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

[COOL BREEZE]

This is a "CUE". THey did the same thing to me years ago for the exact same thing. I had all my tests done at a heart hospital. I high lined the 50% with a yellow high lighter, put a stickem under this, and then copy and pasted from the rating manual "ventricular dysfunction with an ejection fraction of 30 to 50 percent.................. 60". I also high lighted this as well. I won and received back pay from the original date. Now I am attempting to do another Cue from 1996 as the VA failed to use a gonimeter to measure my neck movement per guide lines and gave me a big fat 0. Just had major surgery, so now that will have to give a higher rating anyway!

[Berta]

Oh now I get it. They used an analogous rating ( this type of rating is fairly common but I think ,by doing that type of rating VA ,can make mistakes)

And I was thinking of an actual ECHO result. This is an impression of the ECHO result and that is why the word “about” is there.

Do you have a copy of the actual ECHO result?

I am sire glad Cool Breeze reminded us of the similar CUE he won.

By VA SRD I just meant the rating schedule here:

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&sid=c130ec487ea61b8a40ad0836188b94bc&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38

I am wondering if the word "about" was on the actual ECHO results.

One single word can sway the VA, against us.

I fought a claim for years because the VA manipulated a C & P exam and deliberately 'forgot' 6 critical words the actual C & P report contained,which was not quoted in the SSOC.

Yes, I would file the CUE claim.....as it sure appears they violated this legal reg:

"The error was made in determining the degree of disability based on the available evidence. (38 CFR 3.105(a))."

Did the VA rate your HBP as separate from their analogous rating or was that part of it?.

Reason I ask is because, for almost 2 decades the VA failed to pay for my husband's HBP under 1151.

I failed, as well, to NOD in time on that.

The ratiing sheet says (1998) NSC HBP (which is correct-they dont put 1151 in rating sheets) but VA failed to pay under 1151 for the HBP, which was clearly misdiagnosed per all FTCA documents I obtained.

I thought last year that maybe a CUE should be filed (I filed 3 other CUEs on the same 1998 decision and it took 8 years to win them)and briefly ran that by my Nehmer lawyer as to another CUE on the same decision but instead I filed a Section 1151 claim (no time limit on them,nor on CUE)

I am rattling all this off here because I am not familiar with pulmonary hypertension and don't understand how they rate the HBP ,unless it is included in the overall rating for the pulmonary problems....

You have a very good handle on your decision and the regs.

If that word "about" is not on the actual ECHO (I have an ECHO print out right here and that word isn't there because EST EF means Estimated Ejection Fraction, this single redundant word (with no medical significance) could have swayed the VA to use the lower rating.

Edited August 25, 2013 by Berta

[vern2]

Berta, I wish I had the actual Echo, all I have is the report and the doctor's office stated that they destroyed all old files. Cool Breeze, thanks for the advice. I received 30% for pulmonary HTN and a simple reading of the facts/evidence shows that should have been rated at 60% back then. I will file my CUE this week. Agreed, every word is vital when dealing with VA. This agency tends to lose files, transpose words to suit their denial, etc. Wish I could afford a lawyer to do this task, but it will be me!

[COOL BREEZE]

You need to have an actual medical report with that statement listed. Unfortunately if they used the word "about" you may have a problem. I would see if they could do another one without "about". Mine had used the word between 50 and 30. This gave me the lottery award. I agree one word will throw everything out. Kind of like buying some milk. It will be good from today till about 1 week from today. Would you buy this? Still, if you can't have it written without the "about" high light in yellow the 50 and Cue-see what happens. Good luck!

[jbasser]

The regs are clear. If your EF is 50 or even about 50 you have an error in the rating.

Now I do have a concern, Your topic stated Pulmonary HTN.

Pulmonary HTN has nothing to do with Hypertensive heart disease. I should know as I am connected for both. It can, however, aggravate heart disease.

Hypertensive heart disease effects the left side of the heart.

Pulmonary HTN effects the right side of the heart and vasclature to the lungs. This is a lung rating and is a 100 percent rating if it is associated with lung disease.

Basser

[Berta]

Thanks John because you are correct and that is why I asked about Vern2's rating too:

I asked "Did the VA rate your HBP as separate from their analogous rating or was that part of it?"

Jbasser said:

"Pulmonary HTN has nothing to do with Hypertensive heart disease.I should know as I am connected for both. It can, however, aggravate heart disease.

"

I sure learned from you today, John.

I would think CAD might be secondary to PH, if a doctor said it was?