Establishing a diagnostic date for atherosclerosis

Discussion in 'General Medical' started by Tom130, Nov 13, 2008.

  1. Tom130

    Tom130 New Member

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    I have been awarded 20% SC disability for DMII caused by Agent Orange. The effective date of diagnosis for that was set to May 2007. That date was from the last dated statment by a doctor who explicitly diagnosed me as having DMII.
    In the documentation I provided, I tried to make it clear that other doctors had diagnosed my DMII as starting much earlier. The reason for doing that was to show that a complication of diabetes, atherosclerosis, had started after the onset of diabetes. In my origional claim application I had requested and was denied that atherosclerosis be considered a complication of diabetes. At present, I have filed a letter requesting the VA to reconsider the 5/2007 date. I provided additional evidence showing that Oct 2002 should be the date of diagnosis.
    It is most important to me to show the VA that my atherosclerosis is a complication of diabetes. Through a process of elimination and exhaustive testing, all other known causes for it have been ruled out leaving only diabetes as a constant factor. I have received coronary and peripheral artery stents, one at a time, about every 5 months since 2003. The cost of this has been staggering and I now have had to postpone getting stents in 3 different locations.
    During all this time, I do not have any documentation stating a diagnosis that I have atherosclerosis. There maybe others reasons why my arteries get blocked but as I said earlier, it would be difficult to find one. With my history it might be obvious that I have had atherosclerosis for a long time, but if so, then the same standard of proof should be applied to the onset date of DMII.
    My question is this:
    . If I got a doctor statement stating that my last stent I got on Sep 11, 2008 was caused by atherosclerosis, and diagnosed on that date, as a complication of diabetes, would that set a diagnosis date for a VA claim?
  2. TinCanMan

    TinCanMan Active Member

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    In order to be successful in a claim for atherosclerosis secondary to DMII you need a diagnosis by a doctor and he will have to opine it is secondary to DMII and provide a rationale for his opinion. The effective date of that issue will be the effective date of the claim. When you were diagnosed is irrelevant.
  3. Tom130

    Tom130 New Member

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    Thanks, TCM. At the moment, I have 2 cardiologist, one private and one at the VAMC. I am sure that both would be willing to sign a statement saying that my atherosclerosis is secondary to DMII.
    Question: Is there any degree or level of atherosclerosis that needs to be described or is just a simple statement?
  4. TinCanMan

    TinCanMan Active Member

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    They need to provide a medically sound rationale as well. Careful there, that word is rationale, not rational. There's a substantial differance.

    I'm not sure how it would be evaluated, have to look it up. OK what kind of arteriosclerosis is this? Are we talking hypertensive arteriosclerotic cardiovascular disease, cerebal arteriosclerosis, renal arteriosclerosis, coronary arteriosclerosis, what?
  5. Tom130

    Tom130 New Member

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    The stent I got on 9/12 was from cardiovascular disease (CAD). The cardiologist said that it was a complication of DMII. I also have a blocked left vertebral artery which falls in the cerebal arteriosclerosis catagory; it looks like this one is inoperable so I'll have to live with the symptoms. Those 2 are handled privately. The VA is looking at my right iliac and left femoral arteries, PAD. The iliac can be fixed with a stent but the femoral might have to be bypassed. All of these are complications of DMII and I have no doubt that the doctors involved will sign a statement to that effect.
    Could you advise me as to specifically how that statement should be worded?
  6. CEDAR FALLS

    CEDAR FALLS Member

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    Funny I had a doctor opine for atherosclerosis secondary to DMII so the va RO stated DMII was to include atherosclerosis so no seperate rating

    Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913.
  7. TinCanMan

    TinCanMan Active Member

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    CAD and PAD can be considered secondary to DMII but I don't know about cerebal arteriosclerosis.

    Your doctor should state your CAD or PAD is 'at least as likely as not' or 'more likely than not' the result of your DMII. He will have to provide a rationale explaining why he believes this to be. His rationale must be scientifically sound.
  8. TinCanMan

    TinCanMan Active Member

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    This would appear to be completely wrong and contrary to CFR as you point out. If it has been less than a year since the decision, file a NOD and ask for a DRO review. If its been over a year, ask to reopen the claim based on Clear and Unmistakable Error (C&UE) the VA failed to follow regulations. Then point out the regulation they failed to follow.

    Be careful here. I'm basing my opinion on what you say. I'd like to see exactly what the RO said in their decision.
  9. CEDAR FALLS

    CEDAR FALLS Member

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    TinCanMan
    I will scan my info and post it for ya to look at
  10. TinCanMan

    TinCanMan Active Member

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    Make sure you delete any personal data
  11. jaxter

    jaxter New Member

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    I think a good suggestion is given by Tincanman. Doctor's opinion and advices will be beneficial for you. I don't have any idea about this matter. I also appreciate Tom130 for his post.
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    Lifealert

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