Jim,

The following is what I sent in to the VBA in Helena this week, I think its pretty straight forward. I have researched this myself without any help from any service agencies. Do you think i should have waited for a denial on pericardial adhesions first? and do you think I should have seen a lawyer first? if I should need a lawyer, who would you recommend?

Two weeks ago, I was helping another veteran research disability ratings on the V.A. website and I came across a disability rating for pericardial adhesions and decided to apply for compensation. what I was warned about was that because pericardial adhesions are not an unexpected consequence of heart surgery I would be denied.

I would like to change my "1151 claim for pericardial adhesions due to heart surgery" to "entitlement to benifits persuant to 38 U.S.C.A, 1151 for additional disabilities based on failure to timely diagnose pericardial adhesions. As you are aware I initially had heart surgery at the V.A. hospital in Houston on March 2000. My first concern is as follows, "if pericardial adhesions are a reasonably expected result or complication of the V.A. care or treatment , why was I not monitored, checked for or treated for it?"

I have received printouts from Mid America Cardiology at the University of Kansas Hospital, where the V.A. sent me, that states " Films were reviewed by Columbia VA, as well as KUMC, Cardiothoracic surgeons, and he was not found to be a surgical candidate", I do remember a conversation with the VA in Kansas City where they told me that surgery was no longer an option and I would be "medically maintained". Kind of a disturbing statement to say the least.

Still, I found no information about having pericardial adhesions being diagnosed or treated at Kansas City VA. Less than a year later,in 2008, while I was in North Platte Nebraska I suffered another heart attack and was sent to the Omaha VA and they in turn sent me to Creighton University where Dr. Sugimoto elected to perform surgery on me. This begs the question, "what would have happened if I had stayed in Kansas City and was treated by the Kansas City VA?"

At this point I would be remiss if I did not praise Dr. Sugimoto for his skills. His post surgery report states that he could not save the vessels on the back side of my heart because they had become adhered to the pericaldial wall. so the next question is" If I had been diagnosed and treated for pericardial adhesions, would those vessels have been saved?"

Your own rules state that "Hospital care or medical or surgical treatment cannot cause the continuance or natural progress of a disease or injury for which the care or treatment was furnished unless VA's failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. "38 C.F.R 3.361(c) As you are aware I am still not diagnosed with "pericardial adhesions" After reviewing the statement from Dr. Sugimoto, do you think that I should be diagnosed and treated for pericardial adhesions?

Reply:

I'm not sure I understand why you filed an 1151? It seems a waste of your time to me. This opinion is based on my 35 year career of working in hospital heart centers as a cardiovascular technologist and executive. I know a little about hearts.

I'll assume that you have coronary artery bypass surgery because you needed it. That means that arteries in your heart were clogging up and not delivering blood to the muscle of your heart. Grafts were probably taken from your legs and used to supplement the flow of blood to your heart muscle.

The heart is encase in a sack called the pericardium. To get to the outside of the heart where those blood vessels lie requires that the pericardium be surgically opened. In many people the pericardium will then become somewhat scarred and it will bind or adhere to the surface of the heart. This is not at all unusual, the fact that one has pericardial adhesions does not mean that anyone on the medical team did anything wrong.

Severe adhesions may be a problem but under ordinary circumstances the adhesions aren't at all remarkable or even detectable. Adhesions from a previous surgery are always seen on a second surgery. The surgeon must take great care to work his way through the adhesions during the second surgery.

An 1151 claim or a tort case is a legal filing to say that someone on your care team was guilty of medical malpractice. To sue for pericardial adhesions is sort of like suing for a scar that might result from a hernia operation. The scar would be a normal result of the surgery so saying that it was a result of malpractice won't be accepted by the law.

You had a second heart attack after your bypass surgery. Again, there is nothing unusual about that. The vascular disease that caused those clogged blood vessels in the first place hasn't stopped because you had surgery. More vessels can become clogged and even the bypass grafts can be clogged up and then they need to be replaced. Many people have 2nd or 3rd or even 4th bypass surgeries because of their underlying disease.

From what you tell me your VA did everything right to help you. You had bypass surgery and that worked for a time. Then you needed another operation and the VA transferred you to a place to receive it. During the second surgery it was seen that you had some degree of pericardial adhesion that made things a bit more complex.

I can't see any way that there is any malpractice in that trail of events. Were I you I'd withdraw the 1151 filing and forget it.