Granted service connection for hemorrhagic stroke

[lee.edwards]

Greetings! I was recently granted service connection for hemorrhagic stroke by the BVA.  My appeal was received Mar 2010 and granted 21 Apr 2021. How will that granted service connected claim be rated?
One Granted: Service connection hemorrhagic stroke
Three Remanded:
-Service connections Degenerative Arthritis
-Service connection Bunion
-Increased rating Diabetes
Two Denied:
-Increased rating -Lumbosacral or cervical stroke
- Increased rating, Sciatic nerve paralysis

Best Regards
Chiefhouse00

 

[Berta]

This BVA decision contains ratings for TIAs:

https://www.va.gov/vetapp15/Files1/1508038.txt

I dont think the TIA ratings have changed since 2015.

The veteran had evidence of Lacunar infarct, which can only be determined via a MRI or CT scan.

My husband had multiple TIAs a few years , misdiagnosed, before he had a full blown stroke,that the VA has misdiagnosed.

They never rated the TIAs, but it was part of my FTCA/1151 award, they went back to 1988, when I proved the TIAs first  occurred, but this was found to be , beginning in 1988, due to improperly treated and misdiagnosed  HBP.

It was not until 4 years later that VA did an MRI that revealed at that time multiple lacunar  infarcts ,as well as a full blown misdiagnosed stroke....and never tol me or the veteran how much brain damage he already had.

In a case of a hemorrhagic stroke- I dont know what MRI evidence would reveal.

I assume you have had an MRI of your brain. Do you have the results?

Also deficits of TIAs, and/or stroke depend on the area where the infarctions occurred.

For my FTCA/1151 claim, I used a diagram of a brain as to each part-and then did another diagram of brain that I indicated on it what deficits he had because of where the infarcts occurred.

I didn't have an IMO doctor but I think you might need an IMO/IME-to determine the residuals of the TIAs. They are easier to find today than when my husband died, in the days of a very limited internet.

 

 

 

 

 

[Berta]

This article  and there are more on the internet , show what I mean.

https://www.gehealthcare.com/article/mri-of-the-brain-to-diagnose-and-monitor-stroke

Lacunar infarcts are also called ischemia - 

My husband also had AO IHD and AO DMII, that ischemia can cause.

The article mentions CT scan but his VA doctor misread the Ct scan and I contacted the doctors who read it in a different VAMC, from the nurses station- I was really pissed because the doctor told my husband  the CT scan revealed he would need brain surgery and they were going to send him to Syracuse VAMC for that.

It was that same day that I realized her original diagnosis and treatment  for his 2 week hospitalization had been completely wrong.

I am aware of neurology as to Brain Tumors, as my long ago deceased Army husband had a brain tumor- I told my husband this is Not a surgical situation, and a Syracuse VA doctor read the MRI over the phone to me.He was shocked that the  other doctor told the patient it was a surgical situation-

(but my husband thought maybe brain surgery would take away Vietnam.No, it wouldn't)

 

 

 

Edited May 4, 2021 by Berta
added more.

[Chief1954]

Greetings Berta Here's a copy of my 2009 MRI: Radiology Result Details

Procedure	Exam Date
MRI, TIA W & W/0 CONTRAST (GROUP)	17 Sep 2009 @ 0700

Status:  Complete (Amended)

Report Text:   Procedure:MRI, TIA W & W/0 CONTRAST (GROUP) 20090901154900 Order Comment: NO BRIEF COMMENT Reason for Order: TIA Exam #:09127872 Exam Date/Time:20090917070000 Transcription Date/Time:20090917091600 Provider:27497 MANGROBANG, CECILIA M (VA) Requesting Location:VA CLINIC, HON VETERANS AFFAIRS DIVISION Status:COMPLETE Result Code: 9 SEE REPORT TEXT Interpreted By:23154 BURGOS, RICARDO MIGUEL Approved By: 23154 BURGOS, RICARDO MIGUEL Approved Date:20090917091500 Report Text: CHCS 09127872 Procedures: 1. MRI brain with and without IV contrast. 2. MR angiogram of the brain without contrast. 3. MR angiogram of the neck with IV contrast. Comparison: None available. MRI BRAIN WITH AND WITHOUT IV CONTRAST. TECHNIQUE: Sagittal T1, axial T2, axial FLAIR, and axial diffusion weighted images. Post IV contrast axial and coronal T1-weighted images. FINDINGS: There is mild to moderate diffuse brain parenchymal atrophy with commensurate enlargement of the intra and extra axial CSF-containing spaces. There are multiple small left greater than right bilateral basal ganglia and bilateral supratentorial white matter lacunar infarcts. Multiple subcentimeter patchy foci of T2 hyperintensity in the supratentorial white matter without diffusion weighted imaging correlate are compatible with chronic microvascular ischemic disease. Multiple large prevascular spaces are also noted in the bilateral parietal white matter. There is no acute infarct, hemorrhage, mass-effect, hydrocephalus or space-occupying lesion. Calvarial bone marrow signal is normal. There is no pathologic enhancement after IV contrast. MRA HEAD WITHOUT CONTRAST. TECHNIQUE: 3D TOF images of the brain without gadolinium. Multiplanar reformations of the brain MRA data were also performed. FINDINGS: The distal internal carotid arteries are patent, with adequate flow related signal intensity and give rise to patent bilateral anterior middle cerebral arteries. The distal vertebral arteries are nearly symmetric and terminate in a patent basilar artery and demonstrated posterior fossa branches. There is no evidence of flow limiting disease in the circle of Willis. There is no aneurysm larger than 3 mm, flow-limiting disease, or evidence to suggest vascular malformation. MRA OF THE NECK WITH IV CONTRAST. TECHNIQUE: Post IV gadolinium first pass MRA of the neck from the aortic arch to the skull base with maximum intensity multiplanar reformations. FINDINGS: There is a normal anatomic branching pattern of the brachiocephalic vessels from the top of the aortic arch. The brachiocephalic vessel origins are patent. The bilateral common and internal carotid arteries and the carotid bifurcations are patent, without flow limiting disease. The vertebral arteries are symmetric and terminate in patent vertebrobasilar junctions. The basilar artery demonstrates normal contrast enhancement. IMPRESSION: 1. No acute infarct, hemorrhage or MRI evidence of acute intracranial pathology. 2. Findings compatible with chronic microvascular ischemic changes, as well as small chronic lacunar infarcts in the bilateral basal ganglia. Please correlate for cardiovascular risk factors. 3. No flow limiting disease in the circle of Willis on MRA of the head. 4. No flow limiting carotid artery disease on MR angiogram of the neck with IV contrast. Amended Result Code: 9 SEE REPORT TEXT Interpreted By:23154 BURGOS, RICARDO MIGUEL Supervised By:23154 AO4 Ricardo M. Burgos, ARMY Approved By: 23154 BURGOS, RICARDO MIGUEL Approved Date:20090917091500 Supervised By: 23154 AO4 Ricardo M. Burgos, ARMY Report Text: CHCS 09127872 Note is made of a small chronic mucous retention cyst in the floor of the left maxillary sinus. Notes:  TIA Approved By:  BURGOS, RICARDO MIGUEL Reading Radiologist:  BURGOS, RICARDO MIGUEL Transcription Date:  17 Sep 2009 @ 0916 Supervising Radiologist:   Supervised Date:   Final Report Verifier:  BURGOS, RICARDO MIGUEL Verification Date:  17 Sep 2009 @ 0915 Facility:  TAMC, HI

Amendments
CHCS 09127872 Note is made of a small chronic mucous retention cyst in the floor of the left maxillary sinus.

[Chief1954]

Greetings Berta Here's a copy 2009 MRI:  Radiology Result Details

Procedure	Exam Date
MRI, TIA W & W/0 CONTRAST (GROUP)	17 Sep 2009 @ 0700

Status:  Complete (Amended)

Report Text:   Procedure:MRI, TIA W & W/0 CONTRAST (GROUP) 20090901154900 Order Comment: NO BRIEF COMMENT Reason for Order: TIA Exam #:09127872 Exam Date/Time:20090917070000 Transcription Date/Time:20090917091600 Provider:27497 MANGROBANG, CECILIA M (VA) Requesting Location:VA CLINIC, HON VETERANS AFFAIRS DIVISION Status:COMPLETE Result Code: 9 SEE REPORT TEXT Interpreted By:23154 BURGOS, RICARDO MIGUEL Approved By: 23154 BURGOS, RICARDO MIGUEL Approved Date:20090917091500 Report Text: CHCS 09127872 Procedures: 1. MRI brain with and without IV contrast. 2. MR angiogram of the brain without contrast. 3. MR angiogram of the neck with IV contrast. Comparison: None available. MRI BRAIN WITH AND WITHOUT IV CONTRAST. TECHNIQUE: Sagittal T1, axial T2, axial FLAIR, and axial diffusion weighted images. Post IV contrast axial and coronal T1-weighted images. FINDINGS: There is mild to moderate diffuse brain parenchymal atrophy with commensurate enlargement of the intra and extra axial CSF-containing spaces. There are multiple small left greater than right bilateral basal ganglia and bilateral supratentorial white matter lacunar infarcts. Multiple subcentimeter patchy foci of T2 hyperintensity in the supratentorial white matter without diffusion weighted imaging correlate are compatible with chronic microvascular ischemic disease. Multiple large prevascular spaces are also noted in the bilateral parietal white matter. There is no acute infarct, hemorrhage, mass-effect, hydrocephalus or space-occupying lesion. Calvarial bone marrow signal is normal. There is no pathologic enhancement after IV contrast. MRA HEAD WITHOUT CONTRAST. TECHNIQUE: 3D TOF images of the brain without gadolinium. Multiplanar reformations of the brain MRA data were also performed. FINDINGS: The distal internal carotid arteries are patent, with adequate flow related signal intensity and give rise to patent bilateral anterior middle cerebral arteries. The distal vertebral arteries are nearly symmetric and terminate in a patent basilar artery and demonstrated posterior fossa branches. There is no evidence of flow limiting disease in the circle of Willis. There is no aneurysm larger than 3 mm, flow-limiting disease, or evidence to suggest vascular malformation. MRA OF THE NECK WITH IV CONTRAST. TECHNIQUE: Post IV gadolinium first pass MRA of the neck from the aortic arch to the skull base with maximum intensity multiplanar reformations. FINDINGS: There is a normal anatomic branching pattern of the brachiocephalic vessels from the top of the aortic arch. The brachiocephalic vessel origins are patent. The bilateral common and internal carotid arteries and the carotid bifurcations are patent, without flow limiting disease. The vertebral arteries are symmetric and terminate in patent vertebrobasilar junctions. The basilar artery demonstrates normal contrast enhancement. IMPRESSION: 1. No acute infarct, hemorrhage or MRI evidence of acute intracranial pathology. 2. Findings compatible with chronic microvascular ischemic changes, as well as small chronic lacunar infarcts in the bilateral basal ganglia. Please correlate for cardiovascular risk factors. 3. No flow limiting disease in the circle of Willis on MRA of the head. 4. No flow limiting carotid artery disease on MR angiogram of the neck with IV contrast. Amended Result Code: 9 SEE REPORT TEXT Interpreted By:23154 BURGOS, RICARDO MIGUEL Supervised By:23154 AO4 Ricardo M. Burgos, ARMY Approved By: 23154 BURGOS, RICARDO MIGUEL Approved Date:20090917091500 Supervised By: 23154 AO4 Ricardo M. Burgos, ARMY Report Text: CHCS 09127872 Note is made of a small chronic mucous retention cyst in the floor of the left maxillary sinus. Notes:  TIA Approved By:  BURGOS, RICARDO MIGUEL Reading Radiologist:  BURGOS, RICARDO MIGUEL Transcription Date:  17 Sep 2009 @ 0916 Supervising Radiologist:   Supervised Date:   Final Report Verifier:  BURGOS, RICARDO MIGUEL Verification Date:  17 Sep 2009 @ 0915 Facility:  TAMC, HI

Amendments
CHCS 09127872 Note is made of a small chronic mucous retention cyst in the floor of the left maxillary sinus.

[Berta]

This is how the VA rates stroke:

https://cck-law.com/blog/va-disability-benefits-for-stroke/

100% Temp for 6 months and then the residuals are rated.

I read over the MRI and the amended MRI:

." IMPRESSION: 1. No acute infarct, hemorrhage or MRI evidence of acute intracranial pathology. 2. Findings compatible with chronic microvascular ischemic changes, as well as small chronic lacunar infarcts in the bilateral basal ganglia. Please correlate for cardiovascular risk factors. 3. No flow limiting disease in the circle of Willis on MRA of the head. 4. No flow limiting carotid artery disease on MR angiogram of the neck with IVcontrast. Amended Result Code: 9 SEE REPORT TEXT Interpreted By:23154 BURGOS, RICARDO MIGUEL Supervised By:23154 AO4 Ricardo M. Burgos, ARMY Approved By: 23154 BURGOS, RICARDO MIGUEL Approved"

What stands out to me is the lacunar infarcts in the basal ganglia-as well as the statement to correlate with cardiovascular risk factors- has the VA done that with an ECHO of your heart?

Lacunar infarcts can cause deficits such as within this article:

https://www.medicalnewstoday.com/articles/313596#outlook

That would be considered possibly at a ratable level

It looks to me like you got Very good care from the VA a proper diagnosis and immediate treatment. If the rating  ,after 6 months is too low, in your opinion, I would definitely suggest that you get a strong Independent Medical Opinion.

My husband's MRI was vastly different from yours. His rating was 100 % under 1151 until he died, 2 years after the stroke, from AO IHD with strokes and TIAs contributing.

 

It would take a thorough reading of all of your medical records, to determine what residuals the VA should consider and rate.

 

 

 

 

 

 

Edited May 12, 2021 by Berta

[lee.edwards]

Greetings 

I looked at ebenefits today and my TIA was rated 10% with no residuals.  I was hoping for a much higher rating. It was rated 10% effective 2009. I have several residuals mentioned in my BVA grant letter.  Why weren't any of them considered.  I should get the VA letter explaining the decision soon.

Best Regards 

Chiefhouse00