hypertension Old C & P Exam

[FrankieG23]

My husband filed for DMII in 7/01. Got approved for DMII, hypertension and PN, both secondary to DMII. In 6/03stenting and ablation approved for heart disease at 60% and 8/03 approved finally at 100% as he had a pace maker/defibrillator (the defib part made him 100%PT, I dont think just a pace maker alone would have done it) The heart disease was approved as secondary to DMII. His IMOs all had heart disease due to DMII. That is just a little background. This is my question. He put in for IHD 10/31/10. The 800 number said to do so, since a rater can decide if he ever got rated for IHD or it would make difference if he passes away. I did it as maybe he could get an EED. Well I have been going thru papers as I had never put in for CHAMPVA, and I find on his C & P exam copy of doc's report that the doc found a soft 4th heart sound. This was exam for DMII back in 12/01, but it also had he listed as no heart disease. Things I have looked up under 4th heart sound show this is never audible in normal subjects, and cardiomyopathy can be a result of this (which is part of IHD). He is still in the decision phase. Do I fax over this report, does the writing of "no heart disease" on it hurt him for chances of EED? Would this be part of something that was found during an exam that should have been address by the VA, and can quailify for having a disease without a formal claim. Is he better off waiting until the R/O makes decision? It was less than 2yrs and all his heart problems came to head. The C & P doc's report seemed to be contraditory 4th heart sound can be IHD, how can he write on page 2 of same report no heart disease. Also no further testing was done at that time, except maybe a EKG, which doesn't always show heart disease the first time. He never received a stress test or echo during this C & P exam. He was never denied heart disease. Would this be something I should show to the overseers of Nehmer? Thank you for your time, this is a very knowledgeable board and I have learned many things. That is why I am putting in for CHAMPVA. I have always had insurance, but have had co-pays on my meds. I didnt know I could get re-imbursed until I saw it here.

[john999]

I don't think you can get two ratings for heart disease. If he was already rated for heart disease secondary to DMII unless he claimed IHD before his rating for secondary heart disease (DMII) I don't know if there is an advantage to it. I am in the same boat. I got rated for heart secondary to DMII back in 2006. I never claimed it before that date.

I understand why you would file for IHD anyway, but I don't know how it helps unless you can establish EED. You have to have claimed heart disease (IHD) for Nehmer to help if I understand it. I still think you were right to claim IHD.

[carlie]

I am moving the thread to VA Claims / Benefits where more people

will probably see it.

[FrankieG23]

Thank you for your help and thoughts. There has been so much confusion betw VA C & P office and 800 number for us this time. Pursue issues don't pursue issues. I have to other claims going on tinnitius (he has hearing loss at 0%)and menieres disease (secondary to DMII) sorry about spelling. I have IMO for both. I am hoping for either so he can get insurance for new condition. We didnt respond in time for the 2 yr period for other conditions he was granted. I am just amazed how a doctor can make statement without testing to prove or disprove. Again thanks for the site with people who can help with questions.

[Berta]

You put in the IHD claim about same time I did and I received my Nehmer letter 2 months ago and they said my claim has been ready for decision since April 16th.

Have you received a formal Nehmer letter yet from VA telling the veteran his claim falls under the Nehmer Order?

." In 6/03stenting and ablation approved for heart disease at 60% and 8/03 approved finally at 100% as he had a pace maker/defibrillator (the defib part made him 100%PT, I dont think just a pace maker alone would have done it)"

If the EED for that claim was wrong , then I would think the newer IHD claim claim would correct that-but that decision might be correct and as others said they will not pay comp for IHD and DMII cardiomyopathy at the same time.

Did he, prior to the 60% and then 100% award for heart disease- ever have had a previous claim for heart disease that was denied and not appealed? Or did any past rating decision show heart disease as NSC with any rating?

If so that might put him under Nehmer with the more recent claim for a more favorable EED.Hard to tell.

From what I see here, I dont see the connection to Nehmer at all for his new claim.

Was this claim sent to a Nehmer coordinator or is it still at the same VARO it was filed at?

[FrankieG23]

Thanks Berta for response

No formal letter was received by Nehmer. My husband was 60% for all combine conditions (DMii, PN both hands and legs, hypertension) I dont have exact %s hearing loss 0% prior to heart dease. No previous claim made for IHD prior to 6/03 when he had testing and was told he needed stent. Had 30 day halter which found a lot of heart disease including a silent heart attack. I beleive he was granted heart disease all secondary to DMII 800 number told me that since I am not a doctor and there is alot of conditions with the heart, they might not have called it IHD, and 800 # told me that the VA needs to put it on his rating, if they have used other medical terms for his heart disease. When we went to a regular check up I looked on computer that listed his diseases and there associated %'s. It should 20% DMII, PN upper lower each arm/leg 10% each Hypertension 20% I think and I saw Heart Disease 100% he does get SMC home bound also. The claim made in 10/31/10 started at VARO regional office Chicago. It was sent to Fast Track as 405 claim to Rocket WV. Rocket sent it back to Chicago for more medical information as they received not all of his records. Then it went back to Rocket for review. I was told all this info by 800# and his POA the VFW. I asked several 800# people if his claim was looked at as Nehmer claim and they all responded "yes". I ran across the old C & P exam he had for the DMII, which stated on pg 1 "soft 4th heart sound". Upon checking on what this condition could be, it indicated "heart disease and cardiomyopathy included (which is IHD). On pg 2 same doc list "no heart disease". This test was done 12/01. I was hoping under the Footnote 1 that maybe the VA needed to follow up on this, they did not, and they could count this as condition found during exam, which could be used for an earlier effective date. 4th hearts sounds are not found in normal subjects. He lately cant even lie flat in bed room spins. Sorry this was long. Vets go thru so much even after coming home.

[Berta]

"I saw Heart Disease 100% he does get SMC home bound also"

The only benefit I foresee from the claim is if the EED was wrong as explained within my other posts and if that could produce some additional SMC benefit.

If I were you I would contact NVLSP at their Agent Orange addy and ask them if this is a claim under Nehmer.

"No previous claim made for IHD prior to 6/03 when he had testing and was told he needed stent. Had 30 day halter which found a lot of heart disease including a silent heart attack. I beleive he was granted heart disease all secondary to DMII 800 number told me that since I am not a doctor and there is alot of conditions with the heart, they might not have called it IHD, and 800 # told me that the VA needs to put it on his rating"

Was the 100% for heart disease EED determnined back to June 2003?