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ASU_0331

Hypertension C&P

Question

So had a NOD with DRO review in for hypertension and CAD.  CAD was rated at 60%, but it appears that hypertension will be rated at 0% because my diastolic readings at my C&P only averaged out to around 85.  However, this was done while medicated on two different blood pressure medications so I do not understand the rationale that VA determines their rating when they use the criteria they have for ratings;

The ratings: If the average diastolic pressure is 130 or more, then it is rated 60%. If the average diastolic pressure is 120 to 129, then it is rated 40%. If the average diastolic pressure is 110 to 119, or the average systolic pressure is 200 or more, then it is rated 20%. If the average diastolic pressure is 100 to 109, or the average systolic pressure is 160 to 199, then it is rated 10%. If the average diastolic pressure was 100 or more before fully controlled by medication and continuous medication is required to keep the blood pressure under control, then the minimum rating is 10%.

I have been on blood pressure medication since my heart attack and hypertension diagnosis in 2005 and all my vitals on record with the VA, with the exception of a few, are also while on blood pressure medication.  So there is no way they can determine what my average diastolic pressure was before being fully controlled by medication, except that continuous medication is required to keep my blood pressure under control (currently prescribed Lisinpril & Metoprolol).  Below are my BP readings since I first started being cared for by the VA.  Note that when I came to the VA, I had already been on blood pressure meds since 2005;

131 80 9/27/2018
127 74 8/15/2018
127 82 7/16/2018
139 90 6/15/2018
148 92 6/5/2018
144 83 6/5/2018
150 85 2/14/2018
144 94 1/11/2018
114 75 9/1/2017
123 83 5/4/2017
152 104 5/3/2017
131 89 10/24/2016
152 83 6/13/2016
197 120 6/12/2016
164 105 6/10/2016
145 89 6/3/2016
144 86 6/3/2016
146 95 3/3/2016
146 100 5/27/2015
142 91 10/16/2014
150 92 2/24/2014
157 96 10/7/2013
130 79 5/29/2013
121 82 1/16/2013
136 92 10/30/2012
150 86 10/30/2012
144 95 10/30/2012

 

You can see the instances where I was off my blood pressure medications with readings over 100 as well as most of the medicated readings being in the high 80's to mid 90's.  I am planning on requesting a reconsideration once I get my BBE for this appeal and making the argument that my diastolic would he averaging over 100, as evidenced by the instances where it has been over 100, and that absent continuous medication my blood pressure would not be fully controlled. Anyone have thoughts on this angle on reconsideration? 

  

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It isn't enough to just argue with the VA, what a lot of guys don't understand is going in there with evidence. Such as you have laid out in a quick chart. But this evidence can't come from a lay person. The evidence needs to come from your doctor. Anyone can say I have high readings when I'm off my meds, but a letter from a doctor can come and make a much bigger difference. Basiclly, we have to prove our disability to the VA in order to make the connection. An 85 reading at the C&P is pretty low (for VA standards) when taking meds. At minimum, I would hound your doctor to get you a letter of what happens when you are off your meds (readings) and at max, request another C&P exam when off your meds. That may be dangerous for you so, that is your call. Good luck.

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Pretty much, the VA does not "do requests from the Veteran for C and P exams", with few exceptions.  The VA orders a C and P exam, pretty much at their own discretion, but sometimes the Board or CAVC will order the VA to provide an exam.   If the Veteran could chose when/if/who to examine him, for benefits purposes, it would be pretty simple:  Look online and find out which examiners give evidence to award, then have VA give you a c and p exam from that examiner.  It does not work that way.  VA, because they pay for the exams, hires an examiner at their sole discretion.  

However, you can hire an IMO/IME from an examiner of your choosing, which can be sufficent to rebut a VA paid examiner.  This is precisely why most Vets who actually get benefits wind up hiring their own IMO/IME.  

Its the way the VA works.  You dont have to like it, in fact, the more Vets an examiner makes mad, the better VA likes him.  

Edited by broncovet

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To add, you can only rebut medical evidence with medical evidence.  Lay evidence does not rebut medical evidence.  That is to say your opinion does not matter.  You need medical opinions to rebut medical opinions.  

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