Jim,

Hello and thank you for your service! My husband is a Viet Nam vet and is already receiving agent orange benefits due to his diabetes type II, but that is not my question. He developed a heart murmur 20 years after Viet Nam, and underwent open heart surgery May 11th at the VA in Gainesville, FL. They say that his aortic valve was calcified to the extent that only 20% of the blood was getting through and his heart muscle was enlarging.,.and without the surgery immediately, then he would probably be deceased within 2 years.

We filed in March 2010 for the ischemic heart disease issue...the question is does his aortic valve issue fall under the definition of ischemic heart disease, or are we kidding ourselves? He also has a bad liver due to medication (not alcohol), but we cannot prove that of course even though our primary care physician states that..but the main issue is the compensation for this heart issue.

You asked me if there were bypass grafts done during his aortic valve surgery? No, there were no bypasses done.

What is your opinion?

Reply:

Aortic valve disease is a completely different problem than ischemic heart disease. The heart is a complex organ made up of a number of different parts that all function together.

His (and your) heart is a pump. It works some 70 times per minute during your lifetime to push fresh blood to vital parts of your body and to bring that blood back to the lungs for replenishment of oxygen and so on.

There are 4 chambers within that pump system, each chamber will hold blood and serve to push it along as the heart beats and squeezes. These internal chambers have valves to allow the flow of blood to move forward and to ensure that blood doesn’t flow backwards or settle in one spot.

Each of those valves is subject to have a problem if its delicate mechanical structure is damaged. The valves may become weak (incompetent) or they may become too tight (restricted) for varying reasons. Surgical repair or replacement is often required.

On the outer surface of the heart muscle are arteries that provide fresh blood to the heart. When those blood vessels become diseased, the caliber or internal diameter of the vessel is smaller and results in less flow to the heart muscle. If the artery is completely occluded, a heart attack is often a consequence.

Although all these parts are in the same organ, they are quite separate as they function.

The VA presumptive condition addresses only “ischemic heart disease” (IHD). IHD is the condition in which the coronary arteries themselves become diseased and don’t allow adequate delivery of fresh blood to the working heart muscle. IHD is a separate disease process and markedly different than aortic valve disease.

Sometimes the two problems coexist and if IHD is present during valve replacement surgery, the doctors will proceed to do a bypass graft operation simultaneously with valve replacement.

You tell me that there was no bypass grafting and that is a solid indication that he does not have IHD.

VA is not likely to approve the IHD claim.