hypertension What Is Considered New Evidence To Open A Claim

[mountain tyme]

Good Evening...I have a question...I am helping a vet with his claim for hypertension that began during his military service. He filed for hypertension back in 2008 and the VA denied his claim...the VA stated

"The service treatment records show occasional isolated elevated blood pressure readings, often associated with weight control counseling. In xxx of 19xx, you were referred for a 5-day blood pressure evaluation; hypertension was not shown. In xxx of 19xx, you were seen for neck pain, feeling faint, and dizziness associated with going from a sitting to a standing position. You were referred for a 5-day blood pressure evaluation, and again, a confirmed diagnosis of hypertension was not warranted. In xxx of 19xx, you were admitted to xxxxxx community hospital for an extensive cardiovacular evaluation to rule out coronary artery disease. This evaluation revealed no chronic cardiovascular condition, to include hypertension. Routine periodic examinations including your retirement physical, revealed normotensive blood pressure readings, with no evidence of hypertension.

At the VA examination dated xxx 31, 19xx blood pressure reading were within normal limits. Hypertension was not claimed by you or noted by the examiner.

The VA treatment reports show that you first complained of elevated blood pressure readings on xxx 26, 20xx; hypertension was diagnosed at the time and you were prescribed medication.

On xxx 15, 20xx, your claims filed and all the available evidence were reviewed by a VA examiner for the purpose of providing a medical opinion regarding the onset/etiology of your hypertension. The examiner notes that there were isolated elevated blood pressure readings during active military service. However, he notes that the majority of your blood pressure readings thoughout military service were normotensive, and he also notes that a 5 day blood pressure check did not confirm a diagnsis of hypertension. He notes that your current hypertension was first diagnosed and treated many years after your discharge from active miliaty service. Based on these factors, he provides the opinion that your current essential hyperstension did not at least as likely as not manifest to a compensable degree during active military service.

Sevice connection may be granted for a disability which began in military service or was caused by some event or experince in service."

Now what would I need to do to reopen this claim?? would the following be enough to open the claim...

1.) after filing this claim he remembered that right after he retired out of the Military he went for a few years to a family practice doctor that the company he worked for had on retainer...

his blood pressure within 2 years from discharge were in the 140/102 range years before he was diagoised the doctor did write in this notes that he may have hypertension but the vet did not know that until he picked the records up last friday...these records were not submitted to the VA.

2.)A few months ago I told him to send for the (civilan hosp.) medical records to the hosp. that the Military sent him to after he had an episode of Arteria Fib back in 1988...

He received the medical records...that he did not send into the VA for his claim nor did the VA mention they had the medical records from the civilian hospital the VA only stated what the AF doctor said and did not even mention that the civilian cardiac doctor highly recommened a Cardiac Catherization *that never was preformed to rule out cardio diease*

While in the Hospital the Cardio Doctor did recommend that the "vet" undergo a Cardiac Catherization which he was willing to do. Yet, the base decided not to approve the procedure at that time. Needless to say the Cardiac Catherization was never performed.

In The medical records from xxxxxxx Hospital the Doctor wrote:

"In view of this new onset of chest pain and accompanying atrial fibrillation and J point abnormality on the exercise treadmill, cardiac catheterization was recommended for further assessment of early cardiomyopathy. This will be done on an elective basis at an Air Force Base Hospital. The results of the above-mentioned tests and the recommendation for cardiac catherization were discussed with Dr. xxxxx at xxxxx Afb Hospital.

The patient is discharged on no medications and will see Dr. xxxx for follow-up tomorrow."

After reviewing the "VET's" military service records by all accounts the "Vet" went in for his follow up appointment to discussed the plan of treatement and to inquire when he would have the cardiac catherization preformed at the time doctor (Air Force doctor) did not feel the test was warranted since the Fib. Resolved itself...now get this..his B/P and pulse taken on that day was...

10 May 1988 90/58 pulse 60 and he was released back to work that day.

so based on the VA denial letter not all test were preformed esp. the one that WOULD HAVE ELIMINATED HYPERTENSION or cardiac diease.

3.) 2 months ago he had a pacemaker put in...and while there he was given information regarding hypertension and by his in service b/p readings he most definaly had pre-hypertension readings and as the VA denial letter stated there were hyperstension readings...

4.) He will be dropping off his in-service medical records to his cardiologist to see if he can determine if the vet had hypertension based on his military records...or even pre-hypertension

any advice would be so highly appricated by this Vet and his family...I feel strongly he has a good case he just did it alone with no help...so here we are...can he reopen this claim...

thank you in advance and God Bless

MT

[*Bergie*]

Good Evening...I have a question...I am helping a vet with his claim for hypertension that began during his military service. He filed for hypertension back in 2008 and the VA denied his claim...the VA stated

"The service treatment records show occasional isolated elevated blood pressure readings, often associated with weight control counseling. In xxx of 19xx, you were referred for a 5-day blood pressure evaluation; hypertension was not shown. In xxx of 19xx, you were seen for neck pain, feeling faint, and dizziness associated with going from a sitting to a standing position. You were referred for a 5-day blood pressure evaluation, and again, a confirmed diagnosis of hypertension was not warranted. In xxx of 19xx, you were admitted to xxxxxx community hospital for an extensive cardiovacular evaluation to rule out coronary artery disease. This evaluation revealed no chronic cardiovascular condition, to include hypertension. Routine periodic examinations including your retirement physical, revealed normotensive blood pressure readings, with no evidence of hypertension.

At the VA examination dated xxx 31, 19xx blood pressure reading were within normal limits. Hypertension was not claimed by you or noted by the examiner.

The VA treatment reports show that you first complained of elevated blood pressure readings on xxx 26, 20xx; hypertension was diagnosed at the time and you were prescribed medication.

On xxx 15, 20xx, your claims filed and all the available evidence were reviewed by a VA examiner for the purpose of providing a medical opinion regarding the onset/etiology of your hypertension. The examiner notes that there were isolated elevated blood pressure readings during active military service. However, he notes that the majority of your blood pressure readings thoughout military service were normotensive, and he also notes that a 5 day blood pressure check did not confirm a diagnsis of hypertension. He notes that your current hypertension was first diagnosed and treated many years after your discharge from active miliaty service. Based on these factors, he provides the opinion that your current essential hyperstension did not at least as likely as not manifest to a compensable degree during active military service.

Sevice connection may be granted for a disability which began in military service or was caused by some event or experince in service."

Now what would I need to do to reopen this claim?? would the following be enough to open the claim...

1.) after filing this claim he remembered that right after he retired out of the Military he went for a few years to a family practice doctor that the company he worked for had on retainer...

his blood pressure within 2 years from discharge were in the 140/102 range years before he was diagoised the doctor did write in this notes that he may have hypertension but the vet did not know that until he picked the records up last friday...these records were not submitted to the VA.

2.)A few months ago I told him to send for the (civilan hosp.) medical records to the hosp. that the Military sent him to after he had an episode of Arteria Fib back in 1988...

He received the medical records...that he did not send into the VA for his claim nor did the VA mention they had the medical records from the civilian hospital the VA only stated what the AF doctor said and did not even mention that the civilian cardiac doctor highly recommened a Cardiac Catherization *that never was preformed to rule out cardio diease*

While in the Hospital the Cardio Doctor did recommend that the "vet" undergo a Cardiac Catherization which he was willing to do. Yet, the base decided not to approve the procedure at that time. Needless to say the Cardiac Catherization was never performed.

In The medical records from xxxxxxx Hospital the Doctor wrote:

"In view of this new onset of chest pain and accompanying atrial fibrillation and J point abnormality on the exercise treadmill, cardiac catheterization was recommended for further assessment of early cardiomyopathy. This will be done on an elective basis at an Air Force Base Hospital. The results of the above-mentioned tests and the recommendation for cardiac catherization were discussed with Dr. xxxxx at xxxxx Afb Hospital.

The patient is discharged on no medications and will see Dr. xxxx for follow-up tomorrow."

After reviewing the "VET's" military service records by all accounts the "Vet" went in for his follow up appointment to discussed the plan of treatement and to inquire when he would have the cardiac catherization preformed at the time doctor (Air Force doctor) did not feel the test was warranted since the Fib. Resolved itself...now get this..his B/P and pulse taken on that day was...

10 May 1988 90/58 pulse 60 and he was released back to work that day.

so based on the VA denial letter not all test were preformed esp. the one that WOULD HAVE ELIMINATED HYPERTENSION or cardiac diease.

3.) 2 months ago he had a pacemaker put in...and while there he was given information regarding hypertension and by his in service b/p readings he most definaly had pre-hypertension readings and as the VA denial letter stated there were hyperstension readings...

4.) He will be dropping off his in-service medical records to his cardiologist to see if he can determine if the vet had hypertension based on his military records...or even pre-hypertension

any advice would be so highly appricated by this Vet and his family...I feel strongly he has a good case he just did it alone with no help...so here we are...can he reopen this claim...

thank you in advance and God Bless

MT

You are so worried about the HTN issue. What you should be looking at is the cardiac issue ie; the fact that he did not have a cath way back when. Now 20+ years later he has a pacemaker. What you should do is ask the cardiologist if the pacemaker could be the result of a missed diagnosis when the cath was not performed. If you get the cardiac issue SC'd then the HTN can be a secondary connection to the cardiac issue. Again look at the big picture and get out of the tunnel. In other words open your eyes, he has a better chance if the cardiac doctor states the pacemaker is more likely than not connected to the fact that the cath was never done. You posted a similar question recently and the answer is still the same, the HTN is weak from the records you've discussed because everyone has the ocassional elevated BP reading. According to you he had 2 seperate 1 week BP checks and they were both negative. It's good that you want to help this guy, and you are in the right place so listen to what I'm tryin to tell you. Hope you are not offended, that is not my intention.

Regards,

Bergie

[halos2]

Your post topic is Replying to What Is Considered New Evidence To Open A Claim...You basically told of the records/documentation the vet now has in hand which the VA does not have...so anything that has not been presented which shows the relationship needs to be submitted, and let them decide if useable or not or if appealable too... also Bergie suggests records from the Cardiologist and also the diagnoses he now has related to the pacemaker implantation. Get to the root of the problem and which diagnosis would warrent agrant of claim and then seek out if secondary conditions may be claimed. Is he on antihypertensive medications, and if so how many? One two or more?

I am on 2 and recently won a claim for HTN secondary to PTSD. Hard to win but with medical validation and actual case studies relating the relationshi, it can occur. Heart then circulation...Review all records and smr's for ANY notations to heart issues too.

[mountain tyme]

You are so worried about the HTN issue. What you should be looking at is the cardiac issue ie; the fact that he did not have a cath way back when. Now 20+ years later he has a pacemaker. What you should do is ask the cardiologist if the pacemaker could be the result of a missed diagnosis when the cath was not performed. If you get the cardiac issue SC'd then the HTN can be a secondary connection to the cardiac issue. Again look at the big picture and get out of the tunnel. In other words open your eyes, he has a better chance if the cardiac doctor states the pacemaker is more likely than not connected to the fact that the cath was never done. You posted a similar question recently and the answer is still the same, the HTN is weak from the records you've discussed because everyone has the ocassional elevated BP reading. According to you he had 2 seperate 1 week BP checks and they were both negative. It's good that you want to help this guy, and you are in the right place so listen to what I'm tryin to tell you. Hope you are not offended, that is not my intention.

Regards,

Bergie

Hello Bergie...Please, I am not offened in the least! just the opposit..I came here looking for advice and that is what you are giving me...I do have tunnel vision esp. since I am in unfamiliar waters...I have explained the same to the VET that I am trying to help...you wrote: " Now 20+ years later he has a pacemaker. What you should do is ask the cardiologist if the pacemaker could be the result of a missed diagnosis when the cath was not performed. If you get the cardiac issue SC'd then the HTN can be a secondary connection to the cardiac issue. Again look at the big picture and get out of the tunnel. "...

Ok...that makes sence since he has a pacemaker now...due to his heart not beating correctly...I wish he had that cardio test done!

The vet told me that his cardio doctor has never done a letter before for the VA...

so I am not sure how the vet should word his request...

would something like this be ok...

Dear Dr. xxxxx,

could you please review my in-service medical records and evalulate them to determine if the pacemaker that I have just recently received could be the result of a missed diagnosis when the cath was not performed back in 1988.

*should he add anything else??

thank you again for your insight!!

God Speed

MT

[*Bergie*]

Hello Bergie...Please, I am not offened in the least! just the opposit..I came here looking for advice and that is what you are giving me...I do have tunnel vision esp. since I am in unfamiliar waters...I have explained the same to the VET that I am trying to help...you wrote: " Now 20+ years later he has a pacemaker. What you should do is ask the cardiologist if the pacemaker could be the result of a missed diagnosis when the cath was not performed. If you get the cardiac issue SC'd then the HTN can be a secondary connection to the cardiac issue. Again look at the big picture and get out of the tunnel. "...

Ok...that makes sence since he has a pacemaker now...due to his heart not beating correctly...I wish he had that cardio test done!

The vet told me that his cardio doctor has never done a letter before for the VA...

so I am not sure how the vet should word his request...

would something like this be ok...

Dear Dr. xxxxx,

could you please review my in-service medical records and evalulate them to determine if the pacemaker that I have just recently received could be the result of a missed diagnosis when the cath was not performed back in 1988.

*should he add anything else??

thank you again for your insight!!

God Speed

MT

As for a Nexus letter everyone has different opinions. The most important point is for the Nexus letter to paint a picture so that the reader fully understands the relationship between the current medical condition (pacemaker), and the symptoms documented in ALL the medical records. If the vets cardiologist can do this than he should win SC for the pacemaker. He can then file for secondary SC for HTN. The cardiac condition is the more important of the two, because it carries up to a 100% disability rating, far more than HTN for sure. This should be the focus of your efforts.

JMO,

Bergie

[Pete53]

The VA is pretty lenient about reopening but it starts a new clock on effective date so anyone considering it should be very careful it is best for them

[jbasser]

Do you have all of his BP readings both in service and post service?

If you do and I hope that you do have them, You should make a chart of all readings.

Kind of like this example.

DATE SYSTOLIC DIASTOLIC PLACE TAKEN

1: 5-1-XXXX 155 101 US Military

2: 10-5-XXXX 142 100 MD office

Then you will need to bold the ones that are compensable. ALso put when he started meds on there.

Take the chart to his private DOc and let the DOC review it. Ask him to write a statement to the fact that he has been treating for HTN and was diagnosed on a certain date. Upon reading the medical history the the elevated in service BP readings are most likely the onset of essential hypertension.

That will be considered New and Material Evidence.

If the readings in service are higher or compensable, even if he doesnt have a diagnosis, Then The RO may have erred.

J