Hypertension and Sudden Death

[Tmon82]

Hello,

First I just want to say that I love this community. I always come here to search through posts when I need to find an answer. I’m a vet and the daughter of a vet. I don’t know why I took so long to finally create an account.

My current situation: my father passed away a few years ago at the age of 48. His cause of death is listed as “sudden death” on his death certificate. No autopsy was performed. He had a 20 year history of poorly controlled hypertension that kept him in and out of the emergency room and the doctors office.  I just received a copy of his c-file and learned that they service connected his hypertension...a decision they came to 3 weeks after his death. I knew he was going through the VA disability process prior to his death but we (my mom and I) never received any follow-up or were alerted of their decision. Wish I knew then what I know now as far as navigating the VA system. I was going through his c-file and noticed as recent as 2 months prior to his death, he had a C&P exam where they did an EKG. The EKG that was considered “borderline” showed “PACs arrhythmias and leftward axis, abnormal T-waves in anterolaterial leads, prolonged QT”. However when they referred him for a stress test, that came back normal with supposedly no signs of heart disease. I looked further into the file and came across several notes that same year from his private doctor. One of the entries noted how they had a serious talk with my father about his BP and how he was at risk for a stroke or heart attack.

I am helping my mom file a DIC claim. Our plan is to request records of emergency room visits that we noticed were missing from his c-file. We will also request the records from the night he was pronounced dead. We want to submit all those records, along with his c-file, to an. MD who can hopefully write a nexus letter. I’m not sure if one is needed or not (maybe someone could chime in) but I just want to make sure this is done right. 

I guess what I’m asking is for any advice or useful tips that would help us be successful with this claim. Does anyone think we would have a problem with it? If you need any more info, I can provide. Thanks in advance.

Edited November 5, 2018 by Tmon82

[Tmon82]

Berta, no my father was enlisted during the gulf war era. And he never served in a war zone.

Final update:

Last month the claim was approved! HOWEVER, immediately following the decision I filed a notice of disagreement and sent for a higher level review. While reading through a ton of BVA decisions throughout this process, I learned that when someone applies for death benefits with the SSA, it is also to be treated as an application for DIC. My mom applied for SSA benefits a month after my dad passed in 2009. Apparently this lack of communication between the VA and SSA creates a loophole that allows for benefits to be backdated all the way back to a persons death. This week my mom received back payment going all the way back to 2009. I am so happy this is OVER. I highly recommend anyone reading look into this. I have no doubt there are many, many, many people who are owed a crapload of money and don’t even know it. I ran across this information by accident or else I wouldn’t have known either. 

Here’s one of the BVA decisions I ran across to give everyone an idea. There’s many more if you run a search.

https://www.va.gov/vetapp18/files8/18131017.txt

Edited February 26, 2020 by Tmon82

[Berta]

My husband died  of what appeared to be "sudden death syndrome", at age 47. However the death certificate had much more information than that.I am surprised they put "sudden death" on the Death certificate.

His heart disease, diabetes mellitus ,and improperly treated HBP, and a catatrophic stroke were all contributing factors to his death.

He had been a VA patient for many years, and none of the above were properly diagnosed or treated.

Exactly how long did your father die? was it less than 2 years ago?

Was all of or most of  his medical care from the VA?

  "I just received a copy of his c-file and learned that they service connected his hypertension...a decision they came to 3 weeks after his death. I knew he was going through the VA disability process prior to his death but we (my mom and I) never received any follow-up or were alerted of their decision."

I think the VA would have alerted your mom if she had filed for substitution as the claimant, within one year after his death. The VA might have erred however in not sending her the  HBP award letter---

if it is in the C file can you scan and attach that award here? ( cover c file #, name, etc prior to scanning it.

Still, I think her only recourse is to file for DIC as soon as possible.

I am just not sure at all if she should file for DIC as a direct SC death due to the SC HBP contributing or as a 1151 death....or both.I filed for both.

You stated:

" I looked further into the file and came across several notes that same year from his private doctor. One of the entries noted how they had a serious talk with my father about his BP and how he was at risk for a stroke or heart attack."

Was this private doctor also treating him for HBP ?

But she will only attain DIC with , as you said,a strong medical nexus opinion-and that opinion should also cover the possibility of a Section 1151 death ( wrongful death) if the VA caused this due to malpractice.

FTCA  has a 2 year statute-that is why I asked when he died.

You need to obtain a complete copy of his VA medical Records as well as his private medical records.

 

But- many questions need to be answered.

Exactly what does the death certificate state as primary and secondary (contributing cause) of death?

Did he have any other SC ratings in his lifetime? If so what for and what was the rating?

"I guess what I’m asking is for any advice or useful tips that would help us be successful with this claim. Does anyone think we would have a problem with it?"

As a surviving spouse, I urge all veterans here to get their spouses up to speed on DIC and accrued benefits and to  make sure they have our web site info, and can use a PC.

I encountered multiple problems with my VARO when I filed for DIC and accrued 23 years ago.

I fought back at every turn. Part of the problem was that I won a FTCA settlement for Wrongful death at the General Counsel's office ,in spite of many attempts by the VARO to withhold my most probative evidence from them. That evidence was my husband's autopsy.My most recent award was a 1151 claim for HBP 2 years ago.

FTCA has time limits , Section 1151 has no time limits.

If we can read the HBP award letter and the Evidence list, maybe we can help more.

 

 

 

 

 

 

 

 

 

Edited November 5, 2018 by Berta

[Berta]

to add, you stated:

" I looked further into the file and came across several notes that same year from his private doctor. One of the entries noted how they had a serious talk with my father about his BP and how he was at risk for a stroke or heart attack."

What did the private doctor attribute his poorly controlled HBP to?

And what condition did the private doctor believe his HBP was caused by?

Was this a private cardiologist?

I believe, (and hopefully others will chime in) that the best thing your mother can do now is to  file an ITF form- 

https://www.vba.va.gov/pubs/forms/VBA-21-0966-ARE.pdf

This is not the formal DIC claim application but will preserve the date of the DIC claim.

I assume that within that year of intent she will be able at some point to file a formal 21-534EZ form-as she will have some evidence to bolster her claim, with enough time to get a strong Independent Medical Opinion...which would hopefully support either a direct SC death  or a Section 1151 death-both pay DIC, but Section 1151 has limited ancillary benefits.

You mother is not eligible for accrued as I understand this.Accrued benefits must be applied for within one year of the veteran's death . (Unless the claim falls under the Nehmer Court Order and this claim would not)

If the DIC claim succeeds, the date of retroactive DIC payment will go back to the ITF date.

When you scan and attach the HBP award here,  please tell us the date of that award and if the address they used was correct when they should have sent it to her.You can cover the address and C file # ,name etc prior to scanning it. If they used the wrong address, maybe something could be done to recover the accrued amount, if she could still substitute herself as the claimant, but I am not sure about that at all.

When your mother requests the complete VA medical record, by no means suggest this request is for a Section 1151 death claim.That is when stuff starts to disappear from the medical record.

 

 

 

 

 

 

 

[Tmon82]

Hi Berta! Thanks for the insight. We will definitely complete the intent to file and send that off right away.

My dad passed away going on 10 years ago...in 2009.

Yes, the immediate cause of death is listed as “sudden death” and the underlying cause is listed as “unknown”. This was in Virginia.

All of his care was with a private doctor(s) aside from the C&P appointments. He didn’t have anything service connected until it was too late. He was being treated for high blood pressure by these private doctors. If he was being followed by a cardiologist hopefully that will be revealed once we get the rest of his private records. 

My mom says she spoke with someone from the VA who gave her the impression that since he died, everything just stopped. This is why I wish I knew more (or even anything) about navigating the system back then. 

I haven’t ran across anything in his records that is listed as a cause. The earliest diagnosis I came across was when he was still active duty and all they did was educate him on healthy eating (but he wasn’t overweight and no meds were prescribed). I did run across a note that says he has history of cardiomegaly. If I go off memory, this diagnosis would have been from 1996 ER trip where his nose was bleeding non-stop and he was admitted for a sky high BP. Once we request those records, hopefully they will provide more insight. 

Attached is a copy of the ratings decision. It shows the 3 and only ratings he was service connected for. 

Do you have any good recommendations on an MD who can potentially write this nexus? Preferably someone reasonably priced. 

Edit: the one part that annoys me is they have his service dates wrong. He served from 1981-92. But I’ll worry about getting that corrected after we get through this first.

Edited November 5, 2018 by Tmon82

[Berta]

This info is not what I expected- not a 1151 issue against the VA.

This list is about 2 years old but you might find a cardiologist near you that could help prepare an IMO.

." I did run across a note that says he has history of cardiomegaly. If I go off memory, this diagnosis would have been from 1996 ER trip where his nose was bleeding non-stop and he was admitted for a sky high BP. Once we request those records, hopefully they will provide more insight. "

You would need to give them copies of all available private medical records, to certainly include any ER trips and/or private hospital records in addition to his private doctor's records.

This will be a very difficult DIC claim to succeed in.I have never seen a death certificate with unknown cause of death on it. I am Very surprised that the 'unknown cause of death' didn't trigger an autopsy.I thought that was state law but maybe not.

I dont see how the "0" SC for HBP will help prove direct SC death. Maybe others here will chime in. 

 

 

 

 

[Tmon82]

Regarding the 0% rating, I dug deeper into that. It was based ONLY on the 3 same day BP’s they took at his C&P exam. It definitely wasn’t because of his history. And I know had he lived, he would’ve added secondary conditions. 

Do you think maybe we could get the death certificate amended? Have you heard of anyone doing that?

Thanks for the list. I’ll check it out.

Edited November 5, 2018 by Tmon82