hypertension Hypertension Leading To Cad And Cabg

[saturneptune]

With a 10% rating for hypertension, how hard is it to make a connection to CAD? Also I have had a six way bypass operation. They scheduled a C and P exam two weeks after the operation then cancelled it, but are still working on the new claim. Has anyone else had this happen?

[saturneptune]

My case is now in the rating section. If I knew how, I would post my C and P exam for comment, but cannot figure out how to post scanned images.

[saturneptune]

Here are some comments from the C and P exam. This is a 57 year old white male who appears for a C and P exam regarding his heart. The veteran is service connected for hypertension at 10% since 2002. He is claiming ischemic heart disease as secondary to hypertension. The veteran was in the Navy from February 71 to Nov 82, not in Vietnam.

Medical History. The patient was alright until December 2005, then he started noticing chest pain on exertion and shortness of breath with easy fatigueability. He also became dizzy with moderate exercise. He went to local emergency rooms twice and twice had a treadmill stress test with negative results. This continued until October 2009, when the symptoms got so bad he retired from his federal job. (not disability, regular retirement)

Soon after, November 2009, he had a severe episode of chest pain and he saw a primary doctor who sent him to a cardiologist. On Dec 28, he did a nuclear stress test which showed an old MI and 41% ejection fraction. This lead to a catherization Jan 11, 2010. Six blockages were found, and on Jan 12, 2010, he underwent open heart surgery and six grafts were done. In his catherization the EF was 75%.

He started rehab in March and is currently doing it. At 3.2 miles per hour on the treadmill, he can go up to 15 minutes before fatigue and shortness of breath stop him. This was estimated at 4.8 METS. He says he can climb two floors of stairs or walk moderately one mile before fatigue and shortness of breath.

He worked as an electronics tech and mechanic at the Post Office and has also worked as a substitute teacher, but generally, he was a full time employee on a midnight shift for 27 years. He continues to apply for varioius jobs, but when the perspective employers hear about his heart condition he gets rejected. He cannot do much heavy lifting such as carrying boxes to the attic. By his own admission, depression is part of his problem, but fortunately, it is mild and transient. He continues to have pain around the incision.

He smoked lightly, for 15 years, about a pack a week, and quit 20 years ago. He does not drink. Current medications are Pravastatin, Metoprolol, Levothyroxine, Nicain, Pramipexole, Hydrocodone, lisinorpil, and Plavix.

He has no objective signs of heart failure (congestive). He has hypothyroidism, but his cprs or records from outside do not mention any cardiac arrhtymias. Exam of the heart and cardiovascular system shows a sternotomy scar which is well healed. The first and second sounds are normal. There is no gallup or murmur. Breath sounds are normal.

Diagnosis

1. Ischemic heart disease status post open heart surgery and six bypasses.

2. Hypertension, which appears to be under good control, and service connected.

Discussion:

Hypertension is a well know ristk factor for ischemic heart disease. The patient has been known to have hypertenison for many years, ever since he was in the Navy. Other risk factors are diabetes, smoking, and high cholesterol. The patient is not diabetic. He has done some smoking, but only sparingly. He has hypercholesterolemia, and he is moderately obese (thanks a lot). One of his diagnosis is hypothyroidism and his is on a maintenance dose of synthroid. Hypothyroidism is also known to contribute to IHD. The patient is quite symptomatic by the way of shortness of breath, dyspnea on exertion, and a sense of fatigability.

The cardiac cath done just before the surgery showed an EF of 75%, suggesting that the left ventricular contractility was quite normal. This study ir fairly recent and there is no reason to believe that any significant impairment has occurred with the functioning of the heart. He continues to have some easy fatigueability and shortness of breath, but no palpitations.

OPINION: The veteran's ischemic heart disease is at least as likely as not caused by or related to his service connected hypertension.

Any comments appreciated.

[saturneptune]

bump

[Pete53]

You need a Doc to opine that your current condition is due to your service.

[saturneptune]

You need a Doc to opine that your current condition is due to your service.

Pete, thanks for your response. I am going to get a civilian doctor to say its connected to the service connected hypertension. Does the VA Dr. saying it is at least likely as not connected to the service connected hypertension help or hurt?

[Lorraine]

We've corresponded previously so you know that my husband and I are very new to this journey through a VA claim process, so, I can't comment as to the outcome of your rating for disability. But, I'm just thrilled for you to read that after your heart attack that your your EF was 75% during the recent angiogram. I know you've been kind of in the "dumpers" after your CABG surgery, but this is really good news for your cardiac health. The 75% EF might not be so great for your disability rating, but it's wonderful for your prognosis. Hope you are feeling better every day. Just know that if things DO worsen, you can re-open your claim with supporting evidence of your cardiac status worsening. Best of luck to you.

Lorraine