hypertension Pulmonary Hypertension, Secondary To Ihd/cad

[Swabbie]

HelloAll;

Newbie here and thought I would share my experience regarding a claim submitted
for Pulmonary Hypertension (Secondary). I am rated 60% IHD/CAD, 20% DMII, 10%
Peripheral Neuropathy each extremity and 10% for Tinnitus , 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 indicating 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 for Pulmonary Vascular Disease (6817) 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 by the VA, 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.

From what I have read on these boards it appears that I have an uphill battle,

in that the VA does not seem to look favorably on PH claims.

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.

[jbasser]

There are likely causes of Pulmonary HTN. Acquired or You are born with it.

The problem is with Heart disease, it effects the left side of the heart.

Pulmonary function occurs on the right side of the heart. If Lung disease is present, the heart works too hard pumping blood through diseased lung elevating artery pressures int he PA.

In your case, have you if you have ever been diagnosed with Sleep Apnea?

If you have not you may want to check into it. Sleep Apnea is a leading cause of Acquired Pulmonary HTN.

Other factors that can be attributed to PH are:

COPD

Restrictive Lung Disease

Asbestos Exposure

Interstatial lung disease

Lung Cancer

Mesothelioma

J

[Chuck75]

Leaving the dichotomy between the C&P opinion and the pulmonologist's as a separate issue.

One of the things I would always do in a similar situation is to add "caused and/or aggravated by" in place of just one or the other.

Going back to the difference between the C&P opinion and the other doctors - -

A VA RO will almost always take a C&P result as "golden", even when it's not, for one reason or another.

If both opinions are medically sound, the question then becomes which is more qualified to render an opinion.

Let's say that the C&P doctor/examiner is not a board certified specialist in the appropriate area, and the other doctor is.

At a BVA level, this should/would create at least an "equipoise" that supports a ruling in the veteran's favor.

(I'd likely try to get another qualified opinion from a second non VA doctor to go with the first.)

It's easier to say that one condition does not cause another than it is to rule out aggravation.