saturneptune

May 17, 2010

Here are some comments from the C and P exam. This is a 57 year old white male who appears for a C and P exam regarding his heart. The veteran is service connected for hypertension at 10% since 2002. He is claiming ischemic heart disease as secondary to hypertension. The veteran was in the Navy from February 71 to Nov 82, not in Vietnam.

Medical History. The patient was alright until December 2005, then he started noticing chest pain on exertion and shortness of breath with easy fatigueability. He also became dizzy with moderate exercise. He went to local emergency rooms twice and twice had a treadmill stress test with negative results. This continued until October 2009, when the symptoms got so bad he retired from his federal job. (not disability, regular retirement)

Soon after, November 2009, he had a severe episode of chest pain and he saw a primary doctor who sent him to a cardiologist. On Dec 28, he did a nuclear stress test which showed an old MI and 41% ejection fraction. This lead to a catherization Jan 11, 2010. Six blockages were found, and on Jan 12, 2010, he underwent open heart surgery and six grafts were done. In his catherization the EF was 75%.

He started rehab in March and is currently doing it. At 3.2 miles per hour on the treadmill, he can go up to 15 minutes before fatigue and shortness of breath stop him. This was estimated at 4.8 METS. He says he can climb two floors of stairs or walk moderately one mile before fatigue and shortness of breath.

He worked as an electronics tech and mechanic at the Post Office and has also worked as a substitute teacher, but generally, he was a full time employee on a midnight shift for 27 years. He continues to apply for varioius jobs, but when the perspective employers hear about his heart condition he gets rejected. He cannot do much heavy lifting such as carrying boxes to the attic. By his own admission, depression is part of his problem, but fortunately, it is mild and transient. He continues to have pain around the incision.

He smoked lightly, for 15 years, about a pack a week, and quit 20 years ago. He does not drink. Current medications are Pravastatin, Metoprolol, Levothyroxine, Nicain, Pramipexole, Hydrocodone, lisinorpil, and Plavix.

He has no objective signs of heart failure (congestive). He has hypothyroidism, but his cprs or records from outside do not mention any cardiac arrhtymias. Exam of the heart and cardiovascular system shows a sternotomy scar which is well healed. The first and second sounds are normal. There is no gallup or murmur. Breath sounds are normal.

Diagnosis

1. Ischemic heart disease status post open heart surgery and six bypasses.

2. Hypertension, which appears to be under good control, and service connected.

Discussion:

Hypertension is a well know ristk factor for ischemic heart disease. The patient has been known to have hypertenison for many years, ever since he was in the Navy. Other risk factors are diabetes, smoking, and high cholesterol. The patient is not diabetic. He has done some smoking, but only sparingly. He has hypercholesterolemia, and he is moderately obese (thanks a lot). One of his diagnosis is hypothyroidism and his is on a maintenance dose of synthroid. Hypothyroidism is also known to contribute to IHD. The patient is quite symptomatic by the way of shortness of breath, dyspnea on exertion, and a sense of fatigability.

The cardiac cath done just before the surgery showed an EF of 75%, suggesting that the left ventricular contractility was quite normal. This study ir fairly recent and there is no reason to believe that any significant impairment has occurred with the functioning of the heart. He continues to have some easy fatigueability and shortness of breath, but no palpitations.

OPINION: The veteran's ischemic heart disease is at least as likely as not caused by or related to his service connected hypertension.

Any comments appreciated.

May 15, 2010

My case is now in the rating section. If I knew how, I would post my C and P exam for comment, but cannot figure out how to post scanned images.

May 13, 2010

Does anyone know how to post douments here that are scanned into your computer?

May 9, 2010

Where did you have your C and P at, Lexington or Louisville?
I know the guy at Lex and he is real good. Usually has his home work done before you get in there.

J

I live near Paducah, KY and went to Marion, IL VA medical center, about 50 miles from here. I have no idea why I got no tests except for the doctor listening to my heart. He did ask detailed questions about cardiac rehab. I have been on 3.3 mph at a 2 percent grade which translates to about 4.5 METs. He also asked how many flights of stairs I could climb, and I said two. Like I said in the other post, he asked about my experiences at job interviews since the surgery, which have not gone well. One interview was with a floral company to deliever flowers in a van, one was a van driver for Easter Seals, and one was for a census taker. I could have had the census taker job, but I would have had to pay back a portion of my federal retirement (civilian) according to them.

Another interesting thing that came up was I had an interview with a VA rep about vocational rehab. The VA may pay for some training in the fall depending on how much leg work I do to research on the recommended occupations they gave me. I also found out that the VA did not know I had been married 33 years, so sent in the paperwork for that.

I have not had a chance to get a copy of the C and P exam yet, and have no idea if the report helped or hurt me with no real testing done. It seems to me that since the RO is the one that orders the exam, and types out the instructions to the doctor as to what they need, that all the doctor does is read the packet. One thought that did cross my mind, is that since I am only three and a half months out of six way bypass, is that they will give me a temporary rating based on the doctor findings, then make me come back in several months to a couple of years for an EKG and stress test.

May 8, 2010

Also, just as important if not more than the C and P exam, be sure the regional office has records from all your civilian doctors. I had records sent from my regular doctor, the cardiologist, and the surgeon, plus any hospital records and results of tests.

May 8, 2010

I had a C and P two weeks ago with IHD and CAD related to a six way bypass secondary to hypertension. I was surprised at the exam. There were no tests other than the doctor listening to my heart. He asked a lot of questions about my stamina, like how many flights of stairs I would climb. He also asked about the MET level I had achieved at heart rehab. There were questions about job interviews and if this condition had affected my work. He read my surgery report, heart cath report, and stress test results. It was over in about 30 minutes. I have no idea what he wrote down, or if the report helped or hurt me. Several other people on this site have told me their C and P exam included a stress test. I suppose it is what your regional office requested of the medical center. Also, I have no idea as to the length of time between the exam and an initial decision. Maybe others can shed light on that.

May 3, 2010

Howdy,

I am fairly new here also, but my case is similar, not exact. I think your estimate of a disability is a good one, as far as can be determined before a decision. The physical pain and depression are not easy to deal with after bypass surgery, and if one battles the urge to smoke at the same time, well it takes a really strong person, and I cannot help but admire someone who goes through that. I tell the following story for your information, and hope it helps.

I have a 10% rating for hypertension. Three or four years ago, I began having chest pains, fatigue, and shortness of breath with moderate to heavy activity such as push mowing a lawn or lifting heavy boxes. From 2005-2009, I had two trips to the emergency room and two stress tests that showed nothing. By October 2009, the symptoms had gotten worse, so I took a regular retirement from the Postal Service (machine repariman). Nothing improved, and after Thanksgiving, went to see a doctor again. This time something showed up on a nuclear stress test, and ejection fraction of 41% and old heart attack. They scheduled a heart cath for Jan 11th. It showed six blocked arteries and veins, and the next morning, had a CABG operation 6 way. I filed for an increase with the VA based on secondary to hypertension CAD, CABG, IHD, and some other minor conditions. I had one C and P exam cancelled two weeks after the operation, but one was rescheduled last week. It was totally not what I expected. The only test the doctor did (I could barely understand him) was a sethoscope to listen to my heart. We talked about half an hour, and he asked me lots of questions about METS from cardiac rehab, my ability to climb stairs, how far I can walk, and apply for various jobs. I have no idea how it came out. I would not have filed the papers if I thought it was not a case with merit. All I know about the progress is that they have all the records from doctors, and now they have the C and P exam. Timing is something that is almost impossible to predict with these people. I have seen very fast results, and others that lasted many months for the initial decision.

Basically, I have no idea how this will come out. So is your husband able to stick to a diet? Is he still in cardiac rehab? The one thing I have noticed is the chest bone still hurts with sneezing or coughing. Sometimes I can even feel bones "pop" near the apex of the rib cage. Personally, from what you said, and from what I know from reading and help from others here, I think you have a good chance. Good luck to you, and God bless you and your husband as he continues to recover.

April 30, 2010

Aim High,

If you see this post, please give me your ideas as our cases are almost identical.

April 28, 2010

Today, April 28th, I finally had a rescheduled C and P exam, and as far as I can tell, it was the biggest waste of time in VA history. I drove 50 miles to what turned out to be a totally verbal exam except for listening to my heart and looking at my incisions. The doctor could barely speak English, and asked many questions. When the subject came up about cardiac rehab, he asked if anyone had calculated my METS. I said yes, based on my speed and grade on a tread mill, which at 3.4 mph and 2% grade is around 4.5 something. He asked how long I could walk and I told him. He asked what symptoms I had, told him shortness of breath, fatigue, and dizziness at times. There is no chest pain but the chest bone. He asked about depression. I had the stress test before the operation, the cath report and the surgery for the 6 way CABG. He made a copy of all those. With the 10% hypertension conncection, he did say I may have a chance. Who knows? I have never been so confused in my life. He asked a lot about me going and looking for a job. Any feedback would be greatly appreciated.

April 13, 2010

Thanks for the reply. I see you are from KY also. I live in the western end near Paducah. To tell the truth, I really do not know what to expect. I know that this six way CABG is taking longer than I expected to regain full strength. In fact, it has been three months today. The chest bone still hurts, and will for a while. Rehab on the tread mill wears me out at 3.2 mph with a grade of 2.

I would never have filed a claim unless I thought I had a really good case based on 10% hypertension. Although there is that, but hypertension on my diagnosis of the medical records relating to the CABG and CAD, I can imagine difficulty if they try to claim it is heredity or something else.

Anyway, it is good to be driving locally again. This is my first time in the hospital and an operation, and some days my outlook is not the best.

Thanks again for the reply.

April 12, 2010

Aim,

I finally got a new C and P exam for April 28th in Marion, IL. I kind of dread the stress test. I cannot get much above 2.5-3mph on the tread mill at rehab. What kind of tests do you think they will do?

April 1, 2010

Aim High,

Congrats!! I appreciate all the info you gave me on my claim. Yours is the closest I have found to mine. Dealing with the VA these last three months has been quite an ordeal in addition to getting over this six way bypass. They lost the surgeon's report three times, plus other delays, I have no idea when I will hear anything. The 800 number seems very vague at best.

Did you ever hear anymore on your third month? Hope you get better really soon. I can already tell after three months that some days it is a struggle to maintain a positive attitude. Hang in there.

March 19, 2010

Have you tried an IRIS inquiry? It worked for me when my claim was stagnant and no one at the 800 number could tell me what was going on.

I thought that the VA might settle my CAD/heart bypass claim without C&P exams, but I was wrong. They put me through a battery of tests...even though I'd already had the same tests done by my own cardiologist and had submitted the evidence with my claim.

Hang in there. You are not alone.

Thanks for the encouragement. I pass the three month mark April 12. I should apologize to you and others. I posted essentially the same post. I thought I was doing something wrong when they did not show up, but then Pete explained the delay time, so most of my posts are repetitive. Thanks for your reply.

March 18, 2010

Aim High,

How long did it take until your chest bone stopped hurting? Also, my skin is still numb to the left of the incesion. I am doing light exercises in heart rehab, but I am light years away from being able to push mow a lawn or carry boxes to the top of attic stairs. I am on a strict diet. How are you doing with yours long term? When I went back to the cardiologist for a check up, he told me the average survival was 20 years after this type of operation if you took care of yourself.

March 18, 2010

Mine is just the opposite. I have a SC of 10% for hypertension. The claim I have in now is for the 6 way bypass I had two months ago and CAD. There is also the term Ischemic and Hypothyroidism in the diagnosis. I have no idea what my chances are. The main thing that remains a mystery is why they cancelled the C and P exam scheduled two weeks after the operation the day before it was scheduled. It was after the VA had received my records on the operation and from the hospital. They are continuing to work on the case. One can call the 800 number or the medical facility of the exam (Marion, IL), and no one knows why it was cancelled or if it is going to be rescheduled.

March 17, 2010

Thanks to everyone for your help. The cancelled C and P exam is still a mystery.

March 13, 2010

It seems to work.

March 11, 2010

Thanks very much for the reply. Yes, I submitted the operation report, the nuclear stress test, and the heart cath results. The strange thing about the C and P exam in this case is this. They scheduled it January 26th, two weeks after the six way bypass January 12th. The day before the exam, the regional office in Louisville cancelled the exam because of the records that I had sent in. The case is still under full consideration. I do not know what to make of the cancellation, if it means they are going to leave me at 10% for hypertension, or if I am in such bad shape they do not need an exam, or if they are going to schedule it later. I have no idea. I am getting better some two months after surgery, but still cannot do things like heavy lifting and push mowing the yard. I also have no idea what type of percentage I will end up with if any. The four diagnosises are hypertension, hypothyroidism, CAD, and hyperlipemia.

New Member · March 9, 2010

I attempted to post this yesterday. Don't know if it went through or not. I'm a new guy here. If it went through, I apologize for the second identical post.

Hello everyone. My name is John. I'm a Vietnam vet diagnosed, by my cardiologist, with Ischemic Heart Disease. I underwent open-heart surgery this past February for one by-pass and for a bicuspid valve replacement. Upon discharge from the hospital, the discharge documents displayed the following:

Aortic Stenosis
Atherosclerotic coronary artery disease, coronary insufficiency
Hypertension
Hyperlipidemia

I'm also taking medication for my heart, hypertension, and cholesterol on a daily basis.

I was really not that familiar about Agent Orange exposure until a fellow Vietnam vet told me about the herbicide and that I should apply for possible compensation (he is getting it for Type II Diabetes and neuropathy) . Now, I've always been the type of person to kind of take care of myself and not be perceived as asking for something free (it's just my nature). So, I was kind of reluctant to take his advice. Nevertheless, I began the search on the Internet about Agent Orange this summer. At the same time, I completed the necessary paperwork to be enrolled into the VA health program at the local VSO. The VSO person was very helpful and I think, is looking out for me and other vets as well. I figured I could use it as a backup, since I do have good private retiree health insurance (I took an early-retirement package this year).

In October, I saw where there were three new diseases to be added and one of those was Ischemic Heart Disease. I got to thinking about this. Heart disease does not run in my family. I have never smoked and it is only on very rare occasions that I may drink alcohol. Over the years, I have taken care of the "ole bod." (not bragging, mind you). My wife and children kind of get a chuckle out of me for my walking exercise (it is a power walk).

As a result, I got with my VSO and she filed for compensation from Agent Orange exposure, resulting in Ischemic Heart Disease. She felt that even though it has not yet been put in the Federal Register, it would be best to go ahead and file the claim and get the process started. I have received the VCAA notice and the VSO and I have responded back. The VA is requesting records from my cardiologist and from my internist, as well. Should be no problem here. They already have the above hospital discharge records for the by-pass and the valve replacement.

My VSO thinks my claim is pretty much "cut and dry." With my records from the above private doctors and the C&P exam, she thinks it's just a question of how much the disability rating will be.

So now, we wait. By the way, I have been reading up on this forum over the past few months and I am very impressed with it. There is a lot of good information here. I hope to learn even more.

I wish I could help you more. I am also new, and my case is similar. I have gotten no responses on my posts either. Anyway, I have a 10% rating for hypertension. Over the last three years, I have become short of breath, fatigued, and have had chest pain when push mowing a yard or carrying boxes up the attic stairs, or sawing limbs off a tree, for example. The first two stress tests showed nothing. Thanksgiving 09, I got so exhausted, I went to the doctor again. He sent me to a cardiologist. A cardiite stress test was done that showed an ejection fraction of 41% and an old heart attack. So, I was set up for a heart cath. The veins and arteries were so bad, they could not use a stint. The next morning (Jan 12th) I had a 6 way cabg bypass operation.

Some of the diagnosis on the report was Ischemic heart disease with artery stenosis, CAD, hypothyroidism, Hypertension, Hyperlipdemia.

I actually filed for an increase in benefits January 4th, as by then, I knew something was wrong. They scheduled me for a C and P exam Jan 26th, then, when they got the operative report, they cancelled it, but are still working on the claim. I have no idea where I stand or when it will be decided. Good luck to you, and take care of yourself.

March 7, 2010

With a 10% rating for hypertension, how hard is it to make a connection to CAD? Also I have had a six way bypass operation. They scheduled a C and P exam two weeks after the operation then cancelled it, but are still working on the new claim. Has anyone else had this happen?

March 4, 2010

Six way bypass

March 3, 2010

Hello everyone. I am pretty new to this, and some of the actions of the VA make no sense to me with the C and P exams. I have a 10% rating for hypertension. To make a long story short, I was rushed into surgery Jan 12th for a six way bypass operation. That was after an abnormal stess test and heart cath. Anyway, I filed for an increased percentage. After the operation, I received a notice from the VA for an exam Jan 26, some two weeks after the operation. The day before the exam, I get a call from the VA that the appointment had been cancelled. The toll free customer service number says the claim is still being considered, and they have no idea why it was cancelled. The hospital says it means my claim will be rated no higher than what I have now. Does anyone have any experience with this? Can they settle the claim with no exam, or is it probably going to be denied, or will they schedule it later?

I have no idea what my chances are. The diagnosis says the typical things, coronary artery disease, ischemic heart disease, coronary stenosis, hypothyroidism, hypertension, and hypertipdemia. One thing is the connection to the hypertension alreay service connected.

Any thoughts or comments are greatly appreciated, and it is good to be here among vets.

March 2, 2010

Hello can anyone see this message

February 24, 2010

Any help would be greatly appreciated. I have no idea where I stand with this claim. Ten years ago I received a 10% claim based on hypertension. That was about twenty years after discharge. About four years ago, I noticed that I had to stop and rest when push mowing the yard. The symptoms were shortness of breath, fatique, and chest pain. I had a stress echo test done. It showed nothing. In 2008, I was rushed to the emergency room because of very low blood pressure. Again, a stress test showed nothing. By October 2008, I got to where my job was very difficult to do with heavier objects (mechanic for the USPS), so I retired on a regular full retirement, being eligible. (I am 57)

Anyway, one month after that, at Thanksgiving, the symptoms got so bad I could not walk to the top of attic stairs or saw a limb off a tree. I went to see my regular Dr Dec 3rd, and he sent me to a cardiologist. The cardiologist did a nuclear stress test (cardiolite). It showed a possible old heart attack and a 41% ejection fraction. He set me up for a heart cath. Jan 11th, I had a heart cath. He came out after the test shaking his head, saying there was not a thing he could do for me. I had three totally blocked arteries and three partially blocked veins. I was not even allowed to go home.

The morning of Jan 12th, I had a six way CABG operation. I am lucky to be alive, as this is my first operation. I have always been healthy until now. Since then, I have done rehab and taken the required medicine. I cannot get another job or do other things until April.

Here are some statements in the surgical report.

Pre and Post operative diagnosis: Ischemic heart disease, with coronary artery stenosis

Other results of catherization

Normal left ventriculorgram, slight inferior hypokensis. Left main normal. The left anterior descending coronary artery is 100% blocked. There is diagonal with significant disease. The left circumflex has a 60% circumflex lesion. The first obtuse marginal ws subtotal. The second was a large vessel. Coronary had 30% to 40% mid stenosis and then a 90% stenosis prior to a small postarterial vessel. In short, there are 3 vessel coronary artery disease, angina, positive stress test, and a fairly well preserved left ventricular function.

Diagnosis

Coronary artery disease

Hypothyroidism

Hypertension

Hyperlipidemia

I filed a VA claim to upgrade my 10% hypertension. They have all the records now. Any thoughts or suggestions or experience would be greatly appreciated. Oh, one other thing, I did have an appointment for an exam at Marion, IL in connection with this, but when they got some of the records, they cancelled it, and the claim is now being considered.

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