Jim,
I'm a vietnam vet and recently filed an ischemic claim with my VSO as I had an echocardiogram with an lvef at 39.1%. Started lisinopril at 5mg and went to 10mg just before another echo after 4 months. That echo came out good at 60.8%. Other problems with the lv didn't change. All my health care is with VA but no service connected disability yet. My question is-will VA likely test me further and which reading will they most consider for any compesation settlement and what's your guess on the settlement rate?
Appreciate your time-Thanks again
Reply:
My comments here are based on my career experience as a health care professional...I worked in cardiology and cardiovascular surgery for 35 years prior to my retirement. My skills and training started at Ft. Sam Houston when the Army trained me first as a combat medic and then as a surgical technician (91-D20). I have the military to thank for a rewarding career in health care.
The first thing you have to determine is why your LVEF is low.
The Left Ventricular Ejection Fraction (LVEF or EF) http://en.wikipedia.org/wiki/Ejection_fraction is a measurement of the efficiency of the main pumping chamber of your heart. Each time your heart beats, the left ventricle (LV) pumps fresh, oxygenated blood out to the rest of your body. The LV is a muscle. If it is damaged, it doesn't heal very well and can have scarring that will restrict how well it can pump. A "normal" EF is somewhere in the region of 60% or so. That figure repesents the amount of the volume of blood that the LV has ejected when it pumps.
When the ejection fraction (EF) falls below the norm, particularly when it falls below 50% or so, the patient will begin to experience symptoms of congestive heart failure (CHF) http://en.wikipedia.org/wiki/Heart_failure . CHF brings about fluid retention and the patient may feel shortness of breath (SOB) and swelling of the extremities due to the inability to pump enough blood through the kidneys to remove water.
The LV is often damaged by a heart attack. If the blood flow is interrupted by an artery becoming occluded or "clogged", then the muscle can die and the patient will suffer that degree of loss, depending on how severe the blockage is. That is what happens during ischemic heart disease (IHD) and that's what the VA will service connect for Vietnam veterans. IHD is also commonly called coronary artery disease (CAD) http://en.wikipedia.org/wiki/Coronary_artery_disease .
However, the LV can also be damaged in many other ways. The LV can be damaged by viral infections, hypertension (high blood pressure), disease of the valves of the heart, and a host of other things.
As you don't say anything about IHD or having had a heart attack, I have to think that you may have a low LVEF because of some reason other than IHD. If that's the case, you won't be eligible for the IHD benefit. If IHD can't be proven as the cause of the low LVEF, veterans won't be eligible for the IHD benefit.
As I said at the start of this message, the first thing you must determine is why you have a low LVEF. If it is because of IHD, then you may have a well grounded claim. If your doctors can't say with some confidence that the low LVEF is due to IHD, I have doubts that you'll have anything from VA but a denial of a service connected disability compensation benefit.
The LVEF isn't terribly accurate in many instances. It's a good guideline to show that medication is working...you've shown a significant improvement with the lisinopril http://en.wikipedia.org/wiki/Lisinopril and I'll assume that you probably feel better.
Yes, you will be ordered to have an examination by VA. Whether it's needed or not, VA will always default to a C & P examination to seek an opinion usually favorable to VA and denying your claim.
If your heart disease, from any cause, is service connected, I'd take a guess that the rating will be 10%. The Schedule For Rating Disabilities http://www.benefits.va.gov/warms/bookc.asp doesn't address an EF of greater than 50%. The schedule reverts to cardiac METs http://en.wikipedia.org/wiki/Metabolic_equivalent and symptoms at that point. Whether or not VA should use the reading that is off of your medication or on the medication is often the topic of disagreement. VA will almost always default to the reading that is taken while you're on medication. If you're tolerating the medication and you have a significant improvement, VA will argue that the condition isn't disabling (and deserving of a rating) even if it is service connected.
The bottom line is that you should focus now on proving that you have IHD. Once the diagnosis of IHD is established, then you may go on to seeking a rating that is consistent with the schedule. From what you tell me, that would be 10%.