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The new AMA-Mobius loop?


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Thanks, Alex, for the map.  I completely agree, and have posted the same, as far as HLR...avoid HLR at any cost.  

One "important" improvement, however, is requested:  Put the new appeal form numbers on the relevant map.  

More than one Veteran is confused about the correct form to use in all the various denials, and we can count on VA to deny us again, even with a case of merit, if we file the appeal on the "wrong form".  

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Funny but all so true.

Alex  here is a

Quote from Ms Berta on another thred

''John, I mentioned your reference to "essential " hypertension in last week's show , in a letter to the Secretary-''

What exactly do they mean by  this ''essential'' In regard to the new A.O. Presumptions? In accordence for Heart Diesease from A.O. 

Vietnam Veterans and other Veterans as well that was around the A.O.  With evidence to prove it.

Also why is it so hard to get a VA Dr's to help A.O. Veterans with presumptive disease  with their claims  when all they need to do is confer they read the veterans medical records and give their opinion as likely as not this veteran disease is caused by or related to his duty from Vietnam service  or where ever the veteran was exposed to this A.O. While serving in the military....The Dr's think they will be fired  and I just don't buy that.

Its not fair the Veteran seek a private Dr for this  when its in his/her military records. (jmo)

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This is what I meant:

This is from my letter to Secretary Wilkie and anyone can make the same point it they write to him.I gave his Washington  address, twitter handle, and email addy here somewhere recently in the AO forum.

I prefaced this with quotes from the 2018 NAN (formerly IOM) reports.

The new report states "Sufficient evidence."The full report is here somewhere.

"Hypertension (category change from Limited or Suggestive in Update 2014)”

 

I feel “Sufficient evidence” is much stronger than the 2014 report regarding AO and hypertension.

 

I am aware how prevalent HBP is in the general elderly population.However that does not account for the Vietnam veteran's population separately, yet this newest report raises the nexus to hypertension as due to Agent Orange, regarding any incountry Vietnam veteran.Since HBP is treated so well these days, a VA rating due to HBP under this report,if considered as a presumptive, would not be as costly as one might think, as I would expect the ratings to be fairly low if the HBP is well controlled, medically. Most veterans have had their hypertension deemed as “essential” by VAdoctors , meaning there was no known cause for it, but now there is a cause and etiology- Agent Orange, based on the 2018 report."

My letter went on regarding ischemic stroke as a potential new AO and why, medically and I raised other issues comng his way.

(The big problem with HBP is the cost factor.)

Buck asked:

"What exactly do they mean by  this ''essential'' In regard to the new A.O. Presumptions? "

If the Sec picks Hypertention as a new AO presumptive, and

If Nehmer 2010 kicks in for a new Nehmer , and 

If it includes the Footnote One stipulation then any vet with past NSC hypertension and a rating of at least 10 % (maybe "0" would do as well that could become beginning of a retro staged Fenderson rating) who becomes an AO HBP vet via any new decision by the Secretary , then

that veteran might well get retro back to when the hypertension first appeared as NSC in a past decision.

Lots of ifs- and then there is the fact-

if Blue Waters succeed with proper regulations, as presumptive to AO, that too will be part of the HBP cost factor.

Nehmer applies to Vietnam incountry veterans. Blue Waters -if they are designated as incountry- will be under Nehmer-but I have no idea what their status will become.

There is so much to these issues- I dont have time to post all they involve- 

as soon as I hear anything on the BWN AO regs or from NVLSP on any new potentials, I will post it here.

Also NVLSP has something else in the works- re: AO and CUE----

Footnote one is explained here in our AO forum ad finitum.

I am a footnote one widow and many if not most of our Vietnam vets with IHD are /were probably Footnote One veterans. And NVLSP checked their retro to see if they got the correct EED.

 

 

 

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This is why I suiggested in another post in th AO forum that now is the time for any Vietnam or BWN vet to see if their medical records reveal "essential" to describe their hypertention.

They might need that record for a proper EED.

And they should pull out any past denials and ratings sheets for HBP as well, if they are not SC for it under a different medical theory and rationale.

I believe that by mid June we will have the Secretary's decision. He could decide to put NONE of the 5 disabilities in the report on the AO list.

I  am still a little in shock that Shinseki did put IHD on the AO list.9 years ago. and it Was BIG News and involved lots of retro for many.

 

 

 

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I keep hitting the wall on IHD. I have a doctor say he has CAD. I get denied. I have a dr say Arteriosclerosis throughout (including the coronary arteries and peripherals). I get denied. I say Atherosclerosis. Denied. So now, I just get the 12 ga. out and have the nexus dr. do the whole gig. I try to get my guys to go to a private  doc on Medicare and get the magic IHD words. I'm finding using IHD is too nebulous for VA. I don't even ask or want the doctor to opine. It's presumptive. I just want them to say the secret word =IHD.

The only VA type docs who will do an IMO/nexus is the VAMCs that share a nursing school with the  VA med center -i.e. Duke/Salem/Seattle etc. Those docs do not "work " for VA. But, if you do not have them say the magic words ('I reviewed the claims file') it's dicey. To begin, a VA medical examination report is entitled to no weight if it contains only data and conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 304 (2008) If the VA Doc just says "It's more likely than not it's AO. " that won't win. Granted, AO is a presumptive and they aren't supposed to get in the weeds, but I'm talking about nasal cancer cases when they say it isn't in the respiratory canal or the lungs. If it's  small cell carcinoma, it's AO in my book. VA doesn't agree. That's when I'm forced to go get a good IMO. 

Edited by asknod (see edit history)
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I got SC'ed for CAD years ago due to AO exposure.   All I was claiming was some blockage in my leg veins which had showed up on a CT scan done by the VA when I complained about it.  I claimed this thing and some how the VA granted 60% for CAD.  I was pretty shocked.  My VA doctor at the time (8 years ago) did do a fantastic medical opinion like an IMO and I got connected.  She was soon dispatched to some other VA job away from patients.

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The VA has Sced CAD to AO.

In the decision the CAD is noted this way:

"Ischemic heart disease (coronary artery disease) was not added to the list of presumptive conditions based on herbicide exposure until August 31, 2010."

https://www.va.gov/vetapp19/files1/19106130.txt

"I keep hitting the wall on IHD. I have a doctor say he has CAD. I get denied. I have a dr say Arteriosclerosis throughout (including the coronary arteries and peripherals). I get denied. I say Atherosclerosis. Denied" 

Gee dont give up on this- I know you won't.

As many know my husband died of IHD.( Vietnam 65-66 USMC) and the ECHO was one of the prime ways I had to prove my AO death claim.

I am shocked to see that this vet has arteriosclerosis( which the ECHO I used proved-due to the measurements etc.)yet VA denied for IHD? Or CAD?

The C & P exam he got was probably flawed and not done by a cardio doc.

Can you scan and attach the VA denial? And the evidence list ( cover names, and C file # prior to scanning it)

The vet above wanted a better EED for his AO CAD-he was in th same glitch I mentioned on th AO show I did last wek here.

He thought the AORegistry stuff was a formal claim. It wasn't.

But my point here is how can he get AO for CAD and your vet can't?

 

 

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I forgot to add, my husband was never diagnosed or treated by VA for IHD.

It was one of the conditions they malpracticed on, (FTCA settlement /1151 award).

The Nehmer VARO gave him a very favorable EED for IHD but they had to guess at the rating-

6 years retro ( but of course the IHD was the prime cause of his death so he could not benefit from that decision)

An ECHO reveals a lot of info, when arteries narrow due to atherosclerosis ,clots can form in the heart.Or go to the brain.

Your vet probably also has PAD-peripheral arteriol disease that might affect his lower extremities.

I wonder if his VA doctor is even a VA employee ( or some contracted doctor who is not a VA employee.)

They sure dont sound like a Dr familiar with cardiology.

Edited by Berta (see edit history)
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I had something called  "calcification of veins and arteries" in my left leg.  I filed a claim on this thinking it was PAD.  The VA corrected me and granted a claim for CAD/IHD?  I am confused about the difference between PAD, CAD and IHD, but I did get 60% on appeal.  My first C&P was done by a nurse.  It was an embarrassment to the medical profession.  I appealed that baby and got 60%.  This took a couple of years, of course.  I got more testing at the VA's expense and the VA came back with some inconclusive results but I got the 60% for CAD anyway.  I just don't understand how the VA came up with this rating but it gave me HB "S" so I can't complain too much.  The VA really is not up to speed on this stuff.

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John- you are so correct!

My AO IHD claim was denied at first because ( as the denial states) my husband did not have evidence of IHD inservice.  Say what???

I cued them immediately- and pointed out that most of these Vietnam vets were KIDS, when they were sent to Vietnam and he was only 18 years old, and his platoon Commander,incountry, was "the Old Man"-

 was only 25 years old.  And if he or any young Vietnam Veteran had IHD , how could they have gotten into the service or been sent to Vietnam

Within weeks ( I believe I Filed an IRIS complaint too-I was pissed) but within a few weeks the Nehmer VARO in Philadelphia awarded for AO IHD, 100% P & T stroke under 1151, and two cues I had filed-

2003 CUE on lack of consideration of SMC   retro SMC

2004 Cue on lack of listing my husbands heart disease on the 1151 DIC award I got.

It was clearly noted on the 1151 DIC award letter ,in their rationale for the award but no code and no rating.

They did code his 100% SC P & T for PTSD in the same code sheet - so duh- 100% PTSD plus over 60%, independent 1151 SCs equals SMC

A few years ago we had  a vet claiming AO, (incountry Vietnam) and questioned their POA how Nehmer would work.

The POA vet rep did not even know what Nehmer was.

How many widows of AO vets got the same BS denial  letter I got at first and didnt know what to do?

And how many Vietnam vets are there , who might file under any new AO regs or under sny new  BWN AO regs and get some stupid VSO or rep who does not have a clue?

I do not think literacy is a job qualification to work at the VAROs.

My 2003, 2004 CUEs took until 2012 to be awarded.They sat at myRO all those years with lots of back and forth BS and they were set for BVA transfer but I got Nehmer Phila to handled them because they were filed prior to the 2010 AO IHD claim and dependent on a proper resolve of the AO IHD claim.

My Nehmer audit is all wrong. I didnt want to deal with them again but it is what it is - I have 4 CUEs filed on it now.

The audit from Nehmer states it is an "estimate."I wonder if anyone else got a retro based on an "estimate".

Past retro payments to me have had errors in them to the tune of $40,000.

It is " as likely as not" they buggered my Nehmer audit.

I got the money in their past errors , and I know  they sure have sophisticated mathematical PC programs, but those programs are controlled by someone putting in the information.

It is a real time comsuming pain in the butt to go over VA audits but I bet they make mistakes in audits, to the claimant's detriment, that are never found by the claimant and never challenged.

 

 

 

 

 

Edited by Berta (see edit history)
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Asknod- I have read over at least 40 BVA decisions from the past few years that held the words

Agent Orange  CAD  denied ,and have not found yet a single CAD AO claim that was actually denied,regarding any incountry Vietnam vet 

Many were denied due to these reasons,

the veteran had an established AO CAD rating and wanted a higher rating, and BVA remanded or denied for that reason or

the veteran claimed CAD from AO but had never served in Vietnam nor proved he was exposed elsewhere,

so he was denied by the BVA .

the veteran claimed secondaries due to the established CAD he had from AO, and was remanded or denied, or

the veteran was seeking a better EED and already had established rating and award for CAD due to AO.

I am still stunned that your vet is being denied.

 

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I think THIS is the reason this vet was denied:

https://legaltimes.typepad.com/blt/2010/02/roberts-startled-by-government-errors-in-vet-cases.html

In summary, at least 60 percent of the time, the government takes a position against the Veteran which is "substantially unjustified".  

This is the reason a Vet can hire a lawyer at CAVC level, and rarely ever pay one cent in attorney fees.  Some lawyers often accept BVA denials (and an appeal to the CAVC) expecting "0" from the Veteran.  You need a recent board denial to do this.  

Pretty much, any time the lawyer gets a remand or a win, EAJA awards attorney fees.  

Right now, Im at the CAVC represented by Chris Attig, and, whether I win or lose, I wont pay attorney fees.  The fees are covered by eaja if I win or get a remand, and if I lose, I dont have to pay attorney fees anyway.  

Even if I lose, my attorney "may" appeal to the Federal Circuit, if he thinks it has merit.  

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Berta, you won't find the decision at the BVA yet. I'm still fighting at the AOJ level on several of these. The repair order seems to be going back to the dr. after a c&p denial (using echo) and obtaining a statement showing cardio cath proof. I'll keep you posted when I win them. One lost a leg to PAD and I used that. NOT.  It has to be in the coronary arteries leading to the heart. Period.

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This is for Jerrell. I promised him I would draw him a map of what we talked about on the show-https://asknod.org/2019/04/12/the-new-appeals-modernization-act-and-more/

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I personally don't like this New Way  but as it is we must follow VA Rules and Guidelines.  I DON'T SEE THE CLAIMS BEING PROCESS ANY FASTER.

I like the traditional claims process better.  Don't take me wrong here  I don't like the HAMMSTER WHEEL in slow motion either  and the long waited appeals to be adjudicated  but so for this new process has to prove itself/JMO

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