hypertension Standard Medical Principles Helped

[Berta]

Yesterday I posted here somewhere:

http://www.va.gov/vetapp05/files2/0509919.txt

The claim was based on getting SC for stroke residuals.

The veterans had established his CAD and HBP etc were service connected but this claim was for residuals of a stroke that he claimed resulted from the SC conditions.

The BVA made this point:

"2. Medical literature establishes that diseases for which

the veteran has been granted service connection, including

hypertension, coronary artery disease with a history of

myocardial infarction, cardiomyopathy and congestive heart

failure, are major risk factors for stroke (cerebrovascular

accident), and the record discloses no opinion that the

veteran's stroke was due to any disorder other than the

service-connected disabilities."

The BVA itself can use medical treatises or any standard medical principles at all to support their opinion.

I dont think the ROs read medical treatises- they sure never readmine regarding my AO death claim-

but IMo doctors use them and the BVA recognizes their validity.

The point the BVA is making is a good one-

if you have a condition that is medical associated in the standard medical community to a SC condition--without any VA opinion that contradicts this with medical rationale- the medical facts as a potential association should be acceptable to VA as prime facie evidence that the secondary condition is due to service.

In my case -I had to prove that my husband- with misdiagnosed(proven to VA in 1997-1998) CVAs and CAD also had been misdiagnosed with the true etiology of these conditions- diabetes mellitus.

The specific type of CVAs and also his heart disease -after carefully study of the MRIs and autopsy- and also extensive medical info on the net-I associated the clinical record and autopsy to top notch diabetes literature on the internet and

I found no other known etiology but for diabetes to have caused Rod's extensive brain and heart trauma.

I even supplied VA with photos of both autopsied brains and a heart and specifically referred them to the areas of damage labeled as to his clinical records that suported this all- and then referred VA too established medical texts and abstracts that ruled out his specific conditions to any other etiology but for undiagnosed DMII.

VA listed all of this extensive medical info simply as " internet printputs" in the evidence section of the SOC and never read the info nor reffered to it at all.

Dr. Bash-after an initial and very brief run down of my evidence- emailed me back Sounds Good! and then provided two separate opinions that supported my claim and also the extensive research I had done.

But before even contacting Craig-and then laying out the IMO fee I had certainly convinced myself that my claim was valid and supported with significant medical evidence-when he called after after he had assessed the evidence I was not surprised at all that he agreed with the claim.

Being a student in a mil school- I sure looked for the potential VA landmines as I call them- the things VA could come up with to use against the claim-

the only one that VA could have used was some other medical etiology for the diabetes other than

Agent Orange (which wont work for them)as Rod spent a year in I CORPs) or to somehow prove that the specific types of CAD and CVAs -in my husband's case-were NOT due to diabetes-

but it was a complete study of the clinical record and all medical data I could find that revealed there was no other etiology-in Rod's case- due to the ECHO result of his heart and the significant MRI narrative of his brain trauma and the complete autopsy narration.

Not all CVA and CAD has its origin in diabetes. That was the only VA landmine I could imagine and the VA expert offered "no opinion" at all that Rods CAD and CVA came from something else but diabetes-as this BVA case reflects -----as to any other potential cause or origin of his undiagnosed DMII.And of course Dr. Bash pounced on her whole IMO as "medically inaccurate" in his second IMO for my claim.

This is a long rendition here but it could help someone out there-

My point is this- A + B equals C----

If a vet has something that has a medically recognized etiology-

the VA cannot pull some rabbit out of a hat to go against the etiology-

unless that rabbit is an expert MD with a full medical rationale.And is willing to make medical history.

The above claim at the BVA involved two issues-Stroke residuals (CVA) and blurred vision.

Blurred vision is symptomatic of stroke but "developmental" and by regulation precluded from SC-per the BVA (I would have challenged that- as the blurred vision could have been evidence of diminished vision-but BVA denied that part of the claim)

The stroke was denied by the Jackson Mississippi VARO as VA said it was not related or due to the veteran's SC CAD and HBP-

Obviously this denial was not based on the standard medical principles that the BVA emphatically stated when they awarded for the stroke residuals in this decision.

Hope all that didnt bore anyone- I think this BVA case is a beauty.

Edited August 24, 2007 by Berta

[Boats]

Berta not boring thanks for the info, was looking at the VA Training Letter for cardiovascular disabilities dated July 17,2000. Do you know if this is the latest version? But here is what it says about the effects/complications of longstanding hypertension

What is hypertension and what causes it?

Hypertension is present if the diastolic blood pressure is 90 mm Hg or more or the systolic pressure is 140 mm Hg or more, or if both are present. In isolated systolic hypertension, the systolic pressure is 140 mm Hg or more, but the diastolic pressure is less than 90 mm Hg. Malignant hypertension is a severe form of high blood pressure that, if left untreated, usually leads to death in 3-6 months.

For rating purposes, we consider isolated systolic hypertension to be present if the systolic pressure is 160 or more. The level of blood pressure considered to be normal has been progressively lowered in recent years.

Some risk factors for essential hypertension (hypertension without an underlying cause) are:

smoking

dyslipidemia (abnormal serum fats)

family history

obesity

sedentary lifestyle

high salt intake.

In a few cases, known as secondary hypertension, there is a specific underlying cause, such as renal artery stenosis, pyelonephritis, glomerulonephritis, or other kidney or adrenal gland disease, or a congenital coarctation (narrowing) of the aorta.

What are the symptoms and complications of hypertension?

Most people with hypertension have no symptoms. However, with long-standing or untreated hypertension, there may be damage to certain end organs (eyes, kidneys, heart, brain), resulting in symptoms such as headache, blurred vision, fatigue, shortness of breath, chest pain, and many others.

What are the effects/complications of longstanding hypertension?

 heart - left ventricular hypertrophy, CHF, stasis thrombi in left atrial appendage and apex of LV (that may embolize), CAD, MI.

 aorta - atherosclerosis with aneurysm, thrombosis, emboli, occlusion of branches causing peripheral arterial disease.

 brain - cerebral infarction or hemorrhage (stroke), TIA, berry aneurysms, hypertensive encephalopathy.

 kidneys - nephrosclerosis in the kidneys.

 eyes - retinopathy with edema, hemorrhages, and possible papilledema.

 lungs - pulmonary edema

[Berta]

That is a very good question-

This is the most recent Schedule of ratings for Cardiovascular disease at the VA web site-is at

http://www.warms.vba.va.gov/regs/38CFR/BOO...ART4/S4_104.DOC

However NVLSP in the 2006 edition of the VBM refers to the VA Training letter dated 2007-re Cardiovascular conditions-as to the METS ( metabolic equivalents)

I dont have a link to that- does anyone else?