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.

[Chuck75]

What bothers me about all of this sort of thing--

Some ROs seem to be ignoring a recent directive that basically says that a C&P is not required when existing evidence establishes the existence of IHD, and the level of disability sufficient to rate.

Part of this goes into the statements in the compensation schedule that such things as treadmill and stress tests should not be given if the medical evidence shows that the veteran had/has heart damage, and an LVEF or METS rating that equates to 100% disability.

A stress test is not without risk. Scheduling one based upon an RO's cover tail mentality is not medically sound, and risks a law suit if things go awry.

Properly done for diagnostic purposes, a chemical stress test on a damaged heart shows actual heart failure, and it's "efficiency".

Improperly done, it can induce further damage, and a full blown "heart attack", possibly resulting in death.

The VA has tried to do this to me. The last time, I hand carried my cardiologist's statement that a stress test was too risky, along with documents showing the extent of existing damage.

The VA Contract Cardiologist declined to do the testing.

Further, several of the routine medications taken can cause problems with tests that use radioactive dye, and other drugs commonly used when cath based tests are made.

Some of the drugs/chemicals used can damage kidneys and the liver if the "routine" medications are not suspended for a period before and after the tests.

One of the dyes used until recently, in lieu of iodine based dye, can cause kidney shutdown, and should have only been used once, if at all.

[stillhere]

I would like to add here that I do not go to the VAMC for my heart treatments I use a private doc who is board certified and came very highly recommended.

My observation on the VA and veteran care is something like the fox guarding the hen house.

Can't proof a thing at this point but I am very worried getting treatment to keep me alive by someone who is also paying me compensation for the same.

Just saying. Stillhere

[Jayco]

Filed a claim a year ago this month based on AO exposure in Vietnam. Still waiting on a rating. I have heart disease (triple bypass), high blood pressure, and type 2 diabetes.

I took a treadmill test August of last year in Bangkok and passed. Doctor said I did really well. Test was done with me taking my normal meds. Without meds there was no way I would have even let them attempt a treadmill test. Up until then my last 3 annual stress test in the states have been chemically induced even on meds. I did the treadmill test because I thought I had to if I wanted any success with my claim. My resting hear rate is well over 100 when I do not take my med even for one day.

Two questions. Was the stress test administered incorrectly? Should I make an issue of this now or wait for the rating and go through the appeal process?

Thanks

[john999]

My resting heart rate drops into high 40's at night. I am as far from being athletic as you can get since PN ruined my feet and herniated disc happened in my neck and back.

[Chuck75]

Filed a claim a year ago this month based on AO exposure in Vietnam. Still waiting on a rating. I have heart disease (triple bypass), high blood pressure, and type 2 diabetes.

I took a treadmill test August of last year in Bangkok and passed. Doctor said I did really well. Test was done with me taking my normal meds. Without meds there was no way I would have even let them attempt a treadmill test. Up until then my last 3 annual stress test in the states have been chemically induced even on meds. I did the treadmill test because I thought I had to if I wanted any success with my claim. My resting hear rate is well over 100 when I do not take my med even for one day.

Two questions. Was the stress test administered incorrectly? Should I make an issue of this now or wait for the rating and go through the appeal process?

Thanks

Only a doctor, with the details in hand, might be able to answer your question as to the stress test. A stress test shows overall heart function, and may be basic or in depth. A heart cath can show more detail, and actually measure pressure and volume ratios within the heart. With a "normal" stress test result, it sounds like your triple bypass is working well. The usual "life" of bypasses varies, but expect 15 to 20 years or so without major problems, assuming you follow the recommended treatment and diet.

However, the presence of HBP and DMII generally places you at a potential risk for further problems in the future. The low heart rate at rest may be an indication of Bradycardia, which is not uncommon, given the history you mentioned. It's also an indication that you may be taking medication that slows the heart rate. There is also something that the VA does not have (to my limited knowledge) a schedular rate, referred to as Metabolic Disorder. There is growing recognition that DMII, IHD, etc. are likely symptoms of this. And, It makes sense, given the known and suspected effects of A/O exposure. Genetics also are a factor.

Edited June 8, 2013 by Chuck75

[Chuck75]

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?

It took me awhile to notice this one!

The invasive test is commonly called a heart cath. Over the years it has become safer and less of a hassle. (I've had several) When I submitted my claim for IHD, etc. the results of chemical stress tests, heard caths, and stint implantation were included. The VA initially denied the claim. I appealed, and eventually, before the appeal really got started, submitted again under the Nehmer rules and VA presumption. The Nehmer review reply back to the originating VARO was interesting. Seems that the review board could not understand why the RO denied the claim to begin with. When all was said and done, the review board awarded the claim(s) and set the EED at the original and earliest date any AO related claim was made. (six years previous to the award.) Unsaid but implied by the review was that sufficient evidence was originally submitted to approve the claim in the first place, with or without presumptive status. It's also worthy of note that long standing "links" between DMII, cardiovascular problems, and various related things such as PAD were removed from various VA documents, Including the M 21. This occurred roughly when DMII was made presumptive.