Jump to content
  • Searches Community Forums, Blog and more

  • Ad Free Subscription.jpgOne Time Financial Gift.jpg

    Subscriptions and Gifts are NOT Tax Deductible. HadIt.com is NOT a Non Profit.

  • 0
Shake-n-Bake

Can I Get an Opinion on this C&P Exam

Question

I am still awaiting the notification letter with full details but, according to eBenefits, they have denied my claim for hypertension secondary to PTSD. The basis of my claim was not so much that the PTSD caused the hypertension (although I suspect it may have), but that my PTSD aggravates the hypertension. It looks like the decision was based on the C&P examiners opinion that my hypertension is caused by my weight, rather than my PTSD. His notes do not address the issue of the one aggravating the other. I guess I'll appeal the decision, although I'm not sure how that process works, or really what I'll be able to say, or do, differently to help my case. Below is a redacted copy of the C&P exam notes, if anyone would be so kind as to offer an opinion and/or advice. It bears noting that in his remarks, he states that in 2009 I weighed 160 pounds and my blood pressure was normal. However, I thought 140/90 was the upper threshold of normal. The evidence he is citing reflects a reading of 142/86. Does the VA use a different criteria, because 142 is not normal by generally accepted hypertension parameters. Also, he states that the BP readings used to diagnose are not present, but I did the medical records from when I was diagnosed and they show a reading of 150/110 at that time. So, I would have to say that his statement is factually untrue, based on that the evidence that I submitted.

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

Hypertension
                        Disability Benefits Questionnaire

    Name of patient/Veteran:  Shake-N-Bank
    
    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
    ---------------
    Evidence reviewed (check all that apply):
    
    [X] VA e-folder (VBMS or Virtual VA)
    [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
              ICD code: 00                   Date of diagnosis: 2013
              
    2. Medical history
    ------------------
    a. Describe the history (including onset and course) of the Veteran's
       hypertension condition (brief summary):
          noted to have high blood pressure and begun on medication on 2013. Had
          normal pressure  in 2009 and weight of 160 pounds.
          
    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?
       [ ] Yes   [X] No
       
    3. Current blood pressure readings
    ----------------------------------
                                Systolic Diastolic
       Blood pressure reading 1:  138  / 82     Date: 8/23/2017
       Blood pressure reading 2:  122  / 78     Date: 8/23/2017
       Blood pressure reading 3:  126  / 80     Date: 8/2017

       Average Blood Pressure Reading: 128 / 80
       
    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?
       [X] Yes   [ ] No
       
           If yes, describe (brief summary):
              8/11/2017 209 lb
              
    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
    ------------------
       No remarks provided.
       


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


                                 Medical Opinion
                        Disability Benefits Questionnaire

    Name of patient/Veteran:  Shake-N-Bake
    
    ACE and Evidence Review
    -----------------------
    Indicate method used to obtain medical information to complete this 
document:
    
    [X] In-person examination
    

    Evidence Review
    ---------------
    Evidence reviewed (check all that apply):
    
    [X] VA e-folder (VBMS or Virtual VA)
    [X] CPRS


    MEDICAL OPINION SUMMARY
    -----------------------
    RESTATEMENT OF REQUESTED OPINION: 

    a. Opinion from general remarks: relation of hypertension to PTSD

    b. Indicate type of exam for which opinion has been requested: hypertension 

    TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE
    CONNECTION ]

    b. The condition claimed is less likely than not (less than 50%
    probability) proximately due to or the result of the Veteran's service
    connected condition.   

    c. Rationale: The pressures used to diagnose hypertension are not available
    but apparently were there in 2013 when he was started on medication. He has
    gained nearly 40 pounds of weight since 23009. This is the most likely 
caused
    of his hypertension and the PTSD is less likely than not. 

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

 
/es/ FRANCIS M REMBERT
MD

Share this post


Link to post
Share on other sites

2 answers to this question

Recommended Posts

  • 0
 Medical Opinion
The condition claimed is less likely than not (less than 50%
    probability) proximately due to or the result of the Veteran's service
    connected condition.   
 This is the most likely caused of his hypertension and the PTSD is less likely than not. 

 

(Not likely to be SC.)

Share this post


Link to post
Share on other sites

Ad

  • 0

 

The examiner's rationale that weight gain "most likely caused hypertension" is purely speculative in nature.

The examiner failed to offer a medical treatise/abstract to back up this opinion.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141329/

Medical evidence shows PTSD is shown to have a causal relationship to hypertension, and also obesity.

You will need an Independent Medical Opinion from a specialist to counter the VA C&P examiner's opinion.

 

 

File a NOD.

Get an attorney after the NOD is filed as I don't think someone with your conditions wants to go through the worries and aggravation going it alone.

Ask the attorney about getting an IMO.

The appeals process is complicated and the stress can worsen your type of health condition.

Edited by 63Charlie

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Our picks

    • CBO Options for Reducing the Deficit: 2019 to 2028 Published Dec 2018
      CBO Options for Reducing the Deficit: 2019 to 2028 - This CBO Report has been making the news. This post includes parts relevant to veterans. Nothing has been decided as of yet and some seem very unlikely but you never know. Forewarned is Forearmed.

       

      https://www.hadit.com/cbo-options-for-reducing-the-deficit-2019-to-2028-published-dec-2018/
      • 8 replies
    • 2019 Veterans Benefits
      State Benefits, Space A and More ... https://www.hadit.com/2019-changes-to-veterans-benefits-state-and-federal/
      • 2 replies
    • Appeal granted and closed.
      My appeal was granted and closed on November 9.  I got an unofficial notification from the DAV on November 15 stating "appeal granted with an evaluation of 30%" which is great!  My question is this:  How long until I get the official notification from the va? Nothing on ebennies has updated since the appeal closed. Appeal is now in historical and just says complete and at originating va office. I understand no one knows va timelines to a tee but a general timeline would be great.  Thank you all! Hope you have a Merry Christmas!

       

      Edit:  This was my first time appealing and it was a VBA grant. 
      • 6 replies
    • Question About Temporary 100% Rating for Hospitalization
      Hey all. I've searched all over the net, and read the CFR on the topic. I will be going to PTSD Dom inpatient treatment here soon. I read that it's possible to get 100% temp for hospitalization. However, the CFR says that PTSD Dom does not qualify, but then in the exceptions it says that it may. Does anyone know if I will qualify for temp 100%. I will be in there for almost 2 months. Here is the CFR code, and the part regarding the matter-

       

      Do not apply the provisions of 38 CFR 4.29 when a Veteran

      is treated as a resident in a State Veterans’ home is currently receiving a total rating for the disability for which hospitalization was required is a resident in a VA domiciliary program, or is a participant in a live-in/work out program being utilized to facilitate transition to community living.

       

      Exceptions:
      Hospitalization in excess of 21 days for an SC disability in a medical facility located at a State Veterans’ home may entitle the Veteran to hospitalization benefits. Veterans are entitled to hospitalization benefits for treatment in excess of 21 days in a day hospital program if the treatment given is consistent with hospital care for a SC disability even though they are concurrently required to be housed in a VA domiciliary.

      The exceptions part is confusing me. Does anyone know if I am entitled to a temporary 100% rating? I'm currently rated for the same reason I'm going inpatient.
      • 8 replies
    • Abbreviations, Acronyms, etc.
      Abbreviations, Acronyms, etc.
      • 0 replies
  • Ads

  • Popular Contributors

  • Ad

  • Latest News
  • Advertisemnt

  • 14 Questions about VA Disability Compensation Benefits Claims

    questions-001@3x.png

    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
    Continue Reading
     
  • Ads

  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • Advertisemnt

  • Advertisemnt

  • Ads

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

×

Important Information

{terms] and Guidelines