Notice Of Disagreement--cardiac Rating

[Ron II]

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.

[stillhere]

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

[Ron II]

"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...

[Boats]

here you go under exams

also the link to it

http://www.vba.va.gov/bln/21/Benefits/exams/disexm28.htm

Boats

Heart

Name: SSN:

Date of Exam: C-number:

Place of Exam:

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

Past history - describe onset of disorder and frequency of cardiac symptoms, including angina, dyspnea, fatigue, dizziness, and syncope. Record dates and severity of episodes of acute cardiac illness, including myocardial infarction, congestive heart failure, and acute rheumatic heart disease. Describe all cardiac surgery, including coronary artery bypass, valvular surgery, cardiac transplant, and angioplasty.

Current treatment - type, dosage, response, and side effects.

With the exceptions given below, examinations for valvular heart disease, endocarditis, pericarditis, pericardial adhesions, syphilitic heart disease,, arteriosclerotic heart disease, myocardial infarction, hypertensive heart disease, heart valve replacement, coronary bypass surgery, cardiac transplantation, and cardiomyopathy, require the examiner to provide the METs level, determined by exercise testing, at which symptoms of dyspnea, fatigue, angina, dizziness, or syncope result.

Exercise testing is not required for the above listed conditions in the following circumstances:

a. If exercise testing is medically contraindicated:

In that case, provide the medical reason exercise testing cannot be conducted, and

Provide an estimate of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing, or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope.

If left ventricular dysfunction is present, and the ejection fraction is 50 percent or less.

If there is chronic congestive heart failure or there has been more than one episode of acute congestive heart failure in the past year.

With valvular heart disease - during active infection with valvular heart damage and for three months following cessation of therapy for the active infection.

With endocarditis - for three months following cessation of therapy for active infection with cardiac involvement.

With pericarditis - for three months following cessation of therapy for active infection with cardiac involvement.

With myocardial infarction - for three months following myocardial infarction.

With valve replacement - for six months following date of hospital admission for valve replacement.

With coronary bypass surgery - for three months following hospital admission for surgery.

For cardiac transplantation - for indefinite period from date of hospital admission for cardiac transplantation.

If an exercise test has been done within the past year, the results are of record, and there is no indication that there has been a change in the cardiac status of the veteran since.

For hyperthyroid heart disease, if atrial fibrillation is present, use arrhythmia worksheet. Also use endocrine worksheet if examining for hyperthyroidism.

Describe the effects of the condition on the veteran's usual occupation and daily activities.

Even when special examinations and tests (e.g., exercise testing) are not required under the worksheet guidelines, they may be requested or conducted at the discretion of the examiner, when the examiner believes that the available information does not fully reflect the severity of the veteran’s cardiovascular disability.

C. Physical Examination (Objective Findings):

Address each of the following and fully describe current findings:

Heart size and method of determination, heart rhythm and rate, heart sounds, blood pressure.

Evidence of congestive heart failure - rales, edema, liver enlargement, etc.

D. Diagnostic and Clinical Tests:

Chest X-ray, EKG, exercise stress test, echocardiogram, Holter monitor, thallium study, angiography, etc., as appropriate, and as required or indicated.

Include results of all diagnostic and clinical tests conducted in the examination report, including status of left ventricular function, if measured.

Valvular heart disease and endocarditis require documentation of diagnosis by physical findings and either echocardiogram, Doppler echocardiogram, or cardiac catheterization, if not already of record.

Other types of heart disease must be documented by appropriate objective diagnostic tests.

E. Diagnosis and Opinion:

Type of heart disease and etiology, if known.

Type of surgery, if any, and results.

If the veteran is service-connected for rheumatic heart disease and later develops non-service-connected arteriosclerotic heart disease, state, if possible, which cardiac findings can be attributed to each condition. If it is not possible to separate the signs and symptoms of one from the other, so state, and explain.

Signature: Date: