hypertension Hypertension And Heart Failure

[JessM]

I have a few question, but here is a little background first. I served in the Navy from 1993-2003. When I got out, I was awarded service connection and compensation for Asthma 30%, Acid Reflux 10%, Tinnitus 10%, and Hypertension 10%. I have a few others rated at 0% but do not remember them off the top of my head.

In January/February of this year (2015) I went to VA medical with some complaints and was subsequently diagnosed with Cardiomyopathy. To be frank, I am a bit unclear about all my diagnosis; it has been a bit of a trial for my family considering I just turned 40 I feel shellshocked. In the initial diagnosis I was told I had an enlarged heart and from there I had an ECHO and was told that I have an EF<10%. Since then I have had a catherization and 2 stents placed in 1 artery. I go back in for surgery on June 12^th to have another stenting procedure on a different artery.

So perhaps I jumped the gun but in March I applied for compensation for the heart failure. I recently received back the denial notice. It was perhaps my understanding that because I had been diagnosed with service connected hypertension and have received compensation for it since I separated in 2003 that the heart failure would be related to that hypertension, especially since I was told by a VA doctor that part of my heart failure was related to the hypertension.

I am going to file my appeal, but I wanted some advice before I do so, don't want to jump the gun again. What should I actually appeal? Their language in the denial notice speaks to not having any complaints or symptoms while active duty, do I need to spell out in my appeal that I am claiming the heart failure is a direct result of the hypertension? Any other items that I need to consider?

Any advice is greatly appreciated.

[vern2]

Hmm. which STR> seems kind of vague. I would request copy of the STR that they used to make decision.Was your HTN diagnosed in service? If so, the heart conditions may be secondary to HTN. You need a cardio doc to make the nexus or connection. It would help if the cardio doc would do the DBQ for HTN and Heart as well.

[JessM]

.Was your HTN diagnosed in service?

Upon discharge from AD 12 years ago I was awarded:

Asthma 30%

Hypertension 10%

Tinnitus 10%

Acid Reflux 10%

If so, the heart conditions may be secondary to HTN. You need a cardio doc to make the nexus or connection.

I don’t know if I have to have a nexus/connection from a cardio doctor, by VA regulations and court precedent it seems that since my hypertension is SC the CAD is as well.

In a VBA decision citation NR: 0304743 the board wrote:

“…the Board determined that service connection was warranted for the veteran's hypertension on the basis that the disease had its onset during service. In addition, the evidence shows that the veteran has been diagnosed as having coronary artery disease… In this regard, the Board notes that VA recognizes that coronary artery disease and its resulting manifestations are part of the same disease process as hypertension. See 38 C.F.R. § 3.309(a). Service connection for coronary artery disease with history of myocardial infarction and tachycardia is thus warranted on a secondary basis. See Allen; 38 C.F.R. § 3.310.”

[jbasser]

Here is the bottom line. You need to get a cardiologist to link the two conditions. The VA will not approve until you do. They are supposed to assist you but in most cases the assist comes as they are lowering your casket into the ground under the 6 foot rule.

NEXUS, NEXUS, NEXUS.

have a doc fill out the DBQ form and attach an opinion letter in this manner.

This veterans Cardiomegaly and CAD are a result of his longstanding Hypertension.

It is proven by medical literature that HTN is a direct cause of both of Hyoertensive heart disease (Cardiomegaly) and CAD. Coronary Artery disease.

Get this done and submit it to the VA.

Remember these folks are government employees and don't even take a dump without following the little written procedure. (M21) That is likely the cause for the Crappy denial.

J

[Chuck75]

The BVA does things a little differently than the RO's. The BVA is more cognizant of the law.

The RO's follow a scripted process, more or less. I'd get the IME/IMO, and list the citations.

In the past, VA often tried to say that HBP was "essential", and would refuse to service connect it unless

pressed to do so. With the existing service connection, that go around is eliminated! It's the hamster wheel bit again!

[Gastone]

What is your current SC % for Hypertension? Have you requested a Heart Failure DBQ from your VA Cardio Clinician? It appears to me that without a DBQ stating your HF is more than or at least as likely caused by your SC Hypertension, could be a significant problem.

I did (2) FDC for PH in early 2014 right after getting the DX based on VA Echo. I made the initial mistake of claiming PH secondary to my CAD on my 1st FDC. About 11/2 months later I realized my error and filed the 2nd FDC claiming PH secondary to my SC SA. C & P was held 07/14 at which time I told the DR about my 2nd FDC and my SC Therory, he agreed with me, CAD did not cause my PH and subsequent RV enlargement. He completed the VA requested DBQ regarding the CAD Nexus and then at my request completed another DBQ listing my SC SA as the cause of my PH. PH Secondary to SA Awarded 08/14.

Has your VA Cardio ordered all the Pulmonary Function tests to rule out any other causes other than your Hypertension. You can develop PH even though you have controlled Hypertension. VA raters have a difficult time differentiating between the pressure readings and how they affect Heart Failure ratings.

Breathing problems such as your SC 30% for Asthma can have (IN MY Lay extensive research Opinion) a possible Nexus to PH which in turn can cause RV and I'm not sure, LV enlargement. What was your Cath Pulmonary Artery Pressure, anything over 25mm is significant. That EF of less than 10% is very troubling. If you have a VSO-Rep get him on the case. Your claim needs to be pushed for an extra-scheduler IU rating. At your current SC%, you don't really qualify for a straight IU Schedular claim. If it were me, I'd file an IU FDC yesterday. You'll get a quick denial because of your 50% rating, but the Rater should present your claim to the Rating Dept Director for possible extra-schedule award. Certainly can't hurt to try, right.

Semper Fi

Gastone

[Gastone]

Jess: You have a stent procedure 6/12 right? You mentioned you still work, no medical insurance?

VA wanted to do a Right Heart Cath back in mid 2014 but I was very reluctant to have it done by the VA. My non VA Cardiologist was out of the country for 6 MOS. I decided to wait for his return and had per his decision to have a full heart cath 04/15. He wanted to check out my 2006 Quad Bypass Surgery. All good, no stents or anything else. Confirmed PH and RV enlargement. Medicare A & B covered the $16K. When I did the VA, Pre-Cath consults, the VA surgeon was only going to do the VA Cardiologist requested Right Heart Cath.

I meet with a number of other Nam Vets on a regular basis and the general consensus is the VA Medical Center is great, but if it comes to major (Life or Death) invasive surgery, we want the "Pros from Dover." At this stage why take the chance of being a VA statistic. Give me the surgeon that's done 1000's of successful procedures not a couple 100 or so. We want the least possible chance of something going wrong, with the Heart, Lungs and Brain, an oops doesn't always equal a limp.

Semper F

Gastone