hypertension Possible Cue

[vern2]

I have reviewed my VA claim from 03-07 and noted a possible CUE.

I was awarded 30 SC based on aggravated hypertension "with confirmed dilation of the heart"

The exact wording is: we have evaluated the condition analogous to hypertensive heart disease based on the fact that you have associated pulmonary hypertension with confirmed evidence of dilation of the heart. this is more advantageous to your as your hypertension would be evaluated as 10 per cent disabling. An evaluation of 30 per cent is assigned is there is workload greated than 5 METS but not greater than 7 METS resulting in dyspnea, fatigue, anginia, diziness, or syncope; or evidence of cardiac hypertrophy or dillatation on electrocardiogram, echocardiogram, or X-ray. A higher evaluation of 40 percent is not warranted unless diastolic pressure is predominantly 120 or more. A higher evaluation of 60 per cent is not warraanted unless there is more than one episode of acute congestive heart failure in the past year; or workload greater than 3 METS, but not greater than 5 METS resulting in dyspnea, fatigue, anginia, diziness, or syncope; or left ventricular dysfunction with an ejection fraction of 30 to 50 per cent. 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.

I was granted 30% according to rating guidelines during my active service with approximatley one year of uncontgrolled pressures with the subsequent development of pulmonary hypertension with cardiac hypertrophy.

A review of the evidence submitted shows that an echocardiogram (which is listed by VA as part of the evidence) shows that in addition to mildly dilated left atrium the left ventricular systolic function revealed distal septal hypokinesia with an ejection fraction of about 50%. Regional wall abnormalities as desccribed above with mild ventricular systolic dysfunction.

My echocardiogram clearly showed that I had an EF of about 50%, which should have granted me the 60% rating. Note the semicolons, which denotes I had to have one of several conditions to meet the 60% requirement. Does this sould like a valid CUE? I am reluctant to go forward unless I can get some advice.

[Berta]

"I was granted 30% according to rating guidelines during my active service with approximatley one year of uncontgrolled pressures with the subsequent development of pulmonary hypertension with cardiac hypertrophy."

Those years of active service might have warranted a different rating than what you feel is appropriate today.

Some of us AO IHD Nehmer widows received IHD ratings based on a rating schedule that was in place 20 years ago when these veterans were alive.

If I were you I would look up the analogous rating code they gave you for hypertensive heart disease in 2007 and then see if that rating was changed by VA in 38 CFR ,since your service period.

If not, it would be the diagnostic code and rating info from the VA Schedule of Ratings here at hadit, that would be the .basis of the CUE and shown to

have altered the outcome of the 2007 claim,via the rating sheet.

Lots of info on CUE here in our CUE forum.

[Berta]

I pulled out my Nehmer decision to explain what I said here better as to the rating criteria for heart disease.

It ,might not help you....maybe will help someone else.

Th veteran was diagnosed with Ischemic Heart disease, ECHO revealing inferior wall akinesis evidence of prior heart attack, EF estimate 40%,hypertrophy and arteriol occlusions.

The award says :” Based on evaluation criteria in effect prior to January 12, 1998 “

I looked that all up to make sure they were right)

an evaluation of 30 percent is assigned from October 25 1988 to October 14, 1994, the date of the veteran's death.”

I have never received a diagnostic code yet for the veteran's. Oddly enough I asked them to CUE something else in this decision, and that is a pending claim, but I just noticed another potential CUE..

The award says that the higher 60% rating in effect per the Schedule of Ratings prior to 1998,

was not warranted unless the record shows a history of acute coronary occlusion or thrombosis or repeated anginal attacks which preclude more than light labor.”

Bingo,. I am filing another CUE claim on that one I think.....

The history of acute coronary occlusion is evident in the 1992 ECHO ,the 1992 major disabling stroke, and the autopsy done on the veteran.1994

He died of IHD with other AOs contributing.

The history of occlusion started in 1988 with numerous ER trips, all misdiagnosed, by VA, yet finally confirmed under FTCA that these were TIAs due to arterial ischemic heart occlusion......

I have read this award letter over many many times in order to prepare and file a CUE against it and I did NOD it in time. I focused however on the SMC CUE claim award within the AO IHD award letter that contained one erroneous statement to my detriment.

I never even caught this other potential CUE until today....

It sure pays to read these awards as carefully as any denials because the VA can make many errors.

The rating schedule for heart disease changed in January 1998, and I cannot determine if that change affected the diagnosis you had and the period of service they based the rating on:

"I was granted 30% according to rating guidelines during my active service with approximatley one year of uncontgrolled pressures with the subsequent devel"

[vern2]

"I was granted 30% according to rating guidelines during my active service with approximatley one year of uncontgrolled pressures with the subsequent development of pulmonary hypertension with cardiac hypertrophy."

Those years of active service might have warranted a different rating than what you feel is appropriate today.

Some of us AO IHD Nehmer widows received IHD ratings based on a rating schedule that was in place 20 years ago when these veterans were alive.

If I were you I would look up the analogous rating code they gave you for hypertensive heart disease in 2007 and then see if that rating was changed by VA in 38 CFR ,since your service period.

If not, it would be the diagnostic code and rating info from the VA Schedule of Ratings here at hadit, that would be the .basis of the CUE and shown to

have altered the outcome of the 2007 claim,via the rating sheet.

Lots of info on CUE here in our CUE forum.

I forgot to mention that the codes and ratings in 38 CFR that the DRO used have not changed since 2007, when my DRO made the decision on my NOD dating from claim in 2004. The key is the semicolon, which in this instance is used to join a list of conditions that would grant you 60%.

[Berta]

Yes, and the word "or" after a semi colon can certainly affect a proper rating...if VA thinks it says 'and' instead of 'or'

I am glad this was not a question of the 1998 reg changes.

And anxious to see what others think here on this.

[Berta]

I think I am misunderstanding this.....

Hopefully our cardio expert Jbasser will chime in here today.

I went back to your initial post

“we have evaluated the condition analogous to hypertensive heart disease based on the fact that you have associated pulmonary hypertension with confirmed evidence of dilation of the heart. this is more advantageous to your as your hypertension would be evaluated as 10 per cent disabling “

6817 Pulmonary Vascular Disease:

Primary pulmonary hypertension, or; chronic pulmonary thromboembolism with evidence of pulmonary hypertension, right ventricular hypertrophy, or cor pulmonale, or; pulmonary hypertension secondary to other obstructive disease of pulmonary arteries or veins with evidence of right ventricular hypertrophy or cor pulmonale

100

Chronic pulmonary thromboembolism requiring anticoagulant therapy, or; following inferior vena cava surgery without evidence of pulmonary hypertension or right ventricular dysfunction

60

Symptomatic, following resolution of acute pulmonary embolism

30

Asymptomatic, following resolution of pulmonary thromboembolism

0

Note:Evaluate other residuals following pulmonary embolism under the most appropriate diagnostic code, such as chronic bronchitis (DC 6600) or chronic pleural effusion or fibrosis (DC 6844), but do not combine that evaluation with any of the above evaluations.

6819 Neoplasms, malignant, any specified part of respiratory system exclusive of skin growths

100

Note:A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

6820 Neoplasms, benign, any specified part of respiratory system. Evaluate using an appropriate respiratory analogy.

Is this the diagnostic code the VA used in your case, as the analogous rating ?

Or did they use this:possibly under Note (3) as a combined rating to 30% which should be a separate rating????

Diseases of the Arteries and Veins

7101 Hypertensive vascular disease (hypertension and isolated systolic hypertension):

Diastolic pressure predominantly 130 or more

60

Diastolic pressure predominantly 120 or more

40

Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more

20

Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control

10

Note (1): Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm.

Note (2): Evaluate hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation.

Note (3): Evaluate hypertension separately from hypertensive heart disease and other types of heart disease.

Or maybe this is it:

7007 Hypertensive heart disease:

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 would think many analogous ratings can be problematic.

Since the 2007 decision, has your condition gotten worse in any way, that would support a re-opened claim for a higher comp rate?

You could reopen and file a CUE separately at the same time.

[vern2]

I pulled out my Nehmer decision to explain what I said here better as to the rating criteria for heart disease.

It ,might not help you....maybe will help someone else.

Th veteran was diagnosed with Ischemic Heart disease, ECHO revealing inferior wall akinesis evidence of prior heart attack, EF estimate 40%,hypertrophy and arteriol occlusions.

The award says : Based on evaluation criteria in effect prior to January 12, 1998

I looked that all up to make sure they were right)

an evaluation of 30 percent is assigned from October 25 1988 to October 14, 1994, the date of the veteran's death.

No, my period of service for this possible CUE was 2001-2003.

I have never received a diagnostic code yet for the veteran's. Oddly enough I asked them to CUE something else in this decision, and that is a pending claim, but I just noticed another potential CUE..

The award says that the higher 60% rating in effect per the Schedule of Ratings prior to 1998,

was not warranted unless the record shows a history of acute coronary occlusion or thrombosis or repeated anginal attacks which preclude more than light labor.

Bingo,. I am filing another CUE claim on that one I think.....

The history of acute coronary occlusion is evident in the 1992 ECHO ,the 1992 major disabling stroke, and the autopsy done on the veteran.1994

He died of IHD with other AOs contributing.

The history of occlusion started in 1988 with numerous ER trips, all misdiagnosed, by VA, yet finally confirmed under FTCA that these were TIAs due to arterial ischemic heart occlusion......

I have read this award letter over many many times in order to prepare and file a CUE against it and I did NOD it in time. I focused however on the SMC CUE claim award within the AO IHD award letter that contained one erroneous statement to my detriment.

I never even caught this other potential CUE until today....

It sure pays to read these awards as carefully as any denials because the VA can make many errors.

The rating schedule for heart disease changed in January 1998, and I cannot determine if that change affected the diagnosis you had and the period of service they based the rating on:

"I was granted 30% according to rating guidelines during my active service with approximatley one year of uncontgrolled pressures with the subsequent devel"