hypertension Ihd -Va Definition And

[Berta]

With the hopeful resolve of most AO IHD claims in the next few months-I wanted to get this info posted here again.

And to remind all- if their claim comes under Nehmer and they have contacted NVLSP, I have posted the link here many times, please contact NVLSP again to let them know of the decision.

"According to Harrison's Principles of Internal Medicine (Harrison's

Online, Chapter 237, Ischemic Heart Disease, 2008), IHD is a condition

in which there is an inadequate supply of blood and oxygen to a portion

of the myocardium; it typically occurs when there is an imbalance

between myocardial oxygen supply and demand. Therefore, for purposes of

this regulation, the term ``IHD'' includes, but is not limited to,

acute, subacute, and old myocardial infarction; atherosclerotic

cardiovascular disease including coronary artery disease (including

coronary spasm) and coronary bypass surgery; and stable, unstable and

Prinzmetal's angina. Since the term refers only to heart disease, it

does not include hypertension or peripheral manifestations of

arteriosclerosis such as peripheral vascular disease or stroke.

http://www.regulatio...A-2010-VBA-0005"

(Of course if IHD has caused stroke or any other secondary condition, those conditions should be claimed as secondary to the IHD and will need medical evidence of the nexus of the claimed secondary to the IHD. )

VA will be using 38 CFR$ 4.104 to rate the AO IHD claims.

They will be using either diagnostic code 7005 0r 7006

"7005               Arteriosclerotic heart disease (Coronary artery disease):

 

                            With documented coronary artery disease resulting in:

 

                            Chronic congestive heart failure, or; workload of 3 METs or less results

                                          in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular

                                          dysfunction with an ejection fraction of less than 30 percent              100 

 

                            More than one episode of acute congestive heart failure in the past year,

                                          or; workload of greater than 3 METs but not greater than 5 METs

                                          results in dyspnea, fatigue, angina, dizziness, or syncope, or; left

                                          ventricular dysfunction with an ejection fraction of 30 to 50 percent              60 

 

                            Workload of greater than 5 METs but not greater than 7 METs results

                                          in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of

                                          cardiac hypertrophy or dilatation on electrocardiogram,

                                          echocardiogram, or X-ray              30 

 

                            Workload of greater than 7 METs but not greater than 10 METs results

                                          in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous

                                          medication required              10 

 

7006               Myocardial infarction:

 

                            During and for three months following myocardial infarction,

                                          documented by laboratory tests              100

 

                            Thereafter:

 

                            With history of documented myocardial infarction, resulting in:

 

                            Chronic congestive heart failure, or; workload of 3 METs or less

                                          results in dyspnea, fatigue, angina, dizziness, or syncope, or;

                                          left ventricular dysfunction with an ejection fraction of less

                                          than 30 percent              100 

 

                            More than one episode of acute congestive heart failure in the past year,

                                          or; workload of greater than 3 METs but not greater than 5 METs

                                          results in dyspnea, fatigue, angina, dizziness, or syncope, or;

                                          left ventricular dysfunction with an ejection fraction of 30 to

                                          50 percent              60 

 

                            Workload of greater than 5 METs but not greater than 7 METs results

                                          in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of

                                          cardiac hypertrophy or dilatation on electrocardiogram,

                                          echocardiogram, or X-ray              30 

 

 

                            Workload of greater than 7 METs but not greater than 10 METs

                                          results in dyspnea, fatigue, angina, dizziness, or syncope, or;

                                          continuous medication required              10 

 

VA Schedule of Ratings.

[treysnonna]

Since this is something you guys are already talking about, may I jump in?  Hubby has a situation, he is approved now or ihd due to having his aortic valve replaced in sept of 2013.  They found he had ihd in left branch just Dow from the aortic valve.  So they rated him at 60 %.  

Now before this in April of 2009, he filed for a heart condition which was deferred.  Service connection for mitral and tricuspid regurgitation also "valvular heart disease" disease (claimed as heart disease) is denied. Ther also deferred peripheral neuropathy associated with diabetes.  

His private cardo dr.  Diagnosised valvularheart disease manifested by moderately severe aortic insufficiency.  C and p  noted min dilated aortic root with aortic insuffiency and mild mitral regurgitation mild tricuspid regurgitation.

i have found in pub med new evidence as of 2012 that states diabetes predisposes to aortic stenosis.  Diabetes is associated with enhanced inflammation within as valves measured by crop expression, which may contribute to faster as progression. 

Aortic valve stenosis shares several similarities with atherosclerosis.  Factor xllll has been detected within atherosclerotic plaques and may contribute to the development of atherosclerosis via mechanisms.

I have pulled up other claims where vets were denied  for valvular disease secondary to diabetes.  And I  guess they appealed it and was approved. Here are the dockett numbers 09-41-933a,10-43-947,08-17-821, and 08-11-503

and my hubby found his medical records.  He had previously claimed hop and they denied it.  But they stated they never looked in service record and it shows in his service med records he clearly had hip.  And also pre diabetes.  He retired in 92.

  I'm asking advice on what to do.  Do we reopen it as April 09.

any advice is greatly appreciated.  

[Berta]

Odd, that there is an older reply  after your recent question here????

Treysnonna asked:

  "Do we reopen it as April 09."

You can re open the claim but you will need New and Material evidence. The citations from Pub Med, in my opinion, might be enough to re-open the claim, with details as to how they are provative, specifically to your husband's situation......but a strong IMO from his private doctor might be far much better...

Can you scan and attach here this VA decision?

  "Hubby has a situation, he is approved now or ihd due to having his aortic valve replaced in sept of 2013.  They found he had ihd in left branch just Dow from the aortic valve.  So they rated him at 60 %."

And any past denial (with the date of denial?) for IHD? (Cover C file # and name,address  prior to scanning it)

I assume when they deferred this in 2009 ,they denied the IHD claim at that time?

"Now before this in April of 2009, he filed for a heart condition which was deferred. "

But I am confused a little here......

When his aortic valve was replaced, is that the first date (Sept 2013) they awarded IHD retro for?

Did VA do an ECHO prior to the EED of the award and did that reveal atherosclerosis  ( found in the ECHO measurements)

Is he service connected for the DMII?

Was this an award due to the Nehmer 2010 IHD Court Order?

I will check those BVA cases out.

[Berta]

 

I could only find two of the BVA decisions:

09-41-933a  On Remand The BVA did service connect the heart disease as I understood this, but remanded for an addition C & P opinion,for a full rationale of the last negative C & P exam.(/) Maybe BVA thought th examiner would alter their opinion to become favorable.???

 

10-43-947- This decision contained  Findings of fact from the BVA:

FINDINGS OF FACT

 

1.  The Veteran's erectile dysfunction is etiologically related to his service-connected type II diabetes mellitus.

 

2.  The Veteran served on active duty in the Republic of Vietnam during the Vietnam War.

 

3.  The Veteran's aortic valve stenosis qualifies within the generally accepted medical definition of ischemic heart disease; his aortic valve replacement and congestive heart failure are due to the aortic valve stenosis.

 

Also

“The Veteran was afforded an additional VA examination in October 2015.  The examiner noted the Veteran was service connected for ischemic heart disease, and had undergone an aortic valve replacement in November 2008.  The examiner also noted the Veteran had had a dual-chamber pacemaker implanted in May 2015 due to a complete heart block.  Importantly, the examiner indicated that the Veteran's valvular heart disease qualified within the generally accepted medical definition of ischemic heart disease.  The examiner further indicated the Veteran's valvular heart disease was the condition which necessitated his November 2008 aortic valve replacement surgery.  The examiner further noted that a July 2015 echocardiogram showed a left ventricular ejection fraction of 40 to 50 percent, as well as abnormal wall motion and thickness in the form of mild left ventricular hypertrophy.”

 

https://www.va.gov/vetapp16/files5/1639405.txt

It is different from your situation ,and the veterans was already SCed for IHD, but this decision would raise his IHD rating.

 

That bears repeating:

"Importantly, the examiner indicated that the Veteran's valvular heart disease qualified within the generally accepted medical definition of ischemic heart disease"...I think due to the surgery and need for  pacepaker....not sure....and of coure the ECHO results- the EF would have been higher tyan many IHD vets ,due to the pacemaker I think.

In that case, I feel any vet could use this decision as a legal rebuttal if any vet's valvular heart disease warranted the surgery ( and/or pacemaker) or their ECHO results warranted an IHD diagnosis due to AO and/or  to DMII from AO.

I am sure no cardiologists but I used my husband's ECHO results to not only prove malpractice on his heart disease, but also to help prove his malpracticed diabetes II , both from AO exposure in Vietnam, and both were never diagnosed or treated properly by the VA.

This is why I might have asked you for his  last ECHO results.

An ECHO can often help prove  PAD ( peripherial arterial disease ) as well but that takes a real doctor to determine, and certainly PN can be attributed to DMII  too, if a doctor makes the link.

 

[john999]

I got CAD connected as secondary to DMII  (AO) based on a CT scan of my left leg.   I am still not sure how I ended up with that DX and 60% rating for CAD, but I don't look the gift horse in the mouth.  DMII has so many secondary conditions that can be connected.  You need a doctor to make the connection and then file the claim.

[treysnonna]

Berta,  I was just looking on ebenefits for when Hubby put in for contrary artery disease and it shows approved.  But it was put on the claim as ihd,also claimed as mistrial and tricuspid regurgitation,  also claimed as valvular heart disease.  Reopened.

in 09 it was the same.  It was brokered out for someone else to look at back then.  I think nemer was nvolved then too.  

We hav not been notified that they have reopened

so I was going to reopen it anyway,  do we have our Vso to find out what is going on.  And since they reopened it again wil it go all the way back to 09.?

[Berta]

If he was awarded already under Nehmer, I dont understand the re-open part  of your question- unless his heart disease should be rated higher by now, and he had formally claimed that , as a re-open, with new and material evidence.

Hopefully your VSO can get more info.