(cell phone 240-506-1556)

To: All veterans

Date: 2015

From:

Topic: Kindey failure secocndary to HTN

Independent Veteran Medical Opinion (IMO)

Veteran Medical Nexus Opinion (VMNO)

for Veteran benefits

Craig N. Bash, M.D.

Neuro-Radiologist
www.veteransmedadvisor.com

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

Secondary issues have been touched on in separate Bash bulletins concerning medical
opinions but a classic secondary condition that is often overlooked as it is a silent killer anmely
Renal failure ( kidney failure)
The kidneys do several functionjs one of which is blood pressure regulation and due to the
co,ples series of tubules and small vessels conatned in the acuve fitration prosecc I nside the
kidneys the kidneys themslc=ves are bery sentive to blood prerssure swings. Thus they sort of
have asel prrsurvantion functions when they modualte blood pressure. High blood pressure
casues irre3veible renal d age.
As an examole, I did an IME for a 60 year old veteran a few years back that had HTN in service
and we got him service cooneted for CAD with STEMI and arrthtmias in his heart.
Then I ordered a 24 hour urine from a local hospital and found nephropathy. Despite multiple
IVPs and continuous hydrochlorothiazide Rx, and recommendation for renal follow-up on the
ETS physical, the VARO denied service his connection in 2011.
I then in 2012 I ordered a 24 hour urine to help the VA with clinically diagnosis. I told the VA
that the patient had nephropathy with nephrotic syndrome after ordering the 24-hour urinalysis
(protein 515, normal=100), and that he had chronic Kidney disease (CKD) with medications of
furosemide and valsartan which are both are for CKD.. He also wears compression socks for
peripheral edemas secondary to CKD. His GRFs have been as follows:
August 9, 2012 the GFR was 79.
April 11, 2013 the GFR was 76.

July 25, 2013 the GFR was 78.

October 10, 2014 the GFR was 82.
****According the National Kidney Foundation, GFR values from 89 to 60 represent Stage 2
chronic kidney disease (CKD), which is described as Kidney damage with mild loss of
kidney function (https://www.kidney.org/atoz/content/gfr).
This case illustrates the fact that kidneys are damaged bu high blood pressure. Moreover, is
also iiluatrates the the VA raters are not phsycians and thus can walk right by medcial records
that justify ratings for life theretening illnesses. Missing a ratig can kead to serious
conseqyences for the poatient because these pati8ent often do not know that they have
treateable dieaseases that are often uncovetred during a professional rait ng process by a
physician.l I can not cpount the numner of times I have either made the formeal diaosis of a
codtion or changed the doagaonis of a patients sympms which I turn casued the patient to alter
his/her treatments, seek an new physician, drop care by NPS or Pas and bebefit from the hgh
quality of care provided inside the va HEATLKTH CARE SYSTEMS DUE TO THE FACT THAQT
THEY HAVE A CORRECT DIAGNOSIS.
Recommendations:
1. Due to the high wide range of co-incidence the co-incidence rate between TBI and cervical
spine injuries most the physicians would be ware of this association and look for subtle cervical
spine injuries in returning sliders. Especially since many of the warriors have done several
tours of duty and have therefore been likely exposed to numerous blasts.
2. Likewise any patient with a TBI should be aware that they might also have a cervical spine
injury. Of course many TBI patient are often not able to advocate for themselves due to there
head injuries, thus the physician needs to have a high level of suspicion for any early spine
symptoms.
3. O course if new secondary conditions are found the veteran should send in a new claim of these
forms:
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)

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