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.

[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.