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Hypertension and Sudden Death


Tmon82

Question

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.

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I had a face to face consultation with Dr. Bash before. I’m currently in the Bethesda area and I was going to have him do an IME for my own claim. I just didn’t have the money at the time. I might need to see what his price is if he’s only doing an opinion with (obviously) no examination. 

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Dr Bash did 2 wonderful IM0s for me and they were worth every penny.

I had done extensive medical research on this claim and poured over my husband's medical reords many times, to prepare a cover letter with the packet of records I had sent to him. I think the fact that this made the IMOs arrive very fast, and did cut down a lot of time, since I had sent the information with my lay medical opinion and documented rationale for it.

But medical work like that is difficult and time consuming. Since I had proven wrongful death without an IMO I was by then fully aware of what medical acronyms mean, how to read blood work, how to decifer handwrittenj medical notations, and I had studied cardiology, neurology ,( had past deceased vet husband with a brain tumor) by then and studied as much as I could for the disability I wanted to get direct SC death for.Endocrinology.

My daughter is a veteran too ,as you are, and she insisted I re open my original claim.

The award was for Diabetes mellitus , never diagnosed or treated by VA , contributing to my husband's death.

I could not file another 1151 death claim-this was a direct SC claim.

A great IM0 doctor like Dr Bash does all of the above work for the claimant.

The decision you posted could have been appealed if your mother had filed for substitution of the claimant. 

Unfortuately she didnt have a vet rep either .

I did see what might be  the basis of a CUE claim, but - that would be way down the road.

It seemed the VA only had a minimal amount( about 1 year and a half) of what I assume would be his private records.And it appears they did not consider anything beyond the C & P exam.

I filed a CUE on a HBP denial dated March  2015, and then awarded April 2015 ( filed recent CUE it is still wrong EED) because the C & P examiner prepared a ridiculous non medical opinion, based on no accurate medical facts at all, and overlooked an opinion from the VA's top cardiologist.My VARO has done this to me multiple times-you need to obtain the actual C & P exam opinion.

Also you will need to see if the medication Lotrel, was contraindicated by any other meds your father took

https://www.rxlist.com/lotrel-drug.htm

I used more than one internet link to prove contraindicated meds , which reduced the value of his HBP med, contributed to my husband's death.

Also, you might think this is an odd question-

but I learned that odd questions can produce some incredible answers:

Have you checked with the Medical Examiners office in the County your father died in, to see in fact, if an autopsy had been done ? I have been to many viewings, open caskets , when the deceased had been autopsied and hardly anyone knew.

Regarding death certificates amendments- that can be done in some states.

You could call the Coroner or whoever prepared the death certificate to see how that can be done, but what would it be amended to?

All of the private medical records will hold some answers, I hope, that could potentially support an amended death certificate.

 "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. "

Those are critical records to all of this. They would not be in the C file- they need to be obtained from his private doctors and  hospitals.Dr Bash would need them all.

 

 

 

 

 

 

 

 

 

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Thanks for the wealth of info, Berta! We submitted the intent to file two weeks ago and just received the remainder of his records. On the ER record from the night he died, cardiopulmonary arrest is listed as the cause of death. Under the past medical history part, the diagnosis of hypertension and heart disease are also noted. We were also able to obtain other records which show more abnormal EKG’s and the diagnosis of cardiomegaly...something the VA claimed they couldn’t  detect when he went in for his C&P. 

I contacted Dr. David Anaise with all the details and he replied back that he can have the nexus done in 2 weeks. Right now I’m trying to decide if we should just send everything to the VA and hold off on paying for the nexus until we see what decision they make. Any advice is of course welcome. 

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" 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"

If the hypertension was a substanially contributing factor to his death- the VA should award DIC- BUT they dont know how to connect the medical dots-

I think this claim will need a strong IMO from Dr Anaise ,to give a medical rationale that the SC HBP predated the Cardio arrest and heart disease, and made a substantial contribution to the primary cause of death.

But I would hate to see you pay for something you might not need.....

Still- the VA might deny the laim without the IMO.....a lot will depend on his private medical records-

Make sure when VA asks for it ( or you could prepare an authorization form below in the link) that VA does obtain the private medical records.

https://www.vba.va.gov/pubs/forms/VBA-21-4142-ARE.pdf

Maybe the 21- 534 (a bit  different from what I filled out long ago, maybe it has an area for this authorization)

but it  cant hurt to fill out the form now and send it to them right away.-under his C file #.

VA used to put an X in front of a deceased vets C file- when the survivor filed a claim-I dont think they use the X anymore-just the same C file #.

 

 

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I think we’re going to bite the bullet and just pay for the nexus. You’re absolutely right about the VA having issues with connecting the dots. I know firsthand from my own claims. I will be sure to keep this post updated for anyone in the same boat who might come across it. 

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Just wanted to give a follow-up, in case there are any future readers. I ended up reaching out to the Ellis Clinic. Dr. Ellis reviewed all of my father’s medical records and gave his opinion that my father’s sudden death was service connected. We were able to give that opinion to our state’s Vital Statistics and they are amending his death certificate. We should have everything resubmitted to the VA before Christmas. All they needed was the cause of death clearly stated to approve the benefits and we now have that.

Dr. Ellis is a compassionate physician and I highly recommend him for anyone else in a similar position.

Edited by Tmon82
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