ptsd Need Your Suggestions On Dic Appeal...

[dubsnpugs]

Hello, I have spent quite a bit of time on here the last couple of days reading and reading and then researching and researching. You all are a wealth of information, thank you so much for the guidance. I feel like I am at the point where I need guidance and reassurance that I’m not fighting a losing battle with the VA to determine if my Fathers untimely death was service related or not…

My Father served 3 tours in Vietnam (USN) from August 1965 to January 1968 (He was in Vietnam just 10 days after his 17 birthday, thanks to his loving mother who sent him off to war (insert sarcasm)). After 1968, he was discharged to deal with 2 knee injuries that he suffered, one in war (66’) and one while in Japan waiting for orders on his next tour (67’). He re-enlisted in the USAF and served with them from February 1974 to September 1979. He was discharged due to his medical needs (knees and back) and psychiatric needs. After his discharge my father spent many years in a dark bedroom, went from job to job, struggled with drug use off and on, and sometimes we would not see him for days (or even weeks). My mother stood by his side the entire time. Trying to seek help and time after time, he was pushed off as a "druggie".

Time line of events:

1990’s: In 1991 my father began to suffer severe nerve issues in his hands, legs, and back. After numerous trips to the emergency room, and several surgeries later, he was approved for SSD in early 1994. He also began seeing VA Dr.’s around that time as he was in need of knee surgery and had limited funds as Medicaid would only cover 80%.

1998: His application for disability benefits was received on September 27, 1998 for Agent Orange exposure, PTSD, Knee & back disorders.

2001: Started receiving 60% V.A. benefits and was solely under the care of the V.A.. VA denied claims of Agent Orange as part of the disability, even though he showed neurological signs of exposure. From what I can see my father never fought that ruling.

September 25, 2006 received 100% V.A. disability for his service related injuries, which according to the V.A was PTSD with secondary major depression disorder, degenerative changes status post fusion at T7-8-9, thoracic spine, degenerative arthritis left knee, and degenerative joint disease right knee.

2009: He was provided a motorized wheel chair as his back was too weak and his knees could no longer support his 160lb body. My parents lived in an old farm house that was not wheelchair friendly and this caused many issues for my father trying to get to and from the bathroom with very narrow door ways. It was suggested by his physical therapist that he should have leg braces to help him get in and out of the door ways. My mother was there to help care for him, however she has M.S. and didn’t have the physical strength to get him to the restroom and back.

2009-2012: He had a spinal fusion surgery and another knee surgery and was hospitalized several times for severe falls, one breaking 2 ribs.

9/3/2012: Saw N.P at a V.A. Clinic. Complained of headaches and had a huge bump on his forehead from a fall and she ordered blood work to be done, and sent him home as there was nothing she felt she could do for him. (Currently waiting on a copy of these reports, will have it next week some time).

9/8/2012: 64 years old, passed away shortly after a fall in the bathroom, when his knees and back gave out. The EMT arrived and he was pronounced dead on arrival. He was taken to the corners office. This EMT service had been to the house over 25 times since 2008, and I’m currently waiting on those reports indicating his numerous falls and ambulance rides to the ER, as the VA never requested them, even though we signed release forms. It was suggested by one EMT that was on scene that evening that most like was a blood clot or aneurism due to the falls and the bruises on his head from pervious falls the prior weeks, I’m not sure if that was documented in the report.

9/11/2012-End of Sept.: Death certificated signed by NP on 9/11 who saw him 5 days prior complaining of headaches. She did not see or examine my father’s body. She listed his cause of death as: A. Immediate cause: unknown, uncertain and B. (due to of as a consequence of) COPD. She also didn’t suggest an autopsy and during this time my mother was literally in shock and was not mentally capable of asking for such, he was cremated on the 12^th, as my mom didn’t have the money for a burial, and I paid for the cremation. I arrived to their home the evening of the 11^th (It’s a long way from Florida to Oregon) and my mother didn’t know her address, important information, etc. She was literally in shock. With the help of her family members I was able to step in and take control and begin making arrangements with the National Cemetery in Portland as well as filing the necessary V.A. claims and dealing with SS. I was there for 4 weeks handling it all, and eventually I had to go back and deal with my life that was on hold.

10/19/2012-VA received application for burial benefits, DIC, and pension.

10/31/2012-Received confirmation that they are processing claim.

12/1/2012-I moved Mom to Florida as she has all of $700 SS income to live off of. Tried to get her a VSO here in Tampa, and no such luck. The gentleman she spoke to said he can’t help her as it was out of his area. So basically she communicated back and forth with the Salem Oregon office from this point forward.

3/1/2012-Per the request of the VA we sent additional documentation for his Dr.’s that he saw for the past 20 years along with a claimant response letter.

3/27/2013-Received confirmation that they got the 3/1.

5/5/2013-Called Salem office to follow up and our case worker was no long employed and they could not locate his file. V.A. at its finest.

5/30/2013-Faxed all documents and previous confirmations to new case worker.

6/19/2013-I received a call from the case worker that we should have a decision soon and wanted to know how things were going??? REALLY???

8/15/2013-Received denial letter.

8/20/13-Sent medical records from a hospital that the V.A. could not seem to get, that I got in about 3 hours. Also sent a release form for them to get the EMT/EMS records from the night of his death.

Between August and December of 2013, we made close to 15 calls and could not get a single person to call us back.

1/23/2014-Received yet another denial letter and stating that they stand by their original ruling, as COPD as cause of death. (More on that in a moment).

Since that date in January (knowing that I have a year for an appeal), I have spent that time building our case, collecting medical records, reading and researching and I feel like I am about ready to submit the appeal (waiting on EMS records and missing VA records).

Here are some of my questions and thoughts….

Like many vets my father was a smoker and did have stage 2 COPD. From my understanding of COPD, there are 4 stages of it. My father was NOT on oxygen nor was he on anything but a simple inhaler. He was never hospitalized for this condition and was not treated for it on a regular basis. He didn’t have cancer or heart issue (ruling out heart attack). How can they say that the cause of death was not service related, when the cause is listed as unknown? How can they say COPD was the cause of his unknown death? Is that even possible? Can you die instantly from COPD (my findings is that most die with COPD, not from it).

Why did it take 8 years (1998-2006) for my father to be 100% disabled when it is very clear he suffered from his PTSD for decades that totally affected every part of his life and his symptoms were first noted in 1968? He has been using a cane to walk since the mid 1990’s and why did it take 10 years to get him a wheelchair and how come he was never given the leg braces to support his legs when he was trying to get from his chair to the toilet or shower? If COPD is really the cause of death wouldn’t that be service related since it was the service who provided him cigarettes in his daily rations in Vietnam? and wouldn’t it be service related if his nicotine addiction was contributed to his PTSD and his other secondary major depression issues (whatever that means)? I’m not convinced that my father died from complications of COPD, considering his issues were not breathing related, they were related from a fall that evening and probably many falls prior. How do I get the V.A. to see that? Also the NP that saw him a few days before his death and completed the death certificate was a total %$&^# when we questioned her findings and asked to have his records updated to reflect just unknown cases/undetermined and list from complications of a fall in the second line, as that is what all the medical reports lead too. She refused to take our calls on that and never responded to our written requests.

What do I need to submit to the VA to get them to see what I see? Apparently they reviewed all his records (minus the EMT records). Is there another angle that I can approach as far as him not being 100% from the start (or even from 2001) when there was no doubt that he was not employable or really even mentally functioning? I’m open to your thoughts, suggestions and opinions. Sorry for such a long post, but at this point I could literally write a book on this case as his records are endless.

Respectfully,

S. Foster

[john999]

Did your father have an autopsy? Would it be morally acceptable to have his body exhumed and examined? This is extreme but may show the actual cause of death. If he did not have an autopsy they are just guessing at cause of death. My mother died due at least 50% from malpractice but she also had illness that would have killed her anyway. We were lucky since the death certificate noted cause of death as infection that started in nursing home and let to amputation that caused her weak heart to fail.

John

[dubsnpugs]

@John999, no autopsy, my mother is not sure if she was even asked for one and due to their financial situation I paid for his cremation and he was placed up in the National Cemetery in Portland. My mom went into shock when this all happened and she didn't know right from left. I spent a month there making all the arrangements, and figuring out where she was going to live, etc., of course by the time I got there, it was time to get his ashes, and she now wishes she could turn back time and was of better mind to make better decisions. But it is what is, and the more I read the more I feel there is so much more to this story. My Mom's only source of income was my father's disability, she quit working many years prior to take care of him, in fear that he would hurt himself (accident and suicidal). But know worries there, she took care of me for 18 years, now it is time for me to take care of her. She won't ever have to worry about anyone but herself, and after 40 years that is hard to do.

@Berta, my father didn't have HBP (did have some reports of it back in 2001-2002), but he did have several emergency visits where his BP was low (Hypotension), and was treated for that. 4 days before his death his BP was 124/79. I will cut and paste the list of medications below as well as a short summary of his medical issues and dates. Although I don't agree with some of the dates. Let me know if anything stands out at you...

These are the MEDICATIONS we show you should continue taking:

Active Medications

============================================================

1) Albuterol 90Mcg (Cfc-f) 200D Oral Inhl

Inhale 2 puffs by mouth every 4-6 hours as needed for shortness

Of breath

2) Ap#2 Ointment

Apply thin film topically to affected area as directed

(Legs) daily to treat skin dermatitis may apply

Up to several times a day.

3) Baclofen 10Mg Tab

Take one tablet by mouth three times a day as needed for

Muscle spasms

4) Carboxymethylcellulose Na 0.5%(Pf)op Sol

Instill 1 drop into affected eye(s) four times a day as

Needed for dry eyes.

5) Epi-pen 0.3Mg/0.3ml Injector

Inject 0.3Ml intramuscularly as directed as needed for

Anaphylaxis due to sulfites

6) Fentanyl Tds 100Mcg Patch

Apply 1 patch to skin every 72 hours (3 days) *use only

The prescribed number of patches. Do not apply heat

To the patch. Dispose of used patches as directed

7) Gabapentin 800Mg Tab

Take one tablet by mouth every day for 7 days, then take

One tablet twice a day for 7 days, then take one

Tablet three times a day

8) Hydroxyzine Hcl 10Mg Tab

Take two tablets by mouth every 8 hours as needed for nausea

And dry heaves. May crush them to swallow.

9) Lorazepam 0.5Mg Tab

Take one tablet by mouth three times a day

10) Moisturizing Cream

Apply liberally topically to affected area as directed

(Legs) daily to treat skin dermatitis may apply

Up to several times a day.

11) Omeprazole 20Mg Ec Cap

Take one capsule by mouth twice a day take 20-30 minutes

Before breakfast and dinner

12) Quetiapine Fumarate 50Mg Tab

Take one-half tablet by mouth three times a day and take

Two tablets at bedtime

13) Spironolactone 25Mg Tab

Take one tablet by mouth every day

14) Tiotropium 18Mcg Inhl Cap 30

Place one capsule in inhaler

15) Venlafaxine Hcl 75Mg Tab

Take two tablets by mouth every morning and every evening

16) Vitamin D 1000 Unit Tab

Take two tablets by mouth every day

17) Zolpidem Tartrate 10Mg Tab

Take one tablet by mouth at bedtime

Active Non-VA Medications:

============================================================

1) Calcium Carbonate

Take by mouth

2) Diphenhydramine

Take by mouth

You have 19 active medications

List of allergies: (My father had major allergy issues that developed around 1999)….

CODEINE, EGGS, NONSTEROIDAL ANTI-INFLAMMATORY, LATEX, AVOCADOS, SHELLFISH

BANANAS, NUTS, ASPARAGUS, SULFITES, SULFA DRUGS, METHADONE, TRAMADOL

METHOCARBAMOL

List of medical issues on his record from the visit that was 9/4/2012 (passed away 9/8/2012). Also not sure of why there is an”*” next to COPD????

SERVICE CONNECTED 50% to

PROLONG POSTTRAUM STRESS (02/11/1999)

PSYCHOGENIC PAIN NEC (03/13/1999)

ORGANIC ANXIETY SYNDROME (06/15/1999)

Sleep Apnea (02/08/2002)

on CPAP

s/p sinus resection and uveloplasty 1/02

Gastroesophageal Reflux Disorder (02/08/2002)

reflux asthma

Peripheral Nerve Disease (02/20/2002)

Asthma (11/14/2002)

Depression - Moderate (04/05/2004)

Anxiety Disorder (05/11/2004)

Unspecified disorder of adrenal glands (07/27/2004)

1.4 x 2.4 cm adrenal nodule found on CT 7/04

w/u after recovery from current illness

Other Personal History of Allergy to Latex (ICD-9-CM V15.07) (02/14/2005)

Other chronic Pain (ICD-9-CM 338.29) (09/11/2008)

Sleep Apnea (ICD-9-CM 780.57/786.09) (09/11/2008)

Chronic Obstructive Pulmonary Disease * (ICD-9-CM 496.) (04/20/2011)

DYSPHAGIA NOS (09/20/2011)

Loss of weight (ICD-9-CM 783.21) (09/20/2011)

Opioid type dependence, continuous use (ICD-9-CM 304.01) (10/18/2011)

UDS + for PCP, THC, Opiates Nov '11

pt denies PCP, but has Card for MJ, uses for muscle relaxant

Degeneration of intervertebral disc (ICD-9-CM 722.6) (03/22/2012)

Impotence of organic origin (ICD-9-CM 607.84) (03/22/2012)

Nicotine Dependence (ICD-9-CM 305.1) (05/21/2012)

[Berta]

I had JR Reih's concerns as well but learned from the net that this is not unusual , and in 2011, many states started to allow NPs to sign death certificates.


I found this site because it appears this vet died in Oregon...but I am not sure.

In part:

http://www.oregonlaws.org/ors/432.307

This contains a little more from Oregon laws as to reporting the cause of death:
https://public.health.oregon.gov/BirthDeathCertificates/RegisterVitalRecords/Documents/Death/cdelderly.pdf

and

"Medical Information on the Oregon Certificate of Death

" Item 46
: Required Yes or No on whether the Medical
Examiner was contacted.
In cases of suicide, homicide, or undetermined manner,
the Medical
Examiner must complete the medical portion of the death certificate Accidental deaths are usually
certified by the Medical Examiner. However, in
some instances the Medical Examiner may give
to certify the accidental death. "

https://public.health.oregon.gov/BirthDeathCertificates/RegisterVitalRecords/Documents/Death/medinfo.pdf

Even though the Coroner and I had no knowledge that my husband had heart disease,

based on the conditions I was aware of ,from his VA heath care, the coroner determined he had a sudden cardiac event as a consequence of his other documented conditions, well I say documented ....but only one was properly diagnosed......

I told the coroner I felt he had multiple episodes of transcient ischemia that his MRI seemed to reveal , after I talked to a VA cardio doctor who was treating him for residuals of a massive stroke.but VA had not diagnosed these events as TIAs, they instead diagnosed them as other problems.

I asked about this vet's EKGs and any ECHOs they did and his blood chem reports because I think he might have had IHD from AO as the immediate cause of death.

But I am sure no doctor ....I am so glad John Dorle chimed in here because John and Dr. Bash are SUPERB at putting medical puzzle pieces together. And I am sure they could determine a valid cause of death, which would either be Service Connectable or come under 1151.(or even possibly FTCA.).

I know my VAola paranoia is showing here....

I am following up today ,a letter ,with evidence, to the FBI on what I feel they need to know as to how VA manipulates 1151 awards and their wrongful death statistics, that I think we discussed at that past radio show.

It is in addition to my letter the Chairman Miller ( H Vac,) emails to the IG and also contact with the FBI.

And I still have more FOIAs to send, but personally, I think I have already given the H VAC enough info to start investigating how VA cooks their malpractice stats.

I hope this is not a case of VA malpractice here. But based on the info you gave us,something seems definitely wrong.

"I have a pile of papers to scan in as well (found his denial letter from 1997 and 1998)."

If we could read those decisions via a scan ( cover C file #, name, address first) as to their Reasons and bases it would help us more.

I am also very interested in the evidence list they used in the decisions and also the actual rating sheet as to what was listed as NSC.

It was some NSC ratings on a 1998 rating sheet that prompted me to file CUE on the 1998 award letter I received.

It took 8 years but I won the CUE.

Also I had hound a notation of DVD in my husband's med recs. This was regarding the IMOs I got from Dr Bash.

Along with another crossed out entry (I found the doctor who made it ,he had left the VA) these were the only 2 medical entries in his written med recs that indicated to me he had DMII that they never diagnosed.

Of course other evidence revealed the DMII. But my point is

the C & P doctor stated my interpretation of DVD was wrong. as I said it meant Diabetic Vascular Disease.per the same Merck texts.,that VA used.

She said the entry meant he "denied venereal disease".(DVD)

The 1998 rating sheet and other documents clearly revealed he had never denied VD and he got it in Vietnam and was rated at "0" NSC for it.

Rating sheets can never be overlooked when advancing a claim

That is also where they make many CUEs.

I just realized you posted much more info and I will go over it as soon as I can.

That is quite a med cocktail he was given .

John said: "My mother died due at least 50% from malpractice but she also had illness that would have killed her anyway. "

That was the General Counsel's first line of defense to me on my FTCA case.

The VA lawyer said to me "Well, He might have died anyway"

I said "anyway my ass Tim, he was only 47 years old. .

(since I didnt have a lawyer I dealt directly first with the RC and then with OGC.)

I fear that this might be the same VA OGC response to some of the survivors of the elderly Phoenix death victims.

I heard VA settled with some of them already but cant verify that yet.

The Hippocratic Oath does not exempt elderly people.

Edited July 23, 2014 by Berta

[Berta]

Fentanal caught my eye. There have been many lawsuits regarding deaths or adverse affects due to this med.

This 2008 warning info to VA health Care professionals came from the VA website itself:

National Pain Management Strategy Coordinating Committee
Pharmacy Workgroup

Fentanyl Transdermal Patch Dosing and Safety Information Paper



Fentanyl transdermal patches have recently been associated with a number of serious adverse events and deaths nationwide. Clinicians should use the fentanyl patch only if they are familiar with the prescribing information. This letter provides clinicians with important information to promote the safe use of the fentanyl transdermal patch.

Who Should Receive Fentanyl transdermal patch
Fentanyl tranasdermal patch is indicated in patients who have persistent, moderate to severe chronic pain that
○ requires continuous, around-the-clock opioid administration for an extended period of time, and
○ cannot be managed by other means such as non-steroidal analgesics, opioid combination products, or immediate-release opioids.
Fentanyl transdermal patch should NOT be used for management of mild, acute, short-lasting, or intermittent pain. It should not be used on an as-needed basis.
Fentanyl transdermal patch should ONLY be used in patients who are already receiving opioid therapy, who have demonstrated opioid tolerance, and who require a total daily dose at least equivalent to fentanyl 25 mcg/h.
Patients who are considered opioid tolerant are those who have been taking, for a week or longer, at least 60 mg of oral morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily, or an equianalgesic dose of another opioid.


Dosing and Administration

Converting from Other Opioids to the Fentanyl Transdermal Patch
As a general rule, when converting to fentanyl from another opioid, use about 25mcg/h of fentanyl transdermally for every 90 mg of oral morphine equivalent.
Appropriate dosage increments should be based on the daily use of supplemental opioids with the equivalency of morphine 45 milligrams/day orally to a 12.5 micrograms/hour increase in the transdermal fentanyl dose. Duragesic-12 delivers 12.5mcg/h of fentanyl.







INITIAL FENTANYL
TRANSDERMAL DOSAGE
Only for converting another
opioid to fentanyl

SOurce:
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&ved=0CHEQFjAG&url=http%3A%2F%2Fwww.va.gov%2FPAINMANAGEMENT%2Fdocs%2FFentanylTDS-IP.doc&ei=WL7PU_7IB-q78gGrqYGoDQ&usg=AFQjCNFyqYwnzOTZzAfPxSWqTFvkx36u1w&sig2=xMbdX6TjK4XlDMtzm5rtxQ&bvm=bv.71667212,d.b2U




















Adapted from the Duragesic PI, 2007


* The VA/DOD Medications Pocket Guide and equianalgesic opioid conversión ratios may be found at http://www.oqp.med.va.gov/cpg/cot/G/OT_Med.pdf .

Alternatively, the dose of fentanyl can be calculated using the following table. This table should only be used when converting to fentanyl; it should NOT be used when converting from fentanyl to another opioid. The conversion ratios are conservative and may result in overdosage if used to convert fentanyl to other opioids.
Prescribe a short-acting opioid analgesic, to be taken by the patient as needed, when fentanyl is first started, since the onset of the analgesic effects of fentanyl may be delayed about 20 hours.
Titrate patients upwards no more frequently than every 72 hours after the initial dose or no more frequently than every 6 days thereafter. Serum fentanyl concentrations increase gradually following initial application of the patch, generally leveling off between 12 and 24 hours and remaining relatively constant, with some fluctuation, for the remainder of the 72-hour application period. Dosage increases made more frequently than the recommended intervals may result in too rapid systemic accumulation of drug and potentially serious toxicity.
Do not cut or damage the patch. If the transdermal system is cut or damaged, controlled drug delivery will not be possible, which can lead to the rapid release and absorption of a potentially fatal dose of fentanyl.

Converting from Fentanyl to Other Opioids
There are no FDA-approved dosing instructions on how to convert patients from fentanyl to other opioids. After discontinuing the fentanyl patch, titrate the new opioid according to the patient’s level of pain relief and tolerability.
Take into consideration the fact that, after removal of the fentanyl patch, serum fentanyl concentrations decline gradually, falling about 50% in approximately 17 (range 13-22) hours.
Patient Education
Clinicians should educate patients on the proper use, storage, and disposal of fentanyl transdermal patch.
Advise patients to wear the patch continuously for 72 hours, and that each patch should be applied to a different skin site after removal of the previous transdermal patch.
Patches should be applied to intact, non-irritated, and non-irradiated skin on a flat surface such as the chest, back, flank, or upper arm.
Hair at the application site should be clipped (not shaved) prior to patch application.
The patch should not be used if the seal is broken, or if it is altered, cut, or damaged in any way prior to application. This could lead to the rapid release of the contents of the patch and absorption of a potentially fatal dose of fentanyl.
The transdermal patch should be pressed firmly in place with the palm of the hand for 30 seconds, making sure the contact is complete, especially around the edges.
Patients should avoid exposing the application site to direct external heat sources, such as:
o heating pads,
o electric blankets,
o heat lamps,
o saunas,
o hot tubs, and
o heated water beds, etc.
If patients develop a high fever while wearing the patch they should contact their physician.
Patients should be advised that fentanyl may impair mental and/or physical ability required for the performance of potentially hazardous tasks (e.g., driving, operating machinery).
Patients should be made aware of the potential for severe constipation and other opioid side effects.
Patients should be informed that, if the patch dislodges and accidentally sticks to skin of another person, they should immediately take the patch off, wash the exposed area with water and seek medical attention for the accidentally exposed individual.
Fentanyl TDS should be kept out of the reach of children and pets, preferably in a locked cabinet.
Patients should be advised to fold (so that the adhesive side adheres to itself) and immediately flush down the toilet any used fentanyl patches after removal from the skin. Accidental exposure or misuse may lead to death or other serious medical problems.
References:

Duragesic Patch . Full US Prescribing Information. http://www.duragesic.com/active/janus/en_US/assets/common/company/pi/duragesic.pdf#zoom=100.

VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. Medications Pocket Guide. http://www.oqp.med.va.gov/cpg/cot/G/OT_Med.pdf.

Opioid Therapy for Chronic Pain. VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. http://www.oqp.med.va.gov/cpg/cpg.htm.

Fudin J. Chemical classes of opioids. (http://www.paindr.com/Opioid%20Chemistry%2004-2006.rtf)

PDR® entry for Duragesic Transdermal System (Ortho-McNeil). From MICROMEDEX. http://vaww.visn8.med.va.gov/mdxcgi/htmldisp.exe?CTL=D:\mdx\mdxcgi\MEGAT.SYS&SET=1C6F2BEA9730B810&SYS=3&T=0960&D=1&Q=18.

[dubsnpugs]

Yes, Berta my father died in Oregon. The death certificate is checked no on line #46, it also appears that he was taken to the crematory, but not entirely sure from where?? The home address is listed as the location of death. So I will confirm this with my mom today when I speak to her as to where he was taken to from the house. They lived in a very small town in the middle of nowhere, so god only knows what happened. As for the medications, this is like reading Chinese to me, so I'm just taking one at a time to research. I will get working on scanning in all the documents I have thus far, and had added a few more Dr.s to my list that I found in notes to contact and get records. I'm assuming that I should contact SSA and get records from them as well? He was on SSD from about 1994 (I think....) for the severe nerve damage in his arms following 6 surgeries. The nerve damage was always there, but I think a short term job he took (1989-90ish) aggravated the problem and that was sort of the start of a can of worms opening. I also have a request that is now about 4 weeks in processing for his medical records in Vietnam (navy) and Air Force. My mother tells me that it was documented that he was hospitalized in 1967, but doesn't know why. He was also hospitalized twice in the AF, once for a fall off a jet, and the other was an accident in which his body was covered in some sort of chemical (paint thinner type chemical) that burned his skin and she remembers him having to wear eye patches for a while. I'm assuming it could take months if not longer to get those records. I know my mom has his DD-214 and some other records from Vietnam, but they are all blacked out.

A question, I noticed that the Paralyzed Veterans of America were helping my dad with his claim in 1997, as I have a letter from them confirming their appointment to the case. Should I contact them for records as well? Not sure what role they played in assisting him....

[Berta]

If you are scanning all of these records to a CD that is good to have that copy for your records .Maybe John or Dr. Bash wanted it all scanned to a CD but

I think our site is limited as to how much anyone can attach here via scans.

It might help us here to see a scan of the denial from 1997. But I think we were assuming there is AO claim potential.

With Vietnam Navy service, it would have to be proven that your dad stepped one foot on Vietnamese soil during the war , for any AO presumptice claim..
Or if his ship is on the VA AO Ships list available here under a search, then VA would concede exposure to AO, whether he left the ship or not ,while during the Vietnam War.

The PVA might not even have a file on him by now.

I think the best thing you can do is to make sure the medical records do not get out of order as you either copy or scan them for Dr. Bash and John.
I highlighted parts of copies of med recs but never altered the ones VA sent to me.

I did tab them as to year.

Also It might be a very good idea to get the SSA records.Then again, my husband's SSA records were on a big dolly at the SSA office and included all of his VA med recs, his SMRs, but very few private records.

All meds have 2 names ...I noticed your father was on Ambien ( because it was listed as Zolpidem ) and was also given

Spironolactone which is also called aldactone, for example and apparently on 2 different inhalers but it is difficult to determine if these were changes from one med to another or if VA had prescribed them all at once. The full med profile from the VA should have dates and more data.

This is why assessments by John and by Dr Bash for IMOs ,are invaluable, as they will readily see, based on when these meds were given, changed or continued, if they were appropriate or if they caused him more problems, by counterindications etc..

I did the work you are doing for my FTCA/1151 case many years ago, reviewing every med,and every single medical acronym,every word or entry in the med recs ( all handwritten in those days) to include nursing notes, Chaplain entries, MRI results, Blood chem reports ECHO and EKG , my husbands VA employment physical , and VA dental and vision records , because I never even knew how to find an IMO doctor in those days.

I won FTCA and 1151 for wrongful death in 1997. HARD work. It had become a full time job for me to develop the evidence to prove my case.

But when I re opened, as I mentioned, for AO DMII death, I sure knew who to contact and it was Dr. Bash.