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 : )

[jbasser]

Smoking has nothing to do with this Topic. So personal opinions about smoking is not needed.

Stick to the subject matter here for Carlies sake.

J

[stillhere]

Attack if you feel like it but I believe the original poster did ask for opinions!

I don't believe this will help her claim and could certainly be the basis for a denial.

I don't believe in denying healthcare to individuals in their situations at all BUT I do believe that once a doctor has made you aware of what you need to fight the disease and get better.

It is in the patient's best interest to do ALL they can to help.

For Teac I will ask you why continue to operate on someone who continues not to follow the doctors advise?

I am not making this statement lightly, my brother recently passed away of liver cancer mainly because he did not heed the advice of the doctors and continued to drink.

[carlie]

Attack if you feel like it but I believe the original poster did ask for opinions!

Stillhere - If you had read my whole post then you would have noticed the last sentence in it.

Advice on smoking or not smoking was not asked for.

I don't believe this will help her claim and could certainly be the basis for a denial.

I do not feel as it will be a basis for denial since the BVA just SC'd Asthma and Bronchitis.

I don't believe in denying healthcare to individuals in their situations at all BUT I do believe that once a doctor has made you aware of what you need to fight the disease and get better.

Just because a doctor tells you to take medication - does not mean you HAVE to take it.

Many side effects are worse then the illness than the medications were RX'd for.

I am not making this statement lightly, my brother recently passed away of liver cancer mainly because he did not heed the advice of the doctors and continued to drink.

I am sorry your brother died, have you stopped to think that, maybe your brother either

1) could not stop drinking or 2) did not care if he died.

This question is not is my heart damaged by my smoking, the question is - is my heart damaged

or has it been aggravated to a certain degree, due to a SC'd disability.

Personally, I do not care if I die - but the question at hand is if my heart is damaged secondary

to a service connected disability - then SC compensation is to be paid until I either,

1) no longer have the secondary condition or 2) I die.

Of course now - that's only going by the regulations.

[john999]

This is one place where we should try and avoid being too judgemental. It is not easy, but we should recognize our triggers. People stop sharing when they think they will be judged. Half the people here with any stress problems have used tobacco, alcohol or drugs to medicate themselves.

[stillhere]

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. ( This would be better served if from a board certified cardiologist rather than a PCP)

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 (again a PCP DX rather than a cardiologist? Why is the PCP not asking for a consult from a cardiologist and if done where are the notes)

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 (This PCP seems to be very active in your care but over stepping in there qualifications)

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 : )

With only having a PCP (general practitioner's notes and DX I personal do not see the BVA granting this) My question again IS why is there no cardiologist's notes or recommendations? If there are why are they not being used to support this claim?

I would suggest that the poster have an evaluation by a board certified cardiologist and get their comments to support the comments made by the PCP. Without that all I see is an general doctor making statements with NO rationale or credentials to stand on.

I certainly hope this is what you were looking for. By the way I am 100% for my heart by the VA and I have suffered with angina and high cholesterol,diabetes 2 and hypertension. All service connected. My heart disease is secondary to my Diabetes 2.

I am also a Vietnam boots on ground veteran with a son born with a congenital heart condition which was corrected at 18 months finally after 6 operations (our second son died in the womb after 6 months with no known cause.

In 2008 our son was to have a valve replaced due to leaking, by a pigs valve but when the doctors went in they found his last operation the surgeon had left enough that they could fix it rather than REPLACE!! Now that was great news!

He now works at a prestigious university hospital in the ER and children's ward as a respiratory technician and is doing very well.

Just wanted to give you some back ground on where I am coming from.

[carlie]

I talked with the C&P department and the 2 examinations I have scheduled for this week

are for updated PFT's and a cervical exam.

These 2 issues were included in the BVA remand along with one for a Cardiac examination

in which the BVA expressly request the Cardiologist to opine on the degree of aggravation

my service connected Asthma and Bronchitis has had on my non- service connected heart

condition.

This past Friday I submitted my signed VCAA Notice back to the VA that was related to

my heart condition.

Now if the RO actually follows the remand instructions, sometime in the not too distant future

I will receive a C&P notice for Cardiology for them to examine me - all medical evidence of record

and provide an opinion in answer to te above.

Being that I went into acute CHF around 2000 (which I believe was partially a result from fighting

my FTC against the VAMC) I have plenty of medical documentation from Cardiology already.

Just to be real clear to all responders, the remand from BVA is for the VA to determine if my

service connected Asthma and Bronchitis disabilities have had any impact on my heart condition

and if so will they be able to ascertain the degree of impact or is it completely due to the natural

disease process.