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 : )

[stillhere]

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.

In order to give an accurate opinion post what the cardiologist said from the 2000 incident?

You in your original post referred only to PCP.

[carlie]

In order to give an accurate opinion post what the cardiologist said from the 2000 incident?

* Well, there are over 1,000 pages related to Cardiology, I was requesting opinions

from the information contained in the original post of this topic.

I was not requesting any opinion on the different scenarios and or question you are advancing.

You in your original post referred only to PCP.

* Not actually, in my original post I stated,

"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."

What I thought to be a C&P examination with Cardiology has not been scheduled yet

but will be scheduled per BVA remand. BVA also made mention to the RO to follow the remand

instructions carefully inorder to prevent future remand.

[john999]

My question would be how could chronic breathing problems not have an impact on a heart condition? My cardiac C&P exam at the Tampa VAMC was a joke. If you have the schedule for the exam it would be interesting to see if the VA follows it. You may have a PA or NP do the exam.

[carlie]

John999,

Thanks, you bring up some very valid points.

I had not even thought about looking over the worksheet for

a Cardiology exam.

I am learning that I put all of my energy into the claims other

veterans have and do not put alot of energy into my own claims.

I have to change this temporarily for right now and work on my

my claims issues more .

[jbasser]

All pulmonary conditions eventually end up in right side heart issues. Pulmonary Hypertension and eventually a condition called corpumonole. Heart failure.

Lungs rarely kill you. It is the failing heart that actually does the job.

J

[carlie]

BTW - for the record the:

2/29/2000 - Echocardiogram from Cardiology states:

Left ventricle is enlarged.*** Mild Pulmonary Hypertension (PAP 35 MMHG).

I am now SC'd for Asthma and Bronchitis by way of BVA Decision.

This claim goes back prior to 2000.

38 CFR - Schedule for rating respiratory:

DISEASES OF THE TRACHEA AND BRONCHI

6600 Bronchitis, chronic:

FEV-1 less than 40 percent of predicted value,

or; the ratio of Forced Expiratory Volume in one second to

Forced Vital Capacity (FEV-1/FVC) less than 40 percent,

or; Diffusion Capacity of the Lung for Carbon Monoxide by the

Single Breath Method (DLCO (SB)) less than 40-percent predicted,

or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption

(with cardiac or respiratory limitation),

or; cor pulmonale (right heart failure),

or; right ventricular hypertrophy,

*** or; pulmonary hypertension (shown by Echo or cardiac catheterization),

or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy...100

So I wonder why VBA did not go ahead and grant the Asthma and Bronchitis as

service connected and provide my 100 percent evaluation level then.

WHY - Because they screwed up and I think that now this BVA Decision

has caught up with them.

Some additional 2000 Cardiac medical evidence:

6/5/2000 - Another Echocardiogram states:

Wall motion is abnormal. Generalized Hypokinesis. Mild tricuspid regurgitation.

PAP31 MMHG.

The EF is 40.

7/29/2000 - Cardiology Progress Notes:

Congestive Heart Failure - 36 percent muga (EF).