(cell phone 301-651-6392)

To: All veterans

Date: Dec 2014
Ischemic Heart Disease (IHD)
Coronary Artery Disease (CAD)
Peripheral Artery Disease (PAD)

From:
Craig N. Bash, M.D.
Neuro-Radiologist
www.veteransmedadvisor.com

Diabetes Mellitus (DMII)

Pages: 2

NPI or UPIN-1225123318- lic #--D43471

4938 Hampden lane, Bethesda, MD 20814
Phone: (301) 767-9525 Fax: (301) 365-2589
E-Mail: drbash@doctor.com

Update on IHD and CAD and PAD and DMII

Veteran Independent Medical Opinion/Exam- IMO/IME

Veteran Medical Nexus Opinion (VMNO)

These terms, besides looking like alphabet soup, are all inter-related. The veteran patient can get a
rating for IHD, which is the disability that stems from CAD. CAD is the anatomic narrowing of the
coronary arteries but until it reaches a major narrowing the effect on the hearts blood flow is minimal.
But once the CAD sufficiently narrows the coronary arteries the heart looses significant blood flow and
the tissue become ischemic and dysfunctional. Once the arteries are narrow they usually stay narrow
and heart muscle can die from low blood flow. Ischemic tissue can die in an irreversible and
permanent way, thus early treatment is important.
Veterans exposed to Agent Orange can be granted benefits for their IHD, which is secondary to the
AO with well-reasoned medical opinions. Often these patients will also present with diabetes mellitus
type II, which is known to also be associated with AO exposure.
DM II is also known to cause vessel scarring and CAD and thus secondary IHD. Since DMII is a well
known systemic disease is also causes secondary PAD.
Vascular PAD primarily due to Agent Orange likely does occur but AO is not recognized by the VA as a
presumptive cause of PAD. The literature documents many articles that have estimated risks greater
than 1 for All circulatory, Circulatory and cerebrovascular disease. Additionally, animal studies
and in vitro (Lab) studies document increased oxidative stress, inflammatory markers, structural
remodeling, lipid mobilization, Increased LDLs and macrophage lipid accumulation in vessels exposed
to AO. These findings are consistent with my experience in that patients with CAD also have PADlikely due to the same contributing factors as is supported by the literature.

Recommendation:
Each PAD case needs a special careful review in a veteran medical opinion to sort out the variables
that could contribute to the PAD such as AO and diabetes, but a well-reasoned IMO should be
acceptable to the VA as evidence of a causal link, if the medical data supports that opinion.

Craig Bash M.D.

Associate Professor

drbash@doctor.com cell 240-506-1556

Independent Veteran Medical Opinion (IMO)

Veteran Medical Nexus Opinion (VMNO)
based on Veterans medical records