Heart Disease Rate Increase

[stillhere]

I am rated 60%heart disease / 20% DBII / 10% NP left / 10% NP right I am being compensated at 70% VA Math.

Recently had another blockage issue in the heart and another stent implanted doc said limit duty next month and come back and see him for evaluation. Called the VA for advise as to rate increase they said would send paper work in 60 days and then file.

My questions are should I file for this rate increae or go with a NOD from my last award in Feb. 07

If I go with NOD (Sept.06 one year from that date)I was thinking of asking for a different award date. They only added the heart disease after I had a heart attack in Oct. 05 although I had complained of heart pain on my first claim in 03 and it was denied. I then reapplied in August of 06 and they again denied heart only after I had my heart attack in 05 did they finally allow the heart issue as secondary to DB2.

I feel it is obvious that something caused my heart issue and it was there long before Oct. 05 but all the test they where running stress, cardio and such showed nothing. Is this a CUE?

Anyhow all help would be appreciated on this matter. I have the feeling things are going down hill very quick and don't know how much more I can battle with them before I have another heart attack.

[Berta]

Not a basis for CUE-

you still have other ways to go on this-

If you are not working and your SC disabilities are preventing you from working you should apply for TDIU- the 100% rate of VA comp-

2,200 a month?? I forget!-someone will correct

I will attach the TDIU form-

How did the VA consider you and then deny you for TDIU in the 70% decision?

That statement from VA in the 70% decision can shape what evidence they still need from you to award TDIU- if you arent working-

[Berta]

sorry -I just noticed something-

you still can perform limited duty ?

This is possibly why the VA did not consider you yet for TDIU.

One thing about DMII- SC-

if VA can find that the heart disease was prior to the SC DMII , they can deny heart disease as secondary in vets who get the DMII diagnosis with heart disease too-

I mean- say vet has DMII with obvious heart disease mosst likely due to DMII.

The VA could find evidence showing the NSC heart disease predated the SC DMII and then fail to award as secondary.

The VA has done this and still tries to-

what bothers me the most is that DMII is the most underdiagnosed diseases in the US of A-per the ADA-

a vet could have DMII and one or two glucose blood tests at VA over a few months will not reveal whether the vet has high glucose

days before or after the test.

Even the HBIAC test has its limits.

So a vet could actually have diabetes for years and not even know it or have VA not diagnose it and then the vet sufferes from CAD BEFORE they diagnose the DMII-and then the VA can say this was NSC and predated the SC DMII and therefore isnt secondary.

A good IMO from a real doc who uses the ADA guidelines and knows all the literature that can define a specific type of heart disease as Exactly due to DMII-such as left ventricular hypertrophy-etc can help a vet get proper secondary as well as the proper EED on these claims.

[stillhere]

Thank you for the reply from reading other posts I am sure you are one of the best.

I am still working although I am not doing about half of what I used to. I am in sales now because of a hearing problem from Nam. But that is another story.

I would like to file a nod but if I got 100% I would still like to work for a few more years. I am strictly on comission so I hade dropped quite a bit in the past 3 years.

Should I try for the earlier award date for the heart disease? The VA told me to file for the rate increase for the recent surgery I was in the hospital 2 days and told no driving for a couple of days and then take it easy.

Thanks

Not a basis for CUE-

you still have other ways to go on this-

If you are not working and your SC disabilities are preventing you from working you should apply for TDIU- the 100% rate of VA comp-

2,200 a month?? I forget!-someone will correct

I will attach the TDIU form-

How did the VA consider you and then deny you for TDIU in the 70% decision?

That statement from VA in the 70% decision can shape what evidence they still need from you to award TDIU- if you arent working-

[john999]

Stillhere

I don't think you have anything to lose by applying for the EED. All the VA can do is deny it and you will never get it unless you ask for it. The only thing is that if the Heart disease proceded the diagnosis of DMII the VA might very well say you had it before the DMII and not connect it. The VA did this with my PN even though I had the high glucose levels before the actual diagnosis of DMII. I got sc'ed for the PN eventually. Keep trying and don't give up!

[john999]

Berta

I know the VA tried to deny my PN as being secondary to DMII saying it existed prior to the DMII. This is an old trick on their part. I bet many thousands of vets are denied for secondary conditions due to DMII by the VA saying they existed prior. They are acting in bad faith even when you have a doctor saying the secondary condition is caused by DMII and the VA denies it. You know it they do it to you they are doing it to thousands of others. Nothing personal, just business as usual. How can any say this system is not adversarial?

[stillhere]

John999,

My family doctor first diagnosed DB2 in 2001 I did not know about the presumed untill an legion newsletter in 2003 I applied for DB2 and heart disease as chest pains at that time and during the exam they came up with the PN. I had not even noticed that but I really do now.

Anyhow when I go back to my cardio doctor in May I am going to ask if he will write something for me an file for the EED of 2003 and see what they say. Unless my cardio doctor advises otherwise, I just have a hard time swallowing that this just came up in Oct. 05!!

By the way Berta last time I was in for surgery my cardio doc asked if I was still working!

Thanks,

Stillhere

I don't think you have anything to lose by applying for the EED. All the VA can do is deny it and you will never get it unless you ask for it. The only thing is that if the Heart disease proceded the diagnosis of DMII the VA might very well say you had it before the DMII and not connect it. The VA did this with my PN even though I had the high glucose levels before the actual diagnosis of DMII. I got sc'ed for the PN eventually. Keep trying and don't give up!

[Berta]

That would be good if the cardio doctor could write that up-

then you could even ask the VA to reconsider their last decision-

It doesnt stop the clock in the year the NOD is due- and you would have to watch out for that year date- but a Request For Reconsideration

at top of the page could show to VA in your own words and with the doc's statement to refer to- that the heart disease is directly due to the DMII that you were diagnosed with and that the heart disease was prevalent before the EED they gave you-

Again it is not the formal NOD- but a reconsideration request might get you a faster and better decision-

John is also making the point I am making- they WILL pull this-if they can -and they tried to pull it on him-regarding the PN.

Ridiculous.

I see vets with DMII already established and the VA gives them the date of the C & P exam as the EED for the DMII-

Absurd!

How can a vet catch diabetes from a doc at a C & P?

That sounds nuts but it is basically the same logic Va USES SOMETIMES.

We are trying to help you overcome these pitfalls by making sure the VA doesnt try to say your heart disease happened before the DMII occurred.

Then they might not want it to remain SC at all! if you catch my drift----

The doc would have to clearly state that the heart disease you have is result of your diabetes which he diagnosed in 2001.

[Berta]

One other thing I just thought of-

You applied for the heart disease in 2003. You continuously appealed any denials.

then they gave you the 2005 date after you had a heart attack---

60 %- SC -

Therefore what happened to the staggered ratings that got you to the 60% point?

In other words- one does not go from nada to 60% overnight.There must have been medical evidence to warrant staggered ratings back to 2003-

Anyone see what I mean?

If the VA ever removes their digits from their rectums on my Cue claim for SMC - this is the same problem they will face-and I want them to consider it all-

at death Rods heart disease was obviously 100% (fatal heart attack)

first misdiagnosed heart attack-1988 -right at the VAMC.

1992- major CVA due to the same problems that caused heart disease (misdiagnosed diabetes)

the VA will have to make a staggered rating for 2 years prior to his death for DMII as well as CAD.

They gave him 100% for the CVA and residuals under Sec 1151 but never paid for it or the other stuff-

Any I seeing this right?

surely at some point your heart condition was at ratable percentages-

because one does not have CAD that is 0 then is 60%-overhight-

By the way-do you have HBP too and is this in your claim?

was it in the original claim?

[Chuck75]

This is the exact issue I'm struggling with! It seems that the classic diabetes diagnosis levels used to determine that a patient has diabetes are high enough that there is a strong likely hood that various other problems such as cardiovascular can and do occur well before the formal diagnosis of diabetes.

The key seems to be "prediabetes", something that is only obvious after the fact, and (at least from current medical references) may exist for years. (Ten or more) It is during the "prediabetes" period that cardiovascular problems may occur. Further, a cardiovascular "friendly" diet will likely delay reaching the levels used to formally diagnose diabetes. A nexus for both (if you look at recently released "Ranch Hand" results) is guess what! Agent Orange exposure.

Even if The VA refuses to service connect Diabetes as causative to a secondary condition, you should be able to get them to SC on a "develop further", if you can show that the problems were stable until diabetes was diagnosed, and then became worse.

If the secondary condition reaches a schedular 100%, and diabetes contributed to the severity, then the secondary condition (By the VA's rules) be considered SC. This supposedly eliminates the % offset used when the condition is less than 100%.

"So a vet could actually have diabetes for years and not even know it or have VA not diagnose it and then the vet suffers from CAD BEFORE they diagnose the DMII-and then the VA can say this was NSC and predated the SC DMII and therefore isn't secondary.

A good IMO from a real doc who uses the ADA guidelines and knows all the literature that can define a specific type of heart disease as Exactly due to DMII-such as left ventricular hypertrophy-etc can help a vet get proper secondary as well as the proper EED on these claims."

Unfortunately, the highest rated doctor(s)(by my insurance company)are not interested in writing an IMO that meets the VA's requirements. Naturally, when I first started going to them, it was "no problem" to write the IMO. (Until I showed them what a real IMO was - today!) This wasted quite a bit of my time and money.

Edited April 11, 2007 by Chuck75 (see edit history)

[stillhere]

Berta,

Glad you picked up on that and is my point exactly. They denied 3 times heart disease and any rating for heart disease until I had my heart attack! Then they gave me 100% for 3 months and 60% since after my first operation. Now that I have had another operation I assume they will make it another 100% and then back to 60% after recovery so to speak. I just don't see how they could deny, deny, deny and then bam!

Oh and by the way I am rated 0 but sc for Hpertension GO figure!

One other thing I just thought of-

You applied for the heart disease in 2003. You continuously appealed any denials.

then they gave you the 2005 date after you had a heart attack---

60 %- SC -

Therefore what happened to the staggered ratings that got you to the 60% point?

In other words- one does not go from nada to 60% overnight.There must have been medical evidence to warrant staggered ratings back to 2003-

Anyone see what I mean?

If the VA ever removes their digits from their rectums on my Cue claim for SMC - this is the same problem they will face-and I want them to consider it all-

at death Rods heart disease was obviously 100% (fatal heart attack)

first misdiagnosed heart attack-1988 -right at the VAMC.

1992- major CVA due to the same problems that caused heart disease (misdiagnosed diabetes)

the VA will have to make a staggered rating for 2 years prior to his death for DMII as well as CAD.

They gave him 100% for the CVA and residuals under Sec 1151 but never paid for it or the other stuff-

Any I seeing this right?

surely at some point your heart condition was at ratable percentages-

because one does not have CAD that is 0 then is 60%-overhight-

By the way-do you have HBP too and is this in your claim?

was it in the original claim?

Edited April 11, 2007 by stillhere (see edit history)

[Berta]

Chuck in 1997 the ADA lowered the diabetes glucose criteria-

the VA "expert" opined on my claim and said that my husband didnt fit into the ADA criteria prior to that time-and could not even tell what military time was on the med recs for glucose readings.

Dr. Bash said she was "medically inaccurate"

She did not even consider after Rod had a CAD and many strokes- that he had abnormal high glucose while on a feeding tube-for 3 weeks-

and also had exhibited many signs of diabetes as far back to 1988- all documented in VA med recs.The VA abnormal high glucose criteria at that time was anything over 105-that would trigger VA to test further.

By the time a VA doctor (former VA doc who gave me a freeby brief supporting IMO)

wanted to diagnose him properly- so much damage had been done in the years of misdiagnosis that I guess they figured he would die anyway-

and proper care would have been quite an expense for VA at that point.

That doctor was overruled by the other VA docs-when he ordered the fingerstick test.

Best to cover it up- the vet and the wife will never know.

But it ended up costing them plenty under FTCA.I found out what they did.

The coroner was astonished when he asked me twice- if Rod was a diabetic -because I said no-

now I know why- Rod had considerable atherosclerotic heart disease and numerous strokes-proven via autopsy -with no possible etiology at all but for diabetes mellitus- never diagnosed or treated by the VA.

What might look like a normal glucose level on blood work you got done after sitting around at a VAMC for hours waiting to see the doc and having no food since breakfast might not indicate anywhere near how high that glucose could raise hours later after you have eaten a meal and then be fully within a diabetic criteria.

[stillhere]

Wow that is scarey!!

Chuck in 1997 the ADA lowered the diabetes glucose criteria-

the VA "expert" opined on my claim and said that my husband didnt fit into the ADA criteria prior to that time-and could not even tell what military time was on the med recs for glucose readings.

Dr. Bash said she was "medically inaccurate"

She did not even consider after Rod had a CAD and many strokes- that he had abnormal high glucose while on a feeding tube-for 3 weeks-

and also had exhibited many signs of diabetes as far back to 1988- all documented in VA med recs.The VA abnormal high glucose criteria at that time was anything over 105-that would trigger VA to test further.

By the time a VA doctor (former VA doc who gave me a freeby brief supporting IMO)

wanted to diagnose him properly- so much damage had been done in the years of misdiagnosis that I guess they figured he would die anyway-

and proper care would have been quite an expense for VA at that point.

That doctor was overruled by the other VA docs-when he ordered the fingerstick test.

Best to cover it up- the vet and the wife will never know.

But it ended up costing them plenty under FTCA.I found out what they did.

The coroner was astonished when he asked me twice- if Rod was a diabetic -because I said no-

now I know why- Rod had considerable atherosclerotic heart disease and numerous strokes-proven via autopsy -with no possible etiology at all but for diabetes mellitus- never diagnosed or treated by the VA.

What might look like a normal glucose level on blood work you got done after sitting around at a VAMC for hours waiting to see the doc and having no food since breakfast might not indicate anywhere near how high that glucose could raise hours later after you have eaten a meal and then be fully within a diabetic criteria.

[Berta]

What is even scarier is that according to the ADA (American Diabetes Association:

"Diabetes is a silent disease. You could have it for years and never know it. During this time, your eyes, nerves, and kidneys may have been harmed by too much sugar in your blood"

AND

"American Diabetes Association Home Page. Skip to Navigation ... Help find the 6.2 million Americans with undiagnosed diabetes. Conduct an email campaign to ...

www.diabetes.org/communityprograms"

6.2 million Americans with undiagnosed diabetes.

That is not an excuse for VA or any health care outfit to fail to diagnose diabetes when the patients medical tests and records reveal that they have it. That goes for anyone -not just VA vets-

I did not mention that-

not only were Rods VA glucose values too high- he had been in fasting state for 3 weeks when these values were taken and hospitalized-(paralysed throat and right side paralsis of body,) and the VA "expert doctor" -using only 3 blood records- did not even know he already had one CAD heart attack, 4-5 prior strokes, a major CVA, a full autopsy,and that these records were while in a fasting state-and that the Veterans Administration had already admitted to caused all of those disabilities as well as his wrongful death.

Think about that -that's scary-

This is an endocrinologist for the VA who opined on my AO death claim.

This doctor -based on the 'C & P' opinion she gave of the deceased veteran-10 years after his death - would have killed him too if she had treated him when he was alive-

if she had only used the same 3 blood chem records.

In my opinion C & P doctors are often misdiagnosing veterans with poor C & P exams -for VA claims purposes-in a way that is no different than an actual misdiagnosis.

[Guest terrysturgis]

stillhere, I am also denied SC for Hypertension as secondary to DMII. My HTN was diagnosed before my DMII. I received a copy of my C-file and discovered this statement in the Reasons and Bases section of a denial decision.

"The VA examiner in the exam of March 27, 2006, stated that since there is no diabetic neuropathy from your diabetes, the hypertension is not aggravated by or related to the diabetes. That finding is most consistent with general VA policy that hypertension is not related to diabetes unless there is diabetic neuropathy. Therefore, based on that opinion, service connection for hypertension is not established."

I have been diagnosed with PN, 40% bilaterial lower body and 20% bilaterial upper body. I am going to file a claim using there statement of gereral VA policy because even though I am 100% P&T if I die from a heart problem my wife's DIC claim should be easier. Because you have a diagnosus of PN, according to the statement above your HTN should be service connected. The 10% will not get you to the 100% level but it might get you to 70%. Take care. Terry Sturgis

[Guest terrysturgis]

stillhere, I am also denied SC for Hypertension as secondary to DMII. My HTN was diagnosed before my DMII. I received a copy of my C-file and discovered this statement in the Reasons and Bases section of a denial decision.

"The VA examiner in the exam of March 27, 2006, stated that since there is no diabetic neuropathy from your diabetes, the hypertension is not aggravated by or related to the diabetes. That finding is most consistent with general VA policy that hypertension is not related to diabetes unless there is diabetic neuropathy. Therefore, based on that opinion, service connection for hypertension is not established."

I have been diagnosed with PN, 40% bilaterial lower body and 20% bilaterial upper body. I am going to file a claim using there statement of gereral VA policy because even though I am 100% P&T if I die from a heart problem my wife's DIC claim should be easier. Because you have a diagnosus of PN, according to the statement above your HTN should be service connected. The 10% will not get you to the 100% level but it might get you to 70%. Take care. Terry Sturgis

[Berta]

Terry-that 'medical statement' is absurd.

Diabetes can cause hyperlipidemia which causes atherosclerosis which causes HBP. As well as PN.

If a vet has peripheral Neuropathy that is from DMII how can the VA possibly disassociate the Peripheral neuropathy from diabetic neutopathy if the vet has diabetes diagnosed too?

I have posted the link to the VA's own Diabetes Trianing Letter here many times-

I have supported local claims with the whole thing-

it clearly states:

"Complications are often divided into several categories.

Microvascular complications (small blood vessel damage)

• retinopathy - eye

• neuropathy - nerves

• nephropathy - kidney

Macrovascular Complications (large blood vessel damage)

• heart problems

• hypertension

• peripheral vascular disease

• stroke

Other Complications

• infections

• impotence

• pregnancy complications

• foot problems

• skin problems"

Neuropathy is a nerveous system issue.

HBP is a cardiac issue.

How can the VA make that absurd statement? Easy-

they can fail to see what cardiac involvement or problems the veteran might have due to diabetes.

Then they can say the HBP is due to anything else and get away with it.

Been there- done that.

Their medical "rationale" here is absurd.

[jbasser]

CAD is commonly associated with Hypertension. Hypertension does damage to the blood vessels and causes enlarged heard or cardiomegaly, or cardiac myopathy. Heart disease in my case was diagnosed secondary to hypertension after 15 years of hypertension denials. ( Cue was filed last November)

The VA may point this out as it may give them reason to deny DMII.

A Good IMO to counter act in advance may be needed to put all the pieces in place.

John

Edited April 12, 2007 by jbasser (see edit history)

[Guest terrysturgis]

Berta, I agree that it is absurd. That is why I posted the actual statement from the decision as we all know some of the best evidence we can get to help our claims comes right from the decisions themselves. I will simply copy the statement and enclose the diagnosis of PN and hopefully their own statement will make it so I can get SC for HTN. Also I appreciate the information you provided on the board that helped me get to 100% P&T. (DMII Training letter for example). Thanks! Terry Sturgis

[stillhere]

Berta,

Your statement below is very interesting I went back and checked in one of my denied SOC the Va refers that "However the evidence shows a diagnosis of hyperlipidemia only" as ther is no evidence of a current heart condition secondary to DB2, service connection is denied.

This from a SOC in 2004 again explaining why they were dening a heart condition at that time. I tried again in August of 05 and was asked for any new evidence in Sept. 05 which I had none so I did not answer them but when I had my heart attack in Oct. 05 I had new evidence, so I sent that. They made a decision on my calim again dening and only after I appealed and sent the records of the hospital surgery and a letter from my cardio doc did they finally grant heart disease "mycardial fraction" BUT only back to the date of my attack not back to the date I orginally filed this claim of August 05 but I still feel my EED should be back further. Please let me know how you all thing I should proceed with this.

Also one other thing if I had died my wife would not have had the knowledge on how to claim for my death like you are doing for Rod I wish you all the best in yours!

Terry-that 'medical statement' is absurd.

Diabetes can cause hyperlipidemia which causes atherosclerosis which causes HBP. As well as PN.

If a vet has peripheral Neuropathy that is from DMII how can the VA possibly disassociate the Peripheral neuropathy from diabetic neutopathy if the vet has diabetes diagnosed too?

I have posted the link to the VA's own Diabetes Trianing Letter here many times-

I have supported local claims with the whole thing-

it clearly states:

"Complications are often divided into several categories.

Microvascular complications (small blood vessel damage)

• retinopathy - eye

• neuropathy - nerves

• nephropathy - kidney

Macrovascular Complications (large blood vessel damage)

• heart problems

• hypertension

• peripheral vascular disease

• stroke

Other Complications

• infections

• impotence

• pregnancy complications

• foot problems

• skin problems"

Neuropathy is a nerveous system issue.

HBP is a cardiac issue.

How can the VA make that absurd statement? Easy-

they can fail to see what cardiac involvement or problems the veteran might have due to diabetes.

Then they can say the HBP is due to anything else and get away with it.

Been there- done that.

Their medical "rationale" here is absurd.

[Berta]

I think- by showing the SOC to your doctor- and explaining to him briefly- (I also suggest giving him a written statement too)

he could prepare an additional expanding opinion that supports that your EED should be earier then VA says it is.

The hyperlipedimia is a symptom and VA wont SC that condition-

but this symptom of one of many that involve diabetes.

The VA is saying that they are only aware of the heart attack itself and don't have medical evidence of your heart disease prior to that-and also since you initially filed the claim-

they need medical evidence to show that

prior to the heart attack- you had ratable heart disease.

This could be angina med prescriptions, ECHO report, EKGs etc-etc-- anything that shows that the heart disease

did not occur on the day of the heart attack but is medically documented prior to that date.

Edited April 13, 2007 by Berta (see edit history)