Question:

On Jan 8, 2016, I had 3 C&P exams completed at the VA Medical Clinic, Orlando FL. that were done by the same doctor. All 3 medical conditions were secondary conditions to Diabetes Mellitus: 1. Artery & vein conditions (Vascular diseases including varicose veins). 2 Heart conditions (including ischemic & non-ischemic heart disease arrhythmias, vascular disease and cardiac surgery). 3. Hypertension.
On all 3 DBQ’s the doctors MEDICAL OPINION were the same “IS LESS AS LIKELY AS NOT PROXIMATELY DUE TO OR THE RESULT OF DIABETES MELLITUS.” My question is, somewhere I read that to be rated separately for secondary conditions or complications the conditions must not have been considered in your initial rating decision. When they say “INITIAL RATING DECISION” are they referring to the about 3 C&P exams for are they referring to the ‘RATING DECISION” they mail you? I never received a RATING DECISION for the 3 C&P exams. I want to file a claim with a DBQ along with a medical opinion on all the secondary conditions they said were likely as not proximately due to or the result of diabetes mellitus. What do you suggest I do?

Jim's Reply:

First up,  I'd suggest that you work on what the rules, regs and science allow you to do. While service connected diabetes mellitus (DM) is the accepted cause of many secondary conditions, any number of the things you cite (vein conditions, varicose veins, non-ischemic heart disease arrhythmias, hypertension) are clearly not secondary to DM and will be denied whenever claimed. When you make claims for conditions that aren't accepted as secondary, you must provide proof of your claim and in this case, you can't do that. DM is the cause and contributes to arterial vascular diseases,  but does not cause venous conditions like varicosities. DM will cause ischemic heart disease but isn't usually associated with arrhythmias. "Cardiac surgerys" isn't a disease or a diagnosis of the sort VA requires and can't be claimed as such. I can't offer advice to submit such evidence as you want since that doesn't exist.