hypertension Appeals Remand Back To St.paul Varo -Way Around Chemicals

[steve&pat]

DC APPEALS remanded the claim back to the VARO- C&Ps .Apparently they can read at appeals in DC.the hearing was a year ago last december at St.Paul a traveling judge.

Up until now they have ignored connecting the heart and hypertension .

I guess I sent to much on the contamination in GUAM. SO now i,ll send a little more on our nas well and TCE and as the crow flys we were located about 6 miles south of THE POLLUTED ANDERSON AIR BASE

Hi all just a update on my heart appeal and how the government squirms around to NOT have to connect it to chemicals and all the other contamination in GUAM. I was sent for a heart cp and I will copy the medical opinion from the VA C&P.

They will pick the lesser of 2 evils.

COMPENSATION AND PENSION EXAMINATION

MEDICAL OPINION

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A NON-STANDARD MEDICAL OPINION WAS REQUESTED.

PROVIDERS RESTATEMENT OF REQUESTED MEDICAL OPINION.THIS IS NOT THE MEDICAL OPINION ITSELF.

RESTATEMENT OF OPINON REQUEST :The reviewer should provide an opinion as to whether it is at least as likely as not(50%or greater probability) that the Vetern's currently diagnosed CAD is traceable to the vetern's active military service,to include exposure jet fuel,herbicides,pesticides,ground water contamination ,or any other in-service chemical exposure :or in the alternative, whether it is at least as likely as not (50% or greater probability )that the Veteran's currently diagnosed CAD was caused or made chronically worse by by his service-connected glomerulonephritis with hypertension.The examiner must provide a complete rational for each opinion expressed.

records reviewed

OPINION:

1)It is my opinion the question of whether it is at least as likely as not (50% or greater )that the Vetran's currently diagnosed CAD is traceable to the veteran's active military service , ,to include exposure jet fuel,herbicides,pesticides,ground water contamination ,or any other in-service chemical exposure cannot beanswered without resort to mere speculation.

2) It is my opinion that it is at least as likely as not(50% or greater probability) that the Veteran's currently diagnosed CAD was made chronically worse by his service-connected glomurelonephritis and hypertension.

RATIONAL FOR OPINION GIVEN :

1) I have reviewed the C-file including the literature the veteran provided. I also discussed the issue of toxin exposure and coronary artery disease with a cardiologist and reviewed the literature regarding the etinology of coronary disease on line: Other than the presumed association of agent orange and ischemic heart disease I know of no authoritative medical literature that would support or deny an association of chemicals/toxins and coronary artery disease as claimed by the veteran.The information to make an informed opinion regarding this question is not available.Further, the type and formof all the chemicals/toxins, the method and the duration of exposure cannot be clearly identified and quantified in this case.It is presumed this veteran does not meet the criteria for Agent Orange exposure as this is not a request for evaluation of a presumptive service connection for ischemic heart disease.

2) The National Kidney Foundation in 2002 and the American College of Cardiology/American Heart Association 2004 task force have presented practice guidelines thatinclude chronic kidney disease as a risk factor for,and an accelerant of ,coronary artery disease.

This vetern's service connected hypertension has been long standing and frequently in poor control.

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. They dont want to open a can of worms in GUAM----

I sent enough information for two paths to follow.Lookslike they are choosing the heart and hypertension. They put the MET's at 3 - 5 so maybe thats the 60% plus a couple 10 %.

sorry this is long - start another wait -this has been in the system since 2006 and 2007 ----------------------

STEVE & PAT

[steve&pat]

Remand went back to BVA now Im looking for comments on appeals sheet---

The medications are off and missing -like asprin, plavix,multiable bp pills,and 3 spring placement in heart in 06-07weight gain way back to 1970s from all the inproper va meds.It looks like even the bva didnt read the info from the heart hospital which they paid for . So Im getting information for my REPLY.THANKS FOR ANY HELP-

GOT THIS LAST SATURDAY

DEPARTMENT OF VETERANS AFFAIRS Appeals Management Center
1722 Eye Street/ NW Washington DC 20421
00000000000000000000
VA File Number========
Represented by:
AMERICAN LEGION
Rating Decision January 22, 2013
INTRODUCTION
The records reflect that you are a veteran of the Vietnam Era. You served in the Navy from January 26, 1967 to October 1, 1970. The Board of Veterans Appeals remanded the case to our office on January 23, 2012. Based on a review of the evidence listed below, we have made the following decision( s) on your claim.
DECISION
Service connection for coronary artery disease (CAD) is granted with an evaluation of 0 percent effective March 8,2007. An evaluation of 10 percent is assigned from May 22, 2012.
EVIDENCE
Board of Veterans' Appeals remand, dated January 23, 2012
VA examination, St. Cloud VA HCS, dated May 22, 2012
Agent Orange inquiry notification letter, dated April 23, 2012


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Page 2
REASONS FOR DECISION
Service connection for coronary artery disease (CAD) as secondary to the service-connected disability of glomerulonephritis with hypertension (previously evaluated under Diagnostic Code 7101).
Service connection for coronary artery disease (CAD) has been established as related to the service-connected disability of glomerulonephritis with hypertension (previously evaluated under Diagnostic Code 7101).
We have assigned a noncompensable evaluation for your CAD effective March 8, 2007, the date your claim was received based on a condition without objective symptom(s).
On your recent VA examination, dated May 22, 2012, the examiner opined that is at least as likely as not that your diagnosed coronary artery disease (CAD) is traceable to your active duty military service, to include exposure to jet fuel, herbicides, pesticides, ground water contamination, or any other in-service chemical exposure cannot be answered without resort of mere speculation. The examiner also opined that it is at least as likely that your diagnosed CAD was made chronically worse by your service-connected glomerulonephritis and hypertension.
In the examiner's rationale he noted that upon reviewing your claim file, along with the literature you provided, he also had a discussion about toxin exposure and coronary artery disease with a cardiologist and reviewed the literature regarding an etiology of CAD online. The examiner noted that other than the presumed association of Agent Orange and ischemic heart disease (IHD), there is no authoritative medical literature that would support or deny an association of chemical/toxins and CAD. The examiner noted that such information is not available. It is also noted that the type and form of all the chemicals/toxins, the method and duration of exposure cannot be clearly identified and quantified in your case.
The examiner noted that the National Kidney Foundation in 2002 and the American College of Cardiology/American Heart Association 2004 task force have presented practice guidelines that include chronic kidney disease as a risk factor for coronary artery disease even if it is mild or moderate. It has been long known that hypertension is a risk factor for, and an accelerant of, coronary artery disease. Your service connected hypertension has been long standing and frequently in poor control.
In addition, it is quite evident that as a result of your military occupation specialty (MOS) as an aircraft, you were exposed to jet fuel. The examiner noted that your exposure to jet fuel is a contributable.factor of your CAD.
Your ~xamination results revealed that continuous medication (aspirin 81 mg) is required for your diagnosed CAD. The examiner also noted a METs of>3-5. But he noted that half of your METs level is as a result of your morbid obesity/deconditioning. The examiner noted no congestive heart failure, no arrhythmia, no heart valve or infectious heart condition and no pericardial adhesions.

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Page 3
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We have assigned a 10 percent evaluation for your coronary artery disease effective May 22, 2012, the date it became factually ascertainable your condition worsened based on the requirement of continuous medication for your condition.
A higher evaluation of 30 percent is not warranted unless there is:
o Workload of greater than five METs but not greater than seven METs results in dyspnea, fatigue, angina, dizziness, or syncope, or;
o Evidence of cardiac hypertrophy or dilatation on electrocardiogram, echo cardiogram, or X-ray.
One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute.
On January 26, 2012 we sent you a letter requesting additional evidence from you in support of your exposure to herbicide (Agent Orange) which you clamed caused your CAD. As of today's date, we have not received any response. All attempts were made to corroborate your exposure to Agent Orange during your military service however, we have been unsuccessful. As a result, no further herbicide development should be conducted.
TIns rating decision represents a full and final determination of this issue on appeal. As such, this issue is considered resolved in full.
REFERENCES:
Title 38 of the Code of Federal Regulations, Pensions, Bonuses and Veterans' Relief contains the regulations of the Department of Veterans Affairs which govern entitlement to all veteran benefits. For additional information regarding applicable laws and regulations, please consult your local library, or visit us at our web site, www.va.gov.