J Basser: 0:04

It's time for the Exposed Vet Radio Show. The Exposed Vet Radio Show, we discuss issues affecting today's veteran. Now here's your host, john and Ray. Welcome, ladies and gentlemen, to another episode of the Exposed Vet Radio Show on this September 5th 2024. My name is John Stacey. They call me Basher. Folks probably remember Basher better than John Stacy. We're going to bring you a good show today. We've got a guy riding side shuttle today from the great state of Tennessee, mr Ray Cobb. How are you, ray?

Ray Cobb: 0:37

I'm doing great. It's a nice day down here, a little cooler, sun shining, slight breeze blowing. It's been great. I've been out all day.

J Basser: 0:45

It's been pancake hot here today. I don't know, I don't know. We've got a treat today, folks. We've got this young lady that comes on. She's on about once a month and we make it a squall and pledge to bring her on once a month because she's nothing but a bushel basket of information and we went over several DBQs in the past. But today we're going to get our shoulder pads on and our football helmets and our mouthpieces in and we're going to tackle the endocrine system. Dbq Bethany how are you doing?

Bethanie Spangenberg: 1:19

I'm doing well. I'm doing well. I'm excited for tonight's show. This will actually mark off our endocrinology section of the DBQ, so finish strong on that section and keep moving on. Talked about you know the rain.

Bethanie Spangenberg: 1:42

A couple shows we did this summer. Somehow I was recording or we were doing the show during a rainstorm and I had talked about like how we really weren't getting rain and just a couple days ago they actually declared a natural disaster for our county because of how bad the drought has been in Ohio. So I just thought about that as a follow up to all my complaining about the rain, or me cheering for the rain, I guess.

J Basser: 2:12

There's an Indian website out there you can actually learn how to do that rain dance and maybe it'll help it rain you know I've talked about that quite a bit.

Bethanie Spangenberg: 2:21

So I, um, I have a family member that's lived, grew up in Southern Ohio and then moved out to California. He married a California lady and came back and that California lady she was born and raised in LA and she decided to build a garden this year. So they came back to Southern Ohio, built a garden and I guess she went outside and started watering the garden and her husband started yelling at her like hey, you're not supposed to water the garden. And I'm like no, no, no, no, no, it's okay, you can water your garden. Like, I understand there's a difference between what you do in california and here, but we don't have any rain. You need to water your garden. You'll get nothing. I I just found it comical that I guess you don't know how to do a garden.

J Basser: 3:09

I had a friend in San Diego that lived in a big house in Rosecrans. We talked every once in a while. He ate him on grass, it's always as dry and how fair as it can be. He had his asphalt company come in and they asphalted his whole yard and he painted it green.

Bethanie Spangenberg: 3:28

Oh my gosh.

Ray Cobb: 3:31

Well, my son used to work for a company and he was the manager of it. And what they did? They sold AstroTurf. And they would go in and take a guy's yard up and put some rock and things down and cover it with astroturf. Never had to mow the yard again.

Bethanie Spangenberg: 3:53

Man well, how do you grow your garden? I guess, To put it in a raised bed, a window box, exactly.

J Basser: 3:59

No we just leave you a little place out for that. It's good to take that dirt out every once in a while and put some good topsoil in there and the best topsoil you can get. If you know anybody that's got a farm, ask them if you can borrow some dirt out of their barn. That would be all you need.

Ray Cobb: 4:14

Oh yeah.

J Basser: 4:17

That corn would be over your head.

Bethanie Spangenberg: 4:21

Yeah, it's actually interesting to see because you know we drive around here to the different cornfields and they're just really struggling and we haven't seen anything like this for several years. I don't know. But I just had to follow up on that because the last two shows. I think it was a major thunderstorm and you could hear it in the background of the radio. And I'm like of all the times to rain, it has to be at 7 pm Eastern time on the first Thursday of the month.

Ray Cobb: 4:51

You can't rain any other time I heard it too.

J Basser: 4:55

I heard it too. I think you were sitting in the car waiting for somebody to come out of a tractor or something, but anyhow, I thought you had that cassette going with golf books that kept raining.

Ray Cobb: 5:04

I didn't know, oh shoot.

Bethanie Spangenberg: 5:09

But today we're going to talk about the endocrine system and it's a big one, but the VA has it really tied down to, I'm going to say, two sections, and it's the thyroid and the parathyroid, and that's really what we're going to hit home today.

J Basser: 5:24

Yeah, okay, we love this. I've got thyroid issues. You can go right ahead. You know what I mean.

Bethanie Spangenberg: 5:30

Well, I want to introduce the endocrine system first, because you know, we talk about the cardiovascular system, which is the heart and the blood vessels. We talk about, you know, the urinary system or other systems in the body, and the endocrine system isn't as clear in its name as some of the other ones, but the endocrine system is a lot of different organs and glands that regulate hormones and signals for body function.

Bethanie Spangenberg: 5:58

So if I start at the top and we're looking at the brain or the head, we have the hypothalamus, the pituitary gland and the pineal gland and all of that sits in the center of the brain and that controls and helps to regulate hormones such as sleep cycles or temperature regulation, hunger, behavior, and it's also part of the feedback system. So if we're not making or getting enough thyroid hormone in the system, the pituitary gland will send out function as far as signals go. Then if we drop down into the neck, the neck contains your thyroid and your parasyroid glands and in the center of the chest right where they would just above, where they would start doing chest compression.

Bethanie Spangenberg: 7:01

So right in the center, just above the bottom part of the sternum, is called the thymus. A lot of people don't hear about the thymus. It has to do with more of immune regulation and sending out, like battle the battle, the cells that fight off the battle. Excuse me, they're the battling. How do I want to word this? If there is a virus, the thymus will trigger the immune system to release cells to fight that virus. So they're the battle cells is what I'm trying to say. The battle cells is what I'm trying to say. And then, if we drop down into the abdomen, we have the pancreas, which we've beaten up pretty well when we talk about diabetes. But the pancreas also releases digestive hormones or digestive enzymes. And then at the top of our kidneys sits the adrenal glands. And then, if we drop lower into the genital region, we have the ovaries and testicles. So all of those systems communicate to regulate hormones and regulate our immunity. They also help with growth of our youth. So when we're young, growth of our youth. So when we're young, or if we have broken bones or if we get injuries, it helps to repair and also helps with reproduction.

Bethanie Spangenberg: 8:32

So there's a lot that goes on within the endocrine system and they all work together, they all communicate together as I said previously about the thyroid hormone and the pituitary gland but they all regulate our body system or our systems to work together. We say, and the research has shown that endocrinopathies, or diseases of the endocrine system, occur in threes. So typically what we see in the clinic is if an individual develops diabetes, about 10 to 15 years later we'll see them develop some other type of endocrine disease, such as hypo or hyperthyroidism, and then we add another 10 to 15 years and then they start to develop another endocrine disease. And so, when we talk about it in the terms of service connection, if you have an endocrine disease and you go on to develop another one, if you have an endocrine disease and you go on to develop another one, you need to consider filing as a secondary because of how the endocrine system functions together.

J Basser: 9:57

Does that make sense? Yeah, it makes sense. It's kind of you know, put them in the same bag. I think you need to know before you even do it, or they're going to deny it. It's what they do.

Bethanie Spangenberg: 10:06

I would agree a thousand percent, because that is what we see, and I get surprised by that, because the research is there and it is very clear that these endocrine diseases are not standalone diseases because of how they communicate, because they are a regulatory system. So if you have one part of the system that's malfunctioning, something else in the body has to make up for it, or they're going to change or modify their function to accommodate to that original dysfunction. And so we see it clinically. The research is there. Yet we're looking at all these negative nexus opinions, and that's where the disconnect between clinical medicine and doing VA disability does not line up, like why are we changing our clinical thought process because we're doing a DBQ or we're writing a nexus opinion when clinically it is very clear what happens and transpires in the body? So I think that's why it's important to talk about the endocrine system and talk about these, because diabetes is so prominent and then thyroid to follow. So, but you're right, I think a lot of times you have to go in with a nexus.

J Basser: 11:30

It's sad, but you do. You got to realize all these people that are doing the adjudication of these claims. They're not medical professionals. They don't have a license to practice medicine, plus they're not attorneys either. They don't have a license to practice medicine, plus they're not attorneys either. You know they don't have a license to practice law.

Bethanie Spangenberg: 11:45

We'll get that quick, you know. And then, when we look at the DBQs that are available for the endocrinology system, the endocrine system.

Bethanie Spangenberg: 11:56

The VA has three DBQs. The two primary DBQs are the diabetes mellitus, which we've discussed, and then the one we're going to talk about mainly tonight is the thyroid and parathyroid. The third one is everything else that has to do with the endocrine system and it's often the very rare diseases that, honestly, I've probably only seen two or three of these diseases in 15 years. Am I 15 years now? Where am I at 2009. So, yeah, 15 years of practice. I've only seen two or three of Cushing's syndrome or Addison's disease, and those are diseases affecting the adrenal glands, or diabetes insipidus, which is a different kind of diabetes where the kidneys make you urinate a lot, or even some of the hyper or hypopituitary dysfunctions. We don't see a lot of those. Those are when you go to the specialist or the endocrinologist, or in the bigger cities they're going to see some of those diseases.

Bethanie Spangenberg: 13:19

So if you have one of those diseases. You really should be relying on your medical evidence from your specialist to prove or demonstrate the symptoms and the residuals of that condition. I would not rely on a VA compensation attention examiner. I would try to get your specialist to write the evidence there to write the evidence there, but we're not talking Go ahead?

J Basser: 13:46

Is that pituitary issue itself? Is that where the people that have that issue that they never stop growing and they want to be about eight foot tall before they die?

Bethanie Spangenberg: 13:55

Yeah.

J Basser: 13:55

So, pituitary.

Bethanie Spangenberg: 13:57

Yes, they call it giantism? Or they? Have different names for it.

Bethanie Spangenberg: 14:06

But, yes, that's where the growth hormone, the pituitary, doesn't regulate the growth hormone appropriately and it can go both ways you can have really little people and you have really tall people. But it also has several hormones, so not only the growth hormone but the thyroid stimulating hormone, the prolactin, and there's several more. The pituitary dysfunction is typically recognized in use because of some of the dysfunctions that we see or the abnormalities in their growth cycles that we see, the abnormalities in their growth cycles that we see, but those are the ones that are rare and that again compensation and pension examiner should really not be.

Bethanie Spangenberg: 14:57

They're not experienced enough. Even I'm not experienced enough and that really that evidence needs to lay a an endocrinologist or a specialist for those particular ones. So that's. We're not even going to attempt those because that trying to spit out some of that content, I would lose absolutely everybody so today our focus is thyroid and parathyroid.

J Basser: 15:24

Good, you know, most people have had thyroid issues over the last time, you know, but I'm taking that medicine levothyroxine for hypothyroidism?

Ray Cobb: 15:44

Yes, is that? The one I take every morning, when I get up a little bitty pink one On your stomach with a full glass of water.

J Basser: 15:52

Yep, yep, that's going to be your thought.

Bethanie Spangenberg: 15:55

That's it.

J Basser: 15:56

Yep, I've been taking that for several years.

Ray Cobb: 16:02

Well, and it's actually Go ahead yeah.

Bethanie Spangenberg: 16:08

There's actually a delay when people are diagnosed with the endocrine conditions because a lot of times the diseases will. There's not like an instant moment or there's not like a sudden symptom that you feel when you start to develop an endocrine disease. It's something that happens over time and you start to develop symptoms and you start to go, oh, that's not normal, but I can cope. And then a year or two can go by and symptoms persist and you're coping just fine, but then it gets worse and then a couple of years go by and then you're like okay, I can't, I can't cope anymore. So a lot of your endocrine diseases they'll pop up with symptoms over a long period, and so in order to capture the exact moment when things went wrong is very difficult, and so people will experience symptoms for several years before they ever get a diagnosis of an endocrine disease.

Ray Cobb: 17:07

I don't know that I had any symptoms of any of it, but does it show up when you have your blood work or your urine?

J Basser: 17:14

test or anything. Blood work.

Bethanie Spangenberg: 17:17

Yes, blood work. And so again going back to where these endocrine diseases come in, threes the typical screening for diabetics who do not currently have a thyroid disease. They are to be screened for thyroid disease once a year, whether they have thyroid issues or not or whether they have symptoms or not, because that can occur very slow, very subtly, no symptoms. And part of the screening as a clinical standard for patients with diabetes is to check their thyroid gland every year, check their thyroid hormone, making sure everything in that area is normal, that's TSH right.

Bethanie Spangenberg: 18:05

Yes, that's the screening, and then, once you get into treatment, there's a few other labs that they typically do. Now I've seen some in the clinic where, for the lack of a formal term, it'll start to peter out, the thyroid will start to kind of not like function correctly, and so you'll get one abnormal TSH or thyroid stimulating hormone.

Bethanie Spangenberg: 18:35

And the provider's like, oh okay, well, it's a little bit off, this is the first time it's off, we'll repeat it again in three months. And then three months goes by and it's normal. And then a year is like, okay, well, now it's normal, there's no issues. And then a year goes by and it's abnormal again. Or you're asking about it to be retested because something's not right. So clinically I've seen where you'll get an abnormal TSH. And then the provider's like, oh okay, well, let's repeat this again in three months. And I don't know why, because the evidence shows that once it starts like you get that dysregulation, yeah, three months later it may be normal, but that high TSH is a signal that something's not right. So we can't just repeat it in three months and then pretend it never happens.

Bethanie Spangenberg: 19:22

And I've seen that a lot. So if you have an abnormal TSH, you really need to stay on top of it to see, because any time a TSH is elevated is not normal and so you have to monitor. If you're a patient, you're listening. You're a veteran, you know that you've had an abnormal TSH in the past, but it's been, you know, a year since you've had it tested, three months since you've had it tested. You really need to push to stay on top of it.

J Basser: 19:51

What's some of the issues? Like I know, you can get a rapid heart rate, things like that, or slower heart rate, things like that. A lot of people try to say, well, it could be a potassium issue, things like that. So there's a lot of confusion with that.

Bethanie Spangenberg: 20:06

So if we focus only on hypothyroidism, you think the thyroid is really the metabolism, your fat breakdown, how your energy is utilized, and so if you have a low thyroid, your metabolism is slowed, so you're not burning fuel, you're not burning fat like you should be, and the symptoms are weight gain, slow heart rate, muscle weakness or cramps. You can get a puffy face, puffy eyes, joint stiffness, swelling in the legs, depression, fatigue, constipation and tolerance of cold. In the room You're always saying, oh, it's cold in here, it's cold in here. You're always asking for a sweater, for a blanket. You need extra blankets at night because it's really cold, or even brain fog. Those are many of the symptoms. Now, the subtle symptoms that kind of creep in is the weight gain, the fatigue and the depression and cold intolerance. Those are the ones that kind of hit you first and you're like okay, there's something going on.

J Basser: 21:26

Well, so if you've had one reading and then it went back to normal and maybe later on you'll have another high rating, so basically, once you have a high rating, it's worth jumping all over to kind of get something. Because it's one reading means there's something wrong, right?

Bethanie Spangenberg: 21:42

Correct One elevated reading. It's not one of those things where it's like you know well your blood sugar, you're non-diabetic. You go in for labs and you're like, oh well, your sugar is a little high today. Let's repeat it again in three months. Well, your sugar can be high because you didn't fast long enough, or you ate too much sugar beforehand, or maybe you are showing some prediabetes For blood sugar. Yeah, you can repeat that in three months and see what it's doing the thyroid. It's not that way.

Bethanie Spangenberg: 22:13

Once your thyroid stimulating hormone is elevated, at that point your brain is telling your body that you are not getting enough. So it is already saying there's something not right here. We need more thyroid hormone. We need more thyroid hormone. That is when it's starting to go out, it's starting to not function normally. And so you repeat it in three months and it's like, oh, is this fine? No, it's not fine. You need to stay on top of it, because you've already seen that the brain is telling the body there's not enough thyroid hormone. So before we get too far, I guess into each disease.

Bethanie Spangenberg: 23:07

Let me jump into that DBQ. So, as I normally do, I have the DBQ in front of me and I'm going to go through each page and talk about some of the questions that are asked and why they're asked and what to expect when the veteran goes in for a thyroid or parathyroid DBQ or condition. So if I look at page one, so this is eight pages and this particular DBQ again thyroid, parathyroid, are in the neck, so we're just focusing on the endocrine system involving the neck. So page one contains information for the provider to document their relationship with the veteran and what evidence was reviewed, and so typically it's just going to be if it's a VAC and P examiner, then it's going to be you know, claims filed, reviewed.

Bethanie Spangenberg: 23:52

If it's a private provider or you're asking your doctor to fill it out, then it's typically you know medical records, maybe service treatment records if you provide them, lab results and anything that you have brought to your clinician. And this page, these questions, are standard for all of the public-facing DBQs. So if we go to page two, I always emphasize the very first question at the top Does the veteran have, or has he or she ever had a thyroid or parathyroid condition? This is where we're saying you must have a diagnosis. You don't want to apply if you don't have a diagnosis. I emphasize that because of how, if you go in without a diagnosis, your success rate goes down significantly. That provider says no to this question and they move on and your claim is denied. So I cannot emphasize enough, just as I have at every radio show that you should be going in with a current diagnosis.

Bethanie Spangenberg: 24:59

So there's a list of medical conditions that pertain to specific diagnosis, that pertain to the thyroid and the parathyroid. The ones that are most predominant are the hyper and hypothyroidism hyper and hypoparathyroidism. When we say hyper, it means hyperactive or overactive. If we say hypoactive, it's a slowing or a decrease in function. We'll talk briefly about what we call goiters. The VA references them as thyroid enlargement and whether those goiters or that thyroid enlargement is toxic versus non-toxic. So there's other diagnosed conditions on there. We're not going to hit on those because they are not common. If we jump down to Section 2 on page 2, it talks about the medical history and, believe it or not, the examiner should be able to fill out this section without the veteran ever being in the room. And I say this because the veterans that are listening and have heard me preach they have already provided a beautiful statement and supportive claim that not only discusses the onset but discusses the course of their thyroid or parathyroid condition. So you want that evidence in front of that examiner before you ever sit down to talk with them. And I want to give a specific example that I just ran into. Last week we got a request for a record review. They want us to look to see if condition A is related to condition B and I said, okay, I review the evidence and this condition has affected him over the last 20 years. And that hurts that veteran, because I can't support that veteran in saying, well, yes, this condition affected his sleep, for instance. I can't say that it affected his sleep over the last 20 years because I don't have any evidence showing that. So you really have to discuss the course of that disease.

Bethanie Spangenberg: 27:44

So let's use an example for the thyroid condition. If a veteran talks about well, maybe the thyroid condition is not the best one to say because I'm trying to think secondary here. Okay, let me give this example If we're trying to tie sleep apnea to PTSD, and in 2000, your event occurs and you tell me about that event and then you jump 2024 and you tell me what your current symptoms are, what happened for those last 20 plus years that has caused issues with your sleep, that you think that your PTSD has caused sleeping issues, if you don't tell me that you've had sleeping troubles or provide examples with a timeline, then I cannot say I can't fill in the gap for you that this condition affected your sleep in 2001, 2002, 2003, 2004, 2005, and so on. There's an absence of evidence. I can't assume that your mental health condition caused sleep issues for 20 years. You have to tell me that. If that's the case, does that make sense?

J Basser: 29:13

If they don't tell you, you won't know right yeah foundation is veterans. You're gonna have to see if the examiner examiner you need to go ahead and look at your. What you got and write up the statement explains your condition and you're in your terms and let the examiner look at it. That might we'd have a lot of problems within the exam itself. Yes, that makes sense, but it has to be on what they have. It can't be something new or something extra. It has to be an evidence that they already have in the system.

Ray Cobb: 29:46

Yeah, that's where I'll refer back to my notes and highlight them and just say, here's my notes where it talks about it. Do you need to see them? A lot of times they'll say, oh yeah, thank you times they'll say, oh yeah, thank you.

Bethanie Spangenberg: 30:07

So I can't emphasize enough that statement of support acclaim and how it lays out your medical history and what has happened. And if it is the thyroid, tell me when you went and had an ultrasound In your statement. Tell me. Tell me what happened when you started feeling your heart skip or jump and then when you went to go see your doctor and then the ultrasound was done and then surgery was done. Tell me about what has happened and how that has affected you. Before you had surgery, you had these symptoms. After surgery, you had these symptoms after surgery. You had these symptoms.

Bethanie Spangenberg: 30:39

To really lay it out there for that examiner to understand what has transpired with your condition that you're claiming.

Bethanie Spangenberg: 30:49

So the next few questions on the page two talk specifically about types of different types of treatment that a veteran may have had for their thyroid or parathyroid condition and it specifically asks about radioactive iodine.

Bethanie Spangenberg: 31:05

It talks about surgery, any type of genetic testing that may have been done and that will vary based on the condition. Not everyone will have radioactive iodine, so that's specific to hyperthyroidism. Some will have the radioactive testing done. That is different than the treatment, so treatment really doesn't say a whole lot as far as, like, the rating schedule goes, but the next section on page three, we're going to dive into that rating schedule. So on page three, if the very top section talks about the signs, symptoms or residuals of a thyroid condition, so the thyroid specifically is a butterfly-shaped gland at the base of the neck. So if you push on your chest and you push up into there's a little like hole is what I'm going to call it a little your thyroid sits right about there and it's in the shape of a butterfly and at the tip of each wing is your parathyroid glands and so they sit on each.

Bethanie Spangenberg: 32:29

There's four of them and they sit at the top of each wing of the thyroid glands. So you have four parathyroid glands. So the thyroid and the parathyroid communicate and if you have any type of thyroid condition it can irritate the parathyroid and vice versa. So when an individual has thyroid issues, they should also be looking at the parathyroid function. The residuals for question 3A is they're trying to capture what other body systems are affected, and that's really where the majority of the ratings for thyroid conditions and parathyroid conditions come from is the residuals, not necessarily the disease itself, but the residuals, and we'll talk about those residuals as we go through.

Bethanie Spangenberg: 33:22

Question 3B has to do with hyperthyroidism, and earlier we were talking about hypothyroidism, the slow acting or the slowed. Thyroid 3B talks about hyperactive or overactive thyroid 3B talks about hyperactive or overactive thyroid. So symptoms related to hyperthyroidism can be weight loss, anxiety, rapid heart rate, can have some tremors, fatigue, diarrhea, frequent bowel movements. You get hot a lot. It's like man, it's really hot in here and you start peeling off your coat or layers of clothing and then hair changes. You have thick hair. So personally I and I always I always like to tell stories because I feel like it sticks a little bit better, and so they always talk about hyperthyroidism. And women can be something that women really like, because they lose this weight, they have this thick, beautiful hair, but then they're tired all the time, and so I personally experienced that when I went through my thyroid. Issue is I had lost a bunch of weight and I was like in clothing that I hadn't worn for many years, and so, even though I knew I had thyroid issues and I was tired all the time, it was like man, I'm wearing clothes that I bought years ago that I couldn't wear before.

Bethanie Spangenberg: 34:51

But again, sometimes that hyperthyroidism or thyroid disease creeps up and you don't really realize you had it until you can. You show up in the hospital for heart palpitations and here you're in atrial fibrillation, and so they would do the workup to see why you have AFib and they find out that your thyroid is a little active, a little overactive, and so for the rating schedule for hyperthyroidism, you get a 30% rating for six months after the initial diagnosis and then it's rated by the residuals. So residuals can be the atrial fibrillation, you can have some heart changes. From the thyroid, the frequent bowel movements, you can actually develop what they call exopsalmus, but where the eyes pop out and it looks like you have buggy eyes. Sometimes hyperthyroidism is called Graves' disease and that's really what a lot of people know hyperthyroidism as, and there's commercials out there for the eye disease. I don't know if you've seen those or not. Any questions about it?

J Basser: 36:13

Gray's is listed in Title 38. Gray's is listed in Title 38, Part 4. There you go.

Bethanie Spangenberg: 36:25

So any questions about the hyperthyroid or Graves' disease.

J Basser: 36:33

Ladies, if you got it, enjoy it, but you know, get it fixed it, you know, get it fixed.

Bethanie Spangenberg: 36:48

Thyroid issues tend to also cause reproductive health issues, both men and women, so that can be something that can pop up as a residual or some issues there, some issues there. So if we look at 3C, it has to do with thyroid enlargement and this is also known as goiters. We call this goiters. They're just growths on the thyroid and you'll look at old history or old medical books and they'll show pictures of goiters and they associated goiters with iodine deficiency and that's why all of our salt is now iodized is because we were lacking iodine in our dietary system or all of our lovely processed foods. We weren't getting enough iodine and so the treatment for goiters was iodine, and so that's why we have iodized salt, just to help prevent any type of goiter development.

J Basser: 37:51

Again here, In case we get nuked yeah.

Bethanie Spangenberg: 37:58

Oh gosh, yeah, oh gosh. Now goiters or the thyroid enlargement is broken down into toxic or non-toxic. So if you have a goiter or growth that has no symptoms but you do have like swelling or like the obvious neck swelling, like I was talking about for the pictures, or difficulty swallowing or hoarseness, that's where you will get rated on what they call disfigurement and we've talked about the disfigurement before or you'll get rated for your other symptoms, your other symptoms. If it is toxic, they're going to base the rating off of what the hormones show. So if your goiter is toxic and it's causing excessive thyroid hormone release, then they're going to rate you based off of your hyperthyroid or overactive thyroid hormones and vice versa. So not a lot of meat on that one.

Ray Cobb: 39:11

Any questions about goiters.

J Basser: 39:12

Can that also be a secondary to diabetes or something else?

Bethanie Spangenberg: 39:17

Your goiters are typically going to be from something else. We don't see a lot of the non-toxic goiters anymore. That's very rare. The toxic goiters we do see, and that's mainly you'll get a, and they're not as obvious because we get more medical care than we used to, and so sometimes we'll have patients that come in and they notice a swelling in their neck and I say you know my neck, I was looking in the mirror, I was doing my makeup and it just looks off, and so you'll get an ultrasound of the thyroid and you'll find a goiter. A lot of times the goiters are incidental on scans anymore. We'll pick them up on the scans before the patient ever comes in and complains of it. It is very rare that we see the hoarseness or the difficulty swallowing from a goiter. Usually people seek medical treatment before it gets to that point.

Bethanie Spangenberg: 40:28

I can see that. So if we go down to 3D, this is hypothyroidism that we talked about before. Hypothyroidism talked about the symptoms weight gain, depression, fatigue, cold, intolerance. Those are the big ones. The rating is 30% after the initial diagnosis and then rated by residuals. However, if you have what they call myxedema with a series of symptoms, they will give you a 100% rating. This is not a realistic rating. This is not something that veterans should be trying to capture or trying to get the myxedema. What that is is that is a combination of your hypothyroid symptoms in addition to swelling in the legs, and this occurs in those with untreated hypothyroidism or undiagnosed thyroid disease. So I've never seen this occur. It is very rare.

Bethanie Spangenberg: 41:42

A lot of times the patients present to the emergency room or they can even go into a coma if it's to the point that the body is not getting any thyroid hormone and so it's not able to regulate the body's endocrine systems. So, aside from the swelling in the legs, they have to have cold intolerance, muscular weakness, heart involvement, such as low blood pressure, low heart rate, swelling around the heart and a mental disturbance. In order to get that 100%, you have to have all four of those components the mental disturbances, dementia, slowing of thought or depression. If somebody has myxedema with dementia, that is a significant like it has been going on for some period of time that they have progressed to develop this myxedema. It is rare. This is not where you hang your hat if you're trying to get a disability percentage for hypothyroidism. I bring it up just because it is. You know several questions in the DBQ that are being asked, but it is not something you don't want. This condition in your license. Any questions about that? No, no no, no.

Bethanie Spangenberg: 43:27

So the last one, last question on page three has to do with thyroiditis. Thyroiditis is just inflammation of the thyroid and there's no actual percentage to capture here. If it's normal function, it's zero percent. Excuse me, it's like your thyroid hormones are normal, it's 0%. If it's overactive, then you're based off of hyperthyroid schedule reading. If it's hypoactive, then it's based on the hypothyroid schedule. So very straightforward on that one. So very straightforward on that one. So if we move on to page four, we're going to transition into the parathyroids and the parathyroids again, those four little glands that sit at the tip of the butterfly wings in the thyroid. If an individual has surgical removal of their thyroid, the parathyroids need to be monitored for a period of time. Sometimes you can remove the thyroid tissue and keep the parathyroids intact. If they are manipulated or irritated too much, you can cause damage to the parathyroids and then develop a parathyroid issue. And so for a series of several months after you have your thyroid removed, they have to watch your parathyroid function. So that's how close they work together and in their space. That's how close they are. So 4A talks about the residuals. Here again, the residuals are really what gets your rating percentages for parathyroid function. 4b talks specifically about hyperparathyroidism. Symptoms are typically subtle.

Bethanie Spangenberg: 45:18

Parathyroidism Symptoms are typically subtle. This is an overactive parathyroid function and it causes excessive calcium to be released into the bloodstream. If the parathyroid doesn't function correctly, symptoms are fatigue, muscle weakness, heart arrhythmias. That's similar to what we talked about in the thyroid condition. Hyperparathyroidism can also cause bone fragility and kidney stones. What happens is the parathyroid because it's saying, telling the body it needs more calcium into the bloodstream, telling the body it needs more calcium into the bloodstream, it pulls the calcium from the bone in order to get the calcium into the blood, and so that's where we see fractures that are occurring with a little pressure, like you know, like we tripped over something or some minor trauma happened and a bone broke. That's typically how we find parathyroid issues. Well, that's not enough force. That shouldn't have broke. What else is going on? Do you have something else going on in your body? And so often that's the first sign of there being parathyroid issues and an individual is an abnormal or atypical fracture, bone fracture. Any questions?

J Basser: 46:52

regarding the parathyroid, at least the hyperparathyroid.

Bethanie Spangenberg: 46:59

How common is that?

J Basser: 47:02

It's not.

Bethanie Spangenberg: 47:04

It's not, I would say more of your parathyroid issues, again because of how the endocrine system functions. It's usually something else in the endocrine system that's malfunctioning in order to cause the parathyroids to act up. We see it when there's parathyroid issues in young kids, like even tumors can put pressure in the brain, and then it tells the parathyroid to not function correctly and then it's like okay, wait a minute. They were hitting in the shin with a ball baseball practice and they broke their leg.

Bethanie Spangenberg: 47:44

That should not have broken their leg, and so when we see stuff like that, we start to question you know what else is going on?

J Basser: 47:51

Yeah, that's why I started looking for cancer and all kinds of stuff.

Bethanie Spangenberg: 47:56

Yeah, yeah.

J Basser: 47:57

Oh, my mother hit cancer in her arms and reached down to pick a dog up. Her arm snapped and took.

Bethanie Spangenberg: 48:03

Yep, yep.

Ray Cobb: 48:04

Oh goodness what did we do Question Bethany, if you is thyroid problems, can they sometime be inherited?

Bethanie Spangenberg: 48:25

time be inherited. So the reason or the thought process behind the genetic component of, or hereditary component of, endocrine diseases is because of how the immune system works and how your body, basically the DNA that's inherited from your mother and father. So if, for example, my children are more likely to get diabetes because I am a diabetic and it has to do with the genes that they carry. So endocrine or autoimmune diseases can occur if the person has the susceptibility in the wrong environment. So let's say I'm going to use diabetes again because that's the one I preach about and most comfortable with. So let's say that for some reason my body found a and it's immune system so thymus is your immunity. My thymus found a cell and decided that it was an enemy and that cell was actually a friend, like the beta cells in the pancreas. So something in the immune system triggered the body to attack those beta cells or those healthy, good cells. And now that the body has attacked those cells, those cells malfunction or are killed off by the body.

Bethanie Spangenberg: 50:00

There is a genetic predisposition and then you expose the individual to the wrong environment and it will trigger that to occur. Now, if you also think about it, if as a child, you not only have your parents' genes, but you also have the same environment. For most children, most children are raised by their biological parents. So not only is the adult in that same environment, but the child is in the same environment. So now you have that storm of genetic susceptibility in the environment, triggering the onset of that dysfunction. So, yes, thyroid, yes, diabetes, yes, all these endocrine diseases have a genetic predisposition. But that doesn't mean that you're going to what viruses they have. If they're exposed to mold, chemicals, dioxins, agent Orange, once you expose those injuries in that environment, it can attack the body.

Ray Cobb: 51:24

Yeah, and that explains it. I have this individual I know a friend and their mother had thyroid problems and their sister had thyroid problems and from listening to the conversation tonight I'm beginning to think that that person may have thyroid problems and don't know it because of some of the things you talked about with the weight gain or the weight loss and the heart AFib mainly things of that nature. So I think I could reach out to that person and tell them they may want to ask their doctor about checking that thyroid, if he hasn't already.

Bethanie Spangenberg: 52:08

Correct, and even if you have a strong family history, you want to have your thyroid checked regularly. The same with diabetics. For some reason, type 2 diabetes is in both my grandmother, my mother's, my maternal grandmother, my maternal grandfather, my uncle, which is my mom's brother, my aunt and my other aunt, but my mother is the only person that does not have diabetes Of the all five of those individuals. Out of six people, my mother is the only one that doesn't have type 2 diabetes. So there's the genetic component. But why? Her environment might be different. Maybe she doesn't carry that gene, maybe everybody else just had the susceptibility and the same environment, or the injury.

Ray Cobb: 53:10

Okay.

Bethanie Spangenberg: 53:13

The one thing I like to talk about when it comes to calcium and in the body is calcium does a lot in our body, from the electrical signals in the heart to muscle contraction, to signaling the nerves in our fingers to move, and the strength in our bones or pair of bones. The calcium is used to regulate so many body functions and so the parathyroid can affect any of those conditions. And I don't think we realize when we talk about our health and our well-being, we don't really realize how much calcium does play a role in our body's function. So I just always like to talk about that. For hyperparathyroidism, if it's overactive, typically what will occur is they will go in and they will take out some of the parathyroid glands. Of the four, they may take out two and leave two and then monitor to see how things progress out to and leave to and then monitor to see how things progress. So if it is a true hyperparathyroid issue, then they will remove it. If it's a secondary issue, then they'll try to treat. You know why it's being a secondary issue, such as a tumor in the brain. When we look at the DBQ, we're oh my gosh, I didn't realize the time.

Bethanie Spangenberg: 54:53

When we look at the DBQ on page four, the questions that go through. There there's six questions. It's specifically tied to what is in the rating schedule and typically, just like it was for the thyroid, it's a temporary rating schedule for a six-month period and then they rate on the residuals. So there's not a whole lot of of meat in the parathyroid either. If we turn to page five, there's only one question for hypoparathyroidism and the rating again is temporary for certain months after the diagnosis and then rate it based on the residuals.

Bethanie Spangenberg: 55:44

Looking at section five is the physical examination and there is a requirement for that examiner to touch on the neck to feel the thyroid. They are to capture their pulse and blood pressure and they are also assessed, their reflexes to test the reflex response. Reflexes to test the reflex response. Clinically we'll see an increase or hyperreflexia if the thyroid is elevated and we will see a decrease in the reflexes if the thyroid is low. And that just helps to support what we may be seeing in the lab work. And based on the symptoms, we'll do reflexes and then, if they're consistent, you know that helps us clinically.

Bethanie Spangenberg: 56:36

The last few sections of the DBQ are the standard questions. Talks about scars and disfigurement, talks about tumors and tumors and masses, and those are standard in all the DBQs. The diagnostic testing is pretty straightforward. When we have any type of thyroid or parathyroid issue, we find it on lab first. That is normally how it occurs. Then the individual goes for an ultrasound or even a CT scan of the neck and then we refer them to a specialist for either biopsy or medical intervention. On page seven it talks about functional impact. Again, you put that in your statement of support of claim you talk about how your condition may be affecting you. Your statement in support of claim you talk about how your condition may be affecting you. And then the last page is for the examiner's information and any additional remarks the examiner may have. When a veteran goes in to this exam, they can expect anywhere from 30 minutes to an hour or more if they find, or the examiner finds, that there are residuals associated with their thyroid condition.

Bethanie Spangenberg: 57:54

And, believe it or not, that was it.

J Basser: 57:57

But if they find residuals, that means there's got to be more DBQs. That's not good.

Bethanie Spangenberg: 58:02

Now, that is, that is what is supposed to happen and it's funny that you bring that up. That is what is supposed to happen. And it's funny that you bring that up because just this Tuesday, two days ago, my uncle went in for his comp and pen exam. He in the 1980s. He was in a motor vehicle accident. He was a passenger in a vehicle and was thrown out of the vehicle and had a fracture of the upper arm and it was a spiral fracture, so it is not grown back correctly and it's actually compressed the nerve. They would not assess the nerve condition because it wasn't in the exam request. They were only going to evaluate the bone condition. So the examiner told him that he had to go back and file for the nerve damage related to that bone fracture and that's not what's supposed to be done.

J Basser: 58:56

It's supposed to be a similar benefit. You find that you're supposed to do it, but since they're preaching that, now it should become a burden symptom. Yep, just like diabetes and all its secondaries. Burden symptoms, that's Yep, just like diabetes and all its secondaries.

Bethanie Spangenberg: 59:11

They're taught and they're prompted to do their residuals, and they don't.

J Basser: 59:17

Okay, since we ain't got much time left, bethany, give us your website real quick before we shut her down wwwvalor4vetcom. Okay, if you guys need an IMO or any medical things like this, especially dealing with intestinal questions, reach out and touch her. She'll be glad you did With that. Saying, guys, we're out of time. This is John on behalf of Bethany and Ray Cobb. We'll be signing off for now. You have been listening to the Exposed Pet Podcast. Any opinions expressed on the show are the opinions of the guest speakers and not necessarily the opinions of Exposed Pet, exposedpetcom or BlogTalkRadio. Tune in next week for another episode of the Exposed Pet Podcast. Thanks for listening.