Mets rating in question

[dennis simpson]

 

  I am going with a claim to try and increase my current rating of 60% ischemic heart disease to 100%.  I am basing this on testing that I feel VA Medical reports which are vague and are not telling the the entire and accurate

story of my condition. Has anyone experienced the same thing with the VA? Also, can anyone offer advise before I file this claim as to what I may need to add to the letter below.All my medical reports are in my VA history, so C & P examiner can get what ever they need. I have just pulled small segments from certain reports to emphasize my points in this letter. Please read and offer your comments. All will be appreciated, whether positive or negative.

 

Department of Veterans Affairs

Evidence Intake Center 

P.O. Box 4444 

Janesville, Wisconsin 53547-4444 

 

Dear Sir/Madam,

 

**Subject: Request for Re-Evaluation of METs and Disability Rating Increase**

I am writing to respectfully request a re-evaluation of my current disability rating due to observed inconsistencies in recent assessments and the need for a more accurate measurement of my METs level. My ischemic heart disease, a service-connected condition, has significantly impacted my daily functioning, and I believe the current evaluation does not fully capture the severity of my worsening condition.

 

**1. Inconsistencies in Testing and VA Reports:**

Upon reviewing the recent test results and VA reports, it is apparent that there are discrepancies needing resolution. The METs rating, determined through an interview-based assessment, appears vague and not reflective of my current physical capabilities. And definitely outdated. Given the serious nature of my heart disease, I am concerned that these estimations do not adequately reflect my daily experiences and struggles.

 

**2. Concerns Over Interview-Based METs Testing:**

The decision to estimate my METs based on an interview, rather than a physical test such as a treadmill exam—which I was denied due to perceived risk factors—leads me to question the accuracy of this estimation. Despite my ejection fraction being noted near 40%, the reliance on non-physical testing means critical aspects of my condition may not have been fully captured.

 

**3. Detailed Observations Contradicting Current VA METs Rating:**

- **Physical Limitations:** My daily life is severely restricted by my condition, with significant

     changes in my abilities compared to four years ago, including:

·         Excessive weight loss.

·         Inability to perform any yard work whatsoever. Light or otherwise.

·         Severe dyspnea and fatigue when walking even half a block at a slow pace.

·         Shortness of breath

·         Take baths instead of showers, due to standing exertion.

·         Frequent breaks needed while eating due to tiredness.

·         Difficulty changing clothes due to fatigue.

·         Occasional chest tightness with minimal exertion. (Angina)

·         Experience of chest pain and dyspnea during my most recent non-treadmill stress test, as documented in my VA records.

·         Resignation from my job due to lack of stamina; inability to be productive for even several hours.

·         Sleep Apnea diagnosed - Extreme Sleep issues- cpap use

·         Relocation to a one-level home due to inability to manage stairs.

·         My third major heart attack in 2019 occurred during light yard work, not involving strenuous activity. I was not even mowing lawn, just picking up sticks.

·         Frequent extreme dizziness, sometimes feeling like I'm about to faint.

·         Equilibrium unstable. Persistent unbalanced feeling, leading to frequent stumbles against walls.

·         Need for multiple rest stops from the car to the appointment area at every VA hospital visit.

·         Requirement for several daily naps due to overwhelming weakness.

·         Leg and body weakness when walking short distances.

·         Driving limited to very short durations; fatigue sets in after an hour of driving.

·         Full-time care is provided by my daughter, and has been for almost three years now. She manages all household chores and maintenance. This includes cooking, cleaning, yard work, grocery shopping, taking out trash, and other personal tasks. This is on a 24/7 basis, and she lives with me.

·         Recent VA tests categorized me as "frail" with a level 4 risk factor, yet supposedly according to their assessment of my functional capacity (interview based), I can perform fairly normal activities without many issues. This conflicts with one another.

 

  - **Reports and Testing:** The interpretations of tests such as myocardial perfusion images and low-dose CT scans suggest the need for more definitive data to accurately determine my left ventricular ejection fraction (LVEF). There are too many uncertainties in these reports. For example, one report states as follows:

    > ["Moderate sized, moderate to marked severity fixed perfusion abnormality involving the basal to mid inferolateral and basal inferior wall... The left ventricular ejection fraction is probably close to 40% based on visual assessment, though the calculated left ventricular ejection fraction of 32% might be slightly low due to contouring errors." Clearly his ejection fraction is depressed as it has been documented in the past but we need more data to know exactly what his LVEF is. In the meantime without evidence of ischemia on a stress test or angina clinically we would not recommend cardiac catheterization."] <

  There are two points here I wish to make concerning reports, testing, and conflicting information.

  Point 1: The statement above from the VA says in the last sentence; "In the meantime without evidence of ischemia on a stress test or angina clinically we would not recommend cardiac catheterization." Whereas, the report on my stress test shown below clearly indicates that I experienced dyspnea and chest pain during this exam, and this was not on a treadmill;

 > ["Subsequently, an intravenous infusion of regadenoson was performed. Standard myocardial perfusion images were obtained after tracer injection at the peak effect of the pharmacologic stress agent. Low-dose CT images spanning the heart were obtained for attenuation correction. The patient experienced dyspnea and chest pain during the exam." ]<

  Point 2: If the ejection fraction cannot be determined with any degree of accuracies using sophisticated equipment, how can my METS be considered accurate with a few questions in an interview. Not enough questions have been asked to evaluate my cardiovascular functional capacity in regards to METS. Previously my rating was 3-5 Mets. As of now the VA has updated my METS as less than 4. Not 4, less than 4. VA Ratings in regards to METS are 1-3, 3-5, 5-7, & 7-10. So, what does less than 4 actually mean? If dealing in whole numbers, to me it means 3, at the most. This is what I mean by vague analysis.

This is one comment taken from my latest medical files;

 > ["CARDIAC FUNCTIONAL ASSESSMENT:

     Functional Status less than 4 mets limits activity due to DOE.]<

 

**4. Request for a New METs Rating Interview or Evaulation:**

In light of these observations, I urgently request a new, comprehensive interview that accurately reflects my current health status and functional capabilities related to my METS, because I am experiencing severe limitations, and debilitating symptoms appear with very minimal exertion. With what I have listed above, I believe my MET rating should be between 1 and 3, and that I should be considered 100% disabled in regards to my Ischemic Heart Disease.

It is essential that this new assessment address the noted inconsistencies and involve a detailed examination of my actual physical capabilities, regardless of ejection fraction findings.

 

**5. Application of VA Policy on Reasonable Doubt (38 CFR 3.102):**

Given the balance of positive and negative evidence regarding the extent of my disability, I request that any reasonable doubt be resolved in my favor, as stipulated by VA policy found within (38 CFR 3.102). This supports the need for a fair re-evaluation, given the significant potential for underestimating the impact of my condition based on current evidence.

 

**Conclusion:**

I am committed to providing any additional information or participating in further assessments required to accurately determine my condition. Your attention to this matter is crucial for adjusting my disability rating from 60%  to 100%  and ensuring that I can continue to manage my health with the appropriate support and resources.

 

Thank you for considering this request for re-evaluation. I look forward to your timely response and am available for any further information, testing,  or clarification needed.

 

Sincerely,

[broncovet]

Welcome to hadit.  

   Did you put your request for an increase on the applicable form?  VA used to allow a 21-4138, but now requires the applicable form.  

   You also mentioned sleep apnea.  Have you applied for OSA?  

   Last, but not least have you cosndiered applying for tdiu?  My guess would be you are not working, and unable to work based on your post.  

While there are certain advantages to a "single" 100 percent rating, it does not matter a lot "how you get there", that is, if you have tdiu, a single 100 percent or combined 100 percent rating.  Let the VA rater decide which you qualify for (tdiu, OSA, or an increase in IHD, or maybe more than one of these).  

 

[dennis simpson]

No I haven't applied for OSA . I get my CPAP Machine on September 4th. I heard it was very difficult to get Sleep Apnea as a nexus to anything. As far as TDIU, being that I am 72 and was still working, I felt they may simply believe I should have quit long ago or retired for the normal reasons. Age! So, I haven't applied for that either. I have been diagnosed with PTSD with a VA Psychologist, and have had 3 sessions with her. Been now assigned to extended therapy beginning august 21st.. Even though the diagnoses may be considered provisional, I am filing both it and the increase on IHD with the DAV today, and we are going to be putting this on form 526, which supposedly allows a new claim and one seeking an increase to be claimed simultaneously. This allows both to fall within my intent to file which i made almost a year ago. In one week it be a year. Hopefully both will receive backpay if I am awarded my claims. However, I'm crossing my fingers and trying to present as strong a case as I can. It's all I can do. Thank you for your suggestions. I will discuss those options with the DAV this morning, Might just be worth exploring.

[broncovet]

Be careful about basing a significant portion of your future earnings on "what you heard about sleep apnea" or even your own feelings "that you should have quit long ago or retired for the normal reasons".  

Often, we are our own worst enemy when it comes to VA claims, "Especially" if we pre judge our own claim to be "not valid".  Instead, apply and let the people who's job it is to determine "whether or not" our claim is valid do their job.  Most of the rest of us have not been trained in VA claims, as to what, or what is not valid.  

Indeed it can be difficult to get an OSA nexus "especially" by people who work for the VA are paid by the VA to assist VA in awarding as little benefits as possible to save their employer money.  This is why many Veterans have to hire their own medial opinion, where the examiner does not have a financial interest in ensuring claims paid out are as low as possible.  When the VA signs your paycheck, most doctors understand that they must protect VA's financial interests, not the Veterans.   When in doubt, apply.  100 percent of claims not filed are denied.  

If I would have listened to the naysayers, I would be zero percent now, because my VSO suggested "not appealing" my zero percent rating, even suggesting it could be reduced!!!!!!   I have never figured out how to reduce a zero percent rating, yet.  Maybe someone else can tell me.  

Edited July 29 by broncovet

[ShrekTheTank]

Bronco is right, If I would have listened to the DVA I would be stuck at 30% and not made it to 100% P&T.  

The VA wants you to not file, as they do not need to pay a claim or give medical if you don't file.  You have every right to file and get the benifits you deserve!  

You fought for our county, and it sucks you have to fight for this, but it is the way it works.  

Keep fighting and don't back down.  

[dennis simpson]

Yes, you an Bronco are right. I just left the DAV and was reminded why I didn't use them when I went from 30% to 60% on my IHD. My documentation and my own letter won that claim. Today the DAV tells me I shoudn't file for 100% on the IHD, because they may reduce me below the 60% I'm getting. I couldn't believe my ears. I had to stop him in his tracks. I told him there was no way the VA was going to reduce my percentage of disability, because the VA hospital records alone show a definite reduction of heart functioning from what even got me the sixty percent in the first place. Ischemic heart disease does not get better. It gets worse. And all you can do is adjust your lifestyle as it does.I had a lot of paper work that I wanted submitted with the claims and he acted as though it was a pain in the ass to make a pdf of everything. He was reluctant even with my initial claim's letter, which was the backbone of my reasoning for the claim. My medical file is probably 400 pages long and I know raters are not going to read it all, so I highlight certain aspects and related items to my claims for their convenience and to save them time. That research got me the 60% rating. I also had every ptsd segment, conversation and therapy session done thus far, so they wouldn't have to browse several hundred pages and maybe miss something important in their efforts to address my PTSD. Well supposedly he sent them all in with the claims,but to tell the truth, I really can't be sure. I am going to come alive on them if they held back one item I gave them for this claim. Two weeks of organizing, writing and preparing for this, and he didn't bother to read one sentence of anything I had with me. Kept saying he had another appointment and had to hurry. And that was after only fifteen minutes. His claim letter document of which he gave a copy of (kind of a receipt) was pathetic. I may not get the hundred percent on IHD. I have been prepared to expect this could happen. However, I won't be getting reduced, that's for sure! And it won't be because I didn't prepare properly. And the sleep apnea....well he didn't have time to talk about it. I left there frustrated as all get out, and will never use them again.  I can do this on my own, and if an appeal becomes necessary I can handle that as well. thye are filed and I will follow them on VA. GOV, as well as check what he truly did submit. I can still update more information if I need to as we go forward. I Hope all of you have a better representative than I did.

Edited July 29 by dennis simpson

[dennis simpson]

Yes, you an Bronco are right. I just left the DAV and was reminded why I didn't use them when I went from 30% to 60% on my IHD. My documentation and my own letter won that claim. Today the DAV tells me I shoudn't file for 100% on the IHD, because they may reduce me below the 60% I'm getting. I couldn't believe my ears. I had to stop him in his tracks. I told him there was no way the VA was going to reduce my percentage of disability, because the VA hospital records alone show a definite reduction of heart functioning from what even got me the sixty percent in the first place. Ischemic heart disease does not get better. It gets worse. And all you can do is adjust your lifestyle as it does.I had a lot of paper work that I wanted submitted with the claims and he acted as though it was a pain in the ass to make a pdf of everything. He was reluctant even with my initial claim's letter, which was the backbone of my reasoning for the claim. My medical file is probably 400 pages long and I know raters are not going to read it all, so I highlight certain aspects and related items to my claims for their convenience and to save them time. That research got me the 60% rating. I also had every ptsd segment, conversation and therapy session done thus far, so they wouldn't have to browse several hundred pages and maybe miss something important in their efforts to address my PTSD. Well supposedly he sent them all in with the claims,but to tell the truth, I really can't be sure. I am going to come alive on them if they held back one item I gave them for this claim. Two weeks of organizing, writing and preparing for this, and he didn't bother to read one sentence of anything I had with me. Kept saying he had another appointment and had to hurry. And that was after only fifteen minutes. His claim letter document of which he gave a copy of (kind of a receipt) was pathetic. I may not get the hundred percent on IHD. I have been prepared to expect this could happen. However, I won't be getting reduced, that's for sure! And it won't be because I didn't prepare properly. And the sleep apnea....well he didn't have time to talk about it. I left there frustrated as all get out, and will never use them again.  I can do this on my own, and if an appeal becomes necessary I can handle that as well. thye are filed and I will follow them on VA. GOV, as well as check what he truly did submit. I can still update more information if I need to as we go forward. I Hope all of you have a better representative than I did.