hypertension Ihd And Secondarys

[Berta]

"According to Harrison's Principles of Internal Medicine (Harrison's

Online, Chapter 237, Ischemic Heart Disease, 2008), IHD is a condition

in which there is an inadequate supply of blood and oxygen to a portion

of the myocardium; it typically occurs when there is an imbalance

between myocardial oxygen supply and demand. Therefore, for purposes of

this regulation, the term ``IHD'' includes, but is not limited to,

acute, subacute, and old myocardial infarction; atherosclerotic

cardiovascular disease including coronary artery disease (including

coronary spasm) and coronary bypass surgery; and stable, unstable and

Prinzmetal's angina. Since the term refers only to heart disease, it

does not include hypertension or peripheral manifestations of

arteriosclerosis such as peripheral vascular disease or stroke."

http://www.regulatio...A-2010-VBA-0005

Peripheral Vascular disease is synonymous with PAD Peripheral Arterial Disease and can be a secondary to IHD.

A veteran could have both PAD and also PN as they are two distinctly different disabilities.

Although the regulations above seems to rule out PAD it really doesnt rule it out if there is medical evidence that it is in fact secondary to IHD.I didnt even know my husband had PAD until Dr. Bash ,in a 2004 IMO, stated the veteran's Agent Orange induced diabetes caused development of his PAD.quoting a reference from Braunwald.

As I mentioned here before the VA granted my DMII AO death claim but never rated the DMII at all or any of it's secondarys.I filed a NOD on that.

But:

“People who have coronary heart disease or a history of heart attack or stroke generally also have an increased frequency of having peripheral vascular disease. “

“Peripheral artery disease is due to atherosclerosis. This is a gradual process in which a fatty material builds up inside the arteries.”

http://www.emedicinehealth.com/peripheral_vascular_disease/page2_em.htm#Peripheral%20Vascular%20Disease%20Causes

Since IHD can also cause PAD I mentioned this in my AO claim.

If you have strong medical evidence that you have PAD that is due to your AO IHD, then be sure to claim it as a secondary.It would not surprise me if VA overlooks this condition as a formal diagnosis

because I think the meds for other conditions such as IHD or DMII would control it.

As the regs state Stroke- if you have had a stroke as either consequence of IHD or DMII (by medical evidence) and/or have PAD that can be directly associated to either DMII or IHD under the new regs -you should claim it.

Braunwald is the TOP cardiology text in the USA. Harrison's Principle's (what the IHD regs are based on)was also written with considerable input from Braunwald.

My daughter got me Braunwald for Christmas and unfortuantely I cannot scan anything in it because it takes two people to do that- the book is very heavy and large.

I did get my neighbor to hold it to scan something but the pages are larger than my scanner glass so that didnt work well.

Still there are some excerpts from Braunwald that are googleable.

And from Harrison's Principles.

If you get an IMO from a Cardio doc they surely would use these texts as a citation to bolster their opinion.

I am assuming that all IHD claims under Nehmer are getting a very concise review and might well consider all secondarys to the IHD if a past decision reveals a NSC rating for something that is obviously due to IHD.

But the mantra of VA has always been that you have to ask for what you want so it is best to claim anything that could potentially be a ratable condition directly stemming from the IHD (by medical evidence).

[stever]

So if I have coronary artery disease,cholesterol build-up in my arteries and I am on medication, I have IHD?

Stever

[Berta]

The best indicator of IHD is an ECHO (Doppler) test.Or in some cases METS test.

Best to check with your doctor as to whether you have a confirmed diagnosis of IHD or not.

CAD almost always is IHD but VA needs a medical diagnosis.

Then -if you are an incountry Vietnam vet. file the claim ASAP.

There is a brief C & P type form if you have a private cardio doctor and it should be available here to copy and give to the doc.

This form, when used by a private cardio doc, can make a claim go a little faster as it alleviates ,in most cases, need for VA cardio C & P exam.

Edited April 29, 2011 by Berta

[stever]

The best indicator of IHD is an ECHO (Doppler) test.Or in some cases METS test.

Best to check with your doctor as to whether you have a confirmed diagnosis of IHD or not.

CAD almost always is IHD but VA needs a medical diagnosis.

Then -if you are an incountry Vietnam vet. file the claim ASAP.

There is a brief C & P type form if you have a private cardio doctor and it should be available here to copy and give to the doc.

This form, when used by a private cardio doc, can make a claim go a little faster as it alleviates ,in most cases, need for VA cardio C & P exam.

Thanks Berta,

Yes, I am a vietnam vet, the reason for my concern was that on a recent chest xray they noted that I had sclerosis on my aortic arch and proximal descending aorta.

Stever

[Berta]

I agree with RonP who answered elsewhere-

that ECHO and/or METS results will indicate IHD or your doctor can confirm whether you have IHD or not.

The VA is resting on either METS or ECHO results or,in some cases, both to rate IHD.

VA will be using 38 CFR$ 4.104 to rate the AO IHD claims and there will go by METS or ECHO results

They will be using either diagnostic code 7005 0r 7006

"7005 Arteriosclerotic heart disease (Coronary artery disease):

With documented coronary artery disease resulting in:

Chronic congestive heart failure, or; workload of 3 METs or less results

in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular

dysfunction with an ejection fraction of less than 30 percent 100

More than one episode of acute congestive heart failure in the past year,

or; workload of greater than 3 METs but not greater than 5 METs

results in dyspnea, fatigue, angina, dizziness, or syncope, or; left

ventricular dysfunction with an ejection fraction of 30 to 50 percent 60

Workload of greater than 5 METs but not greater than 7 METs results

in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of

cardiac hypertrophy or dilatation on electrocardiogram,

echocardiogram, or X-ray 30

Workload of greater than 7 METs but not greater than 10 METs results

in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous

medication required 10

http://webcache.googleusercontent.com/search?q=cache:rBclG7kx49IJ:www.benefits.va.gov/warms/docs/regs/38CFR/BOOKC/supple-c-41.DOC+Title+38+CFR+4.104,+diagnostic+codes+7005+and+7006+s&cd=1&hl=en&ct=clnk&gl=us&client=firefox-a"

The ECHO can reveal impact of IHD on aorta.

I am looking at a Doppler ECHO of my husband.

He had IHD based on the findings under M-mode and 2-d measurements adding that his aortic root dilated.

But ECHOs reveal so many measurements that this is why VA uses the Ejection Fraction to determine ratings for IHD.

In his case the dilated aortic root was a consequence of left ventricular atherosclerotic heart disease.

It is best to ask your doctor if you have IHD and if it is evident in the doctor's interpretation of the X ray you had.