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Vync

Asthma

18 posts in this topic

Please review my logic regarding an increase in SC rating. I am currently SC (6602) 10% for asthma bronchiole and would like to increase it above 10%.

Here is a snippet from 4.97 - Schedule of ratings - respiratory system

6602 Asthma, bronchial

FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications

100 %

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids

60 %

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication

30 %

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy

10 %

Note: In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record.

Here are the corticosteroid I was prescribed in my medical records

2009-12-16 Aristospan corticosteroid (Non-VA, for lumbar epidural injection)

2009-12-11 Asmanex 220 mcg - Mometasone furoate corticosteroid inhaler (VA)

2009-12-11 Nasonex 50 mcg - Mometasone furoate corticosteroid nasal spray (VA)

2009-11-03 Aristospan corticosteroid (Non-VA, for lumbar epidural injection)

2009-10-23 Asmanex 220 mcg - Mometasone furoate corticosteroid inhaler (VA)

2009-09-03 Asmanex 220 mcg - Mometasone furoate corticosteroid inhaler (VA)

2009-09-03 Prednisone corticosteroid (VA) *** 1 ***

2009-08-28 Nasonex 50 mcg - Mometasone furoate corticosteroid nasal spray (VA)

2009-04-07 Nasonex 50 mcg - Mometasone furoate corticosteroid nasal spray (VA)

2009-02-13 Nasonex 50 mcg - Mometasone furoate corticosteroid nasal spray (VA)

2009-01-15 Prednisone corticosteroid (VA) *** 2 ***

2009-01-06 Medrol corticosteroid (Non-VA) *** 3 ***

2008-12-01 Decadron corticosteroid (Non-VA)

2008-10-02 Prednisone corticosteroid (VA)

2008-09-10 Decadron corticosteroid (Non-VA)

2007-11-09 Prednisone corticosteroid (VA)

2005-05-24 Prednisone corticosteroid (VA)

2002-03-27 Prednisone corticosteroid (VA)

Note: I was prescribed Prednisone and Medrol corticosteroids orally three times within the last 12 months.

I also take a Singulair pill and a puff from my Albuterol inhaler daily.

Regarding Mometasone Furoate

The Asmanex 220 mcg instructions say to inhale once daily at bedtime.

The Nasonex 50 mcg instructions say to spray twice in both nostrils twice daily.

Inhaled

220 mcg

Nasal

50 mcg x 2 sprays x 2 nostrils x 2 times per day = 400 mcg

I'm getting 620 mcg of this stuff per day!

Without taking my Albuterol inhaler, I can blow about a 350-400 l/min on my peak flow meter. For my age (38) and height (68"), I should be normally pushing about 650 l/min, placing my lung capacity at about 54-61% of normal. If I take my Albuterol inhaler, things improve a good bit.

Please review and offer your recommendation as to the appropriate SC percentage.

Edited by Vync

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I'd prolly grant 30 on your puffer medications, or possibly higher based on your pulmonary function tests depending on your FEV1 or FEV1/FVC ratio, post-bronchiodialator (which is the measurement that counts).

Don't try and fake the pulmonary function tests. The doctors know, and they put things like "suboptimal effort" or "results not reliable."

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I'd prolly grant 30 on your puffer medications, or possibly higher based on your pulmonary function tests depending on your FEV1 or FEV1/FVC ratio, post-bronchiodialator (which is the measurement that counts).

Don't try and fake the pulmonary function tests. The doctors know, and they put things like "suboptimal effort" or "results not reliable."

JB,

That's why I noted the "or's" in bold. I know not to fake the PFT's. I have not had any PFT's in a while, but they did give me a free peak flow meter. Generally, when I test three times, the l/min each successive attempt reduces by 15-20%. I'm usually out of breath in three or four attempts.

I have a long history of asthma and exercise induced asthma. Big stack of papers and tests from the Army. I am currently being treated by my VA allergist, who has done a heck of a better job than anyone else.

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JB,

That's why I noted the "or's" in bold. I know not to fake the PFT's. I have not had any PFT's in a while, but they did give me a free peak flow meter. Generally, when I test three times, the l/min each successive attempt reduces by 15-20%. I'm usually out of breath in three or four attempts.

I have a long history of asthma and exercise induced asthma. Big stack of papers and tests from the Army. I am currently being treated by my VA allergist, who has done a heck of a better job than anyone else.

I'd file a claim TOMORROW with numbers like that, if it's a claim for increase.

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I'd file a claim TOMORROW with numbers like that, if it's a claim for increase.

Would I just fill out the regular claim form and then attach copies of my prescription lists from the VA and Wal-mart?

I know the VA has the doctor's Allergy exam notes in their computer (just got them about a week ago). Should I put together a list (like I did for the meds) of my recent doc visits?

I am beginning to recall the prednisone/medrol being given for something other than asthma (which actually helped my asthma too), but regardless, they got my on some strong inhaled/nasaled steroids which should warrant an increase anyhow.

What do you think?

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I think you are entitled to an increase to at least 60% based on what you stated. Keep in mind when the va is talking about asthma and steriods they are talking about steriod pills or shots prescribed for the asthma only. Any other steriod ( ie back injury) will not qualify. Also the va is more likely to rate based on the PFT and in reality a rating based on a PFT would be more permanent than a rating based on steriod use, unless steriod use is constant.

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