(cell phone 240-506-1556)

To: All veterans

Date: 2015

From:

Topic: PTSD and STROKE

A Brain bleed complication

Craig N. Bash, M.D.

Independent Veteran Medical Opinion (IMO)

Neuro-Radiologist
www.veteransmedadvisor.com

Veteran Medical Nexus Opinion (VMNO)

for Veteran benefits

Pages: 2

NPI or UPIN-1225123318- lic #--D43471

4938 Hampden lane, Bethesda, MD 20814
Phone: (301) 767-9525 Fax: (301) 365-2589
E-Mail: drbash@doctor.com

PTSD and a Brain Bleed Complication

I usually do not do primary psychiatric illness PTSD type diagnoses except for those that have imaging
defined structural abnormalities, but I do help patients obtain dual reports between myself and my
local psychologist so that the full spectrum of VA diseases is covered in a one stop way.
However, his week, I had a patient with a major life threatening complication of his PTSD, namely,
hypertension (HTN) with right hemisphere cerebro-vascular accident (stroke)/left hemi-paresis (AKA
brain bleed with paralysis). The patient had long-standing PTSD since the 1960s and associated HTN.
PTSD is associated with cardiovascular disease as is documented below:
Open Cardiovasc Med J. 2011; 5: 164170.
Published online Jul 11, 2011. doi: 10.2174/1874192401105010164
PMCID: PMC3141329
Post-traumatic Stress Disorder and Cardiovascular Disease
Steven S Coughlin*
Author information Article notes Copyright and License information
This article has been cited by other articles in PMC.
Abstract

This review provides an up-to-date summary of the evidence from clinical and epidemiologic studies
indicating that persons with post-traumatic stress disorder (PTSD) may have an increased risk of
coronary heart disease and possibly thromboembolic stroke. Persons with PTSD, a common anxiety
disorder in both veteran and nonveteran populations, have been reported to have an increased risk of
hypertension, hyperlipidemia, obesity, and cardiovascular disease. Increased activity of the
sympathoadrenal axis may contribute to cardiovascular disease through the effects of catecholamines on
the heart, vasculature, and platelet function. Reported links between PTSD and hypertension and other
cardiovascular risk factors may partly account for reported associations between PTSD and heart
disease. The associations observed between PTSD and cardiovascular diseases have implications for
cardiology practice and research.
The patients blood pressure was in the 180-110 ranges for years. All patients should strive for a blood
pressure in the 120/80 range as this patients HTN induced stroke was so devastating that he was left
with residuals that are severe enough that he qualifies for maximum SMC at the R-2 level of benefits
(with auto and house grant) due to total loss of use of his legs with bowel/bladder incontinence .
Recommendations:
1. Any patient with PTSD should make sure that they monitor their blood pressures carefully over time.
2. Secondary complications of PTSD should be applied for as they are service-connectable.
3. Please remember the VA had adopted a new policy of NO COMPLETED FORM = NO BENEFITS thus
please use the VA forms for all claims or you will loose benefits.
4. Some useful forms are:

VA Form 21526 Veterans

Application for Compensation and/or Pension
VA Form 210966, Intent to File
a Claim for Compensation and/or
Pension Benefits, (hereinafter VAF 21
0966)
VA Forms 21526EZ, 21527EZ,
and 21534EZ (hereinafter EZ forms)
5. These e-sites are useful to compete the forms above online:

eBenefits and The Stakeholder Enterprise Portal

Craig Bash M.D. Associate Professor drbash@doctor.com cell 240-506-1556
Independent Veteran Medical Opinion (IMO)
Veteran Medical Nexus Opinion (VMNO)
based on Veterans medical records for veteran benefits