Need advice on denial and appeal

[joevet]

I filed for VA benefits secondary to diabetes related to Agent Orange exposure for glaucoma, cataracts and hypertension. I am receiving 70% for diabetes and stents in my heart. The VA has denied my filing for secondary aliments because they say I have no proof that they are caused by diabetes. In their words they are "at least as likely not caused" by diabetes. My question is how does one prove that they are at least as likely caused by diabetes since all medical evidence reports they can be caused by diabetes? I have my claim under NOD. Any advice would be appreciated. Thanks.

[broncovet]

You need medical evidence.  Your opinion is insufficient, you must have a doctor or medical professional give an opinion that your (secondary) ailment is "at least as likely as not" due to your service connected diabetes.  

You may already have the above evidence.  Read your medical file and see if a doctor stated something similar.  If you do not have this evidence, then you may be able to obtain it from an IMO/IME.  If you already have the evidence then you can/should file a nod.  

If you do NOT have the evidence, but think you can get it, go ahead and file the nod, and submit the evidence when you get it.   One possibliity is that you have the evidence, and the VA just did not read it.  It happens all the time.  

[joevet]

What is IMO/IME?

[jbasser]

Independant Medical opinion.. Do me a favor and tell me exactly what your rated for and what percentage for each.

 

[Gastone]

J-V, we need way more info to really be of any assistance. 1. Date of your most recent Award/Denial.    2. A complete breakdown of your current SC Conditions, including DX and Award Dates.    3. A redacted copy of your most recent C & P DBQ as well as a redacted copy of all pages of your recent Denial Letter.

When you received your VA CSC rating of 70%, was there an "inferred IU Claim" mentioned in the Award Letter? Have you filed for IU since getting the CSC 70%. Are you currently Employable or earning in excess of $12,400 under 65, $11,400 over 65?

Do you use a VSO-Rep?

Semper Fi

[joevet]

I was first diagnosed with diabetes in 1993, but the doctor I was going to would not prescribe medication saying sometimes the side effects were more harmful than the disease. My eye doctor told me several years later that I should go back and tell him that an ole country eye doctor said that I should be on medication since diabetes can affect my eyes and every organ in my body. On 07-30-1997 the medical doctor finally prescribed medication for diabetes. But the diabetes was not getting any better so I changed medical doctors on April 30, 2003 and the new doctor immediately increased my medication three fold. In July of 2003 he prescribed medication for hypertension even though HBP was on my medical record for several years.

On November 8, 2003 I filed an original disability claim for service connection for type 2 diabetes due to herbicide (Agent Orang) exposure. I did not file for secondary disability due to hypertension. On March 26, 2004 I received a rating decision for approval of 20% for diabetes but a denial for hypertension. They had reviewed my entire medical record and made a decision without any evidence or filing that my hypertension was not related to my diabetes. Their decision states that "The evidence does not show that hypertension is related to service-connected condition of diabetes mellitus, Type 2, nor is there any evidence of this disability during military service. The available medical evidence only shows you with a history and treatment for hypertension".

On July 14, 2015, I filed for hearing loss, coronary heart disease, glaucoma, cataracts and again for hypertension. On November 23, 2015, I received a letter with decision. They awarded me 10% disability for tinnitus and 60% for coronary artery disease effective as of July 14, 2015. They denied any disability for the other ailments. They said I had not reported any "new" and material evidence concerning hypertension that they had not previously considered. The new and material must raise a reasonable possibility that when considered with all the evidence or record (both new and old), that the outcome (conclusion) would change. The evidence can't simply be redundant (repetitive) or cumulative of that which we had when we previously decided your claim. My question is: What else can I provide? I have had a long history of HPB which the medical proves and they have previously acknowledge. I started taking medication for hypertension after having taken medication for diabetes for several years. I don't know anything else to provide. I have HPB currently being controlled by medication and it is a known medical fact that hypertension can be secondary to diabetes.

Their denial for glaucoma and cataracts were almost identical. They said that the evidence does not show that glaucoma (also cataracts) is related to the service-connected condition of diabetes mellitus, Type 2, nor is there any evidence of this disability during military service. Your service treatment records do not contain complaints, treatment, or diagnosis for this condition. The evidence does not show an event, disease or injury in service. We did not find a link between your medical condition and military service. They have refused to consider these conditions as secondary to diabetes even though again it is a proven and acceptable medical fact that glaucoma and cataracts can be related to diabetes.

Now to try and answer your questions: When you received your VA CSC rating of 70%, was there an "inferred IU Claim" mentioned in the Award Letter? Have you filed for IU since getting the CSC 70%. Are you currently Employable or earning in excess of $12,400 under 65, $11,400 over 65?

Do you use a VSO-Rep?

I don't know what an "Inferred IU Claim" is and I can not see it mentioned in the Award Letter. I have not filed for "IU" since getting the 70%, but I did file a NOD. I am not employed. I am 74 years of age and have been retired since 2005. I am using the county veterans affairs office who is a VSO representative registered with the VFW. The VA office out Nashville has an employee that comes to Knoxville once a month. I went and talked to him about my claim and he said it appears the local VSO filed it wrong. He said he would take it back to Nashville and let the "guys" upstairs review it and I should be hearing something soon. Nothing so far. He said I might have to go for another C&P. Looks like I will be pushing up daises before this is resolved! On the HBP it has been since 2004.

Edited June 10, 2017 by joevet

[Berta]

The Original VA diabetes training letter (1997) on the older forum board, clearly states that those secondarys you mentioned are more than likely due to DMII...

I used that training letter to prove my husband had been undiagnosed and untreated for DMII and that contributed to his death.

If I can find that TL I will post some of it here, it was a very long TL.

But the problem is that it usually takes a IMO doctor ( I mean a real doctor-non VA doctor) to prepare an IME/IMO to get SC for secondarys.VA went against my DMII death claim twice with an Endocrinologist. By then I knew more about endocrinology than she did.

Dr. Bash agreed with my lay medical opinion and evidence and his IMOs were ignored by my RO but I knew the BVA  would read them. Award 2009 SC death due to DMII from the AO in NAM.

A VA Neuro whose DMII diagnosis was crossed out ( I managed to read it) because another VAMC was trying to cover up the malpractice from the local VAMC-had gone into private practice and he gave me a freebee IMO  too to support he DMII claim. He was the only VA doctor who treated my husband who knew what he was doing.No wonder he left VA. He saw too much negligence  and cover ups I think.