hypertension Either just had the worst or best C&P exam.. Still not sure!

[Infantry1985]

Just got back from my C&P exam for Secondary GERD and Secondary Hypertension that lasted all of about 15 min with a NP at Hines. She seemed to be a little ruff around the edges at first, then we somehow go on the conversation of the oxygen generating plants in her office which seemed to perk her up. She only asked a few questions: For both - Was I diagnosed in service?, was I diagnosed at the VA?, do I still have symptoms?, only treated at VA?. For GERD only - Did I have a upper GI? That was it..... Never deep dived into symptoms, but did shake her head at the end and tell me that my pulse was consistently extremely high and that the doctors should have been prescribing me a beta blocker..... After that, and about 15 minutes she said your done and good luck with your service connection. I've had plenty of exams with Docs, but never a NP for C&P; so I'm kind of just still in shock... I guess we shall see!

[Infantry1985]

Based on this I would say, no go on Hypertension, and possibly a go with GERD... We shall see what the raters think..

 

TITLE: C&P

STANDARD TITLE: C & P EXAMINATION NOTE

DATE OF NOTE: JAN 06, 2016@12:30 ENTRY DATE: JAN 06, 2016@12:34:05

AUTHOR: REMES,VALERIE NP EXP COSIGNER:

URGENCY: STATUS: COMPLETED

Hypertension

Disability Benefits Questionnaire

Name of patient/Veteran: xxxx

Is this DBQ being completed in conjunction with a VA 21-2507, C&P

Examination

Request?

[X] Yes [ ] No

ACE and Evidence Review

-----------------------

Indicate method used to obtain medical information to complete this

document:

[X] In-person examination

Evidence Review

---------------

CONFIDENTIAL Page 27 of 53

Evidence reviewed (check all that apply):

[X] CPRS

1. Diagnosis

------------

Does the Veteran now have or has he/she ever been diagnosed with

hypertension

or isolated systolic hypertension based on the following criteria:

[X] Yes [ ] No

[X] Hypertension

Date of diagnosis: 2013

2. Medical history

------------------

a. Describe the history (including onset and course) of the Veteran's

hypertension condition (brief summary):

VET DX WITH HTN IN 2013

b. Does the Veteran's treatment plan include taking continuous

medication for

hypertension or isolated systolic hypertension?

[X] Yes [ ] No

If yes, list only those medications used for the diagnosed conditions:

LISINOPRIL

c. Was the Veteran's initial diagnosis of hypertension or isolated

systolic

hypertension confirmed by blood pressure (BP) readings taken 2 or more

times on at least 3 different days?

[ ] Yes [ ] No [X] Unknown

d. Does the Veteran have a history of a diastolic BP elevation to

predominantly 100 or more?

[X] Yes [ ] No

If yes, describe frequency and severity of diastolic BP elevation:

LISINOPRIL

3. Current blood pressure readings

----------------------------------

Systolic Diastolic

Blood pressure reading 1: 132 / 80 Date: 12-2015

Blood pressure reading 2: 138 / 80 Date: 12-2015

Blood pressure reading 3: 138 / 80 Date: 12-2015

Average Blood Pressure Reading: 136 / 80

 CONFIDENTIAL Page 28 of 53

4. Other pertinent physical findings, complications, conditions, signs,

symptoms and scars

-----------------------------------------------------------------------

a. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs or symptoms related to the conditions

listed in the Diagnosis Section above?

[ ] Yes [X] No

b. Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

Section above?

[ ] Yes [X] No

c. Comments, if any:

No response provided

5. Functional impact

--------------------

Does the Veteran's hypertension or isolated systolic hypertension impact

his

or her ability to work?

[ ] Yes [X] No

6. Remarks, if any

------------------

HTN NOT FROM OR AGGREVATED BY HIS PTSD NO MEDICAL EVIDENCE TO SUPPORT

THIS

CLAIM

****************************************************************************

Esophageal Conditions

(Including gastroesophageal reflux disease (GERD), hiatal hernia

and other esophageal disorders)

Disability Benefits Questionnaire

Name of patient/Veteran: ASBURY TEJAY LEE

Indicate method used to obtain medical information to complete this

document:

In-person examination

Evidence review

---------------

Was the Veteran's VA claims file reviewed: Yes

List any records that were reviewed but were not included in the

Veteran's

VA claims file: CPRS

 CONFIDENTIAL Page 29 of 53

Diagnosis

---------

Does the Veteran now have or has he/she ever been diagnosed with an

esophageal condition? Yes

Gastroesophageal reflux disease (GERD)

ICD code: Date of diagnosis: 2013

Medical history

---------------

Description of the history (including onset and course) of the

Veteran's

esophageal conditions: VET CLAIMING GERD STARTED IN 2004 WAS TREATED WITH

MOTRIN FOR HIS BACK AND STARTED GETTING GI REFLUX S/S SO WAS GIVEN TUMS

WHEN HE RETURNED FORM THE STARTED STARTED ON A PPI

Does the Veteran's treatment plan include taking continuous medication

for

the diagnosed condition: Yes

Medications used for the diagnosed condition: PPI

Signs and symptoms

------------------

Does the Veteran have any of the following signs or symptoms due to any

esophageal conditions (including GERD)? No

Esophageal stricture, spasm and diverticula

-------------------------------------------

Does the Veteran have an esophageal stricture, spasm of esophagus

(cardiospasm or achalasia), or an acquired diverticulum of the esophagus? No

Other pertinent physical findings, complications, conditions, signs and/or

symptoms

-----------------------------------------------------------------------------

Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

section above? No

Does the Veteran have any other pertinent physical findings, complications,

conditions, signs and/or symptoms related to any conditions listed in the

Diagnosis section above? No

Diagnostic Testing

------------------

Have diagnostic imaging studies or other diagnostic procedures been

performed? Yes

Diagnostic Testing Preformed:

Upper endoscopy Date: 2013 Results: ESOPHAGEAL

REFLUX

 CONFIDENTIAL Page 30 of 53

Has laboratory testing been performed? No

Functional impact

-----------------

Do any of the Veteran's esophageal conditions impact on his or her

ability to

work? No

Remarks, if any:

----------------

GERD DX IN THE SERVICE

NOTE: VA may request additional medical information, including additional

examinations if necessary to complete VA's review of the

Veteran's

application.

/es/ VALERIE REMES NP

NURSE PRACTITIONER

Signed: 01/06/2016 12:34

Edited January 12, 2016 by Infantry1985

[Vync]

1 hour ago, Infantry1985 said:

Just got back from my C&P exam for Secondary GERD and Secondary Hypertension that lasted all of about 15 min with a NP at Hines. She seemed to be a little ruff around the edges at first, then we somehow go on the conversation of the oxygen generating plants in her office which seemed to perk her up. She only asked a few questions: For both - Was I diagnosed in service?, was I diagnosed at the VA?, do I still have symptoms?, only treated at VA?. For GERD only - Did I have a upper GI? That was it..... Never deep dived into symptoms, but did shake her head at the end and tell me that my pulse was consistently extremely high and that the doctors should have been prescribing me a beta blocker..... After that, and about 15 minutes she said your done and good luck with your service connection. I've had plenty of exams with Docs, but never a NP for C&P; so I'm kind of just still in shock... I guess we shall see!

Hey Infantry,
When I filed for secondary GERD, they first drew blood to test for heliobacter pylori. It's a bacteria that is known to cause GERD. If positive, they give you a course of antibiotics and then retest. If positive, the VA tends to deny unless symptoms and problems continue. Also, they did an upper GI. My h. pylori was negative, but my upper GI was positive, so I ended up getting SC eventually. I wanted to let you know about this because you might get a letter at some point asking you to come in for one or both of those tests. Then again, you might get an approval letter which would be much better.

Wait a few days and then try to get copies of your C&P exams so you can find out what they said.

Good luck!

[Infantry1985]

Thanks for the heads up Vync! I'm anxious to see how it plays out due to how fast and the lack of detail that was given in the symptoms. My ebenefits was updated this morning with prep for decision, so hopefully in the next month or so Ill hear something.

[broncovet]

I suggest you not wait for the decision, but instead go to your release of information at your VAMC and read what your C and P examiner said.  

Then you will know if its a favorable exam or not.  

If the exam is favorable, you simply wait for your decision.  If its unfavorable, you can pretty much expect a denial.  So you want to challenge the exam if possible, on one or more of these:

1.  Did the C and p examiner have "medical experience" with Gerd or hypertension?  If not, then challenge the examiner credentials.  It isnt about being a NP or not, its about if the NP knows anything about your issues.  She is acting as an "expert witness".  Tiger woods is an expert witness about golf swings, but he is not an expert witness on hypertenions.   If you dont call them on that the examiner will be presumed competent.   

2.  Did the examiner state (s)he reviewed your records?  An exam is not considered thorough if they dont bother to read your history, and understandably so.  

3.  Did the examiner answer all the questions the RO asked?  Sometimes they dont bother.  

4.  Did the examiner perform needed tests?  For example, did the examiner take your blood pressure?  How can the examiner opine on blood pressure if (s)he does not even know what your's is currently?   

[Vync]

That is promising!

[Buck52]

 Infantry 1985Let us know how it goes...Good Luck

 

.................Buck