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 : )

[Vync]

My county VSO told me that if medical records said a condition was 'minimal' or 'mild', the RO will ignore them.

I hope he is definitely wrong in your case. From what you posted, your case looks promising.

[carlie]

My county VSO told me that if medical records said a condition was 'minimal' or 'mild', the RO will ignore them.

I hope he is definitely wrong in your case. From what you posted, your case looks promising.

That would be in relation to other issues but NOT pulmonary hypertension.

Pulmonary hypertension is a condition that does not get better, only worse

and that report was from 10 years ago,

[jbasser]

It does not get any better that is for sure. Once they see this issue, You win. Game over.

Go get them and get r done.

J

Edited October 27, 2010 by jbasser

[stillhere]

It is very strange with the cardio information in the file that the RO, or the BVA have not addressed why in their denials in the past why they feel they can not SC? Did they ever say anything about this in the past?

[broncovet]

Carlie

An ejection fraction of 36 means that your heart is pumping about half the blood it should, since EF normal is about 55-75%, according to Wikipedia:

http://en.wikipedia.org/wiki/Ejection_fraction

IMHO the nexus between pulmonary issues and heart issues is so strong that you should definately win. I am not a cardiologist, however, my wife is a cardiac nurse with 10 plus years caring for cardiac patients at a hospital known as one of the best heart hospitals in the nation.

Example of why I think heart problems are linked to lung problems: I went to the doc with chest pain. VA was full, so I went to a local heart hospital and my wife selected the cardiologist, since she pretty much knows all of them here locally. This cardio doc did his tests on my heart and diagnosed sleep apnea! How did he diagnose sleep apnea with heart tests? Because the right side of my heart was enlarged, and the cardiologist knows that the heart compensates when I did not get enough oxygen at night. The diagnosis of sleep apnea was confirmed with a sleep study.

Of course, when it comes to predicting what a VA rater will do, it is always a crap shoot, but there is not much doubt in my mind anyway of the heart/pulmonary/asthma link, and that you will get your link you need for benefits. Unfortunately, most raters know little, if anything about the medical field, so it may take more time for more appeals if this rater does not get it right.

Wifey is not here now, but I will try to get her to look at your post in the next few days if you are interested. She does not like (nor is she qualified to give) medical opinions, but she just might tell me what she thinks. She would probably at least tell me if she thinks I am all wet, but I have an idea she would agree with me on this.

If you do have to appeal, I suggest you apply for an advance on the docket (if you go back to the BVA), since congestive heart failure is very, very serious..and life threatening. IMHO "congestive heart failure, ejection fraction 36%" and "mild" should not be used in the same sentence together.

[carlie]

Thanks to all for your replies.

I welcome any additional comments.