hypertension Is This A Cue?

[vern2]

I was granted 30% service connection for mild pulmonary hypertension in 2007.

The VA granted me 30% compensation due to fact I had evidence of cardiac hypertrophy or dilation on electrocardiogram, or echocardiogram, or X-ray as revealed on the echocardiogram dated XXX. by Dr. XYZ. A further reading of the reasons stated: “left ventricular dysfunction with an ejection fraction of 30 to 50 percent” would be reason to grant the claimant 60%.

The Echocardiogram clearly stated that I had an EF of about 50%, thus the error was made.

My question is was a CUE committed by the DRO in arriving at this decision? He used part of the evidence to grant me 30%, but the entire evidence showed that I should have been granted 60% based on the VA schedule of ratings. Is this a mere difference of opinion or evaluation or is this a real CUE?

§4.104 Schedule of ratings—cardiovascular system.

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

This schedule was updated in 2006, and decision was not made until 2007, so has not changed.

I am unsure as to what to do, seems like a CUE, but want the mor experienced members input before I proceed with a CUE letter.

Vern2

[Berta]

Could you clarify this:

“The Echocardiogram clearly stated that I had an EF of about 50%, “

Do you mean it stated Est EF 50%?

I have never seen an ECHO using the word “about”.

If any of these conditions were present:

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

And if the Est EF didnt go over 50% I would file a CUE on that if I were you.

[vern2]

No, the echo stated "about 50%", never saw this before either.

[Berta]

I think I might have given you the wrong advise here and am very sorry if I did.

“Pulmonary hypertension is abnormally high blood pressure in the arteries of the lungs. It makes the right side of the heart work harder than normal. “

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001171/

Was the decision indicating that the heart problems were secondary to the Pulmonary hypertension?

Can you give us the breakdown on the rating and what diagnostic code (s) they used?

It still could be a CUE but after I thought about, I am not sure.

What is the 20% for in your profile?

Hopefully others here with more experience then me on Pulmonary Hypertension will respond too.

Since the PH is associated with right side of the heart working harder, I guess the ECHO revealed that.

Have you checked the VA SRD for the Pulmonary Hypertension rating?

Edited August 24, 2013 by Berta

[vern2]

My profile is wrong, should be 30% , not 20%. The VA used an analogous rating for hypertensive heart disease. At this time in 2003, I had out of control htn, for over 15 months. Since then my health has gotten much worse, and the htn has attacked my heart. Cardiac ablation in May for atrial fibrillation/ flutter, for which I have also filed a claim for increase. Not sure what a VA SRD is? The paperwork that I received quoted 38 CFR, and that was all. I had to research to find out how they came up with the 30%.

[vern2]

Berta, I really appreciate your and Jbassers help. Ok, let me post the page from the decision and also a copy of the evidence that the DRO used in arriving at this decision. It appears that the DRO used one part-dilated heart, but ignored the EF of about 50% in arriving at the decision. See Attachments. This is clearly an error. The higher rating should have been used per CFR 38.

extract from my CUE letter:

This CUE error is not a disagreement on evaluation of evidence or difference of opinion. This is not a disagreement as to how the facts were weighed or evaluated. The error was made in determining the degree of disability based on the available evidence. (38 CFR 3.105(a)).

Disability evaluations are determined by application of the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity as a result of enumerated disabilities.

38 CFR 4.7 states where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Since I had both dilation of the heart AND 50% Ejection Fraction I should have been granted 60% disability rating.

[Philip Rogers]

Personally, I would submit the CUE claim and let them figure it out and appeal if denied.

pr