hypertension Need Critique On Statement In Support Of Claim (draft)

[71M10]

I have drafted out a response to VA letter on my current claim for service connection. It is not quite finished but I would appreciate any comments (good or bad).

In reply to VA letter dated December 4, 2007 in reply, refer to XXXXXXXXXXXXXXXXXX.

In this letter you indicate “VA needs evidence showing that the following condition(s) existed from military service to the present time:” I would like to point out this is an incorrect statement. CFR 38 Part 3:303(:o Chronicity and continuity. With chronic disease shown as such in service (or within the presumptive period under §3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. I was diagnosed with Essential Hypertension in Seoul Korea at the 121 EVAC Hospital by Captain M B, MD on 3/10/1986. 6/37 FA medical personnel did not follow the treatment plan developed.

In the 12/4/2007 letter seven bullet points are in the letter as types of additional evidence that is required I will address them in order.

1. Dates of medical treatment…. As stated earlier in this letter I was diagnosed, but the Army failed to implement the treatment plan. I will list below the elevated blood pressure readings contained in the service medical records. I have indicated the date, medical facility, my rank, my assigned unit and the details of the medical record.

12/12/1984 0715hrs, Kimbrough Army Community Hospital, PVT, Headquarters Company United States Army Garrison Fort Meade Md. Reading 140/100, M C, CPT MD was physician of record

2/8/1986 BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 160/100 laying down and 130/90 upright. Treating medical personnel CWO D W, PA.

2/10/1986 BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 134/96 laying down and 136/112 upright. Record does not indicate who took the reading.

2/11/1986 1100hrs BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 142/90 laying down and 136/92 upright. Record does not indicate who took the reading.

2/11/1986 1518hrs BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 122/78 laying down and 142/100 upright. Recorded by L W.

2/12/1986 0930hrs BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 132/82 laying down and 138/100 upright. Recorded by J W

2/12/1986 Noted as PM BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 140/86 laying down and 144/96 upright. Recorded by J W

2/13/1986 0944hrs Camp Red Cloud, Uijongbu, Korea. SP4, Headquarters Battery 6/37FA, 2^nd ID. Clinical Record Electrocardiographic Record SF-507, Blood pressure recorded as 142/100 and EKG print-out indicates Non-specific T wave abnormality – Abnormal ECG. Radiological report from same date notes no significant abnormalities by S V, but a marginal note CPT J D “?RT Atrial Hypertrophy?”

2/28/1986 & 3/10/1986 BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Medical Record Consultation Sheet SF-513. Diagnosis of prob essential hypertension. BP readings of 126/96 left arm(seated), 128/92 R arm(laying down), 4 step plan on consultation report not implemented by medical personnel.

5/13/1987 0633hrs Consolidated Troop Medical Clinic, William Beaumont Medical Center. SP4, A Battery 1^st Support BN. Emergency Care and Treatment SF 558 Blood pressure was recorded as 140/110. CPT D D. C, MD treating physician.

In summary, the complete copy of my service medical records provided to me by the Veterans Administration contains 26 blood pressure readings covering my 4 years of service. Of those readings 6 have diastolic readings equal to or greater than 100 mm hg, which is clarifying for a rating of 10% under code 7101. 14 of the diastolic readings are equal to or above 90 mm hg, which under criteria from the American Heart Association and National Institutes of Health qualifies as hypertension. 4 of these readings have diastolic readings in excess of 80 hh mg, which is regarded as pre-hypertensive by these same organizations. I was sent to two different medical facilities and reviewed by medical personnel with a diagnosis by an internal medicine specialist of essential hypertension. Clearly, this meets the requirements for direct service connection as set out in CFR Title 38 part 3, 3:03.

2. Statements from persons who knew you…… I have no evidence to submit in this category.

3. Records and statements from service medical personnel…I have no additional records of this nature.

4. Besides my Military Entrance Examination I have not taken any employment physical examinations.

5. Medical evidence….

Please find attached Magnetic Resonance Report from Michigan State University Clinical Center dated 11/26/2007. This report indicates paraspinal and presacral soft tissue evaluation suggests cardiomegaly. It also indicates in findings axial images suggest cardiomegaly. This exam was followed up by a VA echocardiogram on 12/20/2007, that confirmed cardiomegaly and stated my Left ventricular function was 50%. This warrants a rating of 60% under code 7007.

Letter from Dr. CB, D.O. dated January 8, 2008 listing medications that have been prescribed by her over the years for my hypertension.

Letter from D K. Y, dated 11/12/2007 in this letter he clearly characterizes me as having hypertension in service. He reviewed the VA provided copy of my SMR prior to writing this letter.

My current VA primary care physician is A T S, he currently is prescribing 40mg Lisinopril and 25mg of HCTZ for High-blood pressure. This medication causes me to have to go to the bathroom frequently. It causes me to have to urinate approximately every 90 minutes.

6. Pharmacy prescription records. I have no records of this nature to turn over see letter from physician on medications prescribed.

7. Insurance examination reports. I have taken no insurance examinations and therefore have nothing to forward.

I have enclosed an authorization and consent to release form for Dr. C B although information from her is not necessary since hypertension was diagnosed in service and the VA is also currently treating me. I have met the requirements for in-service diagnosis and am currently being treated for the same disability by the Veterans Administration.

I have enclosed my VCAA notice response

Please rate my Hypertension, Cardiomegaly(hypertensive heart disease) secondary to Hypertension, Urinary frequency of 1-2 hours (90 min) secondary to Hypertension (side effect of Medication).

Sorry, I know it is long. Should I list the dates and readings out like this(make it easy for them) or will it just alienate the ratings officer? In thier letter they said they were requesting an exam, but I havn't heard anything on that yet.

Best regards,

Tyler

[Josephine]

I have drafted out a response to VA letter on my current claim for service connection. It is not quite finished but I would appreciate any comments (good or bad).

In reply to VA letter dated December 4, 2007 in reply, refer to XXXXXXXXXXXXXXXXXX.

In this letter you indicate “VA needs evidence showing that the following condition(s) existed from military service to the present time:” I would like to point out this is an incorrect statement. CFR 38 Part 3:303(:o Chronicity and continuity. With chronic disease shown as such in service (or within the presumptive period under §3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. I was diagnosed with Essential Hypertension in Seoul Korea at the 121 EVAC Hospital by Captain M B, MD on 3/10/1986. 6/37 FA medical personnel did not follow the treatment plan developed.

In the 12/4/2007 letter seven bullet points are in the letter as types of additional evidence that is required I will address them in order.

1. Dates of medical treatment…. As stated earlier in this letter I was diagnosed, but the Army failed to implement the treatment plan. I will list below the elevated blood pressure readings contained in the service medical records. I have indicated the date, medical facility, my rank, my assigned unit and the details of the medical record.

12/12/1984 0715hrs, Kimbrough Army Community Hospital, PVT, Headquarters Company United States Army Garrison Fort Meade Md. Reading 140/100, M C, CPT MD was physician of record

2/8/1986 BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 160/100 laying down and 130/90 upright. Treating medical personnel CWO D W, PA.

2/10/1986 BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 134/96 laying down and 136/112 upright. Record does not indicate who took the reading.

2/11/1986 1100hrs BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 142/90 laying down and 136/92 upright. Record does not indicate who took the reading.

2/11/1986 1518hrs BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 122/78 laying down and 142/100 upright. Recorded by L W.

2/12/1986 0930hrs BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 132/82 laying down and 138/100 upright. Recorded by J W

2/12/1986 Noted as PM BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Chronological Record of Medical Care SF 600, reading was 140/86 laying down and 144/96 upright. Recorded by J W

2/13/1986 0944hrs Camp Red Cloud, Uijongbu, Korea. SP4, Headquarters Battery 6/37FA, 2^nd ID. Clinical Record Electrocardiographic Record SF-507, Blood pressure recorded as 142/100 and EKG print-out indicates Non-specific T wave abnormality – Abnormal ECG. Radiological report from same date notes no significant abnormalities by S V, but a marginal note CPT J D “?RT Atrial Hypertrophy?”

2/28/1986 & 3/10/1986 BN Aid Station 6/37FA Camp Essayons Korea, SP4, Headquarters Battery 6/37FA, 2^nd ID. Medical Record Consultation Sheet SF-513. Diagnosis of prob essential hypertension. BP readings of 126/96 left arm(seated), 128/92 R arm(laying down), 4 step plan on consultation report not implemented by medical personnel.

5/13/1987 0633hrs Consolidated Troop Medical Clinic, William Beaumont Medical Center. SP4, A Battery 1^st Support BN. Emergency Care and Treatment SF 558 Blood pressure was recorded as 140/110. CPT D D. C, MD treating physician.

In summary, the complete copy of my service medical records provided to me by the Veterans Administration contains 26 blood pressure readings covering my 4 years of service. Of those readings 6 have diastolic readings equal to or greater than 100 mm hg, which is clarifying for a rating of 10% under code 7101. 14 of the diastolic readings are equal to or above 90 mm hg, which under criteria from the American Heart Association and National Institutes of Health qualifies as hypertension. 4 of these readings have diastolic readings in excess of 80 hh mg, which is regarded as pre-hypertensive by these same organizations. I was sent to two different medical facilities and reviewed by medical personnel with a diagnosis by an internal medicine specialist of essential hypertension. Clearly, this meets the requirements for direct service connection as set out in CFR Title 38 part 3, 3:03.

2. Statements from persons who knew you…… I have no evidence to submit in this category.

3. Records and statements from service medical personnel…I have no additional records of this nature.

4. Besides my Military Entrance Examination I have not taken any employment physical examinations.

5. Medical evidence….

Please find attached Magnetic Resonance Report from Michigan State University Clinical Center dated 11/26/2007. This report indicates paraspinal and presacral soft tissue evaluation suggests cardiomegaly. It also indicates in findings axial images suggest cardiomegaly. This exam was followed up by a VA echocardiogram on 12/20/2007, that confirmed cardiomegaly and stated my Left ventricular function was 50%. This warrants a rating of 60% under code 7007.

Letter from Dr. CB, D.O. dated January 8, 2008 listing medications that have been prescribed by her over the years for my hypertension.

Letter from D K. Y, dated 11/12/2007 in this letter he clearly characterizes me as having hypertension in service. He reviewed the VA provided copy of my SMR prior to writing this letter.

My current VA primary care physician is A T S, he currently is prescribing 40mg Lisinopril and 25mg of HCTZ for High-blood pressure. This medication causes me to have to go to the bathroom frequently. It causes me to have to urinate approximately every 90 minutes.

6. Pharmacy prescription records. I have no records of this nature to turn over see letter from physician on medications prescribed.

7. Insurance examination reports. I have taken no insurance examinations and therefore have nothing to forward.

I have enclosed an authorization and consent to release form for Dr. C B although information from her is not necessary since hypertension was diagnosed in service and the VA is also currently treating me. I have met the requirements for in-service diagnosis and am currently being treated for the same disability by the Veterans Administration.

I have enclosed my VCAA notice response

Please rate my Hypertension, Cardiomegaly(hypertensive heart disease) secondary to Hypertension, Urinary frequency of 1-2 hours (90 min) secondary to Hypertension (side effect of Medication).

Sorry, I know it is long. Should I list the dates and readings out like this(make it easy for them) or will it just alienate the ratings officer? In thier letter they said they were requesting an exam, but I havn't heard anything on that yet.

Best regards,

Tyler

Tyler,

I read all of your readings and can state, you certainly had high blood pressure in service.

What is their problem??

Can't they read?

I like the way you have your readings typed out, it makes it so easy to follow.

This is just my opinion. We will see what the others think.

Always,

Betty

Edited January 28, 2008 by Josephine

[rentalguy1]

Tyler...

1. Omit items 2, 3, 4, 6, and 7. If you have nothing to provide, then there is no reason to give them possible ammuntion (anything we write could somehow be turned into ammunition by them). It is one of those "the less said, the better" issues.

2. In your summary of item 1; the third sentence starts with the numeral 14. You need to spell out the word fourteen, just to be grammatically correct. It's easier on the eyes when you don't start a sentence with a numeral.

Oustside of those miniscule things, it's perfect! I used the exact same "bullet" format on my statement. Go for it!

[ruby]

I'm with rental, just the facts. I would cut it down more.

In reply to VA letter dated December 4, 2007 in reply, refer to XXXXXXXXXXXXXXXXXX.

I was diagnosed with Essential Hypertension in Seoul Korea at the 121 EVAC Hospital by Captain M B, MD on 3/10/1986.

I have attached pertinent sections of my SMR, VAMR and private medical records that demonstrates this condition.

I am also requesting service connection for Cardiomegaly(hypertensive heart disease) secondary to Hypertension, Urinary frequency of 1-2 hours (90 min) secondary to Hypertension (side effect of Medication).

I have enclosed my VCAA notice response

I hereby certify etc.

Short and sweet, don't defend your evidence at this point. Send you evidence--by asking that a new claim be started this will slow your claim down.

If you can give them the evidence to connect they will from what I am told.

I keep asking the wrong way for what I want. Now I have to fix my errors.

[rentalguy1]

Thanks for the agreement ruby, but I would leave the bullet statements about the evidence in there. It makes the exact points that you want them to draw from the evidence. It makes a sublimenal mark on their mind, and when they look at the actual evidence it will subconsiously come back to them. (Darn those adverising classes I had to take in college...lol). I would also highlight the pertinent parts of the medical evidence.

[Josephine]

I have not reviewed your blood pressure readings with this

post, but they are still fresh in my mind.

I agree keep it short, but I would leave my medical evidence for the

rater to see and will not be so apt to forget

as I have not.

Betty

Edited January 29, 2008 by Josephine

[ruby]

I agree to a point but this is going to someone who knows little about medical, they are just going on rules, they don't care about explanations. Writing out each point does nothing but take thier time up, they will flip to the evidence to see if its there.

I would just send the evidence and not explain anything, they are going to look at the evidence, they can't and won't take your analyze of the issues.

If they deny then you explain the evidence and how they went wrong. At least that's what I have gathered from my research.

Make it easy on the RO, perhaps yours will be the most succinct and clear and its an easy approval.--They are required to do so many, the more succinct it is the faster you'll get an answer.

If he shows it occurred in the sc by his records, he has meet that burden. They will ask for a CE to determine the rating, there is nothing wrong with telling them what percentage he wants. If his evidence supports that percentage he might get it without a CE.

What the heck do I know, I have screwed up several request, not knowing what or how to ask.

Based on my results, I have gone from 10% to 60% in 18 months. If I had known what I was doing from the beginning I think I could have accomplished this in a shorter time frame, if I had really known what I was doing I would be 100% PT

I sent in everything but the kitchen sink to support my claim. They went by my smr's, vamc's and CE.

It's my opinion to keep it short, short, short when you first ask for an increase or new claim.