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cetay

Hypertensive vascular disease increase denied

Question

Hi everyone, I have two questions:

I`m receiving a 20% compensation for hypertensive vascular disease
(1) Recently received another decision by the VA and am curious about the wording of the decision in the last paragraph.
 
What We Decided
We made the following decision(s)........
We reviewed the evidence received and determined your service-connected condition(s) hasn't`t/haven`t increased in severity sufficiently to warrant a higher evaluation." NOTE: If you wish to claim service connection for an eye condition as secondary to your hypertension, please submit a claim on a standard form."
I was wondering if the rating was trying to hint to a compensable eye injury that i could claim?
 
(2) On another C&P, the NP filled out the DBQ and answered the question:
3. Renal dysfunction
b. Does the Veteran have any signs or symptoms due to renal dysfunction?
 [X] Yes [ ] No If yes, check all that apply: 
[X] Proteinuria (albuminuria) [X] Constant
 
 c. Does the Veteran have hypertension and/or heart disease due to renal dysfunction or caused by any kidney condition?
 [ ] Yes [X] No
 
In my VA treatment records there is evidence of 20% disability for hypertensive vascular disease, left ventricular hypertrophy, "Hypertension with nephropathy - poorly controlled."
Am I interpreting the question incorrectly ( c. Does the Veteran have hypertension and/or heart disease due to renal dysfunction or caused by any kidney condition?) to mean: Is there other renal dysfunctions caused by CKD? And should the NP have checked "YES" to that question?
 
Any feedback would be greatly appreciated.

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Renal disease IS kidney disease:

https://medlineplus.gov/kidneydiseases.html

When is the last time the VA checked your glucose?

Do you have a copy of your VA medical records?

The decision stated "Hypertension with nephropathy - poorly controlled."

 

"Hypertensive Nephropathy is a disease of the kidneys."The vasculature of the kidneys is damaged with an increase in blood pressure (high blood pressure)."

https://www.myvmc.com/diseases/hypertensive-nephropathy/

I hardly think the NP was qualified enough to opine on this C & P exam.

What treatment does the VA give you for the hypertensive nephropathy?

Have they made any increases or to your HTN medications?

Can you scan and attach the rationale part of the decision ? (Cover C file,name ,prior to scanning it)

When is the last time the VA gave you a CT scan of your kidneys?

 

 

Edited by Berta

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Forgot to add:

NOTE: If you wish to claim service connection for an eye condition as secondary to your hypertension, please submit a claim on a standard form."
I was wondering if the rating was trying to hint to a compensable eye injury that i could claim?"
 
The VA knows perfectly well that hypertension, and renal involvement as well as diabetes, can lead to many types of eye conditions, most specifically glaucoma...
 
What is the diagnosis of the eye condition?

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Berta,

                Thank you for your prompt reply, I do have a history of diabetes from 2003, I also have a history of uncontrollable hypertension since 1981 and to date take six different medicines to try a control it. Service connection for hypertension started in 1980 ( diagnosed in 1978 in service, 23 years before dmII was detected.

After filing for ckd secondary to hypertension. I received a C&P report in 01/03/2017 from Nurse Practitioner, on opinion if chronic kidney disease secondary to service connected HTN.  Her Rationale: In review of VA treatment records Nephrology note 11/30/2016 annotated chronic kidney disease "due to" type 2 diabetes mellitus. Therefore it is less likely as not the Veteran's chronic kidney disease stage III/IV is proximately due to or result of his service connected hypertensive vascular disease. The Rationale quote, supporting her rational is really from the endocrinologist (diabetic doctor who saw me one time) not the nephrology doctor. Endocrinologist surmised that my stage III renal problem was because I had diabetes since 1981 ( which is in his treatment notes, which in incorrect) ( dmII started in 2003).  

Nephrology doctor stated on 30 Nov 2016 @ 13:40: " diabetic nephropathy with hypertensive nephrosclerosis", rationalized it was a combination of both htn and dmII.

Nurse Practitioner`s rational mixed up the diagnosis of the endocrinologist with that of the nephrology doctor.

            I`ve been service connected for hypertension since 1981, didn't develop dm II until somewhere around year 2003. Had high creatinine levels in 1995 of 2.4, which are pre-diabetic era.

 There are statements by two other doctors in my treatment records stating:

            (1)("Note Title: NEPHROLOGY PROGRESS NOTE: diabetic nephropathy with hypertensive nephrosclerosis. But will check proteinuric w/u next visit."

            (2)("Emergency room: 03 May 2016 @ 1336, YOUR DISCHARGE DIAGNOSIS: Diabetes (your hemoglobin a1c was 9.5% which is above the goal of 7) High blood pressure, TIA (Mini stroke) Kidney disease likely from your blood pressure and diabetes").

I have tried to get my C-file since 07/2016, but have not received them to date. Before I file an appeal, I would like to go through all my files for addition information.

Kidney scan showed: Unremarkable sonographic evaluation of the kidneys with no

evidence of hydronephrosis.

Va decision:

            Issue/Contention

diabetic nephropathy (claimed as kidney condition) ***"wrong, I claimed ckd secondary to htn"

Explanation

·         The evidence does not show that diabetic nephropathy (claimed as a kidney condition) is related to the service-connected condition of Hypertensive vascular disease, nor is there any evidence of this disability during military service.

·         Your service treatment records do not include evidence of treatment for or diagnosis of a chronic kidney condition during service. Your treatment records from the Northern Florida VA Healthcare System show you was diagnosed with diabetes mellitus with renal(kidney)manifestations in May 2003. There is no evidence of a link between this condition and your service connected hypertensive vascular disease. In the report of your examination of January 3, 2017. the examiner confirmed the diagnosis of diabetic nephropathy and expressed the opinion your current kidney condition is less likely than not related to your Hypertensive vascular disease and more likely than not caused by diabetes mellitus.\Because the available evidence does not show your current kidney condition began during or was caused by service or is secondary to a service connected  condition, service connection cannot be granted.

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If they did not consider the entire reason given by the Nephrologist they were wrong. You should note that and request a reconsideration.

They have to consider your entire medical history, not just parts that fit what they want to deny for. If they did not give a reason and basis for all the other mentions in your med file that details that both DMII and Hypertension are both causes, then they made an error. They have to give the reason and basis for why they did not include all relevant information in coming to the conclusion that they made, if not, it will be overturned.

Reconsideration is not official at this level but they do it, and if you had a valid CUE (they failed to use the whole medical record) then they will take 3-4 months to correct the initial mistake before you get another answer. Meanwhile the time keeps ticking, you have 1 year to file the appeal. Document every incidence they failed to discuss in your decision with the date and time and summarize the content for them. IF the C&P examiner screwed up, document that as well, detailing the exact contradictions between your medical record that the examiners report.

I had some 8 different qualified medial professionals (including specialists) that contradicted the C&P examiner. They didn't even open my VA medical record even though I documented the dates and times of treatment for them. They just read the top sheet and concluded that the C&P examiner did his/her job. After I filed a statement on the case they did the reconsideration and gave me everything because  it was all documented. Once you document the errors they made, they dont want to let it go to the BVA because they will get eaten alive by the alligators.

 

I found this on MEDSCAPE here

I found this on MerckManuals here

Edited by pwrslm

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Sorry for the bold, not trying to shout, tried to turn it off??

pwrslm,

 I appreciate your response, very helpful with the research websites. What I`m looking for is some information that will require the VA to recognize the fact that the service connected Hypertensive Vascular Disease existed for 38 years and DMII started 14 years ago. Would getting an IMO be enough to refute the VA negative decision. In addition, 

n.  Granting SC for Arteriosclerotic Manifestations Due to Hypertension

If additional arteriosclerotic manifestations are subsequently diagnosed in a Veteran with SC hypertension, grant SC on a secondary basis through the relationship to hypertension for any of the following

 

·   cerebral arteriosclerosis or thrombosis with hemiplegia

·   nephrosclerosis of the kidneys with impairment of renal function, or

·   myocardial damage or coronary occlusion of the heart.

 

Important:  A claim for benefits is required to adjudicate a secondary SC claim for any of the arteriosclerotic manifestations.

 

Notes: 

·   Do not address SC for the above-listed cardiovascular conditions through the relationship to the hypertension when a sympathetic reading of the claims does not show a claim for SC for a heart condition. 

·   Arteriosclerosis occurs with advancing age without preexisting hypertension, and may occur in some younger individuals who are predisposed to arterial changes.

·   The existence of arteriosclerosis does not imply/indicate prior hypertension.

 

References:  For more information on

·   secondary SC, see M21-1, Part IV, Subpart ii, 2.B.5

·   intent to file and informal claims, see M21-1, Part III, Subpart ii, 2.C.1

·   reopened claims, see M21-1, Part III, Subpart ii, 2.D, and

·   claims for increase, see M21-1, Part III, Subpart ii, 2. E.

 

Does this section apply to my case, where i have a  arteriosclerotic manifestation ( nephrosclerosis of the kidneys) but is consider not applicable because I have DMII? And is there any case law that defines the application?

Thank you.

 

 

Edited by cetay
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