Rating code for Neurocardiogenic/Vaso-vagal Syncope

GunNut55

Registered Member
#1
Hello all, I am fairly new to this forum in regards to posting, however, I have been following this site for awhile now...
Anyways, I thought it might benefit everyone to know the results of my case. As far as I can tell thus far, I have seen everyone with the Neurocardiogenic/Vaso-vagal Syncope get rated under the code for seizures or paralysis of the vaso-vagal nerve, which has seemed to be insufficient in encompassing the actual disability of this disorder. I must note there are three types of this disorder: those who have a severe drop in blood pressure, those who have a severe drop in heart rate, and those that have a mix of both- all of which lead to syncope. A tilt-table test diagnosis seems to be the standard.
I developed the mixed form of this disorder about a year ago, which was diagnosed this past February-via Tilt Table. In my records, there is a lot of evidence pointing to the Cardiac component of this disorder. I just received my DA 199 this week and was rated at 60% for my unfitting condition of Neurocardiogenic syncope. It was rated under the general cardiac output scale (METs), to which I received the 60% rating. This was obtained through an interview MET test with my VA examiner at my C&P exam. I feel this rating was accurate, because I spend days and weeks at a time where I can barely move without developing symptoms of pre-syncope, followed by possible syncope if I do not stop what I am doing. The focus was not on how many times I have blacked-out, but how much this disorder effects my ability to work, which is the overall goal of this process. I had evidence through the tilt-table test, heart monitors, and ECG. Also, a possible treatment for my disorder, which was listed in my medical documents, was implantation of a pacemaker. I am having a pacemaker put in on Monday.
My goal for this post is to inform anyone with this condition it is possible to get a correct rating, in accordance with your disability, especially if your disorder has any cardiac etiology. Make sure you get the proper cardiac work-up, as well as documentation stating your drop in heart rate should be rated in reference to the general cardiac output scale. Then be honest and direct with your VA examiner. I hope this helps, and please feel free to ask any other questions you may have. I wish everyone the best in their IDES and DES cases.
 

Jason Perry

Benevolent Leader
Site Founder
Staff Member
PEB Forum Veteran
Registered Member
#2
Thank you for sharing your experiences! Hope all goes well for you in retirement.
 
#3
Hello all, I am fairly new to this forum in regards to posting, however, I have been following this site for awhile now...
Anyways, I thought it might benefit everyone to know the results of my case. As far as I can tell thus far, I have seen everyone with the Neurocardiogenic/Vaso-vagal Syncope get rated under the code for seizures or paralysis of the vaso-vagal nerve, which has seemed to be insufficient in encompassing the actual disability of this disorder. I must note there are three types of this disorder: those who have a severe drop in blood pressure, those who have a severe drop in heart rate, and those that have a mix of both- all of which lead to syncope. A tilt-table test diagnosis seems to be the standard.
I developed the mixed form of this disorder about a year ago, which was diagnosed this past February-via Tilt Table. In my records, there is a lot of evidence pointing to the Cardiac component of this disorder. I just received my DA 199 this week and was rated at 60% for my unfitting condition of Neurocardiogenic syncope. It was rated under the general cardiac output scale (METs), to which I received the 60% rating. This was obtained through an interview MET test with my VA examiner at my C&P exam. I feel this rating was accurate, because I spend days and weeks at a time where I can barely move without developing symptoms of pre-syncope, followed by possible syncope if I do not stop what I am doing. The focus was not on how many times I have blacked-out, but how much this disorder effects my ability to work, which is the overall goal of this process. I had evidence through the tilt-table test, heart monitors, and ECG. Also, a possible treatment for my disorder, which was listed in my medical documents, was implantation of a pacemaker. I am having a pacemaker put in on Monday.
My goal for this post is to inform anyone with this condition it is possible to get a correct rating, in accordance with your disability, especially if your disorder has any cardiac etiology. Make sure you get the proper cardiac work-up, as well as documentation stating your drop in heart rate should be rated in reference to the general cardiac output scale. Then be honest and direct with your VA examiner. I hope this helps, and please feel free to ask any other questions you may have. I wish everyone the best in their IDES and DES cases.

Hello, I just began my IDES last week and am new to the forum. I read the previous post because it was the closest to what I am experiencing, and had a few of questions. First, after researching how vasovagel syncope has been coded through VA typically through this forum (correct me if I'm wrong) but it seems like it would be regarded as paralysis to the 10th cranial nerve (8210), which maxes out at 50%, how did a 60% rating occur with the same titled diagnosis? Second, whats the difference between service-connected and combat related-I mean I started having this condition right after my second deployment to Iraq, along with other issues (lack of sleep, back pain, and bad headaches), will any of that be taken into consideration? I'm really inclined to think if I hadn't gone to Iraq I would be normal like the rest of my family that wasn't exposed to the things I was. But I'm no doctor, so I don't know if this condition is typically seen that way to the VA. Can this be considered combat-related? 3rd, sometimes I feel like my conditions are worsening, I went from 3 episodes in three months no profile, to 2 episodes this month w/ profile, last one happend two weeks ago. The question is will I recieve sceptism by continually reporting throughout MEB if they continue, or will these episodes be taken into consideration towards %. Actually, this is the same for my sleep issues, and headaches, does it matter if I report them now that MEB has already begun? Also, I have to say I am somewhat apprehensive with the process, I noticed one person posted they recieved 0% in this forum yet others anywhere from 30-60% for vasovagal syncope. I understand this condition occurs by habitually passing out at least once or twice a month. Not just feeling like they're going down but actually going out cold. How can the ratings differ so much when having such a diagnosis recorded I 'd assume would disqualify many occupations that the average healthy person could apply for (fireman/police/laborer etc) upon release from active sevice? It just seems there should be a more thorough system to determine the effects. I get essentially no early warnings of when the episode is about to happen, and it can be caused now by merely walking at times. I am on anti-depress meds to mitigate syncope for past 10 days, but dosage only goes out for 30 days, if I don't have any episodes while using meds, how is that judged effective or not? I think this is a lot of info for now, any advice is greatly appreciated!
 

lulu2481

PEB Forum Veteran
Registered Member
#4
Hello! So I was diagnosed with Neurocardiogenic Syncope (NCS) and in my NARSUM it was wrote up under Heart (Including Ischemic & Non-Ischemic heart disease, arrhythmias, valvular disease and cardiac surgery). The METS they put me under are 3-5 METs which should give me a rating no less than 60% from my reading.

I completely understand your migraine issues. I never had them like this before. Ever since I started fainting (Oct 14) I have had daily/consecutive days a having a migraine. I have gone through so many different medications that now I am getting nerve block shots in the back of my head to prevent the migraines.

My MEB started with my PCM stating my unfitting conditions are NCS, Migraines, and dizziness. I just got a call from my PEBLO saying my IPEB case worker needs more info on how/why my migraines are an unfitting condition. So now I am waiting to see what our SGH and PEBLO come up with that one.

So what has happened with your MEB? Do you have your ratings yet?
 

brianmatt31

PEB Forum Veteran
Registered Member
#5
Hello all, I am fairly new to this forum in regards to posting, however, I have been following this site for awhile now...
Anyways, I thought it might benefit everyone to know the results of my case. As far as I can tell thus far, I have seen everyone with the Neurocardiogenic/Vaso-vagal Syncope get rated under the code for seizures or paralysis of the vaso-vagal nerve, which has seemed to be insufficient in encompassing the actual disability of this disorder. I must note there are three types of this disorder: those who have a severe drop in blood pressure, those who have a severe drop in heart rate, and those that have a mix of both- all of which lead to syncope. A tilt-table test diagnosis seems to be the standard.
I developed the mixed form of this disorder about a year ago, which was diagnosed this past February-via Tilt Table. In my records, there is a lot of evidence pointing to the Cardiac component of this disorder. I just received my DA 199 this week and was rated at 60% for my unfitting condition of Neurocardiogenic syncope. It was rated under the general cardiac output scale (METs), to which I received the 60% rating. This was obtained through an interview MET test with my VA examiner at my C&P exam. I feel this rating was accurate, because I spend days and weeks at a time where I can barely move without developing symptoms of pre-syncope, followed by possible syncope if I do not stop what I am doing. The focus was not on how many times I have blacked-out, but how much this disorder effects my ability to work, which is the overall goal of this process. I had evidence through the tilt-table test, heart monitors, and ECG. Also, a possible treatment for my disorder, which was listed in my medical documents, was implantation of a pacemaker. I am having a pacemaker put in on Monday.
My goal for this post is to inform anyone with this condition it is possible to get a correct rating, in accordance with your disability, especially if your disorder has any cardiac etiology. Make sure you get the proper cardiac work-up, as well as documentation stating your drop in heart rate should be rated in reference to the general cardiac output scale. Then be honest and direct with your VA examiner. I hope this helps, and please feel free to ask any other questions you may have. I wish everyone the best in their IDES and DES cases.

Thanks for your post. I just received my DA199-1 for Neurocardiogenic Syncope. 10%. Didn't have a C&P Exam and the MEB/PEB only used my cardiologists documents and a DBQ I had him feel out in July of 2017. The DRAS did the rating in June 2018 and in Dec 2017 my dr diagnosed me with CAD. For my point to this in the best wisdom the DRAS has for some weird reason they rated my condition with code 6204 Peripheral Vestibular Disorder at 10%. So looking this up in the VASRD they rated it compared to a ear condition that causes dizziness and not anything like fainting, passing out, blood pressure tanking out..... "Code 6204: conditions that affect the ears’ ability to sense proper body balance. Symptoms include dizziness, sense of being in motion or spinning, wooziness, or motion sickness." I seriously can't begin to even imagine if any of them at DRAS has to have any experience in the medical field. Besides all they have to do is read the NARSUM and other doctor diagnosis then compare to the VASRD. So I'm fighting this.
 
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