Carlie, Could You Please Take A Look At This

[bm6546]

Carlie,

I would appreciate it if you would please look at this and tell me what you think. I know you deal a lot with claims that involve a CUE.

I would like your take on this.

Thanks in advance,

Brian

[bm6546]

Thank you for confirming that my memory hasn't failed me completely!

Another question: Did the military diagnose you with heart disease? ~Wings

Nothing wrong with your memory. The Navy only diagnosed me with PAT. But I do have heart disease now.

[carlie]

My understanding of this thread is that :The diagnosis and evidence in the SMR's helped get the issue SC'd.

It was SC'd at a compensable level - something happened and an amendment was

made that stated the condition was still SC'd but the evidence used in the prior decision

did not support a compensable level of disability and a reduction was made to SC at zero percent.

[Wings]

Brian,

For VA rating purposes, PAT is classified under "diseases of the heart", 38 C.F.R. 4.104

The Navy diagnosed you with a heart disease (PAT) with 4.5 months of observation, testing and inpatient hospitalization.

Did the Navy assign your 10% rating, or was the rating assigned by the VA?

What diagnostic code (DC) was applied to the original 10% service-connection?

~Wings

Post Script

See STAGED RATINGS

Where entitlement to compensation has already been established [1967] and an increase in the disability rating is at issue [2010] the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994).

Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007).

VA changed the rating criteria for diseases of the heart [effective January 12, 1998]

Under former Diagnostic Code 7013, a 10 percent rating was provided for infrequent tachycardia attacks with a 30 percent assigned for severe frequent attacks. 38 C.F.R. § 4.104, Diagnostic Code 7013 (1997). Under the revised rating criteria, a 10 percent rating is warranted for supraventricular arrhythmias of one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor. A 30 percent rating requires paroxysmal atrial fibrillation or other supraventricular tachycardia with more than four episodes per year documented by ECG or Holter monitor. 38 C.F.R. § 4.104, Diagnostic Code 7010 (2010).

-snip-

Throughout the claims period, the Veteran has reported experiencing occasional episodes of tachycardia. While these episodes have not been confirmed on ECG or Holter monitor, the Veteran has carried a diagnosis of paroxysmal tachycardia during the entire claims period and he is considered competent to report symptoms such as an increased heart rate. Private and VA records document consistent complaints of palpitations and episodes of tachycardia characterized as sporadic, occasional, and intermittent dating from April 1996. The Board therefore finds that the Veteran's paroxysmal tachycardia has most nearly approximated infrequent attacks and a 10 percent evaluation is warranted under former Diagnostic Code 7013.

The Board finds that a rating in excess of 10 percent is not warranted under former Diagnostic Code 7013 (1997) or current Diagnostic Code 7010 (2010). Although the record documents complaints of tachycardia at various times during the claims period, there is no objective evidence of paroxysmal tachycardia and ECGs, Holter monitors, and stress tests conducted throughout the claims were negative for tachycardia. The October 2009 VA examiner noted that the Veteran had only a clinical diagnosis of paroxysmal tachycardia without clear objective evidence of the condition, and the May 2010 VA examiner further stated that the Veteran had never been to the emergency room or hospitalized due to tachycardia. The disability therefore does not most nearly approximate severe, frequent attacks of tachycardia or manifest four episodes per year documented by ECG or Holter monitor. The record does not establish that a rating in excess of 10 percent is warranted under the former or current criteria pertaining to paroxysmal tachycardia.

[bm6546]

Brian,

For VA rating purposes, PAT is classified under "diseases of the heart", 38 C.F.R. 4.104

The Navy diagnosed you with a heart disease (PAT) with 4.5 months of observation, testing and inpatient hospitalization.

Did the Navy assign your 10% rating, or was the rating assigned by the VA?

The VA assigned the 10%.

What diagnostic code (DC) was applied to the original 10% service-connection?

7013

~Wings

Post Script

See STAGED RATINGS

Where entitlement to compensation has already been established [1967] and an increase in the disability rating is at issue [2010] the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994).

Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007).

VA changed the rating criteria for diseases of the heart [effective January 12, 1998]

Under former Diagnostic Code 7013, a 10 percent rating was provided for infrequent tachycardia attacks with a 30 percent assigned for severe frequent attacks. 38 C.F.R. § 4.104, Diagnostic Code 7013 (1997). Under the revised rating criteria, a 10 percent rating is warranted for supraventricular arrhythmias of one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor. A 30 percent rating requires paroxysmal atrial fibrillation or other supraventricular tachycardia with more than four episodes per year documented by ECG or Holter monitor. 38 C.F.R. § 4.104, Diagnostic Code 7010 (2010).

-snip-

Throughout the claims period, the Veteran has reported experiencing occasional episodes of tachycardia. While these episodes have not been confirmed on ECG or Holter monitor, the Veteran has carried a diagnosis of paroxysmal tachycardia during the entire claims period and he is considered competent to report symptoms such as an increased heart rate. Private and VA records document consistent complaints of palpitations and episodes of tachycardia characterized as sporadic, occasional, and intermittent dating from April 1996. The Board therefore finds that the Veteran's paroxysmal tachycardia has most nearly approximated infrequent attacks and a 10 percent evaluation is warranted under former Diagnostic Code 7013.

The Board finds that a rating in excess of 10 percent is not warranted under former Diagnostic Code 7013 (1997) or current Diagnostic Code 7010 (2010). Although the record documents complaints of tachycardia at various times during the claims period, there is no objective evidence of paroxysmal tachycardia and ECGs, Holter monitors, and stress tests conducted throughout the claims were negative for tachycardia. The October 2009 VA examiner noted that the Veteran had only a clinical diagnosis of paroxysmal tachycardia without clear objective evidence of the condition, and the May 2010 VA examiner further stated that the Veteran had never been to the emergency room or hospitalized due to tachycardia. The disability therefore does not most nearly approximate severe, frequent attacks of tachycardia or manifest four episodes per year documented by ECG or Holter monitor. The record does not establish that a rating in excess of 10 percent is warranted under the former or current criteria pertaining to paroxysmal tachycardia.

[Hoppy]

Carlie and Brian,

I am going back over this thread.

“After reading thru about 10 old BVA decisions, I think one of the reasons

VBA amended / reduced your 10%

down to zero percent due to the pulse rate shown on the 12/67 exam”.

The case you cited was for “sinus tachycardia”. Sinus tachycardia is a different medical condition than paroxysmal atria tachycardia. A paroxysmal condition is one that onsets rapidly and ends rapidly. Paroxysmal tachycardia does not have ‘sustained heart rates”. When rating “sinus tachycardia they look for “sustained” resting heart rates over 100. When rating paroxysmal tachycardia they look for frequency of events. The rating schedule was a joke and they did not know how to apply it.

The heart rate taken in 12/67 was a static test. It is my contention, which was developed in my position papers, that given the history of Brian’s symptoms static heart rate tests are not sufficient to determine improvement and are CUE able..

12/1/ 67 was the reduction exam not the original rating. Brian was service connected in July 1966 at ten percent (see page for of remand

Page four of the remand states that “By rating decision in February 1968, the l0 percent evaluation for PAT was reduced to noncompensable. In making that determination the RO noted that in the December 1966 VA examination a compensable disability was not shown.”

The best I can tell this is a lie. Brian posted the 2/68 rating decision. That decision clearly shows the last exam was dated 12/1/67. 12/1/67 is the date of the reduction exam, over a year after he was rated 10%. The 2/68 decision does not state that the cited exam for the reduction was from 1966. To the contrary the 2/68 reduction decision states that the reduction was based on a “current” exam. The most current exam of record was the 12/67, the reduction exam.

I will try and re-attach the 2/68 decision again

Rating Decision 2-5-68 a.pdf

[carlie]

In looking over this reduction letter again - I still question what the following is in reference to - at the given time period.

10. Not entitled - - 38 USC 336

This is something I found but do not know if or how it would relate to this claim.

I am only posting an excerpt from the following BVA decision to try and understand

why and what,the OP's reduction decision was actually based on.

This excerpt IS NOT from the OP's information.

It is only to address the portion of the reduction decision that states :

"10. Not entitled - - 38 USC 336.

I am in hopes that someone here might have more knowledge or info on

38 USC 336 - in effect, during the OP's timeframe.

carlie

http://www.va.gov/vetapp09/Files2/0918127.txt

However, a review of a May 1966 rating decision reflected

that the Veteran was entitled to 38 U.S.C. 336, while engaged

in extra-hazardous service.

Title 38 U.S.C. § 336 in effect in 1970 stated that any veteran otherwise entitled to

compensation under the provisions of this subchapter shall be entitled to receive the rate of compensation

provided in section 314 and 315 of this title,

if the disability of such

veteran resulted from an injury or disease received in line

of duty (1) as a direct result of armed conflict, (2) while

engaged in extrahazardous service, including such service

under conditions simulating war, or (3) after December 31,

1946, and before July 26, 1947. This statute indicated that

higher compensation could be awarded to a veteran who was

involved in either armed conflict or extrahazardous service.

As such, it appears that a veteran could receive "hazard"

pay when not necessarily serving in a combat situation as

contemplated in 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f).

Accordingly, the case is REMANDED for the following action:

1. Please attempt to corroborate the

Veteran's allegations that he engaged in

combat with the enemy by obtaining any

hazard pay records and make attempts to

verify that he received combat/imminent

danger/hostile fire pay during his service

in Vietnam from August to November 1965.

Note that the Veteran was entitled to 38

U.S.C. 336, while engaged in extra-

hazardous service at the time of his May

1966 rating decision. If hazard pay

records or confirmation of combat/imminent

danger/hostile fire pay cannot be

obtained, document the record accordingly