17-25 802
17-25 802
| Board of Vet. App. | Sep 27, 2017Background
- Veteran served Aug 1950–Jun 1954 and appealed a December 2016 VA rating decision denying 38 U.S.C. § 1151 compensation for a transient ischemic attack (TIA).
- Veteran alleged VA's hypertension treatment (antihypertensive medication) caused low blood pressure and precipitated the TIA.
- Medical record: diabetes diagnosis (May 2004) treated with metformin; long-term antihypertensive therapy with generally controlled blood pressures in VA records.
- April–May 2016 notes: VA neurologist reduced BP meds for hypotension/dizziness and documented possible nonadherence/overdosing; private urgent care noted reports of “mini-strokes” and belief BP meds were the problem.
- December 2016 VA DBQ: reviewed 14 years of BP readings, concluded it is less likely than not that VA treatment caused or worsened the TIA, citing patient nonadherence and underlying HTN/DM risks.
- Board found VA satisfied notice and duty-to-assist obligations, adopted the DBQ as adequate and persuasive, and denied § 1151 compensation because proximate causation and VA fault were not shown.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether TIA is compensable under 38 U.S.C. § 1151 as proximately caused or aggravated by VA treatment | VA-prescribed BP meds caused hypotension leading to TIA; VA at fault for continuing medication | Medical evidence shows controlled BP, diabetes and HTN are underlying stroke/TIA risks, and DBQ finds less likely than not that VA treatment caused TIA | Denied — preponderance of evidence: TIA not proximately caused or aggravated by VA treatment; no VA fault shown |
| Whether VA failed to exercise reasonable care or lacked informed consent when prescribing antihypertensives | VA negligently continued meds despite risk | DBQ and records show appropriate management, BP control, and no foreseeability that treatment would directly cause TIA; no informed-consent issue raised | Denied — no evidence VA lacked reasonable care or failed informed consent |
| Adequacy of VA medical opinion and duty-to-assist compliance | Veteran contended DBQ development/location scheduling issue | VA provided DBQ, considered pertinent evidence, avoided conflict of interest, and complied with notice/assist duties | VA met duties; DBQ found adequate and persuasive |
| Applicability of benefit-of-the-doubt doctrine | Veteran argued uncertainty favors claimant | Board found preponderance against claim, so doctrine not applicable | Not applied — evidence weighs against claim |
Key Cases Cited
- Gilbert v. Derwinski, 1 Vet. App. 49 (establishes benefit-of-the-doubt rule in veterans claims)
- Pelegrini v. Principi, 18 Vet. App. 112 (notice requirements for VA claims)
- Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (notice and procedural protections in VA claims)
- Bernard v. Brown, 4 Vet. App. 384 (duty to assist standard on obtaining records)
- Barr v. Nicholson, 21 Vet. App. 303 (standards for adequacy of VA medical examinations and opinions)
- Soyini v. Derwinski, 1 Vet. App. 540 (development and prejudice standards)
- Sabonis v. Brown, 6 Vet. App. 426 (development and adjudication principles in VA claims)