good afternoon and welcome to CCK live and happy Halloween my name is jena Zellmer joining me today are Emma Peterson and Cortney Ross and today we’re going to be talking about heart conditions and other related cardiovascular conditions as always if you have any questions please feel free to leave them in the comment box below we’ll do our best to answer them and we’ll also be posting links to additional information that can be found on our website at C CK law comm so let’s get right into it nearly 1 million veterans have service-connected cardiovascular conditions so you know this is a very timely and relevant topic I would say that they’re most commonly rated at 10 percent and so even though they’re not always the most compensable rated disabilities that doesn’t necessarily mean that they’re not important so Emma can you talk to us a little bit about what the most common cardiovascular conditions veterans can have and get surface skated for sure so one of the big ones that we talk about a lot not just in the context of diseases in general but Agent Orange presumptions is coronary artery disease also known as ischemic heart disease so a lot of veterans who were exposed to herbicides ended up developing this disease and can get that presumptively service-connection but a lot of veterans just end up developing CAD your later in life either again due to service or due to other conditions that are service-connected and the other very common one that we see a lot of is hypertension so both of those are probably the two most common heart conditions that we see with our clients great and um you know first we’re going to talk a little bit about different ways to get service-connected for these cardiovascular conditions and then we’ll go into the ratings but we have a lot of information on our website and I’m sure we’ve done several Facebook lives in the past about a second of a direct service connection but Courtney’s you just want to give us a quick refresher on how a veteran can get direct service connection for a heart condition yep so you’ll need a diagnosed heart condition and then you’ll need an in-service event or illness so it could be what Emma suggested of exposure to herbicides and service or it could be that you actually had an onset of symptoms of your heart conditioning service and then you’ll need a medical nexus so of likely a medical opinion linking your currently diagnosed a heart condition to that event or illness in service great and I think that this is a good time to kind of delve in a little bit more into that Agent Orange presumption that you both discussed so you know we have direct service connection where you can use that that three-step process and get a nexus but under the Agent Orange presumption there’s an easier way to get service connection at least for CAD right now is that right Emma yes so for a CAD – ischemic heart disease if you can show that you were exposed to an herbicide whether it be in Vietnam Thailand or now for our blue water veterans with a new legislation if you can show that your Coast and herbicide and you have a current diagnosis you don’t need that Nexus evidence it’s going to be presumptively service-connected so that eliminates part of the burden in terms of getting service connection mm-hmm and I think um the VA has different time periods during which you know it’s already established that Agent Orange was was used in those different areas so the dmz vietnam and blue water etc and so i’m you know to the extent that you you mentioned if you can show a lot of times just by serving in those areas that has been enough to demonstrate that you were exposed to Agent Orange and so I would really recommend checking out our website there’s a lot of information about the new blue water legislation that you just mentioned which is that essentially extends that presumption to veterans who were serving in the Navy who actually didn’t set foot on the ground in Vietnam but we’re still exposed to Agent Orange and so that just lets lessens the burden for veterans to demonstrate because I think it would be it’d be pretty hard to show that you were exposed to Agent Orange you and so you mentioned that that’s just for CAD or for ischemic heart disease what about hypertension so hypertension historically has not been well sort of it is not currently one of the presumptive conditions for service-connection however in 2018 the National Academy of Sciences which does these annual or biannual reviews of the evidence linking certain conditions to herbicide exposure finally indicated that there was sufficient evidence linking the development of hypertension with Agent Orange exposure there was a lot of rumblings and a lot of communication coming out of VA indicating that hypertension was going to be added as a presumptive condition and then that just stalled out talks about that or really we don’t really know too much more about when that’s gonna be added as a presumptive cailli ongoing sometime in the future you know we certainly hear it next couple months and a couple months and it’s it sort of come up in the news again lately so feel free to google that if you’re interested to see what’s going on lately with the hypertension presumption but unfortunately it is not a presumptive condition now just because it’s not presumptive doesn’t mean you can’t get it service-connected with some medical Nexus evidence and certainly that opinion report from the National Academy of Sciences is very persuasive so submitting that getting together with your representative your via so whoever you work with on your claim to either submit that report or submitting it to your doctor to look at and then providing a nexus opinion certainly could be a path to getting you service-connected for hypertension yeah and I think it’s really important for example this National Academies report even though it’s fairly well known the board isn’t going to necessarily need to discuss it unless you and your representative you know submit it and make an argument about why it should be considered in support of your claim there has been some case law recently about you know what the board should be um should know about despite it potentially not being in record and so it’s always just good to be on the safe side and if you think that there are some medical literature out there that would support your claim just you know talk to your your VSO or your attorney about potentially you know submitting that as part of your claim and making potentially an argument about why it should help you and in support of your claim and so that’s something to note and so studies like the NIH report are really helpful and so you know we you could find information on our website about that as well so Courtney we talked about direct service connection we’ve talked about presumptive service connection but is there another way that veterans could potentially get service connected for heart conditions that maybe aren’t directly related to service or aren’t related to an Agent Orange exposure yes so veterans may be service-connected secondary to a condition that they’re already service-connected for and I’ll give you some examples to kind of provide some context to that so there’s medical literature literature that supports if a veteran is maybe already service-connected for a condition like diabetes it’s possible that diabetes could cause a heart condition or aggravate maybe a heart condition of the veteran already has and if you’re able to show that through medical evidence a veteran can also be service-connected for heart condition that way another common example is PTSD or other types of anxiety inducing psychiatric conditions literature also supports that there’s a connection between those psychiatric conditions and how they might impact or cars are caused rather hard conditions certain types of medication that you might be taking to treat service-connected conditions could also have possible impacts on your heart condition so these are all different things that you want to consider if you have a heart condition and you’re trying to find a way to link it to or you think it’s due to your time in service it may not be directly due to your time in service but it may be related to a condition that you have as a result of your time and we’ve done Facebook labs and we have a lot of information on our website about secondary service connection and what you need to demonstrate in order to you know meet that standard since it is a little bit different than direct service connection but the good thing to know is that you don’t necessarily need a heart condition in service you can you know potentially get a heart condition after service related to some other service panting disability and so it’s important to kind of talk to your rep and potentially your doctor and kind of explore all different avenues of service connection because just because you can’t prove one doesn’t necessarily mean you can’t get service-connected so so those are kind of the different ways that veterans with cardiovascular conditions can demonstrate service connection so let’s go on and let’s just assume that VA has already you know acknowledged that a veteran has a service-connected heart condition let’s talk about kind of ratings so Emma do you want to talk about Metz or metabolic equivalent tests sure so the way that the cardio of the Rivier heart conditions like I mentioned before CAD are rated it’s based on a series of tests that the examiner most likely will perform your private doctor could perform them too really they test just sort of the efficiency and function of your heart so one big one that is included in most of the diagnostic criteria for heart conditions are the Met testing the metabolic equivalents tests otherwise known as exercise testing so it measures the energy cost on your heart for doing different physical activities and it also measures when in sort of how strenuous of an activity you’re doing you start to feel symptoms so if you’re walking and you already are out of breath and feeling I can’t say this word to say by like dyspnea dis Nia yeah Davina essentially shortness of breath yes it’s just worrying yeah too many confidence well I think this is really helpful to you because you know a lot of times veterans are looking at these rating criterias right you don’t even know what these things right and so you know shortness of breath rocking your alien shortness of breath obviously that’s gonna result in a low Mets rating because at that low level you’re already feeling the symptoms so what they do is the higher the Mets rating the more efficient the more functioning your heart is and the lower your disability rating is going to be so look at shortness of breath fatigue and China which is heart pain dizziness fainting loss of consciousness and then also they consider the medications that you might have to take to maintain maintain your condition mm-hmm I think um it’s really important to kind of in in cases like this where the rating criteria is pretty objective you know it requires an examiner to either interview you or do an exercise based test and then make a determination based on on those tests what level you’re at it’s really important to you know talk to your doctor and talk to your rep you know provide evidence about kind of the daily activities they you struggle with due to your cardio vascular disease and so Courtney do you want to kind of talk about you know I mentioned earlier a lot of veterans are only rated at 10 percent but you know there’s obviously a broad spectrum what are kind of the symptoms that are that VI considers totally disabling like what are the things that it’s gonna look for when veterans are submitting an increased rating claim yeah so similar to what mo was alluding to if you are on doing physical activity that’s just something like shower showering or walking one block or just while you’re getting dressed you’re starting to suffer from some of those symptoms so the shortness of breath the chest pain the fatigue those are the kind of things of the better excuse me the VA is gonna look forward to say that your heart condition is totally disabling chronic congestive heart failure is another thing that VA will consider in terms of granting you a total disability yeah so anywhere between that spectrum so if you can walk let’s say a mile or two but you still feel shortness of breath maybe that’s a 10% rating but if you really can’t do anything without you know needing to stop a lot you need help maybe dressing or eating or anything like that um that’s something that VA is going to consider and so it’s really important to tell VA you know what what issues you’re having and be really upfront don’t try to minimize any of the experiences that you have because you want to make sure that you’re getting the compensation I think that’s really important because sometimes due to the severity of your heart condition doing an actual Metz testing an actual exercise test is not gonna be indicated mm-hmm so they’ll do interview based MEPs testing and in that interview they’ll ask you what happens after you walk the block what happens after you do X Y and D so it’s very important that you are very clear about when you start feeling these symptoms because they’re just gonna be estimating that I’m actually gonna make you do the physical exercise because it again it might be that you’re you know you’re at the 80% range and they’re looking at a hundred percent and it’s just not safe to make you start running on a treadmill right so again if you’re in that situation make sure that you are explaining how this impacts you in your day-to-day life mm-hmm so that’s for cardiovascular conditions heart conditions you know in the beginning we talked about how there’s CAD or ischemic heart disease they’re named the same they’re used interchangeably which is sometimes a little bit confusing but then we also have hypertension and hypertension isn’t rated based on Matt’s level so Courtney do you want to talk a little bit about how VA rates hypertension sure it’s rated based on your systolic in diastolic um readings or pressure so you know we’ve most of us have been to the doctor where they put the little blood pressure cuff on your arm and they listen as they float up on your arm and they listen for the two different ticks and those two different ticks are indicating where your systolic in your diastolic pressure as and usually they’ll give you one number over the other the diastolic pressure is the bottom number and the systolic is the top number so VA uses again its Frye objective uses those readings to determine what your rating should be for Hyper ticking yeah and I think despite the fact that both Metz testing and hypertension read high low pressure readings are both objective I think there’s that is really hard to kind of use lay statements to demonstrate that you meet a higher rating it’s really just based on what that blood pressure reading says and so um unfortunately there’s just that’s just a higher yeah I think one thing to keep in mind with hypertension that was usually if your hypertension is so severe that it warrants you a higher rating for based on these rating for care for hypertension typically you you also have other medical conditions that have developed from that including heart conditions which can also develop secondary to hypertension so while you might not be able to be rated as highly just for hypertension you know consider what other conditions you have as a result of your hypertension because you may be able to get secondary circuits connected so there’s connection and a higher combined rating overall I think that’s a really good point and it’s it’s B A’s duty to kind of make those leaps the connections between a disability and a potential other ratings um you know it’s being suited to maximize a veteran’s ratings but you know it’s always helpful to help VA do their job you know make it as easy as possible for them to grant you the highest possible rating in it and so if you can talk to your rough about that and kind of you know look at at the regs and look and see what other potential compensation you might be entitled to it’s super easy if you just kind of like give it all to VA and just let them stamp it rather than relying on them to correctly apply bla I think one pitfall just backing up to service connection to with hypertension that we see is that the rating criteria requires that the readings be taken over so goes in ways it’s not just you had a one time high blood pressure reading therefore you have hypertension so a lot of times we’ll see folks that have a singular high blood pressure reading in service and then subsequent ratings are maybe normal but then they end up getting diagnosed with hypertension outside of service but that doesn’t count as a diagnosis for VA purposes but again that’s not to say that you can’t still get service-connected by getting some medical evidence your doctor PCP to opine that that first reading was the start of your hypertension but that’s just something to be aware of that you know just because you’ve had that one high blood pressure reading mmm-hmm a lot of times we’ll see VA explain it away oh they were sick they were on cold medication they were stressed out subsequent readings were lower mm-hm they do require that it’s over several days so just something to keep in mind it’s not a barrier but it might be something that you face so just just be aware of that and I think yeah it’s really helpful to look and see what VA actually considers hypertension because you know high blood pressure is kind of a range you know certain people are pre-hypertensive versus actually having hypertension and so it’s important you know to keep up you can measure your blood pressure or self you can you know go I’m sure like CBS still has those and keep a journal of of what your blood pressure readings are and so that you can make sure that VA is getting a full picture of your actual disability and you’re not getting shortchange just because you only go to a doctor one day great this is really helpful um just as a reminder if anyone has any questions please feel free to leave them in the comments box below we’d love to answer your questions we know that this is a really complicated area of law the heart I think is different than you know having a knee problem like because it’s internal and so it lends a little bit of mystery so great let’s move on so we’ve talked about kind of how VA rates heart conditions and hypertension now but VA is actually has proposed some changes to how they rate heart diseases and so Courtney do you want to kind of give a little overview about what VA is is gonna do in the future yeah so the proposed changes are really to make it so that the Mets testing it’s going to be the primary way that they rate heart conditions so we’ve alluded just alluded to this throughout the broadcast but other things they look at in our part of the criteria are things like a measurement of ejection fraction of the left ventricle and then episodes of congestive heart failure so the proposed changes are proposing to do away with those things so to take them out of the criteria and really focus on them that’s testing they’re also proposing to clarify that do this yeah I also struggle someone could write in a comments how you would be this is really referring to breathlessness or show yeah I think that makes sense because then you won’t require people to say basically yeah or look it up because that’s not really a common phrase for something that is this common issue yes so it makes it a little bit clearer yes so we talked a little bit about you know how a veteran could potentially get a hundred percent reading under the reading criteria there are a couple other ways the veterans can get a hundred percent readings so Emma let’s talk a little bit about temporary total ratings sure so if you have for example the big one is a heart attack you will be rated at a hundred percent for three months following that incident and then you’ll be reevaluated based on your max testing and and seeing how severe the resulting condition is but for those three months after the heart attack you will get a 100% rating some other ways that you can get a temporary total rating so temporary hundred percent is if you’ve had a pacemaker installed they’ll give that to you for two months following surgery and then rewrite you them see how severe the condition is there’s something else out there now these days called an ICD or a CID which is an implantable cardiac defibrillator it’s like a pacemaker in the same way it works the same way in that it senses when your heart is out of rhythm it’s beating too fast or irregularly and but it gives you a shock kind of like the full-on defibrillator machines that you might see in your favorite medical drama better but it’s implanted actually right into your heart if you have one of those that is a hundred percent rating the entire time the entire time so it is important to find out whether you are getting a pacemaker or an ICD because that makes a drastic difference in your rating if you have a heart valve replacement while being treated and then six months following that treatment that replacement will then get reevaluated and then finally a heart transplant percent for one year yeah and then re-evaluated based on your new heart so hopefully at that point things are much better yeah probably if things are going well you won’t get a good rating and then finally as always we have to touch a little bit on TBI you so Courtney you want to give us a brief refresher on TVI you actually do we have a question before we get into tdiu let’s answer this question so Hosea says would being overweight due to back problems and other issues affect the heart resulting in the in a condition that we can apply for compensation that is a really excellent question and I think that it it kind of relates back to secondary service connection so Courtney you want to touch on that yeah absolutely so yes but it would be so short and serve as an intermediate step for that secondary service connection so if you have a back condition that is already service connected and so disabling that it causes you to become obese and that obesity then results in your heart condition it’s that middle step there that then makes that the obesity is the middle stuff there that connects your back service-connected back condition in the resulting heart condition so you can use that to link the two and then get service connection for the heart yeah also another way I mean this is not exactly the question but we talked about medications so if you’re taking medications for the back pain that increase your blood pressure or long term medications long term steroid treatment could affect it and then also if you had I hope your medication use causes weight gain right that’s what I what is the taking medication that causes weight gain that also could be the animator it’s deaf but yes obesity can be the link between the two yeah so a few years ago VI and the court had made clear that you know you can’t get a disability rating based on obesity but the a general council has come out and said they recognize that OBC it can be this step between a service county disability and another disability and so um it’s a little unclear kind of how that relates like what the standard is between the service cognate condition and the obesity and then what the standard is between the obesity and the secondary condition and so I think it’s really helpful if you’re gonna be making those types of arguments to consults you’re wrapping it there a VSO or an attorney and really make sure that they’re doing research on what va is gonna require to demonstrate that link because it is so there’s so many chains link in the chain yeah and so that’s a really great question yeah great so let’s go back to TDI you and I just talked to you Cortney so I’ll go back to that and Emma can talk a little bit about TDI you so yes you ask you of course can get TDI you based on a heart condition and certainly heart conditions would impact your ability to do all kinds of work and if you’re getting out of breath just showering and getting dressed you certainly aren’t going to be able to do any type of physical or strenuous labor probably not even a desk job necessarily getting to and from work might just be impossible but you absolutely can apply for TDI you as part of an increased rating and for your service connected heart condition also in then in conjunction with other conditions that you have um so as always TDI you is on the table if you’re a service type of disability is prevent you from being able to secure and follow a movie substantially gainful job yeah and we have a lot of information on TDI you and what VA considers when it’s determining whether or not a veteran can you know obtain and maintain a job do anything that’s one are you I think just all on TV or even a door closing but I’m just gonna say closing thought the heart conditions in general I think as you’ve heard throughout the broadcast there’s many different ways that you can get possibly compensated for your heart condition so you just want to make sure that if you are suffering from our condition that you really take into consideration all of the different possible avenues like you’ve said a few times to talk to your rep or talk to your doctor to see if they can provide medical evidence and support of your case because it’s not really one size fits all for each one mm-hmm yeah and I think you know going back to that talking to your doctor you know there are there are certain disabilities that you can get serviced catered for that are really you are competent as a layperson to describe and to you know say that you have a concerning condition but for heart like I said earlier it is a lot it’s a little bit more complicated and so getting good evidence from your doctor to support your claim for service connection or your claim for an increased reading I would really suggest doing that any question lots of questions no I think that that’s that’s a fair point and like you mentioned the Hart’s internal it’s not like anywhere you can you know see how far do you spending right you can see like a swelling colon name right you can’t see like your ejection fraction you can see your math testing so while all your lay evidence about your symptoms your breathlessness you know how it impacts your life is very valuable at the end of the day these are a lot of objective medical tests they’re gonna perform and it might really box in your rating so you know don’t be disheartened no pun intended but just know that this criteria is out there so talking with your doctor is very important mm-hmm great well thanks for joining us and again a happy Halloween I hope everyone stays safe and we’ll see you next week you
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