Thanks To Wings And Hoppy

[bm6546]

Wings and Hoppy,

You both are providing some excellant information that I am trying to absorb and understand. I am keeping all the information that you two are posting and will take this information to my VSO when the VA responds to my NOD. I sent an IRIS e-mail a few days ago and got this response:

"Our records indicate that your appeal for increase and service connection due to supraventicular arrhythmia is open and in process at the Oakland Regional Office. We are unable to determine whether your documentation has been added to your claim folder. We are only able to access your electronic files through our inquiry system."

It appears they have now changed my diagnosis from PAT (Paroxysmal Atrial Tachycardia) that I have been SC for over 40 years and changed it to Supraventicular Arrhythmia. Not sure what this means or if it will help or hurt my claim. This whole VA process is very confusing and frustrating. It's enough to give anyone an anxiety disorder or depression or at the very least, Supraventicular Arrythmias.

Thanks for your help. Brian

[jbasser]

Wings and Hoppy,

You both are providing some excellant information that I am trying to absorb and understand. I am keeping all the information that you two are posting and will take this information to my VSO when the VA responds to my NOD. I sent an IRIS e-mail a few days ago and got this response:

"Our records indicate that your appeal for increase and service connection due to supraventicular arrhythmia is open and in process at the Oakland Regional Office. We are unable to determine whether your documentation has been added to your claim folder. We are only able to access your electronic files through our inquiry system."

It appears they have now changed my diagnosis from PAT (Paroxysmal Atrial Tachycardia) that I have been SC for over 40 years and changed it to Supraventicular Arrhythmia. Not sure what this means or if it will help or hurt my claim. This whole VA process is very confusing and frustrating. It's enough to give anyone an anxiety disorder or depression or at the very least, Supraventicular Arrythmias.

Thanks for your help. Brian

Brian, here is the rating criteria for SVA.

JBasser.

7010 Supraventricular arrhythmias:

Paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor 30

Permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor 10

7011 Ventricular arrhythmias (sustained):

For indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for indefinite period from date of hospital admission for ventricular aneurysmectomy, or; with an automatic implantable Cardioverter-Defibrillator (AICD) in place 100

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 100

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

Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30

Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10

Note: A rating of 100 percent shall be assigned from the date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia or for ventricular aneurysmectomy. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter

Edited February 10, 2009 by jbasser

[Pete53]

Thanks to all the Members who chip in and help Veterans with their claims. Sometimes it just nice to know that you can ask a question and someone on Hadit will try to help you fairly quickly.

[Wings]

I sent an IRIS e-mail a few days ago and got this response:

"Our records indicate that your appeal for increase and service connection due to supraventicular arrhythmia is open and in process at the Oakland Regional Office. We are unable to determine whether your documentation has been added to your claim folder. We are only able to access your electronic files through our inquiry system."

It appears they have now changed my diagnosis (SC for over 40 years);

from

DC 7013 Paroxysmal Atrial Tachycardia (PAT)

to

DC 7010 Supraventicular Arrhythmia

Brian, I explained in detail, and sent you evidence, that the RO did not just "now" change the Diagnostic Code. The Schedule for Rating Disabilities (in this case, 4.104 Schedule of ratings--cardiovascular system) was changed to reflect (supposedly) contemporary medical knowledge. The Federal Register published that change several years ago.

The important thing now, is that you stay on top of your Claim!

Submit additional evidience, including your VA medical records ASAP.

The VAMC has diagnosed you with "generalized anxiety disorder". You MUST somehow, some way, get an independent medical opinion (IMO) or Independent Medical Evaluation (IME), which will provide a Nexus statement: linking the Anxiety D/O to your service-connected Heart Condition (PAT and/or Supraventicular Arrhythmia). You do not need a Cardiac Dr, you need a DSMIV Clinition. A shrink, Psychologist, MSW, etc. You can do it! At the very least, your claim will generate a VCAA Letter, and probably a C&P Exam. Keep us posted, and good luck! ~Wings

I found a recent case (2008) that should offer some encouragement:

http://search.vetapp.gov/isysquery/b28e205...9b8b559b/6/doc/

Mr. Ross served in the U.S. Army from August 1969 to August 1971. In May 1999, a VA regional office (RO) reopened his previously denied claim for paroxysmal atrial tachycardia (a heart condition), awarded service connection, and assigned a disability rating of 10%, effective February 1989.

Mr. Ross, through his current counsel, appealed the disability rating assigned, and

on December 7, 1999, submitted a statement from Carl Barchi, a certified vocational specialist, who opined that Mr. Ross's heart and anxiety condition had prevented him from working since 1985. The RO considered Mr. Barchi's statement as a claim for secondary service connection for depression and for a TDIU rating.

The RO, in January 2001, awarded service connection for depression with anxiety,

secondary to his service-connected heart condition, and assigned a 70% disability rating. The RO also awarded a rating of TDIU.

Note: Secondary service connection is awarded when a claimant suffers an

additional disability that "is proximately due to or the result of a

service-connected disease or injury." 38 C.F.R. 3.310(a).

The Court held, that the "effective date assigned for a secondarily service-connected condition is governed by 38 C.F.R. 3.400.

[Hoppy]

Bm,

You think you were confused before, check this out. I really think this can only be resolved by a specialist as far as the medical side of your situation. It appears from the article below that the halter is not an accurate diagnostic tool for PAT. The symptoms you have described in to military docs sounded exactly like panic attacks to me. The symptoms noted are identical to the symptoms of panic attack in the DSM IV.

While active-duty, veteran reported heart palpitations, shortness of breath, aching chest pain, dizziness, fainting and syncope. An active-duty diagnosis of Tachycardia necessitated Holter Monitoring for approximately three weeks duration, which objectively confirmed the diagnosis Paroxysmal Atrial Tachycardia (PAT), and was positively evaluated under Sec. 4.104, Diagnostic Code (DC) 7013.

I originally suggested that you ask a doctor if the heart irregularities that happen during a panic attack would show with the halter. The halter findings and how they might relate to panic attacks is what needs to be addressed.

You can file for an anxiety disorder secondary to the PAT. The question is when was the last time you were diagnosed with PAT or any other new terminology for such a medical condition. In your previous posts the only current diagnoses I saw were for anxiety disorder, panic attacks and depression.

You can file for both and anxiety disorder secondary to PAT and or panic disorder with in-service symptoms to include PAT and let the doctors figure it out. The advantage to a report that the in=service PAT is directly related to the current panic disorder diagnosis is that you were previously service connected for the PAT. It will be hard for them to argue that you did not have a chronic condition in the military if you were already service connected for it. Also, it might result in more favorable laws to allow service connection of any manifestation of the disorder post service (see CFR’s in the next paragraph.

A disorder also may be service connected if the evidence of

record reveals the veteran currently has a disorder that was

chronic in service or, if not chronic, that was seen in

service with continuity of symptomatology demonstrated

thereafter. 38 C.F.R. § 3.303(<_<; Savage v. Gober, 10 Vet.

App. 488, 494-97 (1997). For the showing of chronic disease

in service, (or within a presumptive period per § 3.307),

there is required a combination of manifestations sufficient

to identify the disease entity, and sufficient observation to

establish chronicity at the time, as distinguished from

merely isolated findings or a diagnosis including the word

"chronic."

38 C.F.R. § 3.303(B). Subsequent manifestations of the same

chronic disease at any later date, however remote, are

service connected, unless clearly attributable to

intercurrent causes. Id.

Paroxysmal Atrial Tachycardia

Definition

A period of very rapid and regular heart beats that begins and ends abruptly. The heart rate is usually between 160 and 200 beats per minute. This condition is also known as paroxysmal supraventricular tachycardia.

BACKGROUND: The diagnostic criteria for panic disorder include symptoms commonly experienced by patients with paroxysmal supraventricular tachycardia (PSVT). Since electrocardiographic documentation of PSVT can be elusive, symptoms may be ascribed to other conditions. OBJECTIVE: To systematically evaluate the potential for PSVT to simulate panic disorder. METHODS: A retrospective survey of 107 consecutive patients with reentrant PSVT was conducted. Objective and subjective assessments of PSVT symptomatology were made, including the application of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), panic disorder criteria. RESULTS: The criteria for panic disorder according to DSM-IV were fulfilled by 67% of patients. Paroxysmal supraventricular tachycardia was unrecognized after initial medical evaluation in 59 patients (55%), including 13 (41%) of 32 patients with ventricular preexcitation by electrocardiogram, and remained unrecognized for a median of 3.3 years. Prior to eventual identification of PSVT, physicians (nonpsychiatrists) attributed symptoms to panic, anxiety, or stress in 32 (54%) of the 59 patients. When PSVT was unrecognized, women were more likely than men to have symptoms ascribed to psychiatric origins (65% vs 32%, respectively; P < .04). Paroxysmal supraventricular tachycardia was detected in only 6 (9%) of 64 patients undergoing Holter monitoring vs 8 (47%) of 17 patients who wore an event monitor (P < .001). During a 20-month median follow-up, electrophysiologically guided therapy (ablation in 81% of patients) resolved symptoms in 86% of patients; only 4% continued to meet DSM-IV panic disorder criteria without evidence of PSVT recurrence. CONCLUSIONS: The clinical characteristics of patients with PSVT referred for electrophysiologically guided therapy can mimic panic disorder. Diagnosis of PSVT is often delayed by inappropriate rhythm detection techniques (Holter instead of event monitoring) and failure to recognize ventricular preexcitation on the sinus electrocardiogram; symptoms due to unrecognized PSVT are often ascribed to psychiatric conditions.

Lessmeier TJ, Gamperling D, Johnson-Liddon V, Fromm BS, Steinman RT, Meissner MD, Lehmann MH.

Department of Internal Medicine, Wayne State University, Detroit, USA.

PMID: 9066458 [PubMed - indexed for MEDLINE]

Edited February 14, 2009 by Hoppy

[Hoppy]

As a follow up to my previous post.

If they were to determine that you were having panic attacks in association with the PAT’s in the military and link a current panic disorder to military service and you are service connected it would be rated not by a count of the episodes over a period of time. The rating is based on the overall impairment including any changes in behavior caused by the panic attacks. The changes in behavior are essential to the diagnosis of panic disorder.

Below is a sample BVA case of how panic disorder was rated.

The Board further acknowledges that a claimant may experience

multiple distinct degrees of disability that might result in

different levels of compensation from the time the increased

rating claim was filed until a final decision is made. See

Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in

the following decision is therefore undertaken with

consideration of the possibility that different ratings may

be warranted for different time periods.

In this case, the veteran is assigned a 30 percent rating for

his service-connected panic disorder pursuant to 38 C.F.R. §

4.130, Diagnostic Codes 9412 (2007)

General Rating Formula for Mental Disorders:

Ratin

g

Total occupational and social impairment, due to such

symptoms as: gross impairment in thought processes or

communication; persistent delusions or hallucinations;

grossly inappropriate behavior; persistent danger of

hurting self or others; intermittent inability to

perform activities of daily living (including

maintenance of minimal personal hygiene);

disorientation to time or place; memory loss for names

of close relatives, own occupation, or own name

100

Occupational and social impairment, with deficiencies

in most areas, such as work, school, family relations,

judgment, thinking, or mood, due to such symptoms as:

suicidal ideation; obsessional rituals which interfere

with routine activities; speech intermittently

illogical, obscure, or irrelevant; near-continuous

panic or depression affecting the ability to function

independently, appropriately and effectively impaired

impulse control (such as unprovoked irritability with

periods of violence); spatial disorientation; neglect

of personal appearance and hygiene; difficulty in

adapting to stressful circumstances (including work or

a worklike setting); inability to establish and

maintain effective relationships

70

Occupational and social impairment with reduced

reliability and productivity due to such symptoms as:

flattened affect; circumstantial, circumlocutory, or

stereotyped speech; panic attacks more than once a

week; difficulty in understanding complex commands;

impairment of short- and long-term memory (e.g.,

retention of only highly learned material, forgetting

to complete tasks); impaired judgment; impaired

abstract thinking; disturbances of motivation and mood;

difficulty in establishing and maintaining effective

work and social relationships

50

Occupational and social impairment with occasional

decrease in work efficiency and intermittent periods of

inability to perform occupational tasks (although

generally functioning satisfactorily, with routine

behavior, self-care, and conversation normal), due to

such symptoms as: depressed mood, anxiety,

suspiciousness, panic attacks (weekly or less often),

chronic sleep impairment, mild memory loss (such as

forgetting names, directions, recent events)

30

38 C.F.R. § 4.130, Diagnostic Code 9412 (2007).

In assessing the evidence of record, it is important to note

that the Global Assessment of Functioning (GAF) score is a

scale reflecting the "psychological, social, and

occupational functioning on a hypothetical continuum of

mental health-illness." See Richard v. Brown, 9 Vet. App.

266, 267 (citing DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL

DISORDERS, 4th ed. (DSM-IV) at 32).