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Hypertension And Heart Disease


vern2

Question

Saw on another Vet forum that a member wrote that heart disease is automatically assumed as a secondary condition if you are service connected for high blood pressure. Tthen another member wrrote that not just any heart diseasee, it was limited to myocardial damage and coronary occlusion. "Essentially we are talking about coronary artery disease. If you have this heart disease the connection to service connected hypertension has already been made for you by the Secretary. This is spelled out in their operating manual, M21-1MR. Any other type of heart disease, except for hypertensive heart disease of course, will require a medical opinion from your doctor"

I was service connected for hypertension, and filed a claim for atrial fibriallation, carotid artery disease (coronary artery diesease- CAD), and hypertensive heart disease. They were denied as not service connected, even though I had extensive heart tests 5 months after came off AD to confirm had enlarged heart, and CAD. I am on appeal and have filed new claim for cardiomapathy, cardiomegaly and re-filed the CAD again.

Has anyone ever hear of automatic connection for heart disease if you have SC hypertension? The actual M21-1MR was part III, Subpart iv, Chapter 4, Section E. Sounds like a CUE has been made in my claim, but not sure?? Or could have been judgement call on the part of the C & P examiner??

Vern2 :sad:

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It does sounds like a possible CUE.

Can you scan and attach their Reasons and Bases here ( cover C file number, name and address first)

And the Evidence list?

M21-1MR was part III, Subpart iv, Chapter 4, Section E. Sounds like a CUE has been made in my claim, but not sure?? Or could have been judgement call on the part of the C & P examiner??

Under that M21-1MR link at 20, ( G) it states:

"If any of the following arteriosclerotic manifestations are diagnosed in a veteran with service-connected (SC) hypertension, grant service connection through the relationship to hypertension:

· symptoms and signs in the brain that warrant a diagnosis of cerebral arteriosclerosis or thrombosis with hemiplegia
· nephrosclerosis of the kidneys with impairment of renal function, or
· myocardial damage or coronary occlusion of the heart.

Notes:
· Arteriosclerosis occurs with advancing age without preexisting hypertension, and may occur in some younger individuals who are predisposed to arterial changes.
· The existence of arteriosclerosis does not imply or indicate previous hypertension."


I am not a doctor but unfortunately familar with some of these terms due to my husband's VA issues.

"symptoms and signs in the brain that warrant a diagnosis of cerebral arteriosclerosis"

This means evidence by MRI of ischemic events in the brain ,usually due to clotting, which is often due to atherosclerosis (plaque build up in brain. There can be many others reasons for ischemia of the brain but it means ( as in IHD as well, something stopped the flow of oxygen to the brain, cauing the ischemic event.

In my husband;'s case, the ischemia led to multiple transcients attacks and ultimately to a major stroke, which the VA ( under FTCA) determined was due to his improperly treated HBP and also prescribed medication, contraindicated by his HBP.

This was not an award for SC HBP causing heart disease. It was a 1151 award. His IHD was Sced under Nehmer.Still I had to prove the nexus between his HBP , TIAs, and his major catastrophic stroke

Thrombosis and hemiplegia can mean evidence of brain hemmorage on an MRI.

The VA does SC HBP to service connected renal disease mentioned in M21-1MR

Myocardial damage or coronary occlusion of the heart is determined often by noting hypertrophy in initial heart X rays but more adequately by a Doppler ECHO, which gives measurements of arteries that can reveal occlusion.

Although M21-1MR is quite clear on this way to get heart disease service connected as secondary,to SC HBP , I bet plenty of C & P examiners probably don't have the medical background need to properly consider every cause.

What is the SC HBP rating you have now?








Edited by Berta (see edit history)
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We have a Board remanded appeal in for hypertension that the RO recently denied via SSOC, it's on it's way back to the Board. Our argument was that it was a secondary effect of steroids taken for service connected hypoadrenalism. This question interested me because my husband, a 'Nam vet, is already 10% rated for ischemic heart disease for two cardiac stents. The hypertension claim pre-dated the IHD claim. I wonder if there's also a plausible cause and effect there, as well.

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Berta, the reasons and bases simply stated " not service connected", in both 2005, again in 2007 and again in 2012. They did use one page of my heart test in October 2003- ( I came off AD in May 2003), dilated left atrium in the analogous award of 30% for mild pulmonary hypertension. I am thinking CUE, but in either respect, the evidence was ignored 3 times!! I am still waiting on DRO review. I am coming up on 1 year in September 22, 2014. I have sent three separate NOD letters, I refuse to use the form 9. I have recieved one form letter and thre IRIS emails on the delay. The IRIS emails do not even acknowledge my NOD, but mention the one year time limit?? I think the VA has too many "teams" handling the claims and they are not on same page, as usual.

lotzaspots, please check out the M-21, part iii, subpart iv, chapter 4, section E-H. Sounds like a valid claim.

Vern2 :wacko:

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  • HadIt.com Elder

That is not a possible cue, It is definite cue as the regs state that cardiomegaly and enlarged left ventricle are rating criteria for heart disease.

Do you have a copy of an echo? Have you had a cath?

I have been connected for this for years.

Basser

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Many echos, heart cath on Nov 3, 2003, less than 6 months after I came off Active Duty, and denied my claim for CAD as not service connected. Unbelieveable, but that is typical VA response to claims. My heart was also noted as enlarged by VA in granting me SC for hypertension. Been fighting the VA system since 2005. I will prevail, but just a long stressful experience.

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  • HadIt.com Elder

what is your lfev from the echo?

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Jbasser, Sorry for not responding, overlooked your comments. My EF has ranged from about 50% to 70% and then 44%, then 60%, then 65%, then latest was 70% I think. My heart is enlarged, so have heart failue with preserved ejection fraction.

44% was when had CHF, and spent 4 days in hospital, the out for few days, the CHF again, the cardiac ablation, but nowhave very low heart rate, down as low as 37 bpm while I was asleep. It has ranged from 37 to 118 bpm, and this is while resting or asleep.

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  • HadIt.com Elder

We have a Board remanded appeal in for hypertension that the RO recently denied via SSOC, it's on it's way back to the Board. Our argument was that it was a secondary effect of steroids taken for service connected hypoadrenalism. This question interested me because my husband, a 'Nam vet, is already 10% rated for ischemic heart disease for two cardiac stents. The hypertension claim pre-dated the IHD claim. I wonder if there's also a plausible cause and effect there, as well.

"I wonder if there's also a plausible cause and effect there, as well" There is, but it's a chicken and egg situation. And to add insult, the VA often tries to say that Hypertension is

"Essential". Usually, at least mild hypertension can be a pre-cursor to heart problems. Males in their twenty's can have small heart blood clots that come and go, and the only indication may be slightly elevated blood pressure that is not up to a formal diagnostic level. It can also happen that heart problems cause high blood pressure.

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  • HadIt.com Elder

Jbasser, Sorry for not responding, overlooked your comments. My EF has ranged from about 50% to 70% and then 44%, then 60%, then 65%, then latest was 70% I think. My heart is enlarged, so have heart failue with preserved ejection fraction.

44% was when had CHF, and spent 4 days in hospital, the out for few days, the CHF again, the cardiac ablation, but nowhave very low heart rate, down as low as 37 bpm while I was asleep. It has ranged from 37 to 118 bpm, and this is while resting or asleep.

In your situation, I'd talk to a cardiologist you can trust. The 37bpm is of concern, as is the 118 at total rest. you may be a candidate for a pacemaker.

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yes, my cardiologist is going to discuss this on 30 April. He has mentioned ACID device which is both a pacemaker and defibrillator.

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Update. Had stress test on treadmill, lasted 4.3 minutes, stopped due to chest pain, PAC. 72 % predicted capacity, METS 5.8. All 4 stress tests have been stopped, 3 due to hypertensive BP response. Been having a lot of angina recently. Cardio C& P Friday, where they will probably say I am fine. Wish I were!

Edited by vern2 (see edit history)
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See my other posts, now the VA is stating that I have hypertensive heart disease, secondary to hypertension. Hell, this is what I claimed back in 2003, but denied. And then there is my CUE, where they ignored all the medical evidence that had heart disease less than 6 months after came off AD. VA has tacitly acknowledged that " MISTAKES WERE MADE " in my claim back in 2013.

Oh well, back on the hamster wheel:)

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"now the VA is stating that I have hypertensive heart disease, secondary to hypertension."

If that is documented in your medical records, or bya private cardio doctor, have you submitted that information to the VA?

This concerns me: from a post you made in August 2014:
"I am still waiting on DRO review. I am coming up on 1 year in September 22, 2014. I have sent three separate NOD letters, I refuse to use the form 9. I have recieved one form letter and thre IRIS emails on the delay. The IRIS emails do not even acknowledge my NOD, but mention the one year time limit?"

Do you have any proof that VA received the NOD?

Have you had a DRO review yet?

Do you know the exact status of this claim?

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Yes, I have had 2 phone calls from a Kelvin, at VARO, who stated he is part of VRO review team. The VA has acknowledged my NOD.

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Berta, still waiting on DRo Review since NOD of 7 October 2013 sent via certified mail as usual. Finally sent Ms.Hickey an email and there was some movement, had email from ms. Kitty (VARO St. Pete Director) telling me more C & P exams and more opinions. It has been almost 60 days since that email. I will give another 30 days and then more emails to Washington. I was patient for over 18 months, but this claim has been in process since 2003, denied 2005, then DRO Review in 2007, awarded 30% analogous rating for aggravated hypertension. Condition worsened dramatically in 2012-2013 and filed new claim in 2012, denied in 2013 and currently waiting on DRO Review. Filed a CUE in April on VA failure to consider all evidence in their possession in denying my claim in 2013. The hammer is that the VA ignored all evidence I submitted via eBenefits in 2013, in excess of 400 pages. I have tacit admission that mistakes were made as Kelvin ( senior DRO team member at St. Pete VARO) put it. I have a strong case for CUE claim. Of course as per usual VA has not responded to my CUE. Prior post from me stated that VA had acknowledged the CUE, well it was in phone conversation, nothing in writing. Wait just a little longer and will bump it up to Washington.

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Would left mains disease be considered ? or does it fall in line with CAD?

.....................Buck

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"Filed a CUE in April on VA failure to consider all evidence in their possession in denying my claim in 2013. "

Good , that is a iolation opf 38 CFR. 4.6.

"The hammer is that the VA ignored all evidence I submitted via eBenefits in 2013, in excess of 400 pages."

Yow can ebenefits accept a large download like that?

"I have tacit admission that mistakes were made as Kelvin ( senior DRO team member at St. Pete VARO) put it. I have a strong case for CUE claim. Of course as per usual VA has not responded to my CUE. Prior post from me stated that VA had acknowledged the CUE, well it was in phone conversation, nothing in writing. Wait just a little longer and will bump it up to Washington."

They only acknowledged my pending CUE filed in Fall 2012, when I contacted Ms. Hickey.

I wish I could use tape recorder on phone because their phone calls were just BS.

Here in NY you must tell the party they are being taped.

I won the CUE claim but they dont want to pay me.Fighting that.

My pending CUE was very brief, one sentence of a prior decison contained the CUE , the violation was under 38 CFR 4.6, and I submitted 13 pieces of evidence (in VA's possession at time of alleged CUE) which so far, even verified by phone call from VA, they had, but still have failed to address.

I never accept or believe what VA 'says'. I did accept the director's apology for two errors they made so far that they fixed.

One of them was a denial of proper application of the Benefit of Doubt regs. We cant file CUE on BOD errors because they fall under duty to assist but I found a way to CUE them on that anyhow and they fixed that fast.

I have had CUE awards that took mere weeks and one took 8 years, one took 9 years.

My current CUE they (Peggy) told me about 1 1/2 years ago was with a 'specialist'.They didnt allow widows on ebenefits at that time.

Specialist my ass.......The first time they acknowledged and read it it at all was only a few weeks ago....and only because I griped to the Under Secretary.

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Berta, no I did not send all 400+ pages at one time, sent 43 separate uploads from April 2013 through 12 Sept 2013. The VA rater chose to ignore what was in my VBMS, even though I sent certified mail in July 2013 telling them of the VBMS uploads. This was well before the denial of 22 September 2013. They clearly made an error in not considering all the "material evidence". Had an email from Ms. Witty on 22 April 2015 stating that they were looking into it. Nothing since then.

BTW: I have copies of my VA activity as well as what was uploaded each of the 43 separate times. I had to scan and convert to JPEG file and then save in separate folder, so I know what was uploaded on each instance. I have learned always keep meticulous records of any dealings with VA.Wish I could record phone conversations, but against the law in Florida! I have literally spent hundreds of dollars on certified mails to VA. kept all green cards and stamped receipts. Sometimes do not get green card back, but go to USPS web site and download the receipt. Noticed that Newnan, GA intake center just has someone stamp the green card, no date, no time. Going to USPS today to complain about not getting what I paid for. Still feel like on the hamster wheel. :wacko:

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OK, not to steel anyones post, but I am not understanding the topic (obviously not the first time).

I am SC'd for hypertension (high blood pressure) at 0% because controled by drugs.

I also have been diagnosed with a enlarged left ventrical while on active duty.

Whats the difference and do I have a (new or additional) claim??

Confused,

Hamslice

Also, my speel checker is down, so bare with me.....

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Enlarged left ventricle ( hypertrophy) is often a marker for the cause of HBP.

http://www.mayoclinic.org/diseases-conditions/left-ventricular-hypertrophy/basics/definition/con-20026690

http://my.clevelandclinic.org/services/heart/disorders/left-ventricular-hypertrophy-lvh

An ECHO is the best way to diagnose this condition.

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