hypertension Absence Of Evidence=Negative Evidence/va Dr. Shopping

[lotzaspotz]

I suspect we've fallen prey to the VA's well known practice of no news is bad news, and if they don't like one C & P examiner's opinion, just shop for another. Please tell me what you guys think,

My husband underwent surgery in November 1992 to remove a pituitary brain tumor. He medically retired in August 1993 and filed for hypertension (HTN), secondary to the pituitary surgery which is service connected at 60%, because he undergoes hormone replacement therapy (Depo-testosterone by needle every two weeks) and has done so since November 1992. A known by-product from the use of testosterone is hypertension. He has been taking meds for hypertension since 1995, when he was formally diagnosed with HTN, even though there was ample evidence of elevated blood pressure readings prior to his retirement and within one year of that date (August 1993). The VA wants to argue that that the HTN developed due to non-service connected reasons.

He's undergone a number of C & P exams for this condition over the years. The claim has been repeatedly remanded between the Board and the RO. He underwent a C & P exam on 6/26/11, wherein the examiner opined that it was at least as likely as not that HTN was present within one year of military separation and is less likely it was related to the pituitary tumor condition requiring surgery (no rationale as to WHY he reached this conclusion in any clinical sense). The examiner stated that he reviewed the records and there was documentation of elevated blood pressure between August 1993 and April 1995. My husband's records also included blood pressure readings for July 1993, 143/87, December 1994 130/95, February 1995 145/102. However, the first actual diagnosis of HTN was April 17, 1995. That went to the Board who bounced it back to the RO for details. What we now have from a C & P conducted January 15, 2014 states this:

"STRS indicates blood pressure July 1993 143/87 mmHg. This elevated blood pressure does not make the diagnosis of HTN, and STRS do not indicate treatment or diagnosis of a HTN condition, and therefore, given this examiner opined that the chronic hypertension began in May 1994, it is less than likely the hypertension was present in-service, especially since VA rating purposes require the initial diagnosis of HTN to be confirmed by reading taken 2 or more times on at least 3 different days. Review of the veteran's medical record did not show a consistently elevated blood pressure readings to make the hypertension diagnosis while during military service. Therefore, it is less than likely the current HTN occurred during military service, but was diagnosed between May 1994 and September 1994, which was within the first year of after military separation, but not during active military duty."

This opinion offers no rationale regarding why there is no relationship between the use of testosterone in hormone replacement therapy and my husband's HTN. The fact that no one at Wilford Hall where the surgery took place took blood pressure readings two or more times a day for at least three different days is understandable, considering the fact that at that point, we didn't know he had HTN. He was TDRL at Wilford Hall until his retirement date of August 1993. We did notice he started to experience increased blood pressure readings, which led to the VA acknowledging those readings, but not formally diagnosing him with HTN until after the fact in April 1995. That's absence of evidence, but does that equate to negative evidence?

We have yet to read any discussion in either the June 2011 C & P or the one last month that discusses WHY there is no correlation between the HTN and his bi-weekly innoculations of Depo-testosterone. It appears to me that this
C & P is as inadequate as the previous one.

I guess I need to clinically determine just how long it takes HTN to manifest itself after use of Depo-testosterone begins? What the incubation period is?

Thanks for any insight you guys can give. I need help with strategy, thank you.

[meghp0405]

for a diagnosis, it appears that you need a strong(er) IMO/IME stating when he was diagnosed with hypertension and a rationale on how and why the doc came to that conclusion.

Now, to receive compensation for HTN, the diastolic number (bottom number) of his readings must be 100 or greater. I think this is why it has been disapproved over and over again. Again, just a WAG, because I haven't seen his STR's. I don't have my 38 CFR with me or I would give you the reference for that.

[63SIERRA]

Get a full lab done on him. ALOT can be learned from a comprehensive lab summary. They can check everything with the blood gasses, minerals, glucose, toxins, ect. Its amazing how many systems can be checked with a few vials of blood. Its likely that the meds will have something out of whack, that affects something else.

When one body system is affected it is no longer in perfect balance and other things are almost always affected. also did they try chemo on the tumor before they tried surgery? chemo can cause irriversable cell damage. Think outside the box, look where you wouldnt look.

Heres a perfect example, I found out accidentally , just surfing the web chasing down rabbit holes, that kidney cancer is usually linked to hepc. I submitted an article, that the va couldnt dispute, because it entailed 8 years of controlled study, by an accredited university, and they granted me service connection for the kdney cancer.

Ok, doing more research, I found that when they removed my kidney, the removed most of my right adrenal gland. VA doctors lied to me and told me left side adrenal gland would take over complete function for right gland that was removed. LIE, LIE LIE LIE. The right gland and left gland do different function, they are even shaped differently. Ok theres more legitamite claim. Dont believe everything the va docs tell you, theres so much accurate information on the net you can access, research everything. shortly after surgery, erectile dysfunction became an issue for me, well low and behold, the adrenal gland is responsible for certain sex hormones. CLAIM. When a kidney is removed, the blood pressure usually increases. CLAIM. NOBODY will tell you these things, matter of fact they will lie to you. They will try to tell you that anything you have 2 of , you really only need one the other takes over.

Ok back to the blood pressure. REQUEST from his primary care majician, a blood pressure monitior. Tell them you want to do a long term blood pressure monitoring.

take his blood pressure 3 times a day, for 2 weeks. Bring those readings to his doctor and have them record them into his records.

Thats what I did. I now have undisputable proof, because a more detailed study had not been prevoiusly done.

If you need a blood pressure monitor pm me and I will mail it to you for free. They didnt want it back/

Edited February 10, 2014 by 63SIERRA

[63SIERRA]

Also keep this in mind. PAIN can and does cause blood pressure to rise. So if he is in any pain from surgeries, headaches ,ect, that can cause blood pressure readings to be higher than normal.

[lotzaspotz]

Sierra, thank you for your kind offer. We do have a BP monitor at home. My husband's on meds to control his BP, I don't think I want him to go without his meds for the three days it would take to do these measurements, but that's the only way we'd get a true reading. This has been an open claim for 20 years, and he's been taking meds for this since then. The VA found that the condition wasn't present while he was active duty but was present within one year of discharge. You can see my obvious argument on the timing aspect of things. I also know that besides depo-testosterone shots bi-weekly, my husband has also been taking Cortef, a steroid, since back then, one of the byproducts which is hypertension. This is for a service connected hypoadrenalism.

The C&P read, "Review of the a veteran's military medical records did not show a consistently elevated blood pressure reading to make the hypertension diagnosis while during military service. Therefore, it is less likely the current HTN occurred during military service, but was diagnosed between 5/94 and 9/94, which was within the first year after military separation, but not during active duty military."

So, is this saying that diagnosis during the first year after discharge is NOT assumed to be service connected? Discharge was 8/23/93.

The brain surgery for a pituitary tumor took place November 1992. He was immediately prescribed steroids for hypoadrenalism. He went TDRL at Wilford Hall at Lackland until he was medically retired in August 1993.

I also dug a little on the examiner's credentials. He is an MD, but not an endocrinologist. He is an anesthesiologist. Would you consider this a "qualified medical professional" as stated in the Board remand?

[Berta]

Unfortunately I feel the VA statement is correct:

“I also dug a little on the examiner's credentials. He is an MD, but not an endocrinologist. He is an anesthesiologist. Would you consider this a "qualified medical professional" as stated in the Board remand? “

I sure wouldn't. That opinion could be rebutted.

Getting back to the initital post here:

“My husband underwent surgery in November 1992 to remove a pituitary brain tumor. He medically retired in August 1993 and filed for hypertension (HTN), secondary to the pituitary surgery which is service connected at 60%, because he undergoes hormone replacement therapy (Depo-testosterone by needle every two weeks) and has done so since November 1992. A known by-product from the use of testosterone is hypertension. He has been taking meds for hypertension since 1995, when he was formally diagnosed with HTN, even though there was ample evidence of elevated blood pressure readings prior to his retirement and within one year of that date (August 1993). The VA wants to argue that that the HTN developed due to non-service connected reasons. “

“The brain surgery for a pituitary tumor took place November 1992. He was immediately prescribed steroids for hypoadrenalism. He went TDRL at Wilford Hall at Lackland until he was medically retired in August 1993.

Is there any other reason ,in addition to the Depo-testosterone ;such as potential increases of HBP from any other SC med he takes,that could be the cause of the HBP?

A good IMO doctor could possibly resolve this in a heartbeat.

“The VA wants to argue that that the HTN developed due to non-service connected reasons. “

Did the VA give a full medical rationale as to their opinion as to the etiology or 'cause' of his “NSC” HBP?

If they did, can you tell us exactly what they said?

[jbasser]

Actually all doctors have one thing in common. They have to go to medical school. After medical school they chooze a specialty and get extra training in their specialty areas.

The VA looks at the MD part and the opinions of an MD are hard to dispute once a decision has been made but it can be done,

J