Can I Get an Opinion on this C&P Exam

[Shake-n-Bake]

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

[pwrslm]

 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.)

[63Charlie]

 

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 August 28, 2017 by 63Charlie (see edit history)