A Link Or Case Law Needed

[oldman273]

Hey I need some help I am SC for Hypertensive heart disease and have been diagnosed as having sleep apnea are these two related and does anyone have any case law on these two animals? I have searched VA got nothing I can see ANy help thanks

[stillhere]

Oldman as I promised here is the letter I just got from my cardio doc.Let me know what you or anybody else would like to add. do you think this is good to go??

Re: Me

To whom it may concern:

I am asked to provide documentation of disability for xxxx. He suffered a myocardial infarction in 2005 with emergency right artery stenting from an occluded right coronary artery. He went on to develop recurrent coronary disease with circumflex stenting in 2006. He has hypertension, hyperlipidemia, diabetes mellitus and sleep apnea. He is mediated on Coreg,Losartin, Aspirin, Metformin and Plavix for his multiple cardiac factors and health conditions. He additionally carries a diagnosis of sleep apnea. It has been established that sleep disorder breathing such as sleep apnea is common in men with coronary artery disease and is associated with coronary artery disease.

I would note that diabetes is a significant risk factor for conorary artery disease. I would note that diabetes mellitus has been identified as a deveolpmental condition following exposure to agent orange. The patient served in Vietnam 1969-1970 with exposure to Agent orange.

On the basis of these notations of sleep apnea, coronary artery disease, diabetes mellitus and hypertension, I would suggest a thorough re-evaluation of his disability status.

sincerly

Edited February 22, 2008 by stillhere

[Berta]

Did the doc provide his area of expertise and any background on his ability to opine?

Of course being a cardio doc-that should be good enough- but does it say Cardiology on the letterhead or anywhere else?

Also- did he use any medical texts to punch up his statement:

"It has been established that sleep disorder breathing such as sleep apnea is common in men with coronary artery disease and is associated with coronary artery disease"

You yourself could attach any good medical printout- John Hopkins, Mayo Clinic, or from any good medical site- if he didnt add a text.

In the post "Getting an IMO" available here under search I used my own IMOs from Dr. BAsh as to how he provides a fully and adequate IMO-compliant with all the landmines that VA finds in some IMOs and then they reject them.

[Berta]

PS - Merck (which the VA itself uses), JAMA (Journal of American Medical Assoc, the ADA,Diabetologia, Brunwald, Harrison's Principles of Medicine,

these are excellent medical sources-

I have used many of them for my own claim and Dr. Bash used Brunwald and Harrison for my IMos-these are the cream of the crop of medical texts but very costly and not published on the web.

Also Dr. BAsh rebutted a VA doctors opinion in part due to fact she provided no medical rationale whatsoever (such as a quoted medical sourse) for her opinion that-as I showed him- had been based on nly 3 or 4 clinical records whereas Dr. Bash read the whole 9 yards and used his Neuroradiology expertise to nterpet the MRIs and autopsy etc.

I heard Dr Bash's fees have gone up-from one vet recently- however- I think he quoted this vet a very high fee because there was an extraordinary amount of medical records and paperwork he had to go through-

If a disability is already presumptive (meaning the SMrs dont have to be studied)or if there is already significant evidence in the clinical record or with the RO- the fees of IMOs are compatible with that.

I used for my AO death claim "it has been well established in the standard medical community that" etc etc and then I would scan and insert the actual quote from the text and give the citation and then enclose the entire printout as evidence.

I wish the doc had sort of said it that way in your case-

with some references to medical literature that does establish this-

still- this is a good IMO - would the doc be willing to add a citation to some medical text?

Edited February 22, 2008 by Berta

[stillhere]

Did the doc provide his area of expertise and any background on his ability to opine?

Of course being a cardio doc-that should be good enough- but does it say Cardiology on the letterhead or anywhere else?

Also- did he use any medical texts to punch up his statement:

"It has been established that sleep disorder breathing such as sleep apnea is common in men with coronary artery disease and is associated with coronary artery disease"

You yourself could attach any good medical printout- John Hopkins, Mayo Clinic, or from any good medical site- if he didnt add a text.

In the post "Getting an IMO" available here under search I used my own IMOs from Dr. BAsh as to how he provides a fully and adequate IMO-compliant with all the landmines that VA finds in some IMOs and then they reject them.

Yes it is typed on his letter head with all the MD FACC TESTMUR NASPExAM whatever that means.

If you have a feel this will not be good enough I can go back and see if he will "punch it up" as you say.

Thanks, Stillhere

[stillhere]

bump

[allan]

--------------------------------------------------------------------------------

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

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EMBARGOED FOR RELEASE

Tuesday, April 11, 2000

4:00 p.m. EST Contact:

NHLBI Communications Office

(301) 496-4236

NHLBI Study Shows Association Between Sleep Apnea and Hypertension

People with sleep apnea are at special risk for hypertension, according to a study funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Data from the NHLBI's "Sleep Heart Health Study" (SHHS), which are reported in the April 12, 2000 issue of the Journal of the American Medical Association, show that middle-aged and older adults with sleep apnea have a 45 percent greater risk of hypertension than people without the condition. Hypertension, or high blood pressure, is a major risk factor for cardiovascular disease.

According to NHLBI Director Dr. Claude Lenfant, "This is the first study large enough to examine the relationship between sleep apnea and hypertension, independent of other cardiovascular risk factors. It is extremely important, since hypertension is a major risk factor for cardiovascular disease, which is the leading cause of death in the U.S. today."

"Although these results must be verified, they offer hope that we may be able to reduce cardiovascular mortality in hypertensives by more aggressively diagnosing the apnea," he added.

Approximately 12 million Americans have sleep apnea, a breathing disorder characterized by brief interruptions of breathing during sleep (up to 20-30 breathing pauses per hour, each lasting at least 10 seconds). These breathing pauses are almost always accompanied by loud snoring. The most common treatment is continuous positive airway pressure (CPAP), a procedure involving use of a face mask which forces air through the nasal passages. Behavioral changes, especially weight loss, are usually recommended as well.

The SHHS involved more than 6,000 adults, ages 40 and over, who were participating in other NHLBI cohort studies of cardiovascular and respiratory disease between 1995-1998. Sleep apnea was assessed through at-home polysomnography, a test that records a variety of body functions during sleep, such as the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, air flow, and blood oxygen levels. Following NHLBI guidelines, hypertension was defined as blood pressure of at least 140/90 mm Hg.

The study showed that the risk of hypertension increased with the severity of the apnea in all participants, regardless of age, sex, race, or weight. The risk was seen even at moderate levels of sleep apnea.

The centers participating in the study were: Boston University, Boston, MA; Cornell University, New York, NY; Johns Hopkins University, Baltimore, MD; New York University, New York, NY; University Hospital-Rainbow Babies & Children's Hospital, Cleveland, OH; University of Arizona College of Medicine, Tucson, AZ; University of California at Davis, CA; University of Minnesota, Minneapolis, MN; University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Washington, Seattle, WA; and University of Wisconsin, Madison, WI.

For additional information, call the NHLBI Communications Office, (301) 496-4236.

NHLBI press releases, fact sheets, and other materials on sleep are available online at www.nhlbi.nih.gov/about/ncsdr.

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SOURCE: http://www.nhlbi.nih.gov/new/press/apr11-00.htm