Bva With Remand To Amc

[jeeperrs]

I am new and posted much of what I am copy/pasting in another forum. However, I did not get much of a reply on that forum and thought I would try here. I will try to be as clear as I can, feel free to ask questions.

I will try to make this short and simple. I was discharged in 2003 for Supraventricular tachycardia. I found out after leaving the Army that they damaged my AV node and they took someone else's heart monitor and put my name on it (documented by VA cardiologist). The problem is that by putting my name on the other monitor and not my monitor, I received a 10% and not 30% rating in 2003. I have been fighting this for many years once a VA cardiologist pointed out the issue. I had a BVA hearing 2 years ago and just received my remand decision. I stressed the importance of the monitor that was miss identified and had a VA cardiologist document in 2009 that the heart monitor from 2003 was not my monitor and someone else's monitor. The judges remand said that I had to get current evidence, as that was too old of evidence for the increase in rating (she didn't once mention how I had false labs placed in my chart). This is my only issue that I have been fighting and I will post my timeline and then my questions. I have followed this board for 2 years but I can't seem to find an answer to this question, so I joined and am now posting.

Timeline (because I searched timelines all the time):

03/31/2009

Local VA Office Decision

RO

11/09/2009

Notice of Disagreement (NOD)

RO

11/16/2009

Appeal Pending

RO

03/17/2010

Statement of the Case (SOC)

RO

04/09/2010

Substantive Appeal (Form 9)

RO

01/11/2011

Supplemental Statement(s) of the Case (SSOC)

RO

07/27/2011

Certification of Appeal

RO

12/29/2011

Received by BVA

BVA

12/29/2011

Administrative Case Processing

BVA

10/15/2013

With VLJ

BVA

10/15/2013

With VLJ

BVA

10/23/2013

With VLJ

BVA

11/18/2013

With VLJ

BVA

11/19/2013

Pending Dispatch

BVA

11/19/2013

Decision & Claims File Dispatch

AMC

11/21/2013

Decision & Claims File Dispatch

AMC

Since it is now at the AMC you can all understand that I am in a remand.

My letter:

The Issue: Entitlement to a rating in excess of 10 percent for supraventricular tachycardia.

The introduction states:

This matter comes before the BVA on appeal from March 2009 rating decision issued by the VA RO in Muskogee, OK.

They had a quick review of my hearing and additional evidence

This paragraph was in bold and one of my questions (I was never seeking a secondary issue):

The issue of entitlement to service connection for degenerative mitral valve disease, to include as secondary to service-connected supraventricular tachycardia, has been raised by the record, but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action.

The appeal is REMANDED to the RO via the AMC in Washington DC.

Questions:

1) Can I not do anything about them discharging me under false laboratory findings, as I have a VA cardiologist and private cardiologist that says that is not my heart monitor?

2) I did not ask for the mitral valve to be a secondary condition but additional evidence to the chronic supra ventricular tachycardia. Are they starting their own claim to make this a secondary issue? What date do they use, my appeal or the order date?

3) They want evidence between the time I filed the appeal (when I found out about the errors in my medical records) but also said in the remand that I am to have an examination. The issue is that I had way more recorded episodes when I left the army than they want to use. However, the VA has agreed to count 4 recorded episodes but I need 5 recorded episodes to get the increase I am seeking. The examination criteria says "It is left to the examiner's professional judgment whether the veteran needs to be monitored by ECG or Holger monitor to satisfactorily complete this examination." but the requirements the BVA stated earlier said I had to have 5 recorded episodes. Should I allow the doctor to submit an opinion or require the doctor to put a 30 day holter monitor on me? I can get the needed recordings if they put a 30 day monitor on me.

4) Should I get a lawyer at this point? I have use VFW thus far.

Thank you for any feedback. I will probably think of more questions but these are the big four.

This was what I posted after talking to my VSO......

I finally got my VSO to return my call (they are 3 hours away making a day drive impossible with work). He suggested I fill out a DD form 149 and have the board review the MEB discharge and change my discharge from 10% to 30%.

As far as the secondary issue goes, he said the AMC will review the mitral valve and make a decision as secondary issue to the SVT. If they deny it, the BVA judge can then make a final ruling. I was told that it should most likely be approved because the judge implied that she felt it was raised by the record in her remand. That was promising news as I was getting frustrated.

I have not received anything from the AMC as of yet. I hope this doesn't take another 2 years for a blatant error the RO refuses to acknowledge.

Any additional comments will be appreciated.

[jeeperrs]

I will also add my C&P results.

Heart Conditions: (Including Ischemic & Non-ischemic Heart

Disease, Arrhythmias, Valvular Disease and Cardiac Surgery)

Disability Benefits Questionnaire

Indicate method used to obtain medical information to complete this

document:

[ ] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) process

because

the existing medical evidence provided sufficient information on which

to

prepare the DBQ and such an examination will likely provide no

additional

relevant evidence.

[ ] Review of available records in conjunction with a telephone interview

with the Veteran (without in-person or telehealth examination) using the

ACE process because the existing medical evidence supplemented with a

telephone interview provided sufficient information on which to preparethe DBQ and such an examination would likely provide no additional

relevant evidence.

[ ] Examination via approved video telehealth

[X] In-person examination

Evidence review

---------------

Was the Veteran's VA claims file reviewed?

[X] Yes [ ] No

If yes, list any records that were reviewed but were not included in the

Veteran's VA claims file:

VBMS

1. Diagnosis

------------

Does the Veteran now have or has he/she ever been diagnosed with a heart

condition?

[X] Yes [ ] No

[X] Supraventricular arrhythmia

ICD code: 427.9 Date of diagnosis: 2001

2. Medical History

------------------

a. Describe the history (including onset and course) of the Veteran's

heart

condition(s) (brief summary):

Veteran underwent Holter monitor on 10/29/01 showing atrial tachycardia

while still on active duty. He was medically discharged in 2003, after

undergoing ablation in 2002. He continued to have frequent episodes of

SVT. He underwent another procedure in 7/03 at Oklahoma Heart Hospital

and was told that another ablation would not be advisable given his

condition. Since then the patient has been managed medically. He has

been followed by the VAMC in OKC as well as OHH. He reports that he

still has approximately one episode of SVT per week. The symptoms are

feeling of flutter in his chest, like he has lost his breath, and

light-headedness. He has not lost consciousness. Many of his episodes

are precipitated by vigorous activity such as jogging or running,

specially if there are short bursts of intense exertion followed by a

break and then another burst of exertion (playing soccer or basketball

are examples he gives).

b. Do any of the Veteran's heart conditions qualify within the

generally

accepted medical definition of ischemic heart disease (IHD)?

[ ] Yes [X] No

c. Provide the etiology, if known, of each of the Veteran's heart

conditions,

including the relationship/causality to other heart conditions,

particularly the relationship/causality to the Veteran's IHD

conditions,

if any:

Heart condition#1: Provide etiology

unknown

d. Is continuous medication required for control of the Veteran's heart

condition?

[X] Yes [ ] No

If yes, list medications required for the Veteran's heart

condition

(include name of medication and heart condition it is used for, such

as

atenolol for myocardial infarction or atrial fibrillation):

diltiazem

3. Myocardial infarction (MI)

-----------------------------

Has the Veteran had a myocardial infarction (MI)?

[ ] Yes [X] No

4. Congestive Heart Failure (CHF)

---------------------------------

Has the Veteran had congestive heart failure (CHF)?

[ ] Yes [X] No

5. Arrhythmia

-------------

Has the Veteran had a cardiac arrhythmia?

[X] Yes [ ] No

Type of arrhythmia (check all that apply):

[X] Supraventricular tachycardia

If checked, indicate frequency:

[ ] Constant [X] Intermittent (paroxysmal)

If intermittent, indicate number of episodes in the past 12 months:

[ ] 0 [ ] 1-4 [X] More than 4

Indicate how these episodes were documented (check all that apply)

[X] Other, specify

>4 episodes per month identified by the patient.

6. Heart valve conditions

-------------------------

Has the Veteran had a heart valve condition?

[ ] Yes [X] No

7. Infectious heart conditions

------------------------------

Has the Veteran had any infectious cardiac conditions, including active

valvular infection (including rheumatic heart disease), endocarditis,

pericarditis or syphilitic heart disease?

[ ] Yes [X] No

8. Pericardial adhesions

------------------------

Has the Veteran had pericardial adhesions?

[ ] Yes [X] No

9. Procedures

-------------

Has the Veteran had any non-surgical or surgical procedures for the

treatment

of a heart condition?

[X] Yes [ ] No

If yes, indicate the non-surgical or surgical procedures the Veteran has

had for the treatment of heart conditions (check all that apply):

[X] Other surgical and/or non-surgical procedures for the treatment of a

heart condition, describe:

ablation

10. Hospitalizations

--------------------

Has the Veteran had any other hospitalizations for the treatment of heart

conditions (other than for non-surgical and surgical procedures described

above)?

[ ] Yes [X] No

a. Heart rate: 62

b. Rhythm: [X] Regular [ ] Irregular

c. Point of maximal impact: [ ] Not palpable [X] 4th intercostal space

[ ] 5th intercostal space

[ ] Other, specify:

d. Heart sounds: [X] Normal [ ] Abnormal, specify:

e. Jugular-venous distension: [ ] Yes [X] No

f. Auscultation of the lungs: [X] Clear [ ] Bibasilar rales

[ ] Other, describe:

g. Peripheral pulses:

Dorsalis pedis: [X] Normal [ ] Diminished

[ ] Absent

Posterior tibial: [X] Normal [ ] Diminished [ ] Absent

h. Peripheral edema:

Right lower extremity: [X] None [ ] Trace

[ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Left lower extremity: [X] None [ ] Trace

[ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+

i. Blood pressure: 112/78

12. Other pertinent physical findings, complications, conditions, signs

and/or symptoms

-----------------------------------------------------------------------

a. Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

section above?

[ ] Yes [X] No

b. Does the Veteran have any other pertinentphysical findings,

complications, conditions, signs and/or symptoms related to any

conditions

listed in the Diagnosis section above?

[ ] Yes [X] No

13. Diagnostic Testing

----------------------

a. Is there evidence of cardiac hypertrophy?

[ ] Yes [X] No

b. Is there evidence of cardiac dilatation?

[X] Yes [ ] No

If yes, indicate how this condition was documented:

[ ] Chest x-ray [X] Echocardiogram

Date of test: 10/2/09

c. Diagnostic tests

[X] Echocardiogram Date of echocardiogram: 10/2/09

Left ventricular ejection fraction (LVEF): 65-75 %

Wall motion:

[X] Normal [ ] Abnormal, describe:

Wall thickness:

[X] Normal [ ] Abnormal, describe:

[X] Holter monitor Date of Holter monitor: 9/24/09

Result:

[ ] Normal [X] Abnormal, describe:

"Frequent (up to 13% of recording) runs of

ectopic

atrial rhythm and ectopic atrial tachicardia with

rate up to 177 bpm are noted."

14. METs Testing

----------------

a. Exercise stress test

No response provided.

b. [X] Interview-based METs test

Date of interview-based METs test: 2/24/14

Symptoms during activity:

The METs level checked below reflects the lowest activity level at

which the Veteran reports any of the following symptoms (check all

symptoms that the Veteran reports at the indicated METs level of

activity):

[[X] Dyspnea

Results:

METs level on most recent interview-based METs test:

[X] (>7-10 METs) This METs level has been found to be

consistent

with activities such as climbing stairs quickly,

moderate bicycling, sawing wood, jogging (6 mph)

c. If the Veteran has had both an exercise stress test and an

interview-based

METs test, indicate which results most accurately reflect the

Veteran's

current cardiac functional level:

[ ] Exercise stress test [ ] Interview-based METs test [X] N/A

d. Is the METs level limitation due solely to the heart condition(s)?

[X] Yes [ ] No

e. In addition to the heart condition(s), does the Veteran have other

non-cardiac medical conditions (such as musculoskeletal or pulmonary

conditions) limiting the METs level?

[ ] Yes [X] No

If yes, identify each condition and describe how each non-cardiac

medical condition limits the Veteran's METs level:

15. Functional impact

---------------------

Does the Veteran's heart condition(s) impact his or her ability to

work?

[X] Yes [ ] No

If yes, describe impact of each of the Veteran's heart conditions,

providing one or more examples:

Veteran should not engage in duties requiring heavy physical exertion.

16. Remarks, if any

-------------------

Information for Remand:

The information in VBMS was reviewed. Particular attention was

directed toward the Holter monitor report dated 9/24/09. This report

documents "Frequent (up to 13% of recording) runs of ectopic

atrial

rhythm and ectopic atrial tachicardia with rate up to 177 bpm are

noted."

In this Holter monitor tracing of 9/24/09 there are 5 discrete

episodes

of atrial tachycardia within the 24 hour period, occurring at 0803,

0935, 1430, 1624 and 1954. Each episode lasts for several beats, with

the last documented episode noted on the tracing to last 1255 beats

for

a duration of 3 minutes.

On the Holter monitor tracing of 9/2/09 there are 3 episodes of

isolated supraventricular (atrial) tachycardia.

Taking this information into consideration it is this examiner's

opinion that it is more likely than not that there is evidence

documenting more than four episodes per year of atrial tachycardia

during the period of January 2008 to present.

[jeeperrs]

Since I can't track my appeal progress on benefits once it went to the AMC, I sent an IRIS message. This is the reply which hopefully indicates the long ride is almost over.

Mr. XXX,

We received the results of the examination. The results are pending review. We will notify you in writing of the decision once it has been rendered.

Thank you.

[jeeperrs]

I feel that a strong independent medical opinion would possibly square this away.

The criteria for IMOs ( Or the IMO doctor might well want to do an IME) is in our IMO forum.

However dont excpect too ,much from the Black Hole (AMC) .

I had 3 IMOs for my AO DMII claim filed in 2003.

The Buffalo RO ignored them, the AMC ignored them and then the Seattle RO ignored them and then when the BVA got the IMOS, after a brief remand they awarded. All that took 6 years. I would handle that situation much differently these days.

With the IMO ...which could clear up your issues,in my opinion, if the IMO doc has ALL available med recs ,all VA C & P and all AL:L VA decision,

and your SMRs. and the doc could cover the mitral valve issue as well, it could possibly get a decent response from the AMC.

If you do get an IMO send it to the BVA as well as the AMC and the AOJ you had originally.

If the AMC ignores the IMO, then I can tell you what to do next.

However the BVA wont ignore it ,if it supports your claim ,and if it follows the IMO criteria here at hadit in our IMO forum.

I guess I never said thanks for the advice. I called a couple doctors trying to get an IMO. The two that I called said they only do them for court ordered cases. Hopefully my C&P will be enough and life can move on.

[Navy04]

Jeepers,

I wish you the best bud. I know how you feel, all our patience is wearing thin. We bust are butts to go to Exams and do whatever the VA wants from us, then we sit around waiting, going crazy. My SSDI was approved last week after only 4 months, did all the leg work on my own, and due to my recent C&Ps, I should be 100%. Just tired of us being taken advantage of. God Bless and good luck. Keep us posted.

[jeeperrs]

I agree Navy. However, I get even more upset when I think about how this would never have been an issue if they did not mix up my records with another soldier when I was going through my MEB. I should never have been in this position to begin with. I am just praying the AMC processes my claim quickly, as it is only focused on a single issue and not multiple complex issues. The wait is worse when you think you are getting close to the finish line. I have been waiting almost 1900 days since I filed my last appeal. My biggest mistake was letting it lapse while the Physical Evaluation Board made their decision. I thought it was open and closed, even in their write up they said I met the criteria if the mixed up monitor showed just one episode or if they counted any hospital stays, but that they were leaving it at 10% to be consistent with the VA. It is very frustrating.

[jeeperrs]

I am trying not to get excited but this is what I was told yesterday by a VA rep when I called at the 1-800 #.

I asked, how can I track the status of my claim now that it is located with the AMC for a BVA remand. I explained that on ebenefits that it only shows me the BVA status that a decision was made, which was a remand. He said that I can't really track it now that it is at the AMC but that he would look at my file for me if I wanted. At first he said it was "with the RO but the file still had an AMC code". He looked at my recent C&P and said it had been reviewed and then he said it looks like a rating has been made yesterday, the same day I called. I am assuming that if the RO is handling most of the rating decision that I am going to have a favorable decision. He wouldn't say much else except that I should most likely receive some correspondence soon. I thanked him and explained that I know he is not at privilege to tell me anymore details.

It is taking everything in me to not get excited because I have no idea how much longer this will last.

Edited March 11, 2014 by jeeperrs