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Hypertension Claims And Blood Pressure Readings

blood pressure claims hypertension VAMC

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4 replies to this topic

#1 Vync

 
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Posted 06 January 2012 - 12:36 PM

Hello everyone,
I have an active hypertension claim and have a couple of odd questions regarding BP readings. Hypertension is listed as an active problem in my VAMC medical record and I also take daily medication to help control it. The rating criteria for hypertension is listed further below.

My VAMC takes my blood pressure (BP) only taken at the first clinic I visit each day. If my BP reading is high (usually the case), then the nurse waits a bit, takes another reading, and notes the lower of the two. While reviewing my progress notes, I find that only one BP result is noted. Sometimes the notes indicate it was taken two or three times, but do not include the numbers.

Per the rating criteria below, Note 1 indicates that "hypertension must be confirmed by readings taken two or more times on at least three different days". With the VA noting the results of only one reading this makes it difficult for a veteran to meet the specific requirements of note 1.

Are the nurses supposed to record the values of each BP reading or only the best one?

I usually take my own BP a couple of times a day and log the readings. Would it be helpful to submit a copy of my BP log or would they only consider readings taken at the VAMC or other medical provider?

How does medication used to control high BP factor into a claim?



7101 Hypertensive vascular disease (hypertension and isolated systolic hypertension):
Diastolic pressure predominantly 130 or more----- 60 %
Diastolic pressure predominantly 120 or more----- 40 %
Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more----- 20%
Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control---- 10%
Note (1): Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm.
Note (2): Evaluate hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation.
Note (3): Evaluate hypertension separately from hypertensive heart disease and other types of heart disease.


For comparison purposes, I included this chart from the Mayo Clinic's web site.
http://www.mayoclini...ressure/HI00043
op number (systolic) in mm Hg Bottom number (diastolic) in mm Hg Your category* What to do** Below 120 and Below 80 Normal blood pressure Maintain or adopt a healthy lifestyle. 120-139 or 80-89 Prehypertension Maintain or adopt a healthy lifestyle. 140-159 or 90-99 Stage 1 hypertension Maintain or adopt a healthy lifestyle. If blood pressure goal isn't reached in about six months, talk to your doctor about taking one or more medications. 160 or more or 100 or more Stage 2 hypertension Maintain or adopt a healthy lifestyle. Talk to your doctor about taking more than one medication.

#2 boomer2

 
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Posted 06 January 2012 - 04:21 PM

Are you a VN vet? If you are I'm pretty sure that hypertension is part of IHD which is presumptive. I don't know if you can do this or not but, I would ask the nurse why she is not putting all three readings in your record. I would then ask her to please put all readings in the file. It is your file why shouldn't you be able to ask them to put readings in there that pertain to your health and your claim. I don't know if what I'm telling you is 100% accurate or not. I'm sure others who have had a claim for that will post something.

#3 Chuck75

 
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Posted 06 January 2012 - 05:04 PM

This is the statement that the VA usually uses, along with the 10%, regardless of what B/P is without drugs.

"Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control---- 10%"

#4 jbasser

 
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Posted 06 January 2012 - 06:18 PM

Even with medication the readings have to be 100.
I went down that road several years ago before I got my HTN service connected.

A good thing is if you develop heart disease related to the HTNm then the HTN is to be rated separately.

The regs also state that HTN must be compensable during the first post service year to be considered presumptive.

J

#5 jvretiredvet

 
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Posted 06 January 2012 - 06:35 PM

If my BP reading is high (usually the case), then the nurse waits a bit, takes another reading, and notes the lower of the two. While reviewing my progress notes, I find that only one BP result is noted. ... Are the nurses supposed to record the values of each BP reading or only the best one? Only the BP after you have stabilized a bit.There is something called the "white coat syndrome", whereby some people may have an elevated B/P when they first get to the clinic. The thinking is that it may be due to agitation, concern, being rushed, fear, whatever. After a bit of a wait, it usually goes down. Well, at least in my case it does.

Would it be helpful to submit a copy of my BP log or would they only consider readings taken at the VAMC or other medical provider? It wouldn't hurt but I'm not sure how much it would help either. Blood pressures can vary depending on the time of the day, the arm used, the size of the cuff, technique, and so forth. So, your BPs (for diagnostic purposes) optimally should be done the same time of the day, with the same size cuff (optimally, the same cuff and machine), same clinician, etc. However, I do believe that your BP readings may be instructive as to the trend but probably not for actual diagnosis.

Hello everyone,
I have an active hypertension claim and have a couple of odd questions regarding BP readings. Hypertension is listed as an active problem in my VAMC medical record and I also take daily medication to help control it. The rating criteria for hypertension is listed further below.

My VAMC takes my blood pressure (BP) only taken at the first clinic I visit each day. If my BP reading is high (usually the case), then the nurse waits a bit, takes another reading, and notes the lower of the two. While reviewing my progress notes, I find that only one BP result is noted. Sometimes the notes indicate it was taken two or three times, but do not include the numbers.

Per the rating criteria below, Note 1 indicates that "hypertension must be confirmed by readings taken two or more times on at least three different days". With the VA noting the results of only one reading this makes it difficult for a veteran to meet the specific requirements of note 1.

Are the nurses supposed to record the values of each BP reading or only the best one?

I usually take my own BP a couple of times a day and log the readings. Would it be helpful to submit a copy of my BP log or would they only consider readings taken at the VAMC or other medical provider?

How does medication used to control high BP factor into a claim?



7101 Hypertensive vascular disease (hypertension and isolated systolic hypertension):
Diastolic pressure predominantly 130 or more----- 60 %
Diastolic pressure predominantly 120 or more----- 40 %
Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more----- 20%
Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control---- 10%
Note (1): Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm.
Note (2): Evaluate hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation.
Note (3): Evaluate hypertension separately from hypertensive heart disease and other types of heart disease.


For comparison purposes, I included this chart from the Mayo Clinic's web site.
http://www.mayoclini...ressure/HI00043
op number (systolic) in mm Hg Bottom number (diastolic) in mm Hg Your category* What to do** Below 120 and Below 80 Normal blood pressure Maintain or adopt a healthy lifestyle. 120-139 or 80-89 Prehypertension Maintain or adopt a healthy lifestyle. 140-159 or 90-99 Stage 1 hypertension Maintain or adopt a healthy lifestyle. If blood pressure goal isn't reached in about six months, talk to your doctor about taking one or more medications. 160 or more or 100 or more Stage 2 hypertension Maintain or adopt a healthy lifestyle. Talk to your doctor about taking more than one medication.