For several years, the VA has acknowledged that veterans who served in the Republic of Vietnam between 1962 and 1975 were likely exposed to tactical herbicides such as Agent Orange. The U.S. Department of Veterans Affairs mandates that any veteran who served in Vietnam (or, now, in some other areas where Agent Orange was stored or sprayed) during the relevant time period is presumed to have Agent Orange exposure. The VA has identified a list of diseases that it accepts as having been caused by Agent Orange. If a military service member who has been exposed is affected by one of these diseases, it is presumed to have been caused by his exposure to Agent Orange and will, then, be considered service-connected. In 2010, the VA expanded its list of twelve Agent Orange-related diseases to include Parkinson’s disease, chronic B-cell leukemia, and ischemic heart disease. Show
We will focus on ischemic heart disease in this blog post.
Ischemic heart disease involves a reduction of blood flow and oxygen to the heart, which results in the heart muscle not getting enough blood and oxygen. Usually, there is a buildup of cholesterol and other substances, called plaque, in the arteries that bring oxygenated blood to the heart muscle. Over time, ischemic heart disease damages and weakens the heart muscle, making it very difficult for the heart to fill and pump blood to the rest of the body. Ischemic heart disease is a common cause of congestive heart failure. Veterans with this condition may, at one time, have had a heart attack, angina or chest pains, unstable angina, or sudden and increasingly worsening chest pains. Often, veterans with ischemic heart disease may not have noticed any previous symptoms. Common Symptoms of Ischemic Heart DiseaseSome common symptoms of ischemic heart disease include:
It’s important to note that a veteran does not have to experience all of these symptoms to prove service connection. Ischemic Heart Disease as a Presumptive ConditionNot all heart disease qualifies for the presumption, but just because a veteran has not explicitly been diagnosed with Ischemic Heart Disease does not mean that he does not have the condition. Ischemic Heart Disease includes coronary artery disease, coronary heart disease, ischemic cardiomyopathy, and myocardial ischemia. The veteran may or may not have the initial symptoms listed above. Vietnam-era veterans with heart disease should ask their doctors if their particular diagnosis is a form of Ischemic Heart Disease.
Importantly, so long as the veteran was exposed to Agent Orange (either directly or presumptively) during active duty, he need not have been diagnosed with Ischemic Heart Disease within any certain time frame. This exposure is very common for Vietnam veterans In other words, if a veteran served in the Vietnam war in 1969 and develops Ischemic Heart Disease forty years later in 2009, he is still entitled to service connection for his health conditions. The Blue Water Navy Vietnam Veterans Act extended eligibility to Vietnam war veterans. In addition, although there are other risk factors for Ischemic Heart Disease, such as smoking, obesity, high cholesterol, hypertension, and diabetes mellitus, if the veteran has been exposed to Agent Orange, he is entitled to a presumption of service connection even if he has those other risk factors. In addition to new claims for Ischemic Heart Disease, the VA must also reopen and re-adjudicate the claims of Vietnam-era veterans who applied for compensation for heart disease prior to the change in the VA regulations. The veteran could, then, be entitled to an effective date all the way back to his earlier claim. On that note, medical research is constantly identifying new links and relationships, and veterans should be aware that just because their particular illnesses or diseases have not yet been recognized as being related to Agent Orange does not mean that they will not be recognized at some point in the future. If the veteran feels that there is a link, it is worth filing the claim. The claim may initially be denied, but if the VA then later recognizes the veteran’s disability as connected to Agent Orange, he could be entitled to an effective date as of the date he filed his claim. Obtaining a Diagnosis of Ischemic Heart DiseaseThe 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). 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:
How Does The VA Award Disability Ratings for Ischemic Heart Disease?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:
In general, heart conditions are rated using a set rating system known as VA disability ratings.
VA Disability Ratings for Ischemic Heart DiseaseHere is a brief look at the VA rating schedule for heart disease:
How Does VA Diagnose Heart Disease?Electrocardiogram of Ischemic Heart Disease ( Myocardial Infarction ) Another factor the VA will consider, outside the symptoms the veteran is experiencing, is any heart surgeries. VA will look at whether you had any procedures which might qualify you for a higher rating, at least temporarily. VA will assign 100% for procedures such as:
Can You Get TDIU for Heart Conditions?Finally, as with rating most disabilities, the VA must consider whether the veteran’s heart disease prevents the veteran from maintaining employment. Knowing the symptoms of heart disease allows you to keep your doctors informed if you are having these symptoms. In addition, if your doctor is aware of your symptoms have him document them in your medical records. This makes it easier for the VA to assign the proper rating for your disability. For more information about Ischemic Heart Disease, download our free e-book. Have Questions About Ischemic Heart Disease and Agent Orange?If you’re struggling to obtain disability compensation for a condition through presumptive service connection, the team at Hill & Ponton can help. Our veterans’ disability attorneys are committed to helping former service members and their family members file VA claims or obtain eligibility for VA disability benefits. Contact our law firm today for a free consultation. Ischemic Heart Disease WorksheetsThe VA used to have public-facing Disability Benefits Questionnaires, also known as DBQs. These were fantastic tools for veterans and their dependents seeking to prepare for their upcoming Compensation & Pension Exams or in preparation for filing their disability claims. During the summer of 2020, the VA removed these from their website without much explanation. We have gathered these from public internet archives and are providing the Heart disease DBQ sheet here. Update: 2021 VA has republished the DBQs for public download. We will continue to provide a download link here. Download Heart Disease DBQ sheet What qualifies as ischemic heart disease?Ischemic heart disease is also known as coronary artery disease or "hardening of the arteries." Cholesterol plaque can build up in the arteries of the heart and cause "ischemia," which means the heart is not getting enough blood flow and oxygen. If the plaque blocks an artery, a heart attack can result.
Can you get disability for ischemic heart disease?Yes, Ischemic heart disease (also called coronary artery disease) may cause disability if your symptoms interfere with your ability to work. However, you must meet the qualifications set forth by your long term disability policy to receive benefits.
Is ischemia a VA disability?Ischemic heart disease is recognized by the United States Department of Veterans Affairs (VA) as a debilitating condition, and if a veteran can provide evidence linking his condition to his military service, he may be eligible for disability.
What is the difference between heart failure and ischemic heart disease?Ischemic heart disease is one of the most frequent causes of heart failure and it is normally attributed to coronary artery disease, defined by the presence of one or more obstructive plaques, which determine a reduced coronary blood flow, causing myocardial ischemia and consequent heart failure.
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