The Nehmer claim went back to July 1988. I was found to be rated 30% after evidence of IHD was submitted (coded) at that time during a C&P for PTSD.
Then I was rated 100% in 1993 to 1994 for Coronary Bypass surgery x5. Then it went back down to 30%.
Then I was rated 60% from August 2010 when they did the C&P for my recent AO claim.
I have previously submitted service connection for IHD approx. 4 times.
Now the interesting thing is the evidence they used. It is all listed but it is contradictory, and found in the VA favor instead of the veteran.
For the initial 1988 rating of thirty percent it states. "Evidence shows you suffered a myocardial infarction in April 1988, this is evidence in a VA exam submitted in July 1988. This is the initial claim date for the purposes of Nehmer". etc. etc. Now in the rating portion it says: "While evidence of a heart condition is shown in a VA Exam done in July 1988, a myocardial infarction was ruled out. A rating of 30% is assigned due to moderate reoccurring episodes of angina pectoris, as shown in the evidence".
Now in the Rating for 100% in 1993 it says " Evidence shows you we admitted for possible myocardial infarction. This was ruled out by Dr. *******. However, an angioplasty was performed at this time, and evidence of post myocardial infarction was found." and "It was found in evidence that you had a CABG x5 performed in April of 1993. This qualifies you for temporary 100% for one year and one month from the date of surgery.
Then the rating dropped back to 30%. "You have been assigned a rating of 30% from June 1994.........There is no evidence of cardiac abnormality. A stress test performed in 1990 shows no cardiac symptoms and was normal ......You denied any shortness of breath, chest pain on exertion or dyspnea, a finding of 30% is appropriate"....
The rating for 60%..."Evidence shows a history of heart disease abnormalities and severe unstable angina pectoris. IN a VA exam performed in August 2010 Dr. **** found evidence of IHD. An electrocardiogram found wave abnormalities, and an ejectionfraction of 45. METs are estimated at 4. Evidence also show a valve insuffiency due to post myocardial infarction, and previous CABG surgery. Patient is currently medically managed and it at a maximum for this therapy".
0% SC for Bypass Scar on Chest, (didn't include the scar from my groin to my ankle where they took the vein out to use in my heart (which would bring it to 10% for SC'ed scar)
SMC S from 1993 to 1994, and from August 2010 to
O.k so now that is out of the way. My perspective. I have been on SSD since my first heart attack in 1988, I have received multiple checks on this since I was first rated with SSD. Each time i was found unemployable solely due to my heart condition. I have been on medications since 1988 that I can never stop or my heart will stop beating. The VA have based some of the ratings on estimated ejection fractions while the actual tests have a much lower ejection fraction that was never taken into consideration. I have not been allowed to take a stress test by my cardiologist for nearly ten years because of the liability issue. I have been told never to take one because it may kill me. I take around 10 medications just to keep my heart going and have since 1988. I don't understand why I received a 30% rating. (One of my doctor in the evidence they reviewed stated the the time that I was "the worst case of Coronary Artery Disease I have ever had the misfortune to treat. This patient is a candidate for heart transplant". My heart has not gotten better and it has not gotten worse. I don't understand how I could be considered unable to work and completely disabled by the SSD and VA think I have a little angina? Very weird. And apparently I had a heart attack then I didn't then I did, (in 1988). But I actually have had three separate ones. I have had multiplle angioplastys until my CABG x5 and I am not able to be treated surgically since 1993 when I had my surgery. Yes my angina went down after the CABG because I could no longer do anything after that and my level of activity went down drastically to the point of not being able to exercise. So using subjective statements about how I felt is not very good evidence (purely subjective and circumstantial).
Does any know how I should approach this. Should I do a NOD or DRO review? We are talking about 30 years of retro SMC S (Also rated PTSD 100% from 1988) if this goes through so it is definitely worth my time, I just don't know the best way to approach this..... I currently have another claim in, should we wait for this to be decided? (Could take too long though).....
Anyway if you have any input let me know! :-)
(Edited for spelling errors)
Edited by hawkfire27, 28 September 2011 - 06:13 PM.