Ao / Ihd Treadmill Stress Test Question

[NSA-Saigon-ET]

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.

[Sgt Schmidt]

I had my C&P exam for IHD in June of this year. The doctor said that she had all of my records from my private cardiologist and asked me a few questions. She asked me when I was first diagnosed, when was my first heart attack, how many stents I had and when they were implanted, and when was the last time I worked full time. That was the extent of my C&P. No tests of any kind were performed.

Jeff

[john999]

I took the chemical stress test with an echo before and after. I also took the treadmill test. The treadmill test was a failure since I have foot problems. I don't even know why they set me up for it. I have PN so how do I do the treadmill. The chemical test was no problem. You can get hurt on the treadmill just by losing your footing. Neither one of these tests are conclusive for heart disease. The only real way to tell if an artery is blocked is the invasive test where they run the wire up through your groin. The VA would never swing for that for a C&P exam. Has anyone had the invasive test done?

[stillhere]

John I have had the cath test done by my private cardio doc twice each time I had stents laced because of blockages.

I have not ever heard of a CnP being a request for a cath but I do know a few vets that have had it done for treatment after a CnP showed there was the need. I think we all need to remember a CnP is not for treatment but just to check your conditons for compensation. I personally feel this is why we have to fight our claims with private IOMs and special testing.

The VA ain't going to do it!'

[john999]

Still here

I agree with that. Without IMO's I would still be at 30%. My last cardiac C&P was just a sham done by a PA. I appealed and got 60%.

[stillhere]

Yeah they almost killed me! Last time I listen to their docs! They already killed my brother with a liver operation and then he got infected at the hell hole of a medical center!!

[BW326]

I just had the stress test 2 weeks ago for a C&P exaam for my IHD claim. I was rated at 10% 2 years ago and filed an appeal. The results of the stress test gave me a high LVEF number (around 7.6) the same as previous test had. The first test was treadmill, latest test was chemically induced because I had passed out at the previous test after reaching about 85% of goal bpm.

During this latest C&P exam, the examining doctor told me it was unlikely they would change my rating based on the LVEF from most recent test. He asked if I had any further questions and I said, "My only question is, if my LVEF is so good why do I have the continued daily issues with angina every time certain triggers happen (stress, after a meal, during light or moderate exercise)?

He looked again at the tests and asked if I had taken my normal meds, which I had. Beta-blocker (Metoprolol), also Isosorbide, and 2000MG of Ranolazine (for chronic angina). He left the office for about 10 mins then came back and his whole attitude had changed. He said that I should not have taken meds for this test or the previous one and that, especially with the Ranolazine. He wrote up notes on my exam for about another 10 mins then said I would now, likely get an increase in my rating and it would go back 3 years to when I originally filed my claim.

I was condused and several days later was doing some reserach about whether to use meds for a stress test and I found an article that looked at a study on this and the recommendation to doctors was, "Depends on what you want to test for." If the doctor wants to see the efficicency of the meds, then take meds before test. If teh doctor wants to asses the degree of the disability, do not take meds starting 48 hrs before test (tapering off the first 24 hrs then no meds the 2nd 24hrs).

This is probably the answer to the question I originally posed to the doctor, "If my LVEF is so good, why do I have daily angina when trigger trhesholds are exceeded ?" (i.e., stress, after meals, during or after exertion).

Seems to me that the VA needs to re-evaluate the policy for stress tests for C&P vs. normal testing to see effectiveness of meds under normal (none trigger situations).