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Question

In 1985 I left the military and in 1984 I underwent a Bruce Stress test due to chest pain and hypertension that was borderline in that it was suggestive of CAD although not diagnostic. Now, I still have chest pain, on Nitrostate and have been diagnosed as having IHD, cardiomyopathy and a blockage supposedly due to hypertension. I am due to undergo an echocardiogram and angiogram and if the results are what the MD thinks they'll be, I'll be in a cardiac mess. Would there be a nexus or link to the 1984 testing and treatment?

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That could be a possible nexus however,in my opinion you would need a strong IMO to support a SC claim as well as documented evidence that the inservice problems caused continuous disability.

"that was borderline in that it was suggestive of CAD'

Do you have copy of the EKG they did at that time?

Do you have copies of subsequent EKGs? and additional med recs since 1985?

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I have all the ECG's, records etc. but I don't know what the date VA uses if they validate and affirm an AO claim. I've requested several ratings for heart condition due to LVH since '85 and have been denied all x's the most recent was in 1998 which the QTC exam revealed LVH. Now I have the symptoms, SOB, palpatation, chest pain, dizziness etc. I guess it doesn't matter what any of us think, we're all at the mercy of the VA and if we don't like their decision, we can appeal and obtain an IMO. I know that sometimes one has to enter the fray of battle to obtain rightful benefits.

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I am confused here as to your claim-

If you are a Vietnam incountry veteran-and have a documented presumptive AO condition- the "nexus" factor as been satisfied.

Your conceded AO exposure was your nexus.

If you filed a claim after Sept 25th 1985 with the VA for IHD, or

if CAD or IHD appeared in any rating decision since then with a diagnostic code and NSC rating percentage,then you are a Nehmer veteran under Footnote One of the Nehmer court order and Stipulation.

The date of the earliest denied IHD claim after Sept 25th 1985, is what should be your EED-earliest effective date.

Footnote OneI need to remind all again- applies not only to coded ID in past VA decisions it also applies to IHD that SHOULD have been coded in past VA decisions.

My email from the NVLSP lawyer I go back and forth with on advocacy issues is in our AO forum here somewhereand he explained this significant part of Nehmer as to Footnote One.

If you did not have a prior past denial of any claim after Sept 25,1985 in which the IHD was never clainmed or mentioned- that is not a Nehmer claim and your EED will be the date the VA received the AO claim.

I dont understand what your mean here:

"and have been denied all x's the most recent was in 1998 "

Do you mean denied all claims or denied a proper diagnosis?

If you were denied all claims for IHD then have you contacted NVLSP at their email addy have posted here many times?

If you feel you presented heart disease at any point to the VA by virtue of tests results etc, and they didnt diagnose and treat you properly you have basis for a Section 1151 claim as well as an AO claim.

There is significant info here on 1151 claims in our FTCA forum.

LVH Left Ventricular hypertrophy does not happen overnight.

When you say you "requested ratings "for IHD do you mean you formally claimed this and they denied?

The echocardiogram can determine the extent of your IHD.

Coronary disease is not always IHD.An ECHO can reveal the extent of atherosclerotic disease that is the essense of ischemia in the heart or due to the heart.

My doc always tells me I have no ischemia and I think she determines this solely by the EKGs I get every year.

An EKG band will often state possible ischemia.

Or something to that affect.

An EKG band strip for my husband done in 1988 was the most definitive piece of evidence I had when I FTCAed and 1151ed the VA.

They said he should take 3 days off work from the VA where he worked and gave him sudafed.

6 years later he died of ischemic heart disease and VA malpractice .The VA failed to follow up on notations in his med recs based on the abnormal EKG and on successive additional abnormal EKGs.

I am a Nehmer footnote one widow and NVLSP will review my award as soon as it gets here.Because I emailed them right away at their AO email addy site.

The VA's defintition of IHD is in our AO forum.

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This is my history: Republic of Vietnam 1965-67

1984: Hypertension/chest pain, Left Ventricula hypertrophy per ECG, Bruce Test suggestive of very early CAD although not diagnostic

1985: Inverted T-waves suggestive of ischemia

1987: LVH per x-ray/ECG

1987: Moderate concentric LVH

1988: Cardiomyopathy with LVH

1988: One episode of syncoop with atrial fibrillation

1989: LVH with repolarization abnormality

1999: CAD w/o clinical bais

2007: ECG w/borderline sinus rhythm and abnormal left axis deviation

Hypertension with renal insufficiency non-sc

Rating Exams are a follows:

13 Dec 85: SC denied because no CAD was shown in military service records and no residual chest pain on exam

24 Jun 88: Denied SC for heart condition because the rating states no heart condition was found on exam.

22 May 2007 QTC exam: ECG with borderline sinus rythm and abnormal left axis deviation which examiner condisdered not significant, no heart abnormalities noted.

Many if not all of the non rating diagnoses were not told me by the VA physicians over the years and after a recent denial of AO (because I didn't show for the app't) were listed and SC denied. I have had fluttering and minor chest pain for many years non-treated and recently changed civilian MDs and th enew MD asked me about chest pain due to the 1984 Bruce Test and referred me to a cardiologist where the determined I have ischemia, blockage and have an Angiogram tomorrow. It is after the Angio tht the cardiologist will advise me of my situation.

Thank you Berta for lsitening.

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"

"after a recent denial of AO (because I didn't show for the app't"

That is very unfortunate.

"referred me to a cardiologist where the determined I have ischemia, blockage and have an Angiogram tomorrow. It is after the Angio tht the cardiologist will advise me of my situation."

If it is ischemia and rated as NSC in prior denials , please email NVLSP at their AO email addy.

This would put you under Nehmer -Footnote One -if the ECHO or angiogram reveals IHD ischemia and the earlier claims were denied for the same disability.

Footnote One is explained here in our AO forum as well as the NVLSP email addy.

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