Heart Disease Rating

[donews]

Does anyone know of a website or any other place I can go to determine what my METs would be?

In the VA Rating Decision and the VA Rating Schedules they rely on a form of measurement of Heart Disease called METs (Metabolic Equivalents).

The problem being that every private cardiologist I called (8 of them) do not use this method and none of them have actually any knowledge of its usefulness.

They all use the New York Heart Association scale.

Even my VA Cardiologist doesn't use METs to measure cardiac function nor does he know how it is measured or what use it has in evaluating heart function.

I can find little so far through google to help me compare my current NYHA Class III rating to METs.

The VA said I was rated at 4 mets and that is one of the reasons they said I am only 60% instead of 100% for my hearty diseases.

I ran through my C-File real fast and found during one of my C&P exams the doctor said I was 3 to 4 mets at the most. Wouldn't you know the VA used the 4 instead of the 3 when rating me.

Any help would be greatly appreciated.

[Ron II]

Hi,

I think the METs rating goes from 3 to 5 in the ratings. In other words, based on the info you provided, 60 percent is the correct rating. Ron

More than one episode of acute congestive heart failure in the past year,

or; workload of greater than 3 METs but not greater than 5 METs

results in dyspnea, fatigue, angina, dizziness, or syncope, or;

left ventricular dysfunction with an ejection fraction of 30 to 50

percent 60

See §4.104 Schedule of ratings—cardiovascular system.

Diseases of the Heart

Rating

Note 1: Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.

Note 2: 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. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner 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 may be used.

§4.104—Schedule of ratings–cardiovascular system

Edited March 5, 2008 by Manitou Sprgs

[Ron II]

Hello,

I should add that I have a NOD pending (actually an appeal to the SOC). I was "assigned"

a METs factor of 7 or higher without any testing. My last treadmill was 6.2 METs. Anyway, I have had an Echo that shows LVH which should qualify me for 30 percent rather than 10 percent.

My cardiologist does not evaluate using METs either. But...I was told that if I really needed them he could convert or interpret the various tests I've recently taken to give a METs score.

Evidentially METs is an archaic method.

Good luck,

Ron

[donews]

Hi,

I think the METs rating goes from 3 to 5 in the ratings. In other words, based on the info you provided, 60 percent is the correct rating. Ron

More than one episode of acute congestive heart failure in the past year,

or; workload of greater than 3 METs but not greater than 5 METs

results in dyspnea, fatigue, angina, dizziness, or syncope, or;

left ventricular dysfunction with an ejection fraction of 30 to 50

percent 60

See §4.104 Schedule of ratings—cardiovascular system.

Diseases of the Heart

Rating

Note 1: Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.

Note 2: 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. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner 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 may be used.

§4.104—Schedule of ratings–cardiovascular system

Ron,

Thank you for the information. I appreciate the time you took to look it up.

Their C&P person said 3-4 Mets.

I absolutely think he is nuts.

I am just looking for something to use as a comparison scale to give the cardiologist so they can feel confident giving me a METs rating or so I can show the VA that NYHA Class III should be 3 Mets or less.

So far everything I have found should put me at a METs of 1-2.

I can not even get dressed without stopping to rest due to shortness of breath.

The one chart I just found so far shows a person with 4 METs should be able to mow a lawn and a person with 3 METs should be able to walk 1-2 blocks at a slow pace without having shortness of breath.

I can not do any of that for sure.

I did not have a treadmill test either. Their C&P doctor did an estimated METs, I have no clue what he based his estimate on.

I just pray I can convince my VA Cardiologist or maybe the Cardiologist from my last stay in the Non-Va Hospital to write something saying I have METs of 1 or 2, which is what I really am at.

I forgot to mention in my first post that I meet all the other criteria individually for the 100% rating, I have Chronic Congestive Heart Failure, an Ejection Fraction of 22%, and an AICD Implant Device from a Ventricular Arrytmia.

In the Schedule of Ratings it says :

Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent

I am taking the OR in the above statement to mean I only need to meet one of the 3 criteria.

Even if I take their C&P into account I meet 2 of the above criteria, I am just trying to get the METs rating on paper from other doctors so that I can prove I meet all 3 criteria just to leave them no wiggle room.

I have learned if you leave the VA wiggle room, they will slip whatever they can by.

[Ron II]

In the Schedule of Ratings it says :

Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent

I am taking the OR in the above statement to mean I only need to meet one of the 3 criteria.

Even if I take their C&P into account I meet 2 of the above criteria, I am just trying to get the METs rating on paper from other doctors so that I can prove I meet all 3 criteria just to leave them no wiggle room.

I have learned if you leave the VA wiggle room, they will slip whatever they can by.

Hi,

Yes, you have to meet only one of the criteria. One semantic that is important is "3 METs or Less." If your workload is "3.1 to 4 METs" it is a lower percentage.

My VA C&p guy must have used ESP to rate my METs. Like you, I was not given any test.

The only thing I can offer is that my cardiologist (private) was willing to interpret my other tests to give a METs rating--that became unnecessary when it was found that I have LVH (on Echo).

I did find a couple of things on the Internet regarding the METs and the test/standard you mentioned. If you put both terms into Google, you should be able to find them. If you have any trouble let me know.

Ron

[jbasser]

Don, You should be rated at 100 percent with that low of an ejection fraction and Congestive heart failure.

The Rater is purposly low balling this and they know it.

It can also be considered a misapplication of the regulations concerning the actual rating.

Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent

Notice it does not say and, It says Or. If you meet 1 of these it is a 100 percent rating. You meet 2 of these.

[Guest morgan]

The key to the congestive heart failure element in the 100% criteria is the word "chronic."

Someone recently told me that the abbreviation for congestive heart failure used to be CHF, now it is HF and the CHF is reserved for chronic heart failure. Whether this has been passed along to the rating specialists is anyone's guess.

Edited March 5, 2008 by morgan