1. Case Study #3

2. Case #3
Veteran served on active duty from August 22, 1968 to August 15, 1970 with verified service in the Republic of Vietnam.
Veteran filed for Diabetes, Bilateral Lower Leg problems with numbness and Impotence on a that was received by VA on April 30, 2001.
Veteran submitted a medical Nexus and diagnosis of Diabetes Mellitus Type I with supporting medical evidence dating back to 1974.

3. Case #3 The VA reviewed the evidence of record:
The treatment reports from Dr O'Connor received November
The treatment reports from Bon Secour received September
The treatment reports from St Johns Family Practice received November
The treatment reports From McLaren Health Care received November
Service medical records

4. VA issued a decision on February 28, 2002. What do you think?
Case #3
VA issued a decision on February 28, What do you think?

5. Case #3 The VA denied the claim stating the following facts:
The treatment reports from Bon Secour revealed the veteran was diagnosed with juvenile diabetes and placed on Insulin on December 19, 1974.
The treatment reports from St Johns Family Practice revealed he has insulin-dependent diabetes mellitus type 1 on January
The treatment reports from McLaren Health Care revealed he was diagnosed with brittle diabetes on October (Brittle diabetes is the type seen in individuals who developed diabetes during childhood )

6. Case #3
The veteran claims he has type 2 diabetes which resulted from Agent Orange Exposure. The treatment reports from Dr O'Connor revealed the veteran has been treated for type 1 diabetes for many years. He takes Insulin for it. He developed diabetic neuropathy and erectile dysfunction as a result of his diabetes.
There is no basis in the available evidence of record to establish service connection for type 1 diabetes mellitus with neuropathy and erectile dysfunction. This condition did not happen in military service nor was it aggravated or caused by service.

7. Did the VA make the right decision? What do you think?
Case #3
Did the VA make the right decision? What do you think?

8. Case #3
How would you advise the veteran at this point? The veteran did not appeal at that time.

9. Case #3 Veteran filed an Informal Claim on December 8, 2006
Request s/c for the following conditions:
diabetes mellitus I was diagnosed in 1974 and have been insulin dependent since 1974
neuropathy (all extremities)
erectile dysfunction
(all due to Agent Orange exposure in Vietnam)
hearing loss & tinnitus due to noise exposure in Vietnam as a helicopter repairman / crew chief.
Also request re-evaluation of my s/c anxiety disorder as I believe it has worsened since my last evaluation.
I will provide medical records for all conditions shortly.
Thank you for your consideration.

10. Case #3
The VA sent a Duty to Assist Letter on April 12, Stating “In order for us to reopen your claim, we need new and material (N&M) evidence.”
The veteran submitted clinical testing procedures on defining the difference between type 1 and type 2 Diabetes Mellitus.
The VA did not consider this N&M and did not request a C&P for any of Diabetes related conditions.

11. Case #3 The VA did request C&P exams on the other conditions.
During the C&P for an increase in s/c Anxiety Disorder the examiner noted the diabetic condition and how is should be tested as part of medical opinion.

12. VA issued a decision on September 18, 2007. What do you think?
Case #3
VA issued a decision on September 18, What do you think?

13. Case #3
The claim for service connection for type 1 diabetes mellitus with neuropathy and erectile dysfunction remains denied because the evidence submitted is not new and material.
Veteran did not appeal this decision.

14. Case #3
Veteran then filed a b on January 12, 2012 to reopen DM1, hypertension and neuropathy in both legs.

15. Case #3
Veteran then filed a b on January 12, 2012 to reopen DM1, hypertension and neuropathy in both legs.
Veteran submitted private medical records and VA progress notes from VAMC-Battle Creek with the claim.

16. Case #3 The VA finally scheduled a C&P exam.
VA Examiner’s opinion was:
Military service does not cause diabetes
DM2 is a presumptive Agent Orange exposure diabetes, not Type 1.
The exact cause of DM1 is unknown.
DM1 results from the destruction of the insulin producing B-Cells in the pancreas.
Speculation varies on what triggers this autoimmune phenomenon including virus stimulus and chemical toxins.
The Veterans progress notes speak of a viral outbreak and Agent Orange exposure that are noted in the veterans claim folder.

17. VA issued a decision on October 26, 2012. What do you think?
Case #3
VA issued a decision on October 26, What do you think?

18. Case #3
The claim for service connection for type 1 diabetes mellitus with neuropathy remains denied because the evidence does not support a nexus between military service and the development of Type 1 Diabetes 3-4 years after service.

19. Case #3
Veteran filed a Notice of Disagreement on October 29, 2012.
Veteran contended the medical opinion of his treating doctor was in-favor of service connection but uses the same medical rationale as the C&P examiner.

20. The VA obtained a new medical opinion on December 18, 2014.
Case #3
The VA obtained a new medical opinion on December 18, 2014.
The new medical opinion matched the old medical opinion word for word.

21. Case #3
The DRO ignored the matching opinions and issued a Statement of the Case continuing the denial on January 15, 2015.
The veteran failed to file a VA Form 9 within 60 days.

22. Can the veteran do anything more?
Case #3
Can the veteran do anything more?
What VA errors are there in this case?

23. Questions ?