Looking For Opinions And Guidance

[carlie]

Warning - this is a long read and I appreciate your guidance and opinions.

Due to remand instructions from BVA, I have a C&P for a Heart Disorder next week.

*** The examiner is to determine the etiology and current level of disability.

*** Also, in the BVA Remand instructions the BVA Judge wrote,

"Moreover, in light of the action granting service connection for asthma

and bronchitis, further discussion of the Veteran's claim of service connection for a

Heart disorder to include on a secondary basis is required.

FYI - to add for consideration - I am service connected for Chronic Suppurative Otitis Media,

(draining infection), this will relate to one of my PCP letters of support you will read further down

in this same post.

The medical evidence I have of record that shows support for SC of Heart disorder is as follows :

June 2, 2000

From my PCP to DVA.

XXX has been a patient since 1998.

She has multiple,severe medical conditions which are more likely than not related to her military service.

2. Congestive Heart Failure - she did have congenital heart abnormality of endocardial fibroelastosis which

was treated at age 8 months at XXX Children's Hospital.

Currently has severe shortness of breath on exertion with 36 percent Ejection Fraction, which was

presumed to be normal when she went into service.

She is currently unable to work due to her Cardiac condition

3. Asthma and emphysema requiring multiple visits to our clinic, missed work, multiple medications.

There is evidence that she was having respiratory problems while in the military.

January 12, 2001

From my PCP to DVA - Memorandum - XXXXXX - Veteran's Service Center Manager

2. Congenital heart condition was severely aggravated this year requiring frequent Cardiology visits

and side effects from medications.

I feel that her lung disease is aggravating this condition. I feel that her heart condition existed

while in the military.

3. Asthma - I feel her recurrent episodes of Bronchitis in the military were highly related

to her Asthma.

January 12, 2001

From my PCP to DVA - Memorandum - XXXXXX - Veteran's Service Center Manager

Patient XXX was seen today for Congestive Heart Failure, Asthma and Depression.

I feel she is permanently disabled. If any questions please call XXX-XXXX.

January 18, 2001

The RO's - VSCM sent a Memorandum back to my PCP with these questions (and others).

2. What is the etiology of the veteran's current Heart condition ?

Reply from my PCP

She had endocardial fibroelastosis as a child.

Currently she has improved ejection fraction of 40 percent, but in 1999 before medication and

Cardiology titration of medication her ejection fraction was 36 percent with dilated Cardiomyopathy.

This type of Cardiomyopathy is very unusual for a woman this age (43 yrs old).

I feel it is related to her Congenital Heart disease.

I do not feel that recurrent bouts of bronchitis / asthma has helped this condition.

I feel that depression and smoking has worsened this condition.

3. What respiratory problem in service has resulted in her current asthma ?

Reply from my PCP

9/1/77 URI, treated with XXX antibiotics, 11/14/77 URI with shortness of breath,

1/12/78 URI with cough, 2/21/78 TMC 3 shortness of breath when running with chronic cough.

In view of her current diagnosis of asthma and chronic respiratory SX's since the military,

I feel that her respiratory downward spiral started in the military.

Asthma is a chronic process that is aggravated by stress, smoking and recurrent infections in the ears/sinus.

Soooooooooooo . . . .

Keeping in mind that the BVA did grant service connection for asthma and bronchitis in the

Order Section of this adjudicated appeal and I am service connected for

Chronic Suppurative Otitis Media (draining infection).

I know quite a bit will depend on what this C&P examiner states.

I am going to take copies of the above and try to get the examiner to accept them.

What's your opinion ?

Yes - I know - Stop smoking is one : )

[john999]

Retired

The VA is a big, steamroller with no soul. If you are on the right side of the machine you can benefit. If you are in the direct path you get crushed. Hang in there and stay on the right side. We will help you.

[Teac]

Carlie,

I didn't realize you had asthma and bronchitis, as I don't remember you ever saying this. You may know I have asthma with Copd secondary, and I am rated 100% due to oxygen use. It never ceases to amaze me that anyone whould smoke. , since I never smoked I just can't understand this. Ok.. with that said. I do know that some heart disease is directly related to Lung disease. I have recently been told that my heart is borderline enlarged because of my Lung disease. Asthma medications put quite a strain on the heart, and diseased lungs just make it worse. I suspect the va might say your smoking is the cause of the heart disease, and it very well may be, but lung disease is also a likey cause. Regardless please , please quit smoking. Stop putting your self at additonal risk it is not worth it. I saw my mother die from lung and heart disease it is a slow painful death. I know you don't want your loved ones to see you expire in such a way, so take care of yourself and hang around for them if not for for you. With that said here are a few references, don't know it they will help your case. There are many more articles on the subject but I thougjt these two might answer the question of a relationship between asthma and heart disease., Best of luck to you....

http://www.scienceblog.com/community/older/2001/A/200110533.html

http://www.ehow.com/about_5463528_relationship-between-asthma-heart-disease.html

[Chuck75]

There is something in the current law/regs that says to the effect that if a disease is service connectible, smoking cannot be used to deny the service connection.

I don't believe it's currently defined as "willful misconduct".

It was my understanding that prior to a law change involving smoking by congress, the VA did claim misconduct in some claims when heart and other diseases were involved.

"How can the VA then say that smoking and the associated problems are now considered willful misconduct?"

Hey Carlie,,,sorry to hear about your issues. Glad you got at least a REAL look from the BVA. However, the reason for this reply has to do with the smoking issue. Up until 1992, I think, smoke addiction was a compensable issue. Even now, I think it can be secondary. Now,,,,,,to rant a little,,,,,,don't you chew on me now: My rant is that back in the 60's when I was in vietnam, the military issued cigarettes in the rations. What gets me about that is that many guys, and gals, did not smoke on entry to the service. It was implied that somehow smoking might help with the anxiety of the conditions (war). Now, I don't want you to actually answer this,,,but the question looms,,,How can the VA then say that smoking and the associated problems are now considered willful misconduct?

[shag]

Thanks Chuck

[stillhere]

Mother n law has colon cancer and has had cancer operation and got as much as they could. She would not take radiation or chemo after operation AND continued to SMOKE! Cancer has come back and yet again she is going to have another cancer operation in Jan.

This time she is doing the radiation but not the chemo yet she continues to smoke! Now it is my opinion that she IS just killing herself and does not give a darn.

Most people when they are presented with an opportunity to save a life will take the advise of a doctor and change their life style to their advantage and go from there. To those that don't, why should our healthcare and benefits be offered to those that will not adjust??

[Teac]

Most people when they are presented with an opportunity to save a life will take the advise of a doctor and change their life style to their advantage and go from there. To those that don't, why should our healthcare and benefits be offered to those that will not adjust??

Man that is a cold statement! Why would you refuse medical care to someone because they smoke? Ok so smoking is stupid we all get that, but withholding medication because someone is addicted to a terrible substance is just flat our wrong. Would you withhold care from someone who is overweight, because they eat to much or too skinny because they have an eating disorder? Where does it stop, and who among us is going to play God. You don't pay the bills for everyone's health care so who are you to make such a decision?