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Ihd Exam


jalexand

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Wow, I have already received notification of scheduled exam on my recently filed IHD AO Claim. I had filed my claim via VONAPP on June 2, 2010 and this morning while I was still in bed asleep the VA telephoned, talked with my wife and informed her that I am to appear at the Roudebush Medical Center this Saturday at 1:30 pm for an exam. This is way unusual in my view of things. I have never, ever received an appointment via telephone for anything connected with the VA, I always in the past have received notification by letter of any appointments, etc..

I have two basic questions about this exam. First, what should I expect? Will they put me through a battery of tests to determine the existence of my Heart Disease, ekg, echos, etc.?

What should I take with me to this exam? My heart disease dates back to 1985 with having received 10 angio-plasties over the years and having suffered a major Myocardio Infarction (MI) in 1993. However, so far I have only managed to obtain my most recent medical records from my current Cardiologist who I have only been seeing since 2006. I have looked through these records and while there are a bunch of references to "Myocardial Infarction" and contain test report documents referring to my "Ejection Fraction" being 35-40%, etc., I have not read the term "Ischemic Heart Disease" anywhere. Also, what I hvae are just test reports, there are no narratives what-so-ever. As I indicated, my disease goes back to 1985 and as a result my records are scattered all over the place where I have received treatment over the years. I contacted the Hospital where I was first treated for my MI back in '93 and they have informed me that they have NO RECORDS of my treatment as they are only required to keep records 7 years and all previous records have been destroyed.

Actually my Heart Disease should be pretty obvious to anyone who looks at an EKG or does an Echo Cardiogram on me, but will the VA do this or is it up to me to proove the disease exists?

Thanks in advance for any help or advice.

Jim

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You can get a schedule of how the VA does rating exams for heart conditions. If they don't follow the schedule you have an appeal and you can also ask your PCP to schedule more tests. My C&P for heart disease was done by a PA who was training another PA. It was a joke. The PA just made guesses about ejection fractions etc. No tests. As soon as I got the exam results I started asking my PCP for more tests. I went from 0% to 60%. Don't get mad, get even. Maybe you will have a real cardiologist do the exam, but I would not bet on it.

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You can get a schedule of how the VA does rating exams for heart conditions. If they don't follow the schedule you have an appeal and you can also ask your PCP to schedule more tests. My C&P for heart disease was done by a PA who was training another PA. It was a joke. The PA just made guesses about ejection fractions etc. No tests. As soon as I got the exam results I started asking my PCP for more tests. I went from 0% to 60%. Don't get mad, get even. Maybe you will have a real cardiologist do the exam, but I would not bet on it.

Where do I get copy of this "schedule"? Or is it the one I already have that I acquired that starts out with A. Review of Medial Records:, B. Medical History (Subjective Complaints): etc., etc.? If so, as I indicated I do have a copy of that one.

Another thing, I just got off the telephone with the Medical Records Section of my current Cardiologist where I inquired about any Narratives in my file. They did indicate that there are some Narratives and one in particular discusses my Diagnosis and refers to "Family History of Ischemic Heart Disease", along with other things like "Irregular EKG", etc.. Should I provide the VA with copies of this type of record? I do have family history of IHD, my mother in her 60's and my father somewhat earlier (although this is just rumored as my father and mother were divorced when I was an infant and I never had any contact with him. I was told he died of Cancer, but am not sure of that.)

Jim

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I stole this from another forum:

Name: SSN: Date of Exam: C-number: Place of Exam:

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

  1. Past history - describe onset of disorder and frequency of cardiac symptoms, including angina, dyspnea, fatigue, dizziness, and syncope. Record dates and severity of episodes of acute cardiac illness, including myocardial infarction, congestive heart failure, and acute rheumatic heart disease. Describe all cardiac surgery, including coronary artery bypass, valvular surgery, cardiac transplant, and angioplasty.
  2. Current treatment - type, dosage, response, and side effects.
  3. With the exceptions given below, examinations for valvular heart disease, endocarditis, pericarditis, pericardial adhesions, syphilitic heart disease,, arteriosclerotic heart disease, myocardial infarction, hypertensive heart disease, heart valve replacement, coronary bypass surgery, cardiac transplantation, and cardiomyopathy, require the examiner
    to provide the METs level, determined by exercise testing
    , at which symptoms of dyspnea, fatigue, angina, dizziness, or syncope result.
  4. Exercise testing is
    not
    required for the above listed conditions in the following circumstances:

a. If exercise testing is medically contraindicated:

  1. In that case, provide the medical reason exercise testing cannot be conducted, and
  2. Provide an estimate of the level of activity (expressed in METs and supported by specific examples
    , such as slow stair climbing, or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope.

  1. If left ventricular dysfunction is present, and the ejection fraction is 50 percent or less.
  2. If there is chronic congestive heart failure or there has been more than one episode of acute congestive heart failure in the past year.
  3. With valvular heart disease - during active infection with valvular heart damage and for three months following cessation of therapy for the active infection.
  4. With endocarditis - for three months following cessation of therapy for active infection with cardiac involvement.
  5. With pericarditis - for three months following cessation of therapy for active infection with cardiac involvement.
  6. With myocardial infarction - for three months following myocardial infarction.
  7. With valve replacement - for six months following date of hospital admission for valve replacement.
  8. With coronary bypass surgery - for three months following hospital admission for surgery.
  9. For cardiac transplantation - for indefinite period from date of hospital admission for cardiac transplantation.
  10. If an exercise test has been done within the past year, the results are of record, and there is no indication that there has been a change in the cardiac status of the veteran since.

  1. For hyperthyroid heart disease, if atrial fibrillation is present, use arrhythmia worksheet. Also use endocrine worksheet if examining for hyperthyroidism.
  2. Describe the effects of the condition on the veteran's usual occupation and daily activities.
  3. Even when special examinations and tests (e.g., exercise testing) are not
    required
    under the worksheet guidelines, they may be requested or conducted at the discretion of the examiner, when the examiner believes that the available information does not fully reflect the severity of the veteran’s cardiovascular disability.

C. Physical Examination (Objective Findings):

Address each of the following and fully describe current findings:

  1. Heart size and method of determination, heart rhythm and rate, heart sounds, blood pressure.
  2. Evidence of congestive heart failure - rales, edema, liver enlargement, etc.

D. Diagnostic and Clinical Tests:

  1. Chest X-ray, EKG, exercise stress test, echocardiogram, Holter monitor, thallium study, angiography, etc., as appropriate, and as required or indicated.
  2. Include results of all diagnostic and clinical tests conducted in the examination report, including status of left ventricular function, if measured.
  3. Valvular heart disease and endocarditis require documentation of diagnosis by physical findings and either echocardiogram, Doppler echocardiogram, or cardiac catheterization, if not already of record.
  4. Other types of heart disease must be documented by appropriate objective diagnostic tests.

E. Diagnosis and Opinion:

  1. Type of heart disease and etiology, if known.
  2. Type of surgery, if any, and results.
  3. If the veteran is service-connected for rheumatic heart disease and later develops non-service-connected arteriosclerotic heart disease, state, if possible, which cardiac findings can be attributed to each condition. If it is not possible to separate the signs and symptoms of one from the other, so state, and explain.
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I stole this from another forum:

Name: SSN: Date of Exam: C-number: Place of Exam:

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

  1. Past history - describe onset of disorder and frequency of cardiac symptoms, including angina, dyspnea, fatigue, dizziness, and syncope. Record dates and severity of episodes of acute cardiac illness, including myocardial infarction, congestive heart failure, and acute rheumatic heart disease. Describe all cardiac surgery, including coronary artery bypass, valvular surgery, cardiac transplant, and angioplasty.
  2. Current treatment - type, dosage, response, and side effects.
  3. With the exceptions given below, examinations for valvular heart disease, endocarditis, pericarditis, pericardial adhesions, syphilitic heart disease,, arteriosclerotic heart disease, myocardial infarction, hypertensive heart disease, heart valve replacement, coronary bypass surgery, cardiac transplantation, and cardiomyopathy, require the examiner
    to provide the METs level, determined by exercise testing
    , at which symptoms of dyspnea, fatigue, angina, dizziness, or syncope result.
  4. Exercise testing is
    not
    required for the above listed conditions in the following circumstances:

a. If exercise testing is medically contraindicated:

  1. In that case, provide the medical reason exercise testing cannot be conducted, and
  2. Provide an estimate of the level of activity (expressed in METs and supported by specific examples
    , such as slow stair climbing, or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope.

  1. If left ventricular dysfunction is present, and the ejection fraction is 50 percent or less.
  2. If there is chronic congestive heart failure or there has been more than one episode of acute congestive heart failure in the past year.
  3. With valvular heart disease - during active infection with valvular heart damage and for three months following cessation of therapy for the active infection.
  4. With endocarditis - for three months following cessation of therapy for active infection with cardiac involvement.
  5. With pericarditis - for three months following cessation of therapy for active infection with cardiac involvement.
  6. With myocardial infarction - for three months following myocardial infarction.
  7. With valve replacement - for six months following date of hospital admission for valve replacement.
  8. With coronary bypass surgery - for three months following hospital admission for surgery.
  9. For cardiac transplantation - for indefinite period from date of hospital admission for cardiac transplantation.
  10. If an exercise test has been done within the past year, the results are of record, and there is no indication that there has been a change in the cardiac status of the veteran since.

  1. For hyperthyroid heart disease, if atrial fibrillation is present, use arrhythmia worksheet. Also use endocrine worksheet if examining for hyperthyroidism.
  2. Describe the effects of the condition on the veteran's usual occupation and daily activities.
  3. Even when special examinations and tests (e.g., exercise testing) are not
    required
    under the worksheet guidelines, they may be requested or conducted at the discretion of the examiner, when the examiner believes that the available information does not fully reflect the severity of the veteran's cardiovascular disability.

C. Physical Examination (Objective Findings):

Address each of the following and fully describe current findings:

  1. Heart size and method of determination, heart rhythm and rate, heart sounds, blood pressure.
  2. Evidence of congestive heart failure - rales, edema, liver enlargement, etc.

D. Diagnostic and Clinical Tests:

  1. Chest X-ray, EKG, exercise stress test, echocardiogram, Holter monitor, thallium study, angiography, etc., as appropriate, and as required or indicated.
  2. Include results of all diagnostic and clinical tests conducted in the examination report, including status of left ventricular function, if measured.
  3. Valvular heart disease and endocarditis require documentation of diagnosis by physical findings and either echocardiogram, Doppler echocardiogram, or cardiac catheterization, if not already of record.
  4. Other types of heart disease must be documented by appropriate objective diagnostic tests.

E. Diagnosis and Opinion:

  1. Type of heart disease and etiology, if known.
  2. Type of surgery, if any, and results.
  3. If the veteran is service-connected for rheumatic heart disease and later develops non-service-connected arteriosclerotic heart disease, state, if possible, which cardiac findings can be attributed to each condition. If it is not possible to separate the signs and symptoms of one from the other, so state, and explain.
Original post:

Yes, this is the form I have. I downloaded it off some site on the net a few weeks ago, but don't remember exactly where.

Jim

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  • HadIt.com Elder

I don't think I would volunteer information about IHD running in your family. I know it does not matter about other AO presumptives but this IHD thing I am not sure you want to volunteer that your family has such a history. I would not lie, but you don't have to volunteer either.

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I had this exam back in Feb. Most of the report that the examiner stated came from my private cardiologist.

Answer only the questions that are asked of you. Do not volunteer information. I tend to ramble on and it has jumped up bit me in the butt !!

They are looking for METS and LFV's. It would be good if your records stated IHD, but I think MI,s and stents, along with CAD will meet the threshold for IHD. But that is my personal opinion. No test were performed or ordered due to the fact that I have been using VAMC for heart doctor and most of records were in treatment notes. In and out in less than a hour.

I was also asked "how has this affected you and your daily living"? I ended up with a METS level of 3 or less and a LV of 46. This should put me in the 100% rating if they use the METS, which I think they do.

Also, have you been denied for this in the past, because Nehmer will effect a lot of veterans.

And your test results have to be less than a year old. Dave

Edited by rotorhead
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