ptsd Ischemic Heart and Agent Orange

[philusmc]

I JUST HAD MY C&P FOR ISCHEMIC HEART CONDITION AND THE RESULTS ARE BELOW.  I got this off another webpage: 

A 60% rating is given if there is one or more of the following:

1) Two or more episodes of congestive heart failure in the past yearn (I've had only one episode)
2) The condition scores 4 or 5 METs and causes shortness of breath, fatigue, chest pain, dizziness or fainting  (I scored 4. something)
3) Left ventricular dysfunction with an ejection fraction between 30 and 50%  (I'm currently at 32%)

AS I READ THE C&P exam report, I probably fall into #3.  The comment at the end says "at least as likely as not (50% probability).  I interpret this as in my favor and would be awarded 60% for this condition.

I currently have 60% (combined VA math:  30% PTSD, 20% TypeII Diebetes, 10% peripheral neuropathy (right), 10% left)

Assuming the VA will rule a 60% rating for the IHD, how would I calculate the final rating.  I come up with 80%.

 

Heart Conditions: (Including Ischemic & Non-ischemic Heart

Disease, Arrhythmias, Valvular Disease and Cardiac Surgery)

Disability Benefits Questionnaire

 

Is this DBQ being completed in conjunction with a VA 21-2507, C&P

Examination

Request?

[X] Yes [ ] No

ACE and Evidence Review

-----------------------

Indicate method used to obtain medical information to complete this

document:

[X] In-person examination

Evidence Review

---------------

Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA)

[X] CPRS

1. Diagnosis

------------

Does the Veteran now have or has he/she ever been diagnosed with a heart

condition?

[X] Yes [ ] No

[X] Other heart condition, specify below

Other diagnosis #1: CAD s/p stent placement

ICD code: I25.1

Date of diagnosis: 2013

2. Medical History

------------------

a. Describe the history (including onset and course) of the Veteran's

heart

condition(s) (brief summary):

Veteran reports that his claimed IHD condition began in 2013. He was

hospitalized for chest pain and HTN. Cardiac cath was done. In January

of this year, he had shortness of breath as well as chest pain. He went

to the ER. He was admitted and had another cardiac cath and had 3

stents

placed. He is currently under the care of his cardiologist. He takes

Aspirin 81mg daily, Carvedilol 25mg, Bumex 1mg daily,

b. Do any of the Veteran's heart conditions qualify within the

generally

accepted medical definition of ischemic heart disease (IHD)?

[X] Yes [ ] No

If yes, list the conditions that qualify:

atherosclerosis Cad s/p stent placement

c. Provide the etiology, if known, of each of the Veteran's heart

conditions,

including the relationship/causality to other heart conditions,

particularly the relationship/causality to the Veteran's IHD

conditions,

if any:

Heart condition #1: Provide etiology

Age, gender, obesity, ao

d. Is continuous medication required for control of the Veteran's heart

condition?

[X] Yes [ ] No

If yes, list medications required for the Veteran's heart

condition

(include name of medication and heart condition it is used for, such

as

atenolol for myocardial infarction or atrial fibrillation):

Aspirin 81mg daily

Carvedilol 25mg

Bumex 1mg daily,

3. Myocardial infarction (MI)

-----------------------------

Not applicable

4. Congestive Heart Failure (CHF)

---------------------------------

Not applicable

5. Arrhythmia

-------------

Not applicable

6. Heart valve conditions

-------------------------

Not applicable

7. Infectious heart conditions

------------------------------

Not applicable

8. Pericardial adhesions

------------------------

Not applicable

9. Procedures

-------------

Has the Veteran had any non-surgical or surgical procedures for the

treatment

of a heart condition?

[X] Yes [ ] No

If yes, indicate the non-surgical or surgical procedures the Veteran has

had for the treatment of heart conditions (check all that apply):

[X] Percutaneous coronary intervention (PCI) (angioplasty)

Indicate date of treatment or date of admission if admitted for

treatment and treatment facility:

2/1/16 - CW Young VA hospital - with stent placement

Indicate the condition that resulted in the need for this

procedure/treatment:

CAD

10. Hospitalizations

--------------------

Has the Veteran had any other hospitalizations for the treatment of heart

conditions (other than for non-surgical and surgical procedures described

above)?

[ ] Yes [X] No

11. Physical exam

-----------------

a. Heart rate: 62

b. Rhythm: [X] Regular [ ] Irregular

c. Point of maximal impact: [ ] Not palpable [ ] 4th intercostal space

[X] 5th intercostal space

[ ] Other, specify:

d. Heart sounds: [X] Normal [ ] Abnormal, specify:

e. Jugular-venous distension: [ ] Yes [X] No

f. Auscultation of the lungs: [X] Clear [ ] Bibasilar rales

[ ] Other, describe:

g. Peripheral pulses:

Dorsalis pedis: [X] Normal [ ] Diminished [ ] Absent

Posterior tibial: [X] Normal [ ] Diminished [ ] Absent

h. Peripheral edema:

Right lower extremity: [X] None [ ] Trace

[ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+

Left lower extremity: [X] None [ ] Trace

[ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+

i. Blood pressure: 117/64

12. Other pertinent physical findings, complications, conditions, signs,

symptoms and scars

------------------------------------------------------------------------

a. Does the Veteran have any other pertinent physical findings,

complications, conditions, signs or symptoms related to any conditions

listed in the Diagnosis Section above?

[ ] Yes [X] No

b. Does the Veteran have any scars (surgical or otherwise) related to any

conditions or to the treatment of any conditions listed in the Diagnosis

Section above?

[ ] Yes [X] No

c. Comments, if any:

No response provided

13. Diagnostic Testing

----------------------

a. Is there evidence of cardiac hypertrophy?

[ ] Yes [X] No

b. Is there evidence of cardiac dilatation?

[X] Yes [ ] No

If yes, indicate how this condition was documented:

[ ] EKG [ ] Chest x-ray [X] Echocardiogram

Date of test: 1/29/16

c. Diagnostic tests

Indicate all testing completed; provide only most recent results which

reflect the Veteran's current functional status (check all that

apply):

[X] Echocardiogram Date of echocardiogram: 5/10/2016

Left ventricular ejection fraction (LVEF): 32 %

Wall motion:

[ ] Normal [X] Abnormal, describe:

global hypokinesis

Wall thickness:

[X] Normal [ ] Abnormal, describe:

14. METs Testing

----------------

Indicate all testing completed; provide only most recent results which

reflect the Veteran's current functional status (check all that apply):

a. [X] Exercise stress test

Date of most recent exerc

ise stress test: 3/24/16

Results: The stress test was stopped due to fatigue

METs level the Veteran performed, if provided: 4.60

Did the test show ischemia?

[ ] Yes [X] No

If no, was the test terminated due to symptoms related to the

cardiac condition?

[X] Yes, the test was terminated due to symptoms that are related

to the cardiac condition.

[ ] No, the test was terminated due to symptoms that are not

related to the cardiac condition.

b. If an exercise stress test was not performed, provide reason:

No response provided.

c. [X] Interview-based METs test

Date of interview-based METs test: 5/12/16

Symptoms during activity:

The METs level checked below reflects the lowest activity level at

which the Veteran reports any of the following symptoms

attributable

to a cardiac condition (check all symptoms that the Veteran reports

at the indicated METs level of activity):

[X] Dyspnea

[X] Fatigue

Results of interview-based METs test

METs level on most recent interview-based METs test:

[X] (>3-5 METs) This METs level has been found to be

consistent

with activities such as light yard work

(weeding),

mowing lawn (power mower), brisk walking (4 mph)

d. Has the Veteran had both an exercise stress test and an interview-based

METs test?

[X] Yes [ ] No

If yes, indicate which results most accurately reflect the

Veteran's

current cardiac functional level:

[ ] Exercise stress test [X] Interview-based METs test [ ] N/A

e. Is the METs level limitation provided above due solely to the heart

condition(s) that the Veteran is claiming in the Diagnosis Section?

[X] Yes [ ] No

If yes, skip Section 14f.

f. What is the estimated METs level due solely to the cardiac condition(s)

listed above? (If this is different than METs reported above because of

co-morbid conditions, provide METs level and Rationale below.)

No response provided.

g. Comments, if any:

No response provided.

15. Functional impact

---------------------

Does the Veteran's heart condition(s) impact his or her ability to

work?

[X] Yes [ ] No

If yes, describe impact of each of the Veteran's heart conditions,

providing one or more examples:

Difficulty with moderate/severe physical labor

No sedentary restrictions

16. Remarks, if any

-------------------

No remarks provided.

****************************************************************************

COMPENSATION AND PENSION EXAMINATION

MEDICAL OPINION

====================================

 

A STANDARD MEDICAL OPINION WAS REQUESTED.

PROVIDERS RESTATEMENT OF REQUESTED MEDICAL OPINION. THIS IS NOT THE MEDICAL

OPINION ITSELF:

Does the Veteran have a diagnosis of (a) ISCHEMIC HEART DISEASE INCLUDING

STENTS that is at least as likely as not (50 percent or greater probability)

incurred in or caused by (the) AO exposure during service?

WERE PRIVATE MEDICAL RECORDS REVIEWED: No

WERE SERVICE MEDICAL RECORDS REVIEWED: Yes

WERE VETERANS ADMINISTRATION RECORDS REVIEWED: Yes

WERE OTHER RECORDS REVIEWED: No

(STANDARD EXAMINERS MEDICAL OPINION)

THE CONDITION/DISABILITY: It is as least as likely as not (50 percent or

greater probability)that the veterans claimed ISCHEMIC HEART DISEASE

INCLUDING STENTS incurred in or caused by AO exposure during service.

RATIONALE FOR OPINION GIVEN: The vets complete VIRTUAL VA, VBMS and CPRS

records were reviewed.

Vietnam service was verified and Agent Orange exposure is conceded by the

regional office.

Agent orange exposure is presumed to be the cause of the vets IHD by the

dept

 

[toddt]

Yes, 60 + 30 * 20 + 10 + 10 =82 or 80 for VA math.

[philusmc]

Thanks.  Where do I go to see what benefits are associated with a 80% rating?