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Notice Of Disagreement--cardiac Rating

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Ron II

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Re: Sick Sinus Syndrome with Sinus Bradycardia, Status Post Pacemaker

I changed my mind about not appealing one portion of my claim. I was pleased that the VA approved the disability shown above; but upon reading the text of the Rating Decision, I discovered that I had overlooked the fact that the VA rated my METs (One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute) at greater than 7.

The most recent treadmill test,from three years ago, shows my METs as 6.2. The difference between great than 7 and less than 7 is 20 rating points (10% vs. 30%). Soooo...does anyone here have experience with type situation? Should I pay for my own stress test?

Thank you.

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Manitou - How was the 7 determined? Was it based upon a new C/P? If so once again I ask how did they determine the mets was 7+? I would first point out that the official VA stress tess was rated at 6.2 vs paying for a private stress test. And during the time you NOD is pending based upon this argument I would push hard to have your treating VA Doc to redo the stress test. Maybe just the argument that the official stress test rated it at 6.2 may be enough to make the DRO to order a new C/P including a new stress test. I think this would be a good start unless you just have some dollars lying around that you want to spend.

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Re: Sick Sinus Syndrome with Sinus Bradycardia, Status Post Pacemaker

I changed my mind about not appealing one portion of my claim. I was pleased that the VA approved the disability shown above; but upon reading the text of the Rating Decision, I discovered that I had overlooked the fact that the VA rated my METs (One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute) at greater than 7.

The most recent treadmill test,from three years ago, shows my METs as 6.2. The difference between great than 7 and less than 7 is 20 rating points (10% vs. 30%). Soooo...does anyone here have experience with type situation? Should I pay for my own stress test?

Thank you.

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The 6.2 METs was the result of a stress test done by a private physician in Houston in Dec 2003 (I'm covered by TRICARE as I retired from the Army after 23 yrs). The results of that test are in my c-file.

I don't know how in the heck they said I had METs greater than 7 since the VA never gave me a

stress test--I was examined and interviewed by a VA doctor. I guess he had ESP.

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think back to the interview. sometimes they will place met determinations on what you reported in the interview ie.... how far you can walk before coming tired, you say you play tennis, you mow the lawn etc......

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"Should I pay for my own stress test?"

Yes, at least what Tricare or your insurance does not pay. You may find that your Left Ventricle Efficiency (LVEF) is such that you are entitled to a higher rating than that based upon the MET alone. Bradycardia & a pacemaker make me think that using the appropriate scheduler table with LVEF <30% may get you to 100%. There are different types of stress tests. I usually take one that is chemical based, and uses a computer controlled sonic scanner. This can be used to establish LVEF or overall EF.

The first treadmill stress test years ago almost did me in. The Dr. did not listen when I told him that I was in trouble. Lesson: Never take a treadmill test unless you have a "kill switch" in hand, and test to make sure that it works.

Re: Sick Sinus Syndrome with Sinus Bradycardia, Status Post Pacemaker

I changed my mind about not appealing one portion of my claim. I was pleased that the VA approved the disability shown above; but upon reading the text of the Rating Decision, I discovered that I had overlooked the fact that the VA rated my METs (One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute) at greater than 7.

The most recent treadmill test,from three years ago, shows my METs as 6.2. The difference between great than 7 and less than 7 is 20 rating points (10% vs. 30%). Soooo...does anyone here have experience with type situation? Should I pay for my own stress test?

Thank you.

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Thanks to all for the helpful comments. BTW, during my examination interview I was NOT questioned about fatigue, tiredness, activities, etc.

At first, I was pleased as punch at the 10% rating since it had been denied once before. However, once I saw the "greater than 7 METs" basis for the rating I decided to file a NOD.

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