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Notice Of Disagreement--cardiac Rating


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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  • HadIt.com Elder

"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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There is one way to have the actual mets measured.It is risky but here is how to get it done. Find an outside cardiologist amd get a second opinion. If you have a family history of MI, then you may be given a Heart Cath. The heart cath over rules any evidence in the file for it is an actual true measurement. Some folks cant do this because they have no insurance.

J

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I will consider going to an outside cardiologist for a supporting medical opinion. Hmmm...I think I will pass on the heart cath.

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You might want to let the outside cardio dr decide if you need a cath or not. After I had a cardio stress test I was schedueled for one and they found a 90% block so more than likely saved my life!

Stillhere

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  • HadIt.com Elder

My outside internist says that stress tests are not much good unless you have symptoms already. Stillhere, your comment about a blockage worries me. Were you having chest pains?

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  • HadIt.com Elder

Last September I was required to take a stress test to be cleared for surgery. 5 days later I had angioplasty and a intervention procedure that placed a stent for one artery 90% blocked.

Funny how I could go from ok in Feb 2006 to 90% blockage in Sep 2006 but that is the difference between the VA and private Medicine.

Now the VA wants to take me off Plavix and I have to get another prescription from my Cardiologist who told me I would have to be on Plavix for the rest of my life. The VA says it has a study that they won't show me that proves you don't need Plavix after a year.

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In case others with heart problems are checking this cardiac thread, here's a point I want to add: sometimes the ejection fraction can be normal, but a diastolic dysfunction is causing right-side heart failure.

Heart failure may be noted as CHF or HF on the medical record, but a recent change has heart failure noted as HF and chronic heart failure as CHF. The chronic part in heart failure meets the 100% rating.

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John999

Yes and no, i suffer from PN and diabetes2 I have pains and then I don't have pains, I know real confusing. But to answer your question better agina was present and I had been popping the nitro and counting never got to the 3rd one and call 911 but I did take a couple a few times. my problem my doc says is I don't react to pain properly. what ever that means.

Stillhere

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  • HadIt.com Elder

Pete, they did it to me also, no more Plavix, the VA only gives it for one year now, they claim you get the same benefit from an aspirin a day that you get out of Plavix

I have argued it with 2 VA doctors now, and they refuse to write an exemption for it cardiology has to do it and they won't my VA doctor did write me a script for Wal Mart but it's not generic yet and they wanted 150 a month

I have seen the study and it does exist I will see if I can find a link for you, but they aren't lying to you

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  • HadIt.com Elder

I hear the cheapest place to get drugs here in the States is Costco. You might get the stuff you need from a Canadian drug store. Plenty of people do it. Maybe a trip to Mexico since you are in Texas. You need a script from a US doctor to bring it in I believe. I would want to check on that.

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hey testvet do you have only stents or do you have stents and bypass or just bypass? Reason i ask the formulory for VA states if you have had stents metal ones then you can stay on Plavis if bypass then you only get it for 90 days. I would talk to an outside cardio doc and get his recommendation. You are right though Costco has the best price for most drugs. I have to take Coreg and VA has never covered that so I pay for it my self. Whew!

Stillhere

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  • HadIt.com Elder

right stents are 90 days but bypass is a year I had the bypass done in Feb 1997 3 vessel and the stents were placed in August 97 and Nov 1997 the only vessel still pumping blood to my heart is the left main if it shuts down or gets clogged I'm gone they refuse to operate on me the bypasses are closed off to close to the wall of the heart the stents can't be opened so I have to keep the blood pumping and my heart doc and PC doc both felt that Plavix would at least keep the blood slippery and less chance of another clot it was explained to me it works like Mobil One oil just keeps the stuff flowing since surgery isn't an option they just want the blood to keep going.....but I am on so much heart stuff and aspirin if I get cut I bleed for a long time so clots seem to be a slim chance and I have my cholesterol under control for the first time on 10 years the bad is 74 and the good was 54 the last time they checked it the Doc said it was to low hell for years it was over 300 for both of them so it's on the good side of bad if you ask me they told me with congestive heart failure 8 years for life expectancy is normal and I am past that..:huh:

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Test, sounds like you are doing preety good and they should keep you on the Plavix as long as you can. I had another stent (metal) right side in March and like you have others with smaller blockages on the other side of the heart. They have said my next stop would be bypass but trying to put that off for about 5 years.

My blood numbers looked good also last time except for anemia showing up. Now taking B12 shots once a week for a month then they will decide what to do.

I put in for an increase for the heart, PN and the anemia BS last April and still waiting to hear anything.

Apologize for hi jacking thread!

Stillhere

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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.

While at a local hospital to have my six-month pacemaker checkup, I decided to visit my cardiologist's office to schedule a stress-test (I am covered by Tricare). I will have the test in January, approximately four months after I filed a NOD for a 10 percent rating for sinus bradycardia where the METs were "approximated" at 7 (under 7 is 30 percent). I suspect that my NOD will be reviewed no earlier than March '08, if that soon.

As I stated in a post in September, my last stress test (Dec '03) showed my METs as 6.2 which is the basis of my NOD. My question is: if the January 2008 stress test shows my METs to be less than 7, should I forward this to the DRO or wait until the decision is made based on the already existent paperwork the VA has which shows the METs under 7? I suspect I should mail it to the VA, but I'm not sure... I think I read somewhere that a stress test must be within 12 months of a rating for it to be valid. My Dec '03 stress test was outside the 12 month window.

I appreciate your comments...

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