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

[brokensoldier244th]

2 hours 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.

Incorrect on several counts. All evidence is weighed by the rater and weighted based on probative value. We don't 'consider any copy could have been altered by you'. I see hundreds of pages a day of veteran-submitted records- STRs, OMPF, private medical, police reports, Investigative notes, etc. Per the MR everything is accepted on face value unless something is glaringly wrong with it. For example, I have seen a doctored DD214 before that ended up being part of an OIG investigation into fraudulent enrichment. It does happen but it's pretty rare.

We aren't just rated on 'moving something from pile A to pile B'. The performance standards that we are evaluated on are 7 pages long; there are 11 different sections of things that we are evaluated on per individual claim, though not all of those apply to every given claim. One of our three critical evaluative ratings is based on accuracy, and we are reviewed for it every month. I have a meeting with my supervisor sometime in the next few days for last month's review. The three critical elements are what determines if you are promotable later, and they follow me in my eOPF no matter where I go. 

[brokensoldier244th]

If it's found or mentioned somewhere, like in Capri, we are required to at least ask/try to get the non VA records. You don't have to provide release or send them if you don't want to. 

[brokensoldier244th]

Its a standard thing- for all VA knows you've had more treatment that may be relevant since the last time. You can selectively send what you want, if its relevant, or leave it alone and the request will expire. We see both all the time and don't take it personally. There are just certain things that we are required to do under DTA.

[Dustoff1970]

I made everything simple and easy for me and the VA raters by providing with my heart disease claim copies of all my extensive test performed at the hospital heart institute under supervision of my private heart doctor/surgeon.  I simply returned to his office later and requested copies of those test that I then made copies of copies and sent in with the claim and in short order the VA gave me 30% for heart disease. Medical records were clear cut and straight forward!!!!!

I have no idea if the private surgeon sent anything back to the VA after they mailed him my signed ROI and did not care as I already had it all.

No need to make a simple procedure complicated and at age 75 I was not worried about anything including reduction of my other ratings and still no worries at age 77.  etc.

 

 

[WeatherGuy]

 

Thanks all.

Some further info:

I am aware of the various 5/10/20/55 policies (I am 65 and rated for all but one condition for 18+years). That said, some of the policies refer to loss of a service-connection vs. a rating. As I quickly approach a final retirement I worry about these things more than I did in the past. I consider it healthy caution.

I do have a hx of high cholesterol and triglycerides, both of which were claimed at the time of my retirement. At the time those were denied as they were not compensable conditions - the VA said at the time that should they later become an issue (cause a disease) I should send a claim at that time. But it made sense to me that rather than go back 20 years to that it would be best to go another route that was equally as valid - heart disease secondary to the hypertension. Clearly many factors go into the development of heart disease, but with a secondary claim my understanding is that I do not even need to link it back to service (although I did indeed claim chest pains at that time as well, there was just no diagnosis until years later).

NEW - yesterday evening I had a message about setting up a C&P exam for this claim.

@broncovet On my nexus - I believe that it is a good one. My wife is a healthcare professional and she has been helping me a lot with these claims from the start (researching, etc). She provided a basic template to my physician to ensure the wording was on point. I do not have that letter in front of me right now, but I know that the strength of the connection per the letter was that it was “highly likely” (steps above “more likely than not”) that the hypertension had a significant role in the development of my heart disease. The letter is from my personal physician (not someone hired for a nexus) and she discussed reviewing my records from my cardiologist (we now live 3+ hours from my cardiologist and so haven’t seen him in a bit over a year - my pcp has been handling that area since then). 
** sorry to hear about your experience, and the loss of your house, that’s rotten!
 

1 hour ago, Rattler said:

My question is did the letter ask for your doc's info explicitly?

@Rattler  - the letter from the VA said “We are working on your claim. We need additional evidence from you.” And below that with a bullet, it says “Your authorization and consent to release information to the VA from X and Y did not contain an address or contained an incorrect address. Please tell us the address of X and Y so we can request medical information. You may want to obtain and send us the information yourself. “ Note that not far down it says if we do not hear from you we may make a decision on your claim after 30 days”

The thing is, I had specifically clicked, I believe, that I did not need their assistance getting the information from my physicians.. Maybe I mistakenly clicked that box, however it’s impossible to know at this point. I do have copies of all the records. I could send more of that, perhaps? I’m just not sure the best thing to do. I am trying to not shoot myself in the foot for sure. I don’t have anything to hide, but for my experience, and from all the reading, my wife and I have done it definitely seems like they take every opportunity to squish even valid claims. 

 

Edited February 6 by WeatherGuy

[WeatherGuy]

@brokensoldier244th The letter from the VA said “We are working on your claim. We need additional evidence from you.” And below that with a bullet, it says “Your authorization and consent to release information to the VA from X and Y did not contain an address or contained an incorrect address. Please tell us the address of X and Y so we can request medical information. You may want to obtain and send us the information yourself. “ Note that not far down it says if we do not hear from you we may make a decision on your claim after 30 days”.  Actually the same day I got a text to set up a C&P eval.

i don’t know if this is standard or not (if someone uploaded already a number of medical records). I only uploaded a few medical records for my claim a couple of years back and it wasn’t an issue. So I am not sure if I somehow inadvertently clicked that I wanted the VA to get my records for me or if they actually do not have enough. From the info here, do you have thoughts on that given your long experience? Thanks for your help!