hypertension Appeal On A Hypertension As Secondary To Diabetes Claim

[Ruffcreek]

I am a Viet Nam combat vet who served in V.N. during the late 60's.

I have a 60% combined rating from tinnitus, PTSD, and diabetes type II.

In 2006 I submitted a claim for hypertension as secondary to diabetes and was denied.

I hope I am not enclosing too much information but am looking for some advice and want to include as much information as possible.

REASONS FOR DECISION From the VA (January, 2007)

We have denied service connection for hypertension as secondary to the service-connected disability of diabetes mellitus, type 2 with dietary restrictions.

Service connection may be granted for a disease or injury which resulted from a service-connected disability or was aggravated thereby.

At the VA examination dated July 12, 2006 your blood pressure readings were 142/88, 146/90, and 136/92. The VA examiner noted that you had elevated blood pressure readings that were observed beginning in 1997. You are currently being treated for hypertension. Your diabetes was diagnosed in approximately 1999. Your most current renal function studies at the VA Medical Center dated July 2006, were all normal. Therefore, this would show that your diabetes has not interfered with any renal function, making it unlikely that your diabetes is causing your hypertension. He stated he feels your hypertension is most likely essential in nature. Therefore, it is not likely that your hypertension is related to your service connected diabetes.

We received a physician’s statement from Dr. XXX dated December 22, 2006 in which he indicated that you were diagnosed with and began treatment for hypertension approximately one year after being diagnosed with diabetes. However, after review of all the evidence of record it is noted that your high blood pressure readings were first noted in 1997 and were being monitored at this time. You were diagnosed with diabetes in approximately 1999, therefore, it is noted that your blood pressure was elevated prior to your diagnosis of diabetes. Based on the evidence of record service connection for the hypertension as secondary to your diabetes mellitus, type 2 is denied.

The evidence does not show that hypertension is related to the service-connected condition of diabetes mellitus, type 2 with dietary restrictions, nor is there any evidence of this disability during military service as your service medical records are negative.

August 25, 2007 I filed a Notice of Disagreement with the VA.

Researching my medical records, my blood pressure was monitored at the clinic beginning in 1995. Although some of the readings were in the 150/89 range I wasn’t actually diagnosed and did not begin treatment until a few months after being diagnosed with diabetes in October of 1999.

September 2007 Doctors letter that will be sent to the VA as part of my appeal.

To Whom It May Concern:

This letter is written on behalf of Mr. XXX whose date of birth is XXXX. Mr. XXX was diagnosed with Type II diabetes in October of 1999. His diabetes requires a restricted diet and oral hypoglycemic agent. Shortly after diagnosis of the Type II diabetes Mr.XXX was also diagnosed with hypertension. This occurred about a year later. It is my opinion that it is as likely as not that the hypertension cardiovascular difficulties are linked to both his Type II diabetes and post traumatic stress disorder related to his service during the Vietnam War. Mr. XXX was known to be exposed to Agent Orange during the war and there are some recent studies of Vietnam veterans showing evidence that they had elevated rates of hypertension compared to those who were not exposed to Agent Orange.

Sincerely,

Dr. XXXX

Questions: First what if anything should I have my doctor change in his letter before sending it in?

Second, does anyone know of any studies that have been done for hypertension as secondary to diabetes?

Third, any court cases that would provide some support to my situation?

I have also been told that 38-CFR 3.105a, Clear and Unmistakable Error, and 38-CFR 3.102, Doctrine of Reasonable Doubt might be something to use in my appeal.

Again I hope I haven’t made this too long but I am trying to put my case together the best I can and would sincerely appreciate any information on the above.

[john999]

I can tell you that your denial due to being diagnosd for DMII two years after the HBP is very common tactic by the VA. You may very well have had high glucose readings before the actual DMII diagnosis. I think there are plenty of studies linking HBP to DMII. Just keep appealing this thing.

[bob_abad]

Ruffcreek,

"Hang in there and keep trying" as John999 indicated. Lots of help from this forum. Berta, etc.. I also have a NOD for Hypertension in progress. I was approved with DMII from long term AO effects late last year. I was encouraged by a fellow VN vet as I thought applying for C&P with VA was or would be a waste of my time. I work in the IT field(3 decades now) and very familiar with behind the scene or back-end computer/automated processing. If IRS, State or Medicare & other FED. agencies can process "millions & millions"" of data request from diff. applications effectively, why can't the VA system perform similarly? I personally believe lots of improvement still needed within VA system SOP. Consider that they are processing less data volume compared to others. Their internal processing templates or tactics can be improved also. I am still scratching my head as to how we can waste almost 650 billion(1 trillion very soon!), at which majority of $$$'s spent in Iraq since Y2003, and not prioritizing in helping out the aging VN vets????

FYI..

> I hand carried my NOD in the VARO office few months ago, and had it date stamped for CYA purposes. Never trusted sending by mail.

> If denied again, I will seek assistance from my county VSO as per advised.

Here's a latest report(internet) of Hypertension from AO exposure:(07/27/07)

http://www.medicinenet.com/script/main/art...rticlekey=82875

The party with VA is just beginning! There will be more frustrations from our young generation VETS from the Persian Gulf/Afghanistan/Iraq exp..

From Bob,

1966-1967; 4th Div; Central highlands(Pleiku<=>Cambodian border)..

[Berta]

John is correct- and Diabetes is often underdiagnosed and not treated until major complications like heart disease show up-

The ADA has had many ad campaigns on TV and the net as too estimates that 6 million Americans could have diabetes that is not diagnosed or treated yet-

If I were you I would do as he suggested and see if your medical records reveal high glucose prior to the actual diagnosis.

The VA sometimes gives the date of a C & P exam for formal diagnosis of diabetes- this is incorrect-one does not catch DMII at a C & P and those claims should be aggressively Nodded for the correct date.

If you have atherosclerosis which has been diagnosed that too is most likely due to the diabetes and could be the cause of the HBP.

[Guest terrysturgis]

Ruff, I was also denied HTN as secondary to DMII based on the fact that HTN was diagnosed before the DMII therefore my HTN was essential in nature. I dropped my appeal as I opened another door to get to 100% P&T.

Do you have any of the symptoms of Pereperhial Neuropathy? Pain in your hands or feet, lack of sensitivity to hot or cold, etc. In my claim I was awarded as follows: 40% lower body bilaterial, 20% upper right and 10% upper left plus bilaterial.

Do a search on the PN and one thing for sure is your PN will not be diagnosed before your DMII.

I should mention that I am 40% DMII, 10% tinnitus and the rest is PN for a total of 94.5% and I am paid TDIU. Good luck with your claim. Terry Sturgis

[Ruffcreek]

John-Bob-Berta-Terrysturgis

Thanks for your replys. I appreciate all the help I can get.

One additional question regarding the diagnosis of the HBP. I did have elevated readings before diagnosis of the diabetes, however I was not diagnosed with HBP and did I start medication until close to 1 year after diagnosis of the diabetes. Shouldn't the VA use the date I was diagnosed with HBP instead of the date my doctor started monitoring it?

Just trying to learn from this if you or anyone else can give me an opinion.

Thanks,

Ruffcreek

[Berta]

"however I was not diagnosed with HBP and did I start medication until close to 1 year after diagnosis of the diabetes. Shouldn't the VA use the date I was diagnosed with HBP instead of the date my doctor started monitoring it?"

I certainly see your point-

and "cardiac difficulties" ?

If you have cardiac problems linked directly as due to the DMII- this should be claimed as secondary-

The doctor's statement is good -however I suggest you read my post on Getting an Independement Medical Opinion"

under the search feature at top of hadit page-

would he be willing to expand on the cardiac difficulties?

Do you have atherosclerosis involving your heart that he could directly attribute to DMII?

Do you fit into any rating for heart disease as secondary to DMII within

http://www.warms.vba.va.gov/bookc.html#i

Look under Cardiovascular Sec 4.104

Your doctor needs to consider the VA DMII training letter also as to making sure VA is aware of any secondary complications you have-such as PN, ED, etc due to the SC DMII.

The VA DMII training letter also is here under the search feature. if you cant find it let me know.