Echocardiogram

[Ron II]

Ron, if you meet the criteria for a higher rating for heart disease, It should be a no brainer. The Ratings are based on Test results and the ratings are based on the Ejection fraction, Congestive Heart Failure and other information. The most significant test is a Cardiac Catherization. It is an actual person looking inside and taking the measurements.

For example, You have a heart Echo and your EF is 55 percent, You then have a heart cath and it shows your EF at 50 percent. The VA has to go with the Heart cath. It overrides other test results.

J

Hi Jbasser,

I don't have the EF at the rates you mention, but the Echo showed LVH. Isn't that enough to receive a 30 percent rating? Please see the extract from my appeal below, which was partially written by our own Ricky .

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On January 23, 2008 an Echocardiogram (EC) was conducted by Colorado Springs Cardiologists and interpreted by Dr. David A*******. As a result of the testing, Dr. A****** provided a diagnosis of Concentric Left Ventricular Hypertrophy (LVH). This new evidence is an independent medical opinion/examination the VA did not have when they made the previous decision and the evidence bears directly on the issue of why it was previously denied. Your denial included the necessity (for a rating of more than 10 percent) for several medical values including, “A higher evaluation of 30 percent is not warranted unless...or evidence of cardiac hypertrophy or dilation on..., echocardiogram, or X-ray.”

The January 23, 2008 Echocardiogram is the most accurate assessment of my current level of disability and actually supports my contention that my condition has become worse since my 2003 stress test. If nothing else, the new and material evidence shows Concentric Left Ventricular Hypertrophy (LVH) on January 23, 2008. Additionally, since December 2003, there are two pieces of evidence now, the 6.2 METs evaluation and the LVH finding that support a 30 percent rating. It seems that “...reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present .”--now portrays a picture involving multiple tangible medical views warranting 30 percent, and nothing tangible since 2003 that supports a 10 percent rating.

Although my 2003 METs pre-dates my original claim by several years, it does provide a bookend along with the Echocardiogram (which directly bears on the level of disability) to support a higher rating, especially since

no other tests were done between the two elements—past medical report and current finding. As stated above,

the “consistent picture” is tangible.

-----------------

Ron

p.s.

I don't think I have a case for retro past January 23, 2008, but it seems that date should be approved at 30-percent without a problem. For my heart, I am currently rated at 10 percent for cardiac pacemaker. That rating was made retro to my claim of Aug 2006.

[Testvet]

I have an echo scheduled for May 7th my last cath showed an EF of 25% and 2 of my stents being closed off with no surgical solution this was done in Oct 2002, I think the VARO is dragging their feet on my heart claim hoping I kick the bucket before it gets adjudicated. I am expecting another denial after the May 7th appt then my lawyer will appeal the claim to the BVA where similar claims to mine are approved all the time now using DR Bosarino's study as a factor when the cardioligist writes the appropriate nexus statement which mine has done.

[Berta]

Yes Mike-they sure have used Dr. Boscarino's findings to award PTSD to heart claims-

I referred to his studies long ago in another claim I have and I also used a study by a VA cardiologist.

There is absolutely no doubt in my mind that VA -when they realised the Bath VA had not diagnosed Rod properly- continued the cover up at the Syracuse VA.

It is one thing to know they did admit and pay for some of their medical errors but another thing to realise that they also misdiagnosed diabetes from Agent Orange-(my present claim and IMOs support that).

Some VA doctors will take the steps-when they realise malpractice has occurred-to save the veteran's life ( they did in case of a good friend of mine-and they did award 100% plus SMC for their medical errors (he didnt want to file FTCA but I prepared the 1151 for him.)

The VA did save his life when they realised he had been misdiagnosed by the Bath VA but the fact remains that they did shorten his life expectancy.

Only one single VA doctor wanted to rule out diabetes in my husbands case-and he was overruled by the other doctors.

A finding of diabetes at that point could have opened a can or worms and a potential FTCA case at that time.

It was easier to let the veteran die -they never dreamed the widow would find out what they did.

Everyone should know what your medical records contain. If something in them seems odd or you have questions about it- pursue it until you get an answer.

The only reason I even pursued this case was that Rod himself had filed a 1151 claim 6 months before he died.He insisted-even hours before his death-that I pursue that claim.

He believed as stated in his claim that the VA would kill him, with improper medical care.

He was right.

I am outraged at the VA's inability to assess and properly cope with the suicide problem in veterans.

I think many of these veterans are not getting the adequate care they need.

If the VA truly does have professionals who can assess potential suicidal veterans-why are these vets being turned away from VA or being forced to wait weeks and months for appointments?

If a veteran becomes suicidal how does the VA justify that the veteran has to wait for an appointment down the road when that veteran obviously needs immediate mental health care?

The hot line is a crock of crap-

they try to talk a suicidal vet down.

I have been there, done that-

what good is it if the suicidal ideation returns and becomes so strong that the veteran acts on it?

What gets me is that there is some outrage in the veteran's community over the VA emails that continue to reveal how the VA hushed up this whole matter.

Some outrage- but there isnt enough outrage-

anyone with a mental disability could potentially develop suicidal ideation-

It seems that the VA's position is-if you are thinking of killing yourself-hold that thought until we can find a shrink in a few weeks to help you.

Many veterans are dead today because the VA has failed to treat them properly before they took their own lives.

Their family members should sue the VA and contact the media.

[cowgirl]

Hello 68, dont know if I welcomed you. Thanks for answering my inquiry. Do you have a claim in or a rating for cardio? Don't recall that mine is connected beyond 0%.

cg

EF =

ejection factor- they measure how well the left ventricle is pumping blood out. They told me that due to my heart attack that caused some heart muscle damage that my EF was 40%

68chstiger

[carlie]

68chstiger & all,

Welcome. Just need to correct something minimal in this thread.

EF - is not Ejection Factor.

EF - is Ejection Fraction (EF) is the fraction of blood ejected by the ventricle relative to its end-diastolic volume.

The reason it is FRACTION is because it is a mathmatical percentage.

carlie

[Ron II]

Hey Ron,

I'm not jbasser just sharing info..

6 years ago my EF was 36 % and I really felt like crap, digoxin had

so many side effects, I'm off that and doing better now.

This doesn't answer your question, just kind of letting you

know health wise - I know how you feel, I'm always tired.

carlie

Hi Carlie,

Thanks for your comment-- I feel like cr*p all the time. It's a struggle to go out and pick up the newspaper each morning...

Ron

[Ron II]

Ron- you might present a disability that is higher then the 30%:

from:http://www.va.gov/vetapp08/files1/0806493.txt

"The veteran's CAD has been rated as 30% disabling under the

provisions of 38 C.F.R. § 4.104, DC 7005. Under

that DC, a 30% rating is assigned when CAD is productive of a

workload of greater than 5 metabolic equivalents (METs) but

not greater than 7 METs that results in dyspnea, fatigue,

angina, dizziness, or syncope; or evidence of cardiac

hypertrophy or dilatation on electrocardiogram (EKG),

echocardiogram, or X-ray. A 60% rating requires more than 1

episode of acute congestive heart failure (CHF) in the past

year; or a workload of greater than 3 METs but not

greater than 5 METs that results in dyspnea, fatigue, angina,

dizziness, or syncope; or left ventricular dysfunction with

an ejection fraction (EF) of 30% to 50%. A 100% rating

requires chronic CHF; or a workload of 3 METs or less that

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

or left ventricular dysfunction with an EF of less than 30%."

My point is- it might pay for you to access some BVA decisions to see how they determine these ratings for CAD-

the ECHO you have clearly shows the LVH and the dilation readings could also help prove your evidence warrants a much higher rating.

"A higher evaluation of 30 percent is not warranted unless...or evidence of cardiac hypertrophy or dilation on..., echocardiogram, or X-ray"

I think you might fit into the 60% criteria.

The ECHO report you have should have statements as to findings next to Aortic root,LA and LV chamber, statements as to any hypokinesis and Akinesis.

The M-Mode measurments should be there too.

I

That ECHO you have might well show the dilation factor that the VA mentioned.

What is the 40% for- 10 for the Pacemaker- but how did they award 40%?

Hello,

1. The 40 percent is for: 10% pacemaker, 10% asthma, 20% diabetes II --AO caused.

2. The METs of 6.2 was not allowed since the test was given more than one year prior to my claim.

My NOD addressed this issue, but was denied. I was not given any heart-related test during my C&P. The examiner evidentally had ESP (N).

3. My appeal to the NOD denial (actually new and material evidence) is the ECHO which shows

hypertrophy (LVH) which appears to be enough to rate 30 percent (without EF at any prescribed level).

4. In addition to receiving an increased rating for the heart problem, I hope to have the EED for the higher rate retro to the date of my claim since I did not receive an exam and the 6.2 METs and LVH bookend the originial date of my claim. Again, I did not have a test for my current METs--it was "assigned" by the C&P examiner. The NOD denial stated "we have rated your disability using all information available to develop a consistent picture of your current condition." That is why I am emphasizing with my new evidence the bookend aspect of my condition.

5. If I had a METs test today I suspect it would be around 5 or less. In any case, if they approve

30 percent retro only to the date of the Echo (Jan 08), I will be satisfied.

Thanks for your comments,

Ron