Question:

Hello Jim, I am the surviving spouse of a retired Vietnam veteran. He recently passed 5 weeks following a ‘2nd’ AAA, 18 yrs apart, both left & right. He previously (1997) had bypass surgery, mini stroke, and hypertension.

His death certificate states anoxic brain injury, hypotensive shock from ruptured AAA, and cardiovascular disease. Funeral expenses were denied, requiring further med records, etc. I'm currently waiting on a DIC response, but would assume I may receive same determination.

My advocate did not initially submit all medical docs from hospital outside of the VA. I sent them again and the advocate is going to send everything. They are detailed and explain CAD and mention ischemia, bypass, hypertension, his first AAA, and mini stroke.

Any thoughts on how the death certificate reads, or otherwise? I’m trying to determine how much I get involved versus my advocate. We talk often, but the hospital records that weren’t initially submitted was a little disappointing. Although he did believe that the VA would request them. I’m assuming they will not go out of their way??  I am thankful for his knowledge and support however. For what it’s worth my husband also had Alzheimer’s 6 years prior to his death. Many thanks for your Q&A’s.

Jim's Reply:

My condolences, I'm sorry to hear of your loss.
 

I'm hesitant to say too much as you seem to have already developed a relationship with an advocate. Too many cooks spoil the broth as it's been said. My opinions may differ from others and while that isn't a sure sign of correct or not, differing methods of getting from A to Z can be confusing.
 

Having said all that...your situation isn't unusual. When the disabling condition called Ischemic Heart Disease (IHD) was brought forth many of us wondered how the single set of blood vessels had been separated from the rest? Ischemic Heart Disease...also called Coronary Artery Disease (CAD) is a disease of the inner lining of arterial blood vessels often called arteriosclerosis or atherosclerosis.
 

IHD/CAD is a disease of all the arteries throughout your body. Sometimes called hardening of the arteries those vessels may clog up over time and if in the heart, cause an ischemic heart attack. If the vessels that clog up are in your neck, you may have an occlusive stroke. If vessels in your legs are affected, you'll suffer from Peripheral Artery Disease (PAD). Kidneys? Renal Artery Disease.
 

You get the idea. Atherosclerosis is present everywhere so how is it that VA decided it was only that small subset? And how did they ignore the Abdominal Aortic Aneurysm (AAA) as well as the Thoracic Aortic Aneurysm? An aneurysm is a weakening in the wall of a blood vessel causing a ballooning that may eventually rupture. Similar etiology is found in all these blood vessel conditions and VA chose one.
 

In any case, if the death certificate doesn't directly mention at least one of his rated conditions, it's likely that you'll need to speak with a veterans lawyer to appeal the decision. 
 

To pointedly insert at least one rated condition is important. In my experience I've seen far too many death certificates that say "cardiac arrest" rather than saying "heart attack coronary artery disease". Of course in death we all are in cardiac arrest...that just means the heart isn't beating. The cause must be accurately recorded. 
 

If you run into any obstacles your next stop is to speak with a veterans law attorney. All the lawyers you'll meet here will be happy to speak with you https://www.vawatchdog.org/how-to-hire-a-veterans-law-attorney.html  Good luck.