Ihd Claim

[cbtvet]

I have recieved a denial of ihd claim because they determined i have not been "officially diagnosed". They did acknowledge i have a history of chest pain. In my medical history there is a diagnosis of atherosclerosis, 2 ekg's showing past heart attack, high blood pressure, angina upon exertion. stress test revealed center chest pain. plus high colesterol. I was given nitro on my first visit to the va. I guess i made a rookie mistake by thinking they would dig and find this information in my medical history. also i had mentioned at one time i didn't think i had a heart problem. They took that as bible, and pointed it out in the denial letter. Question is how should i proceed.

[Chuck75]

What I would do - - talk to a non VA interventional cardiologist. The previous stress test should show some idea of your hearts damage.

A heart cath should show the extent of sclerosis. The cardiologist's report will likely show that IHD exists. Past heart attacks cannot be ignored,

even though the VA RO tried to do so. Remember that you have to appeal (NOD) within one year to maintain the original claim date.

If you are a veteran that falls under Nehmer, you should also contact the NVLSP.

[Berta]

Chuck is correct.

There is an IHD form here for a private doctor to use.

Did you ever have a ECHO done?

I am a little baffled by this decision.

Did you get an actual C & P exam for the claimed heart disease?

Do you have the results of that C & P?

Something seems very wrong here.

"officially diagnosed"

The VA officially diagnosed my husband with IHD 3 years after he died from it.I diagnosed it myself when I filed FCTA case a few months after he died.

His past ECHO and EKGS were completely ignored by the VAMC in his lifetime as well as by the VARO, when I reopened his 1151 claim.

DO you get any heart meds or cholestrol meds?

Can you scan and attach the C & P exam results here ? (Cover the personal stuff)

You certainly present what appears to be IHD if the atherosclerosis involves your heart.Chuck is right that this is determined best by METS, Stress test, the heart cath or ECHO.

EKGs can reveal inferior wall ischemia (past heart attacks)

Do your EKG result strips have that noted on the top of the strip?

This is a very odd decision.

[Berta]

Here is the form your private doctor will need:

http://www.vba.va.gov/pubs/forms/VBA-21-0960A-1-ARE.pdf

I found a past post you made here:

"Posted 23 September 2011 - 08:24 PM

Thank you. I e-mailed my varo to check on my claim they told me the ihd was in the decesion phase. since i have had no c&p for ihd i was wondering.If they were going to schedule me one , apparently not. "

I responded at the time you posted this to the affect that maybe they had enough current info to rate already in your medical records.

I am concerned here that you might not be getting proper VA care for your heart disease.

You need a private cardio opinion on the IHD form

as well as some input into your overall heart disease treatment.

Can you scan the Reasons and BAses part of the decision and post that here since you didn't get a C & P?

Cover the personal name address C file stuff.

[Berta]

One more question-

if the IHD cardio doctor diagnoses you with IHD, has your Agent Orange exposure been conceded by the VA?

Either proof of boots on the ground - Vietnam or via their AO ship's lists?

Edited December 1, 2011 by Berta

[cbtvet]

Berta i thank you and chuck for your response. I can't scan but i will give you verbatim info from the decision. the ekg's do have reference to past anterior infarction. the medications i use include nitroglycerin, amlodiapine, gimfibrosil, simvanstatin, propranol, wellbutrin, trazodine . one of the ekg's was done in 05 by a civilian dr. the other by the va in 09. the reason for denial states " the evidence does not show a current diagnosed disability ". "Your condition is not one of the chronic diseases that va presumes related to your military service". summary of evidence 7005 ischemic heart disease {Agent Orange - Vietnam/Ischemic Heart Disease} Not service connected, no diagnosis.

In a box below that it states, " Service connection for ischemic heart disease is denied - No Dx, presumptive - no dx.

Please note the veteran has verified in-country Vietnam service. However, there is no evidence of record establishing the veteran has heart disease. There were references to the veteran having chest pains. However, there was no diagnosis of heart disease of record. In the veteran's most recent treatment reports from the VA Medical Center, he denied having heart disease."

[Chuck75]

It seems to me that "past anterior infarction" is by definition, evidence of probable IHD.

EKGs can show damage. The prescriptions you mentioned also indicate treatment for a heart condition, and probable heart damage. These are not normally given to someone without at least a suspected heart condition.

You should also be looked at for DMII at some level, possibly below that used for formal diagnosis.

What is missing at this point is medical information that can be used by the VA to define and "rate" the severity.

However, the "chronic diseases" reference makes me think that the RO may have been in the classic "deny anyway you can" thinking mode, and used the fact that there is no direct reference to IHD in your records to deny the claim.

Your statement that you didn't think that you had heart disease was evidently used against you.

Had you said that you thought you had heart disease, the VA would likely have totally discounted it, since you are not (as far as I know) a "medical professional".

I believe even the mention of it might be considered somewhat prejudicial, but again, that's a lawyers call, not mine.

If no C&P was made, or ordered, this can be used in your favor. You need to file an NOD, and, if you can get the necessary information in hand, use a "form 9" and send a copy of a cardiologist's showing that IHD exists, and the severity of it. The VA "likes" to use a definition (METS) that is not commonly used by cardiologists.

However, a ventricle efficiency measurement (usually left), is also acceptable, and will allow a "schedular" percentage to be assigned by the VA. You can also ask for "reconsideration", based upon "new evidence". This might take less time.

I think that the NOD and appeal route is preferable, unless you can somehow get the VA to "CUE" the decision, (doubtful) based upon the relationship between "infarction" and IHD.

Others may have differing opinions, and I'd ask for legal advice as well before I made a decision as to which route to take. Just don't let your options expire.

The no diagnosis bit is sort of a cop out, in that the medical records show that you likely have IHD at some level, and the VA should have at least called for a C&P to determine if IHD is present or not, and it's severity.

I believe that the VA made some serious errors (nothing new!), and that a competent lawyer can capitalize on them.

Berta i thank you and chuck for your response. I can't scan but i will give you verbatim info from the decision. the ekg's do have reference to past anterior infarction. the medications i use include nitroglycerin, amlodiapine, gimfibrosil, simvanstatin, propranol, wellbutrin, trazodine . one of the ekg's was done in 05 by a civilian dr. the other by the va in 09. the reason for denial states " the evidence does not show a current diagnosed disability ". "Your condition is not one of the chronic diseases that va presumes related to your military service". summary of evidence 7005 ischemic heart disease {Agent Orange - Vietnam/Ischemic Heart Disease} Not service connected, no diagnosis.

In a box below that it states, " Service connection for ischemic heart disease is denied - No Dx, presumptive - no dx.

Please note the veteran has verified in-country Vietnam service. However, there is no evidence of record establishing the veteran has heart disease. There were references to the veteran having chest pains. However, there was no diagnosis of heart disease of record. In the veteran's most recent treatment reports from the VA Medical Center, he denied having heart disease."