OK, I have the ruling from the Judge at the BVA. Short and sweet DENIED.

I think it is important for my fellow Veterans going through the process to understand what you are up against when you file a claim, such as mine. Hypertension and Heart related illnesses secondary to PTSD.
It is our job to provide evidence that our claim has merit when a VA C&P examiner says “less likely” the cause.

This was my process, and I hope it helps you understand the task that lays ahead. If you are just starting.

It is our job to provide evidence that our claim has merit. One thing I have found, and I don't know the answer is that all the Doctors and even those that have published research supporting my claim have the credentials , where as the VA C&P examiner does not, and will not disclose theirs. The Doctors outside of the VA I consulted have a long list of verifiable credentials, but as the Judge pointed out he has the final say in who he determines is giving creditable evidence.

The first C&P examiner had sited my Sick Sinus Syndrome (which I do not have) as one of the reasons my claim was less likely secondary to PTSD. The 2nd C&P examiner pointed out that Hypertension was not mentioned in a published research document, and the Doctor that wrote the report said the reason she had not mentioned hypertension in her report was that “everyone” with PTSD that some form of hypertension.

These two “MD’s” are what the Judge found creditable.

The Judge found the Doctors out side the VA were not creditable, and again the Judge has, in his digression, the ability to decide who he finds creditable. Here is mine that he throw out as providing creditable evidence

Dr Cain, Southwestern Medial (Almost Certainly)
<<MOD Note - Link Removed per user Agreement >>

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Dr Jack Schwade, Cardiovascular Disease (Very Likely)

<<MOD Note - Link Removed per user Agreement >>
DrSchwade,Dallas Heart Group
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Dr Laura Kubzansky, Harvard School of Public Health

<<MOD Note - Link Removed per user Agreement >>

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Dr Boscarino, Geisinger Health System Danville, Pa

<<MOD Note - Link Removed per user Agreement >>
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"The science is conclusively showing that if you suffer psychological trauma, it's going to take a toll on your physical health," Boscarino said. "Getting counseling today is critical to avoiding a related problem tomorrow."

<<MOD Note - Link Removed per user Agreement >>

Dr Boscarino, Links to His Research

VA Doctors credentials unknown (less likely)

I wish anyone going through the process all the best of luck, and as for your journey “Welcome Home”

Salute

This message has been edited. Last edited by: Dave_M,

I reviewed the links you provided before I deleted them per the user agreement.

Now here is a link to one of the doctors you provided on the NIH Web Site and a summary:

Do psychological risk factors predict the presence of coronary atherosclerosis?

CONCLUSIONS: Both psychological and clinical risk factors are poorly correlated with concurrent measurements of CAC (a CAD Marker). Given our findings and previously established associations of these risk factors to cardiac events, further assessment of the relationship between chronicity of these risk factors and coronary atherosclerosis could be of interest. Our findings cast doubt on the use of CAC scanning as a surrogate means for assessing the clinical significance of both concurrently measured psychological and clinical risk factors.

http://www.ncbi.nlm.nih.gov/pubmed/20978226

And this study
http://www.ncbi.nlm.nih.gov/pubmed/19376986

The material I have review suggest that their is a weak correlation by researchers. There is ongoing research, but they have found no clear conclusion. The VA doctors and VLJ (Judge) review the material and use the best medical science that is a current acceptable standard at the time.

PTSD as a cause of Heart Disease are not currently a generally accepted medical standard, nor is there a substantial body of research strongly linking the two. There is a weak link, and that is not adequate to grant a claim.

Normally the Institute of Medicine (IOM) will set these standards for the VA as per the law. The IOM is part of the NIH. To win such a case without an IOM standard, you should have a doctor who has treated you and who can point to published studies in major medical journals linking your diseases.

It is not clear that the doctors you consulted actually examined you, or you found their research and used it in your claim. Did anyone who you used to support your claim actually treat you and write a letter supporting your claim?

Dave,

I am sorry if my links to the Bio's of the Doctors was not within the user agreement, and you are within your right to delete them. Anytime I do something outside the agreement please let me know. I am a hell of lot dumber than I look.

I had been reading through the posts and saw several links by Flash69, a person I have deep respect for, and another person I have huge respect OldFart who said to Flash "These links are a fascinating insight into the problems associated with PTSD. Thanks for providing them!"

As a result I made a error in understanding that links were not allowed to.. say .. such as my personal website.

Even though there was reason for the why I provide links to the Doc's Bios' I remain wrong and I am sorry.

Dave with your vast experience can you tell me why the VA will not release the Bios' of the C&P examiner that offers their opinion of the Veterans claims?

As for the two Drs' discounted by the Judge I have been examined by both prior to their letter of opinions.

One Dr is considered one of the top Cardiologists in the state of Texas, and has a resume to long to list on a forum. The other is, board certified Psychioatry/Neurology, but discounted by the Judge because of his field the Judge did not feel him qualified to offer opinion. Although Drs' in the field of Psychioatry/Neurology have written and published many paper on the effects of PTSD on our Veterans. Still the Judge has the "right" to decide who he feels is creditable.

He chose a young lady (I do not know her credentials because the Va will not allow us to look at them), I think either an Intern of maybe a Dr with limited experience. She misstated a published research paper from the Dr I mention from Harvard. The Doctor (from Harvard) explained the mistake of the young C&P examiner, and sent me her “complete” research. Which I offered to the Cardiologist that examined me for him to interrupt. He gave three pages of his examination. Followed by his opinion letter. The Judge did not find him creditable because he did not offer “enough” reasons to support his opinion.

I also offer the research to the C&P department that offered the opinion based on this research. They would not let me speak to the Dr or the head of the department.

Now my point was to not whine about the unfairness of the Judge, or even that the Judge chose “his right” to consider which Drs’ were creditable. Choosing a young Dr that did not understand the research she offered to support her opinion. Her exam of me was to go to an office “not her’s” take my blood pressure, and talk about my experience. She took my blood pressure one more time before I left and mentioned my blood pressure had really elevated. I don’t know why I had to explain to her, but I did… it was because she was asking about my service, and Vietnam. Now I agree the meds’ I am on keeps my blood pressure under control, there are limits. Talking about Vietnam is one.

They call that an examination..?

Again I wanted other Veterans to know.. The ones that are either going through the process, or just starting “my” experience. It may in some small way help them understand the process. I have now gone through the process since April 2003, and I feel I have more than presented enough evidence to support my claim.

I am tired VERY tired, but I still like to help others, no matter how small my contribution.

I appreciate you Dave and all your years of helping Veterans.

Salute

The rules on links have changed in the last 2 years. If you PM the names of the 2 VA doctors who did C & P exams, I will try to find information on them. You can just reply to the PM I sent you.

You do understand that when I doctor takes a stand that is not generally supported by the medical community, the VA Judge or any other Judge does not have to accept it as accepted science.

Dave,

I wrote my comment before I realized you had offered more insight, and links to some reasoning of "why" the VA is slow to recognize the connection between PTSD, and heart related illnesses. It is the old chicken and eggs dilemma, which came first the chicken or the eggs. I have it on good authority it was the chicken formed from one common DNA of all species belonging to a single Ape in South Africa millions of years ago. The chicken evolved from another bird, and had eggs producing abilities to reproduce. Kind of like man evolved from the “same” DNA. If interested I could explain in more detail, but I am really responding to your links provided.

The links to the research you offered, one 2009, and the other more recent Jan 2011 are compelling, but are not the final answer. However enough of an answer to satisfy the VA in the use of case law to deny a claim.

Where I was wrong in appealing my claim(s) was that I felt there was some understanding of the impact stress (PTSD) has on Veterans. Especially when it comes to hypertension, and heart related illnesses. The answer is simple they do but choose to ignore. It is in reality a money issue, which I now understand.

They can not and never will be able to say with 100% certainty that PTSD caused any Veteran’s hypertension or heart related illness. It is a medical impossibility. Now if you cut your finger with a knife the Doctor can say with certainty that the knife caused the cut. Hypertension and heart related illnesses are much different. Doctors can only offer opinions.

That is why Doctors say: Likely, most likely, not likely, most certainly, almost certainly. They NEVER say that PTSD is NOT the cause, because that is incorrect. Now in my case I had two Doctors heavy with credentials, one said most likely, the other if not ethologically the cause almost certainly, both these are strong opinions. The VA Doctors (credentials unknown) said less likely. The Judge throws out the Doctors from the private sector and goes with the VA Dr “less likely”, which after throwing out the others less likely stands as evidence.

Now that is LAW, and has nothing to do with medical facts. Because all Doctors have offered their opinions. Not the research you linked, although good, it was not presented as evidence in my case.

Thanks for the links, after reading them I called Dr Laura Kubzansky because her name was on both reports. We had an interesting discussion that helped a lot in understanding where the medical field is in regards to research, and what has and is being done.

Thanks Again

Salute

The causes of the depression are:

The depression seems to be related to a chemical imbalance in the brain that makes difficult that the cells communicate between if. The stressantes events in the life such as the death of a wanted being, a divorce, can precipitate a depression.

To take certain medicines, like pills for the alcohol, birth control, to smoke cigarettes or to abuse drugs, or to have other terminal diseases like the cancer, SIDA, etc., can cause a depression in the woman.

The women with premenstrual syndrome have greater probability of depressing themselves. The depression is commonest one week before it comes the period and weeks after giving light, this is called depression postpartum.

http://www.findrxonline.com/rs...depression-woman.htm

Update. I have been arguing my Heart Condition as secondary to my PTSD sense 2003, and I have received many denials. Plus delays in getting responses. As required I delivered evidence from leading Doctors in the area of PTSD/ Heart.. and still my appeals were denied.

BVA was no different, The Judge ruled the VA Doc with only 5 years family practice more creditable that the Cardiologist (likely), major University (almost certainly). The Judge can and did make that ruling.

Of course I appealed the BVA decision, and this time used an Attorney. As a result the Judge ruled in my favor, and set aside the BVA decision. I was notified this Friday.

What it means is..finally someone stepped up and read the evidence rather than just supporting previous decisions.

What does that mean as to my claim? What will the award be? 10% - 100%? Will I be examined again for the 5th time or will they made a decision on the exams on record?

The only difference with this appeal is that I used an Attorney. My evidence remained the same. So I say to my fellow Veterans find an Attorney if your evidence is strong and you will save yourself years of frustration.

Happy Memorial Day, and Salute !!

It appears many have given up on this topic. The last time I commented was 2010, and that comment is the last on this thread.

Update, and my update is only to help others see, through my experience, the difficulty on a appeal.

The last appeal decision sit aside the BVA Judge's decision who denied my appeal, and remanded my case. The new Judge,in his order, also said he would like my exam to be conducted by the same VA Doctor that last commented, less likely. He also wanted to know the rationale of not accepting the outside Doctors opinions. Both were highly qualified. Where as the VA Doctor only had 5 years of family pratice experience.

My C&P exam was to be expedited based on his order.

A few months later I recieved notice of my new exam, and it was not the same Doctor as requested by the Judge. Still it was an exam, and the date was set.

Now here is only my experience and what is happening at this time. Yesterday I was seen by the VA Cardiologist for a routine exam, and he wanted to schedule me for another procedure.. "ablation". When my appointments were being scheduled I ask for a print out of all my upcoming appointnments. This is when I saw my C&P exam for next week had been cancelled by the Clinic. I recieved no notice, and if I had not asked for a print out I would have shown up only to then find out about the cancellation.

The only thing I have been able to find out was that my appointment was cancelled and contracted out to a Doctor outside of the VA. Tbis was to expedite my exam. I had been waiting months and less than a week for my appointment, and now noone can tell me when or where I will be seen,.

I have no idea what is ahead for my claim, but I plan to continue until my death. The ablation may do that.. my heart is at a point it is 100% dependant on a pacemaker for pacing. So the Doctor does not want me to continue my medication for A Fib.. the only way to do that is the ablation. They would have done this earlier but because of my other heart conditions Sinus Bradicardia, CHF, and a thickening of the heart wall muscle added a risk factor.

A note to anyone working on a claim of heart illiness secondary to PTSD. Look at the lack of sleep as the cause of hypertension,, and then hypertension as the cause of your heart illinesses. To many of us file for the heart condition rather than the primary cause.. hypertension caused by lack of sleep, caused by PTSD.

If you will take the time you can do your own research and you will find most all heart conditions are a result of hypertension, or at least the excelleration, and progression of the heart related illiness.

March On..