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 And definitely outdated.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]

The DAV and VSO's get compensated "per POA".  So, the less work they can do to obtain and service a POA, the more money they make.  Oh, you say DAV is non profit?  Its not my fault the DAV/VFW squander buckets of money on beer halls.  

 

[dennis simpson]

This is an update. After filing my claim with the DVA and being told it would be in that very day, I waited five days to see it finally post. And the submittal day was different than the day I talked with the DAV. All well and good right?

I could have lived with that being that it did get filed before my intent to file expired. But here's the kicker! Not on document that I gave the DAV to submit with the claim got uploaded. Not one! I had seven documents, and one of those was 4 pages long, while another was 30 pages long. The 30 page document was a chronologically dated document showing all my reports concerning my PTSD which have been comprised so far by the VA. It was to make it easier for the VA to see the extent of my sessions thus far and their findings, and for the VA to use in searching out criteria within my medical file which can be spread out over months. The 4 page document was the letter you see at the first of this thread which is the very basis of why I am filing for an increase on my ischemic heart disease. My letter didn't even get submitted. Well needless to say, every document has now been uploaded to the VA by me and they immediately showed up as evidence submitted. I advise anyone when dealing with a POA Agencies which are supposed to help us veterans, to just do your own work. How they can effect our lives is not a priority to the ones I have encountered. Disillusioned, but not defeated.