hypertension A Shout Out For Help & Opinions

[carlie]

Rating Decision from my VARO dated November 16,2010.

"The BVA decisions of May 2010 and August of 2010

determined that SC for asthma and bronchitis is granted.

The Board stated that the currently demonstrated asthma and chronic bronchitis are shown as likely as not to their clinical onset during your period of active service."

For the record, this disability has been rated under DC 6600.

" ** An initial 10 percent is granted based on your

FEV1?FVC at 72 percent from August 26, 1999, the date of your claim

for SC for a lung disease.

An evaluation of 10 percent is assigned for forced volume in one second

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71to 80 percent,

or; DLCO (SB) 66- to 80-percent predicted..

** A 30 percent evaluation is granted based on your DLCO of 55.8 percent effective February 28,2002, the date the PFT results showed you

warranted a higher evaluation.

** A 60 percent evaluation is granted based on your DLCO of 52.7 percent effective October 29, 2008, the date the PFT results showed you

warranted a higher evaluation."

** Here's where my disagreement / question comes into play.

DC - 6600

A higher evaluation of 100 percent is not warranted unless

FEV-1 less than 40 percent of predicted value,

or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent,

or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted,

or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption

(with cardiac or respiratory limitation),

or; cor pulmonale (right heart failure),

or; right ventricular hypertrophy,

** or; pulmonary hypertension (shown by Echo or Cardiac Catheterization),

or; episode(s) of acute respiratory failure,

or; requires outpatient oxygen therapy...

**Listed in the Evidence Section of this Rating Decision is :

"A review of XXX XXXXX VA Healthcare System records

dated July 28, 1998 to November 12,2010."

Briefly looking thru my medical records from the above time frame I find:

2/29/2000 - Consult Echocardiogram

Test Indication: Pulmonary Artery Pressure

Impression: Blah - Blah - Blah - Blah,

Mild Pulmonary Hypertension (PAP 35 MMHG).

Confirmed By: XXXX,XXXX, M.D.

Signed by:/es/XXXXXX

ULTRASOUND TECH. XX/XX/XXXX 11:24

Going by the above, doesn't Echocardiogram evidence of Pulmonary Hypertension in 2000 warrant an evaluationof 100 percent ?

[WAC-Vet75]

From what the Schedule for Ratings reads...... yep, 100% and it looks like from 2000. There is no reference in that diagnostic code for "mild, moderate, or severe" in respect to the "requirement" for pulmonary hypertension.....

[broncovet]

While what WAC says is true, you dont often see 100% awarded for "mild" conditions..it usually has to be severe to warrant a 100% rating, but I agree it does not say that THERE.

[carlie]

Pulmonary Hypertension is pretty much un-curable

and only progresses to being worse.

Once you have it - it's for life and has detrimental effects on

everything related to your heart.

[Stretch]

My last 3 PFT have been DCLO = 40 Fev1= 40..

Ask for your read out when the gal does the PFT...She can print it for you so that you do not have to wait at foia.

[Philip Rogers]

I agree. I'd do an updated NOD and waive RO processing on it, if you're at the BVA, now.

pr

[Berta]

“FEV-1 less than 40 percent of predicted value, or; FEV-1/FVC less

than 40 percent, or; DLCO (SB) less than 40-percent predicted,

or; maximum exercise capacity less than 15 ml/kg/min oxygen

consumption (with cardiac or respiratory limitation), or; cor

pulmonale (right heart failure), or; right ventricular

hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac

catheterization), or; episode(s) of acute respiratory failure,

or; requires outpatient oxygen therapy, is rated 100 percent

disabling. 38 C.F.R. § 4.97.”

http://www.va.gov/vetapp10/files4/1034438.txt

This case includes this point:

“The special provisions regarding evaluation of respiratory

conditions note that when evaluating a respiratory disorder based

on pulmonary function tests, use post-bronchodilator results in

applying the evaluation criteria in the rating schedule unless

the post-bronchodilator results were poorer than the pre-

bronchodilator results. In those cases, use the pre-

bronchodilator values for rating purposes. 38 C.F.R. § 4.96(d).”

Carlie, did the VA adhere to this regulation as to use of the bronchodilator?