Benefits

Question:

Does the BVA decision (dated 09/30/16, Archive Date 10/13/16, Citation Nr :1639405, Docket No. 10-43 947) have any affect on your thoughts as to whether Aortic Valve Stenosis qualifies within the generally accepted medical definition of Ischemic Heart Disease?

Jim's Reply:

The decision you mention can be found at Citation # 1639405.
 

I disagree with the conclusion that valvular disease falls within the generally accepted definition of ischemic heart disease (IHD). For the purposes of VA ratings the pure definition of IHD was published in The Federal Register in 2010 and says, "...VA interprets IHD, as referred to in the regulation, as encompassing any atherosclerotic heart disease resulting in clinically significant ischemia or requiring coronary revascularization."
 

In other words, IHD is an occlusive coronary artery disease and nothing else. The pages that VA provides for definitions also confirm coronary artery disease is IHD.
 

I have to back up just a moment and let you know that I am (among my other health care provider credentials) a cardiovascular technologist and I spent years working and leading cardiac cath labs, cardiac surgery centers and so on. The language used here is second nature to me and I can't think of any instance where anyone would refer to a calcific aortic valve as 'ischemic'. This may sound odd but the aortic valve is ischemic by its very nature. While it is bathed in fresh blood as the heart pumps, it doesn't have any large arterial blood supply like a coronary artery. Aortic valves are replaced for 3 reasons, the valve may become calcific and hard and not function well or it may be discovered that the valve has only 2 leaflets rather than 3 and with age that causes problems. There are also occasions where the valve may become infected with bacteria and require removal and replacement.
 

The case you refer to, Citation # 1639405, sort of says that but is about as muddled a decision as I've read lately. The author clearly isn't comfortable with medical terminology and the result is a mish-mash of terms that are used in the wrong way but reach the correct conclusion.
 

The veteran patient is said to have had IHD that was presumptive to agent orange. However it's noted that he had "non-obstructive coronary artery disease" and that isn't operated on. That's an odd comment to find but most of this report is off by a bit.
 

A bypass would only be done on obstructive coronary disease. The record says, "...a VA orthopedist stated that the Veteran's non-obstructive coronary artery disease..." and having an orthopedic (bone) doctor opining on a heart condition is typical VA and wouldn't be acceptable anywhere else.
 

I could go on but in the end I think that they arrived at the conclusion that the aortic valve disease was aggravated by the service connected IHD and thus is a secondary service connected condition to the IHD. While I believe that's a bit of a stretch, it's legit in the end.
 

I believe that if the veteran patient had presented with only the aortic stenosis (many AS cases do not involve the coronary arteries) he would have been denied presumptive service connection.
 

In any case BVA appeals do not establish precedent so thankfully, none of this terribly confused appeal decision will be used in another case.
 

Thanks for the interesting question!

Question:

So unfortunately I'm getting med boarded because I have an ICD defibrillator. I want to know a rough estimate as to what to expect. I'm sort of stressed because I don't know if the army will cover my surgery every 10 years to get the battery replaced.

Jim's Reply:

Have you been affected by the Corona virus? I ask because I've communicated with a small handful of active duty who are being med boarded because of heart problems and long Covid.
 

My experience so far leads me to think that DoD hasn't quite figured out what to do with young troops who are so sick. Because of the relative youth and good health and fitness of an active duty service member, DoD doesn't have to deal with a lot of heart disease. Some who I've communicated with are being isolated because nobody understands what to do with someone who has a pacemaker or ICD implant.
 

In any case you'll have to endure the lengthy med board process. Once you're out you'll be rated at 100% disabled by the VA and you'll begin receiving those benefits pretty soon. Once you have your DD 214 in hand DoD won't be of any help and the VA will be where you'll turn.
 

The finances will get complicated soon after depending on the nature and length of your service, any comorbidities like diabetes or musculoskeletal problems, whether you have dependents and so on. All of your aches and pains should be diagnosed and rated as you exit.
 

Your future health care will be provided by VA or Tricare...post-military health care is changing very quickly these days and it's hard to predict just how your care will be delivered down the road but your needs (ICD battery changes) will all be covered. You'll be rated as a service connected 100% disabled veteran and that will bring you a monthly check and other benefits for you and your dependents.
 

What you face isn't pleasant but the VA health benefits will make life a lot more tolerable for you. Good luck!

Question:

I filed a preauthorization request for adjunctive dental care and dental anesthesia and hospital services for my son through CHAMPVA. I received a denial letter, but it only addresses the adjunctive dental care. I called CHAMPVA and was told to go through the higher level review. I shouldn't have to go through this process because they didn't do their job thoroughly. Do you know who I should contact or write a letter to instead? I don't have 6 months just for a review for preauthorization then have to wait for the claims process. If it was my fault, fine. But it was not.

Jim's Reply:

I understand and I sympathize with your frustration. However, this is CHAMPVA and as I advise everyone, expect less and CHAMPVA will deliver every time.
 

You should take a deep breath and do as they asked you to do. The higher level review will be quicker than writing letters to bureaucrats who will only muddle up the issue even further. Dealing with CHAMPVA requires patience...a lot of patience. 
 

I will congratulate you in that you seem to have a good understanding of how the system should work and you're doing the right thing by lining up preapprovals so that you don't catch a surprise bill down the road.
 

The VA in all it's glory is the most repetitive and time consuming of all the federal agencies. Nothing is ever done right the first time and going back to the drawing board is SOP at VA...not only at CHAMPVA but the entire organization. VA wastes enormous amounts of taxpayers dollars this way. 
 

However...the reality is that there is nothing you or I will say to anyone that will change the way they operate. You want a dental plan for your son and the only way you'll get that is to do an effective, timely appeal.
 

Writing critiques to VA managers is much like arguing with a stop sign. I believe in a saying we use at VAWatchdog: Dealing with VA..."It's a little like wrestling a gorilla. You don't quit when you're tired. You quit when the gorilla is tired."
 

Start the appeal and good luck.

Question:

I'm 90% with permanent TDIU. I have not been offered life insurance. I've done a little research but I cannot find the life insurance I'm entitled to enroll in. Could you assist me please?

Jim's Reply:

We are generally offered life insurance when we are awarded a 100% P & T rating. You'll need to review the paperwork that came with your award. You can learn more here https://www.va.gov/life-insurance/options-eligibility/vgli/ 

Question:

My husband is a 100% disabled veteran that has PTSD and multiple personalities. He is leaving us with nothing. I am disabled and unable to work and we have two kids to take care of. The only money is his disability. I am his fiduciary and don't want to mismanage his money by paying for our house and utilities. What can I do?

Jim's Reply:

If you want to actually settle this as it should be, the family court is the only real answer for you. Unless and until you get all this in front of a magistrate there is nothing anyone can do to provide any real assistance to you. We can talk about what could or should happen but nothing will go forward until you're in court.
 

That you are his fiduciary complicates things...a lot. The very best thing you can do for yourself is to get in touch with a local divorce lawyer and explain what you're up against. Divorce lawyers cost money and you'll be billed but if you ask around I have a feeling you'll find an attorney who will allow you some time to make payments.
 

In the end you really will have to get legal help, either from an attorney or a local legal aid group. I don't see any other option. Good luck.

Question:

My spouse has a VA decision letter that was sent by his attorney. It states he was awarded 100 percent rating and back dated to 2015. The decision is taking a long time to become final and I'm wondering if the VA can change it to a denial. Have you heard of other cases where this had happened?

Jim's Reply:

No, I haven't heard of VA changing an award this soon after it's made. The delay is probably due to the numerous tasks that have to be done since the retroactive award will be large.
 

VA will send the entire file to be reviewed by a quality check team to insure that all t's are crossed and i's are dotted. Then the big labor, it goes to finance to determine just how much he's owed. The retro calculation involves adding the 100% rating to his record and backdating, updating and balancing the account since the rates change each year. 
 

Add the labor challenges that VA has had during the pandemic and there's your delay. Although you don't tell me that this was remanded from a higher authority (BVA) if that's the case the regional office will have more work to do. 
 

This is a great question for the lawyer who represents him...get in touch! Good luck.

Question:

I have sleep apnea but it's not rated as service connected. I served in Desert Storm and have allergies and asthma. I was diagnosed with asthma within a year of separation. I never thought to apply for disability. Now I am unable to get the diagnosis in my medical record. Connected them no recollections. Any suggestions are appreciated.

Jim's Reply:

As luck would have it, your diagnosis of asthma within a year of separation is likely now a presumptive airborne or burn pit disabling condition and you will be due disability benefits after you apply and go through the usual exams. Your timing couldn't be much better. I'm not happy to hear of your health problems but I'm very glad to bring you some positive news for your future.
 

There has been a lot of recent legislative activity about asthma, rhinitis and sinusitis.

https://www.publichealth.va.gov/exposures/burnpits/  
 

I have no clue what, "Connected them no recollections" means but for anything at all to happen you must initiate a claim for your disability. Let me repeat that...you must formally file a claim for disability benefits for anything to happen. If you don't file the claim, nothing at all will happen for you. Don't worry about records and so on, file the claim now and then VA will help you find records. I recommend that you DIY the claim. I urge you to file soon to set the effective date of your claim.

https://www.vawatchdog.org/how-to-file-a-claim.html 
 

Filing your claim is a task you can do from the comfort of your home or you can get some help from a state or county VSO who knows how to get this done. If you choose to get some help, show them this email so they'll know what's up.

https://www.nacvso.org/ 
 

When you file your claim (or someone helps you with the task) be sure to claim asthma as the primary service connected condition and then claim OSA (obstructive sleep apnea and the CPAP) as a secondary condition caused by the asthma. If you don't claim it that way the OSA could be denied...VA has interesting ways of looking at things.
 

I'll go out on a limb and say you're likely to end up with a fairly robust VA disability rating...up to as much as 100% disabled...if you'll simply open a disability claim. This is very hard to try and quantify without seeing your medical records to determine exactly when you were diagnosed but if there is any formal military record to show that you were becoming ill while on active duty you could be owed a lot of retroactive pay.
 

If this is a bit overwhelming or if you have other questions and concerns, don't hesitate to get back in touch with me...this is a big deal in your life and we want to get it right! Good luck.

Question:

I am a military medical retiree and also rated as TDIU but I don't get my retirement from the military. Why don't I get concurrent retirement disability pay?

Jim's Reply:

I don't know why you aren't eligible for CRDP. Each case is different and there are any number of things that can hang you up.
 

You'll have to look at the rules here https://www.dfas.mil/retiredmilitary/disability/crdp/  and sort this out comparing to your own record. Good luck.