Heart Conditions Denied

Discussion in 'Diabetes' started by donewsome, May 7, 2007.

  1. donewsome

    donewsome New Member

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    Hello,

    I am new, so I will throw this out there and hope it is in the correct place.

    Background:

    I am a 61 y/o vietnam vet. I served 2 tours in nam during my 1st and 2nd enlisted term.

    I filed for the following conditions / problems on one inital claim:

    Diabetes Mellitus Type II
    Diabetic Retinopathy
    Neuropathy
    Impotence
    Depression
    Skin Conditions
    Peripheral Vascular Disease
    Myocardial Infarction with Chronic Cogestive Heart Failure
    Coronary Artery Disease
    Cardiomyopathy
    Coronary Bypass Surgery
    Ventricular Tachycardia
    All Secondary To Diabetes Mellitus Type II

    After originally being denied due to them not having the records from my local VA facility, I was given approval on some of the claim:

    Diabetes Mellitus Type II 20%
    Severe Retinopathy 20%
    Neuropathy left lower extrimity 10%
    Neuropathy right lower extrimity 10%
    Impotence % (Entitlement to Special Mothly Comp due to loos of use of a creative organ)

    For a total combined rating of 50% service connection.

    The claim for the following was denied

    Myocardial Infarction with Chronic Cogestive Heart Failure
    Coronary Artery Disease
    Cardiomyopathy
    Coronary Bypass Surgery
    Ventricular Tachycardia

    The reasons given are "Upon VA examination, your heart condition was not found to be caused by your diabetes. Your VAMC Durham treatment records do not show evidence of a causal relationship between your diabetes and heart conditions".

    I must note during the C& P exam the examining doctor asked if I happened to have my latest echo, stress test, and other relevent test results from my private cardiaologist with me. I stated no, that I was not informed I needed to bring any medical records to this exam. He stated that he coldnt make a conclusinve decision based on the limited information he had. He DID NOT do any test, nor did he order any test at all.

    Skin Conditions
    My skin has been medicated and healed as of the tiem I received the c&P exam. Thankfully it has stayed healed since the last treatment, so I dropped this claim.

    Depression
    Peripheral Vascular Disease

    These were denied as they are contributed from the heart, and the heart condistions had been denied.

    I was told be a vso that getting the depression in was a 99% no go and I shouldnt refile for it in my NOD, so I did not. I did refile for the Vascular Disease.

    I did file an NOD for the above items. I included a leter from my cardiologist that stated "There is of course, a well-known association between insulil-dependent diabetes and coronary artery disease, so one can safely conclude that Mr. XXXXXXX's diabetes was a major contributor to his develpoement of his severe coronary artery disease and ischemic cardiomyopathy"

    Do you think this is enough?
    Should I try to scrape together enough money to find another doctor that will give me anotehr letter of opinon?


    I originally began being treated in the late 80's for diabetes via oral medication, with average blood sugars around 340. In early 96 I had a heart attack, bypass, and other misc procedures. I only have a few blood test results fromt he late 80's as proof of my high blood sugars, my docotor at that time has since retired and records destroyed.

    Should I include these blood test results in the information I send the Va?

    My apolagies for a long post, jsut wanted to stuff all the relevant information I could in here. Thanks in advance for any advice.
  2. TinCanMan

    TinCanMan Active Member

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    You're asking a lot of questions, I'll get back to you in the morning.
  3. TinCanMan

    TinCanMan Active Member

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    For what it's worth, Every successful claim has three elements:

    1. Appropriate military service
    2. A diagnosis of a compensable disease or condition
    3. A nexus or connection between 1 & 2

    PTSD claims also require a "stressor" letter

    1. is usually satisfied by your DD-214 or your Service records
    2. is usually provided by a medical professional licensed to provide a diagnosis
    3. is also usually provided by a medical professional that has examined your Service Records and can make the connection based on the evidence in your records.

    The stressor letter must describe the situation that you think caused your PTSD and it must be verifiable.
    Note that the physician must make that nexus based on the evidence of record. Your testimony into events is irrelevant and will be discounted.

    Re: "skin conditions" Skin conditions isn't a diagnosis. You'd need something better than this unless you want the C&P examiner to provide that diagnosis. To my knowledge the only skin conditions presumptive of exposure to AO are Chloracne and possibly Porphyria Cutanea Tarda. Chloracne would have had to manifest within mos of exposure and disappears not long afterward. In any event, you'd need a diagnosis of some specific condition and a link to your service. How do you figure your skin conditions are associated with your military service?

    Re: Depression and Heart/Vascular issues. Both of these have been known to be granted secondary to DMII but it all depends on what the circumstances are and what your doctors say. It's fairly well known that CAD can result from long term high glucose levels in diabetics that aren't watching their blood sugars. The VA will usually grant in this situation provided your doctor is willing to say "it is at least as likely as not that your CAD is caused by your DMII". The phrase "at least as likely as not" is very important because it has been taken by the courts to mean a 50/50 chance. That means the VA has to apply the "benefit of doubt" rule in your favor. The same applies for depression. If you have a diagnosis and the doctor makes the proper nexus with a medically sound rationale, the VA will usually grant. The opinions of their C&P examiners generally have greater weight than private practitioners because they always have access to your Military Medical and Personnel records while your private practitioners usually don't. In addition to the magic phrase, your doctors should also state they have reviewed those records when expressing their opinion.

    Re: Coronary Bypass Surgery. I'm not a doctor but I don't think this is a compensable condition. ISTM Coronary Bypass Surgery is a medical procedure and you might be rated based on the residuals of it.

    I don't think you need another opinion but I do think you need a better one as "There is of course, a well-known association between insulil-dependent diabetes and coronary artery disease, so one can safely conclude that Mr. XXXXXXX's diabetes was a major contributor to his develpoement of his severe coronary artery disease and ischemic cardiomyopathy" doesn't rise to the level of at least 50% assurance. It's a bit wishy-washy which is exactly what he intended.
  4. donewsome

    donewsome New Member

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    Thank you for your response.

    #1 & #2 are covered.

    Its the Nexus or Connection that I have trouble with.

    That letter is the best I could get the doctor to give me after 2 requests.

    I have contacted several doctors and / or medical opinion companies, to get a more definative statement, but this option appears to be too costly for me.

    Does it matter that the C&P doctor ordered no exams, test, or records for my Heart Diseases?

    My current thought is to send the DRO a copy of 3 test reults from 1989.90. & 91 showing I had diabetes as early as that. I also have a Medical record showing my First ever Heart dysfunction to be in 1996 and that I had no prior Heart dysfunction before that.

    Other than that, I am lost as to what I can do to prove my claim or get someone to give a written opinion better that what I have already.

    Again thanks for your time!
  5. TinCanMan

    TinCanMan Active Member

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    Yeah, those are usually the easy ones. Otherwise, most folks wouldn't even file the claim.

    Yup

    While science shows DMII can cause CAD, it doesn't hold that yours was caused by DMII. I suspect that's what your doctor is trying to tell you. Many folks flood the VA with all kinds of papers from the internet showing a nexus and they don't understand when their claim fails because they fail to understand it isn't a matter of what is possible but is a matter of what is for them.

    Probably not as those results would only support a diagnosis which you already have.

    I doubt it will hurt, but it won't provide the nexus. What does your SO have to say about this?

    Other than that, I am lost as to what I can do to prove my claim or get someone to give a written opinion better that what I have already.

    Again thanks for your time![/quote]

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