diabetes Va Ratings Seem To Have Disappeared

[Stan n Pam]

I'll try to explain this – I feel like I need to tell you all that have responded that I have a pretty healthy case of good 'ole ADD. I really struggle reading, especially instructions – so keep that in mind when I don't seem to click right a way on something – I'm a visual learner….so if you guys wouldn't mind drawing a few pictures now and then, that would probably help a lot……. Just kidding J …but if they could be in color……..

In going thru the ROI packet that was printed on 10.10.06 – there are some discrepancies that I need help understanding –

It shows Stan as having a 60% disability rating. It is broken down like this:

"CONSULT REQUEST" (is the title on the top of the page) page 53

Provisional Diagnosis: PTSD CHRONIC SEVERE

Eligibility: SERVICE CONNECT ED 50% to 100% VERIFIED

Total S/C %: 60

FOREARM MUSCEL INJURY 30% S/C

FACIAL SCARS 0% S/C

DIABETES MELLITUS 10% S/C

POST-TRAUMATIC STRESS DISORDER 10% S/C

ARTERIOSCLEROSIS 0% S/C

ARTERIOSCLEROSIS 0% S/C

PARALYSIS OF SCIATIC NERVE 10% S/C

PARALYSIS OF SCIATIC NERVE 10% S/C

Then……………………..

On October 12, 2006 Stan received notice that his disability had been increased to 70% - and that breaks down like this:

….decision on your claim for service-connected compensation received on December 29, 2005….

….Payment start date: Jan 1, 2006 for increased service-connected compensation evaluation; monthly entitlement amount $1,280.00 this includes an additional amount for your spouse, Pamela…..

….We determined that the following conditions were related to your military service, so service-connected has been granted…

<H1 style="MARGIN: 0in 0in 0pt">Medical Description percent assigned effective date</H1>Bilateral hearing loss 0% May 19, 2006

Tinnitus 10% May 19, 2006

…..we determined that the following service-connected conditions have worsened, so we granted an increase in your assigned percentage:…..

<H1 style="MARGIN: 0in 0in 0pt">Medical Description old % new% assigned effective date</H1>Diabetes mellitus, type 10% 20% Dec 20, 2005

II w/nuclear cataracts

Residuals, shell fragment 30% 40% Dec 20, 2005

Wound, right arm

Scar, fragment wound, right and left periorbital areas 0% assigned

…….we denied entitlement to the 100% rate because it wasn't shown that you are unable to work as a result of your service-connect disabilities……

My question here is: What happened to the previous ratings on these:

POST-TRAUMATIC STRESS DISORDER 10% S/C

PARALYSIS OF SCIATIC NERVE 10% S/C

PARALYSIS OF SCIATIC NERVE 10% S/C

Another question is: I wonder where the heck that 10% rating on the PTSD came from in the first place? I'm still in the process of going thru papers so I may find that out – Stan is hoping to be rated 100% on PTSD (his VA doctors seem to think that is a distinct possibility, we'll see) – if that happens will he lose the ratings on everything else? Will they all be absorbed into one single diagnosis of PTSD? I have a problem with that! He was shot serving his country before he developed PTSD! To me everything should be absorbed into that rating. Maybe I'm being too emotional here and I probably haven't thought this thru enough, but most of the time my first instincts seem to be the right ones. ….BUT… then on the other hand – I do have to realize who we are dealing with here!!!! The VA and The Government…….. 'nough said.

Thanks for any direction anyone can give me on this,

Pam

If you need any more background – I'd be happy to supply it – one thing about this board that is so cool, is, that everyone has their own dirty laundry, and we all have to hang it out to dry sometime – and this seems to be the best place to do that.

[Berta]

"Stan has severe hardening of the arteries"

seems to me you have medical evidence to get a higher rating on the atheroclerosis.

"0" is ridiculous-

Also did they Cure his cataracts with lazer surgery?

When is last time he had vision C & P or any vision test at all?

You need to go over the diabetes regs-

as well as the heart disease regs and the vision regs-

I am having problems here - and cannot take time to add links ----

these regs are all in 38 CFR---

I will attach the VA's DMII training letter-

Did he claim HBP as secondary to his DMII?

Atherocsclerosis is a progression of HBP-

M21-1 Part !!! Subpart IV states the atherosclerosis manifestations of DMII-

also there is cardiological manifestations-(VA Training Letter #00-07)

The ECHO report will have an ejection fraction at the bottom of the medical report write up- it also will have arterial measurements- he probably had an ECHO because they determined his atherosclerosis is "severe".

That ECHO contains a lot of info-

It seems to me that he has secondary conditions that they did not rate properly or maybe they were not formally claimed-such as the HBP and cardiac involvement.

If you go to the BVA web site and search the cases regardig DMII and secondary you will find many regs there they use (I would stay with the 2005 and 2006 decisions) and how they should

determine these conditions.

The original VA DMII training letter -1997- I posted here long ago-

It contains a more detailed account of the considerable complications of DMII-

High glucose causes affect to pancreas,blood pressure, heart, brain, neuropathic system, systems involving sight, taste, sleep, ---the whole body system- the ramifications are endless and fortunately all preventable and treatable-if the glucose is well controlled-

This isnt the worse DMII decision I ever saw- it is typical -to some cases- of VA's failure to rate secondary conditions properly-

You might know that I have a DMII claim at the VA - I only filed this at my daughter's insistenece-and then began to study the disease- no one in the family had it-but

Rod had been exposed to Agent Orange-

If I had not spent a lot of time studying it Pam- I would have never know how the VA really killed my husband-

I was astonished at what I read-but knowledge is power-

The ADA web site and many more sites have considerable info on this disease-

and it might help you a lot to get a good picture of what it is.

This will help you to identify whatever secondary conditions he has that the VA should rate-

They do not award on something the vet has not formally claimed.

well sometimes they do-but these cases are few and far between----

cant attach the file-----will try later---

[Stan n Pam]

answers to: Post #14 By: Berta

"Stan has severe hardening of the arteries"

seems to me you have medical evidence to get a higher rating on the atherosclerosis.

"0" is ridiculous-

Pam’s reply:

We have plenty of medical evidence and medical history to back up anything about his cardiovascular system – I think I have mentioned his surgeries and procedures – this all basically started after he was medically retired from the PO in 1984 – the stress of the whole thing was tremendous on our family. Nothing to prove that tho – all families have their stress and problems I guess.

also did they Cure his cataracts with laser surgery?

Pam’s reply:

cure for his cataracts – no treatment was ever offered

When is last time he had vision C & P or any vision test at all?

Pam’s reply:

His last vision exam was in April or May 2006 – he was given prescription glasses at that time – I have the prescription, but nothing else was ever mentioned

You need to go over the diabetes regs-as well as the heart disease regs and the vision regs-

Pam’s reply:

I will do that this evening – is there anything that I am looking for, in particular?

I am having problems here - and cannot take time to add links ----

these regs are all in 38 CFR---

I will attach the VA's DMII training letter-

Did he claim HBP as secondary to his DMII?

Pam’s reply:

Not that I know of – I really haven’t seen any of the paperwork that was turned in to the VA for this appeal process – and I have decided not to request a copy of his c-file right now – since the appeal is now at the Rating Board/Office – I think I mentioned that it supposedly went there on Jan 17, 2007

Atherosclerosis is a progression of HBP-

Pam’s reply:

Absolutely!

M21-1 Part !!! Subpart IV states the atherosclerosis manifestations of DMII-

also there is cardio logical manifestations-(VA Training Letter #00-07)

Pam’s reply:

don’t understand this statement…….?

The ECHO report will have an ejection fraction at the bottom of the medical report write up- it also will have arterial measurements- he probably had an ECHO because they determined his atherosclerosis is "severe".

Pam’s reply:

Let me state here that I don’t have any paperwork or don’t remember if Stan was ever seen for his heart – that is one thing that I absolutely put my foot down on – no VA intervention with any of his heart treatment or symptoms or medications

That ECHO contains a lot of info-

It seems to me that he has secondary conditions that they did not rate properly or maybe they were not formally claimed-such as the HBP and cardiac involvement.

Pam’s reply:

I think you are probably correct when you say that – they were not formally claimed – I’ll probably need help on pursuing that when we hear back from the Rating Board

If you go to the BVA web site and search the cases regarding DMII and secondary you will find many regs there they use (I would stay with the 2005 and 2006 decisions) and how they should determine these conditions.

Pam’s reply:

WOW – don’t know if I could handle that much information at this point!! I have really done well so far – with my frustration level over my attention span problem – I am pacing myself – and I keep having to go over and over some things before they click –

Note to Berta: I have really concentrated on organization – and I am making progress with that – and you are so right when you know that it is comforting to know that you can get something right at your finger tips ---- I’m far from that point, but I’m chuggin’ along - Manila folders are my favorite invention right now –

The original VA DMII training letter -1997- I posted here long ago-

It contains a more detailed account of the considerable complications of DMII-

High glucose causes affect to pancreas, blood pressure, heart, brain, neuropathic system, systems involving sight, taste, sleep, ---the whole body system- the ramifications are endless and fortunately all preventable and treatable-if the glucose is well controlled-

This isn’t the worse DMII decision I ever saw- it is typical -to some cases- of VA's failure to rate secondary conditions properly-

You might know that I have a DMII claim at the VA - I only filed this at my daughter's insistence-and then began to study the disease- no one in the family had it-but Rod had been exposed to Agent Orange-

If I had not spent a lot of time studying it Pam- I would have never known how the VA really killed my husband-

I was astonished at what I read-but knowledge is power-

Pam’s reply:

This is the kind of thing that makes all this work all worth while – I’m so sorry to hear about Rod – but at least you are keeping his memory alive and well with all you are giving back to other veterans!! It is sinking in more and more each day… knowledge is power! (just wish I could remember it more easily)

The ADA web site and many more sites have considerable info on this disease-and it might help you a lot to get a good picture of what it is.

This will help you to identify whatever secondary conditions he has that the VA should rate-

They do not award on something the vet has not formally claimed.

well sometimes they do-but these cases are few and far between----

Pam’s reply:

I’m still working here in Buford, GA (yes, Buford!) ……….. you will hear from me again …………….I’m not going anywhere ……………. DON’T YOU GUYS GO ANYWHERE either :)

[Stan n Pam]

thought I'd post this again - have a few questions in here I need replies on-

(would someone tell me if I am writing too much? do I need to cut down the lengths

of my posts?)

[Berta]

Pam- has your husband formally applied for TDIU?

I will attach the form-

There are many disabilities he has that can be service connected and the presenting rating can be questioned- but then again- I just re-read Vike's post and he is correct:

"If Stan was medically retired because of his Service-connected left arm (I assume it's service-connected because of the GSW), then that would certainly help subtantiate a claim for IU. However, the right arm contributed to his medical retirement and that isn't service-connected, but may warrant service-connection as secondary to his service-connected left arem. I would pursue this claim and ask Stan's doctor to write an IMO. This will not only help substantiate Stan's claim for IU, but will actually help in the over all disability percentage if IU isn't warded."

Vike is correct as to the NSC right arm- because when one arm becomes inaffective the other is used to compensate and sometimes that can cause additional secondary problems in the NSC arm-hard to say in each case-

If he claims PTSD and is symptomatic of PTSD- he certainly should get a diagnosis-the GSW (with a PH on his DD 214) is a stressor that the VA will concede that- so no rigamorale there for nexus-

OOOPS I just re-read again- this decision on the PTSD has been deffered and is still at rating board?

The TDIU award- made if his service connected disabilities interfere with his ability to be employed-will make further NODs and claims moot-

unless he gets into an SMC criteria-Special Monthly Compensation-

I will attach the TDIU form- even though the claim is at the rating board- I would send it in if I were you-but others might disagree-because

it could hold up the rating for PTSD-

then again it can secure the EED-Earliest effective date for TDIU-

Under Remarks You can refer them to a separate page and he can list all SC meds he takes and how they cause side affects that would make one unemployable.

WOuld his last employer possibly be willing to make a statement at some point to the VA that your husband's SC disabilties interferred with his job performance?

If they know he isnt going to sue them, some employers are willing to do this-

If they let him go -rather than if he just quit-

perhaps they would be willing to tell the VA why.( as long as it regards his SC problems- any of them)

I guess the cataracts were not ratable (not compensatable).

Although VA did not rate them- did they-at the time he was employed-interfere with his sight enough on the job to have that as a cause for leabing his job.

He should mention his HBP under # 25 and anything else that would possibly be service connectable and interfere with his employment.

There is a lot to his claims- but a TDIU rating (100% SC $$$) makes it all simplyfied.

As Vike suggested getting a good independent medical opinion that covers many of these disabilities would help greatly-

I dont think he will have any problems on the PTSD claim at all-with the GSW and current diagnosis-they should award 30 to 50% on that-

"He had an ulner nerve transplant due to the GSW in Viet Nam"

Does he have any VA rating at all for the GSW? how about prominence of visible scar or painful scarring? muscular damage rating %?

"He has had 2 separate open-heart surgeries, 3 carotid bypass surgeries (1 carotid was bypassed twice), kidney stints" These are serious cardiac conditions and if due to his DMII-they should all be rated as secondary to the DMII.

Carotid arterys usually clog due to hyperlipedimia- cholesterol problems-that are often caused by diabetes-

diabetes can cause a hyperlipid hypothesis-tryglycerides are too high and other cholestrols are too low-

This is part of the long run affect and damage of diabetes to the heart-

I am not a doctor. I feel it would be nice if the VARO recognized all the potential secondary SC conditions he has- but they wont-it has to be spelled out for them-

TDIU would make much work on all this moot - hopefully-

But more then ever I feel he needs a good IMO as he could potentially be eligible for TDIU as well as additional SMC awards.

The VA -men and women- they have to look at the whole medical picture for diabetes-

they have to consider any cardiac, kidney, PN, vision problems- etc as potentially secondary to the DMII-

But they also have to have formal claim for these conditions and then medical evidence for the trail of this disease-

A heart attack in 1996 and then a diagnosis of DMII in 2003 may or may not mean that the

heart condition is secondary-

in 1997 the ADA Glucose criteria changed putting thousands of Americans into a new risk profile for DMII.

What the VA will want to see (and try to find evidence against) is a trail of DMII initially diagnosed, then the heart disease or renal dysfinction, or anything else that comes later as a secondary disability that was caused by the initial SC DMII.

I forget- do you have a vet rep helping with all this?

[Berta]

FORGOT! TDIU form attached-

I hope others will opine on this -

the claim for PTSD is with a rater-should Stan and Pam send this in now or wait for the rater's decision?

(I advise they should be sent in "yesterday"----to maintain the EED but this could hold up the PTSD claim.)

TDIU_form.pdf