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.

[donews]

Thank you all for the replies.

I found something on the internet called the "Veterans Specific Activity Questionnaire". It appears to give a good example of what activity levels equals what METs.

If you believe what the VA says I currently can mow my lawn and rake the leaves. You betcha, sure I can.

I also found several scientific cardiac studies that use the same VSAQ for a basis in several studies.

It appears from everything I can find that this is a fairly accurate picture of METs.

So I am going to take this information to my Non-VA Cardiologist (From the Hospital) and to my VA Cardiologist and plead with them to write up something saying what they would rate my METs at. I will take a preprinted form just to make it a little easier for them (I hear sometimes they are more wiling to sign a form if you have it ready to go).

I am attaching a copy of the VASQ for you all to view and use if needed.

Currently I should Service Connected fo Heart Conditions under the following codes:

7005 Arteriosclerotic heart disease (Coronary artery disease):

7006 Myocardial infarction:

7017 Coronary bypass surgery:

7020 Cardiomyopathy:

7011 Ventricular arrhythmias (sustained):

Under each one of these I qualify for the 100% rating no matter how I look at it. Also under the 7011 I qualify because I have an AICD Implant and have had it since 2003, the VA replaced it this past summer due to the battery running dead.

I have medical records that show an Ejection Fraction of 24% in 2004 and 22% in 2007 and 22% in 2008. I also have records showing CHRONIC CONGESTIVE HEART FAILURE going back to 2004.

I see 3 big problems with this so far:

#1 - I just decided to take another look at my latest coding sheet. They have all of the above conditions listed under ONE rating code 7005 and thats it. I have no clue how thats possible.

Is this allowed? How can I fight them using one rating code for six conditions that all have separate ratings in the schedule? I know they are lumped together at some point due to them all being heart conditions, but they each have separate criteria ie 7011 and my AICD implant. If its rated under 7005 an AICD means nothing.

#2 - They have these conditions as Aggrivated by not secondary to DMII.

I guess my doctors opinoion wasn't worded strongly enough to get as Secondary to instead of Aggrivated by. CAn this be fixed with another IMO or more solid wording?

#3 - Even at that I still qualify for the 100% rating.

I have an IRIS inquiry in asking for a hearing/ meeting/ whatever with the DRO to point out the evidence that they clearly has made a mistake in the rating. YEs I know its asking from a pile of %$#$ to turn into gold, but I was hoping to avoid a long drawn out battle to fix this since it is an obvious boo boo. Yes I am allowed to dream now and then.

I also noticed they claim I never sent in private medical records for them to review, but the VA Medical Records show my low EF and Chronic Congestive HEart Failure and they are the ones that replaced my AICD. I asked my VA Cardiologist and he double checked and verified that the VA Records show this already. Either way I sent them in and will resend them again (have signed receipt from first time) and take them to my hearing / meeting if I get one.

I know this might be vering off my original title, but I get more questions each time I dig into my C-File, but it still has to do with my Heart so not too far off I don't think.

Veterans_Specific_Activity_Questionnaire.pdf

[danang_1969]

I also have a claim for aggravation of coronary heart disease secondary to PTSD. C&P Dr. asked questions about my smoking history :P . Also I have a hypertention claim as secondary to PTSD. Decision pending.

Danang_1969

[fixit835]

Well, it seems like the VA is extremely reluctant to award 100% rating for heart conditions. I too received the 60% rating only 3 months after the Army medically retired me after 16 years of sevice with 100% rating for non- ischemic chronic congestive heart failure due to DCM (dilated cardiomyopathy) with left bundle branch block, LVH and an ejection fraction of 20% - 25%

While waiting for the VA decision on my claim I was (am) under the care of a civilian cardiologist and oddly enough had an echo on April 8th, 2008 showing NO IMPROVEMENT with an ef in the low 20's yet just ONE day later my C&P echo, according to the VA, showed enough improvement (ef 25 to 30) to justify a 60% rating.

Just like donews, my METS were "estimated" to be somewhere between 3 and 5....

The person asking the questions concerning my activities ( i have to doubt she was a doctor) obviously has no clue how to interpret everyday activities and convert them to METs since I can't even take a long shower without having to rest, but I somehow can mow the lawn...negative!

I found a METs table at www.heart.org

Here's a short excerpt:

Moderate activity 3.0 to 6.0 METs*

The following is in accordance with CDC and ACSM guidelines.

Walking at a moderate or brisk pace of 3 to 4.5 mph on a level surface inside or outside, such as

• Walking to class, work, or the store;

• Walking for pleasure;

• Walking the dog; or

• Walking as a break from work.

Walking downstairs or down a hill

Racewalking—less than 5 mph

Using crutches

Hiking

Roller skating or in-line skating at a leisurely pace

Bicycling 5 to 9 mph, level terrain, or with few hills

Stationary bicycling—using moderate effort border

Aerobic dancing—high impact

Water aerobics

Calisthenics—light

Yoga

Gymnastics General home exercises, light or moderate effort, getting up and down from the floor

Jumping on a trampoline

Using a stair climber machine at a light-to-moderate pace

Using a rowing machine—with moderate effort

Gardening and yard work: raking the lawn, bagging grass or leaves, digging, hoeing, light shoveling (less than 10 lbs per minute), or weeding while standing or bending

Planting trees, trimming shrubs and trees, hauling branches, stacking wood

Pushing a power lawn mower or tiller

(list continues)

Quote:

Any activity that burns 3 to 6 METs is considered moderate-intensity physical activity.

Any activity that burns over 6 METs is considered vigorous-intensity physical activity.

From a different source: A slow walk is 2 mets

So how does not being able to walk a short flight of stairs (6 to be exact), or taking a long shower, or getting dressed without getting dizzy or fatigued translate to 3 to 5 METS????According to the VA rating I should be able to do most of the activities on that list and I certainly wish I could do just one of those things, but the sad truth is I CAN'T, something that is rather hard to swallow for me being only 38 years old and having to rely on my wife to do everything in and around the house.

While the VA in not so many words congratulates me on my health improving, my cardiologist, who is extremely concerned about my condition, has me scheduled for ICD surgery in two days and is working to get me put on the heart transplant list. What a slap in the face by the VA. I will also file a NOD early next week....for what it's worth!

[jbasser]

An ejection fraction of 24 should be 100 percent. IDont care what the Mets are. It is just a formula to give the raters reason for lower ratings.

Let them know that you are aware of the regs. 100 percent criteria. Notice the word OR folks.

The rest of this does not mean crap. Or is the rule. Ef of less than 30 percent.

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