hypertension My Denial Notice In Bbe/ Very Long

[deville905]

This is a copy of my denial I received yesterday. I notice my C&P exams are far from the truth of numbers and conversation. Looking for any advice, but I know I need to file NOD. I'm currently under Voc Rehab.:

REASONS FOR DECISION

1. Evaluation of bronchial asthma currently evaluated as 30 percent disabling.

The evaluation of bronchial asthma is continued as 30 percent disabling. {38 CFR 3.321(a); 38
CFR 3.321(b)(1)}

We have continued a 30 percent evaluation for your asthma, bronchial based on:

· Daily inhalational therapy

· Daily oral bronchodilator therapy

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• Inhalational anti-inflammatory medication

Additional symptom(s) include:

• Ratio of Forced Expiratory Volume in One Second (FEV-I) to Forced Vital Capacity
(FEV-IIFVC): 86 (Not considered for compensable evaluation)

• Forced Expiratory Volume in One Second (FEV-I): 122 of predicted (Not considered for
compensable evaluation)

A higher evaluation of 60 percent is not warranted unless there is:

· Forced Expiratory Volume in One Second (FEV -1) of 40 to 55 percent predicted; or,

· FEV-I to Forced Vital Capacity (FVC) (FEV-IIFVC) of 40 to 55 percent; or,

· At least monthly visits to a physician for required care of exacerbations; or,

· Intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids.

2. Evaluation of erectile dysfunction (claimed as lost of sexual desire) currently evaluated
as 0 percent disablin1;:.

The evaluation of erectile dysfunction (claimed as lost of sexual desire) is continued as 0 percent
disabling. {38 CFR 3.32I(a); 38 CFR 3.32I(b)(I)}

A noncompensable evaluation is assigned whenever evidence fails to show penile deformity
together with loss of erectile power which would warrant 20 percent.

We have continued a noncompensable evaluation for your erectile dysfunction based on:
• Loss of erectile power

Note: In every instance where the schedule does not provide a zero percent evaluation for
a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a
compensable evaluation are not met. {38 CFR §4.3I}

A higher evaluation of 20 percent is not warranted unless there is deformity with loss of erectile
power.

3. Evaluation of hypertension currently evaluated as 0 percent disablin1;:.

The evaluation of hypertension is continued as 0 percent disabling. {38 CFR 3.32I(a); 38 CFR
3.32I(b)(I)}

We have continued a noncompensable evaluation for your hypertension based on:
• A diagnosed disability with no compensable symptoms.

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Note: In every instance where the schedule does not provide a zero percent evaluation for
a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a
compensable evaluation are not met. {38 CFR §4.31}

A higher evaluation of 10 percent is not warranted unless there is:

· Diastolic pressure predominantly 100 or more; or,

· Systolic pressure predominantly 160 or more; or,

·A history of diastolic pressure predominantly 100 or more and there is a requirement for
continuous medication for control.

4. Service connection for prostate cancer.

Service connection may be granted for a disability which began in military service or was caused
by some event or experience in service.

Service connection for prostate cancer is denied since this condition neither occurred in nor was
caused by service.

The evidence does not show an event, disease or injury in service. Your service treatment
records do not contain complaints, treatment, or diagnosis for this condition. The evidence does
not show that your disease developed to a compensable degree within the specified time period
after release from service to qualify for the presumption of service connection. We did not find a
link between your medical condition and military service. The evidence of record show you have
a diagnosis of prostate cancer, however, there is no competent medical evidence which relates
your prostate cancer to your military service. Therefore, service connection is denied.

5. Service connection for sleep apnea.

The claim for service connection for sleep apnea remains denied, as the evidence continues to
show this condition was not incurred in or aggravated by military service.

The evidence does not support a change in our prior decision. Therefore, we are confirming

the previous denial of this claim. The evidence does not show an event, disease or injury in
service. Your service treatment records do not contain complaints, treatment, or diagnosis for
this condition. We did not find a link between your medical condition and military service. The
evidence does not show that your condition resulted from, or was aggravated by, a service-
connected disability. The evidence of record from your VA sleep study notes a diagnosis of

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obstructive sleep apnea, however, there is no competent medical evidence which relates your
sleep apnea to your military service.

We also recognize that you are claiming your sleep apnea as secondary to chest pain, headaches
and depression, however, you are not service connection for any of the listed conditions. The VA
medical opinion found no link between your diagnosed medical condition and military service.
The examiner opined hypertension does not cause sleep apnea. The examiner also stated you are
able to work in any occupation that does not have regulatory restrictions preventing individuals
with severe obstructive sleep apnea corrected by a CP AP machine and sleep apnea does not
impact your ability to work.

6. Service connection for atypical chest pain (previously evaluated as chest pain under DC
5299-5297).

The claim for service connection for atypical chest pain (previously evaluated as chest pain
under DC 5299-5297) is considered reopened. However, the evidence continues to show this
condition was not incurred in or aggravated by military service.

The evidence does not support a change in our prior decision. Therefore, we are confirming

the previous denial of this claim. Your service treatment records do not contain complaints,
treatment, or diagnosis for this condition. The evidence does not show an event, disease or injury

. .

III service.

The evidence does not show that your condition resulted from, or was aggravated by, a
service-connected disability. We recognize you are claiming your chest pain as secondary
to posttraumatic stress disorder (non- combat) however, you are not service connected for
posttraumatic stress disorder.

We did not find a link between your medical condition and military service. Y our VA heart
exam notes a diagnosis of atypical chest pain. You reported having chest pain near your heart
which has become more frequent in the past. Your physical findings from the exam shows no
evidence of congestive heart failure, cardiac arrhythmia, heart valve abnormality, or pericardial
adhesions. Your heart rate and rhythm were normal. There were no evidence of hypertrophy
or cardiac dilatation. Your Mets level were 10.10 with an ejection fraction of 60 to 65 percent.
There is no competent medical evidence which show your atypical chest pain relates to your
military service.

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7. Service connection for headaches.

The claim for service connection for headaches is considered reopened. However, the evidence
continues to show this condition was not incurred in or aggravated by military service.

The evidence does not support a change in our prior decision. Therefore, we are confirming

the previous denial of this claim. Your service treatment records do not contain complaints,
treatment, or diagnosis for this condition. The evidence does not show an event, disease or injury

. .

III service.

The evidence does not support a change in our prior decision. Therefore, we are confirming

the previous denial of this claim. Your service treatment records do not contain complaints,
treatment, or diagnosis for this condition. The evidence does not show that your disease
developed to a compensable degree within the specified time period after release from service to
qualify for the presumption of service connection.

The evidence does not show an event, disease or injury in service. We did not find a link
between your medical condition and military service. Y our VA medical records dated December
2013, notes a reported history of chronic headaches, however, there is no competent medical
evidence which relates your headaches to your military service.

8. Service connection for depression (now claimed as non- posttraumatic stress disorder/
personal trauma).

The claim for service connection for depression (now claimed as non- posttraumatic stress
disorder/personal trauma) is considered reopened. However, the evidence continues to show this
condition was not incurred in or aggravated by military service.

The evidence does not support a change in our prior decision. Therefore, we are confirming
the previous denial of this claim. The evidence does not show an event, disease or injury in
service. Your service treatment records do not contain complaints, treatment, or diagnosis for
this condition. We did not find a link between your medical condition and military service.

Y our VA treatment records show a past medical history of depression. Y our VA posttraumatic
stress disorder examination shows a diagnosis of adjustment disorder with mixed anxiety and
depressed mood, however, there is no competent medical evidence which relates your depression
to your military service.

We recognize you are now claiming your mental disorder as a claim for posttraumatic stress
disorder. We have considered but denied service connection for posttraumatic stress disorder
because there is no evidence of a current diagnosis for posttraumatic stress disorder or an in-

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service stressor linked to the claimed condition.We have not found that you experienced a
stressful event in service, including fear of hostile military or terrorist activity.

Service connection for posttraumatic stress disorder may be granted if the evidence demonstrates
(1) a current diagnosis of posttraumatic stress disorder rendered by an examiner specified by

the regulation; (2) an in-service stressor consistent with the places, types, and circumstances

of service that indicates the Veteran's fear of hostile military or terrorist activity; and, (3) the
Veteran's posttraumatic stress disorder symptoms have been medically related to the in-service
stressor by the VA psychiatrist or psychologist, or one contracted by VA.

VA will now rely on a Veteran's lay testimony alone to establish occurrence of a stressor related
to fear of hostile military or terrorist activity, provided that the claimed stressor is consistent with
the places, types, and circumstances of service, and a V A psychiatrist or psychologist, or contract
equivalent, determines that the claimed stressor is adequate to support a posttraumatic stress
disorder diagnosis and that the Veteran's symptoms are related to the claimed stressor. If the
evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor
is related to that combat, in the absence of clear and convincing evidence to the contrary, and
provided that the claimed stressor is consistent with the circumstances, conditions, or hardships
of the veteran's service, occurrence of the claimed in-service stressor may be established by the
veteran's lay testimony alone. If the evidence establishes that the veteran was a prisoner-of-war
under the provisions of38 CFR 3.I(y) and the claimed stressor is related to that prisoner-of-war
experience, in the absence of clear and convincing evidence to the contrary, and provided that
the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's
service, occurrence of the claimed in-service stressor may be established by the veteran's lay
testimony alone. {38 CFR Sections 3.1(y), 3.304(f), 4.125(a)}

Credible supporting evidence that the claimed in-service stressor occurred" means that there is

a legal standard that must be met and that the veteran's report of the incident must be supported
by service or civilian documentation of the incident, or if that is not available, there must be
other evidence that would lead to the reasonable conclusion that the incident occurred. Such
other evidence would generally include military or civilian documentation of behavioral changes
after the incident which could reasonably be expected from a person who had undergone a
personal assault. Such changes include, but are not limited to: sudden requests for other duty
assignments without justification, obsessive behavior (such as over, or under, eating), increased
disrespect for military or civilian authority etc.

According to your recent VA examination dated December 27, 2013 . You reported experiencing
difficulty falling or staying asleep and exaggerated startle responses, irritability with anger
outbursts. During the psychological examination you were appropriately dressed and cooperative

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toward the examiner. You were oriented to time, person, and place. Your thoughts process and
thought contents were unremarkable. There were no reports of hallucinations, panic attacks,
episodes of violence or obsessive ritualistic behaviors. You reported having chronic sleep
impairment, diminished interest in participation of activities, recurrent distress, problems with
concentration and the inability to recall important aspect of trauma. The examiner notes you
meet the DSM- V stressor criterion for adjustment disorder. The examiner gave a diagnosis

of adjustment disorder with depressed mood which do not meet the DSM-IV criteria for a
diagnosis of PTSD. The examiner states your claimed stressors are not related to your fears of a
hostile military or terrorist activity, however, your claimed stressors do not adequately support
a diagnosis ofPTSD, according to the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV or V)) criteria. The examiner stated your reported stressors are related
to your health conditions and not your military service.

9. Entitlement to individual unemployability.

Entitlement to individual unemployability is denied because the claimant has not been found
unable to secure or follow a substantially gainful occupation as a result of service connected
disabilities. Service connected disabilities currently evaluated as 40 percent do not meet the
schedular requirements for entitlement to individual unemployability. 38 CFR 4.16 provides that
individual unemployability may be granted where there is one disability evaluated as 60 percent
disabling, or two or more disabilities, one of which is 40 percent with a combined evaluation of
70 percent or more. These percentage standards are set aside only when the evidence clearly

and factually shows the veteran has been rendered unemployable solely due to service connected
disabilities regardless of their individual and combined percentages. Such cases are submitted

to the Director of the Compensation and Pension Service for extra-schedular consideration. This
case has not been submitted for extra-schedular consideration because the evidence fails to show
the veteran is unemployable due to service connected disabilities. (38 CFR 4.l6)

You reported not being able to work due to asthma and sleep apnea. You reported your
respiratory condition impact your ability work due to shortness of breathe. You reported having
difficulty when washing your car, doing yard work or even playing with your children. However,
there is no evidence which show you cannot perform sedentary employment. Since you do not
meet the schedular criteria and the evidence does not show you are unable to gain an occupation
in a sedentary or physical environment because of a service connected condition, we cannot
grant entitlement to individual employability (IU).

[63SIERRA]

it seems like your asthma and could sleep apnea could be something to explore as related as well as headaches , and it looks like they could have gave you 10 percent for ED they are sure being tough. you need to do research. Find out what affects what/

[63SIERRA]

does the meds you take for asthma cause any swelling of nasal passages., throat, cause shallow breathing. restless sleep. read the side effects of the astma meds and see if any of the symptoms are one you might have that contribute to sleep apnea.

[deville905]

WOW! You got me thinking, because I've always been told about nasal passage swelling and a lump in my throat area, which may come from the meds. Very good point. So if I can link it all together, there maybe a winning chance for my SA, ed, and headaches. Can you look at my buddy statements for me? Thanks for the great thought!

[63SIERRA]

Thats why we are here to help each other in an unfair corrupt system.

they already discounted the buddy statements in your denial, but they may be needed at some point. you see if you can produce new and material evidence and they look at the claims again, they must consider all evidence of record . you can get sworn depositions from you buddys, or a sworn statement under penalty of perjury. which is a person saying, I am telling the truth and if found otherwise, will be prosecuted.

Dont let the claim die if you can help it. your not a doctor, so anything you submit, they have to prove otherwise. vet friendly system right ? like the undersecretary said, they are there to assist us right, we are important right,?

[FormerMember]

Correct me if I am wrong, but you filed for all these ailments with no supporting documentation in your Service Treatment Records? Did you have the help of a VSO service officer? Filing claims for disease injury that hinge on other claims not yet adjudicated service-connected is one of the oldest ploys in VA's inventory for denials. I cannot say I am shocked to read this. I think a quick stroll through the FRE (Federal Rules of Evidence) would be beneficial before you commit to proceeding down this road. Evidence of these diseases/injuries is a prerequisite to winning your claims.

As to the prostate/PTSD issues, are you a Vietnam Veteran? The prostate issues would be presumptive if so. Similarly, you can substantiate your stressors for combat via a request for the Joint Center for the Research of Uniformed Records (JCRUR). They can tell you who was where when and what military actions ensued. This will help in presenting your case.

Best of Luck

A

[63SIERRA]

heres an example how to be flexible in battle. I applied for sleep apnea and was denied. I said it was from gulf war illness. Ok they steal it from us by saying ohh no, gulf war presumptive is for an UNDIAGNOSED ilness. you have been diagnosed, so you lose fat boy.. Ok fat boy gets to thinking. Because of my other diagnosed ilnesses I have become sedintary and depressed, so this time around, when I go to the bva, im going to say that I am not a doctor and now believe that my sleep apnea is caused by my other health conditions obesity being one of them. They cannot dispute that im obese unless they have a rigged scale, they cannot dispute that I have other health conditions, so they will have to connect the sleep apnea. you have to think outside the box, and do your own research. they wont tell you.