Non VA medical bills

[JohnsWidow]

My husband was 100% service connected disabled USMC veteran. He passed away Oct.22, 2016. He had gone to 2 seperate non VA hospitals via ambulance before his passing. The hospitals were aware he was 100% service connected disabled. They have been sending bills for hospital services and he had told their billing departments to send the bills to VISN 16 Consolidated fee unit PO box 320164 Flowood, MS. 39232 several times. Now that he has passed and the same bills are still coming I decided to just enclose a note in all bills stating to remit all bills for payment to the VISN address. They still don't get it. What am I doing wrong? Can anyone suggest a better alternative? Thank you for your time.

Edited January 2, 2017 by JohnsWidow

[Berta]

I do not know why the VA specifies "respiratory" cancer.

You have confidence in the TVC, so they probably could explain that.

Or, just by talking to the private doctor who treated your father,they would know if the cancer is classified as having been "respiratory".

I am assuming he did not have any other cancer that this was metastasized from.

Only the medical records could reveal that.

And the TVC has probably considered the 30 year rule and it might not even be an issue...pr the "respiratory" condition.

The MOPH ( Military Order of the Purple Heart) in Syracuse NY, years ago, told a widow her DIC claim was "in the bag". The veteran had incountry Vietnam Service and also had lung cancer.But VA denied the claim.

When VA denied the DIC , as I recall, she went to a Syracuse newspaper to tell her story.There might even be more info here on it and I have tried to find any appeal at the BVA similar but there are so many DIC denials there it is hard to find it.

The point is ....I do not know why this widow was denied. MOPH ( I believe I knew the vet rep who told her this) led her to believe she could expect an award, without considering the possibility of a denial.

A similar situation happened to me with my initial DIC claim.It had been denied but still on appeal.

I  sent them settlement papers for my FTCA case.Proof of wrongful death... as soon as I got them.

They denied my DIC claim. Again. I called up VA General Counsel-in DC and said the deal we made was off and I wanted more money. The lawyer called  the RO.

The DIC award letter was soon in the mail.

There may be no issue at all regarding the AO Lung Cancer claim.The TVC seems very confident that it does  fall into VA case law under Nehmer and maybe the 30 year issues has no bearing on it at all.

However, I do not trust the VA to use any regulations, even the Nehmer Court Order, properly.

 

 

 

 

 

 

 

 

[Berta]

The 30 year criteria is explained in this decision:

"Turning first to whether the Veteran's cause of death, lung cancer, was incurred during service, the appellant does not assert, and the Veteran's service treatment records do not suggest, that the Veteran developed this disease during service or shortly thereafter.  Rather, as referenced above, the Veteran was first diagnosed with lung cancer in 2003, more than 30 years after his discharge from active service in 1972.  See Maxson v. West, 12 Vet. App. 453 (1999), aff'd 230 F.3d 1330 (Fed. Cir. 2000).  The evidence does not suggest that the lung cancer manifested many decades earlier closer in time to the Veteran's service."

 

"Once a veteran's exposure to an herbicide agent, such as Agent Orange, during active service is established, certain specific diseases, including respiratory cancers, such as lung cancer, shall be deemed service-connected if the disease manifests to a degree of 10 percent or more at any time after service.  U.S.C.A. § 1116(a), (b); 38 C.F.R. § 3.307(a)(6)(ii). "

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp14/Files5/1440042.txt

I don't think it would be an issue for your mother's DIC case, if they service connect the cancer.

The above claim was denied on a different basis.

 

 

[Berta]

You asked:

"I'm not sure what you mean by "respiratory" lung cancer (I didn't know if came in any other form) I assume this means that the cancer originated in the lungs and did not come from somewhere else in the body is this correct? what is required to prove this?"

A cancer that originates elsewhere and then appears in the lungs, or anywhere else, has metatisized from the original cancer,if a doctor determines that nexus, or link has occurred.

The word  "metastatic" on the death certificate as you posted, has been bothering me since I read it ,because there is no other information to explain what the physician meant.

All of that information will be found in the veteran's private and VA medical records, and/or by contacting his doctors.

It has concerned me because of claims from widows denied like this one was:

http://www.index.va.gov/search/va/view.jsp?FV=http://www.va.gov/vetapp04/Files3/0424102.txt

AO exposure ,In Country Vietnam,  lung cancer.............           Denied

It involved metastatic cancer.

I certainly feel the AO DIC claim should be pursued....but that these are issues that might need to be medically clarified.

Or maybe not- as the TVC is confident of the DIC claim and has probabvly seen more medical info then what we have here.

 

 

 

Edited January 8, 2017 by Berta

[SonOfJohn]

12 hours ago, Berta said:

A cancer that originates elsewhere and then appears in the lungs, or anywhere else, has metatisized from the original cancer,if a doctor determines that nexus, or link has occurred.

The word  "metastatic" on the death certificate as you posted, has been bothering me since I read it ,because there is no other information to explain what the physician meant.

 

The Cancer was stage 4 when My father was made aware of it. My understanding of the medical records is that the cancer originated in the lungs and spread to other areas. The last MRI scan he had showed the cancer had spread to the bones around the spine and hip area causing tremendous pain.

[Berta]

Your mother had posted here:

“The VA knew John had cancer in September of 2015 and did not tell him. He was diagnosed at Conroe regional hospital with stage 4 lung cancer June 2016. John ordered his VA medical records after this and found  five times in the Sept.2015 radiology report that he should be notified. He was never notified by the VA. “

 

My husband had ischemic heart disease and Diabetes Mellitus and the VA never “told him”.

 

I suggest to get back to whoever at TVC filed the DIC claim, (form 21-534)

 

To file a claim under Section 1151, 38 USC.

 

If TVC does not have any form they use for 1151, than there are templates here to use.

 

Also the posts stated:

“Sept 14, 2016, My father filed an A 21-5265EZ claiming Lung Cancer (AO)

I believe the decision on this is still pending”

Yes but your mother will have to substitute herself as the claimant.

I posted that form link here , but TVC will have the form.

You asked :

“Would it be wise to wait for the lung cancer/AO claim to go through before pressing other wrongful death claims? I'm not exactly sure how to go about filing multiple claims.”

NO. The FTCA has a statute of limits.

What is the status on that from the law firm you mentioned? Did they even file a SF 95

The Section 1151 claim should be filed as soon as possible.(and the FTCA if you take that route)

The AO DIC claim could take years, so could the 1151 claim.

My FTCA case went faster than the 1151 claim I filed at the same time. FTCA is handled differently than 1151.

If your mother is willing to pursue negligence /malpractice, she will need a strong Independent medical opinion from a non VA oncologist.

They will need to have copies of all of his private and VA medical records.

Perhaps the oncologist who treated him at the non VA facility would provide and IMO (independent medical opinion)

I have no idea what the cost would be.

There are plenty of oncologists in Texas.

Their opinion, if it reveals malpractice that contributed to your father’s death can be used for both the FTCA matter and the 1151 matter.

If you chose not to file FTCA, then you can file and pursue the 1151 anyhow.

TVC vet reps know how to handle 1151 claims.

Medical records,to include MRI results, have to be reviewed in their complete context.

Also they can be difficult to decifer.I know because I did that. 6 handwritten pages ,MRI of Brain  result) with a brief typed version. But I knew what I was looking for as I had already filed my 1151/FTCA claim and this was a MRI done after, at that point, 4 years of malpractice.

In the  MRI results ,the Neuro doctor revealed the conversations I had with him and the critical dates I gave to him of multiple ER trips etc etc but he still failed to properly diagnose the veteran.(to cover up the initial multiple malpractices at the local VAMC)

I have no idea if your assessment of the MRI is accurate. His doctors would know what it means.

 

 

I regret your father had to deal with so much pain.

 

 

 

 

 

[SonOfJohn]

Berta: I spoke with the private doctor that was giving my dad the immunotherapy trial (very nice guy. He has worked with the VA before and is now in private practice) When my dad was taken off the immunotherapy trial after the first dose showed no results, this doctor said he needed to start chemo immediately. We made the consult request, through the va primary care, but nobody would approve it. I have requested the medical records from this doctor.

I also found out that another patient in the trial who was taken off at the same time as my father for the same lack of improvement. This patient was able to get on Medicare B, got chemo and is now not only still alive, but improving.

The VA screwed up my father's medicare B when he required emergency surgery to repair an aortic dissection in late 2016. The VA hospital referred him to St Lukes and provided paperwork that they would pay the entire bill. This paperwork got held up so Med B automatically kicked in and my parent's got sent a bill for the remaining balance. The VA said in order for them to pay the 100%, my father would have to reject Med B...which apparently rejects it not just for one procedure, but you can't use it until the next enrollment period and then have to be approved again.

Therefore, my father was not having success with immunotherapy, The VA screwed up his medicare B, refused to provide him chemo treatment at the VA or through the choice program to a private doctor already familiar with his case and who strongly recommended it.