dav_marine72

Hi Ricky, I understand what you are saying but here is my comeback. When I first was diagnosed with HBP I was immediately put on medications. Since that time which was 1997 the VA states I have had sporadic diastolic blood pressure readings of a 100 or more. They state I have had no readings of systolic blood pressure over 160 which now is not the case. It may have been in 2004 I'd have to look. Since I have been on medications since 97 and have had readings over 100 and many in the high 150s / 90s range wouldn't that point to evidence that if I didn't take the medication my readings would have been over 160/100. Do you see my point? Since I got put on meds so quick there really is no evalaution period to look at. Since the rating states: Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. There was no chance for th history and I have been on continous medications - furthermore the rating states - Note (1): Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. I have a ton of readings with my diastolic pressure over 90mm. The 100mm readings have been confirmed by readings taken more than twice and on more than three days. I fully understand how you are looking at it as is the VA but I think based on what I have wrote it should tip the scales. I also have seen many BVA cases that have less weight than mine get 10%. That is probably where this is going so maybe they will decide in my favor. Although they screwed once already. Thanks for your time!

Are you talking about the VA? If so I'd fight them to the death over that. Give them hell and if they won't give you an appointment go talk to the patient advocate at the facility. More VA BS!

Hi Everyone, I have filed a claim for loss of a special organ based on my erectile dysfunction from my sc back and the medications I take. It looks like if I can win this claim I will be entitled to special monthly compensation at $91 a month. My question is how intrusive is the C&P exam going to be? Has anyone else gotten this connected based on their back and or medications they are on? What was needed for evidence? Thanks.

Here is the decision DRO_2004_Decision_part_1.pdf

Thanks for Everyone's comments, Here are the answers: I'll start with Ricky because that will lay the history out. I am service connected and it is secondary to my back. You will see in my decision that a doctor I was seeing in 1997 stated he thought the HBP was due to my chronic back pain. I did have a hearing after this decision came out with the DRO and DAV. DAV stated I should have been rated at least 10% because of my meds which is the norm. The DRO said I should have never been service connected in the first place but since the RO gave it to me I rated 10%. Of course after my hearing I was shot down for the 10%. I have had no work ups on my heart. My PCP at the VA said she will keep me on HBP meds unless I lose 30 lbs which would get me to 190lbs. The only reasons my readings are normal now are because of the pain meds, sedative, and anti-anxiety I explained earlier. I did go through and find all the readings that I think rate me 10%. I submitted them even though the RO had them in their possesion. I did the ABC thing for them. They still screwed me. Thoughts?

I hear you John. Right inline with my thoughts. Thanks for the post.

Hi Everyone, I am looking for help to get my BP SC to 10%. I am sc secondary to my sc back condition. It's been on appeal since 2004. I have been on blood pressure medicine almost continuously since 1997. Back in 1997 my readings were consistently 150/95 with an occasional reading over 160 and a couple of 100s with many high 90's. Since then I had consistent 150-160 / 90-100 up until about 2004. I definitely had two or more readings taken on three or more days that were equal or above 160 or 100. In 2004 I started taking sedatives and anti-axiety meds for my sc mental condition. Then in late 2006 I added pain killers. Well the cocktail of it all puts me at an average of 115 / 80 now. Based on the rating criteria I would seem to rate 10%. They ahve all this evidence I have described above yet rate me 0% based on good ratings over the years. Anyone had a similar stituation? Thanks. Here is the rating criteria: Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control 10 NOTE (1): Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm.

Hi Everyone, I have had two IMO's performed by Dr. Bash. The first one cost for $2000 and the second cost for $1000. The first addressed my 20% back rating and my 0% testicle pain which is rated as a urinary infection. My local VARO discounted his IMO and chose to deny any higher rating for either. Once I got sent to the BVA I had him do the second letter. This one again addressed my back and testicle but also my 0% high blood pressure. He discredited the VA raters and offered different diagnostic codes for my back and testicle which would favor me. The BVA report didn't mention Dr. Bash at all. No first letter, no second letter. They also left out a bunch of positive evidence for higher ratings. Once my lawyer gets my c-file is going after them based on no mention of Dr. Bash and not doing a through workup of Dulca. So far $3000 for nothing but I guess we will see after the VAAC ordeal. Based on what the BVA did to me I am thinking if I didn’t have Bash I would be screwed. Good point about not having the money to pay. I am very fortunate that I had it. That is if it pays off.

Thanks hurryupandwait, Both the RO and BVA did consider the earlier ratings for me. My service connection goes back to 2000. It didn't leave the RO until 2005. I should be rated under the old DC 5293 intervertebral disc syndrome. Dr. Bash wrote 2 IMO letters for me explaining why I should be backed with my evidence and how he disagreed with the RO rater. All I have seen from the RO and BVA since 2000 for my 8+ service connections is evidence addressed in SOCs, etc. that help them rate a VET lower. I have never actually seen them balance the evidence and make a decision based on that. Probably because if they put all the pertinent evidence on the table they would look even more ridiculous denying us. It’s easier to lie and pretend it’s not there. As far as mental goes I have 30% SC for adjustment disorder secondary to my back. This is on appeal still for the original rating. It’s kind of funny I rate more for my mental condition than my back. As far as a separate connection for the sexual dysfunction I can still get an erection but I can’t have sex because the pain is so bad. I don’t know if that rates or not. I figured it was only if you couldn’t get it up. Then again how do they know? Thanks.

Yes I am. Thanks Berta!

I agree with that but my main deal is the back. Even if I could get the code changed for the gonad I'm only looking at 10% possibly. The back however is at 20% orth and 10% neuro. I am on oxycodene 4 a day for the pain, ativan 3 times a day, buspar 4 times a day for the panic attacks for secondary mental from the back. There biggest kicker with me is the bending. I took yoga for a few years and had some good bending. Stupidly I guess I shouldn't have bent so far. Now that's all they seem to look at. Thanks.

Sorry forgot to upload Dr. Bash's first IME.

Hi Berta, I don't mean to be a thread jumper but I posted a question in the Appealing Your Claims NOD DRO BVA USCAVC forum and was asked for some more information. If you have a chance to look I have posted Dr. Bash's second letter and more evidence there. Thank you for your help and support!

Hi Carlie, I had been talking with Berta and some others under the research section on some of this too. Here is the link to my BVA decision: http://www.va.gov/vetapp08/files1/0808584.txt I am attaching evidence I believe should have been sued to tip the balance. The only piece of information used in this evidence I am uploading was a reference to my supervisor about needing to stand in meeting. As you can see from her letter they didn't mention the 12 weeks out of work, can't drive, sit or stand, and had to leave the office early. None of the other evidence was mentioned as far as I can tell. Almost like someone lost it. The first letter from Dr. Bash which was an IME the RO quoted in their decision to deny me an increase. Let me know if I am nuts. Thanks. Dr._Bash_2.pdf VA_post.pdf

Hi Everyone, Does anyone know when an RO issues a SOC or the BVA issues a decision they have to include positive evidence to show the balance was not in favor of the Veteran. Every SOC from my RO and my BVA decision mostly only talked about the negative evidence versus my pile of positive evidence. I wasn't sure if they just have to give you the evidence for denial or have to weigh it out in the SOC or decision. It would seem to me under the law for reasonable doubt and weight of evidence they should include both sides of the story and tell you how their side outweighed yours no?

Thanks John. I appreciate the understanding. Makes life hard with a wife and small children. Sometimes I feel like no one can understand me. It's nice to hear someone else who knows what I am going through. Thanks for the advice.

Hi Everyone, I did not ask them to waive the $50 filing fee. I’ll have to look for that response form. What did they want a response to? I don’t have any copies of responses to the appellate court because my lawyer has been handling it all. Her explanation of what is going on is she is waiting for my C file. She says she has never seen it take this long. She has never worked with the attorney for the VA and the woman wasn’t returning her phone calls. She finally talked to her and she said my folder had been sent back to Newington, CT RO for the copy to be made. My attorney is doubtful because she did not receive the normal admin letter stating the RO has so many days to comply. I told her it figures in my case. The VA seems to like screwing with me. Sorry for the Sept 14, 2008 confusion. I imported these word docs from a PC laptop to my MAC and they lost the created dates. The first Bash letter obviously was from 2004 because that date stayed. The second letter that says posting_mriordan was the letter I included to Dr. Bash for his second letter. The actual date he wrote the second letter was Oct 2007 while my case was at the board. The last letter posting_VA Back increase was actually sent to the local RO in March 2008 after the BVA decision. Someone told me to send that in case I lose at the appellate court to get an earlier effective date. Not sure how true that is. The secondary mental issue never made it to the BVA yet. While they were denying my increases I was fighting just for SC for the mental. They service connected me in 2005 back to July 16th 2002 for adjustment disorder. They rated me 30%. I appealed that and actually have one more exam in two weeks before it’s sent to the BVA. You can tell I have tons of faith in the rater LOL. Here is what they wrote for the 30% basis: Report of VAMC examination on Feb. 2005 indicates that you reported experiencing feelings of anxiety associated with your back pain, which you categorize as panic attacks, as well as some minor depressive symptoms, including depressed and discouraged mood, irritability and some decreased interest and motivation for your activities. You denied any compulsive behavior. Your chronic pain keeps wakes you during the middle of the night, but you denied difficulty falling asleep or other non-pain related sleep disturbances. You take Zoloft, Neurotin, and elavin daily. One the mental status examination your effect was somewhat tense, but generally euthymic with range and mood congruent. You described your mood as “not motivated” and it appeared somewhat dysphoric or discouraged. Thought process was logical with no evidence of thought disorder. You denied suicidal or homicidal ideation. Cognition was grossly intact and insight and judgment was good. Diagnoses were impulse disorder, not otherwise specified, by history, and adjustment disorder, mixed. Global assessment of functioning was 65. The 30% evaluation is found based on medical evidence which documents anxiety, depressed mood, panic attacks, and sleep impairment do to pain. The BVA did not mention Bash at all, which blew me away too. Here was how he was addressed by the DRO at the RO: Report from Dr. Bash indicated he reviewed your medical records for the purpose of rendering a medical opinion considering your spine and testicular diagnostic codes. He states that in his opinion, your spine diagnostic code of 5295 should be DC 5293 in incorporate your persistent pain, surgical consequences, sciatic nerve problems, and lumbar muscle spasms, because you have imaging documenting severe multi-level lumbar spine degenerative arthritis / herniations which are out of proportion to the natural aging process. Your hearing testimony and Dr. Bash’s opinion have been carefully reviewed and considered in conjunction with all other evidence of record. However the objective medical evidence does not provide a basis upon which to grant an increased evaluation. Lumbar range of motion documented on your latest VA orthopedic examination (flexion 80 degrees and combined range of motion 310 degrees in Sept 2004), does not support more than a 10% evaluation under current criteria. In addition, recent medical evidence, including examination in Feb 2005, does not document any neurological deficits, which could be separately evaluated. (overturned by BVA with a 10% back to 2002) Your existing 20% evaluation is continued The evaluation was initially assigned under the prior criteria based on muscle spasm documented at your VA examination in October 2000. While subsequent examinations have not documented chronic muscle spasm, the existing evaluation is confirmed based on the limitation of motion shown on your most recent VA examination combined with consideration of your increased functional limitations during intermittent flare ups which involve increased back pain, radiating leg pain, and problems with endurance such as difficulty sitting or standing for very long do to the pain. Such nice people huh? They really should have knocked me down to 10%. Funny how I’m rated more for my mental condition caused by my back LOL. The problem was I was doing yoga from 2004-2006. This made me more flexible and hence screwed me. Thanks again!

Sorry here are the files posting_Bash_Letter.doc posting_VA_Back_Increase.doc

Hi Everyone, Thanks for your responses. Sorry I went back and looked my notes from the lawyer. She stated they didn't do a proper Deluca work up. Then again she doesn't have my C file yet. The references to the private evidence were note dated 1998. I did provide them with everything because I went after the back in 2000. That is the date I am serviced from. Note my back was the worst in late 1999. I had a two level discectomy and laminectomy in Jan. 2000. Once that surgery failed I went after them. I was happy to get SC because I got out in 95 and the first reference to a true back issue was 1997. I had two mentions of going to sick bay while in for back spasms. What I noticed the BVA did was exactly what the RO did. They pointed out the evidence that supported them like the 1998 not but nothing that helped me. I had a tone of evidence from 1998-2000 stating I had bilateral back and leg pain shooting below the knee. I actually have 3 levels of DD. The of the eight surgeons I saw only one wanted to operate. One made me have a disco-gram, which showed L3-4, totally desiccated and collapsed. All the surgeon basically concluded I had 3 level DD and I would only get worse down the road and surgery would not help me. A surgeon from Yale finally thought surgery would help and I went that route. Well the first few months it was hard to tell. I was laying in bed on narcotics all day. I did physical therapy and then went back to work. The surgeon noted good recovery. A month after being back at work everything came back to a more intense degree. That’s when I went back to the surgeon. He had me do another MRI and said except for some scar tissue he did all he could do. This was why I was denied a higher rating then 20% out the gate. The rater stated the surgeon said I had good recovery. This same rater had the evidence where the surgeon says apparently the patient has not had any success from surgery and is actually worse now. I of of course appealed. So moving forward from 2002-2006 I saw everyone you could imagine, chiro, acupuncture, holistic healers, yoga everything. Nothing helped and every scrap of evidence is in the VA hands. I would miss 6-8 weeks a year of work because I would have lock ups that put me in bed for a week or more. Not to mention I couldn't run, lift, hike, or do anything I used to do. During this time I think I have 7 or so documented VA visits with locked back, a spasm, patient is angry, etc. I had been on amitripyline and other non-narcotic drugs for the pain. I had at least eight positive straight leg exams in this time but all the VA folks so no neurological deficit. I had a few bending test where I was 40 degrees or less. Taking into affect flair ups that to me would bounce me to 40% alone based on the 30 degrees rule. Just so happened because of the Yoga my bending was better at the C&P exams. Keep in mind I spent other visits going to the ER for asthma during this time. I also went to mental health visits and podiatry for my service connected feet that always hurt. In 2003 I finally broke and started having multiple panic attacks per day. I got put on zoloft, ativan, and buspar type meds. I am a strong man but I couldn't take the pain anymore. I had my psychiatrist and psychotherapist write letters stating my back and leg pain was causing me to have depression, anxiety, and panic attacks. I was service connected for adjustment disorder for 30%. With a little not stating it was temp because I would get better! I have an exam in two weeks for this one. Been on appeal since day 1. So the VA has known all along what my back did to my mental status. Dr. Bash wrote me a letter in 2004 to support my claim. I will post it here. He also wrote a rebuttal in 2007. In 2006 the mental meds weren't enough. I broke down and asked the VA for painkillers. They told me drive to West Haven if you want these meds. We don't like to give them here. I couldn't even drive to Newington because I couldn't sit. West Haven was an hour away. My wife finally told me I have to see a civilian doctor. This is when I was put on narcotics and given a referral to a pain center. Since that time my painkillers went from vics to percs, to oxys. The board knew all this because I faxed them all the notes from the pain center. Including four or more nerve blocks. The pain center doctor has diagnosed me with scar tisse and nerve entrapment at the two levels I had surgery on. My next move is to try a stimulator. The records from them have always shown the notes sharp shooting, electric pain down both legs, Lower back pain, pain constantly 9-10, can't sleep, no or little relief from nerve blocks. I also have been seeing a chiropractor for the last year straight three times a week. I know they don't look upon their word as highly but he wrote me a letter stating I am impaired neurological and orthopedic issues at L4-5, L3-4, and L5-S1. He also did an extended work up past a VA examiner showing I could only bend to 40 degrees, positive straight leg, and positive for like three other exams for neurological symptoms. No mention of any of the record since 2006 by the VA except continued pain. Again the VA picking and choosing to screw us. FYI the cane and back brace was not prescribed just a necessity. Although I think a couple of docs mentioned it. The VA did give me a tens unit. Please see Dr. Bash’s attached letters. Sorry couldn't find Bash's 2007 letter. I will post when I find. Thank you everyone. This drives me crazy.

Hi Bertha, Thanks for your time as always. Here is the link to my BVA case: http://www.va.gov/vetapp08/files1/0808584.txt

Thanks Pete. You have validated my thoughts. Unfortunately because I have little ones and day care would kill us I need to try and work as long as I can. Once my wife can go back to work I plan to stop working and go after TDIU and SS. I feel a little weak about doing that but I am also concerned that by taking all these meds and having the added stress of working I will not live to see my kids graduate high school. Thanks again.

Thanks I feel a little better now. The first thing my attorney said when she looked at the BVA and regional office decisions was why was there no mention of Deluca B)

Hi Everyone, I wanted to know if anyone has had a good experience at the U.S. Appeals court. I am not feeling good so far. The case has been there since April of this year and my lawyer has not gotten my C file yet. The VA attorney keeps telling her it's in the works. My attorney said after she gets the C file she has 45 days to find any mistakes that were made. She then sits with the VA lawyer. If they can't reach a deal I'll have to wait 18 more months for a decision. Seems insane. Anyone had luck with a deal? My case doesn't seem crazy does it? Rated 20% for degenerative disc decease and 10% for the nerve pain in my legs from it. Although I have bent to meet only a 20% rating at times (which is why they are denying me) my condition is much worse. Three levels of DD, failed surgery in 2000 with scar tissue at two levels, oxycodene 4 times a day, nerve blocks every other month, pain doctor is recommending a spinal stimulator, I take ativan and buspar 3 times a day for the anxiety and panic attacks from the severe pain, 8 jobs in 4 years (fired from a couple and left the others because they were complaining about my performance or days off because of back), pain is always a 9 or 10, miss 6-8 weeks of work a year, can't do anything at home, can't lift anything, back brace all the time, sometimes a cane, can't sit, stand or walk very long. Seems to me I rate more than 20% but who knows with the VA. Thanks.

Hi Everyone, Just wondering if anyone has any thoughts to my adjustment disorder rating. I am currently rated 30% from 2002 and have appealed that I should be rated higher. They are finally getting around to the exam now. I am rated secondary do to my service connected back. My symptoms from the start have been multiple panic attacks daily, lose of work because I have to leave based on the attacks, eight jobs in four years, some I was fired for missing time, others I quit because I couldn't get along with boss and co-workers and was being written up. I have been taking zoloft 60mg once a day, ativan 1mg three times a day (increased from .5 in 2004), buspar 20mg four times a day (increased from 10mg three times a day in 2004), and of course my four courses of oxycoden a day for the back and nerve pain. The pain has been so bad the last two years I have been crying a lot. I am consistently fighting with my wife because I can't do anything around the house. I can't watch or pick up the kids. When I do leave the house I won’t leave without extra meds because I am scared of an attack. My wife has to drive me to work because I am so doped up. When I originally appealed they stated I have some symptoms of 50% but not enough to get it. I also have a problem showing emotions and telling it like it is in these exams. Any advice on what I should do next week at the exam? Thanks.

Hey Jim, I work 40 hours a week myself for the most part. I take 4 OXYs a day. Three ativans a day for the panic attacks. The pain killers are one piece for getting a higher rating. Have you had any MRI's? Do you go to a pain clinic? Any leg or sciatica pain? How about physical therapy or surgeries? How far were you able to bend at your C&P exam? A couple of things that help me get by are bio freeze and a hydroculator. Bio freeze is a cream that doesn’t have much of a smell and will numb out your back. I have good results with it and it’s not too expensive. The hydroculator you can get at any decent full service pharmacy. It’s basically a heating pack that traps water so you get moist heat. You keep it on the stove in a pan of water and heat it up when you need it. Wrap it in a towel and it place under your back.