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Agent Orange Update


SECONDARY CONDITIONS FROM DIABETES
YOU CAN CLAIM DUE TO AGENT ORANGE


medic insignia
 


Summery:  
This page has conditions secondary to Agent Orange Diabetes.
What this means is if you had diabetes prior to any of these conditions you can  file for disabilities related to Agent Orange.
More:   Email Bob:  bob[at]vetshome[dot]com


CORONARY ARTERY DISEASE: In this chronic disease, atherosclerosis narrows the coronary arteries, the arteries supplying blood to the heart muscle. As the coronary arteries narrow, the chest pain called angina may be triggered. And the risk of a heart attack (myocardial infarction), which occurs when a coronary artery is blocked completely, is increased. Coronary artery disease currently affects 11 million people in the United States.

   7000   Valvular heart disease (including rheumatic heart disease):

 

                  1.   During active infection with valvular heart damage and for three

                        months following cessation of therapy for the active infection ............................. 100%

 

                       Thereafter, with valvular heart disease (documented by findings on

                        physical examination and either echocardiogram, Doppler

                        echocardiogram, or cardiac catheterization) resulting in:

 

                 2.   Chronic congestive heart failure, or; workload of 3 METs or less

                        results in dyspnea, fatigue, angina, dizziness, or syncope,

                        or; left ventricular dysfunction with an ejection fraction of

                        less than 30 percent......................................................................................... 100%

 

                 3.   More than one episode of acute congestive heart failure in the past

                        year, or; workload of greater than 3 METs but not greater than

                        5 METs results in dyspnea, fatigue, angina, dizziness, or syncope,

                        or; left ventricular dysfunction with an ejection fraction of

                        30 to 50 percent…......……………………………………………….........………...60 %

 

                  4.  Workload of greater than 5 METs but not greater than 7 METs results

                        in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of

                        cardiac hypertrophy or dilatation on electro-cardiogram,

                        echocardiogram, or X-ray.................................................................................. 30

 

                  5.  Workload of greater than 7 METs but not greater than 10 METs results

                        in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous

                        medication required............................................................................................ 10%

7001    Endocarditis

 

                  1.   For three months following cessation of therapy for active infection

                        with cardiac involvement.................................................................................. 100%

 

                  Thereafter, with endocarditis (documented by findings on physical

                        examination and either echocardiogram, Doppler echocardiogram,

                        or cardiac catheterization) resulting in:

 

                  2.  Chronic congestive heart failure, or; workload of 3 METs or less

                        results in dyspnea, fatigue, angina, dizziness, or syncope, or;

                        left ventricular dysfunction with an ejection fraction of less than

                        30 percent......................................................................................................... 100%

 

                  3.  More than one episode of acute congestive heart failure in the past year,

                        or; workload of greater than 3 METs but not greater than 5 METs

                        results in dyspnea, fatigue, angina, dizziness, or syncope, or;

                        left ventricular dysfunction with an ejection fraction of 30 to

                        50 percent......................................................................................................... 60%

 

                  4.  Workload of greater than 5 METs but not greater than 7 METs results

                        in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of

                        cardiac hypertrophy or dilatation on electrocardiogram,

                        echocardiogram, or X-ray.................................................................................. 30%

 

                  5.  Workload of greater than 7 METs but not greater than 10 METs

                        results in dyspnea, fatigue, angina, dizziness, or syncope, or;

                        continuous medication required.......................................................................... 10

 

7002    Pericarditis:

 

                  1.   For three months following cessation of therapy for active infection

                        with cardiac involvement.................................................................................. 100

 

                  Thereafter, with documented pericarditis resulting in:

 

                  2.  Chronic congestive heart failure, or; workload of 3 METs or less

                        results in dyspnea, fatigue, angina, dizziness, or syncope, or;

                        left ventricular dysfunction with an ejection fraction of less

                        than 30 percent............................................................................................... 100%

 

                  3.  More than one episode of acute congestive heart failure in the past year,

                        or; workload of greater than 3 METs but not greater than 5 METs

                        results in dyspnea, fatigue, angina, dizziness, or syncope, or;

                        left ventricular dysfunction with an ejection fraction of 30 to

                        50 percent........................................................................................................ 60 %

 

                  4.  Workload of greater than 5 METs but not greater than 7 METs results

                        in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of

                        cardiac hypertrophy or dilatation on electro-cardiogram,

                        echocardiogram, or X-ray................................................................................. 30%

 

 

                  5.  Workload of greater than 7 METs but not greater than 10 METs results

                    in dyspnea, fatigue, angina, dizziness, or syncope, or;  continuous..........................10%

RIGHT UPPER EXTREMITY DIABETIC NEUROPATHY

LEFT UPPER EXTREMITY DIABETIC NEUROPATHY

RIGHT LOWER EXTREMITY DIABETIC NEUROPATHY

LEFT LOWER EXTREMITY DIABETIC NEUROPATHY:

Examinations for diabetic neuropathy assess muscle strength, deep tendon reflexes, and sense of touch (temperature, pinprick or pressure sensation, vibratory sensation, position sense). Different functions are affected in different individuals, and symptoms may be out of proportion to the findings on examination. Diagnostic criteria are based on some com bination of symptoms, focused neurologic examination, nerve conduction studies, and special quantitative sensory tests, but some tests are difficult and time consuming, and not all are ordinarily done.

If you have diabetes, your blood sugar levels are too high. Over time, this can damage the covering on your nerves or the blood vessels that bring oxygen to your nerves. Damaged nerves may stop sending messages, or may send messages slowly or at the wrong times.

This damage is called diabetic neuropathy. About half of people with diabetes get it. Symptoms may include

  • Numbness in your hands, legs or feet
  • Shooting pains, burning or tingling
  • Nausea, vomiting, constipation or diarrhea
  • Problems with sexual function
  • Urinary problems
  • Dizziness when you change positions quickly

 FOOT ONYCHOMYCOSIS: What are the skin complications? In addition to infections (for example, Candida, dermatophytes, and bacterial infections) and ulcers, there are several specific conditions that may affect diabetics. Onychomycosis due to Epidermophyton floccosum(Toenail Fungus) Onychomycosi.

SLEEP APNEA: Using a sleep machine, 50% due to weight gain.
Get a letter from your VA or private Dr. (Example Below)

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RE:  YOUR NAME

To Whom It May Concern:

     I have been Mr.________________ primary care physician privately and also his sleep physician.  _Mr.__________ has asked me to comment on the association of diabetes mellitus and obstructive sleep apnea.

     Again, he had diabetes mellitus approximately five years ago.  At that time his weight was 215 pounds.   He was not diagnosed with obstructive sleep apnea until 2000.   He has had at least a 15 pound weight gain since his weight five years prior.  I do think this weight gain is secondary to dysmetabolic syndrome which results in hyperinsulinemia which affects the fasting and postprandial blood sugars, decreased intracellular glucose utilization, muscle fatigue, loss of energy, loss of stamina, and, often times, weight gain.

     In my medical opinion, the obstructive sleep apnea is more likely than not, secondary to his dysmetabolic syndrome, I.e. diabetes mellitus.


     Thank you very much for your consideration on Mr.__________ behalf.  If you have any questions, feel free to contact me.

 

Sincerely,

Doctors name_____




ERECTILE DYSFUNCTION: 
The examiner reviewed the medical records, examined the veteran, and provided the diagnosis of: Diabetes Mellitus. The examiner noted conditions as being secondary to the diabetes: Erectile dysfunction, hypertension, and neuropathy. The veteranreported to the examiner that attempts to alleviate the erectile dysfunction with medication had failed. ANALYSIS: Entitlement to special monthly compensation is warranted in this case because criteria regarding loss of use of a creative organ were met from  This case has been reviewed pursuant to the class action Nehmer v. United States Veterans Administration, Civil Action No. C86-6 160 TEll (N.D.). An effective date of 04-30-0 1 has been assigned. This is the date on which the VA received the claim that resulted in the grant of compensation. The rule stated in 38 USC 5110(g) and 38 CFR 3.114 that an award based on liberalizing law may not be effective earlier than the effective date of the new law does not apply to Nehmer cases.

All about erectile dysfunction and then some.

 RENAL DISEASE:
You need to have your doctor request regular 24 hour urine protein tests. They give you a plastic jug and you take it home, follow the directions and fill it up over 24 hours and then return it to the lab. They should also do a creatine test. The lab report will tell you the amount of microalbumin present. Creatin tests will also give an indication of the amount of renal damage and the efficiency of your kidneys In order to be valid or acceptable to the VA there needs to be several 24 hour tests over a period.
What is the most common diabetic eye disease?

diabetic eye disease
  
DIABETIC RETINOPATHY:
Impairment or loss of vision due to damage to the blood vessels of the retina.  more............
 
Cataract:
 
Clouding or opaqueness of the lens of the eye.
 
GLAUCOMA:
  Increased fluid pressure in the eye. Causes loss of visual fields due to optic nerve damage.
All people with diabetes need to get a comprehensive dilated eye exam at least once a year.

Diabetic retinopathy. This disease is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

Study Demonstrates Clear Inverse Relationship Between OSA and Diabetes

A recent study conducted at the University of Chicago "demonstrates for the first time that there is a clear, graded, inverse relationship between OSA (obstructive sleep apnea) severity and glucose control in patients with type 2 diabetes," writes lead author, Renee S. Aronsohn, MD. The study also confirmed that undiagnosed OSA is common among patients with type 2 diabetes.

Aronsohn and colleagues recruited 60 patients with type 2 diabetes from outpatient clinics to participate in the study. The researchers found that 77% of participants had OSA, but only five had been previously evaluated for the disease, and none were undergoing treatment. Of the study sample, 38% were classified as having mild OSA, 25% had moderate OSA, and 13% had severe OSA.

More severe OSA was associated with poorer glucose control. Relative to patients without OSA, the presence of mild, moderate, or severe OSA significantly increased mean adjusted HbA1c values (the main clinical marker of glycemic control in diabetes) by 1.49%, 1.93%, and 3.69%, respectively. According to the study authors, these effect sizes are comparable to those of widely used hypoglycemic medications, meaning that having OSA may negate the beneficial effects of antidiabetic drugs.

"Our findings have important clinical implications as they support the hypothesis that reducing the severity of OSA may improve glycemic control," said Aronsohn. "Thus effective treatment of OSA may represent a novel and nonpharmacologic intervention in the management of type 2 diabetes."

The findings appear in the American Journal of Respiratory and Critical Care Medicine.

Citation Nr: 1002710	
Decision Date: 01/19/10    Archive Date: 02/01/10

DOCKET NO.  08-08 999	)	DATE
	

On appeal from the
Department of Veterans Affairs Regional Office in Muskogee, Oklahoma


THE ISSUE

Entitlement to obstructive sleep apnea claimed as secondary to 
service-connected  diabetes mellitus, type II.  

REPRESENTATION
Appellant represented by: Oklahoma Department of Veterans Affairs
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
G.A. Wasik, Counsel
INTRODUCTION


The Veteran had active duty service from September 1969 to September 1973.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2007 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified at a Board videoconference hearing in December 2009.

FINDINGS OF FACT

1. Service connection is in effect for Type II diabetes mellitus.
2. There is competent evidence of record of the current existence of sleep apnea.
3. The preponderance of the competent evidence of record demonstrates that there is a medical nexus between the service-connected diabetes and the current sleep apnea on the basis of aggravation.

CONCLUSION OF LAW
Sleep apnea is aggravated by the service-connected Type II diabetes mellitus. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2009), Allen v. Brown, 7 Vet. App. 439 (1995).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service.

38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury.

38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show
(1) that a current disability exists and
(2) that the current disability was either
a proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Where a service-connected disability aggravates a nonservice-connected condition, a veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Id. at 448. Temporary or intermittent flare-ups of symptoms of a condition, alone, do not constitute sufficient evidence of aggravation unless the underlying condition worsened.

Cf. Davis v. Principi, 276 F.3d 1341, 1346-47 (Fed. Cir. 2002); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991).

The provisions of 38 C.F.R. § 3.310 were amended, effective from October 10, 2006; however, the new provisions require that service connection not be awarded on an aggravation basis without establishing a pre-aggravation baseline level of disability and comparing it to current level of disability.

71 Fed. Reg. 52744-47 (Sept. 7, 2006). Although the stated intent of the change was merely to implement the requirements of Allen v. Brown, 7 Vet. App. 439 (1995), the new provisions amount to substantive changes to the manner in which 38 C.F.R. § 3.310 has been applied by VA in Allen-type cases since 1995. Consequently, the Board will apply the older version of 38 C.F.R. § 3.310, which is more favorable to the claimant because it does not require the establishment of a baseline before an award of service connection may be made.

In June 2006, the Veteran submitted a claim of entitlement to service connection, in pertinent part, for sleep apnea secondary to Type II diabetes mellitus.

Service connection is currently in effect for Type II diabetes mellitus associated with herbicide exposure. There is also competent evidence of record documenting the current existence of sleep apnea. A December 2004 private sleep study includes an impression of moderate sleep apnea syndrome. An October 2006 letter from a private health care provider indicates the Veteran has been diagnosed with sleep apnea.

A VA examination was conducted in November 2006 and the examination report was promulgated in December 2006. It was noted that the Veteran had sleep apnea for two years which was diagnosed by sleep study. The pertinent diagnosis was sleep apnea. The examiner opined that sleep apnea was not due to diabetes. Significantly, the examiner did not provide a rationale of any kind to support this opinion. The lack of any type of rationale leads the Board to place significantly reduced probative value on this opinion.

The United States Court of Appeals for Veterans Claims (the Court) has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record.

Miller v. West, 11 Vet. App. 345, 348 (1998). The Court has also held that a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty. Bloom v. West, 12 Vet. App. 185, 187 (1999).

The probative value of the November 2006 opinion is at least matched by an October 2005 letter from a private health care professional which includes the statement that the sleep apnea, along with other medical disorders, was secondary to his diabetes mellitus. Again no rationale was provided. Thus, at this point, the evidence supporting the Veteran's claim is in equipoise.

However, there is more competent evidence associated with the claims file which supports the Veteran's claim.

Associated with the claims file are excerpts of articles from the internet which pertain to the relationship between diabetes mellitus and sleep apnea. The Court has held that a medical article or treatise "can provide important support when combined with an opinion of a medical professional" if the medical article or treatise evidence discussed generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least "plausible causality" based upon objective facts rather than on an unsubstantiated lay medical opinion.

 Sack v. West, 11 Vet. App. 314 (1998); Wallin v. West, 11 Vet. App. 509 (1998) (medical treatise evidence discussed generic relationships with a degree of certainty to establish a plausible causality of nexus), Mattern v. West, 12 Vet. App. 222, 228 (1999). Also associated with the claims file is a letter from a private health care professional, J.S.S., D.O., wherein it was written that the Veteran is a Type II diabetic and has obstructive sleep apnea. It was noted that part of the physiology of Type II Diabetes is obesity, which always serves to worsen obstructive sleep apnea and complicate its management.

It was noted that differing studies have show a high prevalence of obstructive sleep apnea in Type II diabetics, an incidence of 36 to 50 percent. A study was referenced as indicating that the severity of insulin resistance is closely correlated with the severity of obstructive sleep apnea.

The doctor wrote "In my opinion, it is apparent that [the Veteran's] Type II Diabetes and the difficulties we have had controlling it thus far contribute to the severity of his [obstructive sleep apnea]." This opinion is supported by clinical data in the form of the cited research. As this positive opinion includes supporting clinical data, the Board finds it should be accorded more probative weight than the negative opinion flowing from the November 2006 VA examination.

The Board finds there is competent evidence of record of the current existence of sleep apnea, competent evidence of service-connected Type II diabetes mellitus and competent medical nexus evidence establishing a connection between the service-connected disability and the current disability.

See Wallin v. West, 11 Vet. App. 509, 512. Based on the above, the Board finds that the preponderance of the competent evidence of record demonstrates that the Veteran's currently existing sleep apnea is aggravated by his service-connected Type II diabetes mellitus. The Board is aware of the provisions of the Veterans Claims Assistance Act of 2000 (VCAA). However, the Board finds it does not need to determine if VA complied with the VCAA in the current case as the claim has been granted. There is no detriment to the Veteran in promulgating this decision without ensuring VCAA compliance.


ORDER

Service connection for sleep apnea which is aggravated by Type II diabetes mellitus is granted, subject to the laws and regulations governing monetary awards.

BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs

There are 6 diabetes pages

1.What is diabetes
2.Diabetes Claims Secondary
3.Diabetic Neuropathy                    NEXT
4.Diabetes  Medication
5.Diabetes Update
6.Erectile Dysfunction Plus Heart Disease Raises Death Risk

    

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Excellent Forum.  Tons of info.


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