hypertension No Comment - Please Read

[shag]

this may need to be read twice. It is from a vet's remand from the BVA. Accordingly, the case is REMANDED for the following action: 1. The AMC should send the Veteran's claims folder to the examiner who conducted the April 2004 and December 2004 VA heart examinations, or if the examiner is no longer available, a suitable replacement, to request that he prepare an addendum to his report. The Veteran need not be re-examined unless an examination is deemed necessary. If a physical examination is deemed necessary, all indicated testing should be accomplished. The claims files should be made available to and reviewed by the examiner. With reference to supporting data, the examiner is asked to offer a complete rationale for his opinions, expressed in the examinations referenced above, that it is less likely than not that the Veteran's hypertension or heart disease are related to or aggravated by the Veteran's service-connected PTSD. Hard to believe that one.

Edited March 26, 2010 by shag

[carlie]

Ditto with Berta.

[shag]

http://www4.va.gov/vetapp09/files4/0928568.txt by the way, I still have no comment,,,,just trying to learn(understand)

I agree with Hawkfire-I think the C & P examiner gave no medical rationale for their statement.

However-

please post the hyperlink to this decision as it cannot be opined on out of the whole context.

[Wings]

x

x

x

The medical examiner failed to provide a "complete rationale" for his stated opinion, which was, "it is less likely than not that the Veteran's hypertension or heart disease are related to or aggravated by the Veteran's service-connected PTSD."

. . . "The Veteran's claims file contains two VA

opinions, authored by the same VA examiner, finding that the

Veteran's hypertension and heart disease are less likely than

not related to or aggravated by his service-connected PTSD.

However, while these opinions chronicle the Veteran's medical

conditions, they offer no corresponding rationale in support

of their conclusions."

. . . ."In Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), the

United States Court of Appeals for Veterans Claims recently

held that to have probative value, a medical examination

report must contain not only clear conclusions with

supporting data, but also a reasoned medical explanation

connecting the two. Accordingly, the Veteran's claim should

be returned to the medical examiner who offered the opinions

of record, if available, so that a rationale for his opinions

may be provided.

Personally, I would be happy with the remand, but angry that it was

being sent back to the same incompetant examiner, who has twice failed

to provide a medical rationale! In the interum, I would do everything

I could to obtain an independent exam that puts this doctor to further shame! ~Wings

[kw34]

I think it is good for the vet. I am no expert but it sounds like the examiner did not do his job and they have called him/her out. They now need to provide background for the decision they made.

[Berta]

Right-no medical rationale:

In part:

"The Veteran's claims file contains two VA

opinions, authored by the same VA examiner, finding that the

Veteran's hypertension and heart disease are less likely than

not related to or aggravated by his service-connected PTSD.

However, while these opinions chronicle the Veteran's medical

conditions, they offer no corresponding rationale in support

of their conclusions."

"In Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), the

United States Court of Appeals for Veterans Claims recently

held that to have probative value, a medical examination

report must contain not only clear conclusions with

supporting data, but also a reasoned medical explanation

connecting the two. Accordingly, the Veteran's claim should

be returned to the medical examiner who offered the opinions ....."

This is why the BVA did not accept a 2nd C & P opinion negative to my claim- over my IMOs.

The C & P "doc" was a PA with no cardio background that was significant enough for him to have an opinion of more merit than my IMOs from a NeuroRadiologist and a neurologist.

The PA stated any conclusion on his part would be based on speculation.In spite of overwhelming evidence-so he was unable to provide any rationale at all for his opinion.

I am glad you posted the link because this reminds us to use Nieves-Rodriguez if we need it.

[LarryJ]

OK...I'll bite. I read this over 4 times..then I looked up 'Remand' - An appeal returned to the regional office or medical facility where the claim originated - to be sure I wasn't completely crazy in my understanding.

Maybe I'm full of it but it sounds to me like BVA didn't like what they were looking at in this vet's claim. I know a remand means more waiting, but if the outcome is positive for the vet it could be worth it. In this case, let's say the claim had one or more IMO's stating that it was 'more likely than not' and this one examiner said it 'is less likely than not'. Isn't it possible that the BVA is sending it back to 'offer a complete rationale for his opinions, expressed in the examinations referenced above, that it is less likely than not that the Veteran's hypertension or heart disease are related to or aggravated by the Veteran's service-connected PTSD' because they think the examiner didn't offer proper documentation and his statement doesn't support the evidence in the rest of the claim? They say they want an addendum, which tells me the examiner didn't show or give proper rationale for his statement. I've read it and read it and it really sounds to me like they are giving this vet the benefit of the doubt on this one, as they are supposed to. Call me crazy...I can take it. Of course, one could say that they should simply weigh the positive IMO over the examiners....but maybe there were no IMO's and they are simply looking over the evidence...all food for thought.

Hey, I'm new at this!! I can think positive.

OKAY, you are "full of it" and, not only that but, if you insist, you are also "crazy".

but, you are correct in your reading of this remand as far as I can tell.