Claim for cardiovascular disease secondary to hypertension - request for full record?

[WeatherGuy]

Recently I submitted a claim for heart disease secondary to a service-connected condition. I was told by the VA that I had to follow it as a supplemental claim since at the time of my first post-retirement claim many years back I had listed chest pain as a condition. I submitted all of the following online 2 weeks ago:

• A clear nexus letter from my primary physician who wrote that it was likely that my hypertension had played a role in the development of my heart disease.
• Multiple (but not all) records from my recent cardiologist (followed now by the PCP since moving). These select records show diagnoses, heart test results, and symptoms.
• Multiple (but not all) records from my primary physician - I added all records that in any way related to my heart condition (diagnoses and test results).
• A print out of my heart-related medications from my pharmacy for the last several years.

Today I received a letter requesting additional information from the VA. They specifically requested that I complete a VA form 10-5345 to allow them to request records from both my cardiologist and my primary physician. I am confused about their request since I uploaded the pertinent records from each doctor to them already. Also, there is a lot of personal information in those records, particularly those from my PCP, that I would rather they not have (and they aren’t at all relevant to this heart disease claim).  I have been at the same rating for a very long time and this claim will not move that needle at all; my intent was to cover myself for years in the future should the cardio condition worsen (thinking it easier to deal with it now than when potentially very old and sick). But I now am worried they will try to use these records to try to reduce previous ratings or to use against me in any future filings. 

I don’t want to sound paranoid, and perhaps I have been watching too many VA disability related videos online, but I am feeling anxious about sending them my PCP’s medical record on me for a cardiovascular claim. Any words of wisdom or experience anything similar? Any kind input would be appreciated.

Edited February 6 by WeatherGuy

[Dustoff1970]

In 2019 I submitted a claim for Agent Orange Ischemic Heart Disease (IHD/CAD) with a (2014) diagnosis from my private Heart Surgeon and also copies of extensive heart testing procedures and medication prescriptions.  The claim was quickly approved with initial 30% rating.  The VA also sent me the same form for me to sign for release of medical records from the private surgeon and I of course signed it with no hesitation.  As far as I know the surgeon sent VA raters same medical records as I earlier provided to the raters with my claim.  Even if you do not return the signed form to the raters they will after a short time proceed with adjudicating your claim based upon all the medical evidence you have sent them (copies only). They are required by regulation to send you the ROI form.

I was already rated with P&T TDIU due to 70% Nam combat PTSD for over 20 years so I did not need a doctor's nexus letter showing a connection between my IHD and Army Service as the AO act presumptive list included IHD/CAD for vets exposed to AO and boots on the ground in Nam.

The medical evidence you listed sounds solid and especially the doctors nexus letter.  However, I would suggest you sign the ROI form and send it to the raters as your doctor may add additional helpful details/info that will be beneficial to your claim.

Later on appeal to the BVA board I received an increase to 60% for IHD/CAD and a nexus letter from another private heart surgeon was required to win this appeal.  His medical opinion went into great detail and analysis why I should be increased above 30%.  Also included other reputable medical references to support his opinion.  My claim and appeal awards were backdated to 2017 when I filed my claim for IHD/CAD.

My comment is not legal advice as I am not a lawyer, paralegal or VSO.

 

Edited February 6 by Dustoff1970

[broncovet]

Welcome to hadit.  My answer is in 3 parts:

1.  You might as well get used to VA "wanting to know everything and I mean everything about you".  Here is the deal.  You give them all the information they request or its easy for them to deny you.  We do not get to pick and chose what is relevant.  In order to get VA benefits, you have to lay your life bare.  Remember, when you went into the miltiary, they made you strip down and cough for a physical.  So they checked inside and out.  Expect no less with the VA.  While you are not required to release information, they also are not required to provide benefits if you dont provide the requisite information and they get to decide what that requisit information is.  While I agree with dustoff, they send that form out all the time, you could get benefits right away or you could get a quck  denial "if va thinks" they dont have all the information 

2.  Now, the good news.  The "fear of the reduction wolf" mostly turns out to be a puppy.  There are numerous regulations in place which protect your rating from the big bad wolf and they do a great job, but only when you know how to scare the wolf off, and know how to find and use those regulations to protect you from the big bad wolf.  In sum, if you have been rated over 5 years, or are P and T, its very tough for the VA to reduce you.  THe protections for 10 years, is still better, and the 20 year protection is like Fort Knox, because VA cant reduce you after you have been rated for 20 years without proving fraud. 

My short paraphrase of the protections (over 5 years or P and t) mean that "not only" does the VA have to prove you "actually improved under ordinary conditions of life (not with prolonged rest)", but your improvement is sustained (ongoing)  and not just a one exam improvement.   Further, the exam to reduce you has to be "at least as thorough" as the one where you were rated.  

Finally, remember, when the VA issues you a decision, and does not address past disabilities, then the presumption is "there was no improvement in previous disabilities since that time", so they have to show that improvement occurred since your most recent VARO decision.  However, dont take my word for it, then go pet your new puppy:  Read the regulations your self:

The threats to reduce are often overblown BUT you must act if you get a proposed reduction letter or else its assumed you dont protest the reduction.  If you get a Proposed reduction letter, start a new topic on hadit and get help.  

https://www.law.cornell.edu/cfr/text/38/3.344

3.  My last part is concerning to me.  You posted:  

Quote

• A clear nexus letter from my primary physician who wrote that it was likely that my hypertension had played a role in the development of my heart disease.

"Clear nexus letter" is relative.  Clear to who?  You? probably?  VA, maybe not so much if it was worded like that.  Rating specialists search for terms like "at least as likely as not" related to an event in military service.  It may work, but VA seems to love "at least as likely as not caused my heart disease", and not so much the little less clear (to some rating specialists, who may be doing a search for a nexus using search terms like I suggested).   The BVA is full of cases where the nexus was less than clear.  Most of those wind up getting remanded for clarification of the nexus.  This means another c and p exam.  My advice is to read over the nexus letter again.  

Now, "if" your prime care is a va doc, he likely knows how to write a nexus letter.  However, if he does not work for the VA and you get your care outside of VA, he may be unfamiliar with exactly how to do a va nexus to satisfy them.  

Especially critial parts of a nexus letter:  

A.  The doctor provides his CV detailing his competence as an expert witness.  (The VA c and p examiner gets a presumptive, your doc does not!). He needs to demonstrate medical training and experience diagnosing and treating your types of maladies, aka blood pressure/heart disease.  

B.  The doctor needs to state he reviewed your records.  This seems obvious, but VA often loves to do the "gotchas".  This is one.  

C.  The doctor needs to provide a medical rationale as to "why" he presented the opinion your high blood pressure was related to heart disease, such as citing a Harvard medical study that showed this link.  

D.  He needs to sign it, and provide his medical license number along with address and stuff.  "Anon" or "ghost" docs cant provide a nexus because their competence can not be verified.  The VA can check with the medical license number to see if this doctors license in under suspension for any reason.  

E.  Of course, the VA needs to be able to read his writing.  

 

     Im not trying to be a naysayer here about your nexus.  It may be fine.  However, it is best to review it.  It may well save you years of delays and denials, as "there may" be time for your doctor to slightly amend that nexus letter to include all of the above, "if" any one or more of the above is missing, incomplete, or inaccurate.  Instead, Im trying to save you heartache which has resulted in delays and denials for many Veterans.  

     EVen tho, I had a "dead on" nexus, the VA still found a way to deny, and that delay meant I lost my home to foreclosure.  They made up a way to deny.  Even tho, the Caluza elements of diagnosis, event in service, and nexus should suffice, they made up a new one.  They said it had been "too long since military service" a bogus denail.  I overcame their denial..but lost my home in the process.  Im trying to prevent that from happening to you.  

Edited February 6 by broncovet

[john999]

High blood leading to heart disease and stroke is generally accepted medical science, but you still need a MD to say so.  I had CAD diagnosed as secondary to service connected diabetes by a VA doctor believe that or not?  Even so when I had my C&P the nurse that did my exam said my heart disease was not service connected.  So that meant an appeal and I did win it. Bronco's advise is spot on and covers the hoops you must jump through.  It is so easy for VA C&P's to just  deny or low ball your conditions.  Be ready to file an appeal if it does not to your way.  If your high blood is service connected I think you have a very good chance of getting connected for heart disease, but get your medical evidence in line.

[relatively happy camper]

A couple of things to know here:  Any copies the VA gets, from you, they "probably" consider that they could have been altered by you, so they will most/always often get them directly from your med records source.  Also, VA evaluators are evaluated basically by how quickly they move the claim from pile A to pile B(I know old style phrase, as everything is electronically, these days but I'm sure you'll understand what I mean).  They also are never rated on how much of their work is done properly, just moving one pile to the next pile.  

Please note that these comments are my opinion only, based on 34yrs of dealing w/my claims.

[Rattler]

I have a different take on it. 

It sound like you have done your home work and done everything right. At least the way I would do it. My experience is I only send the VA the documentation that relates to my claimed disability and connects it to my service. I have had the VA when I was seeking my claims use the other information that was in my VA records to deny my claim or lowball a ratting. Hears an example lets say that some ware in those records other than what you have provided it says that your hart condition might be caused by high cholesterol. (HDL) The chances are there is a blood test in your records that states you have high cholesterol. Because high cholesterol is related to diet it would give the VA an issue to deny your claim. I NEVER send the form in unless I know what is exactly in the records.

My question is did the letter ask for your doc's info explicitly? If not its required that VA send it to you to give you the opportunity to add the information to your your file. I never give the VA animation for there gun to shoot me in the foot.

My thoughts are were you station where expose you to anything? Or did your MOS expose you to anything? It would make you a PACT ACT Vet?

We have a lot of vets that sent in 500 pages of medical info to the VA only to get denied because the VA picked one thing not related to your claim and use it against you.

I am dealing with two vets that should be a 100% right now that have high cholesterol and high BP in there records and I am having them do exactly what you did.

Others my disagree with this. 

[Rattler]

40 minutes ago, relatively happy camper said:

A couple of things to know here:  Any copies the VA gets, from you, they "probably" consider that they could have been altered by you, so they will most/always often get them directly from your med records source.  Also, VA evaluators are evaluated basically by how quickly they move the claim from pile A to pile B(I know old style phrase, as everything is electronically, these days but I'm sure you'll understand what I mean).  They also are never rated on how much of their work is done properly, just moving one pile to the next pile.  

Please note that these comments are my opinion only, based on 34yrs of dealing w/my claims.

This never happens. The VA may not give your records any weight on your claim. Or what happens most of the time it just doesn't get read because you submitted to much info.