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About ASU_0331

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  1. So had a NOD with DRO review in for hypertension and CAD. CAD was rated at 60%, but it appears that hypertension will be rated at 0% because my diastolic readings at my C&P only averaged out to around 85. However, this was done while medicated on two different blood pressure medications so I do not understand the rationale that VA determines their rating when they use the criteria they have for ratings; The ratings: If the average diastolic pressure is 130 or more, then it is rated 60%. If the average diastolic pressure is 120 to 129, then it is rated 40%. If the average diastolic pressure is 110 to 119, or the average systolic pressure is 200 or more, then it is rated 20%. If the average diastolic pressure is 100 to 109, or the average systolic pressure is 160 to 199, then it is rated 10%. If the average diastolic pressure was 100 or more before fully controlled by medication and continuous medication is required to keep the blood pressure under control, then the minimum rating is 10%. I have been on blood pressure medication since my heart attack and hypertension diagnosis in 2005 and all my vitals on record with the VA, with the exception of a few, are also while on blood pressure medication. So there is no way they can determine what my average diastolic pressure was before being fully controlled by medication, except that continuous medication is required to keep my blood pressure under control (currently prescribed Lisinpril & Metoprolol). Below are my BP readings since I first started being cared for by the VA. Note that when I came to the VA, I had already been on blood pressure meds since 2005; 131 80 9/27/2018 127 74 8/15/2018 127 82 7/16/2018 139 90 6/15/2018 148 92 6/5/2018 144 83 6/5/2018 150 85 2/14/2018 144 94 1/11/2018 114 75 9/1/2017 123 83 5/4/2017 152 104 5/3/2017 131 89 10/24/2016 152 83 6/13/2016 197 120 6/12/2016 164 105 6/10/2016 145 89 6/3/2016 144 86 6/3/2016 146 95 3/3/2016 146 100 5/27/2015 142 91 10/16/2014 150 92 2/24/2014 157 96 10/7/2013 130 79 5/29/2013 121 82 1/16/2013 136 92 10/30/2012 150 86 10/30/2012 144 95 10/30/2012 You can see the instances where I was off my blood pressure medications with readings over 100 as well as most of the medicated readings being in the high 80's to mid 90's. I am planning on requesting a reconsideration once I get my BBE for this appeal and making the argument that my diastolic would he averaging over 100, as evidenced by the instances where it has been over 100, and that absent continuous medication my blood pressure would not be fully controlled. Anyone have thoughts on this angle on reconsideration?
  2. I ended up with a 60% rating for my heart. Even though the estimated METS range covered both rating criteria, the ejection fraction rate was observed at 45% so that got me the 60%. Waiting on direct deposit and BBE.
  3. Did they do an echo cardiogram to determine your current ejection fraction rate? Right now you are at 60% ejection fraction which means all you rate is the 10% despite the other issues the C&P included. Did he give an estimated METS range that you have not included here? These are the criteria for heart ratings; 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
  4. So what happens when the C&P examiners estimated METS range covers two ratings criteria? Had a C&P recently for CAD and hypertension. Estimated METS range by examiner was 5-7. A 60% rating METS is 4-5 while a 30% rating is 6-7. Not sure what my ejection fraction rate was, but tech said that from one angle it was 47% and 49%. If those numbers hold true, then I will be at 60%, but wondering what the estimated METS range would rate. Also, does the examiner and DRO for that matter take into account severity of the CAD or does it just fall on the strict guidelines in the CFR? I had a heart attack in 2005 due to two blockages in my lower anterior descending and right circumflex that required stents. Now that the VA has finally given me a cardiac work-up after 6 years of just prescribing me heart medications, it turns out that my right coronary artery is COMPLETELY blocked and only getting some collateral flow from right conus and lower anterior descending. Cardiologist and surgeons that performed my last catheterization just this last August says there is no remedy to my condition as there is nowhere to bypass on the right coronary since it is blocked from top to bottom and the build-up is "rock hard". Examiner already told me she was service-connected it to my DM II, so that is not a worry. Just waiting on the actual rating now is making me question everything.
  5. I have wondered about this as well. My C&P for hypertension is going to be rated at 0%. My blood pressure was taken by QTC while I was medicated on Lisinopril and Metoprolol and I averaged somewhere between 85-90 on my diastolic. I have been on blood pressure meds since 2005 when I had a heart attack, so finding un-medicated BP readings is just about impossible. I then went into my VA vitals section of MyHealtheVet health records and in the past 3 years I have 4-5 instances where my diastolic was over 100, highest being 120. You also seen a ton in the 90's. When I get the 0% rating, I am going to submit those VA vitals records under a reconsideration to fall under the 10% rating of diastolic averaging over 100 before being controlled by continuous medication and see how it plays out.
  6. Well both of the medical centers I have had to use (Tucson/Phoenix) were rated 1 star. Not surprised at all.
  7. The CAD is a given with nexus established by my VA cardiologist and the C&P examiner agreeing with said nexus and putting that as part of her medical opinion. It is just up to the DRO now and what side she will come down on with the estimated METS range and/or the ejection fraction rate is below 50%. If I get the 60% for the CAD, I will be at 70% with the leg/knee/foot issues possibly pushing it up to 100%. Kinda depends on how they will rate the Plantar Fasciitis. I have seen cases where it has been coded separately from the pes planus and where it has been coded under the pes planus. Just a waiting on rating game now.
  8. Thanks for the great advice. No back issues right now, but as far as ankles, I basically roll them a lot to the outside. It could be attributed to the pes planus because I tend to walk quite a bit on the outside of my feet to avoid foot pain, but weak foot does not get its own rating on its own, it just guarantees that the disability responsible for it gets at minimum 10% per the CFR. I am already service-connected for DM II at 20% and Tinnitus for 10%. I have a SMR documented high frequency hearing loss, but two C&P exams have shown that I am just a point or two below the threshold of getting it rated as being disabling. Currently have a NOD with DRO review about to close for CAD secondary to the DM II and Hypertension. C&P exams have been completed via QTC and are in the DRO's hands as we speak and waiting on her rating decision. Hypertension will be 0% because my medicated diastolic BP reading did not average 100. I have had 4-5 instances in the past three years where it has gone over 100 with the highest being 120. But those have been times where I might have been off medication or not exercising as much. Otherwise, my medicated diastolic has been between 85-95 for the past 3 years. It is a toss-up on the CAD because the examiner gave an estimated METS range of 5-7, which per the CFR covers both a 60% reading with the 5 and a 30% rating with the 6-7. I have not been given the official ejection fraction rate yet, but the technician that conducted the echocardiogram told me that from one angle it was 47% and from another it was 49%. So that would be two other conditions for a 60% rating on the CAD which would be nice considering the extent of my current blockages and existing stents.
  9. Trying to file an intent to claim on Ebenefits today, but apparently the application is not working correctly. In the meantime, I would like to input on structuring the claim for pes planus (flat feet) with secondaries. Pes planus and pain in my feet are both noted and documented on my final physical from the USMC (0331 heavy machine-gunner). In 2017, I visited my VA PCP regarding a marked increase in foot, knee, and hip pain and was referred to MRI/x-ray/podiatry where it was the pes planus was confirmed along with a host of other issues including heel spurs (posterior & plantar), tendinitis (knees), Baker's cyst (right knee), ganglion cyst (right knee), tendinitis ( both quadriceps), ITB syndrome (both legs), degenerative joint disease (both big toes), and joint impingement (hips). My old podiatrist made the comment that everything starts at my feet and that from there is effects everything going up my legs; trying to avoid pain in feet by changing how I walk basically effects the toes, the knees, the tendons, and my hips. He ordered a set of custom inserts and sent me on my way. Since then I have worn out the inserts, still having to walk the same way and my shoes still show the same wear pattern to avoid pain, to no relief. Visited a new PCP this week and was referred to physical therapy for all the tendon/impingement issues and new podiatry for the flat feet. Going to document all with what I hope will include new MRI/x-rays of knees and feet to have double confirmation of issues. But I question how this should all be constructed. I have a great VSO that is always extremely helpful, but he is just swamped so would like to present to him as close to a completed package as possible. I am thinking this; Pes Planus/Plantar Fasciitis L Knee Pain (quadriceps tendinitis/knee tendinitis/ITB syndrome) R Knee Pain (quadriceps tendinitis/knee tendinitis/ITB syndrome) L Toe Pain (arthritis) R Toe Pain (arthritis) L Hip Impingement R Hip Impingement The posterior/plantar bone spurs will probably just be coded under the pes planus coding since it seems like they always are done that way. All the tendon issues surrounding the knees will just be coded all under the knee pain, the toes as arthritis, and the impingement on their own issues. Not sure what or even if the cysts will be rated or what they would fall under. What are thoughts about this from everyone?
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