bm6546

Citation Nr: 0842826 Decision Date: 12/12/08 Ar Citation Nr: 0842826 Decision Date: 12/12/08 Archive Date: 12/17/08 DOCKET NO 06-00 943 DATE Hope I did this right!! I found this case to be interesting. "The RO stated that it assigned the initial 10 percent rating for the veteran's sc irregular heart beat because metoprolol was prescribed during his overnight hospitalization." "There is no other relevant medical evidence of record, and resolving all reasonable doubt in favor of the veteran, the Board finds there is evidence of cardiac hypertrophy on EKG and that based on this, the criteria for a 30 percent rating under Diagnostic Code 7011 have been met for the appeal period. The VA doctor prescribed me with metoprolol back in 2008. I am still taking this medication for my PAT. Brian

"My thoughts are the veteran should be reporting on symptoms of heart disease; just because the vet did not ask for a SC PAT increase until after his MI< does not mean that he was ineligible for an increased rating. Maybe he wasn't motivated to file a claim for an increase in PAT say 10 years ago, because of the injustice of the first reduction. Appreciate your input ;-) ~Wings" Wings...you are correct on this issue. I did apply to the VA twice following my discharge and was denied twice. I just figured it was a losing battle, at that time, and didn't pursue it any farther. I did not know how the system worked back then and didn't bother with it any more. I am sure there are a lot of veterans out there that also were denied several times and just gave up. I have just recently (almost 6 years ago) realized that I do have the right to pursue something that I believe in and deserve my fair justice with the VA. I feel that I am starting to learn a little (emphasise on the word little) about how the VA operates, in thanks mostly to the great people here on Hadit. I am going to continue my fight until I prevail.

I talked with Arthur Fine at Medical Opinions Associates today. They will charge me $1900 for a doctor to take a look at my service records and write up a IMO. I don't know if the doctor that they provide will give me a decision that will be in my favor or not. Guess I will just have to take that chance. I was wondering if anyone has used them before and what they thought of them. Thanks for any help. Brian

Hoppy, Watta ya mean, tomorrow is a play day. I thought you worked every day...LOL Just kidding!! You deserve a day off. Thanks for all the help. Brian PS I got 2 responses from doctors and they want me to call them in the morning. Maybe things are starting to work for me after all. I will let you know what they say. B

Thank you Wings

Hoppy, I will start working on the search at the BVA website. I am currently sending e-mails to several more doctors to see if I can get an IMO. I have a couple of possible leads that I am working on right now. I will let you know what I find. Thanks for your help. Brian

Yes I have a copy of the military discharge examination.

Another thing that keeps bothering me about all this, If I did indeed have this problem before I enlisted in the Navy, and they were aware of this by me telling them that I have this heart condition.......Why would they have enlisted me in the Navy if they were aware of this at the time? And why did they wait for over 2 years to discharge me?

When I was inducted in the Navy, I think I recall the doctor asking me about my heart problem. I believe I told them that I was in good health and that I had "occasional" heart pounding and that it was not incapacitating. That all changed, of course, once I was in the service with all the exercise and drilling. I did feel that at the time of enlistment that I was in pretty good shape, as any 18 year old would be. I don't believe that before I went in the service that I ever checked my pulse, not sure if I even knew how to check it back then. I do remember the doctors in the hospital did show me how to check my pulse with my fingers on my wrist. And they also showed me how to put my head down between my knees to help slow down my racing heart. And again, I repeat, I was never treated by any doctors for my PAT before I entered the service. There are no medical records anywhere that I was seen or treated for any heart problems I may or may not have had. The more I think about this, I am not even sure if I did in fact, have this heart problem before I enlisted in the Navy. I know my records state that I have been having this problem most of my life. I am just not sure of this at all. I know I saw a lot of doctors while in the Navy and just not sure of what I did or did not say to them.

Sorry, I screwed up the last reply. The BVA has remanded: 1. Entitlement to an increased compensable evaluation for a heart disorder, to include paroxysmal atrial tachycardia (PAT). 2. Entitlement to a total disability rating based on individual unemployability. The RO has already denied my Anxiety. There has been nothing mentioned about the CUE in the remand.

Back in 2008 the VA Cardiologist prescribed me with Metropolol Tartrate because my PAT was getting worse. Metropolol Tartrate is used to treat various heart tachycardia arrythmias and anxiety. It seems to be working because my PAT attacks have decreased somewhat. My anxiety seems to be a little better also. In my experiences as a mental health provider (and patient), it would be almost impossible to rule out an anxiety disorder as primary or secondary to the PAT. In other words, I would give the benefit of the doubt to the veteran that the PAT had it's onset in the military service as evidenced by objective, measurable criteria --and the PAT has in fact incresesed in severity. The PAT is iniextricably linked to the anxiety disorder --and both may have contributed to his additional heart disease. This link however, is totally out of my range of expertise.

The VBA is full of claims that were initially denied by the RO due to a determination the condition pre-dated service and later overturned by the BVA because RO raters were relying on veteran’s unsupported statements that they had a condition prior to the military. Most discouraging was that there were even cases in which the BVA was giving negative weight to veteran’s subjective statements in cases involving complex conditions with numerous different potential causes for the symptoms. If the VA is not in possession of pre-service medical reports signed by a doctor who stated in the report that a diagnosis of sinus tachycardia was confirmed by EKG, I would contest any determination your condition pre-dated service. Hoppy, Before I enlisted in the Navy, I was aware of my heart fluttering and skipping beats. It wasn't until I was engaged in vigorous exercise that I started having episodes on my PAT and was taken to sick bay numerous times. When they finally diagnosed me with the PAT and was hospitalized for further tests is when I realized what my diagnosis really was. There are no records or was I ever treated for PAT before I enlisted in the Navy.

Hi 71M10 and everyone else, I am sorry I have not been here the last few days. I have a bad cold or flu or something. I feel like crap but starting to come around a little. 71M10, I scanned and posted my BVA remand here under a different heading. If you go back about 3 pages you will find it as "My BVA Remand" with the last posted date of Nov 18. Hope this helps you. I will be getting around to answering a few questions in the next day or so when I am feeling a little better. Right now I just need to crawl back to my pillow. Brian

Hoppy, Thank you very much for all the hard work you are doing researching my claim. You are sure right about one thing....I think its time I contacted an attorney. This brings up several questions that I have. 1. Should I hire an attorney now? 2. Should I wait until the RO schedules a new C&P? (This could take another 1 or 2 years) 3. Should I continue to try and get an IMO from a Cardiologist before I hire an attorney? 4. Which attorney should I contact? Anyone have any suggestions? 5. Has anyone used Bergmann and Moore? (The attorneys that are at the top of the Hadit site page) Any comments on them would be appreciated. When I filed my first claim almost 6 years ago, all I was trying to do was get back my 10% that the VA took away from me almost 45 years ago. If they would have just given me back my 10% I would probably have been happy with that and more than likely have just GONE AWAY. Now, it appears that "a can of worms" has been opened. I have no intention of giving this fight up and will continue to the end.

I am in the process of trying to find a Cardiologist that will provide me with an IMO. I have e-mailed 5 or 6 doctors but have not received an answer yet. Do you know of any Cardiologists that I can contact? I am waiting for a C&P from the RO that my BVA remand states I need.

Hoppy, After checking the paperwork for my C&P exam on 12-1-67 it appears that no Holter Monitoring was performed to evaluate my rating deduction decision. The C&P notes says: Clinical Impression: Paroxysmal Atrial Tachycardia Normal EKG (and there is a copy of the EKG) -no cough -no dyspnosa -no thyroid enlargement -no precordial thrust -no enlargement to percussion -heart regular -soft systolic at apex -no radiation -no thrill -heart is regular -rate 78-80 -normal peripheral vessels Pulse 80 B/P 130/64 respiration 18 Pulse 80 B/P 130/64 respiration 20 pulse 96 B/P 102/70 respiration 20 Thats pretty much all the C&P reveals. I noticed several sick bay examinations performed while in the service were my pulse and B/P were recorded. 17 Jan 1966 Apicae pulse 132 EKG rate 110 June 11, 1966 Pulse 108 EKG 100 6-17-66 Pulse 138 I can scan all the paperwork for this information if it will help. Thanks, Brian

Hoppy, I am going through all my boxes of records and trying to find the info. I will post it when and if I find it. Hopefully this weekend some time. Thanks for your help. Brian

I was seeing the Clinical Social Worker, the Psychologist and the Psychiatrist at my local VA Clinic for almost 2 years. These visits were a result of my anxiety and depression after my heart attack. Both the Social Worker and the Psychologist indicated in their "Progress Notes" that my visits were related to: "Service Connected Condition". Diagnosis: Generalized Anxiety Disorders and Depression". Primary condition "Supraventicular Arrhythmias" 0% After almost 2 years the Psychologist informed me that he had to change his wording to read "not service connected". I was then billed for my visits to him. Interesting that after all these visits someone told him to change my service connected visits to non service connected visits. All 3 of these MH professionals are no longer working at this VA clinic. Not sure what this means. Its very interesting when you go back through your SMR and MH notes what you find.

I was in the Viet Nam era but never served in a war zone. I have only filed to increase my 0% to 10% for my PAT. I didn't know I could file for my IHD or anxiety until just a few weeks ago. I am still pretty new to all this VA claims stuff, but am learning real quick about the claims process. I am in the process of putting together a IMO letter to a few Cardiologists to see if they can write a IMO for me. Brian

While I was in the service, I was in and out of sick bay many times with my PAT. I have copies of all the different times doctors examined me. The problem is, I can't read half the stuff they wrote or the paper work is either blurry or too light to read it. After my heart attack in 2006, I was diagnosed with Anxiety and PTSD by the VA Social worker, psycholgists and psychiatrists. I was prescribed medication for my anxiety and PTSD. Not sure if tis helps, but there it is. Brian

Here is the "Rating Decision" that determined my award of 10% SC In view of the length of service and worsening of the condition, aggrevation is conceded. 1. SC 38 USC 331 (aggr. PTE) 10% from 11/26/66 PAROXYSMAL ATRIAL TACHYCARDIA 10. Not entitled 38 USC 336. And here is the wording when they reduced me from 10% down to 0%: Cited examination. Evaluation of SC tachycardia. Cited exam discloses the veteran is steadily employed but complains of occasional dizziness, a heavy feeling in the chest and that his heart flutters. Blood pressure was 120/68, 130/64, 102/70 and there is no precordial thrust, no enlargement to percussion. Heart sounds are regular, there is a soft, systolic murmur at the apex with no radiation, no thrill and a rate of 78 to 80. EKG is normal. Current examination does not disclose a compensable condition. Rating of 3-3-67 amended as follows: 1. SC 38 USC 331 & 310 (agg. PTE; VE from 10-1-67) 10% from 11-26-66 0% from 5-1-68 7013 PAROXYSMAL ATRIAL TACHYCARDIA 10. Not entitled --38 USC 336 There is no mention of any holter monitoring and I do not remember any holter monitoring taking place at this C&P exam. Hope this makes sense. Brian PS I just commented in a different post that after reviewing my service records, I noticed that at least 2 times they mentioned Sinus Tachycardia with Anxiety. Another reference was to Paroxysmal Atrial Tachycardia secondary to anxiety. I was diagnosed by the SSDI that my: Primary Diagnosis - Anxiety Disorders Secondary Diagnosis - Chronic Ischemic Heart Disease with or w/o Angina Brian

Berta, You asked whether "Could an in service situation have caused the anxiety as well as the PAT?" As I was going thru my service records, I came across 2 entries in my records that said... " Paroxysmal Atrial Tachycardia secondary to anxiety" And another entry that states...... " Imp: Sinus tachycardia Etiol - Anxiety " Not sure if this helps but thought I would bring it up. Brian

Testvet, Can you give me the name of the Cardiologist in Denver? Thanks

Carlie, I would appreciate it if you would please look at this and tell me what you think. I know you deal a lot with claims that involve a CUE. I would like your take on this. Thanks in advance, Brian