What is IHD?
In the year 2010, VA added ischemic heart disease (IHD) to the list of conditions that are presumed to be caused by exposure to Agent Orange. The addition of IHD was a great victory for veterans; however, it is important for veterans to know that “ischemic heart disease” does not mean any and all conditions that are related to the heart.
The VA has listed the following cardiac conditions as falling within the definition of IHD: acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina. 38 C.F.R § 3.309(e).
Do You Have IHD?
Notably, the above regulation specifically states that IHD includes, but is not limited to, the specific conditions that are listed. Therefore, if a veteran has cardiac complaints and has been exposed to Agent Orange, it is important for the veteran to ask their doctor whether their particular diagnosis or condition is in fact a form of ischemic heart disease and/or if their condition falls within the parameters of one of the conditions the VA has already conceded qualifies as a form of IHD.
If the doctor says that the condition does count as IHD, of course the doctor needs to state that in writing, with a medical rationale. If the doctor says that the condition does not count as IHD, a second opinion may be in order for several reasons. Some of those reasons could be as follows:
- Your doctor may not be qualified to answer this question in the first place– Said another way, the field of heart disease, known as cardiology, is highly specialized and requires special expertise. If your doctor is not a cardiologist, asking him or her to provide a medical opinion outside the scope of their expertise may not be the best idea. It’s always best to receive a medical opinion from a professional who is medically qualified to offer that opinion.
- You may need more specialized testing, before your doctor can provide a definitive answer to this question– In other words, there are several cardiac tests that can be done to determine if heart disease is present, and if so, what type of heart disease. For example, if you have a history of abnormal EKG, but have never had an echocardiogram to ultrasound your heart, then you might need to pursue an echo, a stress test, or even possibly a cardiac catheterization. Until extensive cardiac testing is performed, there is really no way a doctor can validly deny that IHD is present, without doing a full cardiac work-up.
- You may need updated cardiac testing– Very frequently, I have read medical records where a veteran’s doctor will state that there is no diagnosis of IHD, because the veteran had a negative stress test five or ten years ago. As an advocate, when I read statements like this, I always ask my clients to please obtain current testing to determine what their cardiac status is. Just because IHD was not present five years ago, doesn’t mean that it isn’t present now. However, without updated testing to establish the presence of IHD, a veteran who may otherwise qualify for benefits, may miss out on service connection, simply because their doctor doesn’t take the extra step to order new tests.
Determining the Proper VA Rating for IHD
Once it is verified that (1) the veteran has been exposed to Agent Orange and (2) the veteran has a valid diagnosis of IHD, the next step is to determine what the rating for the IHD will be. The proper rating for IHD is determined by looking at several factors, per the VA’s Schedule of Ratings for the Cardiovascular System. 38 C.F.R. § 4.104.
The cardiovascular rating schedule considers the following factors when assigning the rating for IHD:
- Ejection Fraction percentage
- Symptoms such as: dyspnea, fatigue, angina, dizziness, or syncope
- Presence or absence of congestive heart failure
- Evidence of cardiac hypertrophy or dilatation
- The need for continuous medication
- The veteran’s workload capacity, expressed in cardiac METs (metabolic equivalent). For example, the VA’s Disability Benefits Questionnaire for IHD states that:
- The 1-3 METs level is consistent with activities such as eating, dressing, taking a shower, slow walking for 1-2 blocks. A 1-3 METs level would entitle the veteran to a 100% rating for IHD.
As compared to
- The > 7 to 10 METs level, which is consistent with activities such as climbing stairs quickly, moderate bicycling, sawing wood, and jogging. A > 7 to 10 METs level would entitle the veteran to only a 10% rating, which is a drastic difference from a 100% rating.
What Should You Take Away from this Blog?
If you are an Agent Orange exposed veteran and you have cardiac issues, it is to your advantage to obtain an updated and thorough cardiac work-up from a qualified medical professional. You must find out if you have IHD, and if you do, ensure that the severity of your symptoms from the IHD are properly documented by your medical professionals. It serves no purpose for you to finally receive service connection for your IHD, but then be short-changed by the VA on your rating, because the medical documentation isn’t in place to validate the severity of your condition. Start now, so that you can give the VA what they need to get it right. If you need more information download our free Ischemic Heart Disease book.