Heart Attack Secondary to Depression, Should I appeal?

[dbgrace1970]

Forgive me if this has been asked previously.  I am trying to navigate the site and did not find anything searching for it.  I am currently service connected at 50 percent for depression, listed as MDD and Anxiety.  Had a heart attack last year. STEMI.  CAD diagnosis.  In discussing lifestyle changes, I was asked what my stress level was as far as job, home life, leisure, prior health, etc.  Stress is high and depression is thick and real.  Was told that the depression and anxiety COULD be a contributing factor and Id want to be as stress free as possible.  Applied for secondary heart attack, due to depression and anxiety with VA.  had C&P exam.  Saw doctor (contractor, QCV or something) for five minutes in which he said nothing to me.  looked at computer screen, typed some things up, and excused me.  Was later denied..."It is less likely than not that the veteran has a  diagnosis of CAD with MI requiring stent placement that was proximately due to to MDD, anxiety, or OCD.  There is no medical evidence that MDD, anxiety, or OCD cause CAD".  

There are numerous studies performed by the VA, Mayo, and universities and agencies worldwide that connect CAD with depression as a cause and a symptom.  Several rulings have already stated as much.  I have requested the records from the C&P ( a month or more ago) and have yet to receive them.  Deadline for appeal is coming up quickly.  This new system sucks.  I used to just go to the regional office in Lincoln and theyd let me walk out with any copies I needed.  Question, Is it worth appealing on the grounds I have listed in this paragraph?  And is there a way to get a doctor to look at my records on my own and see if they agree that its AT LEAST AS LIKELY that the two area linked?

[ShuMan]

Now you got to fight! You got to build a good supplemental claims package.  What should this include?

1. Solid Independent medical option Nexus

2. Lay evidence- great personal statement/Buddy letters.

3. Medical journals -- https://pubmed.ncbi.nlm.nih.gov/

4. BVA court cases similar to yours. 

Combine that into a package and submit a supplemental appeal. 

Just my option on what I would do.

[Buck52]

I agree with ShuMan

Your going to need to see a Qualified Dr to state what you mention above  because the VA WILL NOT TAKE OUR WORD FOR IT even submitting ''there are numerous studies performed by the VA, Mayo, and universities and agencies worldwide that connect CAD with depression as a cause and a symptom. ''

you and I  have no doubt its is likely as not caused /related to your MDD(Depression/Anxiety  but you need a Dr to say that.

Edited October 5, 2020 by Buck52 (see edit history)

[GBArmy]

I agree also. Don't know how much time you have left to file your supplement claim. You need an IMO/nexus from a doc to fight their original denial. As Buck said, you can't give a medical opinion that they will consider. If you have records from ebenefits, etc. maybe your new doc can pull enough evidence together with medical journals to get it done. Otherwise, after a year you can you can still submit but is starts a new effectivity date. 

[dbgrace1970]

6 minutes ago, GBArmy said:

I agree also. Don't know how much time you have left to file your supplement claim. You need an IMO/nexus from a doc to fight their original denial. As Buck said, you can't give a medical opinion that they will consider. If you have records from ebenefits, etc. maybe your new doc can pull enough evidence together with medical journals to get it done. Otherwise, after a year you can you can still submit but is starts a new effectivity date. 

The year ,mark is in just a few days.  I had figured I had already lost out on the time, and then realized a couple months ago their was still time on the clock.  I requested the C&P records so I could quote exactly what the doctors opinion was.  And challenge anything else he had put in their, like alengthy interview or something.  But the time it has taken to get those back has been its own challenge.  Then, of course because why wouldnt it, my hard drive crashed last week, losing all of my medical records.  Ill have to go back tot eh original hospital that treated me to get those.  Which is good, I suppose, because that cardiologist is the one that told me it certainly could be tied to stress and depression.  This will take some quick action.  ugh

[Buck52]

JUST BE SURE YOU SEND IN YOUR NOD ASK FOR EXTENSION   AND USE EBENEFITS OFF MYHEALTHYVET  ITS FASTER AND SURE TO GET THERE IN TIME. FILLING ELECTRONICALLY IS THE WAY YOU NEED TO FILE THIS ASK FOR CONFIRMATION, DON'T COUNT ON SNAIL MAIL (US POSTAL SERVICE)  IF YOUR COMPUTER IS DOWN ASK AT YOUR VAMC  .DAV OFFICE SEE IF THEY WILL FILE IT ELECTRONICALLY  OR MAYBE THE BVA OFFICE.  IF NOT ASK A FRIEND NEIGHBOR  TO USE THEIR COMPUTER JUST MAKE SURE YOU FILE IT IN TIME. 

[broncovet]

I agree, BUT:

Whoa, Hoss!  In some circumstances CAD is presumptive!!!  READ this to see if its a presumptive for YOU!  

https://cck-law.com/types-of-va-disabilities/ischemic-coronary-artery-disease/

If you were exposed to Agent Orange, and have been diagnosed with CAD, you should be able to get benefits for it.  See the link above.  

[dbgrace1970]

12 minutes ago, broncovet said:

I agree, BUT:

Whoa, Hoss!  In some circumstances CAD is presumptive!!!  READ this to see if its a presumptive for YOU!  

https://cck-law.com/types-of-va-disabilities/ischemic-coronary-artery-disease/

If you were exposed to Agent Orange, and have been diagnosed with CAD, you should be able to get benefits for it.  See the link above.  

Thanks Bronc.  Wouldnt be presumptive for me, I discharged in 1990 with no AO exposure.  That being said, did spend time on Chanute Air Force Base, which is now a superfund area, I believe, and was designated one shortly after I left there. But I just received a phone call from my cardiologists office.  He has received the request to look at the records and determine if it is AT LEAST AS LIKELY or better.  They'll get back to me tomorrow.

 

[broncovet]

Berta may have a list of places for presumptives.  Im not sure, as I said, Vietnam is one.   I think there is another list of presumptives for asbestos, for camp lejune, and probably more.  

https://www.publichealth.va.gov/exposures/publications/agent-orange/agent-orange-2020/presumptive.asp

[Former Member]

Make sure the doctor follows the IMO /IME criteria here at hadit:

Basically the doctor should use those key words, "at least as likely " as due to the SC MH issue, ,and give a full medical rationale which they can support with any strong internet treatises  or abstracts.

Also hopefully they will have a copy of that C & P exam and can point out how inaccurate it is.

Also what kind of Doctor did the C & P exam?

Your Cardiologist should be willing to give the VA a 'curriculum vitae' or a strong description of their cardio expertise.

I was remanded for a Cardio opinion by the BVA many years ago (am widow of Vietnam vet)

and I got a C & P by a PA. I knocked it down medically myself and the BVA gave it no weight and 

awarded on my 3 IMOs ( and additional extensive evidence)

There is nothing wrong with PAs or nurses but they are not qualified to opine on cardiac issues.

Vets have proven their exposure to AO in many places outside of Vietnam. to include CONUS, and by being on ships within the 12 mile limit of the coast of Vietnam during the war, as well as certain crew members of C 123s, who were exposed to the contaminated planes.

 

 

 

 

[dbgrace1970]

UPDATE:  Got a letter from my private doctor, a cardiologist.  Letter stated that connections between depression and heart attacks are well known and well documented and it was  AT LEAST AS LIKELY AS NOT that my heart attack was caused by service connected depression and anxiety.  I filed the appeal on October 15.  I am set for ANOTHER C&P for this Friday, but already received the enclosed letter.  I cant believe they already adjudicated the IU and the P&T. before I even have the next C&P.  And how have they gotten that far before I even get the results of my previous C&P, which I requested in Late August?  My original claim in 2011 only took four months to approve and close.   

 

[broncovet]

You can reopen THIS denial also, with your new and material evidence (doc report) 38 cfr 3.156 b OR

Just appeal to the BVA (my choice). 

[dbgrace1970]

Another UPDATE:  Appeal was filed, second C&P exam was performed.  That nurse told me that she thought I should be checked for COPD due to smoking for years.  I told her that was fine and all, but not what I was here for, and I've never been told COPD might be a problem.  Had a quick exam, and a couple of weeks later received a letter from VA stating they service connected the heart attack at 10 percent, with the mandatory 100 percent rating for 3 months following myocardial infarction.  But weren't done adjudicating because the C&P notes " are not clear and have been returned to the provider for clarity".  The letter went on to say the rating may go up once the notes are cleared up.  I'm assuming its because she included notes about COPD.  So waiting to hear the final decision.  All in all, im pretty impressed, as always, with Nebraska's RO, regarding the minimal amount of time they take to reach decisions.

[jbasser]

You really need to reference CAVC cases over the BVA. The Veterans court opinions have a lot more weight. Both are helpful. 

 

Here is the link:  http://search.uscourts.cavc.gov/