hypertension Federal Register Schedule For Rating Disabilities, Respiratory, Cardio Including Pulmonary Hypertension

[Capt.]

https://www.federalregister.gov/articles/2002/08/22/02-21366/schedule-for-rating-disabilities-guidelines-for-application-of-evaluation-criteria-for-certain

Hello All,

Here is the Federal Register rules proposal from back in 2002 concerning the Cardiovascular , Pulmonary areas and I want to especially bring up the rule governing PULMONARY HYPERTENSION.

For the first provision, we propose to state when pulmonary function testing is not needed for disability evaluation purposes. The first instance would be when there is a maximum exercise capacity of record that is 20 ml/kg/min or less (which would result in a 60- or 100-percent evaluation). Although this test is not routinely done, and not all facilities have the necessary equipment to conduct the test, if available, it is a reliable and precise way to assess respiratory disability, so it may be used to evaluate when it is available and is reported at levels that would warrant a 60- or 100-percent evaluation. If not of record, however, evaluation will be based on alternative criteria. The second instance would be when pulmonary hypertension (documented by an echocardiogram or cardiac catheterization), cor pulmonale, or right ventricular hypertrophy has been diagnosed. Any of these would result in a 100-percent evaluation. The third instance would be when there is a history of one or more episodes of acute respiratory failure, and the fourth instance would be when there is a requirement for outpatient oxygen therapy, because either of these also establishes entitlement to a 100-percent evaluation.

So whenever a veteran has a service connected lung disease with a diagnosis of Pulmonary Hypertension, with Heart Cath or Echocardiogram, Core Pulmonale, Right Ventricular Hypertrophy as the ruling says ......it is 100%.

Many Veterans ,,,,including myself missed the PH diagnosis because , VA really will not want to talk about Pulmonary Hypertension and its limited treatment. It almost always will fall upon the Veteran or his Advocate or a good Friend .......Hooray Jbasser , to find it in the records . Do not expect the VA or Regional Office to list it in the claims process or to award it on their own.

As the saying goes... the Veteran is his or hers own best Advocate.

Lets see how many of our members have one of the diseases listed with a service connected award. It will be so neat to have someone find this in their record and to NOD or even reopen a claim because the VA never spotted it on their own.

Oh yes ,,,,,the pyramiding rule would certainly apply. For instance if you have COPD at say 30 percent and have Pulmonary Hypertension , you would have the 30 percent raised to the 100 percent and any other pulmonary issues would be capped at the 100 percent level.

NEVER GIVE UP. God Bless, C.C.

Edited February 14, 2013 by Capt.Contaminate

[71M10]

The current situation is not really that different from them trying to not SC for my cardiomegally after 27 years of Hypertension. I won that one in a DRO appeal.

[Capt.]

Hello 71,

BINGO...... This may be really big for you. Jbasser hopefully will pick this up on the diaghram issue. he has experience with this one and knows what needs to be done with it. It is interesting that you are not alone when it comes to Pulmonary Hypertension and the Sleep Apnea issue is them trying to stall the outcome. If they change your diagnostic code on a respiratory issue then this could put you into the codes rateable for 100 percent. The sleep apnea is probably going to have to be awarded as a SECONDARY and they are already trying to head that off at the pass by not noticing the important issues which would allow the sleep apnea to be awarded secondary. Its like the VA doesn't want you to make any issue of the PH. Makes sense why the stall is going on for so long. You have them in a choke hold and they don't want to go to sleep and rather than make a decision in your favor , they do the only thing they can do and that is stall the veteran rather than give the award.

You are going to have to get them to start moving in the process. I would get a lawyer to keep the road clear of the obstacles and a fresh IME like you are saying. Do you have any C and P exams concerning your respiratory issues and I would go over those results again?

Isn't it something that the tactics they use are pretty much done to each one of us. I know Hadit has a huge archive but with these folks they use their archives and at least they are consistant. I believe you may have a chance of keeping them having to follow a path they are trying to keep you off of. Now you have something to look at.

NEVER GIVE UP. God Bless, C.C.

[jbasser]

Your condition is rather severe. The pressure is enormous as your spine is bent forward.

Diaphragmatic elevation causes the spine to bend and twist and it does cause Scoliosis.

This would be evident from a nerve injury of either the left or right phrenic nerve either in the trunk of the body by a foreign object like a GSW or stab wound or an injury to the cervical spine at C3 C4 with an accessory nerve in some people at C5.

This nerve is a deep nerve and it is not easy to damage and these conditions are extremely rare and are often overlooked by the duck society called the AMA. A Quict\k easy test would confirm. A sniff test (Flouroscopy)

J

[71M10]

The one thing i do know to a 100% accuracy. Without HADIT and the E-CFR's i would still be SC at 0% for a "Bone Disorder" only.

In 1988 I trusted the VA, what is the old adage quoted by Scotty on Star Trek? Fool me once shame on you, Fool me twice shame on me! Can't recall the episode though.

Thank you all for your help, this site has had a profound positive effect on my life since 2006.

[Swabbie]

Hello All;

Newbie here and thought I would share my experience regarding Pulmonary Hypertension (Secondary). I am rated 60% IHD/CAD, 20% DMII, 10% Peripheral Neuropathy each extremity and 10% for Tinnitus. 80% overall, due to presumptive herbicide exposure in VN.

Since being diagnosed by a private cardiologist with IHD/CAD my primary complaint has been chronic shortness of breath on exertion. Based on past and recent echo's/catherizations which indicated progessing mild to moderate Pulmonary Hypertension I was referred to a pulmonologist.

After multiple tests the pulmonologist came to the conclusion and completed a DBQ that the Pulmonary Hypertension (Secondary) was caused in part and due to a decreased LVEF and slow heart rate.

I filed a claim for Pulmonary Hypertension secondary to IHD/CAD only to be denied, reasons being We did not find a link between Pulmonary Hypertension associated with coronary artery disease and military service and The evidence does not show that your condition resulted from, or was aggravated by, Coronary Artery Disease.

Due to a lack of specific information in the denial letter I had to request a copy of my C file and it was only there that I discovered that on the C&P exam given the examining doctor opined Ischemic Heart Disease/Coronary Artery Disease does not cause Pulmonary Hypertension.

Needless to say I am in the process of filing an appeal for what I feel is an incorrect rating and would be grateful to hear any and all advice from members.

Captain C/Admins/Moderators I did not intend to hijack this thread and if you feel it would be better served in another area feel free to move.

Swabbie

[Capt.]

Hello Swabbie,,,,,,

I welcome you aboard. No problem about thinking you hijacked the thread ,,,,, you fit right into it. I do want to say that you can file for an appeal for a higher rating/incorrect rating. I would point out that the Pulmonary Hypertension is 100% if it has the diagnostic code attached to it. Such as 6604 COPD or Restricted lung disease 6845 that is rateable service connected. AND that a diagnosis from Heart Cath OR Echo cardiogram has been also diagnosed.

Having the CAD/IHD I only see that it could be secondary and then it will be rateable that way , but normally not at 100%, as the regs dictate.

The VA is very defensive of any PH award and usually requires BVA award. Meaning the Regional Offices really do not want to look at it and like to turn their back on it. I am at this stage and waiting. With Service Connected COPD and Restricted Lung Disease and nonservice connected IHD , the PH was diagnosed with both Heart Cath and Echo Cardiogram. CONVIENTLY MISSED by VARO soooooooo its back to an NOD and pointing the test and diagnosis to it.

Hopefully you will be treated fairly and not put on the back burner like me. I am hoping some others will join in ........Jbasser is very knowledgable about the PH and the evaluations and the process concerning it . Hopefully he'll join in with some other thoughts to. NEVER GIVE UP . God Bless, C.C.

Edited February 14, 2013 by Capt.Contaminate