Review Of Echo And C&p

[john999]

My regular private internist reviewed my Echocardiogram and my C&P exam for heart disease from the VA. The VA examiner said No Heart Disease. However, she missed the physical evidence of HBP that the echo showed. She missed it because she refused to see it, or was so incompetent that she could not see it. My doctor looked at the Echo and checked my blood pressure and said that I needed to be on HBP meds. The heart muscle had gotten thicker than normal. This means it is pumping harder which often indicates HBP. The C&P doctor was so focused on ruling out heart disease that she never even considered this. My VA Primary never reviewed the Echocardiogram I am sure. So a potential problem was missed twice by these people that call themselves doctors. Anybody out there who is just depending on the VA to save money I say you are risking your life. You may think you are getting world class care but you are not. They don't have time or the competence to give it to you. Since I have DMII I believe I will claim the HBP as secondary. If I had not claimed DMII they would never have SC'ed it. If I had not claimed each and every secondary condition of DMII they never would have SC'ed it. This makes four secondary conditions and working on cataracts as number five that the VA has just ignored. I have to be a medical Sherlock Homes. Every time I complain about them doing something like this they retaliate by like cutting of my pain meds. I will live long enough to ^%$% on their graves.

[john999]

Jbasser

Where did you find the VA criteria to determine your LVH was 30%? I know I found it one time but now I don't know where to look. I also thought I should be at 30%. I have the exam but not all those rating markers.

[john999]

Forget it. I found it in the CFR. It looks like 30% since I have LVH. They were required to do METs testing so the C&P was inadequate. I wonder if I can get another C&P or have to wait and just NOD the decision that is coming down that will say "no heart disease" based on the c&p. I am mad because this is just the worst sort of crap they call an examination which is just a denial in the making based on a bunch of trash.

[Ron II]

Forget it. I found it in the CFR. It looks like 30% since I have LVH. They were required to do METs testing so the C&P was inadequate. I wonder if I can get another C&P or have to wait and just NOD the decision that is coming down that will say "no heart disease" based on the c&p. I am mad because this is just the worst sort of crap they call an examination which is just a denial in the making based on a bunch of trash.

From the March 2002 VA C&P Service Clinician's GuideC&P Service Clinician's Guide

C&P Service Clinician's Guide 2) Most of the disability evaluations of cardiovascular disease are based on objective tests. Therefore, exercise stress testing, for example, is commonly needed (unless one done within the past year is of record) since it is a primary basis of evaluation for many types of heart disease.

3) Stress testing and METS

Meaning of METS: One MET 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. This is the resting energy requirement. With progressive activity, the number of METs required progressively increases. For example, a workload of three METs represents such activities as level walking, driving, and very light calisthenics, and a workload of between three and five METs represents such activities as walking two and a half miles per hour, social dancing, light carpentry, etc.

Requirements for stress testing: Types of heart disease which require stress testing, and the exceptions for requirements, are listed on the examination worksheets (See B4 on HEART worksheet). Note that if left ventricular dysfunction is present and the ejection fraction is 50 percent or less, or if there is chronic congestive heart failure or there has been more than one episode of acute congestive heart failure in the past year, stress testing is not needed. Many other conditions, especially during active infection or acute stages, such as valvular heart disease during active infection also do not require stress testing.

If stress testing not done: However, when stress testing is needed, an examination will be returned for completion unless there is a medical reason why the stress testing cannot be done.

Estimation of METS: When stress testing is medically contraindicated, the examiner must then provide an estimate of the level of activity expressed in METs that results in cardiac symptoms. Charts that associate METs levels with various activities and that may be used for estimates are available in standard medical and heart textbooks.

Edited September 10, 2008 by Ron II

[jbasser]

Most examiners use the Ef as a scale for Met's.

However, in your case, with diagnosed LVH, your Met,s will not matter unless you go for a higher rating.

You can have 7 met's and it is still 30 percent. The word OR in the regs is a mighty powerful word.

Your C@P exam doc did not use the proper exam criteria for the Heart disease.

Did they do a chest Xray to determine if you have cardiomegaly?.

It amazes me how these docs rush through an exam.

J

[Berta]

John- you make a good point here that cannot be stressed enough-

make sure you all claim each and every condition that there could be SC potential for- either direct SC or as secondary to a SC disability or under 1151 if you think their incompetence caused you a disability or aggravated one you already had.

I had an unfortunate experience with a vet who insisted the VA would surely recognise his secondary conditions-

he got my phone number from the local VA Chaplain I think-

and had no representation-and had been in the claims process for quite some time already-but had only claimed diabetes.

When he got his award he was livid as they had only awarded one condition- the only one he claimed formally-diabetes-yet his actual diabetes secondarys were all ratable.

The VA will not connect the dots- if a vet has even obvious secondaries (as many diabetes vets do) the VA will only adjudicate what they formally claim.Once in a while and this sure doesnt happen often, the VA will pick up on an obvious secondary and rate it.

The vet would not amend his original claim to add his additional disabilities.

It looked to me that he would have to re-open a new claim for the secondarys and lose the EED retro he would have had- if he had added them to the initial claim.

[71M10]

John,

If you are SC for any Repiratory problems look over the rating schedule. Right ventricular hypertrophy is quite often a 100% rating.

Best regards,

Tyler