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]

This shows what is needed to go from 60% on DM II to 100% Both ratings, as well as the 20% and 40% ratings take into consideration they require insulin. So there shouldn't be any need to prove how much insulin you take, or how many injections you need. Your rating already takes insulin injections into account. To get an increase, you need to show that you are closer to the 100% rating requirements than you are to the 60% requirements.

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

[free_spirit_etc]

This 20 pager also has the "new" claims because they are required to do a de novo review of these items while the appeal is still active, or at least, that is what I have read and undertstand. If I am wrong I hope "someone" will tell me.

That is something I am not entirely sure of. I do know if you submit new and material evidence, they are supposed to re-adjudicate your claim. As long as you submit it while the appeal is still active, then it should keep the effective date of the current claim. Presenting more argument and pointing out evidence they already have wouldn't be new and material evidence. Yes. They should consider it, but that would be considered at whatever level you are at -- rather than an actual readjudication. What I am not sure of is if you can submit additional argument to the DRO after you have already had the DRO hearing. I would think that you could, as long as they haven't made a decision and issued an SSOC on the claim. You might want to get ahold of the VA and ask about the status of your claim. If they say a SSOC has not been issued yet, or that the DRO is still reviewing it, then you might be able to submit additional argument for him to consider.

I think I will take your advice and put the "points" on a cover page and reference those "points" by letter or number in the other pages. What do think of that???????

That might be a good idea. You might want to put your stronger arguments and evidence in a concise version, with attachments to a more detailed version.

Re: The rating schedule states sarcoidisis which is ___ should be rated at ____. I should be rated at ___ for this because the evidence shows I am taking ____ medication, and have been doing so since ___. (See attachment # 1 - 3) -- or something like that...

Or my rating should not have been reduced without a 60 day notice CFR_3.105 (See attachment # ___.

I just ran across a BVA case on that.... I will see if I can find it again. They re-instated the veteran because his rating was reduced improperly.

Edited November 2, 2013 by free_spirit_etc

[free_spirit_etc]

"Since my original rating for sarcoidosis was 0% and it was BEFORE CLAIMANTS could appeal ratings, (that changed in '88), I really don't know how to get "them" to reopen that item. Yes, I have more than 5 cases where claimants got 30% or more at the initial rating and they were ONLY Stage 1 sarcoidosis. I was Stage 4 while in the service and AGAIN IN '92-'95."

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

http://en.wikipedia.org/wiki/Sarcoidosis

Granted – this is Wikipedia – not a medical journal, but it says:

“Chest X-ray changes are divided into four stages:^[49]

· Stage 1: bihilar lymphadenopathy

· Stage 2: bihilar lymphadenopathy and reticulonodular infiltrates

· Stage 3: bilateral pulmonary infiltrates

· Stage 4: fibrocystic sarcoidosis typically with upward hilar retraction, cystic and bullous changes

Although patients with stage 1 X-rays tend to have the acute or subacute, reversible form of the disease, those with stages 2 and 3 often have the chronic, progressive disease; these patterns do not represent consecutive "stages" of sarcoidosis. Thus, except for epidemiologic purposes, this X-ray categorization is mostly of historic interest.^[7]”

So it says the stages are not progressive, but it has more to do with what is shown on the xray.

So it looks like they rated you 0% -- based on xray changes. To get a higher rating you need to show pulmonary involvement and the use of steroids to control it.

I know you say your evidence shows that you are on medicine for it.

So that is what needs to be pointed out. You don’t need to argue the stages. The stages don’t have anything to do with the rating. Focus your arguments on how that evidence shows you are entitled to __% because (and then how your evidence lines up with the ratings schedules.

[free_spirit_etc]

"As for presumptions: I may confused all. I have found court cases, where doctors have stated for various claimants, "sarcoidosis more likely than not, came from AO expose in 'Nam", and other cases where DM II more likely than not came from sarcoidosis."

This isn’t actually presumptive. The presumptive conditions are ones that are automatically granted if you have them and you were in Vietnam during the applicable periods. A doctor doesn’t have to write it is more likely than not for a presumptive condition. For presumptive illnesses, if you were boots on the ground in Vietnam and you have the disease = SC.

In the cases you reference, they were granted SC. The sarcoidosis was granted SC in the above mentioned case, on a DIRECT (not presumptive) basis (because the doctor stated it most likely was caused by AO exposure). The DM II was granted SC in the above mentioned case on a secondary basis (because the doctor said it was caused by a SC condition).

The AO presumptive conditions are listed in §3.309 (e)

"So why is this important to me?

I am already SC for sarcoidosis because of active duty,

I am presumptive AO for DM II, so it is SC right?

I am fighting to establish SC for a "chronic" PVC problem"

The PVC isn’t a presumptive condition. The DM II is. But you can’t likely show the DM II resulted in the PVCs because you had the PVC condition a long time before you had DM II. I understand the part about it being chronic. But you need to connect it to a diagnosis.

What does your doctor say is causing the PVCs? I get what you are saying about how they started in service. But what is your diagnosis? What diagnosed illness is causing your PVCs? What would really strengthen your claim in regard to the PVCs is to be able to show “I have been diagnosed with ___, which causes me to have PVCs – and then showing that illness started in service, or was caused by the service, or was aggravated in service. ---

But I am not seeing any link through the AO presumptives.

I know you said you have mitral valve disease. Is that what your doctor said causes the PVCs? If so – does he think the condition started, was caused by, or was aggravated in service? If so – a statement from him stating that (and providing reasoning) would help.

As far as the chicken and the egg thing, it would be hard to show that they were caused by another SC condition, since it looks like you had those before you had the other conditions. However, if your other SC conditions aggravate them, then you might be able to establish that.

Edited November 2, 2013 by free_spirit_etc

[free_spirit_etc]

"So my "mind" says that maybe, just maybe there is a possible presumptive AO, "more likely than not" for the "CHRONIC PVCs" what came first, "the chicken or the egg" and with ALL of that association, presumed or otherwise direct, I have "ammunition" for the sarcoidosis and my "acquired" exo-Cushing Syndrome(not disease) residual effects as secondary to sarcoidosis treatment by high dosage prednisone (corticol steroids)."

I am not following your line of reasoning here. I certainly agree that you have ammunition for the sarcoidosis. But the ammunition is that it started in service and was treated in service. It is already SC. You just need to increase the rating. Even if you could get your doctor to say that AO caused your sarcoidosis, I don’t see how that relates to the PVCs.

And I agree that you need to follow up and see if you can get your Cushing Syndrome and / or residuals SCed, to the extent it was caused by the high-dose steroids used to treat your sarcoidosis.

But I am not seeing the link to the PVCs in all of this.

[free_spirit_etc]

"BTW, actually I have also found cases with the "more likely than not" presumption of high dosage prednisone causing DM II."

Again, this is not a presumption. It is a doctor stating that high dosage prednisone caused DM II. But you don’t need to go there in your argument because you already have a presumptive SC connection for DM II from AO.

"I could care less that they failed to find evidence of PVCs in two separate 5 second EKGs that they are using for denial. Why??? because that means that they never reviewed the cardiologist report that was submitted way before this rating and "can't see the trees"

That is evidence you need to point out for sure. If the cardiologist report states you have PVCs, and they have done testing to measure them, then the fact that they didn’t show up on short measurements the VA did in 2007 shouldn’t be used to support the idea that they don’t exist now, or possibly even that they didn’t exist then.