hypertension Ihd

[FrankieG23]

My husband got letter from VSO VFW ref claim from 10/2010 for IHD, Meneires, Tintinus (sorry for spelling) He went to hearing with RO. Letter said husband will granted EED for DMII and hypertension to 5/01, granted in 7/01. i asked what happened with IHD Nehmer? He said info VA had from ER visit which was requested from 7/01 claim, showed his heart enzymes were elevated and he may have had heart attack, and may does not mean had. Should he have gotten a NSC rating for heart disease? How do I know if he did? The C & P exam showed "fourth heart sound" (which is heart disease), and noted he had no heart disease??? VSO informed me that Nehmer is only if previous claim was made and denied. Would this possibly fall under Footnote 1?

Well just when we thought this was all over, husband's status went from descion phase, to requesting info phase. The info requested is the C & P exam from the 10/2010. The same problem exists: Examiner wrote on exam, "canceling claim". examiner did not want husband to loose any benefits, which can happen if claim gets reopened for anything.. Husband was 100% = 60% since 8/2003., he has defrilblator also records show he had silent heart attack, which I think happened in 2001. We went to C & P office and was told exam results could not be given as cancel was on it (this must be true as VA hasn't been able to get it since 2010) I have seen other people go from back to square 1 on this site so I knew what to expect. Well when I called 800 number, i was told someone is reviewing the ROs decision to prevent any overlooks and they are checking to see if and EED can be given for IHD maybe an earlier 100% date. I hope so and i have my fingers crossed. Also husband has foot drop, he can hardly walk without his brace. VSO said to put in for that if approved he can get another SMC. i thought i should wait until they are totally finished with this claim, but VSO said to put in for it as soon as possible. Thank you, and keep faith

[FrankieG23]

Hi all, went to VSO last week. VRO combined 70% (combo of DMII, hypertension and PN, heart disease last 3 are secondary) and made defib as increase to 100%. He has been 100% + granted SMC S 100% + 60% since 8/03. The VSO caught that the VRO just increased the 70% to 100%, with no mention of SMC S in the findings. I hope this doesn't become an issue. Ok, just mentioned this in case anyone else has this experience. We spoke with VSO of Nehmer, I don't think he was familiar with Foot Note1, however he said he filed 1 of the first AO claims for a Vet. We got letter in mail from VSO yesterday that he wrote VA that "Vet claims VA had evidence of IHD, (medical records of elvated heart enzymes and possible heart attack), also the fourth heart sound as noted in C & P exam for the DMII in 01 in their possession.at time of claim. I looked up info on fourth heart sound, and it states 1 of 3 possible causes is IHD or possible myocardic infraction. VSO stated Vet is requested EED for SC for IHD. Wouldn't it be to request for NSC back then? Husband did get an NSC, but it wasn't IHD back then. Also, can he submitt any internet info, or does VA just snub this type of info, and just want IMO? Hubby did go from decision phase back to gathering of info phase and now back to decision phase. Do I contact NVLSP now or wait till claim finished? Any input helpful, thanks.

[Berta]

"VSO stated Vet is requested EED for SC for IHD. Wouldn't it be to request for NSC back then? Husband did get an NSC, but it wasn't IHD back then. "

What was the NSC diagnosis , rating code, and percentage they used in that older decision?

" Also, can he submitt any internet info, or does VA just snub this type of info, and just want IMO?"

The VA does not consider internet information because it is not specific to the veteran.

" Hubby did go from decision phase back to gathering of info phase and now back to decision phase. Do I contact NVLSP now or wait till claim finished? Any input helpful, thanks. "

NVLSP, if this falls under Nehmer, would want to see the decisionso maybe best to wait.

"The VSO caught that the VRO just increased the 70% to 100%, with no mention of SMC S in the findings. I hope this doesn't become an issue."

If h is still eligible for SMC S and the VA doesn't continue that rating, the VSO can ask them to CUE themselves on that.

Ok, just mentioned this in case anyone else has this experience"

I won a CUE claim in January because VA failed to apply the statutory mandate of the SMC regulations to a 1998 decision I received.

The CUE involved 3 separate issues-all VA legal errors, I already explained in our CUE forum here, but my point is,

when a veteran is eligible for SMC, the VA has to award it, or continue an ongoing award for SMC or give a clear medical rationale as to why the veteran is not eligible for SMC any longer.

I wouldn't think this would be an issue in your case but one never knows what the VA will do,until they get a formal decision.If he is still eligible for SMC and VA fails to award it or continue his standing SMC, the VSO should be able get this fixed fairly quickly.

"We spoke with VSO of Nehmer, I don't think he was familiar with Foot Note1, however he said he filed 1 of the first AO claims for a Vet. "

Footnote One is the essense of Nehmer.

I cannot understand how any vet rep or AO advocate could not be completely familiar with Footnote one as most of us Nehmer claimants are Footnote One claimants.

"Vet claims VA had evidence of IHD, (medical records of elvated heart enzymes and possible heart attack), also the fourth heart sound as noted in C & P exam for the DMII in 01 in their possession.at time of claim. I looked up info on fourth heart sound, and it states 1 of 3 possible causes is IHD or possible myocardic infraction."

VA is looking for past denials of IHD or of what can be construed as IHD, in past rating decisions-that is the basis of Footnote One.

[FrankieG23]

Thank you for reply Berta

Husband was given NSC for asthma, which he did claim along with the DMII, back in 7/01. I didn't realize that he got the NSC, until I looked at the not yet offical response that the VSO had now from claim 10/10. It didn't list code nor percent on it. Maybe I just forgot. I think I'm the one that doesn't understand Footnote 1. I have read it many times and I just don't get it. By the way, claim has gone back to gathering of information phase, from decision made, getting packet ready phase.. I feel like I'm watching a tennis match. But I guess some activity is better than none. I am still of the thought that the VA used medical evidence from ER visit (private hospital) to assist with making a decision on claim from 7/01 (we never claimed heart disease then) to falling apart 2 years later should count for something. I made mistake by not claiming it, I just listed it as place to get medical records from. Hope VA adds more recognition of other conditions.

[Berta]

Rick Spataro, Head Nehmer lawyer of NVLSP, explained Footnote One to me this way in email as soon as the Regulations were being prepared for the 3 new AO presumptives in 2010:

“As for your second question, if the VA should have coded IHD in a rating decision, the claim that resulted in the rating decision could be considered a claim for benefits for IHD under footnote 1 of the Final Stipulation and Order in Nehmer. It basically depends on the timing of the claim, rating decision, and evidence received while the claim was pending. It may also depend on the rules in the Manual M21-1 regarding coding that were in effect at the time of the claim.

Typically, though, the following example would be accurate: A veteran filed a claim for SC for a low back disability on May 1, 1990. The VA obtained medical evidence showing a diagnosis of IHD in the development of that claim. The VA issued a rating decision on April 1, 1991, but does not code IHD (list IHD as “NSC” on the code sheet of the rating decision). Under footnote 1, since the condition should have been coded in the April 1, 1991 decision, the May 1, 1990 claim should be considered a claim for SC for IHD under Nehmer. “

Basically -many IHD claims were coded and rated as NSC for IHD or CAD in past rating VA decisions that then put these claimants under Nehmer regarding the new AO 2010 regs.

In other cases such as my claim , IHD was never coded or rated in any past rating decision but was awarded under Nehmer because it “should have been” coded etc because, as Rick said “The VA obtained medical evidence showing a diagnosis of IHD in the development of that claim.”

My evidence was from an EKG done in 1988 and other forms of medical and legal evidence.

You stated:

"VRO combined 70% (combo of DMII, hypertension and PN, heart disease last 3 are secondary) and ma..."

so it appears they considered the heart disease as secondary to the DMII so if the private records revealed an EKG or any ECHO or METS test, regarding " ER visit (private hospital)"and VA was aware of those records, perhaps the VSO can get a better EED.

But you added:

" I am still of the thought that the VA used medical evidence from ER visit (private hospital) to assist with making a decision on claim from 7/01 " so maybe VA had these records but maybe they did not reveal the evidence of IHD or VA overlooked critical information such as an EKG strip and narrative that indicated IHD at that time.

Actually I now believe ,after reading your reply, that the VSO fully comprehends Footnote One and is trying to use the medical evidence to garner an award under Footnote One.

Luckily you have a vet rep willing to review all of the evidence..