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N4XV

Is Low Balling The Future Of Ihd Claims?

Question

After 20 years of no significant improvement. Since the announcement of IHD to become a presumptive my heart condition has gotten better.

All these tests were performed at the same VAMC

From Chemical Stress Test study performed on 01/27/05.

Impression:

1. Abnormal adenosine myocardial perfusion scan.

Nontransmural infarction of the inferior wall from apex to base

with potential ischemia of the residual viable myocardium

primarily in the apical half of the infarct zone. Potential

ischemia in the adjacent inferolateral wall from apex to base.

2. Mildly depressed resting left ventricular systolic function

with an ejection fraction of 46%. ( I figure this impression to be worth at least a 60% rating)

From Chemical Stress Test study performed on 11/14/2008.  

Impression:

1. Abnormal adenosine myocardial perfusion scan. Potential

ischemia in the inferior, inferolateral, and lateral walls from

apex to base superimposed on inferior wall scar with an element

of post stress "stunning" in the potentially ischemic zone.

However, findings are similar to hard copy images of previous

study performed on 01/27/05.

2. Globally reduced left ventricular systolic function with an

ejection fraction of 42-45%. ( I figure this impression to be worth at least a 60% rating)

From ECHO-DOPPLER REPORT (Echocardiogram) performed on 01/07/2010 for a C&P exam in connection with my recent IHD claim under the new AO presumptive.

Impression:

LV systolic function is preserved. Estimated ejection fraction is 50-55%.

LV wall thickness shows mild concentric left ventricular hypertrophy.

LV wall motion abnormality was noted, suggestive of CAD.

Grade II diastolic dysfunction is present

  ( I figure this impression to be worth no more than a 30% rating)

I also had an Electrocardiogram (EKG) performed on 03/05/2010 that said - Abnormal EKG and possible Inferior Infarction. But the VA cardiologist said my heart condition had improved since 11/14/2008 yet warranted an increase in dosage of two of my heart meds. 

Before 1991 I had 4 heart attacks and a triple bypass. Now since there has been no real changes in my life style or improvement shown in my heart condition for the past 19 except for a Transient Ischemic Attack (TIA or silent stroke) in Feb. of 2008 it makes me wonder if the powers that be in the claims part of the VA are somehow influencing the interpretations of tests and exams for new IHD claims under the new presumptive due to AO exposure.

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After 20 years of no significant improvement. Since the announcement of IHD to become a presumptive my heart condition has gotten better.

All these tests were performed at the same VAMC

From Chemical Stress Test study performed on 01/27/05.

Impression:

1. Abnormal adenosine myocardial perfusion scan.

Nontransmural infarction of the inferior wall from apex to base

with potential ischemia of the residual viable myocardium

primarily in the apical half of the infarct zone. Potential

ischemia in the adjacent inferolateral wall from apex to base.

2. Mildly depressed resting left ventricular systolic function

with an ejection fraction of 46%. ( I figure this impression to be worth at least a 60% rating)

From Chemical Stress Test study performed on 11/14/2008.

Impression:

1. Abnormal adenosine myocardial perfusion scan. Potential

ischemia in the inferior, inferolateral, and lateral walls from

apex to base superimposed on inferior wall scar with an element

of post stress "stunning" in the potentially ischemic zone.

However, findings are similar to hard copy images of previous

study performed on 01/27/05.

2. Globally reduced left ventricular systolic function with an

ejection fraction of 42-45%. ( I figure this impression to be worth at least a 60% rating)

From ECHO-DOPPLER REPORT (Echocardiogram) performed on 01/07/2010 for a C&P exam in connection with my recent IHD claim under the new AO presumptive.

Impression:

LV systolic function is preserved. Estimated ejection fraction is 50-55%.

LV wall thickness shows mild concentric left ventricular hypertrophy.

LV wall motion abnormality was noted, suggestive of CAD.

Grade II diastolic dysfunction is present

( I figure this impression to be worth no more than a 30% rating)

I also had an Electrocardiogram (EKG) performed on 03/05/2010 that said - Abnormal EKG and possible Inferior Infarction. But the VA cardiologist said my heart condition had improved since 11/14/2008 yet warranted an increase in dosage of two of my heart meds.

Before 1991 I had 4 heart attacks and a triple bypass. Now since there has been no real changes in my life style or improvement shown in my heart condition for the past 19 except for a Transient Ischemic Attack (TIA or silent stroke) in Feb. of 2008 it makes me wonder if the powers that be in the claims part of the VA are somehow influencing the interpretations of tests and exams for new IHD claims under the new presumptive due to AO exposure.

________________________________________________________________________________

_____________

You bring up an interesting point. However, I think if you are able to see a private heart cardiologist and have all the pertinent tests and opinion from your private heart primary care provider submitted, I would think this would tend to carry as much weight, if not more with the VA. This is going to be my plan of action. I don't think the VA would refute or downplay the results from your private primary heart doctor. IMHO.

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JRW

Thank You for your input. I was thinking along the same lines but figure this will take some time as I haven't used a private cardiologist in over ten years now. But inlight of the time it is taking the VA to get the new proposed regs published and then the added time it will take before they are finalized it might not prolong the processing of my claim very much. I have an appointment with an HMO PCP on 03/18/2010 and I intend on asking for a referal to see a cardiologist to at least discuss the increases in dosages in my meds and ask him to review the results of the chemical stress tests and EKG's and the recent Echo. I also have an earlier appointment at the VA clinic on the same day with my regular VA PCP and hopefully will be able to obtain all the recent VA medical records since 10/26/2009 that he can review also. I have all my VA records from Jan 2004 to 10/26 /2009 but have been unable thus far to get any records prior to that released from other VAMC's I was seen at. Maybe by the time I see the private Cardiologist I will have them in hand and if he orders any new tests he will be able to offer a more favorable medical opinion for me to submit to the VARO handling my claim as new evidence.

I just received a denial in a claim submitted for IU after I reopen the IHD claim. The reason for denial being I don't meet the eligability rquirements for IU and without a 60% rating for my IHD claim I still won't meet those requirements.  I was hoping the VA would have held off on the decision for the IU claim until the IHD claim was completed but I guess logic is not a factor in the VA process or they already decided the IHD is not going to reach 60% on the results of the Echo and C&P report. 

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We all need to remember that the types of test or t he determining factors for Heart Disease. The Criteria states on EF rateings that the measurememnt of EF is based on either of 2 tests.

A Heart Echo or a Cardiac Cath.

A Heart Echo is a fine test if the Veteran is of normal size. If the Veteran is a bigger person with a big chest then it becomes a guess as the Ultrasound waves have to pulsate through a thick walled chest and the image becomes somewhat distorted.

Cardiac Cath is the Mac Daddy when it comes to measuring EF as it is an actual measurement taken with the Naked Eye. It is a little more risky but it cant be questioned.

If you have had several MI's then you obviously havce had a few Caths in your day. These out weigh the old echo my a mile.

J

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We all need to remember that the types of test or t he determining factors for Heart Disease. The Criteria states on EF rateings that the measurememnt of EF is based on either of 2 tests.

A Heart Echo or a Cardiac Cath.

A Heart Echo is a fine test if the Veteran is of normal size. If the Veteran is a bigger person with a big chest then it becomes a guess as the Ultrasound waves have to pulsate through a thick walled chest and the image becomes somewhat distorted.

Cardiac Cath is the Mac Daddy when it comes to measuring EF as it is an actual measurement taken with the Naked Eye. It is a little more risky but it cant be questioned.

If you have had several MI's then you obviously havce had a few Caths in your day. These out weigh the old echo my a mile.

J

jbasser, 

I have infact had seven Cardiac Caths. Last one in 2001. An angioplasty that failed on the table that lead me into a triple bypass in 1987. I am large framed (obese) and just about all tests requiring an external transducer stated technical difficulties of some sort.  The Echo-Doppler Report of 01/07/2010 states Technical Quality: Poor. While discussing my condition with the VA cardio doc I saw on 03/05/2010 he stated to me an angiogram or any other invasive cardio testing was no longer an option for me because in his opinion my chances for surviving the proceedure were very low. I recently heard of a proceedure where the patient swallows the transducer so it is closer to the heart and much more accurate readings are produced. I will be looking into that option as soon as I see a private cardiologist.

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I am rated 60% for CAD by the VA. I have never seen a VA cardiologist. My C&P was done by a PA. I have seen a private cardiologist on my own dime. I believe the VA thinks that the PCP can DX and treat all illnesses from PTSD to heart disease. I don't know if the VA will low ball IHD due to AO. I do know they low ball all most every other injury or disease. The heart cath is really the only way to know for sure about the extent of heart disease. The cath has risks of its own. I don't want the VA running a wire into my heart. I will pay to have the best heart surgeon in my city to do it. I don't want a first year resident putting a hole in my aorta by mistake.

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