Veterans Medical Advisor

Sample Letter Disagreeing with the VA’s Medical Opinion

Home

Why Use VMA

About Dr. Bash

Dr. Bash is a proud member of

and a veteran of the

Sample letter Page 2

I disagree with the assesment of Dr Smith above when he states “…History of bronchiectasis, however recent CT scan does not show evidence of bronchiectasis…”

because it is based on the inaccurate 29 Feb 1996 CT scan report provided by DR. Brown. I have reviewed these CT images and it is my opinion that this patient does have Bronchiectasis with thick walled, nontapering bronchi (Ref: Radiologic Clinics of North America, page 1041) and he has likely had it since his multiple in-service antibiotic treated pneumonias, fevers, chills, bronchitis and bronchiectasis all of which occurred in 1952 for the following reasons:

The patient had at least two serious antibiotic requiring pneumonias in-service and “…patients often report frequent bouts of bronchitis requiring therapy with repeated courses of antibiotics…” Ref: Cecils page 406 and “…a number of pulmonary infections have been associated with the development of bronchiectasis…” Ref: Cecils page 405

The patient was diagnosed with bronchiectasis in-service and by definition: “…Bronchiectasis, which is an acquired disorder of the major bronchi and bronchioles, is characterized by permanent abnormal dilation and destruction of bronchial walls….” Ref: Cecils page 405.

The patient’s cigarette smoking likely did not cause his bronchiectasis because “ …A causal role for cigarette smoking in bronchiectasis has not been shown…” Ref: Cecil’s page 406.

The patient’s CT scan of 1996 was miss-read. That CT scan shows thick walled, dilated irregular bronchi consistent with cylindrical bronchiectasis.

The patient has had repeated lung infections with sputum production and “…Acute bacterial infections [in bronchiectasis patients] are usually heralded by increased sputum production with enhanced viscosity…” Ref: Cecils page 407

The patient has an obstructive pulmonary function test pattern, which is consistent with Bronchiectasis (Ref: Cecils page 406).

It is also my opinion that this patient’s multiple post service lung infections, as documented by Dr. Smith (above), are all likely secondary lung infections caused by his bronchiectasis because these infections are known to occur in patients with bronchiectatic lungs as “…infection plays a major role in causing and perpetuating bronchiectasis…” and “…bronchiectasis…often leads to pneumonitis that may temporary or permanently damage the lung parenchyma…Ref: Cecils pages 405 and 406.

If I can be of further assistance please call me at 301-767-9525.

Sincerely,

Craig N. Bash M.D.

Associate Professor of Radiology and Nuclear Medicine

Uniformed Services University of the Health Sciences

References:

Cecil’s Textbook of Medicine 2001.

Radiologic Clinics of North America, Imaging of Diffuse Lung Diseases, Sept 1991.

Dr. Bash usually does not evaluate psychiatric conditions, vaccine reactions or injury, or certain skin disorders related to chemical exposure; however, he can refer the veteran to a specialist who can help.

Dr. Bash works with these Veteran Service Organizations (VSO) among others.