If I Have A Presumptive Condition Should I Still Get The Assistance Of A Service Officer To Apply For Disability
Yes. Having a presumptive will make the application easier, but we still recommend veterans retain an accredited service officer to assist them.
- American Legion Veteran Service Officer – 296-5166
- Disabled American Veterans Veteran Service Officer – 296-5167
- Veterans of Foreign Wars Veteran Service Officer – 296-5168
- Vietnam Veterans of America – 283-3164
- State of Vermont Veteran Service Officer Program – 666-9844
Symposium Scheduled For Veterans With Parkinsons Disease From Herbicide Exposure Other Environmental Factors
The Parkinson’s Foundation and the U.S. Department of Veterans Affairs , Ralph H. Johnson VA Medical Center in South Carolina are hosting a virtual symposium next month for all veterans with Parkinson’s disease across the United States. The symposium, which is slated for March 20, is part of a coordinated effort to help veterans and their loved ones understand the latest advances in Parkinson’s treatment and the numerous Parkinson’s resources available through the VA and the Parkinson’s Foundation. It is also important for those who have been diagnosed with a debilitating disease like Parkinson’s allegedly caused by exposure to toxic herbicides and their family members to understand their legal rights and options in possibly pursuing a product liability lawsuit against the herbicide manufacturer.
A Lawyer Experienced In Disability Insurance Laws And Parkinsons Disease Can Provide The Support You Need
Group LTD claims fall under federal ERISA law. When a group claim is denied, the information you present in your appeal to the insurance company will also be the basis for a potential lawsuit against the insurance company. An experienced ERISA lawyer is essential to your case.
In a private disability benefits claim denial based on Parkinson’s disease, state contract and bad faith laws prevail. In each case, our experienced attorneys are prepared to review your claim, explain your legal options, and help you get the compensation you deserve.
A Discussion Of How Environmental Factors Such As Pesticides May Affect Your Risk Of Parkinsons Disease
During my recent interview on Wisconsin Public Radio, many of the callers asked questions related to environmental risks of Parkinson’s disease , specifically, exposures related to farming. Those calls prompted me to delve further into this complicated and murky topic.
Before we start discussing specific factors in the environment that may increase risk of PD, let’s understand some basic ground rules that will help put this topic in perspective
With that background, let us begin.
The Right Legal Guidance Can Make The Difference In Getting Disability Benefits For Parkinsons Disease
At Marc Whitehead & Associates, we can help you prepare an initial SSDI or LTD application for the best possible outcome. If you’ve already been denied benefits for Parkinson’s, our attorneys will develop and file a solid appeal to rebut a wrongful claim denial.
Our accredited veterans’ claims lawyers help vets across the U.S. get their rightful benefit payments approved in the shortest amount of time possible.
We have helped hundreds of claimants with Parkinson’s disease get disability benefits. and as we analyze your situation, we identify and fix critical information gaps in any of part of your claim — including missing medical data or incomplete vocational and functional evidence. We work in cooperation with your treating physicians and may enlist the assistance of qualified vocational experts, and much more.You must never give up. Call us toll free at 866-365-7898 or request a Free Legal Consultation to learn how we can help. Parkinson’s is a serious disability, and we are able to assist you wherever you live.
About Marc Whitehead
Marc Whitehead has been practicing law for over 27 years in Houston, focusing exclusively on disability law. His firm, Marc Whitehead & Associates files applications and appeals denials for Long-Term Disability insurance policies, Social Security Disability and Veterans Disability. He has authored books on each of these topics and presented nationwide on disability law.
B Comments Regarding The Addition Of Parkinson’s Disease To Va’s List Of Presumptive Diseases
VA received nearly 400 comments in favor of the proposed regulation from individuals and organizations that, for various reasons, support the addition of Parkinson’s disease to VA’s regulation listing diseases that are presumptively service connected based upon exposure to herbicides used in Vietnam. Many of these comments also suggest that VA clarify its definition of Parkinson’s disease, to include diseases of Parkinsonism and secondary Parkinsonism syndromes, as well as other Parkinsonian disorders.
VA Response: Update 2008 only evaluated the correlation between certain herbicide exposure and Parkinson’s disease. Parkinsonism, and other similar diseases, is not the same disease as Parkinson’s disease. According to Update 2008,
PD must be distinguished from a variety of parkinsonian syndromes, including drug-induced parkinsonism and neurodegenerative diseases, such as multiple systems atrophy, which have parkinsonian features combined with other abnormalities * * * Pathologic findings in other causes of parkinsonism show different patterns of brain injury .
Institute of Medicine of the National Academies, Veterans and Agent Orange: Update 2008, The National Academies Press , pp. 515-16; available online at http://www.nap.edu/?openbook.php??record_?id=?12662&?page=?515 .
Expanding The Presumption Of Herbicide Exposure Beyond Service In The Republic Of Vietnam
Approximately ten commenters advocated expanding coverage geographically, to include veterans who did not deploy within the land borders of the Republic of Vietnam, but may have been exposed to tactical herbicides in the course of their military service. For example, one commenter, the Vietnam Veterans of America , cited Update 2008 in support of its recommendation that VA adopt a presumption that veterans who served in the South China Sea during the Vietnam era were exposed to herbicides. Another commenter encouraged amending 38 CFR 3.307, to include “Blue Water Navy Veterans” as qualifying for the presumptions listed in 38 CFR 3.309.
VA Response: These comments are beyond the scope of this rulemaking. We proposed to revise 38 CFR 3.309 to implement the requirements of 38 U.S.C. 1116 and directing the Secretary of Veterans Affairs to determine whether there is a positive association between exposure to the herbicides used in Vietnam and the occurrence of specific diseases. The issue of which diseases are associated with herbicide exposure is distinct from the issue of which individuals are presumed to have been exposed to herbicides in service. The latter issue is governed by a separate regulation in 38 CFR 3.307, which we did not propose to revise in this rulemaking. Accordingly, we make no change based on these comments.
After The Vietnam War Many Soldiers Faced Exposure To Other Forms Of Jet Fuel
Jet fuel exposure continued to be a common issue for those serving in the military long after the Vietnam War. Other forms of jet fuel came into play after the use of JP-4 fuel in Vietnam, which were also toxic and could cause long-term health problems. If you are a Veteran and came into contact with jet fuel, you may be suffering from symptoms of jet fuel exposure, even years after your service. Fortunately, jet fuel exposure can make you eligible to receive disability benefits from the VA. These benefits can help you get the financial resources you need to take care of yourself and your family, even if your condition keeps you from working.
In this post, we’ll talk about the symptoms of exposure to jet fuel and the toxic herbicide it was often combined with, Agent Orange. We’ll also discuss how you can receive disability benefits for service-related exposure to these toxic substances. You shouldn’t have to suffer from the long-term effects of jet fuel exposure without getting the help that you need. At Berry Law Firm, we’re committed to helping our fellow veterans get the support they deserve from the VA, including the many veterans who are suffering from the long-term effects of jet fuel exposure.
Veterans Exposed To Agent Orange May Qualify For Va Presumptive Disability
As a veteran of a foreign war, you have no doubt that your disability was caused during military service. You didn’t suffer as badly as many of your fellow soldiers—and you made it home alive—but now you’re suffering from the long-term effects of chemical exposure from overseas. Will the VA still allow you to collect benefits for disability even if you were stationed out of the country over several decade ago?
Exclusion Of Diseases That Do Not Result In Oxygen Deficiency In The Heart
Three commenters expressed a desire for VA to expand the definition of IHD to include diseases that are potentially secondarily connected to IHD.
VA Response: In the preamble to the proposed rule, VA, citing Harrison’s Principles of Internal Medicine—a respected and universally recognized reference in the medical community, clarified and explained the definition of IHD as “an inadequate supply of blood and oxygen to a portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen supply and demand.”75 FR 14393; See Harrison’s Principles of Internal Medicine . This definition is limited to conditions that directly affect the myocardium. “Myocardium” is defined as “the middle muscular layer of the heart wall.” Merriam-Webster Dictionary Online, “Myocardium” available at http://www.merriam-webster.com/?dictionary/?myocardium . Therefore, based on the definition found in Harrison’s, IHD pertains only to conditions that directly affect the muscles of the heart. The accepted medical definition of IHD does not extend to other conditions, such as hypertension, peripheral artery disease, and stroke, that do not directly affect the muscles of the heart. As a result, VA will not include these conditions within the definition of IHD contained in this rulemaking.
Two of these commenters would also have VA allow excluded conditions to be rated as secondarily caused by IHD.
Proving Service Connection For Parkinsons Disease Without A Presumption:
As for any other non-presumptive conditions, veterans with Parkinson’s who did not serve in a location listed above may still qualify for VA compensation. You will need to submit additional evidence to show that your exposure was during military service, and link the exposure to your Parkinson’s.
Because PD is progressive, the VA does not make veterans wait for the disease to slowly evolve. So medical documentation of symptoms should pave the way to service connection. The first thing you need to provide is documentation that you have symptoms of Parkinsonism.
You will need to provide the VA with your
- Military separation records
- Service treatment records
- Medical evidence of diagnosis and treatment of Parkinson’s
Timing and sufficient evidence of Parkinson’s are critical, as a timely filing for VA compensation properly ensures that you can start receiving benefits from the date VA has your claim in hand.
You will also need your physicians’ opinion saying that your PD was caused by exposure to toxins in service, or by a service-connected traumatic brain injury . We recommend providing a statement detailing your exposure or event.
Regarding Parkinson’s in particular, various instances exist by which veterans may qualify for service-connected VA compensation, including
Statements About Personal Situations And Hypothetical Benefit Questions
Many commenters made general statements about their own personal difficulties battling one or more of the presumptive diseases. Another commenter inquired as to the possible implications of Bradley v. Peake, 22 Vet. App. 280 . The commenters who inquired about Bradley asked whether, hypothetically, an IHD disability rating in addition to another disability that meet the statutory criteria under 38 U.S.C. 1114, could potentially establish eligibility for special monthly compensation.
VA Response: Comments regarding hypothetical situations involving the possible outcome of benefit claims or the medical or claims history presented by individual veterans are beyond the scope of this rulemaking. Claimants should contact their VA regional office for assistance with their individual claims.
Parkinsons Ssdi Claim Based On A Reduced Residual Functional Capacity
If you cannot satisfy the guidelines of the SSA’s medical listing for Parkinsonian, you have another option. You may qualify based on a reduced RFC.
Here you must prove that your condition has made it impossible to work consistently and earn a gainful living. SSA will base its decision on the evidence you provide, which can be very difficult at the initial application stage. You need to prove you cannot do your “past relevant work” and “any other work.” Adjudicators often find the claimant’s reported signs and symptoms of PD are not “severe enough” or are incomplete when filed without attorney representation.
You must be thorough and provide what SSA needs to see:
- A detailed history of your medical condition and functional abilities. This process is critical and involves your medical records, doctors’ statements, and further evidence that evaluates and shows your inability to work consistently.
- Evidence of various forms of limitations, such as postural, exertional, manipulative , visual, communicative, mental, and environmental.
- Your case strengthened by documenting all symptoms, carefully tracking worsening symptoms, describing problems with daily activities, including the testimony of family, friends, co-workers, and reporting prescriptions for any assistive devices as a Parkinson’s patient.
Illnesses Can Qualify Vets For Va Disability And Healthcare Benefits
Many veterans who were grateful to have come home safe from the Vietnam War have since recognized just how badly they were wounded through toxic exposure. Agent Orange, the widely used herbicide containing dioxin, stayed with these service members and slowly ravaged their health. Decades later, these veterans are badly in need of disability and healthcare benefits, but the Veterans Administration still plays a game of delay and denial. At Marcari, Russotto, Spencer & Balaban, our attorneys are determined to see qualified veterans get the benefits they deserve.
Is There Health Care Available For Veterans Exposed To Agent Orange
If you are a veteran diagnosed with a qualifying condition, and you meet the service criteria outlined above, you may be eligible for VA treatment of your Agent Orange-related condition.
Health benefits may also be available for children of veterans who have been exposed to Agent Orange, if they havecertain birth defects, including spina bifida, cleft palate or cleft lip, Poland syndrome, congenital heart disease, and others.
Compensation For Veterans Who Suffered Due To Agent Orange Exposure
VA assumes that certain diseases, cancers, and other health problems are likely caused by exposure to Agent Orange. These are considered “presumptive diseases,” meaning that if one of these conditions is diagnosed in a veteran who was exposed to Agent Orange, the VA accepts the likelihood that the victim’s military service caused the condition. A veteran, a surviving spouse, or the veteran’s children can qualify for disability compensation and health care benefits for these conditions without the burden of proving that the condition was caused during military service.
The following conditions may qualify for VA presumptive disability for Agent Orange exposure:
Our attorneys can help you get the full amount of compensation you deserve for your condition. Contact Cuddigan Law today or download a free copy of our book, The Essential Guide to VA Disability Claims, to begin building your case.
Do I Have To Prove My Service And Parkinsons Disease Are Connected
No, the VA presumes a connection between Agent Orange exposure and Parkinson’s disease if you served in the Republic of Vietnam between January 9, 1962 and May 7, 1975. Keep in mind that you may still be eligible for Agent Orange compensation if you served during different dates.
The VA may pay benefits if you:
- Served in the Korean Demilitarized Zone between April 1, 1968 and August 31, 1971
- Served in Thailand between February 28, 1961 and May 7, 1975
- Operated, maintained, or served onboard C-123 aircraft between 1969 and 1986
- Served outside Vietnam, but directly handled Agent Orange
President George H.W. Bush signed the Agent Orange Act into law in 1991. This act made it mandatory to presume a service connection between veterans’Agent Orange exposure and certain diseases. This helped codify the VA’s response to veterans filing claims for Parkinson’s disease.
Agent Orange Exposure Was Extremely Common For Soldiers In Vietnam
If you served in Vietnam between January 9th, 1962, and May 7th, 1975, the VA considers you eligible to receive benefits for service-related exposure to Agent Orange. In addition, the VA will also presume Agent Orange exposure in any veterans who served around the Korean demilitarized zone between April 1st, 1968 and August 31st, 1971. If you were in any way involved with piloting or maintaining the aircraft that sprayed Agent Orange herbicide, you could also have presumed exposure to Agent Orange acknowledged by the VA.
Cck Can Help Veterans Affected By The Ndaa Presumption Expansion
If you are a Vietnam-era veteran suffering from one of the newly determined presumptive conditions , the veteran’s disability team at Chisholm Chisholm & Kilpatrick LTD may be able to assist you. Whether you are filing an initial claim, appealing a denial of benefits, or seeking an earlier effective date, an accredited attorney from CCK may be able to guide you through the process. For more information, as well as a complimentary case review, contact us online or at 800-544-9144.
Vietnam Veterans Exposed To Agent Orange At Higher Dementia Risk
February 11, 2021
Veterans who were exposed to the herbicide Agent Orange during the Vietnam War may be at increased risk of developing dementia compared to fellow soldiers who were not exposed. The results raise worrisome concerns, since many Vietnam veterans are now in their late 60s and 70s, an age when diagnoses of Alzheimer’s disease start to become increasingly common. The findings also raise potential concerns about how environmental toxins may play a role in brain ailments, including Alzheimer’s disease, the most common type of dementia in the world.
U.S. forces used Agent Orange during the Vietnam War to defoliate jungle trees and plants that provided cover for enemy forces, and to kill food crops. Many American servicemen were exposed to the defoliant during the war, most likely to very high doses, and its active ingredient dioxin, may persist in fat tissues in the body for decades.
Previous research has linked Agent Orange to neurologic ailments like Parkinson’s disease, various cancers, Type 2 diabetes, hypertension and other diseases. An earlier study suggested that Agent Orange might also be linked to a slightly increased risk of dementia, but this study, published in JAMA Neurology, was much larger.
They found that veterans exposed to the herbicide were nearly twice as likely to be diagnosed with dementia than their veteran peers who hadn’t been exposed.
How Is The Disability Rating For Parkinsons Disease Calculated
VA’s rating decision will contain a disability rating. Generally, each condition has a separate diagnostic code, which is a four-digit number and name.
But, if you look in the ratings tables, you will not find Parkinson’s disease listed by that name. Instead, Parkinson’s disease is rated using code 8004 – Paralysis agitans. This diagnostic code assigns a 30% rating, but that is a minimum rating. But, most veterans with Parkinson’s disease should receive a rating higher than the 30% minimum. Because rating Parkinson’s is as complex as the disease itself, I wrote this article that focuses exclusively on Parkinson’s disease ratings.
Does This Change Impact Nehmer Class Members And Other Vietnam
Nehmer v. U.S. Department of Veterans Affairs was a class action lawsuit brought against VA by the National Veterans Legal Services Program in 1986. As a result of the case, VA must take certain actions when it recognizes a new condition as scientifically linked to Agent Orange exposure. Specifically, VA must: identify all claims for the recognized condition that were previously filed and/or denied; and pay retroactive disability and death benefits to the veterans or their survivors back to the date of the veteran’s initial claim
The Nehmer class consists mainly of veterans who served in Vietnam and suffer from conditions VA has deemed presumptive. It is important to note that since three new conditions have been added to the list, veterans who suffer from one of the three may now be considered part of the Nehmer class. This is particularly relevant to veterans who previously filed a claim for one of the three conditions but were denied. These veterans may now be able to secure benefits with an effective date back to the date of the original claim.
Veterans who served in Thailand, Korea, and other areas may have also exposed to and affected by Agent Orange. In this instance, a veteran suffering from one of the established presumptive conditions would still have to prove the first two elements of service connection , but they would not have to prove the medical nexus, or link, between their diagnosis and the in-service event.
Can The Agent Orange Act Help Veterans Exposed To Mustard Gas
Alan Oates was exposed to herbicides, such as Agent Orange, while serving in Vietnam in 1968. Decades after returning home, he was diagnosed with Parkinson’s disease, and because Congress passed the Agent Orange Act, he’s able to receive VA benefits. Courtesy of Alan Oateshide caption
Alan Oates was exposed to herbicides, such as Agent Orange, while serving in Vietnam in 1968. Decades after returning home, he was diagnosed with Parkinson’s disease, and because Congress passed the Agent Orange Act, he’s able to receive VA benefits.
To understand the predicament of World War II veterans exposed to mustard gas, take a look at what happened to another set of American veterans who were exposed to a different toxic chemical.
Last month, NPR reported that some of those World War II vets are still fighting for disability benefits from the U.S. Department of Veterans Affairs because the agency says they don’t have enough proof to substantiate their claims.
Alan Oates says that’s the same response Vietnam War veterans started receiving from the VA in the late 1970s and early 1980s.
As a young Army private during the war, Oates was providing security for an engineering outfit in the jungle when he first noticed three planes flying overhead spraying something.
“I asked the engineers: What are they doing?” Oates says. “And said: They’re spraying herbicides to kill the vegetation, so that the enemy couldn’t hide in it.”
Parkinsons Disease And Long Term Disability Insurance Claims
You may have group disability insurance coverage as part of an employee benefits plan, or you may have purchased an individual disability policy as protection against loss of income.
In either case, to receive these long term disability benefits for Parkinson’s disease, you need to meet your plan or policy’s definition of disability. This generally requires that, due to sickness or injury, you are now unable to perform the duties of your own occupation or another occupation.
Your insurance company may not fully understand the impact that Parkinson’s disease can have on a person over time, both physically and cognitively. Claim examiners may not appreciate how is it that you have been able to work for years with PD and now suddenly you cannot.
Our attorneys do understand. We also know what it takes to submit a strong LTD insurance claim to prove disability for Parkinson’s or file an appeal that will stand up in court.
We prepare for the tactics insurers use to avoid having to pay monthly benefits. Here are a few:
Agent Orange Tied To Increased Dementia Risk In Vietnam Vets
January 26, 2021
Exposure to the herbicide Agent Orange has been tied to a significantly increased risk for dementia in Vietnam War veterans, new research shows.
Investigators at the University of California, San Francisco, found that veterans who had been exposed to Agent Orange had nearly a twofold increased risk of developing dementia compared to veterans who had not been exposed.
“This is important because the risk of dementia increases with age, and Vietnam veterans are now getting old enough to start developing dementia,” study investigator Deborah Barnes, PhD, MPH, University of California, San Francisco, and the San Francisco VA Health Care System, told Medscape Medical News.
The study was January 25 in JAMA Neurology.
Jet Fuel Exposure Left Many Vietnam Vets Suffering From Long
During the Vietnam War, exposure to JP-4 jet fuel was widespread, as jet fuel was frequently combined with the powerful herbicide Agent Orange to destroy crops throughout the war. Agent Orange is now widely known to have long-term adverse effects on those exposed to it. On top of that, JP-4 jet fuel exposure can cause serious health problems, and many Vietnam veterans suffer due to exposure to the substance, along with the herbicide it was combined with.
Pursuing Compensation For Injuries From Weed Killer Exposure
If you or someone you love was exposed to a toxic weed killer like paraquat, Agent Orange or Roundup during military service or at any other time and has since been diagnosed with a serious medical condition like Parkinson’s disease, our consumer advocates at the Consumer Justice Foundation can help. We are committed to protecting the rights of consumers who have been adversely affected by defective or dangerous products and we can help put you in touch with a knowledgeable product liability lawyer who can explain your legal options. You may be entitled to compensation for your medical expenses, lost wages, diminished quality of life and other damages, which you can pursue by filing a product liability lawsuit against the weed killer manufacturer. Contact us today to find out how we can help.
Secondary Service Connection Explicitly Listed In Regulation
Some commenters suggest that the proposed regulation should include secondary conditions that result from disabilities presumptively service connected due to certain herbicide exposure. The commenters note that VA published a proposed rule establishing presumptive service connection for nine specific infectious diseases associated with military service in the Southwest Asia theater of operations and that the proposed rule listed secondary conditions potentially caused by those infectious diseases. 75 FR 13051-13058 . Furthermore, the commenters stated that when VA grants service connection for a primary disease, all secondary conditions proximately caused by that disease are also service connected. 38 CFR 3.310.
As the commenters correctly note, pursuant to 38 CFR 3.310, when VA grants service connection for a condition, all conditions proximately caused by that condition may also be service connected. This principle would apply to conditions where service connection is established by presumption or by other means, such as a direct link to incurrence during military service.
Consequently, VA makes no change based on these comments.
Understanding Va Disability Benefits For Parkinsons Disease
If you are a former military service member living with Parkinson’s Disease, you may be eligible for disability compensation through the United States Department of Veterans Affairs. There are a few steps that you will need to complete to receive these disability benefits.
It’s also important to note that Vietnam veterans may be eligible for benefits for Parkinson’s Disease related to Agent Orange exposure. This guide will go over all of these factors, so you can start your disability claim and receive compensation for your medical conditions.
Disability Benefits For Veterans With Parkinsons Disease
The minimum VA disability rating for Parkinson’s disease is 30%. However, you must consider other important factors that can increase this rating to 100%. While you may be awarded 30%, that rating alone may be incomplete.
The 30% rating is the starting point. It is vital to make sure the VA completes its rating and evaluates each of your symptoms associated with PD. The VA then should calculate your rating using the combined rating for each symptom. These may include:
- Tremors, rigidity, and slowness of movement in both upper and lower extremities
- Cognitive problems
- Facial muscle paralysis
F Comments Indicating General Support Of The Rulemaking
In addition to the nearly 400 comments received from the Parkinson’s community expressing support for the addition of Parkinson’s disease to VA’s presumptive list, VA received just over 100 additional comments that expressed support for the rulemaking in general. Many of these comments, which were received from individuals as well as public and private organizations, stated appreciation for VA’s actions in adding one or more of the three diseases to its regulatory list of conditions that are presumptively service connected based upon herbicide exposure in Vietnam. VA appreciates the time and effort expended by these commenters in reviewing the proposed rule and in submitting comments, as well as their support for this rulemaking.Start Printed Page 53207
Meeting Ssas Medical Listing For Parkinsonian Syndrome
With that in mind, the fastest way to win SSDI benefits for Parkinson’s is to qualify under SSA’s medical listing 11.06, Parkinsonian Syndrome. Qualifying under this listing requires detailed medical evidence. In brief, you need a diagnosis of Parkinson’s disease, supported by medical records of symptoms including:
- Significant rigidity
- Tremors in two extremities
Your symptoms should also show difficulty with fine motor skills, large motor skills, standing, or walking. In addition to various test results, SSA will require your doctors’ responses to targeted questions concerning your PD, as well as proof of your adherence to prescribed treatment.
If you meet or equal the requirements of the listing, SSA will find you are disabled without considering your age, education, and work experience.
Perceived Uncertainty Concerning The Definition Of Ihd
One commenter queried “what is ischemic heart disease”?
VA Response: VA’s definition of IHD in the proposed rule is based upon the accepted medical premise that, as stated in the preamble, IHD is “an inadequate supply of blood and oxygen to a portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen supply and demand.”75 FR 14393; See Harrison’s Principles of Internal Medicine . As previously stated, VA interprets IHD, for purposes of service connection, to encompass any atherosclerotic heart disease resulting in clinically significant ischemia or requiring coronary revascularization. In the notice of proposed rulemaking, we explained that the term “ischemic heart disease” does not encompass hypertension or peripheral manifestations of arteriosclerotic heart disease, such as peripheral vascular disease or stroke. To ensure that lay readers are aware of the distinction between these diseases, we are adding a Note 3 following 38 CFR 3.309 to include the information stated in the notice of proposed rulemaking.