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.

[63SIERRA]

". The VA found that the condition wasn't present while he was active duty but was present within one year of discharge."

an argument might be. when on active duty, the regular physical fitness training, running . walking . push ups, sit ups ect, may have masked his high blood pressure/ when he became more sedentary after discharge, the readings changed . when you exersize it causes chemical to be released into the blood that make arteries expand for better blood flow. lactic acid builds up . lots of things occur when you raise your heart rate. People who run alot have the best heart rates and blood pressure/. also how many times did they take is blood pressure while on active duty. Unless a test was done over several days then it may have not been accurate.

Also as Berta Said, if they are adament that service didnt cause it. make them state what they think did cause it.

[63SIERRA]

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

I will add to this post an opinion, and the opinion is, not all doctors are intelligent. you can send a monkey to school and give him a title, but that doesnt make him smart. Doctors are just like any other profession, some are awesome, some are duds ; and ask five different doctors thier opinion, and u will likely get 5 different answers.

Just like the weenie at the vamc that told me I only needed one adrenal gland/ God dididnt give me two, just so if I developed cancer, they could cut one out and all would be well. everything in your body is important. Just like the tonsils and appendix, they used to believe they had no important function. they took them out like bad teeth. They since found out they are important organs. OOPS.

Edited February 10, 2014 by 63SIERRA

[jbasser]

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.

''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.''

Ok what were his BP readings in and within the first separation year? If the diastolic number was 100 or higher, I need to know.

If it was, it is imparative that you ammend the claim to remove the secondary issue of Hyopertension and ask for it to be service connected on a direct basis as he meets the criteria for direct service connection. The RO will play games with you all day long because they know they can get away with it.

On the other hand, get it out of the RO and to the BVA as soon as possible. Many folks will argue a DRO may change a negative decision but what if it goes south and you wait a year for a DRO then have to wait another year to go to the BVA. Cut a year off the wait.

This is all hypothetical unless his BP readings are in the 160 / 100 range.

Basser