Lost my 10% VA Claim for Hypertension. Now what?

[Wico1337]

I know this will sound very bizarre. I just want to be honest and upfront about the situation as I want the honest answer about what I can do to fight this.

I had a VA Claim appointment with a VES Doctor about 4 months ago. I had like 7 conditions I was claiming. The Doctor's information was sent to me, he has 0 years of experience working with VA and 1 year as a doctor. My VES appointment for all 7 conditions lasted about 20 minutes. This is how it went.

- 4 he outright threw out.

- Sinusitis - He service connected me with a 30% rating. 

- Headaches - Gave me the bogus rating of 0%. But at least service connected me. Already filed supplemental claim.

- Hypertension... - decreased from 10% to 0%. But still service connected. - This is where it gets interesting. Let me give full details. I was service connection for hypertension in 2018. I was given a 10% then. My blood pressure Diastolic has had many times been above 110. So I figured I would file the claim for a raise. During this examination, he hooked my arm up to a blood pressure reader and took my blood pressure 3 times back to back. He then insisted to ask me if I took my blood pressure medicine the night before, saying that "some people" dont take their blood pressure medicine and think that making their blood pressure higher for the examination would give them a higher rating, and it wont. I knew this, this is pretty obvious. But the way he was asking me and telling me about it was him acting like I had faked it or some crap. I was pretty xxxxxxx nervous because ive heard horror stories of stuff like this happening where these assholes drop ratings for no reason. 

Anyway, I then tried to hand him a paper saying that I wanted to turn in 3 recent blood pressure readings that show I have consistent high blood pressure. Ironically, all of these 3 readings were from recent VA Visitations. He refused the documents saying that the Evaluation has nothing to do with recent blood pressure readings. He stated that 3 individual readings does not indicate anything about how the VA rated blood pressure. That the VA only cares about the entire last years trend of your blood pressure readings. He then cherry picked times that my diastolic went below 100. He then proceeds to blatantly outright tell me that "I have done thousands of these claims, and the VA simply does not rate anyone above 10% unless they are months away from dying." Yes, you heard that right. He has experienced thousands of results from BP claims while hes been doing this less than a year. He said that the only way that someone can have a 110 consistent diastolic to meet the requirements for the VA rating is if they are on the brink of death and the doctor has given them months to live. This whole thing is so crazy to me, because I have seen everywhere that the blood pressure evaluation is based on 3 seperate readings. I merely was using 3 VA readings, not that he knew, he didnt care who did the readings or what they even were. Its like he had something out for me?

In the VA Decision Letter, he treated the entire thing as if he was denying my claim outright and trying to Un-service connect me for Hypertension. his reasining for the rating decision was to type out a huge thing summarizing the following.

"Veteran had blood pressure of 156/74 and 150/85 the year before entering service (at MEPS)." He did not reveal the 3rd reading. I got a nurse to take tests outside of MEPS because I was freaking nervous there. They accepted me saying that I had white coat syndrome which increased BP.

Continue to list readings during military service of my BP being 150/85. Sometimes it spiked higher, but the military would have me "retake" until it dropped from Hypertension to Prehypertension.

I seperate in 2014. My blood pressure is was still Prehypertension.

Skip to 2017, I am on many more meds, VES evaluator puts "The BP 2017 showed 149/113. This appears to be a nature progression of the vets BP was aggrivated beyond its natural progression by the military service during service. Therefore, it is my medical opinion that the vet's current diagnosis of HTN is less likely than not (Less than 50 percent probability) aggravated beyond its natural progression by an in-service ilness event or injury".

So he is saying that in 3 years, it is normal progression for my Diastolic to rise from 85 to 113.

The rest of the Decision letter reads that I am still service connected, but just now at 0%. I checked benefits.va.gov and it shows I am service connected at 0%.

The VA decision letter end says "A Higher valuation of 10 percent is not warranted for hypertensive vascular disease unless the evidence shows: 

* A history of diastolic pressure predominantly 100% or more and there is a requirement for continuous medication for control: or,

* Diastolic pressure predominantly 100 or more; or,

* Systolic pressure predominantly 160 or more. (38 CFR 4.104)

 

Maybe I am taking this all in wrong? I am hoping that you guys can decipher where I went wrong here. I feel like I just have had so much bad luck with evaluators man. What do I do in this situation from here? Thank you all for all you do on giving us novices advice on this complicated stuff.

 

Edited February 27, 2023 by Wico1337

[broncovet]

If you have a Written decision which reduces your rating, "cry foul" by filing a NOD disputing the reduction.  

You have 3.334 regulations in your favor:

Quote

§ 3.344 Stabilization of disability evaluations.

(a) Examination reports indicating improvement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and Department of Veterans Affairs regulations governing disability compensation and pension. It is essential that the entire record of examinations and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of general examination and the entire case history. This applies to treatment of intercurrent diseases and exacerbations, including hospital reports, bedside examinations, examinations by designated physicians, and examinations in the absence of, or without taking full advantage of, laboratory facilities and the cooperation of specialists in related lines. Examinations less full and complete than those on which payments were authorized or continued will not be used as a basis of reduction. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psychotic reaction, epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Ratings on account of diseases which become comparatively symptom free (findings absent) after prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart disease, etc., will not be reduced on examinations reflecting the results of bed rest. Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. When syphilis of the central nervous system or alcoholic deterioration is diagnosed following a long prior history of psychosis, psychoneurosis, epilepsy, or the like, it is rarely possible to exclude persistence, in masked form, of the preceding innocently acquired manifestations. Rating boards encountering a change of diagnosis will exercise caution in the determination as to whether a change in diagnosis represents no more than a progression of an earlier diagnosis, an error in prior diagnosis or possibly a disease entity independent of the service-connected disability. When the new diagnosis reflects mental deficiency or personality disorder only, the possibility of only temporary remission of a super-imposed psychiatric disease will be borne in mind.

(b) Doubtful cases. If doubt remains, after according due consideration to all the evidence developed by the several items discussed in paragraph (a) of this section, the rating agency will continue the rating in effect, citing the former diagnosis with the new diagnosis in parentheses, and following the appropriate code there will be added the reference “Rating continued pending reexamination ______ months from this date, § 3.344.” The rating agency will determine on the basis of the facts in each individual case whether 18, 24 or 30 months will be allowed to elapse before the reexamination will be made.

(c) Disabilities which are likely to improve. The provisions of paragraphs (a) and (b) of this section apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating.

 

[jamescripps2]

 

# 1, Was your 10% HBP rating fully stabalized by being in effect for five years or better at the same rate?

# 2, The C&P doctor did not /could not reduce you or assign a percentage. The rater made the decision, supposedly based upon all of the evidence contained in the record. Other than self satisfaction, going after the C&P doctor will get you nowhere, causing you to loose focus. I suggest that if you disagree, go for a Supplemental Claim and seek your own medical opinion and DBO.

Being in the same situation once, I complained about the quality of the C&P exam and the credentials of the doctor. I was only offered another C&P preformed by the same doctor. Having no choice, I agreed and got the same old song and dance but the rater granted the claim despite the unfavorable C&P exam.

[john999]

James...VA did the same thing to me after I complained about an exam.  I did not get the same doctor but one of his buddies.  I got screwed but I filed an appeal and got my increase eventually.  This was way back in 2001.  Just file your NOD and go from there.

[flow1972]

On 2/27/2023 at 11:19 AM, broncovet said:

If you have a Written decision which reduces your rating, "cry foul" by filing a NOD disputing the reduction.  

You have 3.334 regulations in your favor:

 

Isn't there a regulation about a rating having to be based on a condition as if it were "unmedicated"?