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Question For Berta

Guest jstacy


Hi Berta, I was told by a NP C@P examiner last week that for Coronary Artery disease the Ejection fraction is how they measure MET. He said that an ejection fraction of 30 to 50 is equal to 60 percent which I saw in the directives. He then said that an ejection fraction measured by Angio or Heart Cath outweighs one taken by a stress test for a stress test or echo is only an estimate. Its funny for a VA stress test measured 53 but the Actual heart cath measured 50.

Have you ever heard this, He also discussed my A1C and said I need to prepare to file for DM.

This may be an important point for Vets that are between the 30 and 60 percent rating for any heart related disease.


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When it rains it pours. I would really go all out to get DMII SC'ed if possible because so many problems flow from that source. The VA training letter on DMII lays out so many complications and secondary conditions it is really amazing.

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A1C is a blood test which measures the "stickyness" of blood hemoglobin over a period of time. It is used in Diabetes2 measurement and contol as it gives an average rather than spot measurement of blood sugar. These days most recommendations suggest an A1C of less than 6.5 which if I recall correctly equates to a bllod sugar level of about 135. Normal non diabetic readings should be up to maybe 4.5.

Generally the recommendation is thta this test be done about quarterly. It is supposed to tell you what your "average " glucose level has been for the past 90 days with heavier weighting given to the last 30 of those days.

This is an average and it is possible someone could be actively diabetic (by fasting and GOTT measurements and have the A1C still very close to if not perfectly in a normal range.

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John-that is an interesting point as to the ECHO and stress test when compared with the Cath or Angio for the ejection fraction.

I would think-if a veteran falls into a lower rating based solely on an ECHO but fulfills most of the other rating criteria for a higher rating, they should ask for the most favorable criteria to be applied to their claim.

Diabetes can cause atherosclerosis- as a cause of coronary artery disease, and I believe that atherosclerosis has to be considered also in any coronary disease ratings.Especially for diabetes which-as John said- has numerous complications that can be rated.

But a veteran has to clearly state what the claims involve. This recent decision involved a complex issue as to hypertensive atherosclerosis.

The veteran wanted a higher DMII rating based on these conditions but claimed the DMII aggravated his cardiovascular disease.

The BVA denied higher DMII rating but did grant the hypertensive cardiovascular diease as service connected.

This is a lengthy decision from July 2006 but a very good read for any veteran with DMII and complications of it. The claim included bilateral cataracts yet was on Remand to clarify this issue.

What appears on the surface (and within the VA's DMII training letter as other conditions that stem from DMII) has to still be adequately proven by medical evidence.


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