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

[Chuck75]

The VA will very likely attempt to use a future C&P to take advantage of the out given in the regs/law-- It may be useful to have one or more qualified specialists opinion that the medical problems are directly related to military service.

"unless clearly attributable to intercurrent causes."

[ruby]

Cowgirl,

Thanks, yea the CE (comp exam) is the same as C&P.

I just wish I found this site and another site I use before I did my claim. Now I have to fix all the damage I did with my original claim.

My new claim is 2 paragraphs 6 lines total. I did get the help of a retired DRO from another site, that helped me understand the process. He pulled a few teeth in doing so.

The time to explain my evidence is down the road, not at the beginning.

I thought if I made it easy for the RO to navigate my claim with the evidence-means I put everything in order and explained every detail that I was helping him with my claim. I actually made his job more difficult and possible wrote something that could harm my claim.

Because I didn't know how to ask or what I was asking for (my VSO sucks)

The rater did what I ask for-period the end, nothing more.

I ask for arthritis in all joints secondary to SC arthritis, now I understand why I was denied. My SC didn't cause my other problems it was the reactive that did, however I just didn't understand, I thought I had reactive, the xrays while in service showed the arthritis, therefore its connected. (doesn't make sense, I know)

Wrong. Now I have to do a new claim, if I had a good VSO or understood the VA or regs when I first applied I would be 100%.

Now with the majority of my teeth pulled I want to repay, by helping others for the help I recieved.

[rentalguy1]

Ruby...don't feel bad about botching a claim due to an SO. I had done the same thing for years until I discovered hadit. I think my most current round of claims was done the right way and will undo what I screwed up on bad advice in years past. I think we all have a duty to spread the information that we have learned through the process so other vets won't have to go through the crap that you and I have gone through. We all just have a little different way of doing it.

[ruby]

Thanks Rental for the support, yea, whatever makes you comfortable is what you should do.

There is nothing wrong with what anyone has said, actually I am going back and numbering my request. Even if its only 2, just making it a little easier for the RO.

[Josephine]

Ruby...don't feel bad about botching a claim due to an SO. I had done the same thing for years until I discovered hadit. I think my most current round of claims was done the right way and will undo what I screwed up on bad advice in years past. I think we all have a duty to spread the information that we have learned through the process so other vets won't have to go through the crap that you and I have gone through. We all just have a little different way of doing it.

Ruby,

Goodness, I have been at it for the last 8 years, and if I knew then what I do now, I could have settled this claim years ago.

How was I to know from the Regional Office to the BVA remanded to the AMC with a SSOC - stating handwritten medical records from 1965 - 1979 were illegible.

Had I known this, I could have took those medical records to my doctor at that time for typed clarification.

He is still a practicing physician. It took him two days to type up his hand written treatment notes.

My, Oh, My,

Betty

[spike]

My personal and professional recommendation when creating a claim with the VA is to look in the Title 38 under the rating schedule and find what closely relates to your symptoms for I.e. back or whatever, and you write the the claim request in the language the Title 38 has it under the rating schedule. After you request the claim on the statement of claim form, I would put examples of how that disability prevents you from doing things or how it hurts. If you put in a claim for PTSD it doesn't hurt to have 'buddy statements' attached to your statement of claim. Thats just my own recommendation.