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CT Scan Results At VA

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lfredrick123

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I took my husband in for a call in to Pulmonary by the CBOC. Here are the results. I am wondering if any of these are attributable to his in service exposure to herbicides etc. Seemed very unusual to have CT scan and then a visit with the Chief of Pulmonolgy fro follow up. They listed the following CT results. Have not seen the narrative yet but CT has confirmed some issues I believe,

VA Radiology Reports Source: VA Last Updated: 16 Mar 2017 @ 1005 Sorted By: Date/Time Exam Performed (Descending) VA Radiology Reports are available 3 calendar days after they have been completed. Some studies done at a non-VA facility may not be available or they may not necessarily include an interpretation. If you have any questions about your information please visit the FAQs or contact the provider who ordered the study or your primary care provider. Procedure/Test Name: CT THORAX HIGH RESOLUTION Date/Time Exam Performed: 12 Mar 2017 @ 1253 Ordering Location: VA HlthCare Sy Requesting Provider:_______ Reason for Study: recurrent infections Performing Location: VA _____________ Clinical History: NO VAMC IMAGING PROCEDURES WITHIN LAST YEAR Plain films obtained concurrent with or w/in one month of requested musculoskeletal/spine CT/MRI? NA (STUDY NOT RELATED TO MUSCULOSKELETAL ISSUE) 1. Responsible provider and contact number/pager: Miller 303-929-2145 2. Symptoms/Duration/Physical findings/Working diagnosis: Recurrent pneumnias 3. Briefly describe how results will impact management: characterize, rule out bronchiectasis >> PLEASE NOTE THAT FAILURE TO PROVIDE CLINICAL INFORMATION MAY LEAD TO CANCELLATION OF THE REQUEST AND REFERRAL TO RESPECTIVE SERVICE CHIEF.  Page 70 of 73 CREATININE (Includes EGFR) - NONE FOUND ********************************* MAY MODIFY EXAM AT RADIOLOGIST DISCRETION BASED ON CLINICAL HISTORY PROVIDED ON IMAGING REQUEST. ********************************** Radiologist: D_________________ I IMAGING Report Report: CT thorax high resolution Technique: Axial images were obtained through the thorax, sagittal and coronal reformats . Clinical history:Recurrent infections CTDI:19.6mGy IV contrast:None Comparison:None Findings: Mediastinal structures:Tracheostomy tube. Exam degraded by patient motion. No masses or adenopathy in the mediastinum, hila or axilla Upper Abdomenunremarkable Vascular structures:Normal caliber aorta with moderate calcific atherosclerotic disease. Dilated pulmonary arteries. Coronary artery calcification. Enlarged heart size at upper cardial effusion Lung parenchyma:There is opacification at both lung bases which is subsegmental. No fluid overload or pneumothorax Musculoskeletal structures:Maintained vertebral body height and alignment. No lytic or blastic lesions. Mild spondylosis. Impression: Consolidations at both lung bases, infection not excluded Coronary artery calcification. Cardiomegaly Tracheostomy tubePrimary Diagnostic Code: MINOR ABNORMALITY Procedure/Test Name: CT 3D RECON W/O POST PROCESS Date/Time Exam Performed: 12 Mar 2017 @ 1253 Ordering Location: VA Eastrn Colrado HlthCare Sy Requesting Provider: MILLER,YORK E Reason for Study: recurrent infections Performing Location: VA Eastrn Colrado HlthCare Sy 1055 CLERMONT STREET, DENVER 80220 Clinical History: NO VAMC IMAGING PROCEDURES WITHIN LAST YEAR Plain films obtained concurrent with or w/in one month of requested musculoskeletal/spine CT/MRI? NA (STUDY NOT RELATED TO MUSCULOSKELETAL ISSUE) 1. Responsible provider and contact number/pager: Miller 303-929-2145 2. Symptoms/Duration/Physical findings/Working diagnosis: Recurrent pneumnias

Briefly describe how results will impact

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management: characterize, rule out bronchiectasis >> PLEASE NOTE THAT FAILURE TO PROVIDE CLINICAL INFORMATION MAY LEAD TO CANCELLATION OF THE REQUEST AND REFERRAL TO RESPECTIVE SERVICE CHIEF. Patient Address: 10861 TENNYSON CT WESTMINSTER, COLORADO 80031 Cell:(720)724-1308 Home:(720)724-1308 CREATININE (Includes EGFR) - NONE FOUND ********************************* MAY MODIFY EXAM AT RADIOLOGIST DISCRETION BASED ON CLINICAL HISTORY PROVIDED ON IMAGING REQUEST. ********************************** F Radiologist: DONAHUE,FRANCIS I IMAGING Report Report: CT thorax high resolution Technique: Axial images were obtained through the thorax, sagittal and coronal reformats . Clinical history:Recurrent infections CTDI:19.6mGy IV contrast:None Comparison:None Findings: Mediastinal structures:Tracheostomy tube. Exam degraded by patient motion. No masses or adenopathy in the mediastinum, hila or axilla Upper Abdomenunremarkable Vascular structures:Normal caliber aorta with moderate calcific atherosclerotic disease. Dilated pulmonary arteries. Coronary artery calcification. Enlarged heart size at upper cardial effusion Lung parenchyma:There is opacification at both lung bases which is subsegmental. No fluid overload or pneumothorax Musculoskeletal structures:Maintained vertebral body height and alignment. No lytic or blastic lesions. Mild spondylosis. Impression: Consolidations at both lung bases, infection not excluded Coronary artery calcification. Cardiomegaly Tracheostomy tube  Primary Diagnostic Code: MINOR ABNORMALITy.

Anyone have any ideas? Recently recieved a call from RO person telling me she was expediting his claim through the DRO process, then we got the call to go in for the CT and follow up, unusual to meet with the Chief of Pulmonology.MD . Started the meeting with a young DR that then left and in came the Chief. What do you think guys?

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This report is both good and bad.  

Your diagnosis of "Minor Abnormality" is not that great.  Keep your focus on the Big 3:  Current diagnosis, in service event, and nexus.  "Minor Abnormality" sounds like there is something "abnormal" but its non specific and would likely have to be rated in analgous ratings.  

However, the term used above, "recurrent" is good.  The VA does not like us to have an "event in service" where we have no problems with it for 20 years, then we apply for benefits for that and begin treatment when we need money.  (This is their view, not mine).  

To give us benefits they want "continuity of symptoms", that is, a problem in service that resolved itself and we have no symptoms wont be getting us benefits.  

This report does not address whether your pulmonary "minor abnormality" is related to herbacide expousure, but it does identify its a "recurrent problem".  

My adivice is that you can apply, but, on the bases of THIS REPORT ALONE you wont likely be compensated over zero percent.  However, if you do have some pulmonary symptoms documented elsewhere, this would supplement your claim.  

If you are seeking benefits for this, keep your eye on the big 3 criteria.  This means you MAY need an IMO/IME to document some things for the big 3 unless you already have that documentation in your records.  The only way to find out is to get your whole medical file and read it over.  

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Hello there - I'm a newbie on hadit and just read your post. My husband is service-connected for A/O CAD and more. I was reading your CT report. I am NOT an expert but I see some key words in the CT report. Bear with me, and know that my advice is worth what ya paid for it:).

If this was my scan, first off I would look for synonyms for every word and phrase that sounds medical: a good search might be "medical definition dilated pulmonary arteries" then you can see what that really means in plain English. I mean who the heck knows what spondylosis is? That way you can translate what the CT report says and correlate the symptoms.

It seems that the VA laws don't speak the same language as the doctors. Knowledge is key for example the phrase "enlarged heart" could/could not be known as dilated or hypertrophic etc and that might/might not be part of a CAD claim. Same with cardiomegaly (if it's heart).

I see key words reflective of potential CAD issues and broncovet noted pulmonary issues.

Since the claim is already underway, the next most important step is to make a list of the items reported, and questions to ask the doctor about what each item means. Ask about possible medications which should be prescribed. Ask about procedures. Ask about the overall picture of all the items combined. Ask about prognosis.

Be a nice, polite, firm squeaky wheel as an advocate for your husband's health. If possible, getting a non-va second opinion is also a good idea. I would certainly ask the va PCP to refer to specialists - pulmonologist and interventional-cardiologist. I always attend every doctor appointment at the va because I want to make sure my husband gets the best health care he can to keep him healthy. I hear different phrases than he does, and I ask different questions. The doctors are very respectful and I have been told that they appreciate my time because we are working together as a team to keep him healthy.

 

Edited by AgentOrangeWife
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Good Advice from A.O.Wife

you can also request to your hubbys  PCP and other specialty Clinics Dr's to use layman terms when speaking in medical terms  so you can understand all this .

Always have pen and pad handy when speaking to the Dr's &  take notes.

get back home get on the old computer and do google research   that's the best way to learn

And when you do file a claim you need to have all this documented from a medical Dr  your lay statements is not enough , it has to be said by a medical Dr  as to this condition or condition's is likely as not caused by this veterans military service..to get this service connected.

once  service connected  then they go by the severity of symptoms as to the ratings % 

you may have your hubby to file a ITF (Intent to File)  you have a year to file the claim for all these conditions  the ITF starts his EARLY EFFECTIVE DATE...During the year you gather up all your medical evidence and any material  related favorable to your hubby claim. & request your hubby C-File  ASAP as broncovet mention  the Big 3  Diagnoses ,In service event, nexus letter from a qualified Dr.

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Thank you all. I did look up the Spondylosis. Spondylosis is usually caused by the development of arthritis in the spine, which causes the discs and vertebrae to gradually wear down over time.Arthritis of the spine. Heavy lifting for example could cause it over time. This is now 50 years later so I am sure they would say its old age, However the pulmonary issues have been well documented, and I already have a pending DRO/Appeal going on. Hubby had a major stroke in 2008 due to his high blood pressure which he developed in Service. I just received information from a toxicologist that Chlordane (Herbicide and Pesticide) as well as others in the 60's has been linked to hypertension. I also have proof of 2,4,5,T being used by the base, and added proof from Industrial Hygiene reports as well. All of these are suspect in the development of hypertension, not to mention the other things going on. I have an IME already submitted that says the stroke was a result of hypertension, and that it was the cause of the brain bleed causing the vessels to rupture, As well he has sleep apnea, and COPD thanks to Diesel and petroleum exposures, I just was not sure about the coronary artery calcification if that is a result of IHD, along with the enlargement and effusions (Pericarditis)

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Just the fact that he had Hypertension in the service that never resolved is a big jump to get SC. Have you had an MD opine that it more than likely was caused by the pesticides and/or carbon dioxide poisoning in service?

Proof that pesticides were used and proof that he was exposed to them are 2 different issues. He must give a lay statement that it happened, and it would be very smart if you had more than one statement from buddies that had been exposed in the same fashion. If you were with him back then, did he tell you about this?  If so, you should also provide a lay statement as to what and when he told you about the exposure (and did you smell it on his uniform, etc...)

Did he have any spine related problems in service?  Back pain or lumbar strain must be documented in SMR or its a real battle to get SC.

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"I just was not sure about the coronary artery calcification if that is a result of IHD, along with the enlargement and effusions (Pericarditis)"

I think it's the other way around: maybe CAD causes IHD. The arteries clog up and cause diminished blood/oxygen flow (unless there is already some diminished heart function) and the clogging causes the heart to work harder to push oxygenated blood into distribution. I think ischemic means lack of oxygen. When the heart works harder I think that is when you get into hypertension.

I would be really shocked if your husband isn't increased from the 10% in your profile.

My husband is service-connected for 7005 (Arteriosclerotic Heart Disease) which seems to be used as a catch-all for ischemic heart disease IHD, coronary artery disease CAD, etc. His DD214 shows Vietnam in-country and getting him s/c was the ONLY easy part of this whole process.

My only other advice would be to research CUE's and NOD's and maybe get ready to file one. I don't understand how your husband could be only 10%. When was his original claim decision date? Do you have a good VSO?

Edited by AgentOrangeWife
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