hypertension New Hbp Reg Change

[Berta]

Someone here was denied HBP due ti a change in VA "policy" I think their denial said-

In 2004 the HBP regs did change-

they had a decision that referred to VA policy as SCing HBP only if it was due to diabetic neuropathy-

The change to the reg states:

"k. Diabetes Mellitus and Hypertension. When a veteran is service connected for diabetes mellitus and diabetic nephropathy, and has a diagnosis of hypertension, review the medical evidence and determine when the hypertension was diagnosed relative to the diabetic nephropathy. Then:

(1) If the medical evidence shows that hypertension was diagnosed after diabetic nephropathy was diagnosed, grant service connection for hypertension as secondary to diabetes mellitus.

(2) If the medical evidence shows that hypertension was diagnosed before diabetic nephropathy was diagnosed, and there has been no change in the treatment of hypertension or increase in blood pressure readings since diabetic nephropathy was diagnosed, deny service connection for hypertension as not secondary to diabetes mellitus.

(3) If the medical evidence shows that hypertension was diagnosed before diabetic nephropathy was diagnosed, but that there was a change in the treatment of hypertension and/or an increase in blood pressure readings since diabetic nephropathy was diagnosed, obtain a medical opinion to determine if hypertension was aggravated by the service-connected diabetic nephropathy.

(4) If it is unclear from the medical evidence when hypertension was diagnosed, or whether there has been an increase in the hypertension disability since diabetic nephropathy was diagnosed, obtain a medical opinion to determine if hypertension developed or was aggravated by the service-connected diabetic nephropathy."

I made the point (without having this reg at the time- I jsut found it in M21-1) that a veteran who gets denied SC of HBP due to DMII-

might have to make the distinct point that -if they do not have neuropathy diagnosis from their diabetes-

this is a nerve condition -

if the have HBP from cardiovascular disease due to DMII that is cause or etiology of their HBP- THAT is the point they have to make sure the VA gets-with medical evidence showed that.

This reg is within: September 23, 2004 M21-1, Part VI

Change 118

I think the VA is denying HBP claims of DMII SC vets by stating this is "policy" now yet diabetic neuropathy and cardio HBP are two very different

medical reasons for HBP.

[Guest terrysturgis]

Berta, great info. If you would help me to understand and translate how to apply this to my case. I would like to cover HBP so if I die from cardio my wife does not have to fight for DIC.

100% P&T, DMII, PN and tinnitus. My HBP was diagnosed before my DMII about six years ago. DMII and PN about three years ago. I have had a hard time controlling BP and at present time I take three BP meds. Paragraph 3 states that if there is a change in treatment for HBP obtain a medical opinion to determine if hypertension is aggravated by diabetes. My outside doctor wrote a letter stating that in his opinion my HBP is aggravated by DMII. Also I have never had a C&P that had acceptable levels during an exam. I have all copies of the exams. All of this information is in my C-file and I can make copies.

As always your advice is helpfull to me. Do you think I should file for SC of the HBP or would it be taking up another vererans space in an overloaded system. THANKS! Terry Sturgis

[Berta]

Terry-if your doctor gave a good medical rationale for that statement-

and it doesn't have to be elaborate-probably just his background will do it- I sure think they should SC the HBP as a secondary condition-

I also think you should definitely file this claim or any other claim whatsoever that can be linked to your service connected disability or directly to your service in any other way.

The overloaded system is NOT the fault of veterans.

I see very very few claims that have little potential of success.IMO

And these claims are usually denied after the veteran has not taken the steps needed to support them with good evidence.Unfortunately they also take up a lot of time when other valid claims should be getting worked on.Like my wannabee -who got a 17 page BVA decision after the VA did all they could to verify his stressors(and me and the American Legion) and he did nothing to help get them verified.

[theotherguy]

Berta,

Just wanted to clarify that the manual citation you posted says nephropathy, and not neuropathy, which are two completely different disabilties. The way it has been explained to me in the past is that most hypertension is essential and can not be attributed to diabetes except in the cases of kidney dysfunction/advanced renal disease, such as with diabetic nephropathy.

Hypertension can still become service-connected with the right medical evidence though, regardless of what their manual says. The manual is guidance for VA employees, but it is most definitely not regulatory. Diabetes can also aggravate pre-existing hypertension, so there are many ways to go about obtaining service connection.

You did hit the nail on the head though since it really all boils down to the veteran having to build their own evidence to support their claim.

Edited April 27, 2007 by theotherguy

[Berta]

Thank you for correcting me- theotherguy- Sorry all--I don't want to give the wrong info- and your correction taught me a lot-

I found this link too that certainly was news to me and might help someone:

http://kidney.niddk.nih.gov/kudiseases/pub...pathy/index.htm

"Analgesic use has been associated with two different forms of kidney damage."

Under nephropathy,also

"The syndrome can be seen in patients with chronic diabetes (15 years or more after onset), so patients are usually of older age (between 50 and 70 years old). The disease is progressive and may cause death two or three years after the initial lesions, and is more frequent in women. Diabetic nephropathy is the most common cause of chronic kidney failure and end-stage kidney disease in the United States. People with both type 1 and type 2 diabetes are at risk. The risk is higher if blood-glucose levels are poorly controlled. However, once nephropathy develops, the greatest rate of progression is seen in patients with poor control of their blood pressure."

from:http://kidney.niddk.nih.gov/kudiseases/pubs/iganephropathy/index.htm

The VA for yuears told me Rod's HBP was "essential" and a doctor said that meant they could not attribute any cause.

However he was suffered from LVH Left ventricular hypertrophy and hyperlipedimia-as well as advanced atherosclerosis due to misdiagnosis of all of above---

and all were part of the HBP picture.With the diagnosis from Dr. Bash-

undiagnosed and untreated long standing diabetes-I could associate the HBP to all of his other conditions-as secondary due to the initial diabetes.

Thanks again- I didnt know that this is not the same thing as neuropathy-

then again- if a vet has a diagnosis that includes nephropathy-from diabetes-

the VA would have to monitor kidney function and this could well become a secondary condition too-to the DMII.

One thing is for sure -it pays to raise as many etiologys as possible for service connection -direct or secondary-

In my Sec 1151 re-open I raised a HBP issue because the VA sent my husband someone else's HBP meds a week before he died-with a higher dosage-I didnt know it until the coroner asked me to read what the bottle said and here it was another vets meds. Rod had a visual problem but I worried that he had seen the higher dosage and taken the higher dosage-he had dropped dead so fast-I was looking for any reason for how he could die so fast-

come to find out the VA admitted after I sued -that this was one more misdiagnosis and that the HBP meds he took all along were of a totally ineffective dosage.Way too low-

He should have been on a higher dose all along.

I found medical evidence to SC his HBP-

but it referred back-in Rods case- to his cardiological disability-ECHOs and other med recs-all misdiagnosed by VA.

A VA expert in a SSOC (1996) actually stated that his intense level of PTSD could certainly have affected his HBP and his heart -but then the VA doc said he probably died of a overdose of Cocaine!

Rod was an organ donor and had complete autopsy-nothing supported this arbitrary VA expert statement.

I knocked that statement down with evidence-

just goes to show how low the VA will go- doesn't it?

In 2004 this same VA doctor (I called him up) agreed with my present claim but told me since I knocked his VA opinions down- twice-there were 2 or 3 incorrect IMos he gave-in 1996-1997- he could not provide any sort of IMO to VA for my claim but he did fully support it medically.

He regretted those opinions because the VA had not given him the veteran's autopsy nor any other medical evidence I had sent to them.

[Guest terrysturgis]

theotherguy and Berta, I have to appoligize to anyone who read my posting on my denial decision for HBP. The decision says "nephropathy" not neuropathy as I stated before. I must have had my rose colored glasses on as I did not catch that difference. The good news is the two times I went to the DAV to file a claim for HBP using that info the rep was not there so no harm no foul.

Thanks again theotherguy for the clarification. I would appreciate info on other ways you might suggest to SC hypertension as every time I tried it was denied bacause my HBP was diagnosed before DMII. THANKS! Terry Sturgis

[Guest terrysturgis]

theotherguy and Berta, I have to appoligize to anyone who read my posting on my denial decision for HBP. The decision says "nephropathy" not neuropathy as I stated before. I must have had my rose colored glasses on as I did not catch that difference. The good news is the two times I went to the DAV to file a claim for HBP using that info the rep was not there so no harm no foul.

Thanks again theotherguy for the clarification. I would appreciate info on other ways you might suggest to SC hypertension as every time I tried it was denied bacause my HBP was diagnosed before DMII. THANKS! Terry Sturgis