diabetes Diabetes Mellitus Help?

[chiefhouse00]

Greetings

C&P statement, "VETERAN WAS DIAGNOSED WITH DIABETES MELLITUS IN 2006. THE DIABETES MELLITUS HAS BEEN DIFFICULT TO CONTROL WITH LARGE DOSES OF INSULIN. THERE HAVE BEEN NOTED DEVELOPMENT OF TYPE I DM DUE TO ISLET CELL DESTRUCTION AFTER TREATMENT WITH RIBAVARIN AND PEGALATED INTERFERON WHICH THE VETERAN DID RECEIVE. NOTEWORTHY THAT THE VETERAN'S DIABETES HAS BEEN VERY DIFFICULT TO CONTROL WITH LARGER AND MULTIPLE DOSES OF INSULIN SUGGESTING ISLET CELL DYSFUNCTION. THEREFORE VETERAN'S DIABETES MAY HAVE EVOLVED FROM SOME DAMAGE TO THE ISLET CELLS RATHER THAN THE USUAL ETIOLOGY ASSOCIATED WITH GRADUAL PANCREATIC INSUFFICIENCY. THEREFORE IT IS AT LEAST LIKELY AS NOT THAT VETERAN'S DIABETES WAS DUE TO TREATMENT INCLUDING THE USE OF INTERFERON FOR HEPATITIS C."

The VA rated me 20% for DM Type 2 but now I have symptoms of DM Type 1. I put in for an increase for regulation of activities and hospitalization for episodes of ketoacidosis and hypoglycemic reactions requiring one hospitalization in 2012,2013, and 2014.

Can I claim this as Type 1 or Type 2? Or does it matter?

Best Regards

Chiefhouse

Edited September 24, 2014 by chiefhouse00 (see edit history)

[Vync]

I am not a DM expert, but I do believe that the pyramiding rule would apply. You did the right thing by applying for an increase.

Good luck on your claim.

[Berta]

"THEREFORE VETERAN'S DIABETES MAY HAVE EVOLVED FROM SOME DAMAGE TO THE ISLET CELLS RATHER THAN THE USUAL ETIOLOGY ASSOCIATED WITH GRADUAL PANCREATIC INSUFFICIENCY. THEREFORE IT IS AT LEAST LIKELY AS NOT THAT VETERAN'S DIABETES WAS DUE TO TREATMENT INCLUDING THE USE OF INTERFERON FOR HEPATITIS C"

Chiefhouse, was this the C & P that award you the 20% ?

Or is it a C & P for this?

"I put in for an increase for regulation of activities and hospitalization for episodes of ketoacidosis and hypoglycemic reactions requiring one hospitalization in 2012,2013, and 2014."

This type of statement:
"THEREFORE IT IS AT LEAST LIKELY AS NOT THAT VETERAN'S DIABETES WAS DUE TO TREATMENT INCLUDING THE USE OF INTERFERON FOR HEPATITIS C"
can definitely support a claim for secondary disabilities as well as an 1151 claim.

If the interferon was administered by the VA you could claim additional disability under Section 1151 as well as secondary.

But the question you asked is a good one.....

I will try to do some research later on both DMII and Diabetes Type 1.

The phrase "due to treatment ' is often a critical part of many 1151 claims, but in some cases treatment for one thing can unintengionally create other medical problensm and could be found a secomdary issues, involving no fault on the VA's part.

Have you gone over the VA Training letter here (available under a search) for diabetes?

That training letter made me realize how many documented symptoms my husband had of DMII,in his med recs, that VA overlooked and/or diagnosed improperly.

Any type of diabetes can cause additional disability and even death , if these other complications of diabetes are not properly diagnosed and treated.

Do your medical records reveal a documented diagnosis of Diabetes Type One ( aka diabetes insipidis) as well as DMII? and are you thinking both should be claimed?

Prior to my USMC husband I had been widow of an Army vet with a brain tumor, that caused diabetes insipidus.

There are 4 forms of insipidus diabetes.

Do you have anything in your medical records (particularly the hospitalization records), that define what type of insipidus you have????

Vync might sure be correct as to the pyramiding but then again, these might well be 2 independent disabilities that shoulld not be rated with pyramiding at all.

[Berta]

to add:
This is a post from a very young veteran, with diabetes insipidus ,replied to at Ray B. Davis's site:
http://www.veteransresources.org/forums/threads/rating-diabetes.3398/


"What rating you get will be dependent on what type of diabetes you have as diabetes insipidus DC 7909 is rated entirely different than diabetes mellitus DC 7913. From what you say, the Navy has rated you as diabetes mellitus.

Here's the rating criteria for DMII:

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%

The amount of insulin or even the taking of insulin is irrelevant to an increase from 20%. Regulation of activities is, but it doesn't mean anything like what you think it does. Since you are newly diagnosed, I doubt any doctor will state you need to regulate your activities to control your glucose. I'm not a doctor but I suspect you'll be at 20% a long while if you take care of yourself"

Source: Veterans Resources link above.

This thread from VBN shows how different the insipidus criteria is:
http://vets.yuku.com/reply/452599/PRE-MEB-for-DIABETES-INSIPIDUS-HELP-#.VCLYLBZRLgE


I found info on DC 7909 in this BVA 2011 decision:


"REMAND

The instant claim for increase was received in August 2006. The
next higher (60 percent) rating for diabetes insipidus (under
38 C.F.R. § 4.119, Diagnostic Code (Code) 7909) requires polyuria
with near-continuous thirst, and one or two documented (emphasis
added) episodes of dehydration requiring parenteral hydration in
the past year. A 100 percent rating requires polyuria with near-
continuous thirst, and more than two documented (emphasis added)
episodes of dehydration requiring parenteral hydration in the
past year. "
http://www.va.gov/vetapp10/files6/1047900.txt

But I also found this highly argumentative statement by the BVA in the decision.

"At the hearing, the Veteran also testified that he has received
Social Security Administration (SSA) disability benefits for
diabetes insipidus since 1988. Inasmuch as governing caselaw
(Golz v. Shinseki, 590 F.3d 1317 (Fed. Cir. 2010)) provides that
only relevant SSA records must be secured, and because records
dating from 1988 or earlier would have no bearing on a claim for
increase filed in 2006, the Board finds that SSA records need not
be sought."

I have not looked up Golz V Shinseki but I find this statement (if the veteran still is on SSDI solely for the insipidus )to be an extraordinary error on the BVA's part.
He should have applied for TDIU long ago.

The SSDI records might have bearing nor only on an increase ( and TDIU) but also set up a CUE potential for the earlier award, if VA knew of these records yet failed to obtain them.I would fight this up the yiong yamngs if I was this vet's rep.

I dont get it.

My husband's SSDI records were "relevant" for his 100% P & T PTSD award that came 3 years after he died, for a claim he filed 3 years prior to his death.
They awarded back to 3 years prior to hisdeath on that.

His CVA 100% P & T Section 1151 award ( due to the initial SSDI awards ---he had 2 separate SSDI due to successful reconsideration)
came 19 years after he died, when VA finally granted a CUE claim I had on that issue, which he himself had filed also in his lifetime under Section 1151, in 1994..

Chiefhouse, I think the VA must consider both of these types of diabetes separately in your case, and they both have different diagnostic codes, so II would claim both the DMII and the insipidus,if I were you and I hope others chime in here on that.

I feel the C & P results will garner a higher rating for sure, but will it be the right rating? I don't think they could pyramid the rating.

We have info at hadit on Pyramiding and in this great CUE claim case from Carlie::


"Therefore, the use of this Diagnostic Code in evaluating the Veteran's right knee disability would constitute improper pyramiding. See 38 C.F.R. § 4.14 [the evaluation of the same disability under various diagnoses is to be avoided]."

[Guest t�e�r�r�y�s�t�u�r�g�i�s]

Many years ago Berta helped me with info for my DMII claim. Great lady with a lot of claim knowledge. Two things I might suggest is for you to study the DMII training letter which helps you to know what the VA will be looking for in your C&P exam and if you have pain and tingling in your hands and feet you may have Peripheral Neuropathy. My rating is 40% bilateral hands and 30% bilateral feet and legs. Terry

[Berta]

Thanks Terry.

I thought my claims were over until my daughter insisted I reopen for DMII. She was in the Military at the time but knew DMII had become AO presumptive.

I studied a lot about diabetes and sure enough, she was right that dad had DMII, another misdiagnosed condition. I thought the 1151 stroke and the heart disease was bad enough.

You are right....the training letter is a wealth of information as to the multiple secondarys for DMII.... everything from renal disease to skin problems, and even an odd condition..... oral candidiasis. This was in my husband's med recs after he had a stroke.

I recalled he also had an entry of white plaque inside his cheeks.in his VA dental records. I didnt think anything of it until I found that oral candidiasis is often solely due to so much glucose in the saliva that it causes this odd problem.

One cannot overlook a single entry in their med recs.The docs after his stroke said this was nothing to be concerned about and not catchy. (They however were trying to cover up the malpractice they saw from a different VAMC.)

Even his drivers license became evidence for my DMII AO death claim and his pre employment physical right before he started working for the local VAMC.was evidence I used too.

They revealed his sudden onset of unusual vision problems, all due to DMII.

Evidence can sure come in many forms in addition to med recs.

Diabetes insipidus has many secondarys as well.

[chiefhouse00]

Berta and All

I was diagnosed by the C&P Examiner as having DM Type 1 but the VA service connected me for DM Type 2. I want to file a claim for an increase due to DM Type 1 because of issues with ketoacidosis or hypoglycemic. Sorry to repeat what I mentioned earlier but I'm not clear on this particular process. I was told that my claim should be submitted as Type 2 versus Type 1. This is driving me crazy...I might already be there.

Best Regards

Chiefhouse

[Berta]

Chiefhouse, after thinking about this again, I think you should pursue the claim for a higher rating of DMII, which I feel the C & P will garner for you.

But I also think you should file a Sectuion 1151 claim for the DM Type One and attach to the claim a copy of the C & P exan with this part highlighted:

"THEREFORE IT IS AT LEAST LIKELY AS NOT THAT VETERAN'S DIABETES WAS DUE TO TREATMENT INCLUDING THE USE OF INTERFERON FOR HEPATITIS C"

(If the VA gave you the interferon and IF this was not a reasonably expected result'.)

I dont think this is a 'secondary' condition, but can stand on it's own and be rated separately.

Section 1151 is briefly explained here at the VA's main web site:

The disability was:

The direct result of VA fault such as carelessness, negligence, lack of proper skill, or error in judgment, OR
Not a reasonably expected result or complication of the VA care or treatment OR
The direct result of participation in a VA Vocational Rehabilitation and Employment or compensated work therapy program.
http://www.benefits.va.gov/COMPENSATION/claims-special-1151.asp

We have much more on this type of claim under our FTCA/1151 forums here.

And/or you could file for this condition as secondary to the Hep C if that is SCed, and even file that the DMII was "aggravated by" treatment for a SC condition ( if the Hep C was SC):

In determining whether such additional disability resulted
from a disease or injury or an aggravation of an existing
disease or injury suffered as a result of VA hospitalization,
medical or surgical treatment, or examination, it will be
necessary to show that the additional disability is actually
the result of such disease or injury or an aggravation of an
existing disease or injury, and not merely coincidental
therewith. 38 C.F.R. § 3.358©(1).

However, if the interferon caused this secondary condition(which the C & P also supports) and the VA stated this WAS a potential outcome of the interferion treatment,you could claim the DM Type One as secondary:

Service connection may be granted for a disability that is
proximately due to or the result of a service-connected
disability. 38 C.F.R. § 3.310(a). To establish entitlement to
service connection on a secondary basis, there must be competent
medical evidence of record establishing that a current disability
is proximately due to or the result of a service-connected
disability. See Lathan v. Brown, 7 Vet. App. 359, 365 (1995).

Additional disability resulting from the aggravation of a non-
service-connected condition by a service-connected condition is
also compensable under 38 C.F.R. § 3.310(a). See Allen v. Brown,
7 Vet. App. 439, 448 (1995). In order to prevail on the issue of
entitlement to secondary service connection, there must be (1)
evidence of a current disability; (2) evidence of a service-
connected disability; and (3) medical nexus evidence establishing
a connection between the service-connected disability and the
current disability. See Wallin v. West, 11 Vet. App. 509, 512
(1998).

You need to determine, with any type of treatment you might have signed something for (in you med files) if VA told you this WAS a potential result of the interferon because 1151 under this basis ( can be a bigger hurdle that claiming 1151 under negligence).

And unfortunately even under a secondary claim or claim for aggravation of a SC DMII existing SC, you might need to obtain an IMO that can associate whioch symptoms and medical conditions are from the DMII and the diabetes Type one.

Personally I would file for all of above.

In my initial DIC claim I filed under three theories. I won under 2 of them and realized recently that one of the theories was completely ignored by thre VA,in light of subsequent awards and by me, almost 20 years after filing that claim.

In any event, we have the right to offer any theory whatsoever for entitlement to SC.

Do you have a vet rep? And are you willing to obrtain am IMO if needed?

And is the Hep C Service Connected ?

If so that would change my opinion here a little and might well be a stronger basis for a Section 1151 or secondary claim.

[Berta]

To add...I hope others chime in a this:

"THEREFORE IT IS AT LEAST LIKELY AS NOT THAT VETERAN'S DIABETES WAS DUE TO TREATMENT INCLUDING THE USE OF INTERFERON FOR HEPATITIS C"

It appears that the examiner stated 'diabetes' in a broad point here . Is it clear to anyone that he means the Diabetes Type One or the DMII?

The word "including" after treatment concerns me as well.

"due to treatment"....."including the use of interferon."

Including what other treatment that led to the diabetes?.......

Did the C & P examiner see something else that caused the diabetes?

This is often why it takes a good reading from an IMO doc to really determine what medical care a vet did or didnt get and

how that care could have caused them additional disabilities.

I squalked with NVLSP over my Nehmer EED., saying a 1988 ER Med cert was the initial presentation of my husband's misdiagnosed heart disease ( AO IHD).

However VA had a C & P exam result dated a few months later (I dont recall him having this exam at all and it was not in the med rec copy I got) for my husband's PTSD a few months after the ER incident that noted heart disease. That is what Nehmer used for the EED.

I had never received this copy of this exam either in the med rec copy or the C file copy.

That single record alone would have made my FTCA/1151 claims definitely go a little easier.

Still, in spite of that omission to the records I got, I read every single word and every page many many times in a large stack of med recs to succeed in my original claims, but when I re opened in 2003 I certainly got IMOs from real doctors for the DMII AO death claim because I knew

by then , the VA would give me problems on my lay medical evidence for my DMII AO death claim.

If the medical evidence is solid (and the service nexus is established or presumptive) then an IMO is always well worth the money invested into it.

.

[chiefhouse00]

Greetings Berta

I'm service connected for Hep C and failed three treatment sessions over an eight year period. My first treatment started before retiring from the military. I'm currently rated 20 percent for Hep C.

Best Regards

Chiefhouse

[Berta]

I wasn't sure about the Hepatitis Chiefhouse ...you could file for the DM type one as secondary to the Hep C.....and that might help separate these two diabetes conditions.Someone mentioned pyramiding here.....

I will post new topic on that....

[chiefhouse00]

Greetings Berta

You made a very good point of maybe connecting my DM Type 1 increase request to my service-connect Hep C instead of DM Type ll, which I'm 20% service-connected for both. I will wait for the BVA judge review/decision on my current increase request for regulation of activities and hospitalization for episodes of ketoacidosis and hypoglycemic reactions which I was hospitalize for in 2012, 2013, and 2014.

Best Regards

Chiefhouse

[chiefhouse00]

Greetings

Still trying to understand how I was rated with diabetes mellitus type II instead of diabetes mellitus type I. This is how the VA rated me, "Service connection for diabetes mellitus type II as secondary to the service-connected disability of hepatitis C. We have granted service connection for diabetes mellitus related to the service-connected disability of hepatitis C. VA examiner opined that your diabetes mellitus is at least as likely as not caused by your service-connected Hepatitis C due to islet cell destruction after treatment with Ribavirin and Interferon for Hepatitis C. The examiner noted difficulty controlling your diabetes
with large and multiple doses of insulin suggesting islet cell dysfunction rather than the usual gradual pancreatic insufficiency."

As mentioned earlier, I want to file a claim for an increase due to DM Type 1 because of issues with ketoacidosis and hypoglycemic. and three ER stays (2012, 2013, and Feb 2014) but I can't under diabetes mellitus type II.

I'm I making to such out of this...can DC 7913 Diabetes Mellitus be used for DM Type ll and Type I? If so, I will try to relax a little.

Best Regards

Chiefhouse