Diabetes Claim

[freedog89]

Hello Everyone. I have a question about getting approved for a diabetes claim. I was diagnosed with prediabetes in 2007 with METFORMIN and taking blood glucose 3 times a day. I was never diagnosed with diabetes until 2013 after I retired in 2011. I put in a supplemental claim and was denied in Jul 2020. They did give me the qualifying event of prediabetes and that I do have a disability of diabetes. I have a HLR in now but I feel they will disapprove it. How do I go about getting this service connected when they tell me I had symptoms of it 4 years before I retired. I am not understanding the process. I have the continuity of symptomatology in my SMR which they pointed that out. Thank you for your time and please stay safe.

[Christie]

#1. You may wanna get checked for cancer as METFORMIN has been recalled for causing cancer.

#2.  No offense, but how did the service cause your diabetes. As someone with a family history of it, there is no way its service connected. And I am seeing more and more of people who are getting diabetes or with other family histories getting service connected for non service connected illnesses. And that is wrong. I had to fight for 20 years for my actual service connected issues. And there are VIETNAM vets STILL fighting. That is what is wrong with this system.  My dad died getting NOTHING. So many things with the system need fixing...on all ends.

[brokensoldier244th]

What are you claiming it’s caused by? There aren’t many things things military that cause DM as a presumed effect, so what about your service is causing you, you think, to have DM?

[freedog89]

Thank you for responding. That is a question I cannot answer and I will do research to come up with one. I always thought if you had an illness or injury that started in service you could connect it somehow. A lot of people are getting compensation for DMII that are not Vietnam Vets. Maybe I should read up on it more. Thank you for your time.

[brokensoldier244th]

Generally you either have to be diagnosed in service for it to be automatically connected, have some kind of exposure event (presumed), or, SA can be a contributing factor, and obesity as an intermediary step ( I dint see many of these- doesn’tn mean they are rated, I just haven’t seen many) 

 

https://cck-law.com/blog/type-2-diabetes-and-va-disability-compensation/

[freedog89]

The reason I am confused is that you read all the information and they give you different answers. On one law blog it says if you can prove chronicity and continuity of symptomatology. I have that with the with them giving me a qualifying condition for prediabetes. I was never obese and am not now. The examiner said it is less likely than not incurred or caused by military service. So I will get a VSO once the HLR review is over. Thank you for your response 

[brokensoldier244th]

What exactly did your examiner say, under rationale? If they didn’t provide rationale it’s an incomplete exam. Were there Any indicators on enlistment? If so it’s not a complete crap shoot because you can still claim aggravation.  
 

I don’t work with a lot of diabetes claims [and I am not a rater] so I apologize if some of my information is a bit general. 

is your pre  indicators clearly marked in your record (by you) or at least noted in your claim “blah blah diabetes diag on DATE....pg yadda yadda. Even if your examiner opines one thing a preponderance of evidence already of record indicating otherwise can be inferred by a rater if call it out to them so they can see it. The opinion isn’t everything. My job is to eyeball your records and find some of this stuff before setting up exams but at hundreds of thousands of pages even I miss stuff, especially if it’s handwritten doctor scrawl. It helps if the vet at least gives me an approximate date or estimate, years, Season even, On their claim form-so I can find some of this stuff-especially if it’s important. 
 

I WANT to make sure vets at least get exams-that’s my part. To do that sometimes I need a little help to go to bat for them so I can argue if a claim gets kicked back to me asking why I scheduled exams if all three  elements For sc exam are thin or not all there. 

Edited August 22, 2020 by brokensoldier244th (see edit history)

[freedog89]

This is her rationale: While poor diet contributes to and/ or causes diabetes II. other causes include family history and lack of physical activity are a greater risk. Therefore the current condition is less likely than not caused by an in service event. illness. or injury. I started taking METFORMIN in 2007 until 2013. That is when I started taking insulin 4 times a day. I retired in 2011.

[brokensoldier244th]

Okay, did your examiner know that? (Somewhat of a rhetorical question) or was it a non face to face record review? Id submit that information of yours on a 21-4138, or better (if you have them), script slips or something from when you were on duty that shows otherwise and counter what that said especially if it’s already in record. If “I” , whomever my counterpart was, didn’t dress that in your records it wouldn’t have been sent to the Doctor. For contractors and Vamc exams e we’re doing just dump all your records up there- we find the high points that support out indicate whatever you are claiming (if we can) ‘cause that’s what we need to justify the exam.  But if they didn’t make it fault obvious the scanners/down loaders that work for the contractors might not have pulled it. The RATERS can see all of it, the contractors only see what we send them, otherwise there they’d get thousands of pages and never get anything done. 
 

note- I’ve never said it’s a perfect system. My job as a vsr is to be like a paralegal for a rater- to find this stuff and annotate it so it’s easy to find for the examiner and the raters. I take it pretty seriously but my performance level is on the lower end of my team because I take my time and assume little. so what, I’m not completely Numbers driven. 

[freedog89]

I rater saw that I was prediabetic and stated that on my decision letter. My exam was basically a BS session without talking about my diabetes. I told her I was taking medicine since 2007.

[brokensoldier244th]

Start reading  under Analysis. It might give you some ammunition. While appeal decisions are not binding except to the particular case, they do provide illumination into things like "what can or cannot be service connected, and with what rationale"

 

https://www.va.gov/vetapp07/files1/0707171.txt

 

https://www.va.gov/vetapp16/Files1/1604148.txt

For this one, scroll down to around the middle. This one is longer. Apologies. 

[Berta]

I helped a vet get awarded for diabetes, by pouring over his entire SMRs.

By then he had been to the BVA and to the CAVC twice. Not a single vet rep or lawyer or the VA even read his SMRs.

His SMRs revealed symptoms of full blown diabetes.But it took me three weeks of working daily on his SMRs to come up with enough entries to make his claim valid. I had to learn many medical acronyms and also I learned more about this vet's penis that I ever thought I would. He had a documented condition that the Mil aid was gonnorhea or some other STD, and I found he had symptoms of penile problems that were conistent with diabetes...not ED but another medical condition Also the SMRs revealed he had urinated on himself unexpectedly a few times and also had developed a "drusen" in his eye in service that also led me to more iinfo on how that condition could have been also related to his diabetes.

These were handwritten SMRs from the 1960s, and I had to blow up many entries to even see what they really said.

I helped him because my former idiot vet rep asked me to--- while he himself was busy trying to bugger  my AO DMII death claim. What I mean was I had apparently the first IMO they had ever seen at this office, and they claimed they presented it to the DRO after I CUED the VARO for ignoring and the same DRO , on the double DRO review ,told the rep she could not read it.

Well that claim was awarded to me  anyhow- Direct SC death of my husband due to undiagnosed and untreated DMII incurred from his Agent Orange Exposure.

 

This vet state org had never mentioned an IMO/IME to the vet they asked me to help- I guess they were not trained to do that...

I prepared an extensive lay medical opinion for the veteran's private Endocrinologist,based on my assessment of the veteran's SMRS, which I tabbed and attached, who then prepared an excellent IME ( his first IME was awful because--- I already told this before here)but in any event this veteran finally got his SC for diabetes, after years and years of denials.

Nothing is impossible.

The veteran's Endo doctor did the IME for free-but most IMO/IME doctors will charge a fee.

Still a good IMO IME doctor will give your SMRs and your entire medical records probably the most thorough reading they will ever get.

 

I suggest that you go over your SMRs very carefully- and if you feel you do have diabetic symptomatology evident in them, you should seek an IME from an Endocrinologist.

I did a lot of extensive Diabetes research for the claim I had pending at the time, and had 3 IMos and even ordered and paid for  a 4th one- which I didnt need. But I knew my claim was a winner, and the research I had been doing for my claim also helped me help this other veteran.

Also I had a copy of the VA's original Diabetes training letter which helped a lot as well.

I used my dead husband's driver's license, his dental records, his "Swich and Swallow VA prescription and numerous other pieces of documented medical evidence, to include his autopsy and also I rebutted the 2 ridiculous Endocrinologist posthumous C & P exam results.

My long point is that there might well be enough evidence in your SMRs to support a strong IMO/IME but you have to determine that from giving them a thorough review.

You cannot overlook anything.

When I won my DMII AO claim, I had misinterpreted one word in the autopsy heart slides - thinking I knew

what it meant but it was one thing that definitely proved my case, and I learned not to overlook anything in medial records, etc.

 

what 

 

[brokensoldier244th]

2 minutes ago, Christie said:

#1. You may wanna get checked for cancer as METFORMIN has been recalled for causing cancer.

#2.  No offense, but how did the service cause your diabetes. As someone with a family history of it, there is no way its service connected. And I am seeing more and more of people who are getting diabetes or with other family histories getting service connected for non service connected illnesses. And that is wrong. I had to fight for 20 years for my actual service connected issues. And there are VIETNAM vets STILL fighting. That is what is wrong with this system.  My dad died getting NOTHING. So many things with the system need fixing...on all ends.

SOooo...your supposition is that people with prior histories of conditions shouldn't be SC for them (despite that the regulations clearly say otherwise) Okay. That's great, moving on past your opinion of the VA system.

First of all, starting a comment with "no offense" usually means offense is coming and you are just trying to make your self feel better. Second, you are not an MD, nor are you obviously up on former and current ratings standards as to what can and cannot be service connected. (hint, in this guys case he already had pre-diabetic conditions that were not found at enlistment, so they presented IN SVC which is 33% of service connection.

There are several conditions that can be service connected by way of other things that aren't even SC. In his case, he has a pre-discharge finding of pre-diabetes, that, after discharge, presented as full on DMII. And only 2 yrs after, even. Its not like he's trying to claim it 20 yrs later.  The rater may have seen 'pre-diabetic' and while they were correct- "Pre-diabetes" doesn't exist- its not a rateable medical diagnosis, that progression from that to full DMII IS a rateable medical diagnosis. 

Op just need to get their own doctor to examine the pre-diabetes to diabetes timeline and chain of events, and opine as to whether OP vet was 'pre-diabetic' or actually diabetic at the time of his original diagnosis, and/or that the DMII now is obviously connected to the pre DM diagnosis and is service connectible as aggravation of a pre-existing condition. 

[brokensoldier244th]

2 hours ago, freedog89 said:

This is her rationale: While poor diet contributes to and/ or causes diabetes II. other causes include family history and lack of physical activity are a greater risk. Therefore the current condition is less likely than not caused by an in service event. illness. or injury. I started taking METFORMIN in 2007 until 2013. That is when I started taking insulin 4 times a day. I retired in 2011.

So, assuming no family history in your svc records or enlistment exam, she ignored that YOU didn't have those conditions, and YOU weren't on a forced diet of whatever they fed you in the mess hall, and, as a soldier, there wouldn't have been "lack of physical activity". Even 2 yrs out unless you stuffed a bucket of chicken every day and didn't get out of your chair you shouldn't have progressed that fast. 

[Christie]

Just now, brokensoldier244th said:

SOooo...your supposition is that people with prior histories of conditions shouldn't be SC for them (despite that the regulations clearly say otherwise) Okay. That's great, moving on past your opinion of the VA system.

First of all, starting a comment with "no offense" usually means offense is coming and you are just trying to make your self feel better. Second, you are not an MD, nor are you obviously up on former and current ratings standards as to what can and cannot be service connected. (hint, in this guys case he already had pre-diabetic conditions that were not found at enlistment, so they presented IN SVC which is 33% of service connection.

There are several conditions that can be service connected by way of other things that aren't even SC. In his case, he has a pre-discharge finding of pre-diabetes, that, after discharge, presented as full on DMII. And only 2 yrs after, even. Its not like he's trying to claim it 20 yrs later.  The rater may have seen 'pre-diabetic' and while they were correct- "Pre-diabetes" doesn't exist- its not a rateable medical diagnosis, that progression from that to full DMII IS a rateable medical diagnosis. 

Op just need to get their own doctor to examine the pre-diabetes to diabetes timeline and chain of events, and opine as to whether OP vet was 'pre-diabetic' or actually diabetic at the time of his original diagnosis, and/or that the DMII now is obviously connected to the pre DM diagnosis and is service connectible as aggravation of a pre-existing condition. 

Yes MY OPINION. If its family history it should not be service connected. PERIOD. It is wrong. And I am allowed my opinion...and if stating no offense bothers you..well no offense...move past it. you stated your opinion without someone telling you moving past your opinion. get butt hurt much?????? Again, family history should not be able to be service connected. Its not right.  You would /may have gotten it even if never served.  Claims like this drain the system. And then people die never getting anything...but hey...tell that Vietnam vet reading this that its okay he aint getting shit for being exposed to agent orange but that person who has family history is getting 100%.

[brokensoldier244th]

1 minute ago, Christie said:

Yes MY OPINION. If its family history it should not be service connected. PERIOD. It is wrong. And I am allowed my opinion...and if stating no offense bothers you..well no offense...move past it. you stated your opinion without someone telling you moving past your opinion. get butt hurt much?????? Again, family history should not be able to be service connected. Its not right.  You would /may have gotten it even if never served.  Claims like this drain the system. And then people die never getting anything...but hey...tell that Vietnam vet reading this that its okay he aint getting shit for being exposed to agent orange but that person who has family history is getting 100%.

Im not telling you anything, so quit inferring. Regulations clearly state that aggravation of pre-existing is a rateable thing. Don't like it, call your Congressman. It doesn't make OP any less eligible for SC for it, even if it WAS in his records or family history. 

As for my 'opinions', they are based in fact and current regulation, and what I see every day working on veteran claims. 

[freedog89]

 Christie I am truly sorry about your father. Thank you very much for your opinion and I will think about what you said. If I had been diagnosed with diabetes before I retired or a year after I retired it would have been service connected. I do not have a family history of diabetes. If this is not service connected then I will move on and not tie up the system as you put it. You are correct in your statement about Vietnam VETS. But each VETS has different stories that I feel need to be respected and because one did not get the rating they should have. It does not mean a person who did should be disrespected. I hope you at least get all the claims you put in. Please be safe and take care. I truly thank you for your response. 

[Buck52]

Veterans coming out of the military should file any claims they have that was due to their military service & its best to file within one year getting out or the veterans ETS Date  but they also can file years later . depending if the condition is worse  or the veteran notice this condition to be worse  such as LOSS OF HEARING. BUT THERE IS OTHER CONDITIONS THAT MAY ARISE YEARS HIS MILITARY SERVICE.. THAT HE MAY NOT HAVE HAD AT THE TIME OF HIS/HER ETS.

As for a pre- existing conditions   being proved by the VA THEN NORMALLY THE VETERAN WILL NOT BE SERVICE CONNECTED FOR IT OR ANY PR-EXISTING CONDITIONS.

BUT THE VETERAN CAN RECEIVE MEDICAL SERVICES THROUGH THE VA AT A LOW COST OR NO COST BUT WITH SOME CO-PAYMENTS.

So if the Veteran can prove any of his/her medical conditions that they may claim can prove these conditions was caused by or related to his/her military service can and should get them service connected and if warranted a  correct Rating % given to this veteran.

YOU DO THIS WITH MEDICAL RECORDS AND IMO'S from qualified Dr/s & SPECIALIST.  AS EVIDENCE TO THE CONDITION FROM  MILITARY SERVICE. 

[brokensoldier244th]

Sort of, you can still be SC for aggravation of a pre-existing condition.