Jump to content
Ads Keep HadIt.com Online. Consider Turning Off Ad Blockers to Keep HadIt.com Online! ×
  • 0

Heart Disease Experts


jbasser

Question

  • Moderator

I have a RVN in Country combat Veteran who has heart disease and may need a Procedure to replace a Valve damaged because of Acquired Aortic Stenosis.

This man has been my best friend for nearly 20 years so this makes this issue personal and is on the top of my list.

I need to know the types of Heart diseases under the new regs as Ischemic heart disease.

Any Replies are appreciated, especially from Med Pros Like Bergie.

JB

Link to comment
Share on other sites

  • Answers 10
  • Created
  • Last Reply

Top Posters For This Question

10 answers to this question

Recommended Posts

I have a RVN in Country combat Veteran who has heart disease and may need a Procedure to replace a Valve damaged because of Acquired Aortic Stenosis.

This man has been my best friend for nearly 20 years so this makes this issue personal and is on the top of my list.

I need to know the types of Heart diseases under the new regs as Ischemic heart disease.

Any Replies are appreciated, especially from Med Pros Like Bergie.

JB

John,

Ischemic heart disease is simply poor blood supply to the heart muscle. With aortic stenosis the bigger worry is the size of his left ventricle. This can lead to congestive heart failure that may or may not improve with the replacement of the valve. For sure though he should feel better when the new valve is in. I would recommend that he get an echo, and stress test ASAP if he has not already done so.

John, PM me with a little more info like, smoking history, other health problems, medications, ect.. I can better advice with this info...

Thank you,

Bergie

Link to comment
Share on other sites

  • HadIt.com Elder

Acquired Aortic Stenosis translates as damage caused by such things as rheumatic fever, or other "low grade" infections that may not have been noticed at the time, or treated. Unless there is a history of a disease that causes this problem in service medical records, I believe that this disease might be used by the VA to say that any heart ischemia is due to the disease, rather than A.O. exposure. (IMO's etc. will likely be required to try and service connect this disease.)

As to what is included in the VA IHD package-- no one outside of the VA likely knows--

But, there was a precedential case in 2000 concerning a POW veteran that tied various conditions to IHD.

There also was a VA internal letter in the last few months that gave some direction in this area, although ischemia claims were delayed pending new regs. I remember one statement in the letter that directed RO's not to schedule C&P's if medical evidence of ischemia already existed in medical records. Assuming there is enough in the records to rate, naturally. To me such things as coronary artery disease, left ventricle efficiency, enlarged heart and a plethora of other heart related problems are associated with ischemic heart disease.

ischemic heart disease is a result. I believe that the thinking was that IHD would cover a whole group of heart problems that are currently "scheduler".

I.E. the progression would be A.O. exposure (presumed or proved) Various heart related problems resulting in IHD.

Diabetes is considered to be related to the causes of heart disease, although the VA tries to disconnect the two.

When both are present, such things as peripheral arterial disease also occur more often. I believe there was a specific mention that the VA will not consider peripheral arterial disease as related to IHD.

Link to comment
Share on other sites

  • HadIt.com Elder
I have a RVN in Country combat Veteran who has heart disease and may need a Procedure to replace a Valve damaged because of Acquired Aortic Stenosis.

This man has been my best friend for nearly 20 years so this makes this issue personal and is on the top of my list...

JB

Sorry to hear about your friend. Glad he is addressing his heart issue. I researched the AO connections, and found the same things that I'm sure you already know. As a fellow combat vet, please give him my regards . I look forward to reading about his R&R fishing therapy, after the surgery. The Largemouth bass should be spawning in your neck of the woods soon, if not already. When your friend gets the surgery behind him, he can hook one later this season. My most positive thoughts are with him.

Edited by Commander Bob
Link to comment
Share on other sites

I dont know if the claim would conform to the IHD regs-because they specifically raise the myocardium-

the musclular area of the heart and I dont know if that includes the heart valves.

"According to Harrison's Principles of Internal Medicine (Harrison's

Online, Chapter 237, Ischemic Heart Disease, 2008), IHD is a condition

in which there is an inadequate supply of blood and oxygen to a portion

of the myocardium; it typically occurs when there is an imbalance

between myocardial oxygen supply and demand. Therefore, for purposes of

this regulation, the term ``IHD'' includes, but is not limited to,

acute, subacute, and old myocardial infarction; atherosclerotic

cardiovascular disease including coronary artery disease (including

coronary spasm) and coronary bypass surgery; and stable, unstable and

Prinzmetal's angina. Since the term refers only to heart disease, it

does not include hypertension or peripheral manifestations of

arteriosclerosis such as peripheral vascular disease or stroke."

http://www.regulations.gov/search/Regs/hom...A-2010-VBA-0005

myocardium

[mī′ōkär′dē·əm]

Etymology: Gk, mys, muscle, kardia, heart

a thick contractile middle layer of uniquely constructed and arranged muscle cells that forms the bulk of the heart wall. The myocardium contains a minimum of other tissue, except blood vessels, and is covered interiorly by the endocardium. The contractile tissue of the myocardium is composed of fibers with the characteristic cross-striations of muscular tissue. The fibers are about one third as large in diameter as those of skeletal muscle and contain more sarcoplasm. They branch frequently and are interconnected to form a network that is continuous except where the bundles and the laminae are attached at their origins and insertions into the fibrous trigone of the heart. Myocardial muscle contains less connective tissue than does skeletal muscle. Specially modified fibers of myocardial muscle constitute the conduction system of the heart, including the sinoatrial node, the atrioventricular (AV) node, the AV bundle, and the Purkinje fibers. Most of the myocardial fibers function to contract the heart. The metabolic processes of the myocardium are almost exclusively aerobic. Many key enzymatic reactions of the heart, such as the citric acid cycle and oxidative phosphorylation, take place in the highly concentrated myocardial sarcosomes. The process of oxidative phosphorylation produces adenosine triphosphate (ATP), the immediate energy source for myocardial contraction. Oxygen, which significantly affects ATP production and contractibility, is a critical metabolic component of the myocardium, which consumes from 6.5 to 10 mL/100 g of tissue per minute. Without this oxygen supply, myocardial contractions decrease in a few minutes. The myocardium maintains a relatively constant level of glycogen in the form of sarcoplasmic granules. Compare epicardium. See also cardiac muscle. myocardial, adj."

http://medical-dictionary.thefreedictionary.com/myocardium

I agree with Chuck.

An IMO could possibly reveal that he does have IHD,which is compounded by the valve problem.

There are 38 comments so far at the Federal Register site-I havent read them all-maybe someone has raised this type of issue.

When I read over the regs to comment on them -I was surprised that they were very concise.

My biggest fear was they could leave too much lee way for the VA because heart disease is such a generic term.But IHD isn't generic and their definition is perfect.

But only for IHD vets.

Does he get any pritvate care and maybe this could lead to a private opinion that would not be too costly?

Edited by Berta
Link to comment
Share on other sites

gee hold that phone!

Did he have rheumatic fever as a child?

Was that the etiology of his problems now? Was it listed on his entrance exam? Did he have anything at all in his SMRS (shorttness of breathe etc) that could have been results of rheumatic fever? as the cause of his heart disease now?

a long shot maybe- but sometimes the long shots are the keys to what we need.

Does he have his complete SMRs?

Link to comment
Share on other sites

  • Moderator

The Echo findings are revelant. Has always been in good health, never had Reumatic Fever.

His Aorta and Valve are calcified and he had Cad to boot.

Time to drop the hammer.

J

Link to comment
Share on other sites

  • Moderator

Update. He had a Cath to check actual condition and Lord and Behold they found a Blockage and have scheduled a Bypass so it is a Moot point as he has CAD so he has IHD. I am personally going to help him with this claim.

Any advice would be appreciated.

J

Link to comment
Share on other sites

Yes-it sounds to me like possible IHD with the blockage.

Cardiology is very intricate so I would not be 100% sure that the blockage indicates IHD but it certainly sounds like it.

Results of an ECHO are invaluable in detecting IHD.His medical records will reveal whether this definitely fits into the IHD regs.

I suggest that-if needed-you could access Harrison's Principles of Medicine on line (hope they don't charge for excerpts) as-since the VA s using Harrison for these regs -then we can use it too for these types of claims and I think VA would have to consider this reference as probative.

http://www.accessmedicine.com/content.aspx?aid=2879933

Access to Harrisons at this site is $29.95 for 24 hour access but I am sure there are other sites that are cheaper and hopefully his med recs will reveal enough that there would be no doubt as to whether this is IHD.

I just bring that up John due to the aortic valve involvement.

For example:

http://www.sciencedirect.com/science?_ob=A...3a02d5145794923

In this article on aortic stenosis there is no mention at all of IHD.

The VA will go with anything that could possibly deny a IHD claim if they can.So a AO heart claim -unless cut and dried IHD, might need to be explained to them.

I had to copy a photo of an autopsied heart and label it step by step as to how the EKGS and ECHO of my husband had damaged his heart.I used his autopsy as the reference for the overtlay I made to the heart photo to explain the significance.

If the IHD regs were in place then I would never have needed to do the work I did nor study cardiology.

I was up against the Chief VA Cardiologist in VACO.

My medical research won that claim.

CXardio disease can be very involved.

The IHD regs focus on the myocardium.

“myocardium

[mī′ōkär′dē·əm]

Etymology: Gk, mys, muscle, kardia, heart

a thick contractile middle layer of uniquely constructed and arranged muscle cells that forms the bulk of the heart wall. The myocardium contains a minimum of other tissue, except blood vessels, and is covered interiorly by the endocardium. The contractile tissue of the myocardium is composed of fibers with the characteristic cross-striations of muscular tissue. The fibers are about one third as large in diameter as those of skeletal muscle and contain more sarcoplasm. They branch frequently and are interconnected to form a network that is continuous except where the bundles and the laminae are attached at their origins and insertions into the fibrous trigone of the heart. Myocardial muscle contains less connective tissue than does skeletal muscle. Specially modified fibers of myocardial muscle constitute the conduction system of the heart, including the sinoatrial node, the atrioventricular (AV) node, the AV bundle, and the Purkinje fibers. Most of the myocardial fibers function to contract the heart. The metabolic processes of the myocardium are almost exclusively aerobic. Many key enzymatic reactions of the heart, such as the citric acid cycle and oxidative phosphorylation, take place in the highly concentrated myocardial sarcosomes. The process of oxidative phosphorylation produces adenosine triphosphate (ATP), the immediate energy source for myocardial contraction. Oxygen, which significantly affects ATP production and contractibility, is a critical metabolic component of the myocardium, which consumes from 6.5 to 10 mL/100 g of tissue per minute. Without this oxygen supply, myocardial contractions decrease in a few minutes. The myocardium maintains a relatively constant level of glycogen in the form of sarcoplasmic granules. Compare epicardium. See also cardiac muscle. myocardial, adj.

Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.”

Myocardial blockage is described here:

http://www.pyroenergen.com/articles/heart-attack.htm

Once you get this vet's complete medical records- any EKGs and ECHO results will help prove beyond doubt that this is in fact IHD as I fear the VA would hinge on the valve problems or stenosis and try to deny on that point unless the ischemic nature of his heart disease is clearly evident in the medical records.

Link to comment
Share on other sites

  • HadIt.com Elder

blockages come under coronary artery disease which is also the same as IHD the only thing that is not covered by this new rule is hypertension but if you have had stents blockages bypass surgery etc you should qualify for the new AO rules for IHD

Link to comment
Share on other sites

  • Moderator

Update: My buddy had his surgury and spent 12 days in the hospital. He has problems with arrythmias as the Valve was real bad. He is home now but he still has a way to go. The VA did receive his claim. They answered the claim with the old we will work it when the New AO regs are published.

J

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now


  • veterans-crisis-line.jpg
    The Veterans Crisis Line can help even if you’re not enrolled in VA benefits or health care.

    CHAT NOW

  • question-001.jpeg

    Have Questions? Get Answers.

    Tips on posting on the forums.

    1. Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery instead of ‘I have a question.
       
    2. Knowledgeable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title.
      I don’t read all posts every login and will gravitate towards those I have more info on.
       
    3. Use paragraphs instead of one massive, rambling introduction or story.
       
      Again – You want to make it easy for others to help. If your question is buried in a monster paragraph, there are fewer who will investigate to dig it out.
     
    Leading too:

    exclamation-point.pngPost straightforward questions and then post background information.
     
    Examples:
     
    • Question A. I was previously denied for apnea – Should I refile a claim?
      • Adding Background information in your post will help members understand what information you are looking for so they can assist you in finding it.
    Rephrase the question: I was diagnosed with apnea in service and received a CPAP machine, but the claim was denied in 2008. Should I refile?
     
    • Question B. I may have PTSD- how can I be sure?
      • See how the details below give us a better understanding of what you’re claiming.
    Rephrase the question: I was involved in a traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?
     
    This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial of your claim?”
     
    Note:
     
    • Your first posts on the board may be delayed before they appear as they are reviewed. This process does not take long.
    • Your first posts on the board may be delayed before they appear as they are reviewed. The review requirement will usually be removed by the 6th post. However, we reserve the right to keep anyone on moderator preview.
    • This process allows us to remove spam and other junk posts before hitting the board. We want to keep the focus on VA Claims, and this helps us do that.
  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • VA Watchdog

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

×
×
  • Create New...

Important Information

{terms] and Guidelines