hypertension Hypertension...secondary Blood Clots, Copd With Lung Fibrosis/honeycombing?

[Guest morgan]

I'm helping a veteran who was treated for hypertension in service (on medication). Several years after discharge, he had multiple episodes of blood clots, one of which was a pulmonary embolism that damaged/scarred his lung. Later, he was diagnosed with COPD with emphysema--many years after service and after stopping smoking (started with military-provided cigs). The veteran says he had several different tests to rule out known blood disorders that could cause the abnormal clotting, and all of them were ruled out. One of his private doctors told him (only verbally...and the doctor is dead now) that the emphysema was related to smoking, but the COPD was secondary to hypertension because the high blood pressure damaged his blood vessel walls causing them to be susceptible to blood clots. He and a VSO wrote a letter to the VARO about the doctor's explanation, as well as submitting something found online from a medical university study supporting his claim for secondary SC. The VA service connected the COPD (didn't mention emphysema).

I want to help him but I'm confused. I thought COPD is emphysema, or vice versa, and that the cause is smoking. Anyone ever heard of this connection to hypertension?

The problem is his POA asked for a rating increase because the lung condition is much worse. Now the VARO (not the original granting office) says it is going to reconsider and sever the SC granted in 2001. Poor guy is devastated. Like many elder veterans, he didn't know until he was 60 that he could file a claim.

My question: can VA do this legally? If so, could this be an example of "failure to appropriately apply the ratings schedule" as legal grounds for CUE (to get around the interpretation of medical evidence rule)? Or is there a difference in calling CUE on itself and merely reconsidering and correcting a rating? Isn't there something about being over 55 with 5 years being rated at 100% that could help him?

Edited July 17, 2007 by morgan

[Vike17]

"My question: can VA do this legally? If so, could this be an example of "failure to appropriately apply the ratings schedule" as legal grounds for CUE (to get around the interpretation of medical evidence rule)? Or is there a difference in calling CUE on itself and merely reconsidering and correcting a rating? Isn't there something about being over 55 with 5 years being rated at 100% that could help him?"

Yes, the VA can do this legally. The VA can sever service-connection at any time when there is fraud or a CUE involved! One thing to keep in mind is that a CUE can go both ways, for and against the veteran.

"One of his private doctors told him (only verbally...and the doctor is dead now) that the emphysema was related to smoking, but the COPD was secondary to hypertension because the high blood pressure damaged his blood vessel walls causing them to be susceptible to blood clots. He and a VSO wrote a letter to the VARO about the doctor's explanation, as well as submitting something found online from a medical university study supporting his claim for secondary SC. The VA service connected the COPD (didn't mention emphysema"

If this is what transpired, I suspect that the reason why the VA wants to sever service-connection lies somewhere within this portion of the claim. The claimant and/or SO cannot make medical statements of fact unless they themselves are doctors. Also the submission of generic online articles without any reference to the claimant is not credible medical evidence of a nexus.

Vike 17

[Guest morgan]

Thanks for your help, Vike17. I see what you're saying. As far as I know, there's no indication of fraud, so what legal error constituting CUE do you think VA would cite in this case?

As I said, I thought COPD was linked to smoking and was not a secondary condition to anything else; unless, of course, something related was diagnosed and treated (incurred or aggravated) during the required service time.

Carrie

[Berta]

I assume the VA called a CUE on itself-

this is basically what they do if they see something that indicates a prior award could be wrong-

in essense the VA is saying they themselves committed a clear and unmistakable error in the decision they found error in.

He must take action on this- apparently he and his SO did-I also assume he received a letter of a proposed reduction-

they gave a distinct reason for this proposed reduction-

if they said they determined smoking and not service caused the COPD they must have full medical rationale.

He also must obtain a medical opinion that strong combats that statement (I say statement at this point because as Vike pointed out a proposed reduction can be result from a CUE a rater or someone has seen but they are not medically capable of determining ir diagnosing the etiology of a medical issue.)

It seems his nexus is not in question for HBP- but that the COPD is -as secondary SC.

SInce it appears that the HBP rating is established and they aren't messing with that-

it also seems that he has advanced atherosclerosis -most probably at a ratable SC rate, as well as the lung condition due to the embolism should be service connected as secondary to the inservice HBP.

The veteran- as I understand this post -could possible succeed in establishing the COPD as SC again-

and I suggest his SO consider filing an additional claim for SC of his pulmonary lung disease due to embolism damage as secondary to his atherosclerotic heart disease (this should be in his meds recs) atherosclerosis is a known cause of clotting-

the only one I know of)sometimes meds cause it too ---

because the atheroscerosis which caused the clotting is directly due to his service connected HBP.

There might be no medical basis for my above suggestion in this case-

Then again the clinical record could reveal exactly what I see here.Based on my studying cardiology to win my Sec 1151 claim.

Also the VA found me medically competent enough for me to win my FTCA claim.

HBP can create a pattern of damage to many vital internal organs.

atherosclerosis is a main component of that type of damage-

narrowing of the arteries due to atherosclerosis is a main cause of blood clots (embolism)

I am basing my suggestion here without the med recs-just on your post.But the SO should have them and be able to use that approach. Please fell free to give the SO a copy of my suggestion.

However the medical records and/or a good IMO will certainly reveal if this vet can not only stop the proposed reduction but ultimately get an even higher SC rating from the VA.

Edited July 17, 2007 by Berta

[Guest morgan]

Thanks, Berta!

Now wouldn't that be the cat's meow if he could get a higher rating because of having to oppose the reduction! The arteriosclerosis related to clotting is a great point. Sure makes sense.

I've dealt with some of these conditions with my husband so I'm familiar with some of it, but as far as a VA claim, each case is unique and hinges on what has already been submitted to the VA.

Once again, you offer sage advice. There has to be a spot we could build a monument to you. Of course, we all know you, you would strongly oppose that! :D (But who could blame me for thinking about it!)

Carrie

[Berta]

This article gives brief overview of what I mean:

I dont know if this vet has atherosclerosis but -more than likely he does-

I would be surprised if he didn't:

Medical Encyclopedia

Other encyclopedia topics: A-Ag Ah-Ap Aq-Az B-Bk Bl-Bz C-Cg Ch-Co Cp-Cz D-Di Dj-Dz E-Ep Eq-Ez F G H-Hf Hg-Hz I-In Io-Iz J K L-Ln Lo-Lz M-Mf Mg-Mz N O P-Pl Pm-Pz Q R S-Sh Si-Sp Sq-Sz T-Tn To-Tz U V W X Y Z 0-9

Atherosclerosis

Contents of this page:

Illustrations

Illustrations

Alternative names

Definition

Causes, incidence, and risk factors

Symptoms

Signs and tests

Treatment

Expectations (prognosis)

Complications

Calling your health care provider

Prevention

References

Illustrations

Atherosclerosis

Carotid stenosis, X-ray of the left artery

Carotid stenosis, X-ray of the right artery

Enlarged view of atherosclerosis

Prevention of heart disease

Developmental process of atherosclerosis

Angina

Atherosclerosis

Cholesterol producers

Coronary artery balloon angioplasty - series

Alternative names Return to top

Arteriosclerosis; Hardening of the arteries; Plaque buildup - arteries

Definition Return to top

Atherosclerosis is a condition in which fatty material collects along the walls of arteries. This fatty material thickens, hardens, and may eventually block the arteries.

Atherosclerosis is a type of arteriosclerosis. The two terms are often used to mean the same thing.

Causes, incidence, and risk factors Return to top

Atherosclerosis is a common disorder of the arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard substances called plaque.

Eventually, the plaque deposits can make the artery narrow and less flexible. This makes it harder for blood to flow. If the coronary arteries become narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms.

Pieces of plaque can break apart and move through the bloodstream. This is a common cause of heart attack and stroke. Blood clots can also form around the plaque deposits. Clots block blood flow. If the clot moves into the heart, lungs, or brain, it can cause a stroke, heart attack, or pulmonary embolism.

Risk factors for atherosclerosis include:

Diabetes

High blood pressure

High cholesterol

High-fat diet

Obesity

Personal or family history of heart disease

Smoking

The following conditions have also been linked to atherosclerosis:

Cerebrovascular disease

Kidney disease involving dialysis

Peripheral vascular disease

Symptoms Return to top

Symptoms usually do not occur until blood flow becomes slowed or blocked. If this happens, you may have chest pain or leg pain, depending on which artery is involved. Sometimes symptoms occur only with activity.

Signs and tests Return to top

A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Early atherosclerosis can create a whooshing or blowing sound ("bruit") over an artery.

Tests that may be used to diagnose atherosclerosis or complications include:

Ankle/brachial index (ABI)

Arteriography

Cardiac stress testing

CT scan

Doppler study

Intravascular ultrasound (IVUS)

Magnetic resonance arteriography (MRA)

Treatment Return to top

Your doctor will probably suggest a low-fat diet, weight loss if you are overweight, and exercise.

There are many different medicines used to treat atherosclerosis. Blood thinners may be given to prevent clot formation. Medications may be also recommended to lower cholesterol and to keep your blood pressure at a healthy level.

Atherosclerosis can lead to coronary heart disease (CHD). If you have CHD that does not cause symptoms, you can be treated with either medicine or angioplasty with stenting. Recent studies show that medicine and angioplasty with stenting have equal benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of coronary artery disease.

Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack

Some people may need a procedure called an endarterectomy to remove plaque build up.

See also:

Coronary artery bypass surgery

Minimally invasive heart surgery

Expectations (prognosis) Return to top

Everyone starts to develop some amount of atherosclerosis as they grow older. In some people, the condition can cause complications such as a heart attack or stroke.

Complications Return to top

Coronary artery disease

Damage to organs (such as the kidneys, brain, liver, and intestines)

Heart attack

Stroke

Too little blood to the legs and feet

Transient ischemic attack (TIA)

Calling your health care provider Return to top

Call for an appointment with your health care provider if you are at risk for atherosclerosis, especially if symptoms occur.

Talk to your doctor before starting a new exercise plan, especially if you have been diagnosed with coronary artery disease or if you have ever had a heart attack.

Prevention Return to top

The following lifestyle changes can help prevent atherosclerosis:

Eat a low-fat, low-cholesterol, and low-salt diet.

Eat fish. Adding fish to the diet at least twice a week has been shown to be helpful. Do not fry the fish, as this destroys the benefit.

If you don't like to eat fish, try a fish oil supplement.

Exercise 30 minutes every day. If you are overweight, you should get 60 to 90 minutes of exercise a day.

Lose weight if you are overweight.

Stop smoking.

Mild to moderate consumption of alcohol or wine (1-2 drinks per day) may also reduce the risk of cardiovascular events. Too much alcohol, however, does more harm than good.

If you have one or more risk factors for heart attack or stroke, ask your doctor if you should take aspirin every day. Aspirin can help some people reduce the risk of heart disease and stroke.

Work with your doctor to bring the blood pressure into the normal range. This may require medication. Follow your doctor's recommendations for treatment and control of diabetes and other diseases.

Do not take hormonal replacement therapy, folic acid supplements, vitamin C or E, or antioxidants to decrease the risk of heart disease or stroke. These methods have not been proven to prevent these conditions.

References Return to top

Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. St. Louis, Mo: WB Saunders; 2005:921-935.

Update Date: 3/30/2007

Updated by: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA, and Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network.

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Morgan-

You stated the vet said:

" the COPD was secondary to hypertension because the high blood pressure damaged his blood vessel walls causing them to be susceptible to blood clots. He and a VSO wrote "

I would try for service connection here by raising this issue as well as any connection in the med recs to what I posted before.

A claimant can raise any potential reason for entitlement to a benefit and certainly more than one.

I have three 3 claims with 3 distinct and separate medical reasons that VA could directly service connect my husband's death.

Each of these claims is separate and supported by evidence.

They are working on the AO claim now but said the had filed Motion at BVA to re-open an older claim I had on CUE basis-

This too would generate service connected death.

This is funny-the VSM agreed with one of my claims in a letter to me- she probably didn't realise what she stated-

what she stated was the exact point of that claim and what the award letter should say.

I am just holding onto that in case I need it-her statement fully service connects Rods death based on the record.

But the claim they are focusing on is the AO claim.

my point is why put one coal into the fire when you can ask for SC on more than one basis.

I hope this vet makes out OK here.

Edited July 18, 2007 by Berta

[Guest morgan]

Pieces of plaque can break apart and move through the bloodstream. This is a common cause of heart attack and stroke. Blood clots can also form around the plaque deposits. Clots block blood flow. If the clot moves into the heart, lungs, or brain, it can cause a stroke, heart attack, or pulmonary embolism.

This is it! Thank you for taking time to post this.

Yes he does have atherosclerosis, and his lung is severely damaged/obstructed from the PE. I always think it's amazing when any one survives a PE.

You answered a question I hadn't even asked yet. :D I was just thinking that if the VA calls CUE about SCing the lungs, then he should straight out ask for SC of COPD secondary to hypertension. There's no question about the hypertension service connection as he first started treatment in service and the C&P examiner noted systolic readings well over 170...on medication.

Now I'm feeling much better about this. I don't think the VA will prevail in severing SC when common medical knowledge says atherosclerosis can cause a PE--and in his case, it obviously did. Even if a veteran with hypertension was a smoker in service, a PE, which we see here is more than likely secondary to hypertension, probably aggravates emphysema as well.

One thing I learned from researching this, COPD is caused by things other than smoking. Sadly, other veterans with SC hypertension are out there with history of PE and COPD but haven't filed for SC because they were smokers. Smoking might cloud the picture but other factors may help constitute relative equipoise.