Looking for Help - SARCOIDOSIS

[purplesmurf]

Hello Everybody, 

Im kind of new to posting on this forum. First, THANKS to all our vets for that you did and are doing. 

I'm looking for advise and guidance on how to get SC for Sarcoid. Towards the end of basic, I started having gland problems. Bilateral swelling. I was seen a few times for bronchitis, acute upper respiratory infection, sinusitis, allergies....etc. Training was coming to an end, so I went to the Dr a few weeks after graduating. I waited to see if the swelling would subside after no longer being in the stressful training environment. After several tests (cat scan, X-rays, biopsy of gland..etc....) I was given a pathological diagnosis of Sarcoid. However, my chest X-Rays were normal. I also had a sialogram. The findings of the sialogram stated an opinion of Srogrens/Sialolithiasis. I did a couple rounds of Prednisone, which reduced the swelling greatly but not completely. My symptoms have continued for the last 6 years.

I tried to file the claim a couple of different ways. Autoimmune, Salivary disorder, Sjogren's. It was denied of course with reasons stated as :

- Neither occurred in nor caused by service

- Denied on "Presumptive" basis because medical evidence fails to show a diagnosis within the required period after military discharge (CLEARLY not true)

- Evidence shows no event, disease or injury......service records do not contain complaints, treatment, diagnosis. 

 

I am currently service connected at 70% for bilateral feet issues, which started in service and were treated in service. I don't know how to do this claim, all I know is that I didnt have this issue until I joined the Military and need help figuring out an approach. Is it possible that it may have been triggered by any medications they treated me with? Any and all help is much appreciated. 

[Berta]

This is a Sjogren's award from the BVA:

https://www.va.gov/vetapp11/files3/1127027.txt

And a sarcoidosis award:

https://www.va.gov/vetapp10/files4/1037330.txt

You need a definitive medical diagnosis.

How long ago did the VA deny you?

Did they have your SMRs when they denied (they would be listed in the evidence list of that decision),?

Can you scan  and attach their denial for the Sjogren's?

(Cover C file # prior to attaching it here)

Did they rule out Lupus?

Do you yourself have your SMRs and do they clearly reveal medical entries for symptoms of your disability?

"Is it possible that it may have been triggered by any medications they treated me with? "

You could search the meds on the net and find out if meds would cause this.

 "Denied on "Presumptive" basis because medical evidence fails to show a diagnosis within the required period after military discharge (CLEARLY not true)"

Did you tell the VA of any private medical records you might have for this disability?

What was the diagnosis -Srogrens/Sialolithiasis? or Sarcoidosis?

You will probably have to obtain an Independent Medical Opinion.

If we can read that last denial ( and we need to know when that denial came) we might be able to help more.

 

 

Edited June 16, 2018 by Berta

[purplesmurf]

The first denial came September 2016. I filed without help and made a mess.

After looking over the first claim, it looks like I actually did NOT specifically claim Sjrogren's. Didnt realize that until now

I claimed: - 1) Sarcoid  2) Mouth Condition also claimed as salivary gland - Parotid gland bilateral swelling

I then sat down with a VA Rep, showed her the specific papers with the listed diagnosis. The rep re-opened the claim under a reconsideration for the same contention. She didnt file it under a new or different contention. 

The 2nd (most recent) denial date is November 2017.

Reason (word for word):

The evidence from Dr XXX, Dr XXX and Dr XXX submitted in connection with the current claim does not constitute new and material evidence because it does not relate to an unestablished fact necessary substantiate the claim and does not raise a reasonable possibility of substantiating the claim. 

I resubmitted some of the evidence because that evidence was not listed under "evidence used" in the first denial. 

 

Do you yourself have your SMRs and do they clearly reveal medical entries for symptoms of your disability?

- I got them after the 1st denial. They reveal symptoms and problems related to allergies, bronchitis, respiratory, shortness of breath complaints. Not much else. 

Did you tell the VA of any private medical records you might have for this disability?

- All of my records (for this) are from private Dr's. and were submitted with my first claim.

- I signed a release form giving access to all records.

 

[purplesmurf]

What was the diagnosis 

Surgical Pathology Consultation report: (Gland biopsy)

Preoperative Diagnosis: Sarcoid of bilateral parotid glands

Postoperative Diagnosis: Same 

Clinical Information: None

 

CT Neck with Contrast

Findings: There is increased density and enlargement of both the parotid glands and submandibular glands without discrete mass, sialolithiasis or periglandular inflammatory change. There is some intraglandular ductal dilation of both the submandibular glands without identified dilatation of Wharton's duct on either side The configuration is most typical of either Sialosis or Chronic Sialadenitis though the early stages of Sjogren's syndrome can have also a similar appearance.

 

After everything was said and done, my ENT gave me 3 options. 

1) Continue steroids 

2) Low dose radiation 

3) Surgical Removal

Edited June 17, 2018 by purplesmurf

[Berta]

"The rep re-opened the claim under a reconsideration for the same contention. She didnt file it under a new or different contention. "

That is a big part of the problem-

"I claimed: - 1) Sarcoid  2) Mouth Condition also claimed as salivary gland - Parotid gland bilateral swelling"- these are terms that are too general  and not specific enough to your issues.

It looks like they rejected  3 medical opinions you had- and it appears that you are within the one year NOD time frame on the November denial.

But I am not really sure on that.

Without seeing their actual decision it is hard to determine what you need to do next-

Maybe request a DRO hearing? Others will chime in on that-

Your doctors ( or at least one if them ) should be willing to help with an IMO/IME that conforms to the IMO/IME forum here at hadit.

The criteria in the IMO/IME link is what the VA is familiar with- as to the "as likely as not" wording-

then they have to give a strong medical rationale that associates your inservice  symptoms and any treatments with the diagnosis you have now.

They should give the VA their Curriculum Vitae or any information that shows they have expertise to opine on your claim.  They can bolster their medical opinion with excerpts from medical treatices or abstracts.

I briefly researched both Sjogrens and Sarciodosis yesterday and found your disability seems closer to Sjogrens, based only what I have read here  but you might have both Sjogrens and Sardio- I am not a doctor but my point is that the actual disabilities must be claimed.

Re-opens that are denied can take a lot of time to be resolved- That is why I had one BVA case.

I had 3 IMOs that my VARO would not consider- I could have filed CUE but at that point I wanted the BVA to get the claim-part of the problem was they - the RO-were refusing  to re open because I already had a DIC benefit.

The BVA can read. They awarded it.

You said the POA "re-opened it as a reconsideration-"Your situation is far different-then mine ---------was a I-9 filed on either denial?

I view a re-open as different from a reconsideration-they both require new and material evidence-

It will help us to help you if we can see the decision and the Evidence list (redact  file# and name prior to scanning it.

 

Edited June 17, 2018 by Berta

[Berta]

https://community.hadit.com/topic/53826-read-first-if-getting-an-imo/

 

[purplesmurf]

Berta, Thank You and here is the redacted decision. 

I also included the list of C&P's/DBQ's/Medical Opinions they ordered on the final pages. 

 

Edited June 18, 2018 by purplesmurf