My 1151 Claim - Did I do this right?

[Army Veteran]

I'd like to prelude my introductory post here by thanking all of those who have paved the way over the years for a better VA claims process and those (Berta, Buck and others) who have given so much of their time to help us Veterans.

Earlier this year, I filed claims for tinitus and a foot fracture incurred during service that I beleive led to over compensation for balance that evetually led to chronic plantar fasciitis.

I also filed an 1151 with the help of my Texas Veterans Commission officer for medically induced pancreatitis with secondary issue of diabetes.  Unfortunately, I didn't much research and took my TVC rep's advice and just filed out the form, though I did document it quite thoroughly and it was quite long.

The tinitis claim was settled earlier this year and I noted a "Regulatory or Procedural Review" claim opened when it was approved and a week or so later, received my packet.

The other two remain.  In the past month, I have seen two different "Regulatory or Procedural Reviews" in my eBennefits.  One with no data, just that it was opened and closed two weeks later.  The other shows that a packet was sent, but doesn't specify which of the remaining two claims and have not received packet.  I asked my VRO? Texas Veterans Commission officer to look at it, but he didn't see the "Regulatory or Procedural Review" or any closure on the 1151 or other claim.

The original claim is still open and shows "Preparation for Decision" and has been there for three weeks now.

1151 Claim

Approximately three years ago, my primary care physician with the VA put me on ATORVASTATIN and LISINOPRIL.  Though I did not know it at the time, both medications have a history of causing medically induced pancreatitis.

Approximately three weeks later, I awoke to the most horrific abdominal pains I had ever experienced.  My first thought was stomach virus, but it was far worse.  It progressed rapidly.  My wife was going to take me to the hospital after taking our son to school, but it was so bad my sister immediately drove me to emergency clinic ten minutes away.

After blood test and some sort of scan, I was told I had necrotising pancreatitis and transferred by ambulance to hospital where I remained for a week and a half.  While there, I presented my VA medical card and asked to please contact VA because it was only insurance I had.  They contacted the nearest VA hospital which was an hour and a half away, but was told "they had no beds available" for me.

For whatever reason, the Center for Disease Control became involved in my case.  Upon discharage from the hospital, I had to visit them and was put on antibiotic IV that my wife had to administer three times a day for a month.

I continued my prescribed medications.  I even called my VA office while in the hospital to report I was in the hospital and to cancel an appointment.

A few weeks after the first discharge, it hit again.  Instant, overwhelming pain.  There is pancreatitis, acute pancreatitis and necrotising pancreatitis.  My wife drives to same ER Clinic and again, blood tests, scan and transfer to hospital via ambulance.  Kept in hospital for a week.  Again, asked that they contact the VA as it was only insurance.  Was told VA responded they had no beds available.

Upon discharge, I continued my normally prescribed medications.  A month later, while visiting family some five hours away from home, it hit again.  My wife takes me to hospital and explains to hospital doctors what I had been going through.  Small town hospital.  Said they did not have medical expertise to treat me.  Contacted doctor in "big city" and I was loaded into an ambulance and driven six hours to hospital in "big city" with "Pancreatitis Specialist."

I have this stark memory of arriving there and in the basement, holding for a room and several doctors visiting.  I was on IV dilauded, but I remember asking one of the doctors "am I going to die from this?" and he said "we don't know yet, son, but we have one of the best pancreatitis teams in the state here.

Admitted to ICU, four days later surgery for a stint.  After discharge, and with no doctor being able to identify cause, I said "that's it, no medications."  Doctor that performed the stint said I had severe scarring from the necrotising pancreatitis.

Over the course of three months, I lost fifty pounds (not a fun way to lose weight).  I couldn't work.  Dozens of doctors asked the same question over and over again; "how much do you drink?"  The answer:  "Zero, I do not drink, I do not do any kind of drugs. I'm a straight arrow, Church on Sunday, take care of my family."

Shortly after the third hospitalization, I received over a dozen letters from the "big city" VA.  All claims denied, "veteran had the ability to walk into to local facility." (which was at least two hours away).

I lost so much weight and was unable to work, that I had to go to our local Good Will to get some second had clothes.

I eventually saw my primary VA (which is not the "big city" VA) and they scheduled me for appointments.  I had to go to yet another "big city" for GI appt regarding pancreatitis.  While there, the "PA" said his first reaction would have been to stop the those two medications and was unsure why my primary didn't do that.  Said there are only so many things that can cause pancreatitis, of which were not present.

Six months later, I have stint removed.  VA determined they did not have expertise to remove it, so they outsourced it to the non-VA doctor that put the stint in.  I asked that doctor if it was possible that the two medications I had been taking could cause it.  He said yes, but that medically induced pancreatitis was rare.  I asked "am I not one of the rare patients?"  He said "yes."  He told me that pancreatitis patients will often see recurrences again down the road.

Shortly after I filed my 1151 claim this year, the recurrences started again.  I've had at least a dozen recurrences this year, three of which have required hospitalization.  Fortunately, I now live about fifteen minutes from a VA hospital.  The three times I was hospitalized this year, as painful as they were, were absolutely nothing compared to those first three times where it was necrotising (literally eating the pancrease alive).

VA doctors say I now have a gall stone, but is not located closed to duct.  Have been told this three times this year.  Still, they want to take gall bladder as it's the "next step."

When I've been hositalized at the VA for this, when the "clown show" (as I call it) comes through in the morning with the interns, I've explained all that I've been through in the past and that I never had any GI problems (other than heart burn) until those medications.  Always quick to dismiss it as "those are rare cases."

This last time, one of the same doctors I had seen earlier in the year making those rounds did the introducution to interns and I again exlained about the medications.  He again said "yes, but those are rare cases."  I said "you just told you interns that I was a rare case without emitology (cause)."  Seems like it's time the VA start considering I'm one of those "rare cases" after three years now, right?"

Yet another doctor that works part time for VA visited me and I explained the details to him.  I asked him "if it's not alcohol and not any of the other reasons normally attributed, wouldn't it be worth looking at the medication?"  He said "when there is no known cause, but there is a history of medically induced by prescribed medications, then the medications are the cause."

One seemingly innocent prescription by the VA has turned my life upside down.  I continue to lose work/income and what little disability I was receiving, they are now taking from me for prescriptions because someone determined I was making more last year, which I wasn't.

I can't help but wonder about the "Regulatory or Procedural Reviews" in my eBennefits account now.  I spent many nights over the past few weeks, researching, and I've seen everything from "it's nothing for you to worry about" to "it happens when your rating is sent to another RO" to those who reported it, followed by a "win" several weeks later.

I expect a denial.  I have not had a C&P for the pancreatitis.  I documented everything well in the 1151, I know they were able to get all my medical records from the hospital.  Along with the 1151, I included half a dozen studies that show a history of medically induced pancreatitis from both medications.  Since I submitted it, I've at least a dozen, three of which required VA hospitalization.

Questions:

Did I do this right?  Three years on, and there is still no etymology for what started this, other than three weeks after starting these medications, it happened and continued to happen until I voluntarily stopped taking all medications.

If by chance an 1151 claim is approved, do they send an "offer" first?  Does someone from the VA call?  I've read so many comments from here and other forums and recall seeing one Veteran state they received a call from the RO when his 1151 was approved.

Isn't acute or necrotising pancreatitis severe enough condition that driving 2 hours to VA facility is waived and VA pays hospital bill?

[broncovet]

The obvious question here, is what did VA prescribe these medications for?  Were they prescribed for a service connected condition?  If so, a much easier route would be to claim your pancreatitis issues secondary to the meds prescribed for a sc condition, rather than an 1151 claim.  But that is just me.  You probably could still do just that, again, if the meds were prescribed for a condition to which you are service connected.  

I dont know why Texas Veterans commission would suggest you go the hard way, so lets assume vA prescribed these meds for a nsc condition, which changes my advice.  

Based on the assumption you were NOT given these meds for a sc condition, that could rule out secondary service connection.  

In that case, you are gonna need documentation.  You have apparently been treated at both VA and non VA hospitals, so expect both to "blame each other" to save their own legal neck.  

Do you have your cfile, or have you reviewed it at TVC?  This claim is unlikely to be awarded on lay evidence alone..you need to see what the doctors had to say.  

You should also look into these meds you say caused the problem.  Were you made aware of the risks?  Were these risks made known to you in the med pamphlet that comes with the meds that you did not read?  Of course, its not the drug companies fault that YOU did not read the pamphlet.  

If you take a medication, KNOWING WELL THE RISKS, then, well, you risked your health on the treatment and bear the burden.  

However, if the drug company knew about these risks, and did not disclose them to you, then you have a lawsuit with the drug company.   They have a duty to tell you of the risks of taking their meds, so you can make an informed choice.  Remember, you can decline to take any meds prescribed, so it behooves you to be informed of the risks.  

I think you may consider getting a lawyer, this sounds like a serious injury by taking a prescribed medication.  This all may hinge on whether or not you knew about these risks.  The doc does not have to tell you all risks (tho they sometimes do that) but, if there is a med pamphlet, then you can read it to find out the risks. Go to the medications website, and see if the company lists this risk.  

     This sounds more like a drug company issue...unless there were "markers" in your file...which made you an unacceptable candidate for these drugs and they were improperly prescribed.  I dont know this, and it would take a review of your file to know.  This is probably way, way beyond TVC, and you are going to need a pro.  That is, a lawyer.  Now, if this is likely to heal up and no symptoms, then you should consider dropping it.  But, if you are likely, like you posted, to get relapses, even when off the drugs, then you should definatley consider professional representation.  

Its possible, or even likely there are already lawsuits against this drug company for these drugs.  

Edited September 5, 2018 by broncovet

[Berta]

Yes- thank you too- former Sec Shulkin's office said my suggestions did have impact on the claims procedure in the  Modernization Act. I have seen the impact here when some vets are getting proper, and much faster decisions. I wanted a Fast letter but the regulations basically covered what we needed, as claimants.

“Approximately three years ago, my primary care physician with the VA put me on ATORVASTATIN and LISINOPRIL.  Though I did not know it at the time, both medications have a history of causing medically induced pancreatitis. “

There is some medical data on the net to that affect.

There is also information the net that gall stones can cause necrotizing pancreatitis and the VA might well deny the claim on that basis.

We have a member here with ERCP induced necrotizing pancreatitis.It was one of the best 1151 claims I ever saw. But he failed to get an IMO/IME and will probably continue to lose the claim.

There have been multiple lawsuits against ERCP procedures, that ended up giving the patients Necrotizing Pancreatitis- I assume ( and hope) you never had a ERCP.

I am a successful FTCA/1151 claimant. Wrongful death of my husband due to multiple instances of malpractice.They malpracticed on IHD, HBP, TIAs, CVA and DMII.

 

One 1151 claim was due to two contraindicated medications: Lisinopril and Sudafed.And was part of my FTCA case.We didn't know of any contraindications- VA doctors are supposed to know that.The fault on contraindications lies with them(VA)

 

I won the 1151 HBP claim 2 years ago, decades after he died. VA does not want to pay me.

I have filed 2 CUEs on that with legal evidence from the VA General Counsel.

I have a wealth of 1151 and FTCA information here at hadit.

1151 applies to SC disabilities and also to NSC disabilities.

 

Dont do what I did.

I did all of the legal and medical work for my FTCA/1151 issues myself.Decades ago.

 

No lawyer would help me and there were no IMO doctors around then.

 

The good part about FTCA is that VA lawyers at General Counsel VACO, and their VACO doctors, can read.

VAROs however won't consider lay medical opinions....unless they are supported by strong IMOs/IMEs

I dont think you need a lawyer at this point-because they will tell you the same thing I am saying here--- you need an Independent Medical Opinion, surely involving an exam, by a specialist.This can be costly BUT

your theory of the drug induced -pancreatitis might not be the main cause – as I learned ,VA malpractice by VA can have multiple ramifications...and multiple ways of occurring.

DMII was not in my FTCA case.

My daughter, a veteran, kept asking me to re-open the death claim on that basis...for years...I didnt want to deal with VA again.

But the coroner, as I suddenly recalled, was shocked that my husband did not have any diabetes diagnosis from VA, because his death certificate held the very causes of death that a diabetic can have, so I re opened the claim, for direct SC due to AO, did extensive medical research on his medical records myself, and then I got 3 IMOs,this time- all supporting my lay medical opinion.

I won that claim.Undiagnosed, untreated DMII, death due to Agent Orange DMII.

1151 claims have to be worded properly. TVA reps got the same training I did (from NVLSP)and all I know about1151 is here in the 1151/FTCA forums.

I dont understand this:

"I also filed an 1151 with the help of my Texas Veterans Commission officer for medically induced pancreatitis with secondary issue of diabetes.  Unfortunately, I didn't much research and took my TVC rep's advice and just filed out the form, though I did document it quite thoroughly and it was quite long."

You need a complete copy of your VA medical records.

Also do you mean you developed diabetes after the pancreatitis or before?

If you can scan and attach the claim that TVC filed here- (cover C file # ,name and address prior to scanning it,) others will determine if it was worded correctly.

My 1151 claims were always very short-the long part was the evidence I enclosed.

A costly IMO/IMO for 1151 can do one of 2 things- overcome any lousy C & P exam results and award a claim  with a full medical rationale.

or find no evidence of malpractice. The benefit of that however is Peace of Mind, knowing VA did not cause an additional disability.

VA saves lives every day but their true malpratice statistics ( I have letter to Sec Wilkie on this) are not revealed to Congress or to the public. I know where those statistics are .Doctors and nurses are fleeing from the VA-in my opinion that is because of the Accountability Act as well as the Choice program.

 

 

 

 

 

 

 

 

[broncovet]

Thank you for giving your opinion, Berta.  I had hoped you would.  Yes, I agree that an 1151 claim it probably would not matter if the conditions were service connected.  However, Secondary service connection (due to prescribed meds) would require, I think, that these meds were prescribed for sc conditions.  The OP did not say whether they were or not.  

I still think the easiest route would be to apply for secondary service connection, if applicable, rather than 1151.  While I dont even start to understand 1151, I think its obvious that its an attack on the hospital or medical center, and that attack probably wont be taken lightly.  While this attack may well be justified (I dont know in your case, I have not read your file), simply asking for secondary service connection would appear to stir up far, far fewer hornets, and could result in similar net outcome to you.  

[Berta]

By all means ,if you think the secondary is the best way to go, please help him file that type of claim Broncovet.

My Nehmer Award  awarded 2 CUE claims I had-in addition to the AO IHD.

One award under OGC Pres Op 8-97 was for 2 years of 1151 CVA plus SMC the CVA was NSC.

The proper amount of that award was 52,967, but as the RO director (who called me twice, tried to tell me, the full amount was not paid in the audit because the veteran's 100% P & T CVA ( by all evidence of record, was Not Permanent when he died.So they only paid for 6 months-I hope she does not use that fully erroneous statement to other widows whose spouse dies with 100 % SC for ten years, eligible for DIC on that basis,yet their disability is not considered Permanent.

They still owe me 36,730.30 for that claim  In addition to 2 other monumentous financial errors in my AO IHD award amount and also the 1151 HBP CUE.

I have had financial errors in 4 past awards. General Counsel helped me get the proper retro, in one instance and the regional counsel in another instance, and the rest were fixed by CUE claims from me. Those errors amounted to just shy of 100,000 bucks.And corrected they made for eligible for additional 20 thousand in REPS benefit and a retro Chapter 35 amount  and full funeral costs. About 8 thousand more.

No one should be fooled by any socalled VA "audit" statement.The total might be right but their calculations by month and year might be well off the base.

My point is that 1151  applies to SC as much as to NSC disabilities....

But thanks for helping this vet file for secondaries,instead of 1151.

I dont see the secondary basis but apparently you do.

He can file both ways.He will still need an IMO/IME.

I have never minded stiring up hornet's nests with the VA.If I did, I would have never won DIC or any accrued benefits , FTCA, 1151s, AO IHD, AO DMII, SMC, REPS, Chap 35, CHAMPVA ,or any of my CUEs.

Death makes any 100% SC or 1151 "as if" SC (NSC)disability, Permanent at death.

The 1151 claim HBP I won is a NSC issue.along with the 2 years of 100% P & T plus SMC (NSC) as if SC under 1151.

OG Pres Op 08-97 makes it very clear that 1151 awards make no distinction between proven malpractice whether it involves SC or NSC and it states "all" monetary benefits will be awarded under 1151,regardless of any SCs the veteran has . 

That is why Nehmer awarded 1151 benefits at 100% P & T under 1151, in addition to the veteran's established 100% P & T for SC PTSD, awarded as accrued, to me, months after  a past ridiculous denial letter.

The VA saves plenty of money when veterans or their survivors accept erroneous denials, crappy C & P exams, and wrong audits and do not fight back.

 

 

 

 

Edited September 5, 2018 by Berta

[broncovet]

The only way this would be secondary, is if the meds were prescribed for a service connected condtion.  

I am pretty sure I recall reading that, if you have a service connected condition, and the doctor prescribes you meds, which causes another condition, this would be secondary service connection, provided that, of course the doctor opined the (service connected meds) "at least as likely as not" caused your condition.  

"Army Vet" has not yet opined whether his meds were for a sc condition or not, as I requested earlier.  So its all speculation on my part.  

Edited September 5, 2018 by broncovet

[Army Veteran]

My apologize for the delayed response.  As I mentioned, I was scheduled for gall bladder removal the morning that I posted.  The gall bladder surgery is complete and has been removed.

Quote

Were they prescribed for a service connected condition?

No, the medications were not prescribed for a service connection.  Both medications have a history of causing medically induced pancreatitis.  I did not know that, nor was advised of that.  Additionally, after the first hospitalization, was not advised to stop taking them.  Not advised after the second or third hospitalization.

Quote

Also do you mean you developed diabetes after the pancreatitis or before?

Diabetes set in AFTER the pancreatitis.  Doctor advised me last year that AC1 and blood sugar was at the diabetic stage and marked my record as "diabetic."  Said if I could not get under control on my own after six months, that he would have to put me on medication.  I cut out all sugar from diet for six months.  Every time I had a VA appointment in the morning, I would ask a nurse to test my blood sugar (I was not issued a device to test this on my own).  It did come down, but I cut out all sodas, all candy, all sugar, period.  Very difficult.

At the next labs for my six month labs, fasting level was 99 and AC1 was out of the "danger" zone.  He left my record as "diabetic" and I have slowly reintroduced sugars, but very limited.  More so as a "once a week treat" and have been able to keep my levels down.  Still, I never had any issue like this before.

UPDATE:  This morning I checked eBennefits and status changed (after 4-5 weeks) from  "Preparation for Decision" to "Pending Decision Approval."

Still curious on these questions:

If by chance an 1151 claim is approved, do they send an "offer" first?  Does someone from the VA call?  I've read so many comments from here and other forums and recall seeing one Veteran state they received a call from the RO when his 1151 was approved.

Isn't acute or necrotising pancreatitis severe enough condition that driving 2 hours to VA facility is waived and VA pays hospital bill?

Thank you all for your help and warm comments.