Pulmonary Hypertension rated at 30% as symptomatic resolved pulmonary embolism

[wbonebrake]

OK, so here's my story. I was in Iraq in 2008-09, and started having chest pain. It was dismissed by the army doctors as probably just a strained muscle. Fast forward a few years, and I was diagnosed with pulmonary hypertension and stage one heart failure, both of which are ultimately fatal. I submitted a claim for these conditions, which was denied. I appealed this denied to the DRO in St. Louis, MO. The contention for pulmonary hypertension has a pending rating decision in the system according to my VSO. Here's my issue. I am diagnosed with Pulmonary Hypertension, as well as other diseases. The doctor who did my C&P exam clearly stated that he believed that my PH was service connected. The pending rating states that I am granted service connection for PH. However, in the section that details the rating, it is rated at 30% as "Symptomatic, following resolution of acute pulmonary embolism." In the CFR 38 section 4.97, diagnosis code 6817, Non-tuberculosis diseases of the respiratory system, Pulmonary Hypertension is clearly listed as a 100% condition. I called the 1800 number to check on the rating decision, and I was informed that it was sent to the authorizer, who then sent it back to the rater, and it is now just waiting to be authorized again. Is it possible that the authorizer saw this, and felt that the " Symptomatic, following resolution of acute pulmonary embolism" was not an accurate representation of my diagnosis, and asked for it to be updated?

[wbonebrake]

They may be working on changing it. As you mentioned, when I was still awaiting my appeal, I researched my diagnoses in the cfr38, and pulmonary hypertension was listed as 100%,with no mention to the severity ,simply the diagnosis. The Rating Decision I originally posted about has been sent back to the rater by the authorizer, was administratively changed, and is now awaiting the rater again. Hopefully it's at 100%this time !

[Gastone]

For better or worse, you'll know soon enough.

Strictly my take on this, I still see your Stage 1 PH as a low 10 to 30% SC.

Do you have an actual Lung Condition DX, I didn't see it? You were advised of a recent PH SC Award of 30%, with a Nexus to a "Resolved Acute Pulmonary Embolism."

It will be interesting to see what SC'd condition is the Nexus for the "Acute Pulmonary Embolism." If that SC has a bump for an "or evidence of Cor Pulmonale" that would be grounds for an Increase.

Keep in mind, a low Stage 1 PH DX while incurable, is not an imminent Death Sentance. Consider getting a Heart Cath from a Non-VA Cardiologist/Hospital. The results of which, will give some peace of mind. It's all about the exact numbers and visually verifying the condition of your Right Ventricle.

Semper Fi

[Berta]

Jbasser, I think you mean the BVA vet....

I can hardly believe some of the claims on remand.....Many of them could have been easily resolved at the RO level.

I was searching for something at the VA for a local person and caught in the VAblog site that they have reduced the '100,000 claims backlog'(I didn't know it was that high) and they might have meant they reduced it

                            to 99,999 for all we know.

[wbonebrake]

I was originally diagnosed by a private cardiologist, who diagnosed me with class b heart failure as well as pulmonary hypertension. Both claims were denied, and i appealed them both. The chf has continued to be denied, but the ph is the only one with a pending rating. 

[Gastone]

Do you have a current Heart SC, what is it?

Semper Fi

[wbonebrake]

Yes sir, 10% for coronary vasospam aka Prinzmetals angina