Received Rating Decision

[jessie0054]

Received the Rating Decision on my son's Claims for Cancer and Polycythemia Vera.

As expected the Claim for Cancer was denied.

However the Claim for Polycythemia Vera due to Benzene Exposure is awarded!!!!

Sad part is the Rating at 0% . Resons said that the desease is in Remission and not active!!!

Guess they didn't countthe ER Report that he has just had a Phlebotomy in November 2006.

Not Sure where to go from here??

NOD , ask for a reconsidersation or Ask for an increase and send new evidence that's shows hes still active and receiving Phelbotomies as treatment??

Jessie

[Pete53]

If it were me I would request reconsideration and point out what VA failed to do in a nice but firm way.

[Berta]

"0" SC is a lot better than "0" NSC!

"ask for a reconsidersation?" I sure would if I were you and attach anything you have to show current and treated condition.

This is a BIGGIE-

no money yet but these claims on chems and fuels etc are VERY hard to win.

Is there any link whatsoever to his cancer and the benzene exposure-

as well as the Polycythemia Vera ?

Isnt benzene a known carcigenic?

[Berta]

PS- per the CDC: and the DHHS:

-http://www.bt.cdc.gov/agent/benzene/basics/facts.asp

"The Department of Health and Human Services (DHHS) has determined that benzene causes cancer in humans. Long-term exposure to high levels of benzene in the air can cause leukemia, cancer of the blood-forming organs."

I dont know what kind of cancer he has but a good medical doctor might well find the link you need based on info like this on the net-

[jessie0054]

Thanks Berta,

"0" SC is a lot better than "0" NSC!

I fully agree, At least they will have to treat his condition now and provide the medications " Chemo" when the time comes.

"ask for a reconsidersation?" I sure would if I were you and attach anything you have to show current and treated condition.

Do i just ask for a reconsideration on the grounds that the Dr. Doing his C&P didn't state things as they were?? Do i just write a letter and explain his condition and treatment. They said that he only received treatment for a year and he stopped his treatment because he is afraid of needles?? Ya gotta wonder where they get this stuff from!!!

He received phlebotomies for 4 years, at least monthly then to bi monthly. I have those records and they were part of the evidence given to them. He then went for nearly a year with Phlebotomy when he became Anemic, Not because of his fear on Needles.

This is a BIGGIE-

no money yet but these claims on chems and fuels etc are VERY hard to win.

Is there any link whatsoever to his cancer and the benzene exposure-

as well as the Polycythemia Vera ? Yes

Isnt benzene a known carcigenic?Yes

[jessie0054]

If it were me I would request reconsideration and point out what VA failed to do in a nice but firm way.

Thanks Pete53.

I'm trying to figure out how to write the letter asking for reconsideration.

Do i just point out all they said in the decision letter that i disagree with?? There is a lot!!

And then is this letter to be from me or my son?? As he couldn't possibly write one, One big problem he has is Memory loss and the ability to concentrate.

This was another area of his claim that got lost somewhere as it wasn't even addressed.

Jessie

[Vike17]

jesie0054,

If you simply disagree with the VA's decision on how they decided the claim with the evidence they had before them, then you should file a NOD.

If you have "new" evidence the VA did not have before them when they made their prior decision, then you should submit that "new" evidence and ask them to "reconsider" their prior decision. In the request for a "reconsideration" you can cite M21-1MR, Part 3, subpart 2, section E, §20©.

Vike 17

[stevedenesha]

I agree with what Vike17 said and would like to add that if you do decide to request for reconsideration, do not repeat do not say that you disagree anywhere in the request for reconsideration or they will automatically change your request for reconsideration to a Notice of Disagreement.

Steve

jesie0054,

If you simply disagree with the VA's decision on how they decided the claim with the evidence they had before them, then you should file a NOD.

If you have "new" evidence the VA did not have before them when they made their prior decision, then you should submit that "new" evidence and ask them to "reconsider" their prior decision. In the request for a "reconsideration" you can cite M21-1MR, Part 3, subpart 2, section E, §20©.

Vike 17

Edited March 24, 2007 by stevedenesha (see edit history)

[Hoppy]

Jessie,

Were the cognitive (thought) problems listed on the original claim? Have you seen any explanation in the medical literature of the cognitive problems being found in association with PV. If not you might consider notifying the RO that this is a secondary condition that was not addressed. The reason I am calling it secondary is based on the assumption that the literature does not say that it is a direct result of the disease. The cognitive problems could be a stress disorder found in association with the PV. A think in this event a shrink would need to get involved. Maybe the RO will schedule a C&P with a shrink. maybe you will neeed to get an IMO.

The doctor who treated me after a traffic accident that resulted in my having surgery was of the opinion that any disease or injury is capable of spawning a stress disorder. It is a question of how the stress disorder resolves. Considering that PV is a chronic disease that has a great potential to be fatal that a chronic stress disorder could be found in association with PV.

Maybe VIKE has a more specific way of notifying the RO as to making a claim for the secondary cognitive condition that was not addressed.

[Berta]

BTW-

if you do ask for reconsideration-

Just a simple letter referring to the decision they sent -

(I always out RECONSIDERATION REQUEST on top of the letter)

tell them what you are attaching that they have not considered yet.

I filed for a Reconsideration when my CUE claim was denied due to a most bizarre statement-

the fact of CUE was not denied- only this bizarre reason was stated-

I immediatley sent the Reconsideration Request pointing out why their statement was factually incorrect and suppored that with evidence.

I also attached an Office of General Counsel Pres op that supports my CUE claim.

I had sent this in before with the original CUE- and BVA referals in 5 claims as to the legal error I had cued and they called this stuff "internet printouts".

I reminded the VA that the OGC opinion was not a mere printout from the net but in fact established VA case law.

I also referred to and attached the part of M21-1 that shows them how to award my CUE -with the reconsideration request-

it went into rating board-

BUT-I marked my calender-

If I dont get what I want by June I think it is- I MUST file a NOD because a reconsideration request does NOT stop the click of a NOD-that ticks only for a year.

[jessie0054]

jesie0054,

If you simply disagree with the VA's decision on how they decided the claim with the evidence they had before them, then you should file a NOD.

If you have "new" evidence the VA did not have before them when they made their prior decision, then you should submit that "new" evidence and ask them to "reconsider" their prior decision. In the request for a "reconsideration" you can cite M21-1MR, Part 3, subpart 2, section E, §20©.

Vike 17

Thanks Vike,

I have made a Chart of all my son's Phlebotomies with dates what his CBC Levels were and How much blood was removed. Could this be considered as new evidence?? All these reports were in the Medical Records submitted as evidence but not the Chart form. With this chart it will be more easy to see when he went into a state of Amemia and Phlebotomies were stopped because the Polycythemia was brought under control after 4 years of monthly to bi monthly phlebotomies. He remained in this Amemic level for nearly a year and then all of a sudden he started back to higher HCt and HGB levels. He ususally knows when he needs a Phlebotomy when he starts having headaches and Dizziness. In November 2006 he fainted after getting Dizzy and had slurred speech and disoriented. His boss took him to an area hospital. All test were ran to determine that he hadn't had a stroke. His HCT was at 45, So they did a phlebotomy and with in mins he was feeling better.

The Problem we are having is that the VA uses the highest Figures in their labs. Twice in the last couple months he has had problems and went to the VA. They did the CBC and said his levels were normal by their standards. His HCT was 50.7 & 51 in Feb. And 53 in March.

I'm not sure what is the problem here?? I wonder if they even understand Polycythemia Vera. zThe purpose of the Phlebotomy is to decrease the thickness of the blood to prevent stokes and heart attacks and reduce the symptoms.

Every Hem/Onc in the country will not let the HCT in a Polycythemia Vera patient get over 45.

So because he fits into the " Normal Standards" of the VA they refuse to treat him with a Phlebotomy.

He's only had this problem with the VA. Before he started going to the VA in July of 2005 he was treated by an outside Oncoligist until the DR. Retired. Because he has no insurance now he has to seek treatment through the VA. He has an appointment in the VA on April 2, With the Onc department hopefully they will treat him with the Phlebotomy if his HCT is 45 or over. If not i have told him to go to the PT advocate and complain until he get treated.

[Berta]

The values of the hematocrits in that CBC are too high.

Unless he was at the Bath Va- we are at high altitude.

http://www.nlm.nih.gov/medlineplus/ency/article/003646.htm

"Hematocrit (varies with altitude):

Male: 40.7-50.3%

Female: 36.1-44.3%

What abnormal results mean Return to top

Low hematocrit may indicate:

anemia (various types)

blood loss (hemorrhage)

bone marrow failure (e.g., due to radiation, toxin, fibrosis, tumor)

destruction of red blood cells

leukemia

malnutrition or specific nutritional deficiency

multiple myeloma

rheumatoid arthritis

High hematocrit may indicate:

dehydration

burns

diarrhea

erythrocytosis (excessive red blood cell production)

polycythemia vera

This test may be performed under many other conditions and in the assessment of many disease states.

What the risks are Return to top

excessive bleeding

fainting or feeling light-headed

hematoma (blood accumulating under the skin)

infection (a slight risk any time the skin is broken)

multiple punctures to locate veins

Special considerations Return to top

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than "

------------------------------------

You could use that printout o support your reconsideration request. with a copy of the CBC report.

I think he should see a Real doctor-I bet the VA he goes to doesn't have a clue on this-

What is his rating?

I saw a 30% rating for this condition at BVA and there are other claims there regarding Polycythemia Vera.

I bet you know 100% more than VA does on his condition and it needs proper asssessment and treatment because it can become very serious.

Edited March 25, 2007 by Berta (see edit history)

[jessie0054]

Thanks again Berta!!!

The values of the hematocrits in that CBC are too high.

Unless he was at the Bath Va- we are at high altitude.

http://www.nlm.nih.gov/medlineplus/ency/article/003646.htm

No, He has lived in Missouri most all his life, Since Sept 2006 he has lived in SC and go's now to the Charleston VAMC. They use the highest Standard of HCT of 54. So his being below 54, he doesn't get a phlebotomy.

"Hematocrit (varies with altitude):

Male: 40.7-50.3%

Female: 36.1-44.3%

What abnormal results mean Return to top

Low hematocrit may indicate:

anemia (various types)

blood loss (hemorrhage)

bone marrow failure (e.g., due to radiation, toxin, fibrosis, tumor)

destruction of red blood cells

leukemia

malnutrition or specific nutritional deficiency

multiple myeloma

rheumatoid arthritis

High hematocrit may indicate:

dehydration

burns

diarrhea

erythrocytosis (excessive red blood cell production)

polycythemia vera

This test may be performed under many other conditions and in the assessment of many disease states.

What the risks are Return to top

excessive bleeding

fainting or feeling light-headed

hematoma (blood accumulating under the skin)

infection (a slight risk any time the skin is broken)

multiple punctures to locate veins

Berta:

At this point my son only has one good vein left in his left arm. The right has none from scar tissue.

Special considerations Return to top

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than "

Although my son has engorged veins,It is very difficult to get the blood to flow with a high HCT level.

------------------------------------

You could use that printout o support your reconsideration request. with a copy of the CBC report.

I think he should see a Real doctor-I bet the VA he goes to doesn't have a clue on this-

I think you are right!! I bet there are other veterans walking around out there who have this diease and havn't been diagnosed because of the " High Standard" of the VA labs.

What is his rating?

He was given a 0% rating!!!!

I saw a 30% rating for this condition at BVA and there are other claims there regarding Polycythemia Vera.

He should be drawing a 40% rate just because of having Phlebotomies to control his high HCT.

I bet you know 100% more than VA does on his condition and it needs proper asssessment and treatment because it can become very serious.

Yes, I know this and right now the VA is the only place he can go for treatment since he moved away and has no insurance coverage. So how do you go about getting the VA to conform to the rest of the Facilities Values and treat these Veterans for this.??

Jessie

[jessie0054]

Hoppy:

Yes, These were part of the Original Claim under Jet Fuel/ Benzene Exposure.

Jet Fuel and it's componets can cause Central Nervious System damage including Behaval Changes, Anxiety, Depression to mention a few. of which he has all of.

I also know a couple more Veterans with PV who claim Bi Polar disorder is a part of PV. I have never checked this out. But Could be i guess!!

I beleive he also has a couple more Secondary conditions that could be claims one is Gerd.

Were the cognitive (thought) problems listed on the original claim? Have you seen any explanation in the medical literature of the cognitive problems being found in association with PV. If not you might consider notifying the RO that this is a secondary condition that was not addressed. The reason I am calling it secondary is based on the assumption that the literature does not say that it is a direct result of the disease. The cognitive problems could be a stress disorder found in association with the PV. A think in this event a shrink would need to get involved. Maybe the RO will schedule a C&P with a shrink. maybe you will neeed to get an IMO.

The doctor who treated me after a traffic accident that resulted in my having surgery was of the opinion that any disease or injury is capable of spawning a stress disorder. It is a question of how the stress disorder resolves. Considering that PV is a chronic disease that has a great potential to be fatal that a chronic stress disorder could be found in association with PV.

[jessie0054]

Vike17,

Where do i find this Citation???

If you have "new" evidence the VA did not have before them when they made their prior decision, then you should submit that "new" evidence and ask them to "reconsider" their prior decision. In the request for a "reconsideration" you can cite M21-1MR, Part 3, subpart 2, section E, §20©.

[Berta]

"He was given a 0% rating"

That is an outrage! This vet had 30% polycythemia vera:

http://www.va.gov/vetapp00/files3/0027275.txt

But- he had cerebral occlusion -basically a stroke that PV medicaltions and proper assesssment of CBCs is supposed to prevent-

"Consequently, based on the evidence of record, the Board

concludes that the evidence of record supports a finding that

the veteran had a cerebral occlusion in 1980 due to his

polycythemia, and that this resulted in the onset of his

tinnitus. Accordingly, his claim of entitlement to service

connection for residuals of a cerebral occlusion is granted."

Also this case contains:

"As noted earlier, an August 1990 statement by

the veteran's treating physician affirmatively related his

enlarged spleen to his polycythemia, and the record contains

no evidence contradicting this opinion. Accordingly, the

veteran has satisfied the criteria for a claim of entitlement

to service connection for a spleen disorder, identified as an

enlarged spleen, and his claim therefor, is granted"

Showing how this condition can affect the spleen as well as brain.

The veteran here also raised the fact that there was potential SC for tinnitus as related to the brain thrombosis that came from the SC PTV- Very interesting case-

The BVA awarded the above two conditions- speen and brain- and remanded for TDIU consideration.

THANK YOU- I saw things in this BVA case that I accessed to help you- and now I have some stuff to help a vet I know------

he has hepatoslenomyopathy- and VA never has treated it.

We couldn't find the etiology for it but now maybe we can-

Is you son working or does this condition prevent employment-

sorry I forget if you answered that before-

this BVA case has the rating schedule for PTV and this vet is remanded for TDIU consideration which the evidence shows is highly probable award.

[jessie0054]

Hi Berta:

"He was given a 0% rating"

Yes, That's what they rated him as 0%, Because they think he is in remission!!

Clearly not so since he is again having problems with his HCT levels

THANK YOU- I saw things in this BVA case that I accessed to help you- and now I have some stuff to help a vet I know------

he has hepatoslenomyopathy- and VA never has treated it.

We couldn't find the etiology for it but now maybe we can-

Check out this sight, PV isn't the only condition here that might cause thses Conditions

<http://www.mpdinfo.org> I believe there must be other Veterans out there with these disorders and have gone undiagnosed because the VA has their Lab Standard set too high to avoid diagnosing. These Vets are walking around sick but don't know whats wrong since the Blood Work is " Within Normal Limits"

Is you son working or does this condition prevent employment-

He is working and thankfully he has a very understanding Boss. Most days he can bearly draw himself around because of the extreme Fatique this condition causes, More so when he is in a state of Amemia. So if he's really starting to drag and his concentation go's bad or he just can't seem to function his boss tells him to go home for a couple hours and rest. With out this dear man watching out for him i'm sure he would be out there on the street because not many bosses would understand.

sorry I forget if you answered that before-

Jessie

[Objee]

Jesse,

Without medical insurance, competent treatment may still be possible if you can find a university's school of medicine or non-profit that is conducting studies

of ailments like your son has.

Haven't researched this myself, but you should be able to find pro bono help in

this fashion.

Ralph

[gdsnide]

Jesse,

Without medical insurance, competent treatment may still be possible if you can find a university's school of medicine or non-profit that is conducting studies

of ailments like your son has.

Haven't researched this myself, but you should be able to find pro bono help in

this fashion.

Ralph

Sorry to hear it's business as usual with but U did get 0% SC.

So, now U are eligible for fre life insurance. Check it out.

[tssnave]

I am sorry to hear about the run around you are getting about your son's illness. Hang in there.

Regarding some of the answers about how to best challenge the VA's decisions:

Vike17, Berta, stevedendsha, others,

I've gone to Section E. Alternative Sources of Service Records and Special Situations (thanks, Vike17) but still have a couple of quesitons. I understand to not, I say again, NOT, use the word "disagree" in any request for reconsideration of new evidence (thanks for the tip, Steve). I also understand that asking for a reconsideration does NOT stop the NOD claim and to mark my calendar to make sure I put in an NOD if I disagree with their original decision and they don't make a decision on my reconsideration request before the 1 year timeframe runs out (thanks, Berta).

However, what I don't understand is whether or not new and material evidence presented within one year that the VA uses to render another decision will take the effective date of the reconsidered rating back to the original claim date or if the effective date will be the effective date of the request for reconsideration. In other words, what is the benefit of a reconsideration?

What date is used as the effective date for a decision based on new and material information sent to the VA with a request for reconsideration?

The reason I ask is that I am not in a position to file a NOD. I believe that based on the incomplete information from the C&P exam that the VA had they made a fair decision. However, there was a lot of information that wasn't asked and I didn't think to tell them (Vike17 - wish I'd had this board and your link to the C&P exams before I went - any newbies reading this - go to that link and save yourself the hassle I'm going through). So, I'm going to a private shrink and getting a more comprehensive report to give the VA all the information they need to make an appropriate rating decision.

Originally my DAV rep said we were going to ask for a reconsideration of new and material evidence but on my last call to him he told me to request an increase. I believe a request for increase would have an effective date of the date of my request for increase.

If a reconsideration request doesn't "protect" your original claim date then I don't see what the difference is between a reconsideration and a request for increase. If a reconsideration request DOES protect your original claim date then I don't understand why my DAV rep would tell me to ask for an increase in rating rather than a reconsideration of new and material evidence. Is there a greater risk somehow to a reconsideration request than there is a request for increase?

Please clarify for me and others who may wind up in this situation trying to figure out whether or not to file a reconsideration of new and material evidence within a year or to just request an increase in rating.

Thanks for all the tips, each time I read the board I learn a little bit more and things become clearer to me.

ts

Edited March 25, 2007 by tssnave (see edit history)

[spike]

some more information that may be able to help you with your claim or increase....

http://injury.findlaw.com/defective-dangerous-products/

great resource!