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Need advice on denial and appeal

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joevet

Question

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.

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7 minutes ago, jbasser said:

You do not have to prove you had secondary conditions in service as many arise years later. All you need is a doc to state that your conditions are related to diabetes.

Are you service connected for heart disease? You should be and that should SC your HTN.

 

J

The reason for denials were not having a medical record of having HTN, etc... in the military.

Yea, I have been approved for 60% based on CAD. But I have not thought of filing for HTN as SC to CAD.

Have not been able yet to get a medical doctor to provide an IMO/IME stating HTN is a SC to diabetes.

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  • HadIt.com Elder

I agree with Jbasser

It could be just me that  thinks this ?...> but it seems the secondary health conditions they look at and rate faster than a regular claim.

And also I believe Vietnam Vets with A.O. Claims are worked faster  b/c there's not than many of us left.

As Jbasser mention all you need is  Qualified Dr to state that your heart condition is related to another condition and you want to claim that.

The Dr will need to examine you and read your medical records that pertains  to your heat condition or what ever condition your S.C. for.

Example   a VETERAN with S.C. PTSD  Is eligible to file a secondary claim to his PTSD Medications that  can cause or be related to other conditions   such as Sleep Disorders (SLEEP APNEA) E.D. and other conditions.  ect,,,ect,,

With the Presumption of A.O.  and the Nehmer Rules (CFR  3.816)  you have a good chance of being approved.

Edited by Buck52
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1 hour ago, Buck52 said:

I agree with Jbasser

It could be just me that  thinks this ?...> but it seems the secondary health conditions they look at and rate faster than a regular claim.

And also I believe Vietnam Vets with A.O. Claims are worked faster  b/c there's not than many of us left.

As Jbasser mention all you need is  Qualified Dr to state that your heart condition is related to another condition and you want to claim that.

The Dr will need to examine you and read your medical records that pertains  to your heat condition or what ever condition your S.C. for.

Example   a VETERAN with S.C. PTSD  Is eligible to file a secondary claim to his PTSD Medications that  can cause or be related to other conditions   such as Sleep Disorders (SLEEP APNEA) E.D. and other conditions.  ect,,,ect,,

With the Presumption of A.O.  and the Nehmer Rules (CFR  3.816)  you have a good chance of being approved.

Buck, after thinking about it, I maybe in the predicament of which came first: the chicken or the egg.

I have had hypertension for twenty years but the CAD for only three years officially. The VA has my medical records showing hypertension several years before the start of medication from both medical doctors and the hospital. It might be impossible to prove CAD caused the hypertension. Perhaps contributed to making it worst.

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  • HadIt.com Elder

I understand what you mean  but  the Dr's (preferably a specialist) will need to give opinions on this  not you,/us....and the rater will need to figure it out as to what the Dr's mention, the raters have a medical manual they go by codes an to the Dr's Medical Impression or Opinion.

 So a IMO'( Independent Medical Opinion) maybe worth it, if you can't get the VA Dr's to help. some will & some won't.

It don't matter how long  you had the secondary condition just have to have the condition  or if it just comes up, just that your S.C. for Heart Disease ...there's no limit has to when these secondary conditions arises.  years later or 3 years ago...it still can be a secondary condition to what your S.C. For   but a Dr needs to say that it is at least likely as not your heart Disease is related to (this other condition) and he needs to give his rational opinion.  this is a nexus to link the two together  so-to-speak.

After that  the VA Will have to figure it all out, you can look up the serverity of the secondary conditions and see what its suppose to be rated at...so  the VA Won't low-ball you and give you a lower rating that what the Regulations say..or in your claim you can request your secondary condition be rated to the full extent of the Law According to the CFR Reg's...I don't happen to have that CFR# but if you quote it back them  and your approved  you will probably get the correct rating....b/c  NOD a (Notice of Disagreement) is taking a long time to Appeal. but there's always that option.

Edited by Buck52
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  • HadIt.com Elder

Joe if they fail to secondary the HTN,you should ask the VA in the form of a NOD to state that the HTN if not secondary be rated as an aggravation to your service connected heart disease. Since it likely will be rated zero % unless your Systolic (top) number is 160 or Diastolic number (bottom) is predominately 100. Any cardiologist will write an opinion for that.

 

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On ‎6‎/‎24‎/‎2017 at 6:00 PM, jbasser said:

Joe if they fail to secondary the HTN,you should ask the VA in the form of a NOD to state that the HTN if not secondary be rated as an aggravation to your service connected heart disease. Since it likely will be rated zero % unless your Systolic (top) number is 160 or Diastolic number (bottom) is predominately 100. Any cardiologist will write an opinion for that.

 

Thanks jbasser. I don't mind hypertension being rated as zero as long as it is considered SC. There are several other ailments that are linked to hypertension.

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