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wbonebrake

Pulmonary Hypertension rated at 30% as symptomatic resolved pulmonary embolism

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OK, so here's my story. I was in Iraq in 2008-09, and started having chest pain. It was dismissed by the army doctors as probably just a strained muscle. Fast forward a few years, and I was diagnosed with pulmonary hypertension and stage one heart failure, both of which are ultimately fatal. I submitted a claim for these conditions, which was denied. I appealed this denied to the DRO in St. Louis, MO. The contention for pulmonary hypertension has a pending rating decision in the system according to my VSO. Here's my issue. I am diagnosed with Pulmonary Hypertension, as well as other diseases. The doctor who did my C&P exam clearly stated that he believed that my PH was service connected. The pending rating states that I am granted service connection for PH. However, in the section that details the rating, it is rated at 30% as "Symptomatic, following resolution of acute pulmonary embolism." In the CFR 38 section 4.97, diagnosis code 6817, Non-tuberculosis diseases of the respiratory system, Pulmonary Hypertension is clearly listed as a 100% condition. I called the 1800 number to check on the rating decision, and I was informed that it was sent to the authorizer, who then sent it back to the rater, and it is now just waiting to be authorized again. Is it possible that the authorizer saw this, and felt that the " Symptomatic, following resolution of acute pulmonary embolism" was not an accurate representation of my diagnosis, and asked for it to be updated?

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Was the PH DX based on an Echocardiogram or Heart Cath?   What was your RV Ejection Fraction numbers? The Heart Cath is the "Gold Standard" for DXing and Determining the exact Ejection Fractions for Staging your PH. Are you currently DX'd requiring Supplemental 02?

I had an Echo DX 11/14 Stage (1) PH SC 0% (FDC filed 01/15) 03/15 Awarded Secondary to an SA (10/10) 50%. I immediately (03/15) filed an FDC for SA Increase, denied 07/15.

Rating Dept 12/15 Quality Review of 07/15 Denial, Awarded SA Increase to 100%. Without the PH DX, the 100% Bump wouldn't have happened. My PH Stage (1) rating is still at 0%.

Semper Fi

 

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My PH was diagnosed via echo. Not currently on O2. I'd have to look at my records to get the ejection fraction but I do know that the pulmonary artery pressures were around 35, clearly a sign of PH. The strange thing is though, that the VA C&P examiner who was working my claim fully agreed with the diagnosis of PH, but it was rated as something different altogether. 

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I had to look at the PH Ratings again, been awhile. What condition preceded the PH DX, Acute Pulmonary Embolism or Thromboembolism?

Any mention regarding the need for a Right Heart Cath, by any of your VA Drs? Do you have an SC'd Heart issue?

I'd have to look back but I think my PAP was 26+, very low end of Stage 1 PH DX. Regardless of low Stage 1 or About to check out high Stage 4, PH is considered Heart Failure (aka Cor Pulmonale). The PH DX itself, not the SC 0%, got my SA bump to 100% because of the Cor Pulmonale/Heart Failure association.

Semper Fi

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Thats the thing, i never was diagnosed with thromboembolism or anything else revarding my lungs other than PH. I was also diagnosed with stage 1 heart failure though. My heart failure diagnosis was denied by the VA, but they did rate me at 10%for vasospastic angina. 

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This below might help: (these types of cases on remand are why the backlog occurred. A Remand is 99% of the time a re-do of what the RO should have done in the first place.

 

"1.  Since September 17, 2012, the Veteran's pleural plaques with mild reactive airway disease has been manifested by pulmonary hypertension.

 

2.  Prior to September 17, 2012, the Veteran's pleural plaques with mild reactive airway disease was not manifested by Forced Vital Capacity (FVC) of 50- to 64-percent predicted, Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) of 40- to 55-percent predicted, maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation, cor pulmonale, pulmonary hypertension, or requiring outpatient oxygen therapy."

https://www.va.gov/vetapp16/files6/1647846.txt

I am glad you posted this in the CUE forum because if you can scan and post the decision here when you get it, it might contain a CUE. You can file CUE within the appeal timeframe. My last one took a month from denial to award...because I requested they CUE themselves on the denial and they did. It is all explained here in this form.

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