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Submission For The Record of Chris Thomas, Gulf War Veteran

•    In 1991 and 1993, I served with the 3rd Armored Cavalry Regiment in the Persian Gulf region.  Between May and December of 1993 he was gassed and shelled in combat with my regiment.  Military records support this point and have been undisputed in claims made to the VARO.  
•    I was discharged from active duty service in 1996. I began service in the reserves from 1996 to 2000.  I suffered chronic kidney problems (stones, other) during the years leading up to my discharge from the reserves.   
•    October 13, 2008 I suffered an episode of anaphylaxis resulting severe respiratory distress.  I had to be rushed by ambulance to the Skyline Medical Center where I was intubated.  This experience is consistent with my claim that symptoms of Parasympathetic Autonomic Dysfunction (PAD) began in 2008.  
•    I was diagnosed on December 4, 2008 by Dr. Zia, a private practice neurologist in Bowling Green, with Parasympathetic Autonomic Dysfunction (ANS/ALS & neuro condition) by my neurologist and began losing feeling in my feet and legs.  DRO Chuck Tate dismissed this diagnosis because he thinks Zia practices in a rural market and doesn’t have the skills of physicians in a university setting.  Zia is a Boston University and Harvard Medical School graduate.   Dr. Zia performs over 300 tilt table tests annually to determine Parasympathetic Autonomic Dysfunction. Dr. Smith (VA neurologist) also rejected Zia’s diagnosis.  
•    November, 2008 I was hospitalized for migraine and tremor.  
•    December, 2008 I was hospitalized for chest pain.
•    April, 2009 I required surgical removal of grossly enlarged axillary lymph nodes.
•    May, 2009 Dr. Diana Cavanaugh, Allergist with Graves-Gilbert Clinic writes a letter opining that the anaphylactic episodes, joint pain, migraines, tremor, lymphadenopathy and chest pain symptoms must have some underlying cause which can link all of these symptoms together.  
•    June 6, 2009 I took the Gulf War Registry exam which was not a complete physical.  Examiner didn’t review my registry paperwork.  My claim was denied.
•    August 15, 2009 I was diagnosed by (Dr. Dewey Dunn) VAMC Nashville as having (a) mild restrictive lung disease; (b) migrane headache disorder; (c) multiple arthralgias of unknown etiology and (d) irritable bowel syndrome.  Yet the DRO said I did not have lung disease and IBS in his denial of my claims for assistance.  
•    March 3, 2010 was the first scheduled appointment with Dr. DeMuth as the primary care physician.  
•    April 21, 2010 While an inpatient at VAMC, Dr. Hatfield (VA Gastroenterologist) indicated to me that Irritable Bowel Syndrome (IBS) is secondary to PAD.  
•    May, 2010 After losing nutrition and fluid and experiencing vomiting for several over two weeks, I was admitted as an inpatient at VAMC.  I went through multisystem failure and was on the verge of coding and was transferred to Jewish Hospital from May 14-18, 2011.  Medical staff at Jewish said my bowels were dying.  Dr. Hatfield explained to me that Gulf War Syndrome degrades your bowels/stomach because they are part of your auto immune system.  He said serin attacks every phase of your auto immune system.  
•    June 3, 2010 Dr. Ron Stattenberg, VA Radiologist conducted a MRI of my brain and reported evidence of chronic small vessel ischemic change.  Small vessel ischemic change is consistent with stroke, hypertension, migraines or other medical conditions.  I have a history of these symptoms.  
•    July 6th, 2010 Dr. Ramirez, Infections Disease physician with VAMC Louisville diagnosed me with radiation poisoning.  Dr. Smith, Neurologist stopped the proposed medications to treat the radiation poisoning so Ginko Balboa or fish oil was proposed as an over the counter medication.  This treatment was discontinued shortly due to adverse gastrointestinal side effects.  Smith’s nurse told me ‘Nothing is wrong with you.’ Again Dr. Smith rejects another physician’s diagnosis as he did with when he rejected Dr. Zia’s diagnosis of Parasympathetic Autonomic Dysfunction.  
•    June through late 2010, I was treated at Southern Kentucky Rehab Hospital where I was treated for physical therapy, speech therapy and occupational therapy.  My inability to perform basic exercises is well documented by qualified therapists.  My musculoskeletal functions progressively worsened and pain increased over those months.  Rehab care was discontinued the hospital for fear that lack of progress would threaten the reimbursement of costs for such care.  
•    Early 2011, My condition worsened.  I frequently experienced swelling and inability to urinate.  Weakness in the left side of his body worsened and I experienced tremors frequently.  No cohesive plan of care was established so I reached out to Congressman Guthrie to do something to get the VAMC to take me seriously and develop a cohesive plan of care to make me better.  
•    In late Spring 2011, Mark Lord from Guthrie’s staff secured a meeting with Louisville VAMC leadership including Director Pfeffer, Chief of Staff Marylee Rothschild, VAMC legal counsel and risk management staff.  Rothschild debated my claims about a lack of diligent care and the risk management person pressed that I was not compliant with efforts to seek PTSD treatment.  Mr. Lord made the point that his anxiety will be dramatically reduced if his medical needs will be treated diligently.  Director Pfeffer brought up the prospect of sending Ito the War Related Injury and Illness Center because he said they are the specialists for these types of cases.  
•    August 2011, I went to the WRIISC in Washington, DC.  It was a major disappointment.  What was described as a specialty center to treat war related injuries of an obscure nature like GWI turned out to be a research facility with very little treatment capacity.  The bottom line was I came home with a diagnosis of low testosterone and a big bag of vitamins.  I also came home very sick and hurting from the MRI’s which heated up the shrapnel in my body.
•    Six weeks passed and no one from WRIISC and the VAMC nor primary care were talking with each other.  So I got Congressman Guthrie’s staff to press them to take action.  Congressman Guthrie got wrote a letter on my behalf complaining about the poor continuity of care associated with my case.  

•     In November of 2011, my health is worsening under the care of the VA.  Dr. Ramirez and Dr. Peyrani, Infectious Disease physicians in the VA described me as having progressive neurological symptoms and multiorgan dysfunction affecting the heart, brain, kidneys, bone marrow, peripheral nerves and the immune system.  

•    As my condition worsened under the VA, the care providers did not demonstrate appropriate diligence in carrying out a treatment plan for me.  My first appointment to discuss the recommendations from the WRIISC did not going to happen until February of 2012 which would have been six months from my discharge from the WRIISC.  Fortunately, with Congressman Guthrie’s help it was moved up to November.  
•    The continuity of care with my case was very poor given the acuity of my symptoms.  My primary care physician, Dr. DeMuth, was not communicating well with specialists involved in my care.  Other than one consultation with WRIISC physician, Dr. Li, DeMuth did not have consultations with the specialists involved in my care.  He relied only on case notes.  Given my involved and worsening condition, more diligence should reasonably be expected.
•    DeMuth did not communicate adequately with me.  DeMuth told me that he would complete the referral for me to see a cardiologist and an urologist for the severe symptoms that I was experiencing.  Instead of completing the referral he put in for tests to take place weeks later that would qualify me to see the specialists.  DeMuth also prescribed tests that would expose me to high levels of radiation that could be potentially harmful to a patient with probable radiation poisoning, yet did not consult with me and did not take my phone calls about the matter days before the procedure was to be done.  In late 2011, DeMuth began sending vitamins and drugs to me without consultation about the purpose of them.  DeMuth even went so far as to demand that I sign a contract with him limiting the number of medical concerns that I can talk to him about at two concerns per visit.  The contract also limited the amount of his time that I could have in a patient visit.   
•    Through late 2011, VAMC leadership was not advocating any material change in the way I was treated.  Upon my desperate request for help Congressman Guthrie’s, sent a letter to Director Pfeffer and Chief of Staff Rothschild outlining these concerns.  The response from Chief Rothschild was that the care I was receiving was completely within their standard of care and that this office “should let doctors be doctors.”  Her only recommendation was to designate a nurse on DeMuth’s staff as a case manager and encourage DeMuth to spend 30 minute visits with me rather than the customary 15 minutes typically provided.  This seems ironic that she advocated letting the doctors be doctors yet nine months ago their plan was to get me into the care of the WRIISC because the appropriate expertise was not sufficient in this VA region to care for me adequately.  
•    There is apparently no defined protocol to treat veterans with symptoms of radiation poisoning or biological/chemical combat exposures.  
•    Meanwhile, I pleaded desperately for the opportunity to see a specialist for the symptoms that I was experiencing.  I have grown increasingly angry at the VA system for not treating my combat injuries and for treating me as though my symptoms are fiction.  I acknowledged that I am 100% PTSD disabled and I am willing to get treatment.  But I want my physical symptoms to be taken credibly so I can get care that is consistent with private health care providers outside the VA system.  
•    In late 2011, I felt that I didn’t not have long to live.  As a former critical care nurse at the Vanderbilt Hospital, I know that untreated atrial fibrillation of the heart, the chronic kidney dysfunction and weakened immune system can easily lead to death rapidly.  This and numerous other symptoms combined to degrade my quality of life.  
•    In early 2012, we seemed to have exhausted all options at the Louisville VAMC level with no good reason to expect improvement in my care.  So Congressman Guthrie’s staff escalated my complaint to VISN 9 Director Dandridge conceded to move my care outside the VA to private physicians.
•    Currently, I am making some progress now but my physicians have almost no experience treating the patients with exposures to bio/chem agents or radiation poisoning.  Reimbursements from the VA are chronically slow pay which makes them want to drop me as a patient.  Likewise, there have been frequent battles with the VA pharmacy to get the meds filled the way the doctors want them filled.