Jim,
I filed a claim for coronary artery disease. My doctor says I have cad with a 30 to 40% stenosis of my left descending proximal artery. I am confused as to the VA's definition of ischemic heart. I have a normal ejection fraction and had a score of 8.3 on my stress test. I have been taking medication for four and a half years and the only real symtom I currently have is fatigue.
My doctor says I have mild cad, but it is nonischemic. My average mets level over the last 4 years has been 6.97. Is cad the same as ischemic heart disease? Should the VA not use the percentage of blockage as a rating factor? The more I read about ischemic heart, the more confused I get.
I have proof of boots on ground in Vietnam, but my cardiologist does not think my condition is necessarily related to agent orange. Thank you for your assistance and for all of the information you provide on VA Watchdog!
Reply:
Coronary Artery Disease (CAD) is the same thing as Ischemic Heart Disease (IHD).
http://en.wikipedia.org/wiki/Coronary_artery_disease
That the VA chose to use the term IHD rather than the more often used CAD is another VA mystery. Although IHD is technically as correct as CAD, you won't find it used as a definition of your condition in most medical settings. VA seems to purposely make things as difficult as they can.
Ischemic means lack of blood supply. The coronary artery is a sort of pipeline for blood so that fresh blood can reach the muscle of the heart. Any narrowing or obstruction in the pipe will impede the flow of blood. Thus, any degree of coronary artery narrowing can cause ischemia. If the artery becomes 100% narrowed, the victim will have a heart attack. A heart attack happens when the heart muscle is completely deprived of fresh, oxygenated blood.
VA uses a measurement called an Left Ventricular Ejection Fraction (LVEF or just EF) of how well the heart is functioning as the standard for how disabling the IHD may be.
http://en.wikipedia.org/wiki/LVEF
An EF is usually obtained by an echo-cardiogram. The normal EF is usually about 65% or in that range. The left ventricle of the heart is the big pumping chamber that distributes fresh blood to the rest of the body. If thyere is severe CAD or if the patient has had a heart attack, the EF will be lower, and the lower the EF measures, the less blood the heart can pump and the sicker the patient will be. VA also uses METS as an alternative measurement and that approximates the EF.
http://en.wikipedia.org/wiki/Metabolic_equivalent
Your cardiologist may or may not be correct that your CAD is related to agent orange exposure. That may be debated forever. The fact of the matter is that as a Vietnam veteran who has boots on the ground service, you are entitled to compensation for the IHD condition. The federal government has determined that veterans who were exposed to agent orange have a higher statistical probability of having IHD and if you are disabled by the condition, you will be compensated for the degree of the disability.
Your single vessel 30% narrowing is mild. Heart bypass surgery and stenting procedures aren't usually contemplated for CAD that isn't much more severe than yours.
In the VA Schedule of Rating Disabilities, we find that VA rates CAD (interestingly, they don't call it IHD here) as follows:
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%
http://www.benefits.va.gov/warms/docs/regs/38CFR/BOOKC/PART4/S4_104.DOC
When we read the schedule you meet the criteria for "documented coronary artery disease" (your doctor tells you of a 30% or 40% narrowing) and you report a METS score of 6.97. VA raters will round the 6.97 to 7.00. You also report fatigue. That tells us that you should receive a 10% rating for the degree of CAD that you have.
You're one of the luckier veterans because you know that you have a mild heart disease and knowing that, you can take measures to keep it from getting worse. Most of us of the Vietnam era have a similar or worse degree of CAD...it's one of the hazards of aging in America. But, we don't all have it defined as well as you do. Although a higher disability rating would bring you more VA money, the good news is that you aren't eligible for a higher rating...your overall heart health score isn't bad at all.