Ray Cobb: 0:00

Love Talk. Radio.

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 M Ray. Welcome, ladies and gentlemen, to another episode of the Exposed Vet Podcast on this February, the 8th 2024. The weather's going by pretty fast. Let's get the warm weather on the way. I placed the order last week and I think it went on back order, but we'll still try to get it here for the next couple of shows. Anyway, today we're going to discuss we're going to start off with hypertension and we've got Bethany Spangenberg. Bethany is valid for vet. You guys know valid for vet. They're a really good company and do a lot of good stuff for veterans. Bethany, how you doing.

Bethanie Spangenberg: 0:53

I'm holding in there. My blood sugar is 67, and I'm hoping we're returning the ship.

J Basser: 0:59

Okay, well, you need some type of sugar to get down your system, to get you going back up.

Bethanie Spangenberg: 1:11

I just ate a nutty bar, so hopefully we're in good hands now.

J Basser: 1:16

I thought about changing the show because every time me and Ray and James get on, I'm going to call it Diabetics R Us. There you go.

Bethanie Spangenberg: 1:28

The diabetes struggle bus.

J Basser: 1:30

It is. It's the worst disease known to mankind. You know, I mean, you've lived with it for a long long time yourself. You know how often do you drop like that.

Bethanie Spangenberg: 1:49

Actually, you know, after I had had my children, it's pretty frequent and for some reason, like I used to exercise all the time, I would exercise for two hours a day, five days a week, six days a week, and didn't have any issues. But even like, I've been trying to get 10 000 steps in and right now I'm about 12,000, but now I'm paying for it. So, my sugar's dropping because of the exercise.

Ad: 2:12

Yeah.

Bethanie Spangenberg: 2:12

Wow, so I've probably used my glucagon probably once a month in the last year.

J Basser: 2:22

Okay, well, I may use the top ones, but it's a little bit different, you know, than top two, so it's kind of it's oh, you are what you eat, girl, you are what you eat there is a video that shows like this guy keeping the balloon off the floor all day long, and I never really perceived diabetes that way, but that's surely how it is. You're trying to keep that balloon from dropping all day long.

Ad: 2:57

Well, the problem is, if you go right next to that person, you'll probably get that balloon and tie a string to it and put some helium in it, but you want to go over to the DBQ-based hypertension.

J Basser: 3:06

Are you able to go with the DBQ based hypertension? Are you able to do that today?

Bethanie Spangenberg: 3:11

yeah, we're, I'm doing good, good enough. If I have to back out, I'll let you know.

Bethanie Spangenberg: 3:16

So we're pretty stable and, like I said, I think we're turning.

Bethanie Spangenberg: 3:20

But you know I talked to you briefly about wanting to do like a I guess what I'm calling DBQ discussions, really diving into each DBQ. That way there's a better understanding for like what the veteran like, so the veteran can understand what the provider is going to be looking for, what questions they may ask. And you know some veterans go online and they look at this DBQ and some of it doesn't make sense. So I wanted to start diving into these DBQs and breaking down each question and what it means and where the percentages kind of come from and how it looks like in the clinic versus the legal side of things, looks like in the clinic versus the legal side of things. There's not a good resource out there for private examiners to do these DBQs and the VA wants the veteran's personal treating provider to complete these, but a lot of them don't want to because they don't know anything about them. So this series can help, you know, the providers and the veterans to kind of understand what is happening with these DBQs.

Ad: 4:34

Make sense.

Bethanie Spangenberg: 4:40

So I'd prefer, like I have the DBQ in front of me. It's three pages and you just talk about each question and what it means, and I think the hypertension one is short enough, simple enough to be a good one to start with.

J Basser: 5:04

I've got a question, john. Yeah, yeah, and I really hadn't thought about this. But Bethany and you are together. You know I'm an Army vet. I don't know what Navy veterans went through and much about what would cause their disabilities, but I'm fixing to have a talk with one of the vets in our chapter. He's a Navy vet. He'd be Vietnam era. I don't think he has agent artery exposure. But they just discovered last week that the man has dropped foot, both feet. Permanent loss of the perennial nerve. What in his naval service could have possibly caused that You're talking about? Drop foot and then rip on the right foot, yeah, drop foot.

J Basser: 6:04

I don't know what the etiology of it was Like. I say he's a naval veteran, I don't In an Army veteran. You know, we've ran further than most people have ever walked. Plus, in the Vietnam era you've got diabetes, secondary peripheral neuropathy or direct peripheral neuropathy. I've got to talk to him and see if I can get a connection between his loss of use of two feet. That has already been diagnosed. Now that has already been diagnosed. Now they're putting him in AFO braces and kind of feel him out and see if there is a service connection.

J Basser: 6:51

Bethany, have you run across anything like that.

Bethanie Spangenberg: 6:55

Yeah, so normally when you have a bilateral drop foot issue, it's going to be something compressing the spinal cord or something affecting the nerves in the lower spine. If it's unilateral, there can be other, like just one leg, it can be issues further down, like there's nerves behind the knee, there's nerves in different areas that can be affected. But normally when you're talking about a bilateral issue it's going to be a spine-related issue, like an injury or a disc herniation, some type of compression on the spine.

J Basser: 7:32

In your opinion, climbing the ladders on a ship does constant rocking and rolling on a ship. Is there anything there that could be connected?

Bethanie Spangenberg: 7:42

Normally it's going to be something that's traumatic connected. Normally it's going to be something that's traumatic. Or if you're doing some type of occupation over a long period of time, like roofing, if you're doing the bending and lifting bending and lifting type stuff, you can get some of the shift in the spinal column that can cause the compression there.

J Basser: 8:02

So then, really, I guess what we're looking for is an event in service.

Bethanie Spangenberg: 8:07

Yes, some type of whether it's a fall or motor vehicle accident some type of trauma.

J Basser: 8:17

What was his Navy job? What was his Navy?

Ad: 8:20

job I don't have any idea?

J Basser: 8:22

Like I say, I'm going to talk to him this week. Is that what he did? Yeah, because his diagnosis was just last week.

Ad: 8:32

And all of us.

J Basser: 8:32

Vietnam era guys. You know, we've got, I guess, 10 different veterans in our chapter that have dropped foot and wearing AFOs, but then we were all exposed to Agent Orange, diabetics and peripheral neuropathy. Well, he could have been a bug killer or something like that. You know, you never know. Yeah, could be. I'll get back with you on that, John.

Ad: 9:00

Okay.

J Basser: 9:02

A lot of Navy ratings are different as far as the same. We've got different ratings that are exposed to different types of chemicals and stuff like that too. You know, because you know each rating, you know Holtex has been exposed to a lot of the best ones and stuff like that because they removed it you got. You know Navy's got a whole lot of Clifford ratings and each job's different, so there might be certain things that could help. I know there's exposures, all kinds of chemicals and all kinds of stuff. They work with it every day. It's all a dangerous job. Well, he was at the seminar and he listened to Bethany. I saw her at breakfast the other morning and had a prescription in hand for the braces and he said I'm going and going and get this prescription rewrote on VA's formulary and get my braces ordered. And I said you know, maybe we can kind of look at service connection. And he said I think I'm on contact Bethany because he heard her at the seminar. So that might be a heads up for you, bethany.

Bethanie Spangenberg: 10:15

Well, I'll keep an eye out for it. I'm going to spend the next few months here taking up a lot of extra nexus letters because I want to make sure that our process is where it needs to be for a lot of the PAC Act changes and we're getting a lot of obesity as an intermediate step. So I want to do a lot of quality stuff over the next few months, so I'll keep an eye out.

J Basser: 10:37

Yeah, I told him to let you know that he had talked to me, but I'll talk to him some more. There might be an easy solution. I don't know, maybe his ship was in the waters. I'll just have to talk to him and find out. Does he have diabetes too? Don't know. Haven't gotten that in depth, had no reason to, because he just came up with his diagnosis last week. I know at this time he's service connected for nothing. Yeah, I know, and that's true yeah, you know.

J Basser: 11:25

I gotta help the, you know. I got to help the guy you know. If I can, that's what you got to do. You got to do what you got to do. All right, All righty High pretension, bethany.

Bethanie Spangenberg: 11:45

All right, I'm going to dive on in. So this particular DBQ was released in September of 2022. They haven't updated it on the public side. I'm looking at the public DBQ, the one that veterans can print off for their provider or the providers can go online and obtain. Sometimes there is a difference between the ones that are within the VA and some, and the ones that are the public-facing ones, but normally they're pretty minor. So for this particular public-facing hypertension DBQ, it has two primary conditions that it's focused on, and it's hypertension and isolated systolic hypertension. Hypertension is your most common diagnosis between the two. The isolated systolic hypertension, we call it ISH. In the clinic that is not as common. You see it in your older veterans, in their 70s and their 80s, in their 70s and their 80s, and the VA actually takes a minute to define what the hypertension on ISH is. But that's going to be on page two. I'm going to stick an order.

Bethanie Spangenberg: 12:57

So the first question on here it just asks are you completing the DBQ at the request of the veteran or the claimant or other, and that's very generic. I'm not really sure the purpose of that. And then the next few questions it talks about are you a VA health care provider. Is the veteran regularly seen as a patient in your clinic and was the veteran examined in person? So they want to know we've talked about ACE before, where they don't have to interview you they want to know how this exam was conducted, and so that first section is just kind of setting the tone for you know who is requesting it, what's your role in this veteran's health care and how was this completed? How was the form completed?

Bethanie Spangenberg: 13:43

The second section is the lower half and it's the evidence review. The provider that's reviewing this always wants to review the evidence. If you put in here that no records were reviewed as the examiner, then your DBQ holds less value, less weight. So you want to always document what records that you have reviewed and the veterans should be providing evidence as well if they're having their private examiner. Do this.

Bethanie Spangenberg: 14:14

Fill out this DBQ and some of the information that the veterans should provide is a list of their clinical diagnoses, so their problem list, any labs from the last year, if it's available, if they've ever had a cardiac ultrasound or an echo, they should provide that information as well. And then those components the ultrasound, the labs those are not required but if you've had a history of hypertension for more than 10 years. Those things are important because there may be evidence in the ultrasound and in the labs that the hypertension has caused other issues, so like it's affecting your kidneys or it's affecting your heart and how it functions. So those that page one. Everything I just talked about is pretty standard. So the evidence should always be reviewed, and then they're just disclosing. You know the relationship between the veteran and the examiner, so nothing too crazy there. Any questions on that?

J Basser: 15:29

Well, you know, I I got a 0% on hypertension. Of course I never filed for hypertension until after the PAC act um, and I'm an R2 veteran. I didn't need it. It's nice to have it conceded and noted on my record. They gave me a 0%, but now I've also got 100% for nephrology, stage 3, or I think it's 4, kidney disease by now, 2 heart attacks, 5 pacemaker defibrillators. I take four blood pressure medicines and have for the last 20 years, since 97. I didn't really understand the 0% on hypertension. I didn't question it because, like I said, I don't really need it. But it sounded like it was kind of low-balled and they didn't check all these things that you're talking about to see if I had heart ultrasound. And you know, I think if they would have done a little more checking it would have come out a little different.

Bethanie Spangenberg: 16:44

So we'll talk about that a little bit. You're actually going to get more percentage from any complications of hypertension than you actually will for hypertension. The hypertension rating schedule is hard to meet and I'll dive into that a little further down.

J Basser: 17:07

I've been in surgery for over 30 years.

Bethanie Spangenberg: 17:11

Maybe you stayed at 0% the whole time.

J Basser: 17:15

Oh, I'm compensated.

Bethanie Spangenberg: 17:18

Well, that's good. Well that's not good medically, but that's good legally.

J Basser: 17:25

No, actually this is a walking death. Okay, this is a walking death. Hey, we got a West Virginia caller. They got their hand raised. You want to grab them and get them to see what we got here, West Virginia you got a question for Bethany.

Ray Cobb: 17:45

Well, I've got a couple questions, but on the DDQ for the hypertension, she's going to go over this later, she said, but from my understanding, it basically boils down to what reading they get three times in a row and then that determines your rating.

J Basser: 18:03

Would that be correct, Bethany?

Bethanie Spangenberg: 18:07

Yes, but there's ways we can talk a little bit about how a veteran can kind of support a higher rating.

J Basser: 18:14

Oh, okay, then I'll have some questions on another subject, but I can wait until you're done with your DBQ before I interrupt you on that.

Bethanie Spangenberg: 18:26

I have to warn you, this DBQ thing might be a little dry, but I think it has some value.

J Basser: 18:33

That's okay. A little oil won't be okay. All right, all right, all right, we'll re-read.

Bethanie Spangenberg: 18:48

So for page two, we're looking at the diagnosis section. Again, this is something that's in every DBQ and I'm actually thankful in this DBQ that the VA takes a moment to define what they look at as far as hypertension is like, defining what it means legally. So for the VA disability rating purposes, the term hypertension means that the diastolic blood pressure is predominantly 90 millimeters or greater. So when you look at a blood pressure reading, that top number is the systolic. So when you look at a blood pressure reading, that top number is the systolic Okay, that's the squeeze. And then the bottom number is the diastolic, that's when it dilates or it relaxes. So that bottom number has to be 90 or greater for the diagnosis of hypertension, for rating purposes, and then for isolated systolic hypertension, that systolic blood pressure has to be greater than 160 millimeters or greater and then a diastolic blood pressure of less than 90 millimeters of mercury is actually what it is.

Bethanie Spangenberg: 19:59

So as we age, the heart doesn't do its job and the blood vessels don't do as well as a good a job to kind of keep your blood pressure going. So you see this kind of frantic rhythm where it's a hard squeeze and it's a dramatic relax. It's a hard squeeze and a dramatic relax. So that's where the isolated systolic hypertension comes in Again. It's not that common, but it is in the CBQ. When it comes to the definition for the rating purpose, the VA is aware that the legal requirements do not match clinical practice guidelines.

Bethanie Spangenberg: 20:37

They are aware and they don't care If you don't meet that legal requirement. You're not getting the disability rating percentage. So that's important to recognize, even though that is very frustrating on the medical side of things. And when you look at the legal requirements for each disability rating percentage. It's unrealistic and we've had this conversation before, so moving on yeah, moving on, if there's any for 1B.

Bethanie Spangenberg: 21:13

The next question if there's any additional diagnoses that pertain to the hypertension, they would add those in there. Normally for hypertension there's not really anything that goes in that box. For the next section it actually, before you get into the medical history it prompts the examiner to complete additional DBQs if they find something that is related to the hypertension. So if during the exam and the review they find that you have cardiomyopathy or changes in the heart muscle because of the hypertension, they are prompted to go on to the next DBQ and sometimes the rater has to request it again or they have to go ahead and request it be done ahead of time. So that's important for the examiner to understand that they are prompted to do that and they should be doing that. So moving on to the medical history, moving on to the medical history, I like to emphasize in the medical history that it's not just the current symptoms that block for medical history. Just like any other DBQ is meant to include the onset and the course of the hypertension. So you want to talk about. You know the veteran was diagnosed in the 90s. He initially started on lisinopril low dose and after about 10-15 years it got worse and the blood pressure was uncontrolled and added those additional medications. A lot of times when I do these DBQs for veterans they really want to focus on in the now. Well, I'm trying to match the rating schedule and this is what I'm having now. But that history behind the medical condition kind of helps us to understand the course and how things have progressed to that point. And there's some factors in medical conditions that can cue us in to other conditions and diseases. So it's important to talk about the onset and the course of the hypertension or the disease, not just the current symptoms. Moving on to the next question is does the veteran's treatment plan include taking continuous medication for hypertension or ISH? In this box the veterans like for all their medications to be listed. The provider really needs to focus on just what is there for the hypertension. We're just trying to emphasize the severity of the hypertensive condition. We're not putting things in there for diabetes or for the neuropathy or their back condition. We're focusing on the hypertension.

Bethanie Spangenberg: 24:03

And then this is where it kind of gets in the messy section. So a lot of times. So let me just read the question. So 2C was the veteran's initial diagnosis of hypertension or isolated systolic hypertension confirmed by blood pressure readings taken two or more times on at least three different days. So this can be.

Bethanie Spangenberg: 24:27

If this is a new onset hypertension condition and the diagnosis or the diagnosis was made within the last let's say, five years and the data is available, the medical records are available to reference, the examiner can fill this out and move on and they don't have to do a face-to-face exam. In my experience that is not the case. So in my experience we're looking at something that was diagnosed and we don't have those initial diagnostic records to show the blood pressure readings. So then we move on to D.

Bethanie Spangenberg: 25:06

Does the veteran have a history of diastolic blood pressure elevation, predominantly 100 or more? Most of the time we're not seeing that diastolic blood pressure elevation of 100 or more, and I say that because in the clinic if an individual's blood pressure is that high then we're seeing alerts go off into CPRS or the computer system that says we have to get this blood pressure down and in fact that provider's performance can be affected and it can make that provider's performance look bad if that individual patient has a blood pressure that is uncontrolled. So that again is not helping the veteran to capture the severity of their condition because their provider is going to be riding their tail the whole time to get their blood pressure down.

Ray Cobb: 26:05

Bethany, I have a question Go for it, if you don't mind here, when you're talking about those three days and getting the blood pressure down, I've had high blood pressure basically probably within a year or two years after I left the military. So back then I was started on medication for it, probably within a year or two years after I left the military. So back then I started on medication for it and been on medication probably 50 years. And I do not recall any time in the 20 years that I've been in the VA system that I've ever had a blood pressure reading without having previously that morning taken my medication. Now I know if I don't take the medication once or twice, you know, somehow or for whatever reason didn't my blood pressure goes right back up and it's high again. How would that affect the outcome of a claim?

Bethanie Spangenberg: 27:05

So there's a few ways to capture those numbers. Are you under the like, a blood pressure monitor where it sends the data to the VA every morning? No, so I find that of value if that's what you're trying to capture, because that is data that goes from your device directly to the VA and to the VA system. So if you are capturing that data and that data is getting directly transmitted, you can use that data to support the higher rating disability. Okay, does that make?

Ray Cobb: 27:48

sense it does, yeah, it does a lot, because a lot of times when I wake up in the morning and I first sit up, I'm kind of dizzy. That's one of the first things I do is actually, I have a little thing I put on my finger to check my oxygen level and then I also check my blood pressure, and of course that's prior to taking any medication and including my insulin and it is, you know, elevated and the way I look at it or the way I kind of go with it, as long as my oxygen level is, I think. The other morning I checked it and my blood pressure was high but my oxygen level was 97. So I didn't worry too much about it and proceeded and took my medication and moved on.

Bethanie Spangenberg: 28:37

So anyway, and that is one thing I do recommend for veterans to support their hypertension claim is because otherwise you're taking these subjective readings or these readings that you're putting into your log and now the VA has to quote, unquote, to validate what you're saying is to use that blood pressure monitoring system and have the data sent directly from your monitor to the VA, because there's no way for you to manipulate those readings. That's the machine sending those readings directly to the VA for them to review. So I think that is. I recommend that because it provides support to what you're saying.

Bethanie Spangenberg: 29:31

And if we use your case and we're looking at question 2C, you're the perfect example where we're not going to have those original records that show those blood pressure readings. You're coming to us let's say I'm doing the DBQ. Now you're coming to me 50 years of high blood pressure. There's no way I'm going to find those records. So what I'm going to do is I'm going to fill out Section 2E, which is a face-to-face exam, and I'm going to capture three blood pressure readings while you're in front of me Now. Does that mean that the VA is going to rate you off of that? Probably, if you take your blood pressure medication and you're having a good day. They're probably going to try to use those readings. But if you show that in your reading log, in your blood pressure reading log, that you're running those higher numbers, you provide that as evidence to show that you're entitled to a higher rating. Sometimes it's an argument.

Bethanie Spangenberg: 30:35

Okay, does that make sense? Yeah, it does.

J Basser: 30:38

You know, just as a point of note. You know, ray and I are in the hills of Tennessee A lot of places like where I live. We don't have good Internet service. Now the VA did set up the blood pressure monitoring system but it didn't work very well because of my internet connection. So what that translates to is if you don't have good internet connection it could cost your hypertension rating, and I know there's nothing we can do about it. But just to note that.

Bethanie Spangenberg: 31:25

That's a good point. I think you know, as silly as this may sound, but if that were me in that situation, then I would take a picture of me, my arm in that blood pressure cuff showing my blood pressure reading, because there's a lot of times that the VA doesn't believe the veteran in their testimony. So by capturing that picture you're now providing. So this is the evidence, this is what I have. You have to kind of figure a way to prove that you have these issues.

J Basser: 31:59

Yeah. Now the question is is that really your arm in the picture?

Ray Cobb: 32:04

Yeah, is that really your blood pressure reading?

Bethanie Spangenberg: 32:08

I know it can be wild.

J Basser: 32:12

You know, I have a friend. They x-rayed the shrapnel and they denied his claim. They said there's a piece of metal in your arm but you can't prove it's shrapnel.

Bethanie Spangenberg: 32:27

I think we've all been doing this long enough. We have all kinds of stories. I think the worst one to this day that I've ever seen is where the Raider copied and pasted the stress test results Because the stress test didn't show any abnormalities. From here they stopped the stress test because the man was having a heart attack and they transferred him from the va to the local hospital and he had a stint that same within like 24 hours of getting transferred over. So they denied him saying that his heart was normal.

J Basser: 33:05

You know there should be accountability for that writer.

Bethanie Spangenberg: 33:12

You would think but that's another story isn't it. I was going to say there was a time that I got a call from the regional office director which I don't want to tell that story right now.

J Basser: 33:29

Mm-hmm. No, it was Rod. Well, we know you'd have to shoot all of us if you did tell us they would just promote them anyway and move them on up. They don't get rid of nobody, they just promote them and move them on to the east side and do something else. That's the only option they have. Guys, I tell you, I battled hypertension my entire life.

J Basser: 34:01

I had it in service, got diagnosed with it in the first year and they still don't have the claim because I couldn't find the records and that, of course now, after we got things situated, we're going to go back all the way to the day I got a service on them. We got a BBA appeal right now on 3.156C issue and we'll see. I mean, I've walked in the emergency room before. My blood pressure is 180 over 130.

Bethanie Spangenberg: 34:28

Oh, I don't want you in my clinic.

J Basser: 34:32

Mm-hmm, I'm serious, I mean, it's just those times Also depends on what medications you have to take too. If you take certain medications like type ofanidine for the back problems stuff that can cause your blood pressure to really drop. You know, that yeah, but it is what it is. You you know we have to keep going. If not, you know what else is there?

Bethanie Spangenberg: 35:08

So I'm going to go ahead and transition to the third and final page.

Ad: 35:12

Go ahead.

Bethanie Spangenberg: 35:15

So the next several sections in the DBQ are the same questions you'll see in a lot of the other DBQ, are the same questions you'll see in a lot of the other DBQs. So for this particular one they're talking about other pertinent physical findings, complications, conditions, signs, symptoms and scars. So they're asking about any other pertinent physical findings and other conditions, and so this is where the examiner should be reviewing the chart and including any abnormal labs. Like you can have protein in your urine if your blood pressure is affecting your kidneys, they should be putting that in that section. They should be putting any type of kidney disease or eye disease, stroke, heart conditions that they feel are related to the hypertension because that is an important or pertinent finding within the record. The next question is does the veteran have any scars? That is a standard question on all the DBQs and I'm not aware of any hypertension condition that has ever caused a scar. So that question for hypertension should probably always be no.

Bethanie Spangenberg: 36:28

The last section here is going to be the functional impact and the question is does a veteran's hypertension or isolated systolic hypertension impact his or her ability to work Normally? For hypertension, if it is controlled, the answer is no. If it is uncontrolled, it can affect employment and the one example I like to give that was pretty obvious is I had a DOT examination where for DOT certificates, you have to have your blood pressure under control and if you present to the clinic and your blood pressure is too high, I cannot certify you as a truck driver. So then they have to go see their primary care doctor. They're not allowed to drive with with a disqualification. They have to get their blood pressure under control and they have to come back. So that's the example that I like to give because it's pretty straightforward. But hypertension can also cause flare-ups of other diseases which then impact, you know, your employment. You know your employment.

Bethanie Spangenberg: 37:41

The last section is the examiner's certification and signature and this is just the provider's contact information. I always provide this information in there with how the VA should contact me if they have any questions. I've been doing this outside the VA since 2013. I have not gotten a single phone call to verify these. I would be happy to verify them. I always put my contact information in there and I welcome them to verify anything with my name on it. So, all in all, for this particular DBQ, the provider can do this as an ACE examination, or this would be a 10 to 15-minute face-to-face appointment.

J Basser: 38:30

I wouldn't have thought you could do that in 10 or 15 minutes, compiling the information and filling out the DBQ.

Bethanie Spangenberg: 38:41

Normally it's pretty straightforward as far as the evidence in hand, because it's tabbed, or when I do them, the veteran is normally like here's my other issues. And so it's pretty straightforward If the provider that's doing this knows your patient like. It's their personal treating provider 10 to 15 minutes, and it's mainly the blood pressure readings, so their medical assistant may do the blood pressure readings while the provider is doing the chart review.

J Basser: 39:10

Yeah, you know, usually you review the chart way before you see the patient anyways, so you kind of know what's going on before you even get to it. Especially if you're doing CMPs Right, A good provider will you get somebody that doesn't do that? Then that could throw something off the rails in a hurry. I've seen it so many times. They've already got their decision made when you walk in. You know, unless you're trying to get the caregiver acting in, that you already denied before the person comes and do your home assessment right. Yeah, Don't get us started.

Ray Cobb: 39:48

You get us rolling on that this week, man, yeah.

J Basser: 39:53

No, but that's what it is. I mean hypertension is deadly, guys. I mean it's a silent killer and you know people have had it all their life and didn't know it. You know a lot of people never went to the doctor. You know, next thing, you know their heart explodes and they fall over dead. Or the worst case scenario is say, for example, you've got hypertension, you've had it for a long time and you develop a AAA or aneurysm. Yeah.

J Basser: 40:23

That happens pretty regular. That's another deadly thing, because once one in blows you're dead if you're not in the hospital. So they can do a lot of different things.

Ad: 40:34

Yeah.

J Basser: 40:36

I got a phone call last week and they wanted to see me the next day for an ultrasound. I said for what she said we're checking for an aneurysm. I didn't have one, but I don't know what triggered that.

Bethanie Spangenberg: 40:53

So that was prompted by the VA, correct.

J Basser: 40:58

Yes.

Bethanie Spangenberg: 41:06

VA correct? Yes, so they have a. Which I like these for the VA is anyone who carries certain risk factors. There's a once-in-a-lifetime abdominal ultrasound screening to look for an aneurysm. So that's just a computer charting alert, kind of like those blood pressure alerts I told you they'll get. They'll get those too. That's the same area of the computer alerts is that abdominal ultrasound blood pressures, a1cs, things like that. So they try to get everybody under control, and pain is what I like to say.

J Basser: 41:40

You know, they explained to me once too. If your blood pressure's high, especially with diastolic, and say you fluctuate between high and go down a little bit low, go back up to high, back to low, if you've got any plaque in your arteries it acts like a squishy pump and it can break that plaque by those changes and cause you to have a stroke too. Yep.

Bethanie Spangenberg: 42:04

So if we take that GBQ and we cross everything over with what the rating schedule looks like, you're getting a 10% rating If that bottom number is 100 or more predominantly, or if that top number is 160 or more predominantly. And then it says a minimum evaluation for an individual with a history of diastolic pressure, predominantly 100 or more, who requires continuous medication for control, would also get a 10%. So you're still looking at that bottom number being 100 or more.

J Basser: 42:52

We don't want it. We don't want it to be 100 or more or 110 or more. No, because the higher.

Bethanie Spangenberg: 42:59

It is shorter you last when I look at these records and it talks about the history of diet, the history of diastolic pressure. That's where, when in that dbq they want the current numbers and I said that they'll probably rate you on those current numbers. But if you have that blood pressure log and you're showing that you're having that higher numbers, you can get that 10% rating. So that's why in the rating schedule it says with a history of. So that's when you can use those records and show hey, these numbers historically are higher than what they got on that DBQ.

Bethanie Spangenberg: 43:42

Now the question from the guy from West Virginia. Did I answer the question or can we? So I need to expand. Can you hear me?

J Basser: 43:59

Yes, oh, okay. No, it's not related to the DBQ, it's related to the heart. I'm going to try to pronounce these Okay. And then sinus tricardia. Okay, am I saying it clearly enough.

Bethanie Spangenberg: 44:29

Do you know what they are? I think it's sinus tricardia.

J Basser: 44:34

Yeah, yeah, that's it. And then the other one is valve regurgitation. The mitral valve regurgitation my question is is there something that I can claim or VA claim for?

Bethanie Spangenberg: 44:52

Normally those are going to be something that's secondary to something else. That's normally not something that's like a direct service connection or a presumptive service connection, because what that indicates is there's something else going on that's affecting the heart and the heart function. So there's something with the heart that's causing the mitral valve regurgitation and there's something with the heart that's causing the sinus tachycardia. So I would suspect that there's some underlying issue here. Are they doing any further workup for you?

J Basser: 45:25

No, I've just been diagnosed with that and that's it. Now I do have high blood pressure, Would that cause either one of those.

Bethanie Spangenberg: 45:40

So I would have to see the actual like testing results to see. But up front, no, that's not something that's going to. That's not the most obvious cause. I would just I would be asking your primary care or whoever did that. I'm assuming it's an echo correct, like an ultrasound of the heart.

J Basser: 46:02

Yeah, I've had multiple ones over the years. I've been diagnosed with these two things for a number of years and I've had stress tests, I've had the echoes and yeah, they just tell me, tell me that I have it. They. I'm on the three blood medicines. One of them made me for one of those conditions, I'm not sure, but they got me on three blood pressure medicines but I don't know if any of them is for those particular things or not.

Bethanie Spangenberg: 46:35

Like the mitral valve regurgitation, they're going to put you on some medication that ends in like a lull. So like a tenolol metoprol or something like that.

Bethanie Spangenberg: 46:46

So that's going to actually help the muscles to squeeze better and work more efficiently. So it definitely sounds like they're treating it with the medications. I would ask questions because obviously if your stress test is normal then you're not having like blood vessel issues. I would ask your provider they know you the best what do you think has caused the mitral valve regurgitation? What do you think has caused the tachycardia issue, Because normally those aren't like primary diseases. Does that help?

J Basser: 47:19

Yeah, thank you. Anybody that's got heart disease, service-needed for lung disease. Say that again. What's that? Anybody that's got heart disease also service-needed for lung disease, restricted lung disease or interstitial lung disease or you know lung disease restricted lung disease or interstitial lung disease or lung disease, COPD, asthma You've talked about this before.

J Basser: 47:47

Yes, I have Nothing there for me. Okay, I do have spots on my lungs, but they seem to be stable. Spots on my lungs, but they seem to be stable. I get a CAT scan or MRI every year or two and they've been stable. Okay, Well, I guess you can send me information, Let her look at it and see if you can figure it out. She's pretty good at that stuff, you know she likes to fish and catch stuff all the time. Well, I'm thinking about doing that because I have a number of different issues that you know could or could not be related to those issues. And obviously I don't know, because I'm not a doctor, but I'm not due. I see a heart specialist for those two issues or a heart doctor, but I'm not due. I see a heart specialist for those two issues or heart doctor and I'm not due to go back to him for a while. So you think I should make an appointment with him and flat out ask him what caused those two issues, or just wait for my normal appointment or what.

Bethanie Spangenberg: 48:57

I would go ahead and prompt the appointment and just say that you have questions about the medications that you're taking for your heart, because that may also help you to understand what's going on, like why am I taking these particular medications? And he may be able to explain the process with what he's trying to treat or what he's trying to target. And then I would ask specifically about the regurgitation and the tachycardia and what he feels he's going to be. Of all the people, he's going to be the one that's going to have the best answer.

Ray Cobb: 49:34

Okay, let me throw something in here if you don't mind In doing that.

Ray Cobb: 49:40

I have found in our area, especially here in the LHC York, if I do it through secure messaging, through the VA, through email, they're required to have to respond back to me within 48 hours. I did that earlier this week concerning a heart condition and I got a response back in 24 hours and it said we'll get back with you as soon as possible. The next morning I had the answer and to come to find out. By the way they responded to me they actually had to do some research as well on a particular type of medication I was wanting to consider taking and I have found that secure messaging is a lot faster to get an answer rather than trying to schedule an appointment because they claim they're so busy you can't get that appointment for three or four months. So, secure message they're required to respond to you within 48 hours. Plus, it's in your medical record. It has to go in your medical record.

J Basser: 50:52

Well, that is a good idea, because I deal with a civilian doctor on these issues civilian doctor on this issue these issues and he has a physician assistant that he works with, so I'm sure she would get a reply to me in a timely manner. So I think I'll go that route initially and I'll probably get an answer pretty quick.

Bethanie Spangenberg: 51:19

I like that.

J Basser: 51:21

That is a good route. Hey, keep in mind, guys, anytime you're dealing with a heart, you've got two different types of doctors the guy that does your actual heart test and looking at your butt, you know, looking inside your body they call them plumbers. They're cardiologists, but they're plumbers. And then when you go sit in front of a doctor with arrhythmias and tachycardia and things like that, you usually see a different type of doctor. It's called an EP doctor, electrophysiologist. They're the electricians they call them. So keep that in mind.

J Basser: 51:49

Bethany is there a certain amount of regurgitation acceptable.

Bethanie Spangenberg: 51:55

They usually grade them on the severity like mild, moderate, severe, usually mild. As long as it doesn't cause issues downstream, then they're not going to do anything with it as it progresses. If it causes further muscle issues or vascular issues, then they may address it.

J Basser: 52:16

Is there a such thing as no regurgitation at all?

Bethanie Spangenberg: 52:21

Yes, that would be a normal heart function.

J Basser: 52:24

Okay, but don't worry guys. I've never had a faucet that didn't leak. They can fix those valves pretty easy now. I've known several folks that have done it. Hey, bethany, yes, the sinus cloud, whatever that word is hey bethany.

Ray Cobb: 52:39

Yes, the sinus uh cloud.

J Basser: 52:44

Whatever that word is, I can't say is that a fast heartbeat or heart rate?

Bethanie Spangenberg: 52:52

yes, and they call it sinus because the the normal rhythm is a sinus rhythm. So you're in a normal electrical rhythm. It's just a little too fast. Okay.

J Basser: 53:09

And I think they got me on, you know my standard heart rhythm reading is 92 to 95. I have a defibrillator pacemaker but I understand it doesn't regulate the higher range, just the low.

Bethanie Spangenberg: 53:27

Correct.

J Basser: 53:33

Well then I'll do that. I'll get with the doctor and then wait for their reply, and then I may contact your organization to go further, Is that?

Bethanie Spangenberg: 53:43

something you often handle. Yeah, we can take a look at it and in fact I'll take a look at it specifically at no cost to you. So if you call in to our office, you let our office staff know that you were on the Exposed to Vet podcast and that we talked about it. Okay, okay.

J Basser: 54:02

I actually went through you years ago.

Bethanie Spangenberg: 54:06

I was going to say don't tell me your name because I don't want to hit the violation right now.

Ray Cobb: 54:12

No, I'm not going to tell you my name, okay.

J Basser: 54:16

I have used you in the past, so I'm confident on your all's capability.

Bethanie Spangenberg: 54:23

Well good, I appreciate hearing that. I'm always striving for the best, so if there's anything that we need to do better, make sure you let me know too.

J Basser: 54:35

We'll just call in Pedro McGillicuddy. Well, caller. The only problem I see with a fast heartbeat is going to sleep. It's like running down the road and jumping in bed right quick and expecting to go to sleep right away. You just can't do it. Your heart's going too fast. My normal heartbeat was 56, and now I'm at 92 to 95. It makes sleep difficult.

Ad: 55:10

Hey, let me give you some advice Everybody.

J Basser: 55:13

Let's give you some advice Now. I wasn't a believer in this until about three years ago. I think Bethany can attest to this. It costs a little bit of money, but I would go buy the newest series Apple Watch and I would get an iPhone and I'd pair that Apple Watch with the iPhone. I'd use the Health app and that Apple Watch will actually take readings of your O2 sats and your heart rate and it'll make a running total and it'll go back as long as you want to keep it back, for years and you can go to the date and look at the days and see what your heart rate was.

J Basser: 55:49

Yeah, well, my defibrillator records that yeah.

Bethanie Spangenberg: 55:54

You don't have to buy a new one. I buy a used one, specifically for heart rate and it monitors the rhythm, in case your rhythm goes out.

J Basser: 56:05

You know if you charge more for DBQs, you could get a new one.

Bethanie Spangenberg: 56:19

Not that you'd want to do that. I think what. I'm hearing is I need to charge more for the DBQs. Is that what I heard? I need to increase my license.

J Basser: 56:30

Just enough to get a new iPhone. Thanks, james. James don't like the high-cost and ignitable stuff anyways. Now he's in bags and passengers to raise their prices. Cost of the medical stuff anyways, and now he's not amazing, and that's the reason to raise your prices.

Ray Cobb: 56:45

Does any of those apps take your blood?

J Basser: 56:46

pressure. No they don't no, but it does do an EKG. It'll catch AFib too.

Bethanie Spangenberg: 57:09

Yeah, and how reliable do you think that information is, bethany? You think they're pretty accurate years, specifically for my blood sugar, so I can look down on my watch and see where I'm at any time of the day.

J Basser: 57:21

So it's the heart rate I have one that does the temperature, does your blood oxygen, the EKG, the heart rhythm, and it's been pretty accurate and that one's on the, not your blood sugar, but the other one is that on a watch on your wrist that it takes the radiation from. Apple.

Bethanie Spangenberg: 57:43

Watch Series 6 or higher. Okay, so before we get um I know we're going towards the end of the show, john, I want to just mention um. I am going to update our blog with the hypertension stuff from like the rating schedule and the 38 cfr I always like to keep that up there and some of that clinical information. And then we're hoping to be expand to be a resource not only for veterans but for the providers too. We're trying to open up private providers being able to do more for the veteran and when it comes to like the DBQs and stuff that we're trying to really focus on not only being, you know, in the past we've been a resource for veterans and attorneys. Now we're trying to focus this year on being a resource for medical providers, because there's not enough out there with proper training and understanding to do the DBQs competently. So, as dry as tonight was for the DBQ stuff, I want to continue the series in discussing DBQs.

J Basser: 58:45

Beth to get some contact information. Say folks, when you get a hold of your.

Bethanie Spangenberg: 58:51

Our website is valor4vetcom and our call, our phone number is 888-448-1011.

J Basser: 59:02

Hey, john real quick.

Ad: 59:04

Yeah.

Ray Cobb: 59:05

Hey Bethany when are you going to be on next?

J Basser: 59:09

and what is going to be your next DBQ that you go over, if you know?

Bethanie Spangenberg: 59:14

that yet. I think we're going to do. My understanding is it's going to be the first Thursday of every month. I believe I had this conversation with John First Thursday of every month and I don't remember what the next BBQ is, but I'll post it on our website.

J Basser: 59:29

On your website.

Bethanie Spangenberg: 59:31

Yes on the homepage. We post our like when we are on the show.

J Basser: 59:39

Okay, all right. Thank you all very much. Thank you, okay, all right. Thank you all very much, thank you. All right guys, we've got 20 seconds left. Bethany, thanks for coming on. As usual, you always give us good information. Bray, thanks for co-hosting and helping out.

Ad: 59:51

And James thanks for talking to me.

J Basser: 59:53

buddy, appreciate you. This is John. This is Jay Besser. John Stacey, on behalf of the Exposed Vet Podcast. We'll be signing off for now. You have been listening to the Exposed Vet Podcast. Any opinions expressed on the show are the opinions of the guest speakers and not necessarily the opinions of Exposed Vet, exposedvetcom or Blog Talk Radio. Tune in next week for another episode of the Exposed Vet Podcast.

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