosis of Ischemic heart disease due to incountry Vietnam service.

You claimed PVC but that does not fall under the Nehmer IHD regulations.

The decision contains the exact Harrison's Principles definition of IHD.

Do you have a confirmed diagnosis of IHD from VA or from any private doctor?

Have you ever been diagnosed with dysrhythmia, atrial tachycardia, cardiac hypertrophy.

or any other heart related condition that could cause the PVCs?

Has any doctor suggested that the PVCs could be secondary to your SC DMII?

I am, not a doctor but I have studied cardiology.

PVCs appear on EKGs of many overall healthy people and yet they indicate no cardio problems unless further testings reveal a cardiac cause that can be diagnosed.

I read over the cardio info carefully.

Have you sent to VA Proof of what they requested here?

They need diagnosis and documented medical proof of the mitral valve disease, PVCs, and/or Coronary heart disease or IHD.

They also requested proof of the mitral value prolapse which 'existed from” your military service.

It is possible that these conditions could stem from your SC DMII ,however it would take an independent medical opinion to support that claim.

This is not a Nehmer situation. You can appeal any of the other parts of the decision if you feel your medical evidence falls into a higher rating category in the VA Schedule of Ratings here at hadit.

I strongly suggest you go through your SMRs carefully to see if VA missed anything possibly indicating the Mitral valve problem.

And I suggest going over the Diagnostic coders and ratings in the VA SRD here at hadit, for all of the SC disabilities ,to see if VA ignored medical evidence (or if you have medical evidence they didnt see yet,) that would support a higher rating for any of them.

I see they did have your SMRs...that does not mean they reviewed them carefully for evidence of the Mitral Valve disease.

Also you need to check the evidence list carefully in the decision to see if,in fact, they had obtained any private treatment records,for any of the conditions claimed.

They are definitely stating in the decision that no IHD diagnosis was made by the VA examiner on April 5,2011.Have you subsequently received a IHD diagnosis and does VA know that?

Edited October 28, 2013 by Berta

[MartyL16]

Sorry for delayed reply...... I was concerned about the Nehmer decision .Thanks for posting it.

There appears to be no diagnosis of Ischemic heart disease due to incountry Vietnam service.

Actually, that is part of the problem with this rating. In 2008-2009 I went to my cardiologist, he tested, said mitral valve prolapse and I sent that copy to the RO thru the Amer. Legion in 2009. The RO is in Albq. NM, The Nehmer review was in San Diego, CA for more AO "stuff" and they actually told me the DD-214s were NOT proof for 'Nam.

Since I already had the presumption for DM II (since 2004), all the Nehmer review did for me is "tick me off" as they were not reviewing my records of VietNam and said there was no proof of Nam, just Thailand. Interesting because they refused to accept my VietNam medals with clusters on multiple 214s. Then I sent them envelope, then they learned how to read and saw my TET OFFENSIVE in my Service Records, which they already had but I "highlighted" the "stuff" for "clarity"

They state in this rating of 2011 "that shows noted history of PVCs" from my private doctors from 1990-2003(CIGNA), and 2004-2008(Associated Internists then they state "service connection for PVCs is denied because current evidence does not show a relationship between the disability which occurred in service and the current condition. That was as of 2006 and thru 2011.

So I am saying(in my appeal), VA is confirming SC for PVCs in 2006 but still denied it anyway, in 2004, 2006, 2009, and 2011. OK, they say no PVCs in 2 separate FIVE SECOND EKG strips somtime in 2010. DUH! The point is my Active duty medical records form 1980-1987 show PVCs (up to 2000 per hour, on rare occasions), and again as stated above from 1990-2008 after my 20yrs. In other words, who are these people and when were their lobotomies performed?

You claimed PVC but that does not fall under the Nehmer IHD regulations. No but the mitral valve prolapse does

The decision contains the exact Harrison's Principles definition of IHD.

Do you have a confirmed diagnosis of IHD from VA or from any private doctor? private cardiologist wrote "MITRAL VALVE PROLAPSE"

Have you ever been diagnosed with dysrhythmia, atrial tachycardia, cardiac hypertrophy.

or any other heart related condition that could cause the PVCs? No, but hadn't seen a cardiologist from 1983 to 2006

Has any doctor suggested that the PVCs could be secondary to your SC DMII? The PVCs were 1st in 1980, the sacoidosis in 1985, and the DM II in 2004, and the mitral valve prolapse in 2008-2009. I was also in Thailand in '69-70 at Urdorn and it has been an AO base for years. So 'Nam and Thailand confirmed for AO exposure.

Also seeing court decision that awarded SC presumption from AO for sarcoidosis and lately, DM II presumption from sarcoidosis. It is common for "learned" doctors to state this presumption as "more likely than not", which "opens the door" for "secondary" claims and "aggrivation" of an SC or even a non-SC association.

Useful for me and others as in my case, I get pneumonia, about every 1.5 to 2 years. More than 9 times since the onset of sarcoidosis, and, of course, chronic bronchitis ( as secondary to sarcoidosis). Sarcoidosis is a immuno-suppressant disease.

I am, not a doctor but I have studied cardiology. My X-wife was an ER and ICU Director and Cardiac certified nurse.

PVCs appear on EKGs of many overall healthy people and yet they indicate no cardio problems unless further testings reveal a cardiac cause that can be diagnosed. You are right, and when there are so many per hour that your heart has trouble getting fresh blood to the brain and the rest of the body. You feel very tired, have trouble breathing, and the PVCs are "pounding away" in my chest. They put me on NORPACE(1980), for many years until they had to take me off as there were severe problems with that medication. Have had PVCs at times similar to what I have described but they went away "by themselves" just as fast as they "came on". As of June 2013, "they are back", bothersome, terrible at times and time for the 24 hour "halter" to measure them and prescribe meds.

I read over the cardio info carefully.

Have you sent to VA Proof of what they requested here? Yes, they had had proof over the years, all the way back to my active duty records but, as many have said, they are ignoring MOST of my records, including "evidence", my Active Duty, The CIGNA, and the Associated Internists, that was in their possession, way before January 2011 regarding the "prolapse". I haven't sent my appeal doc as it is not complete and I don't have a SOC to refer to.

They need diagnosis and documented medical proof of the mitral valve disease, PVCs, and/or Coronary heart disease or IHD.

They also requested proof of the mitral value prolapse which 'existed from” your military service. This did not exist from military service as I told them in 2010 as I was not claiming the mitral valve prolapse to be SC. Just wanted it in the records as DM II is "notorious" for many heart problems.

It is possible that these conditions could stem from your SC DMII ,however it would take an independent medical opinion to support that claim.

This is not a Nehmer situation. You can appeal any of the other parts of the decision if you feel your medical evidence falls into a higher rating category in the VA Schedule of Ratings here at hadit. The Nehmer element was as described above.

I strongly suggest you go through your SMRs carefully to see if VA missed anything possibly indicating the Mitral valve problem. Explained above

And I suggest going over the Diagnostic coders and ratings in the VA SRD here at hadit, for all of the SC disabilities ,to see if VA ignored medical evidence (or if you have medical evidence they didnt see yet,) that would support a higher rating for any of them. Yes, exactly my point. This rating shows how "faulty", (I mean negligent), the claims system is and has been for many years. As I have stated (or bared my soul in other posts), and on occasion, showed my naivete, and I reiterate, that I should't have given up for almost 20 years if I had known the "fight" would take this long.

The VA calls this a "process" and affirms it to non-adversarial. Really....what part?

I see they did have your SMRs...that does not mean they reviewed them carefully for evidence of the Mitral Valve disease. Actually, they elude to having my SMR but NEVER state, affirm dates, years, documented facts of any of my medical conditions. Remember, these idiots couldn't even realize that I had been physically in VietNam, and did "a liitle combat", until I stuck it in front of their faces, so missing this rating and others all the way back to my 20 years of honorable active duty, is no surprise. Fire the 'lot' of them that can't read, comprehend, or are just there for the coffee and doughnuts"

Good news, and bad news. In all the court cases I have read ( and I have been doing that for years and average 4-6 hour per day), the VA examiner is NOT required by law to read, peruse, or examine the claimant's medical records/C-file prior to any exam. That doesn't mean it is not recommended though. (that is the bad news). There are bills in the House that are discussing/proposing that this be made as part of a mandatory process, that should have been in effect all along (the good news)

If I appear "bitter", then that would be an "accurate assessment". I never rant, or rave though.

The original SC 0% back in 1987 for my sarcoidosis was a "clue" that they didn't read everything. I had pneumonia 3 times in 1985, the AF treated the pneumonia and that was it. The 3rd pneumonia almost killed me with a PO2 @ sea level of 56. Almost in a coma and of course death. I was traveling and got to Barstow CA, General Hospital, and a fine and educated Internist did a bronchoscopy and found the sarcoidosis(Stage 4). I was on 4 liters per minute of oxygen for the entire 22 days I was in that hospital. When I got back to the AF base in Albq. NM, the AF proceeded to "terminate" my career on a medical. A Congressman from PA, saved my butt, and they "HAD TO" allow me to finish my 20 years, then they forced me out, as a E-7. This Congressman made them enable me to work in another field, of my choice, for 2.5 years. I was still being treated for "active" sarcoidosis (stage 1), including very high dosages of prednisone (100mg per day, tapered to 10 over 2.5 years). Still dragged a potable oxygen bottle around with me for 6 more months. Had PFT exams about every 6 months until retirement. Went from almost Mr Universe at 206lbs, 6ft, 22 inch biceps, to a big fat, no muscle guy at 330lbs, with a moon face, and the "hump" on my back, up near my shoulders from all that prednisone.

Claimed the sarcoidosis, residual effects of the Prednisone(osteporosis, possible adrenal gland and pituitary gland damage (myopathy), adrenal in sufficiency, and since I was still on prednisone, I was not medically able to even endure a "discharge" physical, dental exam, etc. Still filled out my VA claim form without the "guidance" of a VA representative. I also claimed lower back, hearing, wanted to be tested for asbestosis, skin diseae from the sarcoid, and left knee.

So when the VA called me to a rating appointment, it was very obvious that I was still in distress from the sarcoidosis, the prednisone (still on 10 or 5 mg) at that time, and STILL very depressed from the BS and the prednisone, and other things. Now when the rating came out, the SC was 0 for sarcoidosis, nothing for anything else but arthritis at 10%. I gave up until 2004, and the rest you already know. BTW, the sarcoidosis came "out to play" again in '92-'95(Stage 4). More prednisone for 3 years starting at 60 mg. Even today, still the fat guy, still show the exo-cushing's syndrome, except no hump and no moonface today. No prednisone in large dosages or more than 2 weeks since '95.

Now I am in constant pain with my hips, shoulders, elbows, etc. The DM II is uncontrolled A1C=9.2,, I take more than 5 insulin injections per day, cannot sleep through any might without getting up 3-5 times per night and in the last 2 years, by talking with knowledgeable people like yourself and others her on HADIT, and doing a "slew" of online research, I am fighting now, and I appreciate your collective help.

Also you need to check the evidence list carefully in the decision to see if,in fact, they had obtained any private treatment records,for any of the conditions claimed. My point exactly. I have proof of when many medical records, relating to the facts supporting my clams in this 2011 rating, were hand carried to the VARO, in most cases, more than 10 months before this rating showed up.

In their VCAA letter they are AGAIN asking for "doctor, medical records, and associated information", exactly the same as in the RATING I am appealing. Same years, same doctors that they actually refer to in this rating.

According to regulations and laws, if they do not have some information, or maybe lost it, they should have stated this in the VCAA letter. Some of this stuff is so old, it may have been destroyed years ago. Do I have it, yes, maybe, but where in the vast depths of my garage are they lurking, is the question. I lost my house last year, moved to this one and am too disabled to search thru the boxes. I have asked them for clarification but have gotten no response.

…..under the VCAA, VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Pelegrini v. Principi (Pelegrini II), 18 Vet. App. 112, 120-21 (2004), see 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b).

My appeal document is about 20 pages long, and includes specific dates, places of references, doctors names, treatment, findings, and Is specifically written to point out their mistakes, blunders, incompetance, etc, in very non-adversarial terms and verbiage. This appeal also includes the "new" disabilities, and the what, where, and why, I have requested them to address. I also am including all the signed release forms for my doctors.

It is also worth mentioning that the REDUCTION in the rating for my lumbar was in violation of law. They are required by law to provide written notice of thir intent to REDUCE, a minimum of 60 days befolre they can actually do it, AND can only reduce a rating when there is "documented improvement" and cannot be from a SINGLE EXAM. Also if the disability has been in effect for at least 5 years, it is considered PERMANENT. That makes it extremely hard to reduce it..

It is very important for me, and you, to note, that I AM NOT AN ATTORNEY, and what I say, write, comment on, or reference can NOT be considered LEGAL advice, or RULE OF LAW. These are just my opinions and I read a lot.

They are definitely stating in the decision that no IHD diagnosis was made by the VA examiner on April 5,2011.Have you subsequently received a IHD diagnosis and does VA know that? Answered above, except I always like to mention that since May of 2009, the rating examiners, when asked, always tell me that they have not reviewed my c-file nor have computer access to my records. I did tell the examiner about the cardiologist report, as mentioned, above, but as you said, no IHD diagnosis was made in this rating, but then the extreme pain, lack of strength, coordination, or results of xrays, radiologist, neurosurgeon and internists reports, the pain shots, the incapacitating episodes, or even accurate DM II information was "evident" in this rating.

I really want to get a SOC from the VA, as they never sent one, and the actual notes from any rating examiner. As I mentioned in another post, in all these years, I never saw a "rating worsheet during any exam to date.

Thank you Berta. I hope my answers were helpful to you ( so you can direct me), and others and not too direct, but hopefully detailed enough for you to advise me as to what and where I need to go and do. I thank you for that.

Marty

Edited October 31, 2013 by MartyL16

[free_spirit_etc]

You claimed PVC but that does not fall under the Nehmer IHD regulations. No but the mitral valve prolapse does

MartyL,

Where are you finding that mitral valve prolapse is AO presumptive?

[free_spirit_etc]

They state in this rating of 2011 "that shows noted history of PVCs" from my private doctors from 1990-2003(CIGNA), and 2004-2008(Associated Internists then they state "service connection for PVCs is denied because current evidence does not show a relationship between the disability which occurred in service and the current condition. That was as of 2006 and thru 2011.

So I am saying(in my appeal), VA is confirming SC for PVCs in 2006 but still denied it anyway, in 2004, 2006, 2009, and 2011. OK, they say no PVCs in 2 separate FIVE SECOND EKG strips somtime in 2010. DUH! The point is my Active duty medical records form 1980-1987 show PVCs (up to 2000 per hour, on rare occasions), and again as stated above from 1990-2008 after my 20yrs.

I am not understanding how you are saying that the VA is confirming SC for PVCs in 2006. ???

If you have been denied for the condition that many times, I would say you will most likely need a nexus statement from your doctor or an IMO, where a doctor specifically relates your current condition (PVCs) to service. It seems like they are saying you had a condition in service that caused PVCs, and you have a current condition that causes PVCs, but you need a nexus statement – i.e. a doctor stating that your current condition is related to the military condition, and using some reasoning to connect the two.

And, I think (but am not 100% certain) that even if they connect the PVCs to service on a DIRECT basis, that would still not kick in retro through Nehmer. For Nermer to kick in, it would take the PVCs to be given SC on the AO presumptive basis (as being caused by a condition that is AO presumptive) ***Disclaimer – I don’t know this for sure though. But just putting it out there as a thought…

[free_spirit_etc]

Also seeing court decision that awarded SC presumption from AO for sarcoidosis and lately, DM II presumption from sarcoidosis. It is common for "learned" doctors to state this presumption as "more likely than not", which "opens the door" for "secondary" claims and "aggrivation" of an SC or even a non-SC association.

I don’t think sarcoidosis is presumptive for AO. A doctor wouldn’t have to say “more likely than not” for a presumptive condition. With an AO presumptive condition, as long as you have it, it is SCed.

Sarcoidosis is a presumptive condition under 3.309. So if it is shown that you have it and that it is at least 10% disabling within a year of discharge, they grant SC.

But they already granted you SC for sarcoidosis, as it was diagnosed in service.

Sarcoidosis CAN be connected to Agent Orange with a doctor stating it is more likely than not connected, but that is a direct service connection, rather than a presumptive one.

Your biggest problem with sarcoidosis seems to be that they have rated it at 0% - and you need to increase the rating to reflect your actual condition from it.

And yes, since it is SCed, you can also get secondary SC for other conditions that it, or its treatment causes.

Also- You can claim secondary SC for any condition that is the result of an SC condition -- not just the ones that are AO presumptive.

Edited October 31, 2013 by free_spirit_etc