hypertension Va Fast Letter Changes

[Berta]

Email I just got from Colonel Dan-He is looking for the letter I emailed him about on the AO HBP notice to vet orgs-and sending that question out with this news:

"Does anyone have link to the actual recent VA directive or fast letter on AO & hypertension

I just saw this.. from April 2007

DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration

Washington, D.C. 20420

April 24, 2007 In Reply Refer To: 211D

Fast Letter 07-10

Director (00/21)

All VA Regional Offices and Centers

SUBJECT: Revised Disability Examination Worksheets

Revised disability examination worksheets for Audio; Ear Disease; Hand, Thumb and Fingers; Feet; Mental Disorders; Eating Disorders; Esophagus and Hiatal Hernia; Intestines; and Stomach, Duodenum, and Peritoneal Adhesions have been released nationally to VA Medical Centers for C&P examiner use.

These worksheets are changed in the following significant ways:

Audio and Ear Disease

· The Audio examination worksheet no longer requires frequency and duration for tinnitus. The examiner only needs to state whether tinnitus is persistent or recurrent.

· On the Audio examination worksheet, the request for an opinion about the etiology of tinnitus has been removed. If an opinion about etiology is required for a specific veteran, the regional office must request it.

· On the Ear Disease examination worksheet, questions have been added about history of hospitalizations, surgery, noise exposure and ear trauma.

· On both examination worksheets, examiners are asked to describe effects on occupational functioning and daily activities.

Hand, Thumb and Fingers

· Under history, questions about hospitalizations, surgery, trauma and neoplasm have been added.

· Examiners are asked to describe current symptoms and effects on occupational functioning and daily activities.

· On physical examination, the requirement for passive range of motion has been removed.

Feet

· Under history, questions about neoplasm have been added.

· On physical examination, all requirements for range of motion of the toes; active, passive and after repetition have been removed.

· On physical examination, assessment of posture in various positions has been removed.

Mental Disorders and Eating Disorders

· The credentials of examiners who VBA and VHA recently agreed can perform these types of examinations are listed.

· On a Mental Disorders examination, the examiner is expected to select the appropriate assessment of the veteran from the list provided and support the assessment with examples.

Esophagus and Hiatal Hernia

· Under history, questions about hospitalizations, surgery, trauma and neoplasm have been added as well as the effects of the condition on occupational functioning and daily activities.

· Under diagnostic tests, if there is a history of bleeding (past 12 months) or signs of anemia, a hemoglobin/hematocrit is required.

Intestines

· Under history, questions about hospitalizations, surgery, trauma and neoplasm have been added as well as effects of the condition on occupational functioning and daily activities.

· Under history, for ulcerative colitis, the number of attacks per year has been added as a requirement.

· Under diagnostic tests, if there are signs of anemia, a hemoglobin/ hematocrit is required.

Scars

· Under history, the treatment used and response to treatment has been removed.

Stomach, Duodenum, and Peritoneal Adhesions

· Under history, questions about hospitalizations, surgery, trauma and neoplasm have been added as well as effects of the condition on occupational functioning and daily activities.

· Under diagnostic tests, if there is a recent history (past 12 months) of hematemesis, melena or signs of anemia, a hemoglobin/hematocrit is required.

The following worksheets will be released in approximately 8 weeks: Bones; Chronic Fatigue Syndrome; Cranial Nerves; Cushing’s Syndrome; Eye; Fibromyalgia; HIV-Related Illness; Liver, Gall Bladder, and Pancreas; Lymphatic Disorders; Nose, Sinus, Larynx, and Pharynx; and Rectum and Anus.

These worksheets have been changed in the following significant ways:

Bones

· Under history, questions about hospitalizations, surgery and neoplasm have been added.

· If a joint is involved, the examiner is referred to the Joint worksheet.

Chronic Fatigue Syndrome

· Under history, a question about hospitalizations has been added.

· Under history, questions about debilitating fatigue, incapacitating episodes and cognitive impairment have been added.

· A cursory physical examination has been added.

Cranial Nerves

· Under history, the question about flare-ups has been deleted.

· Under history, the examiner is asked to comment on onset, course since onset and current symptoms.

· Under history, questions about hospitalization, surgery, neoplasm and trauma have been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.

Cushing’s syndrome

· Under history, questions about hospitalizations, surgery, and neoplasm have been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.

· Diagnostic and Clinical tests are only to be performed if not of record or to confirm a diagnosis.

Eye

· Under history, questions about hospitalizations, surgery, and trauma have been added.

· Under history, a specific question for congestive or inflammatory glaucoma has been added.

· Under physical examination, a specific question about the ability to wear a prosthesis after enucleation has been added.

Fibromyalgia

· Under history, a question about hospitalizations has been added.

HIV-Related Illness

· Under history, questions about hospitalizations, surgery and neoplasm have been added.

Liver, Gall Bladder, and Pancreas

· Under history, a question about effects on occupational functioning and daily activities has been added.

Lymphatic Disorders

· Under history, a question about hospitalizations and surgery has been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.

· A focused physical examination has been added.

Nose, Sinus, Larynx, and Pharynx

· Under history, for chronic sinusitis, a question about incapacitating and non-incapacitating episodes per year has been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.

· Under history, questions about neoplasm have been added.

· Under physical examination, the examination for larynx and pharynx has been added.

Rectum and Anus

· Under history, questions about hospitalizations, surgery, trauma, and neoplasm have been added.

· Under history, a question about effects on occupational functioning and daily activities has been added.

· Under Diagnostic and Clinical tests, the examiner is asked to obtain a CBC if there is a history of bleeding, signs of anemia or chronic infection.

If you have any questions about this letter, please contact Vicki Milton, M.D., at (202) 273-9646 or by e-mail.

/S/

Bradley G. Mayes

Director

Compensation & Pension Service"

Edited May 13, 2008 by Berta

[carlie]

Berta,

Hope something here helps you.

I came across this feom Feb. 2008 and it makes mention of Blood Pressure:

http://www.hsrd.research.va.gov/publicatio...m_factsheet.pdf

Possibly here somewhere:

Citations Database Search Results

http://www.hsrd.research.va.gov/publicatio...le_citation.cfm

This is the most updated exam worksheey I could find that may pertain to your post

but it relates to diabetis and hypertension:

http://www.vba.va.gov/bln/21/Benefits/exams/disexm13.htm

E. Diagnosis:

1. State whether the veteran has diabetes mellitus. Indicate type.
   
   
2. Specifically list each identified complication of the veteran's diabetes. Indicate these conditions as "complications of the veteran's diabetes". If the veteran has peripheral edema, indicate whether it is a consequence of diabetic kidney disease or other non-diabetic related etiology.
   
   
3. For each identified complication of the veteran's diabetes, provide a brief rationale for your conclusion. You may base your rationale on such things as the duration of the veteran's diabetes, whether the veteran's diabetes has been poorly controlled, the onset of the condition that you deem to be a complication of the veteran's diabetes in relation to the onset of the veteran's diabetes, the severity of the complication, or anything else you consider relevant.
   
   
4. Where the veteran has visual impairment, cardiovascular disease
   (including hypertension),
   kidney disease, neurologic disease, amputations, or any other disabilities which, in your opinion, are not complications of the veteran's diabetes, please state so and provide a supporting rationale as to the basis for your conclusion.
   
   
5. Where the veteran has a condition that is worsened or increased by the veteran's diabetes but is not a diabetic complication, discuss the relationship between the condition and the veteran's diabetes. In particular, discuss what the degree of disability is of the condition over and above the degree of disability that existed prior to aggravation/worsening by the diabetes. Provide your rationale. Indicate if this is not possible to do without resorting to speculation.
   
   

I think this is what your looking for:

http://www1.va.gov/agentorange/docs/AONewsletterOct07.pdf

"

The most significant changes to earlier “updates” from the

IOM include the nature of association between herbicide

and dioxin exposure and hypertension and AL amyloidosis.

Both of these conditions are now listed as having “limited

or suggestive evidence of an association” with herbicide

and dioxin exposure, their weakest positive category

of association. This means that “evidence suggests an

association between exposure to herbicides and the outcome,

but a firm conclusion is limited because chance, bias, and

confounding could not be ruled out with confidence.”

Hope this helps a vet,

carlie