Question For Berta

[betrayed]

Berta what do you know about the grading of collaterals?

[Berta]

I think you mean collateral vessels and their involvement to coronary disease.

"Collateral circulation is a network of tiny blood vessels, and, under normal conditions, not open. When the coronary arteries narrow to the point that blood flow to the heart muscle is limited (coronary artery disease), collateral vessels may enlarge and become active. This allows blood to flow around the blocked artery to another artery nearby or to the same artery past the blockage, protecting the heart tissue from injury. '

from:

http://www.clevelandclinic.org/heartcenter...ad_arteries.htm

I have a DMII vet with heart disease . He gets 20% for the DMII and they are attempted to rate him higher due to heart disease from the DMII.

Oddly enough the VA denied his HBP to DMII claim but finally conceded it-

His claim is for secondary CAD due to HBO (now SC) and also DMII (SC).

He is a vet rep and did not realise that a veteran claim claim a secondary disability or even an initial one to more then one basis.

He has collateral vessels that appear by MRI to have began to circulate blood to his heart in lieu of the damages vessels.

As the article in this links shows, these collateral vessel can enlarge and begin to do the work of colluded vessels.

I do not know how the VA considered this facet of heart disease, however it is not a cure for heart disease.

The BVA does not mention collaterals much but they do as within this case:

http://www.va.gov/vetapp93/files2/9316746.txt

"The examiner stated that the veteran did

not have significant disease in the left anterior descending

coronary artery, but that the posterior descending artery

was no longer grafted and was not amenable to coronary

angioplasty. It was further noted that this artery did fill

via collaterals."

Although the collaterals filled enough to circumvent the damaged arteries- in this case the BVA stated:

The record shows that the veteran has significant coronary

artery disease. One of the bypass grafts has apparently

occluded although collateral vessels have apparently helped

to mediate the problem. He described angina attacks on

walking approximately 1 mile, up three flights of steps, or

upon doing light yard work. He also gets occasional angina

at rest. These complaints were clinically confirmed by the

findings of ischemia after only six minutes on the thallium

stress test. We find that more than sedentary employment is

precluded by his heart disease. For this reason, we find

that the criteria for a rating of 100 percent has been

demonstrated.

ORDER

An increased rating for arteriosclerotic heart disease,

status post myocardial infarction, is allowed, subject to

the controlling regulations covering the payment of monetary

benefits.

[betrayed]

I was diagnosed with heart disease 23 months after discharge, 11 months to late to fall within the 1 year window for SC. Its crazy for the VA to claim I developed heart disease after I retired. Which they have not said yet. The reason I ask is yesterday I had a cardiology appointment at the VAMC. When I talked with the cardiologist I asked her how long I had heart disease and she said a long time. I explained I was afraid I was going to have a fight on my hand getting it service connected. She said you developed collaterals which basically means you have had heart disease for a while. I asked her to state that in her opinion it was service connected. She told me if I could get a copy of my Heart catherization film on CD she would look at the film and if the collaterals showed something she would gladly provide such a opinion. I think she said if she could look at the film and the collaterals and that the collaterals would give her factual evidence as how long I had CAD. What I think she said is the grade of the collaterals would be the determining factor. My operative report states that I have grade three collaterals in two places on my heart. I sent her my operative report via email and asked her if she still needed the film on CD. So my question to you was would the grade of the collaterals demonstrate how long the heart disease has been present. I wish that I could remember what she said exactlly. She still has not answered my email but it hasnt even been 24 hours yet. I am just trying to be lazy and not drive 60 miles to ask for the CD of the film. And the reason I am asking you is I know you have a extensive knowledge of Heart Disease.

[Berta]

Jim:

"So my question to you was would the grade of the collaterals demonstrate how long the heart disease has been present." I wish that I could remember what she said exactlly.

I have some of coronary background but am not a doc- in my opinion,based on what I have studied on CAD- the answer to your question is no. But-

What I mean is I do believe that a doctor (a Cardiologist) could state "more than likely" this condition was from many years of having heart disease and a doctor to possibly state that-since the diagnosis first came 23 months after your service-

regardless of the collaterals or not-

it is possible that you were symptomatic of heart disease inservice-

But still this would depend on anything in your SMRs to justify this.

This is one good reason to get an IMO-

it does not mean that what isnt there will suddenly appear in SMRs, but it means that a doctor might well see things in the SMRs that we dont have the expertise to see as related to what we are claiming.

I do understand your situation-in a way it is like mine as to properly establishing when a disability first manifested itself-critical to most claims---

in my claim the VA can easily award for DMII (never diagnosed by VA)but fail to consider my husband's heart disease

properly as secondary (they have established heart disease and strokes as cause of death due to VA care-this is for direct SC death award)since it (CAD)was never diagnosed at all until I sued them.

I anticipated long ago how I would handle this-

but I have to tell you it involved reading every single thing in the med recs over and over again-and to get a timeline -of what the VA misdiagnosed- to show that the heart disease did not precede the DMII- thus VA could say the heart disease was not secondary to it-

My IMOs from Drs BAsh and Rabiee support my claim to include this potential approach VA could use and the medical records do too.

The medical records support this after considerable study of them with ADA references and a good medical dictionary.

A condition Rod had that the VA diagnosed and treated in 1992 was first manifested in 1988-by medical documentation and left untreated at that time-only after spending a lot of time to find out what this condition really was-

we paid little heed to it at all-and the VA said it was not important- but medicated it-

this overlooked condition became the most significant evidence I have to support DMII manifestations prior to heart disease.

My long point here Jim is -that unless the doctor can definitively state with your SMRs or something as a good medical rationale that your heart disease was evident in your SMRs or manifested to 10% within the first year after service, I dont see the VA being able to service connect the CAD.

It could be a fainting spell you might have forgotten that was documented there-

have you given the SMRs a very good look?

Do they reflect any HBP readings at all that could indicate CAD?

Were you ever dizzy and was this documented?

I had a local vet with fainting spells trying to get SC for CAD.

His SMRs didnt help much-HBP was a little high-but his personnel records did-

he was required to have someone with him-another airman-assigned to him for 2 weeks during his duty-due to these fainting spells.

I tried to tie this in to his HBP and through that to his CAD.

Dont know how he made out yet on this claim.

[betrayed]

Berta I emailed you a pdf document which contains 21 pages from my SMR which I beleive to provide a nexus for CAD to SC.