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    • Can anybody tell me if this qualifies a Veteran to be able to use the VA's CHOICE program... The VA has refused Cervical Spine surgery on me THREE TIMES. So I decided to finally get away from the VA and go see an orthopedic surgeon in my area. I just recently had a new MRI and the results are now showing I have Cervical Myelopathy at TWO levels. I go this Wednesday (Tomorrow) for the follow up MRI to see what the treatment plan is. I hope its surgery because I am tired of all this pain and not having a life. Since the VA Neurosurgeon has refused me three times for surgery and with the NEW MRI evidence and maybe the Orthopedic Surgeon will say surgery is the only treatment, would this qualify for the VA to pay for this surgery through the VAs CHOICE program? This surgeon is already in the VA Choice Program provider list, I just looked. Remember the VA Neurosurgeon REFUSED to do the surgery not once but THREE separate times. Keep in mind the VA Bay Pines in St Pete NOR James A. Haley has a Neurosurgeon on staff and uses a consultant to make decision if surgery is necessary and if he says yes the VA sends you out to the cheapest doctor in town. After my uncle inlaw just went through this a little over a year ago the cheap surgeon cause paralysis in his left arm I said NOPE, not going there.
    • My IMO with a Psychologist Dr Bash recommended took 4 months to write an adequate IMO. When I called Dr Bash initially,  He called me back personally. I would give the benefit of the doubt, God forbid if he was in the hospital himself et al. I found him to be reputable. 
    • Thanks all- I already get the (Texas) tax break  on my home , car registration and I utilized Voc Rehab for my degree,I already had Tricare and commissary privileges  since I did 22 years in the Navy(1975-2997) ... et al.  I am single, so time to relax!  I will know about the P & T  when I get the packet - I did put i a request and asked for it. I am 59 so and I have a 70% rate just the PTSD with an IMO in place that helped a lot, I thought the $2,000 spent on the IMO was worth it and it was. Now time to pay it forward and volunteer. Blessed Thankful Grateful. 
    • my husband and i are just glad its over.  We will save the money for sure. Money cannot replace the trauma i have survived. Just glad its over and i can go on with my life
    • L,  congratulations on both your award and your degree as well,  Best of Luck to you,  I'm waiting to hear on my tdiu claim as well. 

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Guest Berta

Astonishing Ptsd -hbp Bva Decision!

1 post in this topic

I think this is an astonishing and fairly recent decision because Dr. Boscarini's work is acknowledged in this decision- (as a treatise)

His work on PTSD has never been given much credence by VA-in the past -unfortunately-

And it is a good example of the way Relative Equipoise is supposed to work.

Citation Nr: 0521679

Decision Date: 08/10/05 Archive Date: 08/19/05

DOCKET NO. 93-23 884 ) DATE



On appeal from the

Department of Veterans Affairs Regional Office in Newark, New



Entitlement to service connection for hypertension.


Appellant represented by: New Jersey Department of

Military and Veterans' Affairs


Ronald W. Scholz, Senior Counsel


The veteran served on active duty from July 1968 to April


This matter comes before the Board of Veterans' Appeals

(Board) on appeal from a February 1992 rating decision by the

Department of Veterans Affairs (VA) Regional Office (RO) in

Newark, New Jersey which denied service connection for


The Board remanded the issue on appeal in October 1995,

November 1999, and September 2003. In its September 2003

Remand, the Board directed a VA examination to determine

whether the veteran's hypertension was caused or aggravated

by his service-connected PTSD.


The evidence of record is in equipoise with respect to the

question of whether the veteran's diagnosed hypertension is

secondary to his service-connected PTSD


Hypertension is proximately due to the veteran's service-

connected PTSD. 38 U.S.C.A. § 1110, 5107 (West 2002); 38

C.F.R. § 3.102, 3.310 (2004).


In light of the favorable action taken herein, discussion of

whether VA duties pursuant to the Veterans Claims Assistance

Act of 2000 (VCAA) have been satisfied is not required. The

Board finds that no further notification or assistance is

necessary, and deciding the appeal at this time is not

prejudicial to the veteran.

Factual Background

The veteran has been service-connected for PTSD since May


Medical evidence of record reflects that the veteran has a

current diagnosis of hypertension.

Pursuant to a September 2003 Board Remand, the veteran

received a VA medical examination in April 2004. The

examining VA physician concluded there was no relationship

between the veteran's service-connected PTSD and his

hypertension and, further, that PTSD did not cause

hypertension or contribute to any exacerbations of


An April 2005 letter from Alfred M. Dipiero, D.O., noted that

the veteran had been under his care for hypertension, and

concluded that the hypertension resulted from the veteran's

service-connected PTSD.

Legal Criteria


Service connection may also be granted on a secondary basis

if a claimed disability is found to be proximately due to, or

is the result of, an established service-connected disease or

injury. Establishing service connection on a secondary basis

requires evidence sufficient to show: (1) that a current

disability exits, and (2) that the current disability was

either (a) caused by or (;) aggravated by a service-

connected disease or injury. 38 C.F.R. § 3.310(a) (2004);

See Allen v. Brown, 7 Vet. App. 439, 446 (1995).

The Secretary shall consider all information and lay and

medical evidence of record with respect to benefits under

laws administered by the Secretary. When there is an

approximate balance of positive and negative evidence

regarding any issue material to the determination of a

matter, the Secretary shall give the benefit of the doubt to

the claimant. 38 U.S.C.A. § 5107(B) (West 2002); 38 C.F.R.

§ 3.102 (2004).


The evidence with respect to whether the veteran has a

current disability, hypertension, is not in dispute. The

record reflects that the veteran was first diagnosed with,

and treated for, hypertension, sometime in the 1970's.

In its September 2003 Remand, the Board directed that a VA

medical examination be conducted to determine whether the

veteran's service-connected PTSD caused or aggravated the

veteran's hypertension. Subsequently, two medical opinions

have been obtained and added to the file, both of which are

remarkably inadequate with respect to providing any rationale

for their diametrically opposed conclusions.

The first, a report of an April 2004 VA medical examination,

concluded that there is no relationship between the veteran's

service-connected PTSD and his hypertension. No rationale of

any kind, however, is provided for that conclusion.

The second, a letter from a private physician who has treated

the veteran for his hypertension for many years, concluded

that the veteran's hypertension resulted from his service-

connected PTSD. Again, no rationale of any kind is provided

for that conclusion.

Other than the two medical opinions discussed above, there is

no evidence of record with respect to the issue of secondary

service-connection for hypertension resulting from the

veteran's PTSD.

The Board finds that the evidence with respect to secondary

service-connection is in approximate balance, as there is no

sound basis for choosing one medical opinion over the other.

When there is an approximate balance of positive and negative

evidence regarding any issue material to the determination of

a matter, the benefit of the doubt shall be given to the

claimant and, accordingly, the claim must be granted.

In reaching this determination, the Board notes that the fact

that PTSD was recognized after hypertension was diagnosed is

not determinative, since the record is not lcear as to when

PTSD first existed. Furthermore, in reaching this

determiantion, the Board notes that the VA published

information in the Federal Register. The study did find a

statistically significant increased incidence of hypertension

and chronic heart disease among World War II veterans with

PTSD (odds ratio = 1.25 for hypertension and 1.19 for chronic

heart disease). The conclusion that PTSD may be associated

with cardiovascular disorders is also supported by a 1997

study finding that Vietnam veterans diagnosed with PTSD had a

significantly increased risk of circulatory disease many

years after service. (Boscarino JA. Diseases Among Men 20

Years After Exposure to Severe Stress: Implications for

Clinical Research and Medical Care. Psychosom Med 1997;

59:605-14.) 69 FR 60083-01. In view of the lack of reasoning

in each pertinent medical opinion, the favorable evidence at

least has some support in a document placed in the Federal

Register by VA.


Entitlement to service connection for hypertension, secondary

to the veteran's service-connected PTSD, is granted.



Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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