Question:
I am being compensated for IHD, at 30%. I have recently been treated for sleep apnea (CPAP), AFIB, and hypertension. What does the VA require for a secondary claim to my ischemic heart disease? Thanks!
Jim's Reply:
To claim a secondary condition requires scientific medical evidence that there is a cause and effect or nexus occurring between a rated condition and a claimed secondary condition. Two examples might be (1) service connected diabetes and carotid artery disease leading to stroke. It's fairly well established that diabetes causes, contributes to and aggravates vascular disease throughout the human body. Diabetes may lead to heart disease, stroke, peripheral artery disease and kidney disease...just to name a few. If you have a service connected disease like diabetes you need a physician statement and/or a DBQ that will verify the connection and VA will likely award the benefit without any fuss. Then there is (2) where the veteran has a service connection for pes planus of both feet. After 20 years of the pes planus rating, the veteran has developed arthritis of the hips and knees. The veteran wants to claim that the hip and knee conditions are secondary to the service-connected pes planus because the pes planus has caused occasional difficulty ambulating and sometimes required orthotic footwear. In this case, although the connection or nexus may seem apparent to the veteran claimant, the VA is likely to say that the arthritis conditions are the natural progress of aging. Proving the secondary service condition would be a steep uphill battle.
In other words, the connection must be reasonably apparent or you'll have a fight on your hands. In your case I'd venture that the atrial fibrillation (A-Fib) may be secondary to the ischemic heart disease IF the A-Fib wasn't diagnosed first...it often is. If you can get a physician opinion that the A-Fib is caused by the IHD, you should claim it. Hypertension and OSA requiring a CPAP aren't normally secondary to IHD, it's the other way around. The OSA and the hypertension cause and contribute to heart disease so they won't be found as secondary to it.
Veterans should explore the opportunity to file for secondary conditions that contribute to the overall disability profile of that veteran, just as you've done. There are many conditions that should be rated but aren't since the rating isn't questioned.