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  1. DC APPEALS remanded the claim back to the VARO- C&Ps .Apparently they can read at appeals in DC.the hearing was a year ago last december at St.Paul a traveling judge. Up until now they have ignored connecting the heart and hypertension . I guess I sent to much on the contamination in GUAM. SO now i,ll send a little more on our nas well and TCE and as the crow flys we were located about 6 miles south of THE POLLUTED ANDERSON AIR BASE Hi all just a update on my heart appeal and how the government squirms around to NOT have to connect it to chemicals and all the other contamination in GUAM. I was sent for a heart cp and I will copy the medical opinion from the VA C&P. They will pick the lesser of 2 evils. COMPENSATION AND PENSION EXAMINATION MEDICAL OPINION ========================================= A NON-STANDARD MEDICAL OPINION WAS REQUESTED. PROVIDERS RESTATEMENT OF REQUESTED MEDICAL OPINION.THIS IS NOT THE MEDICAL OPINION ITSELF. RESTATEMENT OF OPINON REQUEST :The reviewer should provide an opinion as to whether it is at least as likely as not(50%or greater probability) that the Vetern's currently diagnosed CAD is traceable to the vetern's active military service,to include exposure jet fuel,herbicides,pesticides,ground water contamination ,or any other in-service chemical exposure :or in the alternative, whether it is at least as likely as not (50% or greater probability )that the Veteran's currently diagnosed CAD was caused or made chronically worse by by his service-connected glomerulonephritis with hypertension.The examiner must provide a complete rational for each opinion expressed. records reviewed OPINION: 1)It is my opinion the question of whether it is at least as likely as not (50% or greater )that the Vetran's currently diagnosed CAD is traceable to the veteran's active military service , ,to include exposure jet fuel,herbicides,pesticides,ground water contamination ,or any other in-service chemical exposure cannot beanswered without resort to mere speculation. 2) It is my opinion that it is at least as likely as not(50% or greater probability) that the Veteran's currently diagnosed CAD was made chronically worse by his service-connected glomurelonephritis and hypertension. RATIONAL FOR OPINION GIVEN : 1) I have reviewed the C-file including the literature the veteran provided. I also discussed the issue of toxin exposure and coronary artery disease with a cardiologist and reviewed the literature regarding the etinology of coronary disease on line: Other than the presumed association of agent orange and ischemic heart disease I know of no authoritative medical literature that would support or deny an association of chemicals/toxins and coronary artery disease as claimed by the veteran.The information to make an informed opinion regarding this question is not available.Further, the type and formof all the chemicals/toxins, the method and the duration of exposure cannot be clearly identified and quantified in this case.It is presumed this veteran does not meet the criteria for Agent Orange exposure as this is not a request for evaluation of a presumptive service connection for ischemic heart disease. 2) The National Kidney Foundation in 2002 and the American College of Cardiology/American Heart Association 2004 task force have presented practice guidelines thatinclude chronic kidney disease as a risk factor for,and an accelerant of ,coronary artery disease. This vetern's service connected hypertension has been long standing and frequently in poor control. ========================================================================= . They dont want to open a can of worms in GUAM---- I sent enough information for two paths to follow.Lookslike they are choosing the heart and hypertension. They put the MET's at 3 - 5 so maybe thats the 60% plus a couple 10 %. sorry this is long - start another wait -this has been in the system since 2006 and 2007 ---------------------- STEVE & PAT
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