Finally, A Diagnosis ...

[VetsLady]

Husband had an appt with his private cardiologist for follow-up to an abnormal EKG (thank you Berta!)

After testing, doc found numerous areas of calcified plaque, confirmation of a prior myocardial infarction (date unknown) although we have a normal EKG from May '04 and then an abnormal one from Sept. '04 that follow-up was done on but apparently not enough.

Private cardiologist diagnosis: ASHD (I believe this is atheroscleriosis heart disease?) IHD, myocardial infarction, patient is taking 4 different medications for his heart disease (he has been for several years.)

His mets are 10.1 (from a QTC exam in '09), left ventricular ejection fraction is 66%

In addition to numerous areas of plaque build-up in the 25% range, the "proximal portion of the first Obtuse Marginal Branch" is totally occluded.

He has a claim opened on his behalf from August '10 as he is service connected for DM2 and residuals due to Agent Orange. He has undergone numerous QTC exams for this condition and although QYC reports marginally indicate possible heart disease, this newest evidence is conclusive and the doc completed and signed the IHD questionnaire. Monday, I will be sending it along with the test report to the Regional Office. I would "think" that with this new concrete evidence, there should be no question to sc him for IHD...will have to await the decision to see what "date" they give him.

I did note in the regs that the language says "or" when referring to ets, syncope, etc. Does this mean in the regs he has to have "all" of the requirements in the individual percentages "or" if I am reading it correctly, it does state "or" ......

At least now we know where he stands heart-health wise and can make changes in lifestyle and diet as best as we can to prevent further build-up. That is the most important thing for now....

Thank you Berta for sharing Rod's story....it sent us straight to the cardiologist. Most importantly, awareness of the current situation and hopefully prevention of further development.

Edited April 6, 2012 by VetsLady

[Berta]

You are correct that the regs say “or” :

“"7005 Arteriosclerotic heart disease (Coronary artery disease):

With documented coronary artery disease resulting in:

Chronic congestive heart failure, or; workload of 3 METs or less results

in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular

dysfunction with an ejection fraction of less than 30 percent 100

More than one episode of acute congestive heart failure in the past year,

or; workload of greater than 3 METs but not greater than 5 METs

results in dyspnea, fatigue, angina, dizziness, or syncope, or; left

ventricular dysfunction with an ejection fraction of 30 to 50 percent 60

Workload of greater than 5 METs but not greater than 7 METs results

in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of

cardiac hypertrophy or dilatation on electrocardiogram,

echocardiogram, or X-ray 30

Workload of greater than 7 METs but not greater than 10 METs results

in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous

medication required 10 “

I am assuming but am not the rating expert here by any means, that he will fall into that 10% rating due to the continuous medication.

“At least now we know where he stands heart-health wise and can make changes in lifestyle and diet as best as we can to prevent further build-up. That is the most important thing for now....”

YES it is!!!!! I am a volunteer for the American Heart Disease and you stated two changes (lifestyle and diet) that can profoundly influence our health, points that the AHA makes and that also can help stave off complications of diabetes and multiple other health problems.

“what "date" they give him.” They will surely use the date he filed the IHD claim, unless this is a Nehmer claim?

“confirmation of a prior myocardial infarction (date unknown) although we have a normal EKG from May '04 and then an abnormal one from Sept. '04 that follow-up was done on but apparently not enough. “

That concerns me. Were these VA EKGs? Didnt they do any EKGs after Sept 2004?

However the QTC said the heart disease was “marginal' and from what I see here, it is, but still I am puzzled at the lack of more follow up EKGs.

But then again, silent heart attacks often are revealed for the first time on EKGs and they might have presented no symptoms at all of chest pain, and minimal cardiac damage and are common to diabetics, in their 'silent' nature.

I sure don't mean they are prevalent in diabetics ,just that most none -diabetics do not have 'silent' heart attacks.

“Thank you Berta for sharing Rod's story....it sent us straight to the cardiologist.”

I hope maybe his story helped others too.His death completely altered the lifestyle and VA medical care of a very good Vietnam Vet friend I have locally, who the sameVAMC misdiagnosed terribly and they almost killed him too.

This same vet called me Thursday with a question for a veteran he is trying to help with her claim.

She was given 20% for residuals for an IED and recently had a DRO hearing and I asked him to send her to us here at hadit and he thanked me again for helping him over a decade ago because he is still alive and well enough to try to help other veterans.But it was my husband's death that really gave me the medical and legal knowledge to help him.

What residuals from the DMII is your husband service connected for?

[Berta]

Another thought-

When the VA diagnosed your husband with DMII due to AO, did any rating sheet reveal CAD or IHD and any rating even at '0' NSC?

VA made a very odd statement in my AO IHD award.

The statement was so odd that NVLSP caught it too and questioned it I wrote toVA for a clarification of it that we both want to see.

Although it took the VA almost ten years to the day to acknowledge a heart attack that my husband had while employed at the local VAMC, the VACO examiner in Deceber 2011, indicated that something VA had (possibly an old C &P exam that I had overturned on appeal for his PTSD rating as they had proosed to reduce his rating as soon as he began working for the local VA)

might have generated a code or rating for his CAD in 1988, due to the ER certificate,

completely unknown to me,or to the veteran, allowing the malpractice to continue.in spite of VA's knowledge at that time of it.

The actual VA medical cover up didnt begin until August 1992.

So I thought.

Do you have all rating sheets that the DMII award generated?

I told NVLSP that, at that time, of the PTSD C & P in 1988, a few months after Rod's initial heart attack,

we were never sent any rating sheet at all.

AMVETS called us and Rod was at work I think and the rep told me (He knew I prepared the NOD) that VA had turned on the NOD and the proposed reduction was dropped and the check would come soon. (My husband asked them to drop him immediately to 10% depending on the NOD outcome because he feared an overpayment.)

I only recall a reinstatement letter and no rating sheet at all.But something happened in 1988 that the Nehmer medical opiner must have caught.

Old rating sheets not only can be critical for claims that are filed even decades later as well as critical to see if VA made any CUEs in past decisions.

Edited April 7, 2012 by Berta

[VetsLady]

Forgot to mention, cardiac hypertrophy is listed also, and yes .... he is a Nehmer veteran.

I don't have the rating sheet for his DM2 Berta. After his sc for DM2, with secondaries of PN, retinopathy, cataracts, (now they are watching him for glaucoma) - the remaining issue (non DM2) was on appeal and at the BVA. His initial claim, filed in '03 included hypertension which the VA denied.

Yes, EKG's were done at the VA after 2004 by his primary doctor there and during QTC exams. The only thing that showed up was a "right bundle branch blockage" ----- Interestingly enough, we received a copy long ago of the Agent Orange Registry exam done in Sept. '04 and that is all it listed on the top of the EKG - Right bundle branch blockage. Then, a couple months ago we requested another copy of this report and along with the RBBB the words "can not rule out previous myocardial infarction was listed on this AO registry exam EHG, alongside the RBBB. So it is my suspicion, they knew he had a cardiac event of some kind but did no follow-up nor told us about.

More importantly, he is now receiving the care he should have - however from a non VA doctor for which we feel fortunate to have the coverage for him to do so ....... but what about the veterans who can't?

His Nehmer letter on IHD is dated August 2010. His original claim was filed in early 2003. We did not appeal the hypertension due to bad advice from a former VSO - not sure what impact that will have on the present claim. He has been on continuous medication for his heart since '03, because of a truly awesome DM2 doctor he saw in the community.

Thank you for your volunteerism with the AHA. Awareness and education are key. I know that my husband is now wondering if he didn't feel the heart attack (I have also heard that a diabetic can develop a neuropathy of the heart muscle, have you heard of this ?) - if he has another, will he feel that one or will it be silent also. Valid concerns, but I have reassured him and we have talked, that he needs to get this off his mind and do the proactive positive changes he can do to perhaps prevent another cardiac event or at the very least, keep it minimal. Replacing a positive thought of action with a negative reminder is extremely important, hard to do and I understand that.

P.S.

As soon as this IHD claim is decided, I will request a complete copy of his claim file from the RO, then I will have the rating sheets for ALL of his sc issues.

Edited April 7, 2012 by VetsLady

[Berta]

As a Nehmer veteran, the date of the past denied claim for IHD should be his EED.

Has he contacted NVLSP yet?

They will be happy to review the EED if he feels the VA doesn't give him the right one,when the decision comes.

If you have any doubt at all that he received proper VA health care, you could always, with the retro ,ask an IMO doctor to review the entire medical record to see if he did get proper VA health care.

IMOs are costly but for this type of situation, they can offer peace of mind -if the care was proper or, offer an IMO that would support a Section 1151 claim.

I thought at first my Nehmer decision was wrong- I was surprised they awarded 100% for a Section 1151 stroke and had already paid 100% for PTSD. I was horrified because I sure didnt want an overpayment but I found the regs they used--something I had not considered even looking for because this part of my claim was so old.

The regs clearly support not only the 1151 offset scenario but also what happens when the VA awards 100% for one SC and also 100% "as if" SC under Section 1151,38 USC.

I cannot determine here at all if he received negligent VA treatment.

Some things here bother me that you mentioned ,but .it takes a very thorough review of all medical records to find evidence of malpractice or negligence that has risen to the level that it has actually caused additional disability. at a ratable level.

We have lots of info on Sec 1151 in our FTCA and Section 1151 forums here.

[VetsLady]

Thank you for your response Berta.

Yes, at your suggestion several months ago I contacted NVLSP who advised me to call them when the IHD decision came in and they will review it for accuracy; the young man I spoke with said my husbands name was in their system already.

I do find it ironic that during his VA "annual" exam yesterday that his doctor, after reviewing the cardiologist report said "I was going to suggest a treadmill test but the cardiologist has already done what I would have" ---- not really, the cardiologist went a step above and did a CT scan of the heart. The treadmill test QTC did at the VA's request in '09 didn't show the blockage, the plaque build-up, nothing else....but it did say "Normal Study" The cardiologist told us last week this plaque and blockage didn't happen overnight.

I am very proactive in my husbands claim(s) and will be watching this one like a hawk. Monday I will be mailing the RO the IHD disability questionnaire and the report. Seems like his claim has sat stagnant (as so many have) for a long time. With this evidence, and what they have already, there should be no reason not decide it and rate it and I will include a VCAA statement saying the same.

Will read up on 1151 and get educated, just in case I need it or, if I can pass it along to someone who does.

Again, thank you for the response. More importantly, thank you for sharing the story of your husband. As I mentioned, it got us into the cardiologist office pronto.

[Lorraine]

Vet's Lady,

I'm so happy for you that you got some clear and straight forward diagnoses from your Vet's private cardiologist. The VA can't just ignore that information, so here's hoping he gets a new rating for his heart disease very quickly. Wishing the best for both of you.

Lorraine