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JRW

Ihd C&p Results Received

Question

Well, I have now received my results in from my very first C&P exam. Keep in mind, this is my first time to be dealing with the VA. I'm thinking that the results look okay and that this will lead to a decent rating. For all of you more knowledgeable ones out there, I would be glad to get your thoughts on it. I am taking heart, cholesterol, and hypertension medicine on a daily basis.

Please feel free to chime in. Below are excerpts taken from the report itself.

HISTORY OF PRESENTING PROBLEM: The veteran states he became aware of ischemic heart disease in 1979, and then he had a major event in July 2008 in which he had atrial fibrillation and underwent stress testing and it was discovered that he had a blockage that required bypass surgery in 2009. In addition to that, they discovered that his aortic valve was damaged, and he needed a valve replacement; that ocurred in 2009 at the same time.

He does not report a diagnosis of congestive heart failure, but has atrial fibrillation. He has dyspnea on exertion and does not report orthopnea. He does have reports of intermittent edema in his ankles that occurs every day in the afternoon. He does not report chest pain.

TYPE OF EXAMINATION: HEART

The veteran is claiming ischemic heart disease as service-connected.

ESTIMATED EXCERCISE TOLEARNCE: Less than or equal to 3 METS.

PHYSCIAL EXAMINATION VITAL SIGNS: Echocardiagram shows an ejection fraction of 52%. An exercise tolerance test is not being done, as it is contraindicated due to ST and T-wave abnormality. EKG shows sinus rhythm with 1st-degree AV block and ST and T-wave abnormality consistent with inferolateral ischemia.

DIAGNOSIS: Ischemic heart disease with myocardial infarction and aortic valve replacement.

COMMENT: The left ventricular ejection fraction is 52%, and the estimated METS is less than or equal to 3. The left ventricular ejection fraction most closely reflects cardiac function because there are non-cardiac factors witch limit the Veteran's exercise tolerance.

The overall exam did not take too long. The examiner seemed to be okay and did not refute any of the medical data. In fact, he seemed to be very impressed with the detail and organization of my private medical copy.

Any idea on what any of you think the rating might turn out to be?

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4 answers to this question

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This is the criteria they go by:

Evaluation criteria

• A 100-percent evaluation is warranted if a workload of three METs or less produces dyspnea, fatigue, angina, dizziness, or syncope. A workload of three METs represents such activities as level walking, driving, and very light calisthenics.  

 

• A 60-percent evaluation is warranted if a workload of greater than three METs but not greater than five METs results in cardiac symptoms. Activities that fall into this range include walking two and a half miles per hour, social dancing, light carpentry, etc.  

 

• A 30-percent evaluation is warranted if a workload of greater than five METs but not greater than seven METs produces symptoms. Activities that fall into this range include slow stair climbing, gardening, shoveling light earth, skating, bicycling at a speed of nine to ten miles per hour, carpentry, and swimming.  

 

• A 10-percent evaluation is included for some conditions, which is warranted if symptoms develop at a workload of greater than 7 METs but not greater than 10 METs. Activities that fall into this range include jogging, playing basketball, digging ditches, and sawing hardwood. When symptoms develop only during such activities, there may be some impairment of earning capacity, but it is likely to be slight. The alternative of the need for continuous medication warrants a 10-percent evaluation for some conditions.

Even if the requirement for a 10% (based on the need for continuous medication) or 30% (based on the presence of cardiac hypertrophy or dilatation) evaluation is met, METs testing is required in all cases except:

(1) When there is a medical contraindication.

(2) When the left ventricular ejection fraction has been measured and is 50% or less.

 

(3) When chronic congestive heart failure is present or there has been more than one episode of congestive heart failure within the past year.

(4) When a 100% evaluation can be assigned on another basis.

 

METs are measured by means of a treadmill exercise test, which is the most widely used test for diagnosing coronary artery disease and for assessing the ability of the coronary circulation to deliver oxygen according to the metabolic needs of the myocardium (Cecil, 175 and Harrison, 966). 

Alternatives to the METs

 Administering a treadmill exercise test may not be feasible in some instances, however, because of a medical contraindication, such as unstable angina with pain at rest, advanced atrioventricular block, or uncontrolled hypertension. In those instances, objective alternative evaluation criteria were provided, such as cardiac hypertrophy or dilatation, decreased left ventricular ejection fraction, and congestive heart failure, for use in those cases. When a treadmill test cannot be done for medical reasons, the examiner's estimation of the level of activity, expressed in METs and supported by examples of specific activities, such as slow stair climbing or shoveling snow that results in dyspnea, fatigue, angina, dizziness, or syncope, is acceptable. 

 

 The other objective criteria as alternatives to the METs are:

 

• A 100-percent evaluation is warranted for a left ventricular ejection fraction of less than 30 percent or chronic congestive heart failure.

 

• A 60-percent evaluation is warranted for a left ventricular ejection fraction of 30 to 50 percent, or more than one episode of acute congestive heart failure in the past year.

 

• A 30-percent evaluation is warranted for evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray.  

 

• A 10-percent evaluation is included for some conditions, and a requirement for continuous medication. 

 

 Note that the Court has held in Otero-Castro v. Principi that Diagnostic codes 7005 and 7007 do not require a separate showing of left-ventricular dysfunction in addition to an ejection fraction of 30 through 50% in order to qualify for a 60% rating.

 

 If left ventricular ejection fraction (LVEF) testing is not of record, evaluate based on the other criteria unless the examiner states that the LVEF test is needed in a particular case because the available medical information does not sufficiently reflect the severity of the veteran's cardiovascular disability.

 

 Whether or not cardiac hypertrophy or dilatation (documented by electrocardiogram, echocardiogram, or X-ray) is present and whether or not there is a need for continuous medication must be ascertained in all cases.

 

 Conditions rated on criteria other than METS

 

 Hyperthyroid heart disease (DC 7008) is usually rated based on hyperthyroidism (DC 7900) or as supraventricular arrhythmias (DC 7010), whichever results in a higher evaluation.

 

 Arrhythmias (Supraventricular (DC 7010) and ventricular (DC 7011) which are rated based on the number of episodes per year or whether there is permanent atrial fibrillation. Ordinarily, supraventricular arrhythmias (7010) are milder with evaluations of 10 or 30 percent, as distinguished from the more potentially disabling ventricular arrhythmias (7011), with a range of evaluation from 10 to 100 percent.

 

 Implantable cardiac pacemaker (DC 7018) is rated for arrhythmias (7010 or 7011) or heart block (7015).

 

 Total Impairment Criteria

 

 A 100-percent evaluation requires chronic congestive heart failure or that a workload of three METs or less produces dyspnea, fatigue, angina, dizziness, or syncope. A workload of three METs includes such activities as level walking, driving, and very light calisthenics. While the development of cardiac symptoms at this level of activities indicates total impairment, it does not suggest that the patient is either housebound or helpless.

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N4XV's post here in April shows their IHD rating criteria.

Also the NVLSP training letter is here somewhere too-

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did you ever get a rating on this. i have a leaky aortic valve and have had my claim in since oct 09

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did you ever get a rating on this. i have a leaky aortic valve and have had my claim in since oct 09

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