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Ischemic Heart Disease

seeking guidance

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#1 georgiapapa

 
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Posted 15 September 2012 - 04:17 AM

Up until a couple of days ago, I never thought I had any heart problems other than a mitral valve prolapse. Earlier this week I had been to my private primary care doctor for a cough and intermittent chest pain. I had undergone a stress test and an echo of my heart in July by my cardiologist and was told everything looked fine so I did not think my recent chest pains were caused by heart problems. My pcp did a chest x-ray and EKG and said it wasn't my heart and he diagnosed me with pleurisy and bronchitis.

Wednesday night of this week I started experiencing severe chest pains and my wife called 911. I took an ambulance trip to the emergency room. After running some blood tests, I was told my cardiac enzymes were elevated and the cardiologist performed a heart cath. After the heart cath, the cardiologist informed me she had placed two stents in my heart due to a 99% blockage in one part of my LCD and 80% blockage in another part of my LCD. I believe the LCD she was referring to is the left anterior descending artery of my heart. My cardiologist advised that I did not have a heart attack but she said I was on the verge of a serious heart attack prior to placement of the stents. I am currently in the heart unit of my local hospital but I hope to be discharged this morning.

I am totally lost as to what I need to do in regards to a claim for AO related IHD. I am a boots on the ground Vietnam veteran so I think I would qualify under the AO presumptive policy. Any guidance anyone can give as to what is needed and how to proceed at this point in time would be appreciated. Even if I would be rated at 0% service connected (since I did not experience a heart attack), at least this would make benefits available to my wife in the event I later had a fatal heart attack. Your thoughts ans suggestions would be appreciated.

Georgiapapa...

#2 Berta

 
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Posted 15 September 2012 - 05:32 AM

The VA's definition of IHD and the rating criteria for it under 7005 are here:

http://www.hadit.com...definition-and/

By all means ,file the AO claim for IHD.

This concerns me:

“I had undergone a stress test and an echo of my heart in July by my cardiologist and was told everything looked fine so I did not think my recent chest pains were caused by heart problems. “

Have you requested a copy of the ECHO results?

“After the heart cath, the cardiologist informed me she had placed two stents in my heart due to a 99% blockage in one part of my LCD and 80% blockage in another part of my LCD. I believe the LCD she was referring to is the left anterior descending artery of my heart.”

I assume this was not the cardio doc who said everything “looked fine” in July.

“My pcp did a chest x-ray and EKG and said it wasn't my heart and he diagnosed me with pleurisy and bronchitis. “

"was told everything looked fine"

A remark like that, by the head VA cardiologist of a NY VAMC, after he had read my husband's ECHO, and I believed what he said, was supported by 2 more years of documented negligent health care regarding my husband's fatal heart disease when I FTCAed the VA for malpractice.

I am not a doctor but after I studied the ECHO and his EKGS and every cardio text I could in 2 or 3 medical libraries on NY (this was pre internet), I knew that his EKGs and ECHO revealed significant heart disease that VA failed to treat.

Wrongful death award 1998, Agent Orange IHD death Jan 2012.




Since the VA,for the IHD claim, will be going over any EKGs, ECHOs, X rays of heart, it would be a good idea for you to obtain your medical records (VA will need them all too) from the VA as well as any private doctors.


Something seems wrong here.

An ECHO can reveal potential blockages as it is a measurement of heart chambers.

Significant blockages do not happen overnight.

I also used a VA Heart X ray that a VA cardio read and said no hypertrophy.

I proved that X ray did reveal significant hypertrophy.

When you get a copy of the Doppler ECHO ,it will reveal the medical state that your heart was in ,this past July.

I am absolutely baffled as to how, if the ECHO in fact revealed no occlusions, why the occlusions occurred so fast that you needed stents by this past Wednesday.

VA will need those private medical records too.

#3 Berta

 
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Posted 15 September 2012 - 06:31 AM

To add, this is the form that many AO IHD vets, with private cardio care, gave to their doctors to fill out and then was submitted to VA in support of their claims.


http://www.vba.va.go...0960A-1-ARE.pdf

#4 stillhere

 
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Posted 15 September 2012 - 07:47 AM

GP&Berta,

I wish I had a dime for every time I hear or read bout a patient having a good ekg and then later to have had either a heart attack or as in GP's case emergency stents placed. The EKG's do not show squat from what I think!

The patient knows his/her body better than anyone if you don't feel good and you are a "boots on ground" vet I would go and get a cath or at least and echo. A good cardio doc can usually catch it on a echo if not and they see something a cath for sure. It is always better to have these things looked BEFORE having to rush to an ER and have it done!

I had the chest pains over an entire weekend and did not go till Monday to my PC and ended up in ER and a couple of stents my first time, but by not going sooner I actually had 2 heart attacks and damaged my heart by 40%!


Case in point over the 2 years leading up to that weekend I had been to PC and VA and ER over 5-6 times and everyone kept giving me a EKG and blood work nothing showed. But I know my body and my chest pain was real! They gave a feeling that there was nothing wrong but indigestion and I tried to believe them??

Guess next time I will believe my body!

By the way I am 100% now for my heart and have trouble even walking up stairs and really can't do many of the things I loved to do, working around the house and gardening. Oh well I am stillhere!

#5 georgiapapa

 
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Posted 15 September 2012 - 07:48 AM

Berta,

I have been going to this cardiologist for over twenty years for mitral valve prolapse and hypertension. Over that period of time, my cardiologist has performed different tests on me including stress test on a treadmill with IV, stress test sitting with IV, echo of heart, ECG, doppler procedures, chest x-rays, etc. The IVs used during the stress tests included some type of nuclear medicine. I have never been told I had a problem with blocked arteries prior to this week.

I am going to ask for copies of all of my medical records at my cardiologist's office for as far back as they are available.

The notification I received from the cardiologist's office regarding the results of my July cardio tests actually came from my cardiologist's PA via telephone. I had an appointment previously scheduled with my cardiologist for September 20, 2012 during which she was going to go over my July test results as well as the results of a Doppler procedure of my legs I had in August.

I am waiting for my cardiologist to come and discharge me. I will ask why the previous cardio tests from July did not reveal the blockages. I will let you know what she tells me.

Georgiapapa...

#6 georgiapapa

 
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Posted 15 September 2012 - 08:00 AM

Still here,

Believe me I have learned my lesson. In the future I will seek emergency attention anytime I start having the chest pains.

As I stated in my original message, I did have a cath this week which revealed my blockages. I don't think I will ever trust an ECG or an echo in the future. The cath seems to be the most reliable test to detect blockages based on what I have been told so far.

Thanks for your input.

Georgiapapa...

#7 jbasser

 
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Posted 15 September 2012 - 10:17 AM

You are correct. Stress tests and echos are only guess work.
Heart cath is the measure for heart disease.

Your Heart disease is related to AO presumptively and you will have little resistance from VA.

J

#8 SP4RVN1971

 
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Posted 15 September 2012 - 11:13 AM

The first of this last July, I started having chest pains. The pain was constantly moving around from the front to my back and into neck. It was't a stronge pain ,but I knew that it was the on coming of a blockage. Since this was not my first rodeo, I called my heart doc. and we did the normal EKG, Stress test, all the tests. My heart look great, the pain continued and got worst, so I went to the local Pharmacy and told them that my Heart doc want me to have Nitro. They gave a small bottle and when I had my next attack, i knew! Since I had two stents already, I knew what to look for and went to my Heart hospital. Sure enough 85 % blockage.

Sometimes you got to lisen to your body!

I know at least one friend that did not, God rest this soul!!

#9 Berta

 
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Posted 15 September 2012 - 01:59 PM

I certainly defer to these excellent comments but I don't understand why the VA puts so much weight on the EKGs,METS and ECHO tests for these heart disease claims,if those findings are not really accurate and no cath was done.



I lost a good friend last year to a sudden heart attack.All her friends were only aware of her very high cholesterol ,which was being medicated . Per her relatives, an autopsy revealed death caused by cardio blockages due to plaque from cholesterol.
She had very poor eating habits and was not a veteran. I guess a prior ECHO or EKG would not have saved her.

VA even depends of the EF ,ejection fraction percent, too in their rating criteria but apparently that is also just a guess.

Well put SPARVN1971:
"Sometimes you got to lisen to your body!"

And i never leave my doc's office without copies of any test results.My last LDL and the other stuff for cholesterol was 'perfect' she said (I had the CBC and the ast /alt test too) but I asked her exactly what she meant ,as those test results are often confusing for me to comprehend.

I checked the results out at a good web site too.

I do believe that most doctors don't mind being asked questions at all.

" I will ask why the previous cardio tests from July did not reveal the blockages. I will let you know what she tells me."

I am sure there is a very sound reason and others have explained that quite well to me here, but ,since this is an AO claim, and if there is any potential at all for being a Footnote One Nehmer claim, which I dont believe it would be, still, I guess the footnote one AO rating would have been "0" % SC IHD up to the date of the stent placements.

Edited by Berta, 15 September 2012 - 02:02 PM.


#10 Chuck75

 
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Posted 15 September 2012 - 03:23 PM

Up until a couple of days ago, I never thought I had any heart problems other than a mitral valve prolapse. Earlier this week I had been to my private primary care doctor for a cough and intermittent chest pain. I had undergone a stress test and an echo of my heart in July by my cardiologist and was told everything looked fine so I did not think my recent chest pains were caused by heart problems. My pcp did a chest x-ray and EKG and said it wasn't my heart and he diagnosed me with pleurisy and bronchitis.

EKG's may not show anything until significant damage exists. I've had 24 hour "halter tests" that showed a "normal" result. (This is years after open heart surgery, an LVEF of about 30% at the time, and long standing records showing "Bradycardia".)
On the other hand, cath based tests showed damage, based upon internal heart pressure waveforms, along with blockages.

I'd think that the PCP screwed up, or relied on a faulty diagnosis. Pleurisy symptoms can be a sign of heart distress and pending failure.
Infections and the resultant immune reactions can cause types of "swelling" or irritation that increases the chances of a heart attack.

Cutting to the chase, you certainly should file for A/O presumptive heart disease. You are/were hospitalized, for heart related problems. The stint implantation counts, and you might very well meet at least the temporary scheduler requirements for 100%. Down the road a bit, further testing, etc. may show the extent of heart damage, and be evidence for a permanent rating.
You may not have experienced (to your knowledge) a heart attack. On the other hand, the first attack or two may be "silent", with the only obvious symptoms something like fatigue.
"cardiac enzymes were elevated" is an indication of a "heart attack"(even a silent one) and significant evidence that heart damage is possible. The VA's definition of IHD is not just confined to heart damage, and extends to the arteries that feed the heart. If nothing else the "preventive" drugs that you will be taking are not cheap, and getting things service connected reduces your drug costs considerably.

Angina often feels like indigestion, even though it might just "go away" with a drink of cold water. There are other common less than obvious symptoms that are often only considered significant in retrospect..


Wednesday night of this week I started experiencing severe chest pains and my wife called 911. I took an ambulance trip to the emergency room. After running some blood tests, I was told my cardiac enzymes were elevated and the cardiologist performed a heart cath. After the heart cath, the cardiologist informed me she had placed two stents in my heart due to a 99% blockage in one part of my LCD and 80% blockage in another part of my LCD. I believe the LCD she was referring to is the left anterior descending artery of my heart. My cardiologist advised that I did not have a heart attack but she said I was on the verge of a serious heart attack prior to placement of the stents. I am currently in the heart unit of my local hospital but I hope to be discharged this morning.

I am totally lost as to what I need to do in regards to a claim for AO related IHD. I am a boots on the ground Vietnam veteran so I think I would qualify under the AO presumptive policy. Any guidance anyone can give as to what is needed and how to proceed at this point in time would be appreciated. Even if I would be rated at 0% service connected (since I did not experience a heart attack), at least this would make benefits available to my wife in the event I later had a fatal heart attack. Your thoughts ans suggestions would be appreciated.

Georgiapapa...



#11 Chuck75

 
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Posted 15 September 2012 - 03:37 PM

"quote name='Berta'
I certainly defer to these excellent comments but I don't understand why the VA puts so much weight on the EKGs,METS and ECHO tests for these heart disease claims,if those findings are not really accurate and no cath was done.

I don't understand why the VA puts so much weight on the EKGs,METS and ECHO tests for these heart disease claims."

They cost less, may favor the VA attitude of minimizing claims, and can be more easily done by VA facilities that do not have serious heart related capability.
(My local VAMC is a case in point. The "Cardiologist" does not seem to be board certified, and the backup regional heart center is half the distance from me, in the opposite direction.
I also doubt that the local VAMC is qualified to administer certain drugs (if they even have them) that can, in emergency, dissolve blockages. TCB is one of the drugs.

Edited by Chuck75, 15 September 2012 - 03:38 PM.


#12 georgiapapa

 
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Posted 15 September 2012 - 04:08 PM

Berta,

I talked with my cardiologist and asked why there was no indication of blockages during my diagnostic tests in July. She seemed truly concerned and said she was going to look into the matter because there should have been some red flags. Apparently, her cardiology group has someone who reviews the tests for the cardiologists and prepares reports of their findings for them. I am not sure of the professional background of the person performing the reviews.

I advised my cardiologist that I was concerned about the reliability of the echo and ECG versus the cath procedure. She told me that an ECG and echo have an important role in diagnosing cardiac problems but are not as reliable as other diagnostic tests in situations such as mine. My cardiologist characterized my blocked artery symptoms as "atypical" because the only symptom I experienced on the night I went to the emergency room was a sharp stabbing pain in the center of my chest. I did not have any pain radiating to other parts of my body, no profuse sweating, no crushing feeling in the center of my chest, etc. Due to my lack of the standard symptoms, my cardiologist instructed me to contact her immediately if I experience any severe chest pains in the future and she will call the hospital and schedule me for a cath procedure upon my arrival in the emergency room.

Georgiapapa...

#13 Berta

 
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Posted 16 September 2012 - 05:53 AM

There are many markers for potential heart disease.

High Triglyceride levels , done as part of comprehensive CBC blood work, for example,




http://circ.ahajourn...0?view=full.pdf


Here is another list of some potential markers .It is from Wikipedia -notthe best medical source)but the citations look OK:

http://en.wikipedia....ac_marker#Types

I mentioned my Cholesterol lab tests here because the LDL marker is within this list.

On my lab results it says “< (less than) 130 -Low Risk of coronary heart disease”
My results were 105 LDL.

As you all know I had to prove my husband had heart disease, never diagnosed or treated by VA for 6 years.
Although I had proof of his initial heart attack (while employed at VA) I also did extensive research on his blood work readings too, and they alone (even without EKGs or ECHO) held some red flags.
I also had to prove he had undiagnosed and untreated DMII, and in that case as well his CBC values indicated markers for diabetes.

But 'markers' for any disability is just that. They are not the best diagnostic tool but they can be the best indication that a doctor needs to watch out for any significant value changes in the results and consider what they potentially might indicate. They can show evidence of a metabolic syndrome (I used my research for that for both above claims I had along with the medical records indicating this syndrome in certain blood values) and also indicate coronary syndrome.

The GPBB test on the linked list for example is a good indicator of a cardiac event, even if the trditional symptoms are missing.
:

“GP-BB is one of the "new cardiac markers" which are discussed to improve early diagnosis in acute coronary syndrome. A rapid rise in blood levels can be seen in myocardial infarction and unstable angina. GP-BB elevated 1–3 hours after process of ischemia. “

In my husband's case, the ER certificate stated "diaphoretic",after a brief loss of consciousness,but he had no chest pain.
The EKG VA ignored revealed possible ischemia and an obvious change in the lead pattern from his last EKG.
The word "diaphoretic", a symptom the doctors ignored, was critical to that claim ( 1151/FTCA)


Chuck said it all: He gave 3 solid reasons why veterans do not always get the best testing and therefore,don't get the benefit of early intervention, and,best of all sometimes , good preventive care.

Georgiapapa -I sure agree with this too....

“Apparently, her cardiology group has someone who reviews the tests for the cardiologists and prepares reports of their findings for them. I am not sure of the professional background of the person performing the reviews. “

I witnessed that many times when my husband was a VA patient.But it involved doctors reviewing findings incorrectly.

It doesn't surprise me that your cardio doctor is concerned. Unfortunately anyone with the metabolic syndrome evident in their blood work , (cholesterol values and triglycerides are in a High range) could have heart disease beginning as secondary to DMII, a metabolic disorder. Some DMII patients with CAD are even susceptible to Sudden Death Syndrome and/or heart attack events with minimal or no chest pain.

I am not a doctor and I do believe the VA as well as non VA doctors save lives very single day.

But as proactive as we must be over our claims, we also need to be proactive with understanding our medical care.

Edited by Berta, 16 September 2012 - 05:57 AM.


#14 stillhere

 
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Posted 16 September 2012 - 10:26 AM

Berta just hit on something we all with high choelesteral and just about anyone. Get a copy of your blood work when you have it and do what I have been doing for a while. Whenever I go for an appointment with my PCP I have her bring up my latest blood work and go over it with her. That way I understand it better and any kind of lows or highs can be addressed.

My advise to you since you have just had an event is to get with your doctor and look at the blood work you had done before and the one you had done after.See if there is anything there A. you need to keep an eye on and B. things that my have been missed so you can be aware of those too.

Good luck to you and remember always listen to your body especially now that you are aware you have a problem!


Stillhere

Edited by stillhere, 16 September 2012 - 10:31 AM.


#15 SP4RVN1971

 
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Posted 16 September 2012 - 11:23 AM

Berta,

I talked with my cardiologist and asked why there was no indication of blockages during my diagnostic tests in July. She seemed truly concerned and said she was going to look into the matter because there should have been some red flags. Apparently, her cardiology group has someone who reviews the tests for the cardiologists and prepares reports of their findings for them. I am not sure of the professional background of the person performing the reviews.

I advised my cardiologist that I was concerned about the reliability of the echo and ECG versus the cath procedure. She told me that an ECG and echo have an important role in diagnosing cardiac problems but are not as reliable as other diagnostic tests in situations such as mine. My cardiologist characterized my blocked artery symptoms as "atypical" because the only symptom I experienced on the night I went to the emergency room was a sharp stabbing pain in the center of my chest. I did not have any pain radiating to other parts of my body, no profuse sweating, no crushing feeling in the center of my chest, etc. Due to my lack of the standard symptoms, my cardiologist instructed me to contact her immediately if I experience any severe chest pains in the future and she will call the hospital and schedule me for a cath procedure upon my arrival in the emergency room.

Georgiapapa...


Georgiapapa, My conditions is simular to your's. Most of the time in the day time. if I was at rest my chest would start to have sharp pain in the center of my chest. If I was moving around It was less. At night time in the mid of the night it would increase. Of course I have Hot Flashes from the cancer medicine, so it is hard to tell about sweating??? The EKG's mostly - only work if you have heart damage and as long you are getting some blood to that part of your heart like in my case 85% bockage the EKG won't show a problem.

#16 georgiapapa

 
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Posted 16 September 2012 - 11:30 AM

My thanks to all of you for your informative replies.

I need some additional guidance from all of you in regards to filing my claim for AO IHD considering the fact that I have a current claim pending for AO Multiple Myeloma and Peripheral Neuropathy secondary to my Multiple Myeloma. I had my C & P for MM and PN on September 12th. Since I am past the C & P process, I do not want to do anything to delay my current claim but I also want to establish the earliest possible effective date on my IHD claim.

I planned to ask my cardiologist to complete a DBQ during my follow up visit with her on September 20th.
I am also considering filing my AO IHD claim through the fast track process.

Question: Do you think filing my AO IHD claim before resolution of my MM & PN claim will delay my claim for MM & PN?

Question: If you believe it may delay my claim, how do I protect myself as to the earliest effective date for my AO IHD claim?

Question: How is the earliest effective date established in an IHD claim? (Is it based on the date claim received, date symptoms recorded in medical records, date my stents were installed or what?)

Question: As to the fast track process, are there any drawbacks to using this process?

Question: If I use the fast track process, how is the DBQ submitted?

All info provided is sincerely appreciated.

Georgiapapa...

#17 SP4RVN1971

 
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Posted 16 September 2012 - 11:49 AM

Georgiapapa,

Back in 04/2010 I filed for the AO for PC, DMII only.

VA had seem from medical records that I had IHD and at 12/2010 I got 10% for secondary to DMII.

On 04/2011 I got compensated for AO for PC, DMII, and long with PN in both legs secondary to DMII and Lypmh Node cancer

The answer I think is to file for the IHD, because you will probably get some form of compensation earlier while the other conditions grind

thru the VA machine.

Later I got all the other conditions on 12/2011 and P&T 100% on 01/2012

Edited by SP4RVN1971, 16 September 2012 - 11:51 AM.


#18 georgiapapa

 
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Posted 18 September 2012 - 10:48 AM

Berta and others,

Today I obtained copies of some of my medical records from my cardiologist's office including the records for my July 2012 diagnostic tests and September 2012 records of my recent heart cath and stent placement. I have an appointment this Thursday September 20th with my cardiologist where I will have a lot of questions. Below is some of the comments found in the various reports:

July 10, 2012 Reports:

MYOCARDIAL SCAN (Lexican/Thalium stress test) "There are no areas of ischemia or scar tissue seen." IMPRESSION: "Normal myocardial scan. No change from the prior exam of 11/09/10."
EJECTION FRACTION: "The ejection fraction is calculated at 74%."
LEFT VENTRICULAR WALL MOTION: "Left ventricular wall contractility is noted to be normal with no areas of hypokinesis or akinesis. There is no paradoxical wall motion seen to suggest left ventricular wall aneurysm.."
IMPRESSION: "Normal left ventricular wall motion."
NOTE: This report is signed by a local radiologist.

LEXISCAN WORKSHEET (Screening for IHD) CLINICAL INFORMATION: "Patient with DOE/Fatigue and history of hypertension, hyperlipidemia." INTERPRETATION: "Resting electrocardiogram reveals sinus bradycardia at 51 bpm with a resting blood pressure of 128/64 mmHg. The patient received IV Lexiscan per protocol. Maximum increase in heart rate to approximately 100 bpm. There was quite a bit of artifact during the completion of the Lexiscan. Minimum drop in systolic blood pressure was to 90/60 mmHg. No significant ST changes were noted above the baseline abnormality when adjusting for the artifact intervening. No chest pain was experienced." CONCLUSION: "Nondiagnostic electrocardiographic response to IV Lexiscan." "Pharmacologic effect achieved." "Isotope study to follow." NOTE: This worksheet is signed by my cardiologist.

ECHOCARDIOGRAM - INDICATION: " sob, cp, htn, dizziness." LEFT VENTRICULAR STRUCTURE: "Normal in size and shape." LEFT VENTRICULAR FUNCTION: "Ejection fraction is estimated at 60-65%. No regional wall motion abnormalities were noted." LV DIASTOLIC FUNCTION: "Abnormal diastolic function with impaired relaxation." RV STRUCTURE & FUNCTION: "Size and function are normal." LA STRUCTURE: "Left atrium is mildly enlarged." RA STRUCTURE: "Right atrium is mildly enlarged." INTERATRIAL SEPTUM STRUCTURE: "Not well visualized." MV STRUCTURE & FUNCTION: "Mitral valve is mildly thickened." "Mild regurgitation." AV STRUCTURE & FUNCTION: "Aortic Valve is a tri-leaflet structure." "Aortic valve leaflets are thickened." TV STRUCTURE & FUNCTION: "Triscupid valve is structurally normal." "Mild tricuspid regurgitation." "Estimated right ventricular systolic pressure is 32mmHg." PV STRUCTURE & FUNCTION: "Pulmonic valve is structurally normally without stenosis or regurgitation." AORTA STRUCTURE: "Aortic root is normal." PERICARDIUM: "Percardium is normal." MISC. ITEMS: "Inferior vena cava is not well visualized." CONCLUSIONS: "Technically good, valvular sclerosis, mild triscupid and mitral regurgitation, diastolic dysfunction, biatrial enlargement." NOTE: This report is signed by my cardiologist.

September 13-15, 2012 Reports Regarding Placement of Stents:

PROCEDURE: "Left heart catheterization, selective coronary angiography, left ventriculogram, drug-eluting stent x 2 to the LAD, intercoronary nitroglycerin complex." ANGIOGRAPHY: "Left main coronary arter has ostial 20% disease." "Left anterior descending artery has a medially located moderate diagonal branch that has ostial 20% disease." "At this level the LAD has a very complex lesion that is 95-99% stenosed with what appears to be some thrombus." "The lesion is approximately 18-19 mm in length." "There is then a second diagnonal that is small to moderate size with a more tubular eccentric 70-80% stenoses in the distal LAD that is approximately 11 mm in size." "There is TIMI 2 flow." The circumflex is a large dominant system." There is a small first and second marginal." There is 20% luminal irregularities in the AV groove." There is a large distal posterolateral marginal and then there is 40% to 50% disease in the proximal segment of a large PDA>" "The right coronary artery is small and dominal." "There is proximal 20% disease." LEFT VENTRICULOGRAM: "Left ventriculogram in the RAO projection." "Three aortic valve cusps are present." Left ventricular systolic function is normal." "Ejection fraction estimated at 55%." "The apex is sluggish with some jypokinesis."
CONCLUSION: "Three-vessel coronary artery disease is significant in the LAD distribution representing the culprit." "Successful drug-eluting stent to proximal portion of distal LAD and mid LAD restoring TIMI 3 flow." "Preserved left ventricular systolic function with segmental abnormality."
NOTE: This report is signed by my cardiologist.

PATIENT HISTORY: "Hypertension, mitral valve prolapse, dyslipidemia, chronic fatigue, obstructive sleep apnea with CPAP, elevated cholesterol, elevated triglycerides, elevated LFTs, elevated bilirubin, plasma cell dyscrasia, GERD, Gastric polyps, iron deficiency anemia, testosterone deficiency, colon polyps.


Question: If the VA relies on METS & ejection fraction so much in their rating criteria, is there any chance I will be rated above 0% with my latest ejection fraction at 55%?

I will ask my cardiologist on Thursday about a METS score.

Please give me your thoughts and input as to what my reports indicate, especially the reports from September 2012 and your thoughts on a possible disability rating for IHD.

Thanks...Georgiapapa

#19 Berta

 
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Posted 18 September 2012 - 12:43 PM

This is the VA Schedule ofRatings criteria for ID (Diagnostic code 7005)

7005 Arteriosclerotic heart disease (Coronary artery disease):



With documented coronary artery disease resulting in:



Chronic congestive heart failure, or; workload of 3 METs or less results

in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular

dysfunction with an ejection fraction of less than 30 percent.......................... 100



More than one episode of acute congestive heart failure in the past year,

or; workload of greater than 3 METs but not greater than 5 METs

results in dyspnea, fatigue, angina, dizziness, or syncope, or; left

ventricular dysfunction with an ejection fraction of 30 to 50 percent............... 60



Workload of greater than 5 METs but not greater than 7 METs results

in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of

cardiac hypertrophy or dilatation on electrocardiogram,

echocardiogram, or X-ray................................................................................... 30



Workload of greater than 7 METs but not greater than 10 METs results

in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous

medication required............................................................................................ 10




"At this level the LAD has a very complex lesion that is 95-99% stenosed with what appears to be some thrombus."
I assume that due to this complex lesion, it probably would not have showed up on the ECHO.

Your documents here reveal some key points.

The 'some thrombus ' entry for example.

Thrombosis is usually what we call a clot.

The ECHO my husband had specifically stated 'no clots found in this study' as the thrombotic clot from his heart had already caused him to have a major brainstroke weeks prior to the ECHO.I assumed that tyour ECHO could have ruled out more thrombosis. Or revealed 'some thrombosis' but it didnt.

Your med recs here revealed something else Very significant.

Not only are your cholesterol levels high and I assume they are being medicated, but you listed that you have anemia.

Have you been diagnosed with thrombotic thrombocytopenic purura,sometimes called thrombocytopenia?

There is also association between Iron deficiency anemia and thrombocytopenia.




These meds can also contribute to formation of thrombosis:ticlopidine, clopidogrel, cyclosporine A, chemotherapy, and hormone replacement therapy and estrogens.

I am not a doctor but know more about heart disease then I ever dreamed I would know.

Many of us here know specific disabilities in and out.

I am only opining on what I read and I see other points in these med recs ,such as the different ejection fractions, and this makes it difficult to know what one the VA will interpret, probably they will use the most recent EF estimate.

I certainly don't see this as any Sec 1151 negligence issue,because your doctor is willing to find the cause of your problems.

But there are definitely things here that concern me and call for preventive measures, in my lay non medical opinion.

Measures which are probably being taken by your doctor already.

Are these cardiologists who signed the reports the same person?

I cant tell yet -are these VA cardiologists or private docs?

The test results don't seem to read like the VA's way of writing a narrative for these types of medical tests, and this is why I ask.

I regret I am asking something else that you probably already answered here.

Have you been diagnosed with Diabetes too or has that been ruled out?

Did you have chemo for the myeloma? It could be a factor in the evidence of some thrombosis, whoch I assume was the prime cause of the difficulties that brought you to the ER.

Why does this not state your multiple myeloma diagnosis?

"PATIENT HISTORY: "Hypertension, mitral valve prolapse, dyslipidemia, chronic fatigue, obstructive sleep apnea with CPAP, elevated cholesterol, elevated triglycerides, elevated LFTs, elevated bilirubin, plasma cell dyscrasia, GERD, Gastric polyps, iron deficiency anemia, testosterone deficiency, colon polyps."

These are all things your doctor will consider I am sure.

#20 georgiapapa

 
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Posted 18 September 2012 - 02:21 PM

Berta,

Thanks for your detailed reply. In response to your questions, the following is offered:

I have not been diagnosed with thrombotic thrombocytopenia purura or thrombocytopenia.

I have been taking medication for several years for elevated cholesterol and triglycerides. I have taken medication at times for iron deficient anemia but it has been several months since I needed the medication.

I do not have diabetes.

The cardiologist who signed the reports is the same person who performed the tests in July and installed my stents in September.

My cardiologist is a private doctor. I have not received any treatment or exams at the VA for heart problems except for a ECG during my annual VA physical in March 2012 which was normal.

I have not received any chemo for my myeloma.

Multiple Myeloma is a "plasma cell dyscrasia" and plasma cell dyscrasia is listed in my patient history. My cardiologist is aware of my multiple myeloma diagnosis.

The information you provided to me will add to the questions I have for my cardiologist on Thursday. Again, thanks for taking the time to give such a detailed response.

Georgiapapa...

#21 Berta

 
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Posted 18 September 2012 - 02:43 PM

I forgot to add:

one of the tests stated:

"Isotope study to follow”

I assume this will be a PET scan-

positron emission tomography- and this test will certainly give more info to your doctor.

I do feel you are getting good care and assumed it was not from the VA but I wasn't sure.

The PET test is only a little more time consuming than a CT scan but similar to it.

You might get a low IHD rating but that is a GOOD thing because so many Vietnam vets are dying from heart disease an you do have other AO claims pending.

Has any doctor associated the PN directly to the Myeloma with a full medical rational? If not maybe your cardio doctor would provide to you,if needed, an IMO for that claim , and hopefully at a reasonable fee.

#22 stillhere

 
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Posted 18 September 2012 - 02:57 PM

Georgia, My injection is 42% last time I was check. To me it looks like your dr is doing a great job.

This need for stents and the blockages with the chest pain will need to be rationalized.

If your were to get rated for this unless your mets are out of wack I would say 0-10%

Your condition and the reports are very confusing to me.

My reports on all medical tests point directly to my condition and all check and balance. Yours don't and I for one wonder why??

But hey that is just me your dr really does seem to have a handle on it.

Stillhere

#23 georgiapapa

 
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Posted 18 September 2012 - 04:39 PM

Berta,

I had a full body PET scan in April at the Myeloma Institute in Little Rock, Arkansas. I have had 4 or 5 PET scans since September 2010 and about the same number of full body MRIs. I am going to look back at the PET scan and MRI reports to see if anything was mentioned about my heart. I do not recall anything being mentioned about my heart. The doctors were more focused on finding lesions or tumors in my bones but I would think the radiologists or technicians who performed the tests would have mentioned it if anything unusual with my heart was detected.

I agree it's better to have a heart with minor problems and a low disability rating than a heart with major problems and a high disability rating. I will gladly take a 0% rating and no more heart problems than a 100% rating and increasing heart problems.

In regards to my PN association with my multiple myeloma, I submitted an IMO from a board certified neurologist with over 30 years experience. He is also one of the associate professors at the local medical school and has an impressive educational and professional background. I originally went to him in 2009 when my PN starting progressing from my toes into the rest of my feet. He ran several blood tests on me including the test that indicated I had m-protein or myeloma protein in my blood. He then referred me to an oncologist/hematologist. I returned to see him in 2011 because my PN had progressed from my feet into my legs. After ruling out stenosis/radiculopathy with a CT myelogram, reviewing EMG and Nerve studies, conducting a thorough clinical examination and reviewing medical literature, he stated in the IMO that my PN was "more likely than not" secondary to my myeloma disease.

I will ask my cardiologist if she has an opinion regarding the connection between my myeloma and my PN but she will probably do like some of my other doctors and defer to the neurologist.

Hopefully I will find out within the near future if the VA agrees with my neurologist.

Georgiapapa...

#24 Chuck75

 
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Posted 18 September 2012 - 08:50 PM

From personal experience - -

Blocked arteries or partially blocked ones may not cause noticeable symptoms, until they get rather "serious".

Depending upon a whole plethora of things, an individual may lead a "normal" life, with seemingly no problems,
or perhaps symptoms so minor that they don't trigger concern or investigation.

I carried an airman's first class medical for decades, with only one "oddity" that was not disqualifying.
This the same medical exam and FAA certificate that an airline pilot must pass and carry.

For two or more decades, the only clue that something was not quite as it should be had to do with extended moderate effort and fatigue.
Since I worked in a semi sedentary position, where only occasional short term physical labor was involved, that was considered to be more or less normal.
A perhaps missed clue was that a cold drink of water tended to completely relieve the symptoms.

One weekend evening, about eleven years ago, I had walked briskly all over the local WM superstore with my wife with no signs of any problems. I woke up early in the AM, with moderate Angina.
Eventually, after trying several things to see of that would make the pain go away, and not working, I ended up getting my wife to drive me to the local hospital.
After the usual undesired delays, the emergency room staff finally decided that indeed, I was likely having the precursors of a heart attack. Well after treatment was started, the angina
changed to the classic "bar of pain" across my chest. A plethora of drugs were administered, including morphine and one that caused my blood vessels to burn slightly.
Finally, a clot buster referred to as TCB was given. That provided relief. When I woke up the next day, while still in intensive care, I was told that I indeed had a heart attack, and a blood clot was the culprit.
Estimates of damage were in the 50% range. The local staff cardiologist was Gung Ho to do a cath the next day. Since the hospital was just beginning to get into this sort of thing, I had to decline.
My cardiologist of long standing happened to be on staff of the regional heart center, less than half an hour away, and I had previous caths at the center. So, that where I ended up getting another cath and a stint. (There were/are reasons why you don't want to do a cath soon after such emergency treatment, unless there is no choice.)

(Why do such things seem to always happen at the most inconvenient times, and when skeleton crews man emergency services?)




Berta,

I talked with my cardiologist and asked why there was no indication of blockages during my diagnostic tests in July. She seemed truly concerned and said she was going to look into the matter because there should have been some red flags. Apparently, her cardiology group has someone who reviews the tests for the cardiologists and prepares reports of their findings for them. I am not sure of the professional background of the person performing the reviews.

I advised my cardiologist that I was concerned about the reliability of the echo and ECG versus the cath procedure. She told me that an ECG and echo have an important role in diagnosing cardiac problems but are not as reliable as other diagnostic tests in situations such as mine. My cardiologist characterized my blocked artery symptoms as "atypical" because the only symptom I experienced on the night I went to the emergency room was a sharp stabbing pain in the center of my chest. I did not have any pain radiating to other parts of my body, no profuse sweating, no crushing feeling in the center of my chest, etc. Due to my lack of the standard symptoms, my cardiologist instructed me to contact her immediately if I experience any severe chest pains in the future and she will call the hospital and schedule me for a cath procedure upon my arrival in the emergency room.

Georgiapapa...



#25 Berta

 
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Posted 19 September 2012 - 07:30 AM

Chuck, that was a very serious experience and fortunately you got fast medical care that could have definitely saved your life!
You stated "Blocked arteries or partially blocked ones may not cause noticeable symptoms, until they get rather "serious"."

YES. So true. and often can be the cause of a major stroke,if not a major cardiac event.

Georgiapapa, PETS are often specific to a particular disability.

You have very good evidence for the PN claim.

It is possible that past PETs you had were solely for the cancer and not focused on any potential heart problems.

And I could be quite wrong about the PET test. I assumed they meant PET by the "isotope study to follow".

Edited by Berta, 19 September 2012 - 07:31 AM.


#26 jvretiredvet

 
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Posted 19 September 2012 - 01:41 PM

There's been a lot of talk all around the subject, but I'd recommend a reread of the echo report that states "biatrial enlargement" combined with the phrases in the DC 7xxx series that speaks of "evidence of cardiac hypertrophy or dilatation on electrocardiogram"

Berta and others,

Today I obtained copies of some of my medical records from my cardiologist's office including the records for my July 2012 diagnostic tests and September 2012 records of my recent heart cath and stent placement. I have an appointment this Thursday September 20th with my cardiologist where I will have a lot of questions. Below is some of the comments found in the various reports:

July 10, 2012 Reports:

MYOCARDIAL SCAN (Lexican/Thalium stress test) "There are no areas of ischemia or scar tissue seen." IMPRESSION: "Normal myocardial scan. No change from the prior exam of 11/09/10."
EJECTION FRACTION: "The ejection fraction is calculated at 74%."
LEFT VENTRICULAR WALL MOTION: "Left ventricular wall contractility is noted to be normal with no areas of hypokinesis or akinesis. There is no paradoxical wall motion seen to suggest left ventricular wall aneurysm.."
IMPRESSION: "Normal left ventricular wall motion."
NOTE: This report is signed by a local radiologist.

LEXISCAN WORKSHEET (Screening for IHD) CLINICAL INFORMATION: "Patient with DOE/Fatigue and history of hypertension, hyperlipidemia." INTERPRETATION: "Resting electrocardiogram reveals sinus bradycardia at 51 bpm with a resting blood pressure of 128/64 mmHg. The patient received IV Lexiscan per protocol. Maximum increase in heart rate to approximately 100 bpm. There was quite a bit of artifact during the completion of the Lexiscan. Minimum drop in systolic blood pressure was to 90/60 mmHg. No significant ST changes were noted above the baseline abnormality when adjusting for the artifact intervening. No chest pain was experienced." CONCLUSION: "Nondiagnostic electrocardiographic response to IV Lexiscan." "Pharmacologic effect achieved." "Isotope study to follow." NOTE: This worksheet is signed by my cardiologist.

ECHOCARDIOGRAM - INDICATION: " sob, cp, htn, dizziness." LEFT VENTRICULAR STRUCTURE: "Normal in size and shape." LEFT VENTRICULAR FUNCTION: "Ejection fraction is estimated at 60-65%. No regional wall motion abnormalities were noted." LV DIASTOLIC FUNCTION: "Abnormal diastolic function with impaired relaxation." RV STRUCTURE & FUNCTION: "Size and function are normal." LA STRUCTURE: "Left atrium is mildly enlarged." RA STRUCTURE: "Right atrium is mildly enlarged." INTERATRIAL SEPTUM STRUCTURE: "Not well visualized." MV STRUCTURE & FUNCTION: "Mitral valve is mildly thickened." "Mild regurgitation." AV STRUCTURE & FUNCTION: "Aortic Valve is a tri-leaflet structure." "Aortic valve leaflets are thickened." TV STRUCTURE & FUNCTION: "Triscupid valve is structurally normal." "Mild tricuspid regurgitation." "Estimated right ventricular systolic pressure is 32mmHg." PV STRUCTURE & FUNCTION: "Pulmonic valve is structurally normally without stenosis or regurgitation." AORTA STRUCTURE: "Aortic root is normal." PERICARDIUM: "Percardium is normal." MISC. ITEMS: "Inferior vena cava is not well visualized." CONCLUSIONS: "Technically good, valvular sclerosis, mild triscupid and mitral regurgitation, diastolic dysfunction, biatrial enlargement." NOTE: This report is signed by my cardiologist.

September 13-15, 2012 Reports Regarding Placement of Stents:

PROCEDURE: "Left heart catheterization, selective coronary angiography, left ventriculogram, drug-eluting stent x 2 to the LAD, intercoronary nitroglycerin complex." ANGIOGRAPHY: "Left main coronary arter has ostial 20% disease." "Left anterior descending artery has a medially located moderate diagonal branch that has ostial 20% disease." "At this level the LAD has a very complex lesion that is 95-99% stenosed with what appears to be some thrombus." "The lesion is approximately 18-19 mm in length." "There is then a second diagnonal that is small to moderate size with a more tubular eccentric 70-80% stenoses in the distal LAD that is approximately 11 mm in size." "There is TIMI 2 flow." The circumflex is a large dominant system." There is a small first and second marginal." There is 20% luminal irregularities in the AV groove." There is a large distal posterolateral marginal and then there is 40% to 50% disease in the proximal segment of a large PDA>" "The right coronary artery is small and dominal." "There is proximal 20% disease." LEFT VENTRICULOGRAM: "Left ventriculogram in the RAO projection." "Three aortic valve cusps are present." Left ventricular systolic function is normal." "Ejection fraction estimated at 55%." "The apex is sluggish with some jypokinesis."
CONCLUSION: "Three-vessel coronary artery disease is significant in the LAD distribution representing the culprit." "Successful drug-eluting stent to proximal portion of distal LAD and mid LAD restoring TIMI 3 flow." "Preserved left ventricular systolic function with segmental abnormality."
NOTE: This report is signed by my cardiologist.

PATIENT HISTORY: "Hypertension, mitral valve prolapse, dyslipidemia, chronic fatigue, obstructive sleep apnea with CPAP, elevated cholesterol, elevated triglycerides, elevated LFTs, elevated bilirubin, plasma cell dyscrasia, GERD, Gastric polyps, iron deficiency anemia, testosterone deficiency, colon polyps.


Question: If the VA relies on METS & ejection fraction so much in their rating criteria, is there any chance I will be rated above 0% with my latest ejection fraction at 55%?

I will ask my cardiologist on Thursday about a METS score.

Please give me your thoughts and input as to what my reports indicate, especially the reports from September 2012 and your thoughts on a possible disability rating for IHD.

Thanks...Georgiapapa



#27 georgiapapa

 
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Posted 19 September 2012 - 02:37 PM

Jvretiredvet,

Forgive my ignorance but I do not understand what you are telling me. You definitely have my attention. Please explain your message in layman's terms because I am definitely interested in any information that will help me understand what is going on with my heart.

Thanks...Georgiapapa

#28 jvretiredvet

 
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Posted 20 September 2012 - 01:14 PM

In your post dated 19 September 2012 - 03:48 AM, you asked: If the VA relies on METS & ejection fraction so much in their rating criteria, is there any chance I will be rated above 0% with my latest ejection fraction at 55%?

As you appear to be aware of the terms EVF and METS, I was - perhaps too subtly - suggesting that you review the rating criteria for many cardiac conditions; there are other criteria besides ejection fractions and metabolic equivalents.

So to answer your specific question, yes ... there is a chance (and a very good one IMNSHO) that your cardiac condition will be rated above 0%.

Jvretiredvet,

Forgive my ignorance but I do not understand what you are telling me. You definitely have my attention. Please explain your message in layman's terms because I am definitely interested in any information that will help me understand what is going on with my heart.

Thanks...Georgiapapa



#29 georgiapapa

 
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Posted 22 September 2012 - 02:06 PM

I have started gathering my evidence in preparation for fling my IHD claim through the "Fully Developed Claim" or "Fast Track Process." I obtained copies of all of my medical records from my cardiologist's office and I am not sure if I should send in all of my records as evidence or not since most of the records before September 2012 may not help my claim. I have had several stress tests, echocardiograms, chest x-rays, ecgs, etc. in the past but there was never any strong indication of blocked arteries in my heart prior to this month.

I definitely plan on sending in the cardiologist's "operative" reports from my recent hospital stay, clear 8 x 10 photos of the blockages in my heart before and after the stents were installed, and the DBQ from my cardiologist. Is there any other type of evidence that I should include?

I want my claim package to be complete but not cluttered with unnecessary documents. However, I feel like if I don't send in all of my records, this could cause my claim to be removed from the "Fully Developed Claim" process and placed in the "Standard Claim" process if the VA has to request more records.

Should I go ahead and send in all of my records or just the records from September?

Again, your input is appreciated.

Georgiapapa...

#30 jcolwell

 
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Posted 22 September 2012 - 02:53 PM

I have started gathering my evidence in preparation for fling my IHD claim through the "Fully Developed Claim" or "Fast Track Process." I obtained copies of all of my medical records from my cardiologist's office and I am not sure if I should send in all of my records as evidence or not since most of the records before September 2012 may not help my claim. I have had several stress tests, echocardiograms, chest x-rays, ecgs, etc. in the past but there was never any strong indication of blocked arteries in my heart prior to this month.

I definitely plan on sending in the cardiologist's "operative" reports from my recent hospital stay, clear 8 x 10 photos of the blockages in my heart before and after the stents were installed, and the DBQ from my cardiologist. Is there any other type of evidence that I should include?

I want my claim package to be complete but not cluttered with unnecessary documents. However, I feel like if I don't send in all of my records, this could cause my claim to be removed from the "Fully Developed Claim" process and placed in the "Standard Claim" process if the VA has to request more records.

Should I go ahead and send in all of my records or just the records from September?

Again, your input is appreciated.

Georgiapapa...



#31 jcolwell

 
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Posted 22 September 2012 - 02:59 PM

Not the expert here , but i would send all those records. My husband case is very similar to yours . He has ventricular cardiomyopathy ( CAD) and he has a AICD. If you have a primary care physician you may want to consider sending those records as well if it is non-va doctor. Have you been evaluated for Diabetes or any chronic renal diseaes ( abnormaL lab reports can pick this up )you may want to look at those to make sure nothing is out of order, I did and found out I had both. Hope you dont go down that road. Also, is SSDI something you might qualify for. My problem is I am not boots on ground so have a much harder row to go down. Good luck with all Jim

#32 georgiapapa

 
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Posted 22 September 2012 - 03:37 PM

Jcolwell,

Thanks for your input. I have been evaluated for diabetes with negative results but I have not been evaluated for chronic renal disease. I have an appointment coming up with my private pcp. I will talk with my pcp about my situation and also request copies of my medical records.

Thanks again,

Georgiapapa