IHD exam for increase but examiner ignored what was in the records

[cathyjourdan]

Okay my husband is rated as follows: 10% tinnitus, 30% Ischemic heart, 40% hearing loss and 100% temp lung malignancy.  He's had that temp 100% for over two years.  He's had all kinds of heart issues since the original heart rating to include two stents, a new aortic valve and chronic congestive heart failure, all of which are documented in his VA file. He is a mess and I take care of everything for him.  I applied for the caregiver program and have just been approved.  The people with that program told me I need to see about getting his heart rating up and to request he be rated permanent and total.

I put in the completed claim and they did a C&P in December.  I just saw the c&p report.  Here is what it says:

PERTINENT HISTORY:1966-1968 USA Viet Nam 1968. OCCUPATIONAL HX: Retired 1993. PMH: SC CAD, SC Lung Cancer S/P Radiation, COPD. PSH (with results): TAVR. 2019. SH: 50 pk/yr of tobacco use, stopped 2014. Denies ETOH.

1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a heart condition? [X] Yes [ ] No [X] Coronary artery disease Date of diagnosis: SC [X] Heart valve replacement Date of diagnosis: 2019 2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's heart condition(s) (brief summary): Veteran is SC for CAD. Reports having several stents in past several years, no stents in past year. Veteran reports a significant noncardiac hx, has a hx of COPD and non small cell lung cancer s/p radiation. Currently using 5 l O2 for COPD. 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: CAD/IHD. 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 Presumptive AO exposure.

Heart condition #2: Provide etiology Hyperlipidemia 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): ASA, Meotoprolol 3. Myocardial infarction (MI) ----------------------------- Has the Veteran had a myocardial infarction (MI)? [X] Yes [ ] No MI #1: Date and treatment facility: 1/16/2002 Fort Myers, Florida. 4. Congestive Heart Failure (CHF) --------------------------------- Has the Veteran had congestive heart failure (CHF)? [ ] Yes [X] No 5. Arrhythmia ------------- Has the Veteran had a cardiac arrhythmia? [ ] Yes [X] No 6. Heart valve conditions ------------------------- Has the Veteran had a heart valve condition? [X] Yes [ ] No a. Valves affected (check all that apply): [X] Aortic b. Describe type of valve condition for each checked valve: AS. S/P TAVR. 7. Infectious heart conditions ------------------------------ Has the Veteran had any infectious cardiac conditions, including active valvular infection (including rheumatic heart disease), endocarditis, pericarditis or syphilitic heart disease? [ ] Yes [X] No 8. Pericardial adhesions ------------------------ Has the Veteran had pericardial adhesions? [ ] Yes [X] No 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: 1. 2002 Coronary Stent, Charlotte Florida. 2. 5/2015 Stents Mid RCA/Proximal Circumflex, Keesler AFB. Indicate the condition that resulted in the need for this procedure/treatment: 1. CAD 2. CAD. [X] Valve replacement If checked, indicate valve(s) that have been replaced (check all that apply): [X] Aortic Indicate date of admission for treatment and treatment facility for each checked valve: 12/2019 TAVR Ocean Springs Indicate the condition that resulted in the need for this procedure/treatment: Hyperlipidemia. 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: 90 b. Rhythm: [X] Regular [ ] Irregular c. Point of maximal impact: [X] Not palpable [ ] 4th intercostal space [ ] 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: [ ] None [X] Trace [ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left lower extremity: [ ] None [X] Trace [ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+ i. Blood pressure: 126/70 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? [ ] Yes [X] No

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: 7/10/2019 Left ventricular ejection fraction (LVEF): 55 % Wall motion: [X] Normal [ ] Abnormal, describe: Wall thickness: [X] Normal [ ] Abnormal, describe: [X] Coronary artery angiogram Date of angiogram: 8/6/2019 Result: [ ] Normal [X] Abnormal, describe: Prior stents patent. No new significant lesions. 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. Exercise stress test No response provided. b. If an exercise stress test was not performed, provide reason: [X] Exercise stress testing is not required as part of Veteran's current treatment plan and this test is not without significant risk c. [X] Interview-based METs test Date of interview-based METs test: 12/7/2020 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] Angina [X] Syncope Results of interview-based METs test METs level on most recent interview-based METs test: [X] (1-3 METs) This METs level has been found to be consistent

a shower, slow walking (2 mph) for 1-2 blocks d. Has the Veteran had both an exercise stress test and an interview-based METs test? [ ] Yes [X] No e. Is the METs level limitation provided above due solely to the heart condition(s) that the Veteran is claiming in the Diagnosis Section? [ ] Yes [X] No If no, complete 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.) METs level METs level on most recent interview-based METs test: [X] The limitation in METs level is due to multiple medical conditions including the heart condition(s); it is not possible to accurately estimate the percent of METs limitation attributable to each medical condition g. Comments, if any: METS is based on general conditioning, natural age and combined medical conditions. Most middle aged individuals have a METS 5-7; and most elderly individuals have a METS of 3-5 - irrespective of heart function. Therefore, the veterans LVEF is more accurate representation of his/her cardiac function at this time. 15. Functional impact --------------------- Does the Veteran's heart condition(s) impact his or her ability to work? [ ] Yes [X] No 16. Remarks, if any ------------------- No remarks provided.

 

Okay so I don't have a clue how this will come out.  Ebenefits says that a Regulatory and Procedural Review opened on Dec 15 and closed on December 23.  Decision letter mailed, allow 7-10 days.

Any thoughts on this report?  One issue I have with this and its a big one if he is denied or lowered and that is that my husband has Chronic Congestive heart failure and has been in the hospital twice this year for treatment of this and pneumonia. It is on his active list of things wrong with him and is documented as being treated when in the hospital.  So I don't get how this guy could so blatantly say he doesn't have it.

Any insight would be appreciated and who should I call if I don't get this letter soon?  I'm trying to be patient because I know the mail is really messed up out there.  Thanks in advance.

[Berta]

I see your point-was this C & P done by a federal contractor like QTC ,LHI ,or VES?

If so I have posted their contact info here and will try to find it.

Have you googled the doctor who did this C & P exam?

If they are not a cardiologist I dont see how they could opine on a cardiac claim?

I had a BVA case regarding my dead husband and a post humous C & P exam was order by the BVA from a cardiologist.

I already had 3 IMOs ( 2 from NeuroRadiologist Dr Bash, and a freebee from a former VA neuroand had ordered a fourth from a Cardio Doc.

The VA had two absolutely ludicrous C & P exams from a VA Endocrinologist.

They ordered the Cardio exam to even the score.

I got a C & P posthumous exam from a Physician'd assistant.

 

I immediately rebutted the exam myself, with medical evidence, and the BVA agreed with me, and considered the VA PA exam as too speculative, was not the type of exam they requested ( from a cardio doctor)  and they awarded that claim.

I would hate to see you have to go all the way to the BVA to get a remand for a proper C & P exam. And you might find, like I did, that you will not get a proper exam even on remand.

I will try to find the C & P contractors contact info-

You need to take action on this right away-

This is one of the prime reasons VA claims are denied.

C & Ps are done by people who do not have a clue medically, and, or they just skim through the veterans records.

 "since the original heart rating to include two stents, a new aortic valve and chronic congestive heart failure, all of which are documented in his VA file."

I am not a doctor but I assume these are all medically secondary to the AO IHD and will tryt to find more info on that-even if not secondary the established IHD is making those disabilities worse I am sure ( I am thinking of the r "aggravation" regulations.

 

You said"One issue I have with this and its a big one if he is denied or lowered and that is that my husband has Chronic Congestive heart failure and has been in the hospital twice this year for treatment of this and pneumonia. It is on his active list of things wrong with him and is documented as being treated when in the hospital.  So I don't get how this guy could so blatantly say he doesn't have it."

Because he probably did not consider alL of the medical evidence.

I assume by 'hospital' you mean a VA hospital.And I also assume you have copy of a discharge certificate that lists the Congestive heart disease.

 

 

 

 

 

 

[cathyjourdan]

Oh I hadn't thought about googling....as it turns out he is a PA but I don't see where or how he is connected to the VA other than the fact that he sits in the VA C&P office.  Yes, he was in the VA hospital.  I appreciate your response but I'm not sure exactly what you are saying I should do right now.  We have not received a decision yet.  Thanks

[Berta]

When you find out where the C & P doctor came from, here is contact info I gave here in January 2019-

Was this a snail mail or email request from VA , as to the time/place of the C & P exam, that might have identified the contractor?

Or a phone call?

Then again there has been no formal denial yet but I feel you should expect a denial-

unless you try to get this C & P exam properly done - and that could hold up the decision ( maybe)

but it is far better to wait for a better decision ( or additional C & P exam) than get a denial right of the bat.

VES Phone 1-877-637-8387;  https://www.vesservices.com/?page_id=37

Veterans Evaluation Services 
PO Box 924089 
Houston, Texas 77292

 

LHI Logistics Health, Inc.

328 Front Street- South

La Crosse, Wi 54601

https://logisticshealth.com/our-company.aspx

mailto:information@logisticshealth.com

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

QTC Quality ,Timeliness, Customer Service

 

Contact info here:

https://www.qtcm.com/about-us/contact-us/

But it might help cut through a lot of BS if you call the White House Veteran's Hot line.

855-948-2311-if that number is still in service

Some Veterans here have taking steps to get a new and proper C & P exam.

I hope they chime in.

 

 

[Berta]

This 2020 BVA decision gives an excellent example of how the veterans's IHD at 30%, then subsequenty involved Congestive Heart disease:

"ORDER Entitlement to a disability rating in excess of 30 percent for ischemic heart disease (IHD) prior to November 20, 2015 is denied.

Entitlement to a disability rating of 100 percent for IHD from March 5, 2020 is granted.

Entitlement to a disability rating in excess of 10 percent for tinnitus is denied.

Entitlement to a total disability rating based upon individual unemployability (TDIU) from March 1, 2016 is granted."

 

https://www.va.gov/vetapp20/files4/20027906.txt

[cathyjourdan]

Interesting and probably useful for an appeal.  Thank you!

[Berta]

The rating info might help with an appeal-it depends what your husband's medical records reveal.... and this only took the above vet a little less than 4 years to succeed on the IHD part of his claim.

If this happened to my husband however, with a bojus C & P exam ,I would be breathing down their necks to fix it.

He had a C & P exam for PTSD higher rating in his lifetime , and as I sat outside the doctor's office I could hear VA employees looking all over for his VA records and they could not find them.I called the examiner the next day to tell him his C % P as not properly done.

The VA never used it anyhow and when he was awarded for SSDI solely for SC  PTSD and Voc Rehab said he could not return to college classes due to a 1151 stroke, we had more than enough evidence for TDIU.

He filed out the authorization for for the VA to get his SSDI records. They told me and my COngressman and two state senators, after he suddenly died,  that SSA refused to release them- that was a lie until I raised a ruckus with them ,but by then my husband (Vietnam 65-66) was dead,and it took three more years for them to properly award him 100% P & T for PTSD. he  Filed in 1992, and they posthumously  awarded in 1997.

M IHD death claim didnt have too many problems- it went to two wrong VA's at first but when Nehmer got it they awarded for the IHD and awarded a SMC CUE I had pending at my VARO by then for almost 8 years.

My husband died from AO IHD at age 47.He never even new he had IHD. or AO DMII. He was a victim of VA malpractice.

I know how the VA treats widows and I also know how hard it is for some veterans to even live long enough to see their proper awards.

He had 2 other C & P exams posthuously done and the examiner was never given the prime evidence for that claim- his 6 page autopsy.

I raised hell again but I won a month after they denied. they had to reverse their denial,  because the OGC can read and I had  already proven FTCA wrongful death, death by VA to the USA (that is who one settles with when they win FTCA)

I admit I see see many things here differently than others because I know how many things the VA ill pull,in order not to award many completely  probative claims.

If you do get denied , I hope you dont,and need an IMO, there are IMO/IME doctors listed here somewhere.