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

[deltaj]

The records from the community hospital used the term veteran. This serviceman was on active duty when he was sent to that hospital by the military. Under 38 CFR 3.1 (d) a person who was been discharged under other than other than dishonorable conditions from active military service is a veteran. Did this veteran have any prior discharged from the U.S. military when he was sent to the community hospital for treatment of a heart condition? Do not lose track of the fact that the records from the community hospital shows this veteran was diagnosed with cardiomyopathy. This veteran needs to be seeking service connection for cardiomyopathy and atrial fibrilliation. This veteran now needs a service officer to help appeal V.A.'s determination that denied service connection for hypertension and to pursue a new claim to service connect cardiomyopathy. He needs expert help because V.A. made a determination that this veteran had no chronic heart condition.

Edited July 6, 2010 by deltaj

[Berta]

"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"

The format for IMOs is here in the IMO forum.

The doc writing the IMO should have SMRs and all other available medical records.

Also for my claim (DMII to include cardio-neuro SC death claim) my IMO doctor had all C & P exam results and the SOCs I had gotten.The VA C & P exams can definitely help by showing an IMO doc VA's own medical rationale-which could be very faulty.

AN IMO with "at least as likely as not" and -with full complete medical rationale

can combat a VA " not likely" opinion and balance the scales for an award under Relative Equipoise.

(In one statement in my IMOs -the IMO Doc said "the VA examiner's statements in the SSOC are medically inaccurate".He then expanded on that.

I didn't have the actual C & P but it appeared to be verbatim statements from the VA doctor in the SSOC.

I had already rebutted the VA medical statements and included my rebuttal with my IMO request.It was a medically inaccurate opinion in many ways.

I have local vet with similiar claim waiting for his SMRs.

In his case I don't foresee SC for his present heart condition- based on his service (long story)as inservice HBP readings might not necessarily have any nexus at all to a current heart disability.

But it takes a good cardio doctor to be able to determine that.

John is right- what readings did he have within that first year after service and when was the cardio problem diagnosed?

Edited July 6, 2010 by Berta

[mountain tyme]

The records from the community hospital used the term veteran. This serviceman was on active duty when he was sent to that hospital by the military. Under 38 CFR 3.1 (d) a person who was been discharged under other than other than dishonorable conditions from active military service is a veteran. Did this veteran have any prior discharged from the U.S. military when he was sent to the community hospital for treatment of a heart condition? Do not lose track of the fact that the records from the community hospital shows this veteran was diagnosed with cardiomyopathy. This veteran needs to be seeking service connection for cardiomyopathy and atrial fibrilliation. This veteran now needs a service officer to help appeal V.A.'s determination that denied service connection for hypertension and to pursue a new claim to service connect cardiomyopathy. He needs expert help because V.A. made a determination that this veteran had no chronic heart condition.

hello..."the records from the community hospital used the term veteran" I used the term veteran instead of the veternas name...the veteran was actually active duty military at the time he had the onset of arterial fibliation and was sent by the base hospital by almbulance where he was admitted into the ICU cardia unit...the veteran is retired from the USAF after 21 years of service....the veteran was not diagnosed with cardiomypathy or I don't believe that is what is meant by the following...per batem from the cardio doctor at the community hospital...

""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."

***please note that the cardiac catherization WAS NEVER PERFORMED....the base hospital decided that since the fib. resolved itself that it was unneccesary...I read the doctor report from both the civilian hosp. and the base primary care doctor and I did not see a diagonis...

***unless the civilian doctor...in this sentance he wrote in the vets record..."

cardiac catheterization was recommended for further assessment of early cardiomyopathy." actually implies that he was in the early stages of cardionopathy? not sure what that sentance implied...

hummmm good catch on that...

what do you think

MT

[*Bergie*]

hello..."the records from the community hospital used the term veteran" I used the term veteran instead of the veternas name...the veteran was actually active duty military at the time he had the onset of arterial fibliation and was sent by the base hospital by almbulance where he was admitted into the ICU cardia unit...the veteran is retired from the USAF after 21 years of service....the veteran was not diagnosed with cardiomypathy or I don't believe that is what is meant by the following...per batem from the cardio doctor at the community hospital...

""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."

***please note that the cardiac catherization WAS NEVER PERFORMED....the base hospital decided that since the fib. resolved itself that it was unneccesary...I read the doctor report from both the civilian hosp. and the base primary care doctor and I did not see a diagonis...

***unless the civilian doctor...in this sentance he wrote in the vets record..."

cardiac catheterization was recommended for further assessment of early cardiomyopathy." actually implies that he was in the early stages of cardionopathy? not sure what that sentance implied...

hummmm good catch on that...

what do you think

MT

Unfortunately the sentence is not a diagosis. The test that never got done (cardiac cath), was to be done to determine if he had cardiomyopathy. Since he never got the test he cannot get the diagnosis. What you want to do is ask the current cardiologist is there is any corrolation between the current cardiac problems and those of the active duty episode. Once you get the connection you will have your proof and can file.

Bergie

[mountain tyme]

"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"

The format for IMOs is here in the IMO forum.

The doc writing the IMO should have SMRs and all other available medical records.

Also for my claim (DMII to include cardio-neuro SC death claim) my IMO doctor had all C & P exam results and the SOCs I had gotten.The VA C & P exams can definitely help by showing an IMO doc VA's own medical rationale-which could be very faulty.

AN IMO with "at least as likely as not" and -with full complete medical rationale

can combat a VA " not likely" opinion and balance the scales for an award under Relative Equipoise.

(In one statement in my IMOs -the IMO Doc said "the VA examiner's statements in the SSOC are medically inaccurate".He then expanded on that.

I didn't have the actual C & P but it appeared to be verbatim statements from the VA doctor in the SSOC.

I had already rebutted the VA medical statements and included my rebuttal with my IMO request.It was a medically inaccurate opinion in many ways.

I have local vet with similiar claim waiting for his SMRs.

In his case I don't foresee SC for his present heart condition- based on his service (long story)as inservice HBP readings might not necessarily have any nexus at all to a current heart disability.

But it takes a good cardio doctor to be able to determine that.

John is right- what readings did he have within that first year after service and when was the cardio problem diagnosed?

hello Bertha...I hope all is well with your family...haven't been on for a bit...but as you can see I am trying to guide a veteran in the right direction...actually he never went in for a C/p the rater based the decision on a VA medical opionin after someone up there reviewed his service medical records...and denied his claim by stating more likely then not...

Bergie brought up a good point...since I do tend to have tunnel vision...the vet was admitted into the Cardiac ICU at a civilian hopital back in 88 during active duty...the civilian cardiac doctor highly recommened a test...the following exert is from the actual doctor note from the civilian hospital...

"""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."

one of the poster on this tread wrote something and a light bulb came on...

the civilian doctor wrote..."cardiac catheterization was reconnended for further assessement of early cardiomyopath"

so was the doctor saying he was in early stages of cadiomyopath...and if he was since the base elected not to run the test...there was never a diagonosis...I truly want to see this vet prevail...he like many vets is having a hard time...at the present he is rated 60% but receives 50% VA math you know...and it's for migraine (cluster/stress headaches they have it written both ways cluster tension and migraines) Gerds, and for his back ....the harness that he was wearing while fixing a plane the saftey snapped from the ceiling (faulty) and he fell quite a distance to the ground messed up his back and knee (he is 0 rated for his knee and scarring at the present...but it is in his VA records that it was approved with 0%)...also he is VA comp.for tenninnis (ears) and has 0% at the time for hearing.

The veteran only had 3 b/p the first year after readings were 125/89 120/80 136/90...18 months after discharge they were higher the top readings were 140-152 range...the vet did not go to the doctor unless he was sick and didn't know anything about what the readings meant...but the doctor did mention within 18 months that he had high blood pressure did not put him on med's but did put him on a low sodium diet and told him to lose some weight..he weighed in at 210 lbs he is 6'2 lumber jack kind of body.

it wasn't until I believe 2001 that he was actually diagnosised with hypertension by the primary care doctor on base (he has tricare) he had a new primary care doctor at the time and he wrote after review of your medical records he noted that his b/p reading indicated hypertension...so he has been on medication since.

Now...the arterial fib. was in 1988...yet by his service medical records it is indicated all thoughout that he had migraines...was sent to relaxation thearpy...was put on meds...also thoughout his service medical records he had complaints of dizziness upon going from a sitting position to a standing...but anyone who has been in the military knows that your very rarly see the same doctors...more then once...it is who ever is there on call...and this veteran is not a complainer...by all accounts by what I know of him...he was worried if he went to the base clinic he would lose his sercurity clearance...when it came to the headaches and the dizzness...

but anyways I do not want to ramble...

I will look at thse IMO to see if one will fit the request he is looking for.

God Bless

Mt

[mountain tyme]

Unfortunately the sentence is not a diagosis. The test that never got done (cardiac cath), was to be done to determine if he had cardiomyopathy. Since he never got the test he cannot get the diagnosis. What you want to do is ask the current cardiologist is there is any corrolation between the current cardiac problems and those of the active duty episode. Once you get the connection you will have your proof and can file.

Bergie

Yes Bergie...that is what the new plan of action is...later tonight I will be going over to his house, to help his wife put his medical records together from active duty until today current...I bought some highlight stickers and will tab all pages with b/p and cardio related material...then write a letter to ask the cardio doctor if there is any corrolation betweenthe current cardiac problems and those on active duty...

*I wish all veterans before discharge could have someone look over there records or educate them on listing everything on there out process medical review...then I don't feel there would be such a mess now...just my thoughts...

thank you for being such a great source of insight!!!

MT