hypertension C & P

[mssoup1]

I have a couple of questions concerning 2 c & P my husband had.

The first was for erectile dysfunction. While I am trying to explain that he did not have this problem until he started taking medication for his PTSD, the examiner jumped down my throat and told me that he really didn't care what he had taken in the past. Any medication which would have caused this that he had previously taken would have corrected the ED problem shortly after being taken off that medication. He told me he only wanted to talk about what he was taking now. I told him that I should know better than anyone else when and why this problem occured since I am married to him. For some, maybe the ED problem does clear up after being taken off the medication, but his did not. I told him that medical record after medical record showed that he was constantly being warned of the side affect of ED with the medication that they would try him on. Before he took my husband back to examine him, he hugged and apoligized to me for screaming at me. I teared up and told him he didn't understand how this problem has affected us. I guess this is a quick denial for us, and I sure did not appreciate the way I was treated by him.

The next C & P was for hypertension. When I told the examiner that his blood pressure was normal on entering the military and was 130/90 at separation, she told me that the diastolic number 90 was not considered abnormal during the year of 1969. I also told her that the doctor that he stopped seeing the doctor he had been seeing since he left the military and started seeing another doctor. He had his records transferred to this doctor. We could not get the records from the first doctor because they stated they had been purged, but the doctor he transferred to wrote in his record that "his BP was elevated - has been up x yrs for diastolic - seen by Dr. .... years ago for this." This note was written in 1990. He also has been on blood pressure medication for years. We also have a record from 1977 from the VAMC that showed his blood pressure was 150/100 and diagnosed with hypertension. I also thought that the examiner was to give the veteran 3 separate blood pressure readings. She gave him one sitting and one lying down. When we inquired about the third reading, she said that she was going to use 2 from previous visits to the doctor. So, I guess this is another denial.

Anyone have any input on these issues which may help.

Thanks

[john999]

If denied get a board certified urologist to do you IMO since the VA just used a primary care doctor. You have to trump them with expertise. You beat them by providing expert medical opinions from those with higher certification.

[Guest terrysturgis]

Missoup, I hope you went to the release of information office to get yourself a copy of the C & P,s. As for now and in the future it helps to know what the C & P examiner has reported. Terry Sturgis

[mssoup1]

Thanks for all of the replies. I do go and pick up all of his progress reports, etc. on every visit he makes to the VA. Amazing what you learn from these reports. Sometimes I think that they have confused my husband with a veteran before or after he was seen, because some of what is written in his record wasn't even discussed in the visit. I know because I always go with him and stay with him during the entire exam. We tried to get this corrected by going to the Patient Advocate, but she told us to work it out with the doctor. If we still had problems, then come back to see her. If we could have worked it out with the doctor to begin with, why does she think we wasted our time to wait outside her office to speak to her.

I am waiting on the results from his C & P. The examiner went out of town for a week, so I have no idea when he will do the write-ups and get them into the system in order for us to get a copy. I intend to review these with a microscope because I think I have a long battle ahead of me. I think just the attitudes alone told us that these claims were going to be denied. It appeared that before the exam even started, they had already made their decision on how they were going to handle these. I'm use to fighting to get him what I feel he rightfully deserves and I have no intent of letting up now. We do have a SO, but the last two times I have spoken to him, he had to end the conversation because he had other things to do. This is why I have and will continue to handle my husbands claims myself. Even though he is of no help, the record does show that my husband is being represented by a SO, which seems to be what the VARO wants to see.

I have another question. Is there a C & P exam form for the doctor to use when doing an examination for hypertension. Also, I thought that if the veteran did have a long standing problem with hypertension, then the examiner needed to take his BP three times and document those readings. When the examiner came into the room, she told my husband that she needed to take three readings of his BP. She then proceeded to take one standing and then one lying down. When he asked her about taking the third reading, she stated that she was going to use a couple of readings from his past doctor visits. I think the reason she did this is because both of the readings she took while he was in the exam room were both high and she needed other readings to help tip the scale on the negative side for him. If three readings are a requirement, I cann call her hand on this.

Thanks so much for your help and support. Right now I need all the help I can get. My stress level is working on overload.

Thanks again

[Guest Berta]

Thanks for all of the replies. I do go and pick up all of his progress reports, etc. on every visit he makes to the VA. Amazing what you learn from these reports. Sometimes I think that they have confused my husband with a veteran before or after he was seen, because some of what is written in his record wasn't even discussed in the visit. I know because I always go with him and stay with him during the entire exam. We tried to get this corrected by going to the Patient Advocate, but she told us to work it out with the doctor. If we still had problems, then come back to see her. If we could have worked it out with the doctor to begin with, why does she think we wasted our time to wait outside her office to speak to her.

I am waiting on the results from his C & P. The examiner went out of town for a week, so I have no idea when he will do the write-ups and get them into the system in order for us to get a copy. I intend to review these with a microscope because I think I have a long battle ahead of me. I think just the attitudes alone told us that these claims were going to be denied. It appeared that before the exam even started, they had already made their decision on how they were going to handle these. I'm use to fighting to get him what I feel he rightfully deserves and I have no intent of letting up now. We do have a SO, but the last two times I have spoken to him, he had to end the conversation because he had other things to do. This is why I have and will continue to handle my husbands claims myself. Even though he is of no help, the record does show that my husband is being represented by a SO, which seems to be what the VARO wants to see.

I have another question. Is there a C & P exam form for the doctor to use when doing an examination for hypertension. Also, I thought that if the veteran did have a long standing problem with hypertension, then the examiner needed to take his BP three times and document those readings. When the examiner came into the room, she told my husband that she needed to take three readings of his BP. She then proceeded to take one standing and then one lying down. When he asked her about taking the third reading, she stated that she was going to use a couple of readings from his past doctor visits. I think the reason she did this is because both of the readings she took while he was in the exam room were both high and she needed other readings to help tip the scale on the negative side for him. If three readings are a requirement, I cann call her hand on this.

Thanks so much for your help and support. Right now I need all the help I can get. My stress level is working on overload.

Thanks again

I believe the VA always takes 3 HBP readings -standing, sitting, and lying down readings.

Three VA HBP readings always pop up in BVA decisions involving hypertension

Yet I cannot determine- from your post- what your husband got a C & P for-

was it specific to just HBP or to cardiovascular disease?

I guess what I am failing to understand is- your husband has PTSD, he also has ED,

are you trying to service connect the hypertension to PTSD?

[Guest Berta]

I believe the VA always takes 3 HBP readings -standing, sitting, and lying down readings.

Three VA HBP readings always pop up in BVA decisions involving hypertension

Yet I cannot determine- from your post- what your husband got a C & P for-

was it specific to just HBP or to cardiovascular disease?

I guess what I am failing to understand is- your husband has PTSD, he also has ED,

are you trying to service connect the hypertension to PTSD?

I found it!!!!! dont know how I missed this-I looked all over the C & P list and couldnt find it at first- here is the hypertension C & P-

I certainly agree with your point:

http://www.vba.va.gov/bln/21/Benefits/exams/disexm31.htm

Looking over my husband's med recs I noted he also got 3 readings of HBP at C & P exams.

You could use the actual worksheet and the subsequent C & P report to rebutt any unfavorable findings.

If you claim the HBP is causing the ED- which is medically possible- I believe-

you would have to get the HBP service connected to the PTSD-

it has been done- it takes a strong medical opinion that states there is no other know medical etiology, but for the veteran's high levels of stress and anxiety (PTSD) that is causing the veteran's HBP.

Medical documentation of anxiety attacks could be good evidence of that, and an opinion showing the link to the SC condition.

[mssoup1]

Berta,

Thanks for giving me the link for the hypertension exam. According to it, he should have been given 3 BP readings. He has had ongoing hypertension, but no cardiac disease that he knows of. I don't understand why she did not following the C & P exam form for hypertension and take the 3 BP readings instead of only taking 2 and then stating she would use several from his previous medical records. The two readings she gave him was high. Makes you think she is handling it this way to justify a denial. She did send him to X-Ray for a chest x-ray and to the lab because she stated that his previous lab work showed that his potassium was low. What does this have to do with his hypertension claim?

I originally put in a claim for hypertension based on his blood pressure reading that was documented at the time of his entry into the military and that on his separation papers. His blood pressure reading was fine when he went in, but was 130/90 when he got out. No where in his in-service military records did it show that they ever took his BP at any time he went to sick bay. They only treated and documented what he was there for and sent him on his way. After all, they were at war and they were lucky to get anyone to even look at them to treat the visible problem. He told me that in order for them to get that low a reading at separation was that he had to wait and was given a BP reading several times. I guess they felt that this was an exceptable reading for separation. The AMA states that this reading is considered hypertension and should be monitored. No one told him anything. After he got out in 1969, he had to go to the doctor for something and that is when he was told that his blood pressure was high and they put him on medication. He stayed with this doctor for a long time. In 1977, he does have a C & P record which states he had hypertension. Along the way, he changed independent doctors and had his records transferred to the new doctor. Later on, when we tried to get his records from the first doctor, they stated that they no longer had the records and that they had been purged. This means we cannot get the first date that he saw this doctor. The doctor he transferred to did put in his records that the patient had had HBP for X years and that he had seen Dr. ? years ago for HBP.

He has been treated for a number of years now for HBP and, again, has been on medication. He continues to have high readings, even though they have him on medication. His C & P exam verified the HBP.

I stated in the claim that his reading at the time he entered the military showed his blood pressure was normal. Even though the word "hypertension" was not spelled out on his separation papers, his blood pressure reading was 130/90 which is considered high. We could not retrieve the records from his original doctor, but we do have a statement in his medical records from the second doctor that he was treated years ago by this doctor for HBP. He even has fairly recent medical records from the VAMC when his BP reading would be ?/90 they stated hypertension. My argument is that he had HBP when he left the military, period. When I tried to tell the examiner of his blood pressure reading at separation and to show her the medical records of where he had been treated for years for this, she did not even want to hear it. She claimed that the 130/90 blood pressure reading was normal back in 1969 and even though one of his doctors had stated that another doctor had treated him for years for HBP, he didn't say how many years ago. I think with the evidence presented, my husband should at least be given the benefit of the doubt on this. After all, she cannot even read an exam form which told her to take 3 BP readings and she only took two.

When he went before the Board of Veterans appeals, they wrote in their remand that he was seeking a claim for hypertension based on his reading at his discharge and also that it was secondary to his PTSD. I'm not sure where this came from. Maybe during the BVA hearing a discussion came up that it was possible that his blood pressure problems were still high due to his PTSD, also. I'm not sure. Anyway, I am so confused on which way to go. I'm waiting on his C & P results from his PTSD and hypertension exam to see what they wrote and then take it from there.

The BVA remand stated "The record reflects that the veteran has not been afforded a VA examination addressing the etiology of his hypertension. Given his blood pressure reading at discharge, the elevated blood pressure readings within several years after service, and his current treatment for hypertension, the Board concludes that such an examination is warranted." They also stated that they wanted the examiner to state whether the hypertension is etiologically related to his service, or was present within one year of his discharge therefrom. The examiner should also provide an opinion as to whether it is at least as likely as not that the hypertension was caused or chronically worsened by the veterans service conncted PTSD.

I know this is a long posting, but while I may get some insight from some of you on what to do or the direction to take, I am hoping that by detailing his situation it may help someone else who is fighting for this same problem.

Thanks to all.

P.S. Since this is such a detailed discussion on this one issue, I will make sure I let everyone know the outcome so they will have a better insight on how this claim started, how it was handled and the end results.