hypertension Hypertension

[huskerfanfl]

I retied from the army about two years ago and of course made a claim for disability. One of my claims was for hypertension. When I received the decision it was listed as not compensable because there was not a history shown in my record. The hypertension medicine was prescribed as a result of a visit to the emergency room where my pressure was measured at 166/122. The meds keep it down but barely (normally 132/86). I have appealed and sent in the copy of the emergency room record (again). I would hate to think I need to come off my meds to show that my blood pressure is high.Anyone have any suggestions?

[qmcorps]

This is the starting point.( http://ecfr.gpoaccess.gov/cgi/t/text/text-...fr4_main_02.tpl ) remove the "()" and cut and paste this into your browser. In a perfect world this should be a 10 (realistic) or 20(lots of documentation) percent. In my case this is the cause of a secondary condition. Submit the documentation for a Comp & Pension examination. Be prepared to wait for up to a year or more for the exam. On my initial claim, I submitted 26 years worth of medical records and the appropriate VA forms. It sat for one year until I filed a congressional complaint. That got the ball rolling. I have been doing this for four years with valid medical records. Treat this like a war and every submission is another campagin to achieve victory. This process is not for the faint hearted, the VA wants you to become discouraged and give up. V/R, Mike

Diseases of the Arteries and Veins

7101 Hypertensive vascular disease (hypertension and isolated

systolic hypertension):

Diastolic pressure predominantly 130 or more................ 60

Diastolic pressure predominantly 120 or more................ 40

Diastolic pressure predominantly 110 or more, or; systolic 20

pressure predominantly 200 or more.........................

Diastolic pressure predominantly 100 or more, or; systolic 10

pressure predominantly 160 or more, or; minimum evaluation

for an individual with a history of diastolic pressure

predominantly 100 or more who requires continuous

medication for control.....................................

Note (1): Hypertension or isolated systolic hypertension must be

confirmed by readings taken two or more times on at least three

different days. For purposes of this section, the term

hypertension means that the diastolic blood pressure is

predominantly 90mm. or greater, and isolated systolic

hypertension means that the systolic blood pressure is

predominantly 160mm. or greater with a diastolic blood pressure

of less than 90mm.

Note (2): Evaluate hypertension due to aortic insufficiency or

hyperthyroidism, which is usually the isolated systolic type,

as part of the condition causing it rather than by a separate

evaluation.

[qmcorps]

By the way, I'm retired Army myself. Become very familiar with 38 CFR, Chap 4 for starters.

[huskerfanfl]

Thank you for the reply. With the fancy VA math even a 10% rating will get me to 60% disability. I also have issues with low compensation awrds in other areas. The link you posted will definitely help in my endeavor.

[Guest jstacy]

We call that Low Balling the awards which is a Common practice by the VARO's.

Regarding the Hypertension, These people are going to Jerk you around. It will always yo yo because Blood pressure goes up and down and the VARO also aduusts compensation down. I guess they cant see to adjust it higher. We have to file a claim.

Has it been a year since the decision? You may want to send in a Notice of Disagreement if it is within a year of the decision. Then Appeal stating the rating was not properly awarded due to the criteria met in the 38 cfr chapter 4 rating code 7101.

Another thing you can do is to get all your med recs and make a spreadsheet of the dates and BP readings and submit them to the VA. If there is a consistant elevation then you should have no problem.

[Pete53]

Unfortunately you waited longer than one year after you separated. Your best bet is to get a Doctor to write up a Medical Opinion which shows hypertension now, and the Doc's opinion that it was caused by your service or started when you were in service.

[huskerfanfl]

My original compensation letter came November of 2004. I did file an appeal within the one year time frame. Included in the appeal were the emergency room records from the visit which resulted in me being put on blood pressure medicine. I also appealed the 10% decision on my back (I have an MRI from active duty that shows 3 bad disks). I know that it may not have been advisable, but I also noted that during my retirement physical the medic had to take my blood pressure three times before it was inside acceptable standards and pointed out that I could prove I have high blood pressure if I came off my meds, but there was also a possibility that the lack of medicine may create some adverse medical issues and considering the fact that doctors take an oath to first do no harm it seemed like a ludicrous idea. I have to admit I was a tad bit fed up with VA.

I had taken an early out in 1993 and went back on active duty in 1998. When I turned in my claim I told them that the claim was based entirely on the last period of active duty and that THEIR regulation prohibited them from collecting my VA check to pay off my SSB. When I came back from my exam, I once again told them this information. On three separate occasions I told them on the phone the information. So of course when I was awarded my disability they bagan to collect the money. It took me 5 months to get that straightened out.

[Pete53]

If you can show that you were taking blood pressure medication prescribed in Military the case should be closed in your favor.

[Guest anfrnkie]

I retied from the army about two years ago and of course made a claim for disability. One of my claims was for hypertension. When I received the decision it was listed as not compensable because there was not a history shown in my record. The hypertension medicine was prescribed as a result of a visit to the emergency room where my pressure was measured at 166/122. The meds keep it down but barely (normally 132/86). I have appealed and sent in the copy of the emergency room record (again). I would hate to think I need to come off my meds to show that my blood pressure is high.Anyone have any suggestions?

go to the doctor, and have put a blood pressure montor on you ,this will take your b/p every half hour, after midnight, it goes down to 1 hour after 24 hours you go to doctor inside the montor will give you your readings over 24 hours,the montor will prove b/p

[Guest jstacy]

Dont take your Blood Pressure every half hour. You will damage your arm by doing so. It is the same as applying a tournicate. It is best to take it 2 to 3 times per day max.

[Vike17]

Huskerfanfl,

Your 10% rating has nothing to do with your MRI's from active duty. Those were used to determine service-connection, not the current disabiling affects of your disability. The VA used the notes from your recent C&P exam, more specifically the range of motion and/or incapacitating episodes to determine your rating (to be rated under incapacitating episodes your back would have to be rated under IVDS).

By having your blood pressure taken on a monitor will only prove you CURRENTLY have high blood pressure. If your SMR's show high blood pressure and you still currenly have it, but have no documented continuity of treatment from discharge to the present, you'll need an IMO to connect the dots. If you have been on medication for high blood pressure since your discharge, do you have any of the old prescriptions? If you do, this would be good enough to show continuity of treatment.

Vike 17

[Guest anfrnkie]

Dont take your Blood Pressure every half hour. You will damage your arm by doing so. It is the same as applying a tournicate. It is best to take it 2 to 3 times per day max.

the only true way to prove high blood pressure is a montor,i don,t think you know about them or you would not make that statmend

[Guest jstacy]

Frank you are the one who does not know what he is talking about. I have been fighting essential uncontrollable hypertension for 30 years and I take 5 different meds and it only works part of the tiome. Also, My wife is a medical professional. So dont heed my advice, Just keep on pumping the air into that BP monitor. DO not give out unwarranted advice on this site. We dont need nor want it.

[mssoup1]

Hypertension seems to be an area that is hard to get service connected, unless you can prove it is seondary to an already service connected disability. We fought for a long time (all the way to the BVA) to get my husbands claim for hypertension service connected. His blood pressure was normal when he entered the military. On his separation papers, it showed his blood pressure to be high. No where in his SMR's was there ever a blood pressure reading as they never took his blood pressure at any time he went to sick bay. He had early records of being diagnosed with hypertension and also being medicated for it. The records didn't quite go back to within a year of his discharge because those records no longer existed. The VARO kept denying his claim. When it went to the BVA, they remanded it back to the VARO requesting another C & P examination. At this C & P exam, we finally got the examiner to put into my husbands report that it was of her opinion that his hypertension was at least likely as not that it was related to his military service. It took only this statement to finally get the claim approved. Without it, we would not have prevailed. He was granted 0% because his blood pressure reading, while at times was high, still showed that it was being controlled with medication and was not consistently high. Since he is now 100% I/U P & T, it was still important to get his hypertension service connected, even though it was at 0% compensation. If in the event, God forbid, he should die from something that can be related to his hypertension, then I can apply for DIC.

As another helpful note, when my husband was granted his P & T, there was still an outstanding claim for cataracts that had not been resolved. I felt that since they had granted him 100%, that this claim would not be completed and would be considered moot since it would make no difference in his compensation or anything else. I just filed everything away and considered us through with everything. I never even responded back to the VARO concerning this claim. A few weeks later, we received a decision letter in the mail approving him for service connection for the cataracts and rated it at 10%. It made no difference in his compensation, but they did grant service connection. Therefore, even though you are granted 100% and have outstanding claims sitting at the VARO, I would not let those claims drop by sending anything to the VARO to do so. Just let the VARO continue on these claims and there is a great possiblility that you may very well find that they get approved, even though you are at rated at 100%. But, if not, you have not lost anything by continuing with the claims.

By the way, why would anyone want to take their blood pressure every half hour. I know this is done in the hospitals for specific reasons, but I would never take mine every half hour at home. I have had 2 heart attacks and have considerable problems with high blood pressure, but I take mine several times a week, maybe several times a day, depending on if I feel I am having some problems or not. If I feel I have a critical enough problem that I have a need to monitor it every half an hour, then I would probably be calling the rescue squad to take me to the emergency room. In fact, I have done this before.

Hope I didn't jump out of turn in this thread, but was hoping that my experience may help someone else.

mssoup1

[Berta]

Good for you! MSSOUP

" At this C & P exam, we finally got the examiner to put into my husbands report that it was of her opinion that his hypertension was at least likely as not that it was related to his military service. It took only this statement to finally get the claim approved."

That is what I call using some Command Presense!

Or -Ask and you shall receive!

There is nothing wrong at all with talking to these VA doctors as equals and telling them exactly what you need.

Sometimes I think they would be more helpful on C & P reports but they dont have a clue what each vet needs for service connection- they don't understand 38 CFR, or nexus factors , etc like we do---

After being frustrated for 3 years over some evidence the VA would not read for my husband I went right over to his shrinks office and asked for what he needed and upon receipt of what I got, the VA resolved that claim in 3 weeks.

My neighbor (retiree who could not benefit from a SC claim at this point but you never know- his VA doctor immediately stated his knee and back problems were due to a well documented back hospitalization in service.) It sure pays to ask for what you need.

[mssoup1]

Berta,

Over the years, my husband has been to numerous C & P exams as a result of our filing and appealing his claims. I think in that time we have been through, seen and heard about everything. So much depends on who the C & P doctor is that is examining you for your particular claim. At his hearing exam and audiology exam, they were superb. More than willing to help my husband with his claim. His PTSD C & P exam was also very well done. But, for what they consider standard exams like the skin, hypertension, ED, etc. the examiner used is so against the veteran. In fact, he did a C & P exam for my husband for an increase in his skin condition. Couldn't finish the exam fast enough because he was going on vacation and my husband was the last veteran he had to see. Well, needless to say, he never did write up a report to send to the VARO. I caught this when I kept asking for a copy of the report. I immediately filed a complaint with the VARO due to the fact that my husband had a C & P exam, but no report was ever written up. I asked that he be given another C & P exam as that exam was inadequate. They did give him another one. I also stated that I did not want the same examiner to give him the second exam. He didn't. End result was that my husband received his increase. And I also was able to get this done before the VARO sent my husband a denial based on the absence of a report for the first C & P exam. Saved time all the way around. This same examiner did a C & P exam on my husband for ED. The entire report was written wrong. Even stated he had a prostate problem which my husband does not have. The claim was ED secondary to his medications, which was not for any prostrate problem. Again, I caught the report early and filed another complaint requesting another C & P exam by another examiner. Never heard back on this claim. I don't want to rock the boat now either because he has been granted P & T. I guess the VARO considered this claim moot, since he was given this rating.

But, from experience, so much depends on your C & P examiner. If you can get a good one, your claim has a better shot at getting approved. He is willing to listen to you and read what is in your file before giving his opinion. But, if you are one of the unfortunate veterans who gets an examiner who is in no way willing to help the veteran out, then you are basically SOL, unless you can get an IMO to help your claim. Should not have to be this way, but it happens every day and at every VAMC, I'm sure. In some of the reports that we have received from C & P exams that my husband has had, there is no way that the examiner heard anything we had to say, much less read anything in his file. And the bad part about all of this is more than likely the examiner is a veteran himself.

mssoup1

[Berta]

I agree that our personal experiences certainly can help others.

We had a doc here at the local VA who would always ask at any exam with a vet--in a heavy accent "What is wrong with you?"

So he sort of left it up to the vet to diagnose himself or herself-

He was a Vietnam vet and also a Chinese American ( it was startling to meet him to some new Nam vets in the system because they thought he was the enemy)and I do value his service but he misdiagnosed his own pancreatic cancer, did not seek medical help and he died.

He also severely misdiagnosed my husband as documented in Rod's med recs.

You are right -many VA docs are veterans-some have disabilities from service-

some of them are absolutely great. This above doc told Rod many times his PTSD rating was too low but not being a shrink and not documenting his opinion, that did not help the claim.

Even though he misdiagnosed Rod I wish he was still alive.

Sometimes between you and me I feel like walking through the halls of the local VAMC and asking every doctor there "What is wrong with you?"

[mssoup1]

Berta,

You stated, "Sometimes between you and me I feel like walking through the halls of the local VAMC and asking every doctor there "What is wrong with you?""

I'm sure most veterans have felt the same way at one time or another. The VAMC, I guess, in some ways is no different than other doctors offices. The only difference is that with the VAMC, some of their opinions can make a difference in whether a veteran is approved or denied his claim. Also, with what the VAMC pays their staff, along with the number of veterans they expect them to see daily, probably has a lot to do with how you are treated and the amount of time you are alloted. But, all doctors offices and facilities are trying to do more with less. I just had a stress test done and while talking with the nurses, they have been told that they are going to increase the number of patients they do a stress test on daily. They can barely keep up now. It is hard to keep track of what patient is where. The staff there is great, but I think if they increase the load on them, there could be some mishaps to occur. I hope not, though. You can only expect so much of someone, especially when you are working in a field whereby a patients life can be at stake.

Also, in the independent world, doctors and hospitals have to get pre-approval from the insurance company/Mdicare on so many more things than they use to. I have been put on oxygen at night due to the results of a sleep study I had done. Because the report from the sleep study is 3 months old showing my oxygen level while sleeping, Medicare has required my pulminary doctor to send a respiratory therapist to my home to have me monitor my oxygen level for one night in order to submit this to them before they will approve my use of the oxygen. Medicare says the report cannot be more than a month old. Go figure! Insurance companies/Medicare is now managing our health care more and more and telling the doctors how they can treat us based on their opinions. I realize health care costs have risen considerably, but I also don't think doctors are out there to break the insurance companies/Medicare by doing unnecessary testing and treatments.

So when you look at this and then look at the way the VAMC is run, I guess the basic element in the whole equation is costs, costs, costs, vs. care, care, care for all involved.

JMO

mssoup1