Hello al,l need your help. I am currently rated at 70% P/T with IU. I have a current claim in for increase of my S/C 10% Coronary Artery Disease. In regards to the METs for the heart condition, on my Feb 11, 2017 C&P exam the examiner noted the following on the DBQ.
Interview-based METs test on 2/11/2017
Symptoms during activity:
The METs level checked below reflected the lowest activity level at which the Veteran reports any of the following symptoms attributable to a cardiac condition:
FATIGUE
Results of interview-based METs test
METs level on most recent interview-based METs test:
7-10 METs; This METs level has been found to be consistent with activities such as climbing stairs quickly, moderate bicycling, sawing wood, jogging (6 mph).
Has the Veteran had both an exercise stress test and an interview-based METs test?
Examiner answered: YES
The questioned was asked "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.)
The examiner's answer was "The limitations in METs level is due to multiple medical conditions including the heart condition(s). it is not possible to accurately estimated the percent of METs limitation attributable to each medical condition."
Now the C&P Examiner copy and pasted the following into the DBQ (Heart Condition)
* * * ATLANTA VA HOSPITAL CARDIOLOGY CONSULT * * *
10/16/2016
PT IS A 51 YR OLD MALE HERE FOR CARDIOLOGY
CC: 1st visit today: Veteran w/ h/o chronic, stable angina - reported CP in service on Sept 6, 1990 in which Veteran was told he had a Myocardial Infarction- had NL MPI. Veteran has undergone heart Caths in 1992 and 2008, which were NL except as noted below - advised he likely has microvascular disease or microspasm or cardiac syndrome X (decreased blood flow in left ventricle).
Veteran has noted intermittent CP for more than 25yrs - averages CP 3 times per month at it occurs at rest and during sleep and with or without activity. pausing/resting typically relieves the pain but uses one 1 nitro tablet to help relieve the CP. Veteran uses on average 1 nitro table per month.
Veteran also has Obstructive Sleep Apnea with use of CPAP nightly.
My last hospital admission for CP was 12-7-2016 to 12-8-2016 at which I had a Nuclear Stress Test and ECHOCARDIGRAPHY done. The Tests revealed the following:
The Left Ventricular Cavity size is normal. There is Left Ventricular Basal Septal Hypertrophy
The Left Ventricular Systolic Function is normal, Ejection Fraction is 60-65%.
The Left Ventricular Diastolic function is ABNORMAL. Mild (grade I) showing impair.red relaxation
The Right Ventricular Cavity size and systolic function is/are normal.
The Mitral Valve Leaflets are mildly thickened
There is Trace Mitral and Valve regurgitation present.
Pulmonary artery pressure is normal.
My question is being that a Exercise METs level cant be determined should my CAD be rated at 100% based on my last Cardiologist exam that is noted above. The last and only time that I had a Exercise Stress Test was in December 1990. I feel that the examiner didn't have a clue as to what she was doing and this may cost me the rating that I deserve. I am also receiving Social Security Disability Compensation for my S/C Heart and Back Conditions. The examiner also noted that my Heart and Back Conditions DO NOT prevent me from working. The Social Security Disability paperwork is in my VA file not to mention I gave her a copy at my C&P Exam.
Question
VAW-126
Hello al,l need your help. I am currently rated at 70% P/T with IU. I have a current claim in for increase of my S/C 10% Coronary Artery Disease. In regards to the METs for the heart condition, on my Feb 11, 2017 C&P exam the examiner noted the following on the DBQ.
Interview-based METs test on 2/11/2017
Symptoms during activity:
The METs level checked below reflected the lowest activity level at which the Veteran reports any of the following symptoms attributable to a cardiac condition:
FATIGUE
Results of interview-based METs test
METs level on most recent interview-based METs test:
7-10 METs; This METs level has been found to be consistent with activities such as climbing stairs quickly, moderate bicycling, sawing wood, jogging (6 mph).
Has the Veteran had both an exercise stress test and an interview-based METs test?
Examiner answered: YES
The questioned was asked "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.)
The examiner's answer was "The limitations in METs level is due to multiple medical conditions including the heart condition(s). it is not possible to accurately estimated the percent of METs limitation attributable to each medical condition."
Now the C&P Examiner copy and pasted the following into the DBQ (Heart Condition)
* * * ATLANTA VA HOSPITAL CARDIOLOGY CONSULT * * *
10/16/2016
PT IS A 51 YR OLD MALE HERE FOR CARDIOLOGY
CC: 1st visit today: Veteran w/ h/o chronic, stable angina - reported CP in service on Sept 6, 1990 in which Veteran was told he had a Myocardial Infarction- had NL MPI. Veteran has undergone heart Caths in 1992 and 2008, which were NL except as noted below - advised he likely has microvascular disease or microspasm or cardiac syndrome X (decreased blood flow in left ventricle).
Veteran has noted intermittent CP for more than 25yrs - averages CP 3 times per month at it occurs at rest and during sleep and with or without activity. pausing/resting typically relieves the pain but uses one 1 nitro tablet to help relieve the CP. Veteran uses on average 1 nitro table per month.
Veteran also has Obstructive Sleep Apnea with use of CPAP nightly.
My last hospital admission for CP was 12-7-2016 to 12-8-2016 at which I had a Nuclear Stress Test and ECHOCARDIGRAPHY done. The Tests revealed the following:
The Left Ventricular Cavity size is normal. There is Left Ventricular Basal Septal Hypertrophy
The Left Ventricular Systolic Function is normal, Ejection Fraction is 60-65%.
The Left Ventricular Diastolic function is ABNORMAL. Mild (grade I) showing impair.red relaxation
The Right Ventricular Cavity size and systolic function is/are normal.
The Mitral Valve Leaflets are mildly thickened
There is Trace Mitral and Valve regurgitation present.
Pulmonary artery pressure is normal.
My question is being that a Exercise METs level cant be determined should my CAD be rated at 100% based on my last Cardiologist exam that is noted above. The last and only time that I had a Exercise Stress Test was in December 1990. I feel that the examiner didn't have a clue as to what she was doing and this may cost me the rating that I deserve. I am also receiving Social Security Disability Compensation for my S/C Heart and Back Conditions. The examiner also noted that my Heart and Back Conditions DO NOT prevent me from working. The Social Security Disability paperwork is in my VA file not to mention I gave her a copy at my C&P Exam.
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Berta
Are you the same member who posted in a different thread a few days ago? That thread got replies. As I recall the examiner was a NP and probably had no cardio expertise. I think I suggested
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