C And P Exam

[Donna]

Will a Vet that has documented DX of IHD over a period of 18 years and now has a ICD implant be called in for a C&P exam? The exam is to establish Mets and EF factor. The Vet would not have a defibrillator if his heart was in good shape. Just wanting to know how all this works?

[N4XV]

Will a Vet that has documented DX of IHD over a period of 18 years and now has a ICD implant be called in for a C&P exam? The exam is to establish Mets and EF factor. The Vet would not have a defibrillator if his heart was in good shape. Just wanting to know how all this works?

I think it would depend on the rater.

[dthurman]

I had to be called in even though I too have a difibulator, but they cancelled the tread mill once they saw I had it and they just did an echo on the heart. EF were 25% mets 4-5.

[Donna]

Lets see here,I am a nurse practicioner with the VA, I can't put him on a treadmill, I will do a chemical stress test to determine his Mets and EF factor. Whoa, the tests look good. Denied claim....uh oh, the man has a defibrillator implant because a cardiologist specialzing in the "electric" part of the heart determined he is in iminent danger of a cardiac arrest due to arrythmia caused by multiple MI and CAD, firm diagnosis of IHD. Oh well, Claim denied, after all we are the VA. (Our worst nightmare)

[Berta]

I dont feel his defibrillator would be contraindicated by a ECHO test-I am sure they have already done ECHOs on him prior to the implant anyhow.The ECHO would reveal the ejection fraction and significant other information.

I think you are as apprehensive as I am as to how VA will interpret the new IHD regs. I just mailed my IHD claim to the Buffalo VARO.

IHD is one of the conditions the VA malpracticed on before my husband died (due to ischemic heart disease).

Since it was malpracticed on the VA never diagnosed or rated his IHD nor mentioned it at all in any rating decision.

The evidence I sent in was the same as this specific part of my FTCA/1151 claim:

VA ER Certificate to rule out CAD (they never did)

2 VA EKGs that were abnormal -one says prior ischemia

AN ECHO with EJ 40% at 2 years prior to his death. Completely abnormal ECHO. VA Cardiologist who read ths report told me there was 'nothng wrong' with his heart.

VA OGC Peer Review Report (which VA said at time of FTCA claim, never existed) but I got it anyhow.

It confirms his IHD had been malpracticed on and that it caused his death.

2 IMOs that support evidence of IHD and also secondary CVAs.

Death certificate-ischemic heart disease as prime cause of death with ischemic cerebral vascular disease contributing.

My biggest concern is that VA will refuse to rate his IHD at all because it was malpracticed on and not diagnosed by VA in his lifetime .But I am prepared to fight that battle.

I figured I might as well get the claim filed now.This way they have plenty of time to lose my evidence before the final regs come out .And I will have time to replace it.

 Original Article

Visualization of implantable defibrillator patches by two-dimensional echocardiography

Veronica A. Covalesky, MD, Michael McAllister, RDMS, Krishnaswamy Chandrasekaran, MD, Daniel J. McCormick, DO, Dr. Gary S. Mintz, MD, Steven P. Kutalek, MD *

Cardiac Ultrasound and Electrophysiology Laboratories of the Likoff Cardiovascular Institute, Hahnemann University, Philadelphia, Pennsylvania

*Correspondence to Steven P. Kutalek, Hahnemann University Hospital, Broad and Vine Streets, Mail Stop 470, Philadelphia, PA 19102

Keywords

Abstract

Implantable cardioverter defibrillators are being used with increasing frequency for the management of life-threatening ventricular arrhythmias. In order to determine whether the titanium mesh of the defibrillator patch causes ultrasonographic acoustical interference, 30 patients underwent prospective serial echocardiographic examination. In addition, studies were reviewed to determine whether the defibrillator patches could be visualized with standard two-dimensional echocardiography. In no patient did the anterior patch produce acoustical interference, and, unless specific measures were utilized (such as a standoff pad, a zoom feature, or a 5-MHz transducer), the patches were rarely visualized. © 1993 John Wiley & Sons, Inc.

http://www3.interscience.wiley.com/journal/112205971/abstract?CRETRY=1&SRETRY=0.

[Donna]

Thank-you for your responses, you all are so helpful. My husband filed his claim in 2006 for IHD due to AO exposure and was denied for nsc. He was going to the VA clinic for health care way before that date, I think in 2004 during the time he was applying for SSDI and we were cash strapped and needed help with his heart meds. If the VA was aware of his heart condition and AICD before the actual claim was filed, will there be an earlier EED?

[Berta]

"My husband filed his claim in 2006 for IHD due to AO exposure and was denied for nsc."

That should trigger a retroactive payment under the Nehmer Court Order and Stipulation with an EED of the date of the denied claim as long as that claim can clearly be interpreted as an IHD claim.

Here is the VA's new training letter on IHD claims and how they are going to handle the Nehmer retroactive payments:

http://www.nvlsp.org/Information/ArticleLibrary/AgentOrange/NehmerTrainingGuide.pdf