hypertension Nod Denied

[noelmc]

My husband I have been reading this board since Oct 7th (we joined Nov 06). And have learned so much information. We have followed the ideas and advice from here with some success and am grateful for all the wonderful people that dedicate so much of their time and energy to help other vets. Thank you.

My husband is a Vietnam Vet and when we were at friends funeral (he was a Vietnam Vetage 59) his widow informed us of the Va's benefits and encouraged us to file. Most importantly she brought us to Hadit.

My husband filed Oct 13th. We were notified on Feb.21 by his SO that he was awarded 60%.

20% Diabetes

20% neuropathy legs bil (10 for each)

20% neuropathy hands bil (10 for each)

10% tinnitus

special k award.

Was denied for heart, hypertension.

We requested a reconsideration because they did not look at his Insulin usage or regulation of activities.

We received a letter giving us the option of an appeal or a DRO.

March 29th we opted for the DRO.

April 17th we received a denial for his heart and htn but they did up his DM11 to 40%.

We are very grateful for this and can't believe how fast it has happened. We do believe this was because of the information you have on this board.

We are surprised and disappointed regarding the denial for the heart and htn. We are unsure of how to proceed to connect the heart and htn. We thought we had given them enough information to connect to the DM. The so has been helpful but we have provided him with a ton information gleaned from this board.

My husband could no longer do the work his job required so he was forced to retire early (5 years ago).

Our question is where do we go from here?

Thanks again for everything you do for so many.

[Berta]

Noel

I will try to answer your question here in claims forum.

I dont use the PM and email thing.

Edited April 26, 2007 by Berta

[Berta]

PS-you had asked if there was a VA training letter in cardiovascular disease-

there is but I have not found it yet at the VA web site-

However the Diabetes Mellitus training letter supports that heart disease, PN,HBP etc can stem from diabetes.

As long as VA doesn't connect the dots they save money especially on claims like this--

it might take the investment that I see an IMO as really being- an investment into your claim-- to state clearly that the SC DMII has caused the other problems.

Gee stillhere- your IMO and cardio stuff reads just like my husbands ECHO and whole medical picture-he did die of sudden death- a syndrome well know to be associated with untreated diabetes.

You get DMII meds and treatment of course -so dont worry- I feel that your doctor was just making sure with this strong medical statement (it is excellent) that the VA gets his point.

[Chuck75]

Since the relationship between Diabetes II and heard disease is a personal issue with me--

What I found so far--

The two are connected.

Diabetes may or may not have symptoms before heart disease starts or becomes obvious. A key to this is info on the ADA web site (American Diabetes Association) Ti seems that there is a condition called "prediabetes" by the medical profession, and serious cardiovascular damage can occur during this phase of diabetes. Unfortunately, as the name implies, prediabetes occurs before the blood glucose levels reach levels used to confirm a diagnosis of diabetes. The ADA shows ~105-130+ as blood glucose levels associated with "prediabetes". This is well below the level currently used to diagnose diabetes. This level is relevent only when diabetes is diagnosed, since it's possible for a person to never reach the levels used to diagnose diabetes.

The VA may try to take the position that Diabetes does not exist until diagnosed by having the glucose level exceed a specific level. This is actually an after the fact diagnosis. It seems that diabetes may exist for years without reaching the diagnostic level.

What I am trying to do --

Find evidence of glucose levels above normal, specifically in the "prediabetes" range, to show that these levels existed when heart disease was found. This is difficult, due to the non availability of old medical records, and the fact that blood glucose was seldom tested for in my case.

Option two is to have my doctors state that they beleive that Diabetes caused my heart problems to become more severe. Virtually all of the doctors I've talked to, including the VA doctors, consider this a given.

Mild (untreated, undiagnosed) Hypertension may exist for years before it becomes an obvious problem. For instance, I was told that I had higher than normal blood pressure during an employment medical for my first job after active duty. The level was such that it was not considered a problem at the time.

PS-you had asked if there was a VA training letter in cardiovascular disease-

there is but I have not found it yet at the VA web site-

However the Diabetes Mellitus training letter supports that heart disease, PN,HBP etc can stem from diabetes.

As long as VA doesn't connect the dots they save money especially on claims like this--

it might take the investment that I see an IMO as really being- an investment into your claim-- to state clearly that the SC DMII has caused the other problems.

Gee stillhere- your IMO and cardio stuff reads just like my husbands ECHO and whole medical picture-he did die of sudden death- a syndrome well know to be associated with untreated diabetes.

You get DMII meds and treatment of course -so dont worry- I feel that your doctor was just making sure with this strong medical statement (it is excellent) that the VA gets his point.

[stillhere]

Berta, Sorry to hear your husband passed from the heart disease! You made me go back and look at my award letter. Noel I hope you don't mind me adding a little bit about mine in your post topic but this may help you too.

No where in my decision do they address the heart disease or what caused it they say in answer to my NOD: "Service connection for Inferior wall myocardial infraction,status post stent placement has been established as related to the service-connected disability diabetes mellitus type 2with hypertension."

But nothing about what caused it??

Stillhere

PS-you had asked if there was a VA training letter in cardiovascular disease-

there is but I have not found it yet at the VA web site-

However the Diabetes Mellitus training letter supports that heart disease, PN,HBP etc can stem from diabetes.

As long as VA doesn't connect the dots they save money especially on claims like this--

it might take the investment that I see an IMO as really being- an investment into your claim-- to state clearly that the SC DMII has caused the other problems.

Gee stillhere- your IMO and cardio stuff reads just like my husbands ECHO and whole medical picture-he did die of sudden death- a syndrome well know to be associated with untreated diabetes.

You get DMII meds and treatment of course -so dont worry- I feel that your doctor was just making sure with this strong medical statement (it is excellent) that the VA gets his point.

[noelmc]

I was able to locate the heart traing letter. Hopefully it is attached.

heart_training_lettert.doc

[Berta]

Noel great work- I haven't read this yet but you have helped many by finding this!

Stillhere- the raters cannot determine what actually caused your heart disease- aside from stating it is due to the DMII.I mean they dont have the medical background to put all that in a decision.

It could be from atherosceloritic involvement that causes the arteries to plug up with plaque- etc-

sometimes called occlusion-best to ask the doctor you have---

this might give more info:

http://www.technion.ac.il/~eilamp/mi.html

Did they rate the heart disease separately from the DMII or lump it all together?

Do you have a copy of the Blue Rating sheet?

I have a CUE filed due to the VA's lack of even rating Rod's heart disease as NSC or as if SC under 1151 and now they will need to rate it-when I succeed on the DMII claim-as direct SC.

Although the VA-when I sued -stated his heart disease was ignored, not properly treated and malpracticed on through those medical errors.