High Cholesterol and Peripheral Vascular Disease

[Frank89]

I have been dealing with Peripheral Vascular Disease for 5 years.  When I was active duty in Naples, Italy, in 1993 during my physical exam coming back to the States, my doctor said that I had High Cholesterol.  I was discharged from active duty in Oct 1995 and during my physical when leaving the military I was still diagnosed with High Cholesterol.  I know that high cholesterol is not considered a disease but a lab finding.  My question to everyone who might have an answer, here it goes.  Can I claim my current PVD to my High Cholesterol as either a service-connection or as secondary to my High cholesterol?  I really would appreciate everyone's help! Thanks in advance.

 

Chacho Cvazos

[GBArmy]

Frank/Chacho

What Vetquest suggested is right on:

To win this I would say that you need a rock solid independent medical opinion by a vascular doctor.  Being there are not that many doctors that fit this bill it may get expensive.  I would ask your current doctor if he believes that this could be caused by your bad cholesterol levels and ...

OK, so your current VA doc is willing to write a IMO for you. That is great; they almost NEVER will do that. Look at the "evidence file" that is included in the letter and see the dbq's that are referenced. Those are what the VRO used to base your 60% rating on. Really go over them and see why he rated the way he did and what can the VA do now to shoot it down. You have to anticipate what they are going to say to start to build up your side. If there is nothing "wrong" with his original logic, then you should be able to defend the position now. If it was wrong, you probably have to wait and see what he used. If the VA formally says it is going to reduce your rating, they have to give you a warning  and I believe you have 60 or 90 days to show why it shouldn't be down graded (the response time limit, etc.  will be in the letter). Your nexus letter/IMO has to say by the doc "based on my experience , education, _ years as a specialist in the (Vascular) field, this veteran's PVD initiated while he was in active duty. The (gentestation period) for his type of PVD is consistent with his time in service, x years ago) manifesting its advanced stage to where it is today. This is based on a thorough review of his STR's and medical records, including his meds XYZ, and my overseeing of his health these last x years. Studies show (here you have to get some tech journals med opinions etc. to correspond to what you need to support . Your doc just can't say "in his opinion" that isn't strong enough.) If you can't find med published items, you are in a weak position. You may have to try and find an IMO vascular expert to do this for you. But this is for sure, they smell blood in the water and they want to get that 60% disability off their books. Do a cost eval  and see if it is worth the risk to go to an independent IMO expert. Lastly, if you can't furnish that med back up for your doc and he doesn't have anything either, any supporting documentation from him ALONG  with an IMO will enhance your claim.

[Frank89]

Vetquest,

Is there a procedure to go about and requesting my DBQs?  The exam was done by LHI a sub contractor for the VA.  Thank you guys for all your help, its a little overwhelming, so please bear with me if I come asking some simple questions that I dont know the answers to.  Again, thank you.

 

Chacho

[Berta]

I see nothing wrong with giving a doctor a cover letter to prepare an IMO with and I did that myself for my AO DMII death claim. I referred to specifics in the medical records, blood chem reports, and autopsy ,etc etc and highlighted all of those records in the stack.

The IMO doc did not need my husband's SMRs as he was an incountry Vietnam veteran.

However, I did not write the IMO for him- and because of his excellent IMOs ( he did 2 for me) I was able to prepare the IMO/IME advice in our IMO forum, based on his 2 IMOs for me and the fact that he had been a former VA doctor.

It would be difficult for most veterans to write an IMO for a doctor to sign, and maybe most doctors would disregard it and want to see all of the pertinent records themselves.

It took me a few weeks to prepare a cover letter that was perfect and based on all of the evidence I found in the medical records.I also had studied endocrinology, enough to get up  and above  the VA Endo's level-who prepared two IMOs that denied the claim. I sent those  C & P results along with the records and also I sent Dr. Bash my rebuttal to the VA Endo's crap- one part was her using a Merck definition of an acronym that she characterized as being an acronym for something else. The C & P exam was posthumous, so the best witness was dead. I held to the Merck acronym's definition.It was a small point but I left nothing unchallenged in her opinion's and I  rebutted with documented medical evidence.

But I had studied enough Endo and Cardio that I knew how to interpret the medical records. One entry was crossed out but I managed to decifer it and the doctor who wrote it also prepared a brief IMO for me, at no charge.He was the only VA doctor at that point who knew what he was doing, and it took me many long months to find him, in private practice. He remembered my husband.He only asked for a few medical records from me.The BVA gave his short opinion as much weight as Dr Bash's, because it coorborated Dr. Bash's findings.

I also learned that she-the endo doc - had limited experience in her field, but Dr Bash, as he stated in his IMO, as a neuro-radiologist -he had read X rays and MRIs of thousands of diabetics and could support my claim with a full medical rationale,  and his medical Curriculum Vitae was outstanding.

Here is our IMO criteria:

https://community.hadit.com/topic/53826-read-first-if-getting-an-imo/page/3/

In the part about the excerpts from well known medical texts, I had a list  and copies of them that helped me prepare the cover letter and I knew my case was solid. Dr Bash used I think excerpts from different medical texts-

maybe one or two of mine, as well. Current medical knowledge in studies or abstracts from well known good medical sites can be worth a lot to support any medical rationale a doctor will give. My daughter paid 300 bucks for a Cardio textbook-for a Christmas gift to me -(Braunwald- Harrisons Principles) the same one the VA developed their IHD regs from,   -when the AO IHD regs came out-thinking I would need it  here for those IHD claims..in 2010 ..but I never really needed it.

The internet is full of good medical treatises and abstracts etc, that can bolster a claim.They are free.

The claim was for AO DMII contributing to death. My husband -a VA PT since 1983 had never been diagnosed or treated for diabetes in his lifetime. You can imagine how much research and time that took,on my part, before contacting my IMO doctor ,andI certainly did not  want to pay thousands for any IM0 that could not support the claim. 

 I won.

NOTHING is IMPOSSIBLE. It just takes a Lot of work.

 

 

Edited September 13, 2019 by Berta
added more

[ruby]

Frank89, 

I missed this post sorry to hear what your going through.  I would search for BVA decisions and CAVC decision.  Where is your occlusion?  PVD usually doesn’t happen over night.  Yes, your increased cholesterol is probably the cause, there are many other factors such as diabetes, overweight, smoking etc but they all go hand in hand.   I’m going to talk to a surgeon in a couple of weeks to decide if I’m going through surgery.  

How or why I developed PVD could be the result of different things but I know the pain your going through is beyond imaginable to others.  I was told by the NP that during surgery for cancer the anesthesiologists  let me get too dry and I threw a clot to my descending aorta which 100% occluded it took 2years for me to be Dx with bilateral claudication instead of a drug seeker, it also took that long to be able to walk.   I am Lucky I did grow more arteries to compensate.  But any set back of not walking I’m back to not being able to walk to my mailbox, can’t bend for several reason  (bad back) or walk up a 1% incline.  

I was recently put on Cilostazol it dilates your arteries and you have increased blood flow. First time in 3 yrs I don’t have leg pain at rest.   While I don’t know if this is an option for you it’s a miracle drug for me.  I was able to grocery shop with a cart i haven’t been able to do that in 3 years.  It has horrible potential side effects that’s one reason I’m thinking of surgery. 

If you have the financial ability to see a private vascular surgeon for other options then amputation I would highly recommend that option.

I can’t offer any help with your claim other then research case law.  I have an auto immune disease I was denied Sc for years finally got an IMO (he did it free- felt the va was screwing me). I had 3 VA physicians specialist write nexuses and it was denied at the raters level because a rent a DO said less likely then not. I was approved at the DRO level  with %.  

I would ask others but I think they can’t decrease until your appeal is final.  Pay attention to deadlines.

Thank care

Ruby