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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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NSA-Saigon-ET

Ao / Ihd Treadmill Stress Test Question

Question

Hi Everyone,

I have suffered with Angina since 1994 and have been on medication since then. This is a result of my in-country Vietnam service and exposure to Agent Orange. I recently had to perform a treadmill stress test for the VA at a QTC facility here in Houston for my AO IHD claim.

Before the test, I was interviewed by a Doctor and I asked him if I should take the treadmill test or simply do the echo-test. His response was my choice, but that most people opt for the echo test since it is easier on the body. The results are not as conclusive as the stress test but again are easier and safer to perform.

If the stress test is attempted and cannot be completed due to fatigue or pain then they will fall back on the echo test.

Anyway, I wanted to attemp the stress test, which is actually called the Bruce Stress Test.

We did it and I was able to last long enough to reach the max. heart rate for me calculated for my age (61) to be (220bpm -age = calc heart rate) or 220 - 61 = 159bpm.

My normal heart rate at rest is around 61-65 bpm due to the medications.

The test was a success and my METS were 7.6

I looked up the IHD rating for compensation in the present table and see I fall into the 10% category as I must take my meds or suffer constant Angina attacks, but the METS level of 7.6 means I am able to ride a bike and perform some light physical work.

Now the question I have is this:

Are they basing the ratings only on the results of the stress test?

If you are testing for IHD, I would like to think that testing is performed without the medications if possible, to see what you can do and can't do.

I can't find any reference to the procedure pertaining to taking meds vs. not taking meds.

I realize that I don't need a stent as yet, but my physical ability seems to be rather curtailed which should rate a higher rating than 10%..

I am not complaining of being in better health just for the sake of a few dollars, but am concerned with the criteria for disability ratings.

Any input greatly appreciated while we wait for the last of the 60 day delay.

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Hi Everyone,

I have suffered with Angina since 1994 and have been on medication since then. This is a result of my in-country Vietnam service and exposure to Agent Orange.  I recently had to perform a treadmill stress test for the VA at a QTC facility here in Houston for my AO IHD claim.

Before the test, I was interviewed by a Doctor and I asked him if I should take the treadmill test or simply do the echo-test.  His response was my choice, but that most people opt for the echo test since it is easier on the body.  The results are not as conclusive as the stress test but again are easier and safer to perform.

If the stress test is attempted and cannot be completed due to fatigue or pain then they will fall back on the echo test.

Anyway, I wanted to attemp the stress test, which is actually called the Bruce Stress Test.

We did it and I was able to last long enough to reach the max. heart rate for me calculated for my age (61) to be (220bpm -age = calc heart rate) or 220 - 61 = 159bpm.

My normal heart rate at rest is around 61-65 bpm due to the medications.

The test was a success and my METS were 7.6

I looked up the IHD rating for compensation in the present table and see I fall into the 10% category as I must take my meds or suffer constant Angina attacks, but the METS level of 7.6 means I am able to ride a bike and perform some light physical work.

Now the question I have is this:

Are they basing the ratings only on the results of the stress test?

If you are testing for IHD, I would like to think that testing is performed without the medications if possible, to see what you can do and can't do.

I can't find any reference to the procedure pertaining to taking meds vs. not taking meds.

I realize that I don't need a stent as yet, but my physical ability seems to be rather curtailed which should rate a higher rating than 10%..

I am not complaining of being in better health just for the sake of a few dollars, but am concerned with the criteria for disability ratings.

Any input greatly appreciated while we wait for the last of the 60 day  delay.

The VA can use either MET's score or LVEF (leftventricular ejection fraction) score in ratingIHD. Sometimes if you have both they can conflict in that one would award a lowrating and other would award a higher rating. You are correct in that a MET'sscore of 7.6 would bring a 10% rating. But an ECHO can show other things aBruce stress test won't show such as evidence ofcardiac hypertrophy or dilatation and LVEF that will give a higher rating. 

I have found, except for some special testing, they want you to take your medications as usual. As I remember for a chemical stress test they didn't want me to have any caffeine products for at least 24 hrs before the test but no problem with taking my meds. I would think withholding meds would/could change the readings of your actual level of disability. ie, make you look more disabled than you actually are.   

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My husband has severe IHD and QTC doc ignored the VA request for a stress test and scheduled him for an Echo instead. I assume they didn't want the risk of him having a MI during the stress test.

However, he's had previous stress tests thru his private cardiologist and has always been instructed to withhold beta blockers, calcium channel blockers, nitrates, and calcium antagonists prior to the testing. You might ask your primary if test results can be compromised if you are taking your cardiac meds. Most cardiac meds help your heart perform better, and would, in my opinion, help you to do better on the stress test than you would do if they were withheld.

Of course, with my jaded outlook, I'd assume that VA WANTS you to do better, less percentage of disability equals less payment!

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I must have a different type of cardio doc and QTC exam. I was told NOT to take my meds every time I have had my private doc do my stress test. They first put in have the nuclear stuff wnd no meds and then do the pictures and then I have to wait a prescribed time and I am allowed to drink water and take my meds and then given the walking treadmill and during the walking I am given the rest of the nuclear by IV and right after another set of pictures.

This way my doc says they get a clear view of how my heart reacts without and meds and after and with exercise and without. I have a damaged heart with some dead muscle after 2 heart attacks so mine may be a little different.

When QTC asked for just a walking treadmill I like you just went in and walked no picture and I took my meds. I failed and the VA then requested an ECHO chemical without exercise.

Took picture before without meds and then took meds and was given some sort of chemical to simulate exercise and hooked up to a machine. After that I was back in the tube and taking more pictures. This test is then sent to a cardio doc to read and write a report. I again failed the test and my heart was deemed 100%. I had been 60% since 05.

Not sure if this will help your case that much but I wanted to show you that there are options and better ways to evaluate better.

If you do not have a private doc or insurance you are at the mercy of the VA. I original filed in 03 and was denied after a walking test. I appealed and was denied again in 05. 30 days after the VA gave me a walking test I had 2 heart attacks with emergency stents!!

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I have a General Medical Examination this Tuesday, and one of the test is a ECHO test. By chance I had a nuclear stress test scheduled with my private Cardiologist. I can not physically do the treadmill. Should not these two test show basically the same results?

Papa

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Almost 2 years ago I had a C&P exam for an AO claim I filed for DM2 with IHD secondary. They gave me an echo on the day of the C&P and scheduled me for a stress test the following Monday. They called me to cancel the stress test. The echo showed an EF of 40% and that gave me a rating of 60% for the IHD. I believe I read somewhere that the procedures state that the C & P for IHD should start with an echo and only go to a stress test if the EF is below 60%. I don't know what they would do if they had both results and they conflicted.

Good Luck,

Dave

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