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    • Question about NOD wait time after applying.
      Maybe so Navy4life &I agree every case is different but plays out with the same format (so-to-speak)  trying to get a decision/ rather a win or a denial...of course we all hope for a win.  When a Veteran takes the evidence to a Hearing  that is clear cut &'' IF THE DRO READS IT'' & Listens, Then no reason for a denial, A DRO has the Authorization to make a decision and expedite the claim then and there. Also a veteran can have a good Idea how the DRO Hearing went before he/she leaves the Hearing,as to rather or not it was a favorable hearing the repore (so to speak)   you have with the DRO and how the hearing went....the veteran is usually contacted within a 30 days time frame on a good favorable Hearing. After your off the Record  the DRO usually lets you know what the decision is or if its going to be in your favor, if he don't do that and says I'll get back to you within 60 days...that to me means he can't decide your claim and is being look at by his peers or  in the upper courts  or if your 60 days has elapse and no word  they probably going to remand it to the BVA. Unfortunately things do get lost in space at the VA...When this happens the only advise I can't think of is to call them 2 or 3 times a week and bug the heck out of them. Member Gastone has experience with the DRO Maybe he can chime in if you don't believe me. Anything that gets in the way of a decision (stand in DRO Unexperienced )is a bad luck of the draw in my opinion... and the DRO can't decide just jams up the whole process, in your case another newbe DRO took your case and he/she could not decide your claim then and there...so you wait for a decision? The standard now days with the VA. No one can give a time as to how long it takes for  them to come to a decision and why they don't get back to the veteran giving an explanation . So we wait. jmo .............Buck
    • My C&P Results and why i'm disturbed
      Based on your post, this should be good news, as far as compensation goes.  Once service connected, the VA uses symptoms, and ROM is a key factor.   If you do get to where you can no longer work, then you should apply for TDIU.  However, it may not be necessary if your increases are sufficient to get you to 100 percent without TDIU.   90%, however, is a tough place to be at.   It takes an additonal 50 percent rating to go from 90 percent to 100 percent, because of the fuzzy math.  This, however, may vary depending on how you got your 90 percent.   If you had a combined 94 percent, rounded to 90, then it will take less than if you had a combined 86% rounded up to 90.  
    • Increase of MRSA from 0%-? unknown, having c&p exam on tuesday
      Your effective date will be the date the doctor says the increase occurred, or the date you applied (for increase), with some exceptions.  Many of these exceptions benefit you.  For example, if you apply within a year of exit from service, your effective date should be the date you exited service.  
    • Hypertension(high Blood Pressure)
      I too get 0% for my SC'd HBP.  Controlled with medicine. I'm currently trying to get secondary for heart disease because of a couple abnormal ecgs, etc.. Hamslice  
    • Is this a cue?
      I have not read your file, but, based on your post, yes.  I hope Berta will chime in.  You may be treading new ground on an important legal issue.   The trouble may be, however, by you cancelling the appeal.  Even when a VA employee lies to you, and you base your decision on a VA employee lies, you are still held accountable, but never the VA employee who lied.  If the VA employee were to take the stand, expect him/her to lie again, and say he never told you to withdraw the appeal.  There is almost zero chance the VA employee will ever take the stand against you, in no small part because they do not hold employees accountable.   One thing you could try is reinstating the appeal.  Again, this is new ground to my knowledge.(which is limited).  Berta has a newer VBM and I wonder if it addresses this issue.   If you have a claim and an appeal for the same thing, and they insist you can only have (1) of these at the same time (not true), then cancel the claim, not the appeal as the appeal will yield an earlier effective date.  They tried this same 3 card monte with me!!!  Fortunately, I was represented by a lawyer and Im an avid hadit/elder and reader,  and I did not take the bait.   The ruse is the VA is saying, "Gee, you have an appeal and a claim going for the same thing.  This is redundandt and save us some work by withdrawing one of these"....the implication here is that the other will be approved.  I understand completely why you chose to withdraw the appeal and not the claim, because appeals take longer.  But this is an effective date killer.  VA wanted me to "apply AGAIN for a claim the VA failed to adjuticate back in 2004, when I had already brought that issue for appealate review, and the BVA simply ignored it, as it was not adjuticated AGAIN, but denied in a "rating sheet" that Veterans are not privy to until the Veteran receives a copy of the RBA.  I have NOT withdrawn the appeal, so I posit my claim is still pending.   One way your lawyer may suggest is to simply, as you suggest, CUE the effective date, since you have been awarded benefits.  I dont know if that is the best route to go.  The only way to determine that is to have a great, experienced VA lawyer review your file, and apply the case law to it.  There is much $$ at stake here.   Your's may well be an interesting and precedent setting case for the VA to not try this farce again.  I hope you get an attorney and make em pay.   You and your NOVA attorney should review your file, and determine if you should file a CUE, a 3.156 to reopen, and/or both.  
    • "Blue Screen of Death" at VAOIG.
      Again.   It took at least one Veteran's death. The "Candy Man" kills with a coctail of 14 drugs, including multiple opiates:   This time: WASHINGTON — A Senate investigation of poor health care at a Veterans Affairs Medical Center in Tomah, Wis., found systemic failures in a VA inspector general’s review of the facility that raise questions about the internal watchdog’s ability to ensure adequate health care for veterans nationwide. The probe by the Senate Homeland Security and Governmental Affairs Committee found the inspector general’s office, which is charged with independently investigating VA complaints, discounted key evidence and witness testimony, needlessly narrowed its inquiry and has no standard for determining wrongdoing. Read full story here.SOURCE:  USA TODAY: http://www.usatoday.com/story/news/politics/2016/05/31/senate-probe-finds-systemic-failures-va-inspector-general/85063032/
    • Mental Health C&P
      jlduty, I know I'm only one of a million Vets getting the shaft, but knowing that sure doesn't make me feel any less penned in and segregated from the herd.  Learned this weekend that I now have one less person to talk to, he thinks I talk too much, rambling on, and so forth.  At what age does a son stop seeking his Father's approval? Or is that something that you either have or don't have? I can recall only 2 C&P exams that I felt good about, and they were the 2 that got me bumped up in the past year or so.
    • Sleep Apnea Claim
      Yeah, SA is pretty much a half or nothing, or all or nothing kinda deal.  Which is one of the main reasons the VA probably resists it so much. I think SA or OSA with out Cpap should be 30%, with = 50% and O2 added in should be 70-100%, or  something like that.   Semper Fi
    • Question about NOD wait time after applying.
      Buck; im sorry but inhale to disagree with you regarding 'if the DRO says he will get back to you in 60 days that's not good'. Several factors play out in a DRO hearing. Not all DRO's are the same. My case in point. I had a 'stand in' DRO. WACO told me after speaking to my DAV rep that they are back logged regarding getting a decision. Some hearings go well and they are decided right away. I know for a fact after my hearing my case basically went and sat on a desk awaiting a DRO to review it.  My DAV rep spoke to the DRO who held my hearing and they indicated they are looking at 6-12 months for a decision. i know many years ago you had a quick turn around but not the case for all.    Wayne; unfortunatley you have to go through the process Lima most of us that had a lousy rater. My rater never looked at the evidence. He took this one examiner's two sentence note stating my injuries were not S/C. That foot never even looked at me. This was a medical opinion!  I have the evidence and I have more evidence as well. I got a lot of advice on this site. I chose an informal hearing BTW.   YOU WILL HAVE TO LEARN PATIENCE WITH THIS PROCESS!!! i know you know you should have been rated and most of us are or have been in the same boat   I've been waiting since the day I filed back in November 2014  I did inquire after one year like I stated in my earlier response to you   best of luck!  

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ammodad

Respiratory Disability To Include Asthma And Copd

30 posts in this topic

my question is will they rate them both as one claim or separately because they both are separately diseases found out they have remanded the sinusitis but are going ahead and rating the asbestos exposure for the copd and asthma i could have sworn the guy at va told me they were counting them both as one or rating them both as one is that possible or will they both be rated separately is there any way to find out when asking them at the va they suddenly get forgetful or their computers are down and they can only see what you just mentioned.

and in the event they do rate them both as one how would they decide the percentage i know whey have a rating procedure they use or a way of doing things

Edited by ammodad

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They COPD and Asthma, I believe will be rated as one under

Respiratory.

They should apply the medical evidence of record to the diagnostic code

in the schedule that will provide the highest rating per the medical evidence.

JMHO

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=a38557b7a2cd96d2ba7924852468ed7b&rgn=div8&view=text&node=38:1.0.1.1.5.2.102.46&idno=38

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They COPD and Asthma, I believe will be rated as one under

Respiratory.

They should apply the medical evidence of record to the diagnostic code

in the schedule that will provide the highest rating per the medical evidence.

JMHO

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=a38557b7a2cd96d2ba7924852468ed7b&rgn=div8&view=text&node=38:1.0.1.1.5.2.102.46&idno=38

thank you for your response to my post it helped me understand it allot better and the link helped me as well i am presently rated at 60% i had and initial 20% they awarded me 50% for sleep apnea. they said they saw granduloma in the right helium and infiltrates this is along with the history copd , dyspnnea and asthma from looking at the chart it could go either way either the 60 or 100 {6602 Asthma, bronchial)6604 Chronic obstructive pulmonary disease)with the 60 i already have what would that take me to and by chance i get the 100 how would i figure that and what would that be haven't wrapped my head around that Chinese math yet i am sorry to seem to be asking you so many question do you get tired of ppl picking through your brain ???

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if your already rated at 50% for sleep apnea ... your not going to get another rating for asthma and copd. You will get one rating for all three

Rating coexisting respiratory conditions. Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. Where there is lung or pleural involvement, ratings under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic codes 6600 through 6817 or 6822 through 6847. A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.

ratings are listed here:

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=c130ec487ea61b8a40ad0836188b94bc&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38#38:1.0.1.1.5.2.102.46

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if your already rated at 50% for sleep apnea ... your not going to get another rating for asthma and copd. You will get one rating for all three

Rating coexisting respiratory conditions. Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. Where there is lung or pleural involvement, ratings under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic codes 6600 through 6817 or 6822 through 6847. A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.

ratings are listed here:

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=c130ec487ea61b8a40ad0836188b94bc&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38#38:1.0.1.1.5.2.102.46

ok i think i understand what your saying, but i am at 60% not 50% i had a previous rating at 20% and was awarded 50% for sleep apnea which took me to 60%now if i understand you correctly me being at 60% they aren't gonna rate my claims individually they are gonna rate them as one adding them to the 60% i already have and following the rating table they will rate it to the next highest int he category that reflects the medical evidence, which means what, whats the next possible rating for a person more than likely doomed to die sucking on oxygen tanks waiting to drown in my own juices .. not taking it out on you and not trying to give you a hard time brother just gets frustrating some times how do you place a value on a life and why do we have to be staring at death before they see us ????????????thanks for your advice and have a blessed day

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ok i think i understand what your saying, but i am at 60% not 50% i had a previous rating at 20% and was awarded 50% for sleep apnea which took me to 60%now if i understand you correctly me being at 60% they aren't gonna rate my claims individually they are gonna rate them as one adding them to the 60% i already have and following the rating table they will rate it to the next highest int he category that reflects the medical evidence, which means what, whats the next possible rating for a person more than likely doomed to die sucking on oxygen tanks waiting to drown in my own juices .. not taking it out on you and not trying to give you a hard time brother just gets frustrating some times how do you place a value on a life and why do we have to be staring at death before they see us ????????????thanks for your advice and have a blessed day

Hey, I know where you are coming from I am rated for asthma/COPD at 100% due to oxygen use, I also have sleep apnea that I haven't even request service connection for... If your rated for the asthma/copd and on oxygen you will be bumped up to 100%.

best of luck.....

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Your rating will be based on your results of a PFT.

To get 100 percent you need real low PFT readings or Be on 02 or Right side Heart Failure (Cor Pumonole) or Pulmonary HTN and I promise you Brother you dont want the last 2 conditions.

Basser

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Your rating will be based on your results of a PFT.

To get 100 percent you need real low PFT readings or Be on 02 or Right side Heart Failure (Cor Pumonole) or Pulmonary HTN and I promise you Brother you dont want the last 2 conditions.

Basser

Not trying to be nit picky, but with COPD a finding of right ventricular hypertrophy will get you the 100% also(but not Asthma). It is an important distinction. I have right ventricular hypertrophy(on ECG), but do not have a medical diagnosis of Core Pumonole. I have SC for arthritis and lumbosacral/cervical strain with kyphoscoliosis on x-ray and MRI and am fighting for the Respiratory service connection for a seperate 100% under kyphoscoliosis with right ventricular hypertrophy. My PFT's are un-remarkable, but the ratings schedule does not require a bad PFT in conjunction with RVH.

If Ammodad has right ventricular hypertophy or is on O2 and can prove/or has service connection for COPD he should be rated under that code instead of sleep apnea. Sleep apnea does not get the 100% rating for O2 or RVH.

Best regards,

Edited by 71M10

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I left the RVH out.

Oh well cant win them all can we.

Your spine rating should due to respitory insufficiency.

Mine is related to the Cervical spine. Nerve Paralysis. Diaphragm.

My problem is Pulmonary HTN.

Good Luck on your claim.

Basser

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I left the RVH out.

Oh well cant win them all can we.

Your spine rating should due to respitory insufficiency.

Mine is related to the Cervical spine. Nerve Paralysis. Diaphragm.

My problem is Pulmonary HTN.

Good Luck on your claim.

Basser

Patiently waiting, they are just about out of dodges and will soon have to address the issue. They screwed up because all of it was listed as evidence in prior decisions.

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ammodad,

This is late but if you are still waiting for your decision, Teac and jbasser are correct. All of those conditions; sleep apnea 6847, dyspnea (a symptom), asthma 6602 and chronic obstructive pulmonary disease 6604, will be rated together and you will get the highest from all conditions. Usually based on the results of a PTF pulmonary function test. So you are not maxed at 50% for sleap apnea, you may rate higher for your COPD.

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hello , once again. just got back from va exam feb 27th for sinusitus and Allergic rhinitis. they approved my claim for the asthma and copd do to asbestos exposure now awaiting rating on the sinus and rhinitus portion now that i am at the 70 % was tryin to figure next posible rating withthem thats kind of hard to do thanks for all of you guys support and knowledge it means allot and i truely mean that without you guys would have freaked out along time ago and my wife thanks you all also if we stand as one they cant iggnor us

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My question is why wasn't I rated with both COPD and Asthma in 1992 when diagnosed? Also any other insights into this situation would be appreciated. I have yet to file a nod etc.. Just trying to figure out where I'm at. Thanks

My Compensation was raised from 10% to 60%, going from just a 10% asthma rating to a combined rating of asthma/COPD 60%.

Asthma was diagnosed in 1988 two years prior to discharge with an ICD code of 493..90.

COPD was diagnosed in 1992 with an ICD code of 496.

This C & P exam was the first time I had ever heard COPD mentioned during the exam. I cannot find it in my medical records but the information was noted that it was taken from my C-File.

PFT results from C & P April 5, 2012

Pre-bonchodilator: Post-bronchodilator, if indicated

FVC: 70 % predicted FVC: 84 % predicted

FEV-1: 60 % predicted FEV-1: 74 % predicted

FEV-1/FVC: 78 % predicted FEV-1/FVC 68 % predicted

DLCO: 102 % predicted DLCO: % predicted

For this C & P they used the FEV-1% Predicted to determine level of disability.

As far as Medications: Oral or parenteral corticosteroid medication. (intermittent), inhalation bronchodilator therapy daily, anti-inflamatory medication daily, albuterol, Symbicort, Albuterol nebulizer as well as oral bronchodilators daily.

If anyone could shed any light on this information or explain why I did not have a combined rating since 1992 I would appreciate it. Thanks for your time.

Edited by casscntyman

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Hello Casscytman,,,,,, There may be an issue with the rating because of the pyramiding rules of VA to keep the lung issues to a minumum for the higher ratings. It is possible to have more than one disease of the respiratory system and if you have core pulmonale or Pulmonary hypetension then the COPD jumps to 100 percent so keep an eye out on your heart. You may be able to file an NOD back to your Earliest Effective Date but it may take an IMO linking that to move it.

Jbasser and Teac are smmoooooth right.

Also some of the problems that many Veterans face with diseases is the possibility that SECONDARY issues can be linked to rateable diseases. That will take IMOs and strong evidence but we have seen that with many of our members so don't forget that track of direction. NEVER GIVE UP . God Bless, C.C.

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My question is why wasn't I rated with both COPD and Asthma in 1992 when diagnosed? I cannot tell you why you think that you were not service connected for both in 1992. However, I suspect that the narrative in the Rating Decision from 1992 stated that both were service connected, with the 10% evaluation based on the then current tests.

Also any other insights into this situation would be appreciated. As another poster noted, there may be (actually, read that there is) a problem with pyramiding (38 CFR 4.14 http://www.benefits....PART4/S4_14.DOC ).

Additionally, I direct you to 38 CFR 4.96.a. http://www.benefits....PART4/S4_96.DOC . The Diagnostic Code (DC) for Asthma is 6602 and the DC for COPD is 6604. So, you will not receive two separate ratings, though the next higher step per 4.96a may be coming into play here.

Whether or not there was an incorrect evaluation back in 1992 depends on the Rating Criteria in effect then. Although I don't care to dig that up, I suspect they would be very similar to today's criteria.

I have yet to file a nod etc.. The current evaluation appears to be correct. If you are contemplating a Notice of Disagreement for the 1992 evaluation, you are far, far too late: that window closed in 1993.

Your only other recourse would be the Clear and Unmistakable Error (CUE). Though, before you go firing that gun, you need to find the 1992 Rating Criteria and review the examination or other data that justified that 10% award in 1992.

My question is why wasn't I rated with both COPD and Asthma in 1992 when diagnosed? Also any other insights into this situation would be appreciated. I have yet to file a nod etc.. Just trying to figure out where I'm at. Thanks

My Compensation was raised from 10% to 60%, going from just a 10% asthma rating to a combined rating of asthma/COPD 60%.

Asthma was diagnosed in 1988 two years prior to discharge with an ICD code of 493..90.

COPD was diagnosed in 1992 with an ICD code of 496.

This C & P exam was the first time I had ever heard COPD mentioned during the exam. I cannot find it in my medical records but the information was noted that it was taken from my C-File.

PFT results from C & P April 5, 2012

Pre-bonchodilator: Post-bronchodilator, if indicated

FVC: 70 % predicted FVC: 84 % predicted

FEV-1: 60 % predicted FEV-1: 74 % predicted

FEV-1/FVC: 78 % predicted FEV-1/FVC 68 % predicted

DLCO: 102 % predicted DLCO: % predicted

For this C & P they used the FEV-1% Predicted to determine level of disability.

As far as Medications: Oral or parenteral corticosteroid medication. (intermittent), inhalation bronchodilator therapy daily, anti-inflamatory medication daily, albuterol, Symbicort, Albuterol nebulizer as well as oral bronchodilators daily.

If anyone could shed any light on this information or explain why I did not have a combined rating since 1992 I would appreciate it. Thanks for your time.

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I was discharged in January 1990 with 10% SC Asthma. I believe I should have been at least 30%. I also had an issue with passing out/seizures over the course of time beginning 1988 forward. I was given a consult towards the end with Neurology but never received the exam before discharge. I now have sleep apnea with possible Narcolepsy which was mentioned by a doctor in 1988. Is all of this too long ago to be considered. I had a young wife and brand new baby at the time and was just confused by all of this going on to put it all in perspective. Any thoughts on this. I would appreciate it.

I was discharged on Jan. 01, 1990. On Nov 3rd, 1989 taking Theodore, Azmicort and Alupent, for Bronchial Asthma. Give round of Prednisone 40, 35, 30, 25, down to 10. My record was closed December 26 for medical discharge.

During last the period of 1989-1990 had several rounds of Prednisone.

16 Oct 1989 PFT's after Proventil inhaler.

Baseline

FVC 3.41 5.22

FEV 2.88 4.19

FEF 25-75 2.7OLPS 3.78

Note: Considerable cough during PFT's.

***Prescribed in home Nebulizer for daily home use with Alupent solution.

Oct 5th, 1989

Clinic Consult Wheezing and Sub S/P, Mild improvement on Alupent, Theodore, Humibid and E-Mycin. Peak flow-420

Throughout the period of 1988-1990 when discharged was repeatedly in the clinic for treatment for bronchitis, Asthma etc.

December 2nd, 1988 consult for passing out 5 times that year. Given Neurology Consult with provisional diagnosis of seizure disorder.

June 28,1988 another episode of passing out, Dr. thinks Narcolepsy which my current sleep disorder lab listed as highly likely with sleep apnea and put on CPAP.

October 15th 1984 Rolled down 30 foot stone hill in 29 Palms, California. Abrasion/Head Trauma with mild concussion.

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While researching my files and medical records I believe I should have been rated completely differently on medical discharge. My original rating is scratched out and hand written in is the 10% rating. (I have quoted material that leads me to this conclusion in this forum previously)

While going to the CFR on your pyramiding concerns I am still a bit confused. COPD and Asthma are very different things. Yes both involve the lungs and do have some of the same symptomatology . In asthma air flow issues are reversible. In COPD partially reversible. Age is significant, asthma is generally diagnosed early in life. COPD is diagnosed much later in life with a history of smoking. In asthma differences in FEV-1 return to normal between attacks. In COPD they generally do not.

At the date of my medical discharge at the age of 26 my FEV-1 is the same as my last PFT/CP Exam taken in 2011. Which is the basis for a COPD diagnosis.

I guess what I am confused about is why after all of these many PFT exams did not an examiner note, notice or figure it out. It wasn't diagnosed till 1988 but I was still given all the meds related to the COPD, several of which are almost exclusively for COPD since almost the date of discharge.

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On an aside, there's a great deal of Peculiar stuff going on in Cass County. Now, on to you ...

While researching my files and medical records I believe I should have been rated completely differently on medical discharge. My original rating is scratched out and hand written in is the 10% rating. (I have quoted material that leads me to this conclusion in this forum previously)

You cannot always use the current Rating Schedule for a Rating Decision done in 1992. While Rating Criteria for some conditions have not changed at all through the years, some/many have.

For example, 38 CFR Pt 4 Appendix A http://www.benefits....pp_a.DOC shows that criteria for DC 6602 were changed in 1975 and 1996. And, COPD (DC 6604) as a separate issue was not even in the Rating Schedule until 1996.

If you want to see the DC 6602 criteria in effect in 1990/1992, I suggest you look at 40 FR 42539, Sept. 15, 1975; or, perhaps 41 FR 11300, Mar. 18, 1976.

Whether that 10% evaluation was correct or incorrect depends upon, guess, the Rating Criteria in effect way back when.

And, as I earlier wrote, the door for an NOD closed sometime in 1993.

While going to the CFR on your pyramiding concerns I am still a bit confused. COPD and Asthma are very different things. (snip)

Thank you so very much for the education. However, it is moot.

Although you refer to pyramiding, you apparently did not consider the other reference I provided, 38 CFR 4.96a. http://www.benefits....PART4/S4_96.DOC . Now remembering that the Diagnostic Code (DC) for asthma is 6602 and COPD is 6604, here are the salient points of 4.96a:

(a) Rating coexisting respiratory conditions. Ratings under diagnostic

codes 6600 through 6817 and 6822 through 6847 will not be combined

with each other. ... (snip) ... A single rating will be assigned under the

diagnostic code which reflects the predominant disability with elevation

to the next higher evaluation where the severity of the overall disability

warrants such elevation. (snip)

If you have a problem with this, I suggest you contact your Senators and or Representatives, share your knowledge with them, and ask that they propose changes to the law.

At the date of my medical discharge at the age of 26 my FEV-1 is the same as my last PFT/CP Exam taken in 2011. Which is the basis for a COPD diagnosis. Again, you need to refer to the criteria in the Rating Schedule in effect in 1990. To restate what I mentioned earlier, I see no purpose for me to find that for you.

I guess what I am confused about is why after all of these many PFT exams did not an examiner note, notice or figure it out. It wasn't diagnosed till 1988 but I was still given all the meds related to the COPD, several of which are almost exclusively for COPD since almost the date of discharge. The fact that DC 6604 was not a separate DC until 1996 may be a clue. Also, I believe that 38 CFR 4.96a has some bearing.

While researching my files and medical records I believe I should have been rated completely differently on medical discharge. My original rating is scratched out and hand written in is the 10% rating. (I have quoted material that leads me to this conclusion in this forum previously)

While going to the CFR on your pyramiding concerns I am still a bit confused. COPD and Asthma are very different things. Yes both involve the lungs and do have some of the same symptomatology . In asthma air flow issues are reversible. In COPD partially reversible. Age is significant, asthma is generally diagnosed early in life. COPD is diagnosed much later in life with a history of smoking. In asthma differences in FEV-1 return to normal between attacks. In COPD they generally do not.

At the date of my medical discharge at the age of 26 my FEV-1 is the same as my last PFT/CP Exam taken in 2011. Which is the basis for a COPD diagnosis.

I guess what I am confused about is why after all of these many PFT exams did not an examiner note, notice or figure it out. It wasn't diagnosed till 1988 but I was still given all the meds related to the COPD, several of which are almost exclusively for COPD since almost the date of discharge.

Edited by jvretiredvet

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Well it appears that I am not the only one that was kinda shafted on medical retirement. I was medically retired at age 32 after having over 15 years service for asthma... at the time of my retirement physical I was diagnosed with COPD secondary to Asthma. At 32 years old I neither knew or cared that Asthma and COPD were separate diseases. I was given 10% for the Asthma and a couple of other medical issues insured a total of 30% for the medical retirement. ( I normally would do a return and start a new paragraph here but for some reason return does not work in hadit anymore since I went to win8) so.... when I went to the va I was awarded 30% just for the asthma. This is a prime example of why congress now makes it possible for those discharged under 30% to get a second look at the medical record and appeal the initial finding as the military was and still does low ball veterans on retirement. Any way it wasn't until almost 20 years after my retirement that I realized that COPD was a different condition apart from the asthma. I applied for a rating for the COPD and it was granted as a separate award of 30%. Ironically, by 2006 I was rated 60% for the asthma, and as has been pointed out legally the va can not grant two separate ratings for asthma and Copd. I appealed the decision under CUE and it was corrected granting 60% for asthma with COPD combined. ................................................................................ I am now at 100% because of the use of oxygen... You can still try to appeal the initial decision using CUE but it will not do you any good because as was stated the cannot be rated separately, and regardless about bumping the asthma rating up to the next rating that is only done on a case by case basic, and only if you meet the qualifications of the next higher rating... Also COPD is not decided base on the PFT alone. you would need to show that bronco dilators do not have any effect .. ( that is if your inhaler doesn't work or relieve the symptoms) and that the before and after inhaler use is the same on PFT's.... There are also other test for this such as blood oxygen etc. As far as why you were not rated for both on discharge wll your guess is as good as ours...... ( as a side note, if I was not diagnosed with copd on retirement I am not so sure I would have gotten a combined rating 20 years later.. and for the record I never smoked).

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I realize this is an Asthma/COPD venue but this speaks to my previous posts in a way. I apologize in advance,

First this is a 2002 claim that I did through the DAV rep at the KCMO VA. I really did not know anything so I just went in filled out the paperwork and forgot about it. That being said, this decision is not making a lot of sense to me.

They stated that I wasn't going to the VA and wasn't taking my meds to warrant the increase to 30%. I was in the VA that month and I reordered my meds. I was taking Flunisolide 2x day, Albuterol as needed, Montelukast, Raberazole, Prozac. I was also using a Nebulizer twice a day and always.

have.

It also stated I continue to smoke cigarettes. I never have. They also stated I hadn't been to the pharmacy since 1989 which is good because I was still serving in the Marine Corps in Norfolk Va. till I was discharged in Jan. of 1990.

All of this information I have from my old SMR's I pulled out of the barn. It should have been easily available at the KCVA.

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I realize this is an Asthma/COPD venue but this speaks to my previous posts in a way. I apologize in advance,

First this is a 2002 claim that I did through the DAV rep at the KCMO VA. I really did not know anything so I just went in filled out the paperwork and forgot about it. The decision is not making a lot of sense to me. They stated that I wasn't going to the VA and wasn't taking my meds to warrant the increase to 30%. I was in the VA that month and I reordered my meds. I was taking Flunisolide 2x day, Albuterol as needed, Montelukast, Raberazole, Prozac. I was also using a Nebulizer twice a day and always have.

It also stated I continue to smoke cigarettes. I never have. They also stated I hadn't been to the pharmacy since 1989 which is good because I was still serving in the Marine Corps in Norfolk Va. till I was discharged in Jan. of 1990.

For that matter I should have been 30% at discharge. I know that now of course.

Also since I was diagnosed with COPD in 1992, does the Veterans Claims Assistance Act come into play for me. Do I need to follow that process or wait or am I even eligible.

Edited by casscntyman

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Welcome to the Club! You appear to have had the same mentality I did when I left the service. You (as did I) thought you were dealing with the VA, and the VA was there to do the right thing for veterans. You had a young family - needed to move on- so like a good Marine (or Soldier) you sucked it up and dealt with it, accomplish the mission (raising family and providing for family). I suspect the decision they gave you was very light on details and they made it sound as if the minimal rating they gave you for Asthma was very generous. 20 years down the road, your body is going to Hell in a handbasket, so you start finding out whats wrong and Doctors start indicating this didn't happen overnight. You dig into your service medical records and your initial VA Decision/s (that was a wait to get the details on those wasn't it), and you see that 20 years ago they wern't concerned with doing the right thing, they were concerned with making you go away quitely with as little as possible. What angers you is that it is quite apparent they lied, besmirched your character, and invented stuff to make thier decision look reasonable!

My story:

In 88 they SC me for a "Bone Condition" rated it 0%. On my exam paperwork I had asked them for a chest xray, ekg and stress test because of multiple physician appointments with specialists done before they would release me.

20 years later I find out, my VA Xrays showed arthritis through-out my thoracic spine. (by regulation they were supposed to survey all major joints and groups of minor joints -THEY DIDN'T). My SMR's had a definative diagnosis of Hypertension and Two physicians were arguing on the margins of my xray report whether I had right atrial enlargment and I had a bad EKG(middle of service). The exit physical with three sets of xrays and a visit to a cardiologist....It is no where to be seen. Detroit VARO signed for those records ---but they are gone!

I sure wish some of these new veterans charities -- the ones advertising on TV, would spend some of that advertising time while they are fundraising to point out the VA isn't doing the JOB and we have to step in to help. I sure wish they would would take 15-20 seconds of that commercial to say we need your help because when Sgt John Smith injured his lungs in combat the VA told him that they couldn't award his claim for a hysterectomy. Or we can't award you for the peice of hand grenade shrapnal lodged in your spine because you don't have any service medical records proving the injury. Some of this STUPID stuff the VA is doing needs broad exposure.

I wonder if John Stuart would add a Segment to his show, he could call it VA Logic, or I'm from the Government and here to help!

Sorry long post and Im all over the map --- must be the pain meds!

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I realize this is an Asthma/COPD venue but this speaks to my previous posts in a way. I apologize in advance,

First this is a 2002 claim that I did through the DAV rep at the KCMO VA. I really did not know anything so I just went in filled out the paperwork and forgot about it. The decision is not making a lot of sense to me. They stated that I wasn't going to the VA and wasn't taking my meds to warrant the increase to 30%. I was in the VA that month and I reordered my meds. I was taking Flunisolide 2x day, Albuterol as needed, Montelukast, Raberazole, Prozac. I was also using a Nebulizer twice a day and always have.

It also stated I continue to smoke cigarettes. I never have. They also stated I hadn't been to the pharmacy since 1989 which is good because I was still serving in the Marine Corps in Norfolk Va. till I was discharged in Jan. of 1990.

For that matter I should have been 30% at discharge. I know that now of course.

Also since I was diagnosed with COPD in 1992, does the Veterans Claims Assistance Act come into play for me. Do I need to follow that process or wait or am I even eligible.

Not sure about what you me " do I need to follow that process or wait ".

If you presently have copd and you have never requested service connection, do not wait on the va or that matter anyone to do anything for you.

I was diagnosed with asthma in 1972, COPD in 1986

I was medically retired in 1986 and never received rating for COPD until 2005 . I reviewed my active duty medical records in 2005 after a doctor told me I had copd. I never realized in 1986 that asthma and COPD were different diseases. I had to go for another C/P exam, but gave the doctor a copy of my retirement exam and he indicated in the va medical record that COPD was diagnosed on active duty in 1986. In 2007 I went on oxygen.

If you wait to get rated for COPD than you could lose thousand of dollars in compensation. For years I had copd, and no-one ever questioned why half of my meds never worked. It was a smart doctor in Fort Gordon that determined I needed oxygen ..prior to that I was told being short of breath was normal for some one with asthma.

So like I said if you haven't been rated for COPD... you need to file a claim. You will still only have one combined rating asthma/copd.. but depending on the complicaitons you have could be the difference between a 30% rating and a 100% rating....

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I finally received my C-File in the mail. What there is of it. As I have said earlier I should have been discharged 30% at discharge in 1990. Enough of that.

Respiratory (Obstructive, Restrictive, and Interstitial) Exam. December 17, 2002

Examining Provider: Vanbuskirk, Terry

Examination Results

"The patient's C-file and, in particular, his compensation and pension March 1994 examination was reviewed. The patient is 10% service-connected reference bronchial asthma. The Kansas City VA hospital progress note of May 2002 indicates that the patient is on Combivent with a sig of 2 qid (however, the patient used to use approximately two to six times a day) from the Kansas City VA Hospital plus Singulair 10 one in the AM plus Advair (from his private physician) one bid; however, for financial reasons the patient has not been on any inhalers for the past one month. The patient states that his dyspnea requires more medication to control same. The patient can breathe in but he cannot breathe out. The patient has minimal cough except at night. The patient denies ever smoking. The patient's weight has increased 40 lbs in the past one year. The patient has chronic chest tightness however, if he exercises (or with summer allergies), he has exacerbations approximately once a day.

Auscultation and percussion of the patient's lungs discloses slight inspiratory and particularly expiratory, wheezing. The patient has no typhoscoliosis or pectus excavatum.

Today we will obtain pulmonary function tests and chest x-ray.

Diaganosis: Bronchial asthma."

The C-file I received has none of the information in it concerning the above. There is one page where Dr. Charoac acknowledges I was a patient. I have had numerous PFT's since my discharge in 1990 COPD has been mentioned twice in PFT's and C & P's in regards to Diagnosis. The radiologist almost all say yes. The doctors interpreting the PFT'S say yes. The final time was in 2012 when Dr. Johnson Underwood stated on

07-26-2012 Addendum

"The veteran has COPD onset in 1992. The Veteran is a non smoker according to the VA records. The Veteran has Asthma. It is at least as likely as not that the Veterans asthma condition is the cause of his COPD."

During this C & P it asks if I was diagnosed with sleep Apnea and/or Narcolepsy and if so complete the Questionnaire. He stated I wasn't. I was diagnosed with Sleep Apnea on 10/27/11 by a sleep study at an independent hospital the VA sent me two. I was prescribed a very expensive CPAP machine at that time.

In my C-file there is no mention of this 1992 C & P PFT that this doctor as well as the one above is reading. They state they have read my civilian doctors notes. They are non-existent in my file. It hasn't been that long ago. I don't believe I was given the COPD rating until this C & P when this doctor stated it is more likely than not. Then they combined the rating and gave me 60%, which still has some pyramiding issues. In 1994 the rater said there was no evidence I was taking my meds etc. when obviously the letters must have been there because as recently as 2012 during my last PFT they noted them. So the information is there, then its gone, then it reappears.

There is nothing in my C-file but copies of PFT's and Rating decisions, my original discharge information and a few tests. There is not one handwritten note of any kind. No work product that would allow you to make any sense out of the material if you didn't already have all of your records from 1990 forward (for the most part).

I'm not sure how to put this all together where it is easy to understand and follow. My original representative wasn't that interested. He even said "you know you can get in serious trouble for lying about smoking". I can just file a NOD the best way I can and then get a lawyer I suppose.

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It seems to me since the examiner stated "as likely as not" you should be rated for the copd & asthma together.

Of course the actual rating would depend on what medications your are using oral steroids( not to be confused with inhalant steroids), and PFT. IN the case of COPD the DCLO part of the PFT will help determine how bad the copd component is... No matter how hard you try or what you may think you are still only going to get one rating for the asthma & COPD. If you use oxygen or have other more serious complications you will be rated at 100%.

Presently, it seems you have not been rated for the COPD , you do have a valid claim for CUE, that is clear and unmistakable error, because based on the statement " likely as not" you should received the benefit of doubt by law and be rated for the COPD if you have not already been rated.

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I finally received my C-File in the mail. What there is of it. As I have said earlier I should have been discharged 30% at discharge in 1990. Enough of that.

Respiratory (Obstructive, Restrictive, and Interstitial) Exam. December 17, 2002

Examining Provider: Vanbuskirk, Terry

Examination Results

"The patient's C-file and, in particular, his compensation and pension March 1994 examination was reviewed. The patient is 10% service-connected reference bronchial asthma. The Kansas City VA hospital progress note of May 2002 indicates that the patient is on Combivent with a sig of 2 qid (however, the patient used to use approximately two to six times a day) from the Kansas City VA Hospital plus Singulair 10 one in the AM plus Advair (from his private physician) one bid; however, for financial reasons the patient has not been on any inhalers for the past one month. The patient states that his dyspnea requires more medication to control same. The patient can breathe in but he cannot breathe out. The patient has minimal cough except at night. The patient denies ever smoking. The patient's weight has increased 40 lbs in the past one year. The patient has chronic chest tightness however, if he exercises (or with summer allergies), he has exacerbations approximately once a day.

Auscultation and percussion of the patient's lungs discloses slight inspiratory and particularly expiratory, wheezing. The patient has no typhoscoliosis or pectus excavatum.

Today we will obtain pulmonary function tests and chest x-ray.

Diaganosis: Bronchial asthma."

The C-file I received has none of the information in it concerning the above. There is one page where Dr. Charoac acknowledges I was a patient. I have had numerous PFT's since my discharge in 1990 COPD has been mentioned twice in PFT's and C & P's in regards to Diagnosis. The radiologist almost all say yes. The doctors interpreting the PFT'S say yes. The final time was in 2012 when Dr. Johnson Underwood stated on

07-26-2012 Addendum

"The veteran has COPD onset in 1992. The Veteran is a non smoker according to the VA records. The Veteran has Asthma. It is at least as likely as not that the Veterans asthma condition is the cause of his COPD."

During this C & P it asks if I was diagnosed with sleep Apnea and/or Narcolepsy and if so complete the Questionnaire. He stated I wasn't. I was diagnosed with Sleep Apnea on 10/27/11 by a sleep study at an independent hospital the VA sent me two. I was prescribed a very expensive CPAP machine at that time.

In my C-file there is no mention of this 1992 C & P PFT that this doctor as well as the one above is reading. They state they have read my civilian doctors notes. They are non-existent in my file. It hasn't been that long ago. I don't believe I was given the COPD rating until this C & P when this doctor stated it is more likely than not. Then they combined the rating and gave me 60%, which still has some pyramiding issues. In 1994 the rater said there was no evidence I was taking my meds etc. when obviously the letters must have been there because as recently as 2012 during my last PFT they noted them. So the information is there, then its gone, then it reappears.

There is nothing in my C-file but copies of PFT's and Rating decisions, my original discharge information and a few tests. There is not one handwritten note of any kind. No work product that would allow you to make any sense out of the material if you didn't already have all of your records from 1990 forward (for the most part).

I'm not sure how to put this all together where it is easy to understand and follow. My original representative wasn't that interested. He even said "you know you can get in serious trouble for lying about smoking". I can just file a NOD the best way I can and then get a lawyer I suppose.

cass,

I had to delete the file you uploaded as it had your real name and SSA # on it.

You are welcome to make a copy of the upload - mark out personal info like name claim / SSA

number etc . . . and re-attach the file.

Too bad you missed the C&P appointment that the VA had scheduled,

it more likely than not would have been helpful.

§ 3.655 Failure to report for Department of Veterans Affairs examination.

(a) General. When entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination, or reexamination, action shall be taken in accordance with paragraph (b) or © of this section as appropriate. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. For purposes of this section, the terms examination and reexamination include periods of hospital observation when required by VA.

(b) Original or reopened claim, or claim for increase. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a reopened claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied.

© Running award.

(1) When a claimant fails to report for a reexamination and the issue is continuing entitlement, VA shall issue a pretermination notice advising the payee that payment for the disability or disabilities for which the reexamination was scheduled will be discontinued or, if a minimum evaluation is established in part 4 of this title or there is an evaluation protected under § 3.951(b) of this part, reduced to the lower evaluation. Such notice shall also include the prospective date of discontinuance or reduction, the reason therefor and a statement of the claimant's procedural and appellate rights. The claimant shall be allowed 60 days to indicate his or her willingness to report for a reexamination or to present evidence that payment for the disability or disabilities for which the reexamination was scheduled should not be discontinued or reduced.

(2) If there is no response within 60 days, or if the evidence submitted does not establish continued entitlement, payment for such disability or disabilities shall be discontinued or reduced as of the date indicated in the pretermination notice or the date of last payment, whichever is later.

(3) If notice is received that the claimant is willing to report for a reexamination before payment has been discontinued or reduced, action to adjust payment shall be deferred. The reexamination shall be rescheduled and the claimant notified that failure to report for the rescheduled examination shall be cause for immediate discontinuance or reduction of payment. When a claimant fails to report for such rescheduled examination, payment shall be reduced or discontinued as of the date of last payment and shall not be further adjusted until a VA examination has been conducted and the report reviewed.

(4) If within 30 days of a pretermination notice issued under paragraph ©(1) of this section the claimant requests a hearing, action to adjust payment shall be deferred as set forth in § 3.105(h)(1) of this part. If a hearing is requested more than 30 days after such pretermination notice but before the proposed date of discontinuance or reduction, a hearing shall be scheduled, but payment shall nevertheless be discontinued or reduced as of the date proposed in the pretermination notice or date of last payment, whichever is later, unless information is presented which warrants a different determination. When the claimant has also expressed willingness to report for an examination, however, the provisions of paragraph ©(3) of this section shall apply.

(Authority: 38 U.S.C. 501)

Cross References: Procedural due process and appellate rights: See § 3.103. Examinations: See § 3.326. Reexaminations: See § 3.327. Resumption of rating when veteran subsequently reports for VA examination: See § 3.330.

[55 FR 49521, Nov. 29, 1990; 58 FR 46865, Sept. 3, 1993]

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=d19bf832eb2c623d379c46f29dc37be8&rgn=div8&view=text&node=38:1.0.1.1.4.2.73.206&idno=38

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I would like to say that you are right ma'am I should have made that first C & P appointment in 2002. I should have realized much earlier that it was my responsibility to take care of my health and pursue any avenue available to me to prevent further harm to my body. For my sake and my children's. I regret that and hope I don't appear like I am not thankful for what the VA has done for me, what the people in the forums do for me. I am thankful and all of you have my gratitude, you really do.

Having missed the first C & P Exam I received a Rating Decision dated 11/15/2002. I have had to reproduce them by typing. I don't have a scanner or a means to get it done.

"Issue: Evaluation of bronchial asthma currently evaluated as 10 percent disabling.

Evidence:

Statement from S. Charochak D.O. received 09-23-2002.

You failed to report for a VA examination scheduled at VA Medical Center Kansas City on 10-18-02.

Evidence expected from this examination which might have been material to the outcome of this claim could not be considered.

Evidence from VA Medical Center Kansas City for the period 05-14-02 to 05-31-02.

Decision:

Evaluation of bronchial asthma, which is currently 10 percent disabling, is continued.

Reasons and Basis:

You did not report for the scheduled VA examination.

Dr. Charochak indicated that he did not have treatment reports for you for the period you indicated, June 1999 to June 2000.

The evidence from VA Medical Center shows that you continue to have complaints of shortness of breath, for which you continue to use inhalant therapy. You continue to smoke cigarettes.

The evidence fails to show this condition has increased in severity to the point where the next higher evaluation of bronchial asthma is continued as 10 percent disabling.

An evaluation of 10 percent is granted whenever there is forced expiratory volume in one second (FEV-1) of 71-80 percent of predicted value; or intermittent inhalation or oral bronchodilator therapy.; or inhalation anti-inflammatory medication."

______________________________________________________________________________

Pulmonary Function Test Scores

FEV1 3.28 4.56 72% 3.82 84% 16% change

FEV1/FVC 69 80 75 9% change

Physician Interpretation: FVC is normal, FEV1 is reduced, FEV1/FVC ratio is reduced, Midflows

are reduced.

Post-Bronchodilator Spirometry was improved.

Rv is increased, TLC is normal, Diffusing capacity is normal

Impression: Spirometry and lung volumes consistent with mild obstructive defect, mild air trapping and mild improvement after.

Naresh K Kodwani Staff Physician

Findings: PA and lateral views of the chest were obtained at 9:44 am on 12/17/2002. The heart is normal in size and configuration and both lungs are clear. No Pleural Effusion or Pneumothorax is seen. There is flattening of the diaphragms bilaterally consistent with chronic obstructive pulmonary disease.

Impression: Chronic Obstructive Pulmonary Disease with no acute Pulmonary infiltrate seen.

Primary interpreting Staff:

Craig M. Watts MD, Staff Radiologist (Verifier)

Medications:

My feelings, not VA Law, Regulations or Rules.

1. Failure to report to an examination was a routine appointment with my primary care physician, no

more than that.

2. There is no information in my C-File other than a VA Form 21-4142 typed up with my

information and Dr. Charochak's information asking for records between 06/00 and 06/99. The

form hasn't been signed by myself or a VA Representative. One other related letter dated Aug

19, 2002 simply states the need for any records of treatment. One small note on that page has

a star next to it stating "patient was first seen her 9-22-00. My first thought is why such a limited

length of time for inquiry. Even if they had some medical records for the other period of time

restrict the from and to dates, why not restrict the nature of the request in regards to pertinent

medical records relating to my disabilities.

3. Medical evidence from the VA period 05-14-02 to 05-31-02. On 05-14-02 I had a consult for an

appointment for an evaluation for Alcohol abuse (problem drinking). During that period of time I

had some of my prescriptions expire.

4. The Rater also stated that I continued to smoke cigarettes. I never have and it is plainly stated

throughout my SMR. I do not believe there is any possible way that the rater was objective in

his application of law and regulation to my case. Given the statement made in regards to my

continuous habit of smoking in spite of my poor health and continuous use of inhalers, which to

his thinking I am not using because I don't get them from the VA pharmacy.

5. Due to having COPD they determined FEV 1% predicted would be the test that most accurately

measures my disability.

6. Dr. Underwood is the first physician doing my C & P's and PFT's all these years to openly say

I was diagnosed with COPD in 1992. I have gone through my SMR's, all of my PFT's and all of

my rating decisions and it is always referred to as an obstructive defect either mild, severe or

chronic. Then rated at 10% asthma. To my knowledge and research through my medical

records C-File it has never been rated until this last C & P exam. The rater stated "

The Veteran has COPD. Onset in 1992. The Veteran is a non smoker. The Veteran has

asthma. It is at least as likely as not that the Veterans asthma condition is the cause of

his COPD. It is at this point, that they decided to give me a combined rating of 60%.

They denied me for Sleep Apnea, Gerd/Barrets Esophagus, Gout, Bi-Polar disorder; etc..

Current Medications: Symbicort Two Puffs x 2 day

Nebulizer w Albuterol Sulfate 0.083% 2.5 mg/3ml (4 x day)

Proventil HFA 90 MCG CFC-F 200D Oral Inhl (as needed)

Omeprazole 20 Mg x 2 a day

Abilify 20 Mg x 1 a day

Trazadone 50 Mg as needed for sleep

Resmed S9 Elite Used nightly

Prednisone As needed/prescribed last round early

January 2013

7. There has never been one time since about 1991 that I haven't had to take Corticosteroid

medicine along with oral steroids like Prednisone. I have been on Omeprazole since 1992.

___________________________________________________________________________

Second Rating Decision dated 01/07/2003

Issue:

Evaluation of bronchial asthma currently evaluated as 10 percent disabling.

Evidence:

VA examination dated 12-17-02 from VA Medical Center Kansas City.

Report from VA Medical Center Kansas City for the period 08-20-99 to 05-14-02.

VA rating decision dated 11-15-02 and the evidence upon which it was based.

Entire VA claims file all evidence contained therein.

Decision:

Evaluation of bronchial asthma, which is currently 10 percent disabling, is continued.

Reasons and Bases:

We received your claim for increased evaluation for this condition on 07-03-02. You did not report for the scheduled VA examination on 10-18-02, nor did you respond to the request for medical evidence to support your claim. Your claim was decided based on the evidence of record. We received information on 11-19-02 that you would be willing to report for an examination and one was ordered, the results of which are the basis for this instant decision.

The current VA examination shows you have inspiratory and expiratory wheezing. You were not shown to have changes in posture due to the asthma. Pulmonary Function test results showed FEV-1 of 84%, FVC of 89% and FEV-1/FVC of 94%. You were stated to have been prescribed medication for this condition, however there is no evidence that you have had such medication filled at a VA pharmacy since approximately 1989.

The evidence fails to show that you are currently taking any medication for this condition. You have, however, been prescribed medication for treatment of the asthma. There is no showing of the need for daily inhalation therapy.

Consequently, the evaluation of bronchial asthma is continued as 10 percent disabling.

An evaluation of 10 percent is granted whenever there is forced expiratory volume in one second (FEV-1) of 71-80 percent of predicted value; or the ratio of FEV-1 to forced vital capacity (FEV1/FVC) of 56 to 70 percent; or daily inhalation of Bronchodilators therapy; or inhalation anti-inflammatory medication.

1. This PFT is the best one out of about 12 or so that I have had. I believe that since COPD is

on the table now and they are doing FEV-1 predicted that all of my PFT's would fall under this

rating. At least back to 2002. Not counting the med's. That alone would do it since 1990.

2. The rater stated that I haven't been to the VA pharmacy since approximately 1989. I was still

serving in the United States Marine Corps at that time. I would not be discharged till 01/02/90

and even then we followed my wife's parents to Ormond Beach when they moved from the Bronx.

I would not make it back here till late 91 or 92.

3. I did respond to there request for records. How would they know which doctor to contact if I had

not advised them of his where about. I have records from Florida and I will forward those to the

the proper destination. Since this is so long I will not list all the medications that are documented

and the appointments and ER visits during this time frame. The fact is the rating decisions

changed a great deal. Yes they both up held the 10%. Then on reflection the rater had another

bite at the apple, he had a window of opportunity to rethink his position. Upon doing so he

removed the smoking portion knowing that it may not affect the the VA but it would for sure

bother the Veteran After that he realized he should shore up his timeline, broadening his scope

from the original 16 days to almost three years. Why do that if all he needed was the PFT's?

4. On 100202 I was refilling my prescriptions at the KCVA:

Albuterol 90 2 puffs four times a day

Fexofenadine HCL one tablet three times a day.

Flunisolide four puffs twice a day .

Fluoxetine Hcl one capsule in the morning

Hydroxyzine one tablet by mouth bedtime

Montelukast one tablet at bedtime

Rabeprazole one tablet before breakfast

Ranitidine Hcl one tablet twice a day.

5. From January of 1995 to 2006 I worked at Southwestern Bell which became SBC Which bought

it's momma in 2005 at&t. During those years I utilized both Corporate insurance and the VA

so far as to provide the VA with my insurance information so they could be compensated for my

care. The insurance provider is still handling the account and they hope they can provide me

with what I need.

if not I can prove I had the coverage from there it's a simple leap of faith, if a Marine was

prescribed Prednisone 40 down to 5 by 5;s, Theodore 300, Azmacort, Alupent, Alupent

Solution for his nebulizer, Afrin and Emycn in Oct/Nov 1989 with the Prednisone being the

second round in as many months. Then discharged SC DNEPTE RC-3P Seperation Code JFL1

on 01/02/1990. Then continued to use a very similar prescription regimine for the next 22 years

I would hope he would conclude that the Marine obviously needs them and it is more likely than

not that he got his medications. I might even go as far as to call him and ask him "where you

getting your med's?"

In reference to the discharge I never realized it what it was. It is Honorable, I was recommended

for re-enlistment. I'm not sure what to think of it. I haven't looked into it fully yet.

In defense: Shortly before discharge I ran my last PFT. Maxed Sit-ups, 18 pull ups, 21 minute

three mile run. I almost died but it was my last. I was a a fourth award expert with a high of 231

on the Rifle Range. Navy Unit Commendation, Good Conduct Medal (2nd award) Sea Service

Deployment Ribbon, three Certificates of Commendation, 4 Meritorious Masts, 3 letters of

Appreciation. Proficiency and Conduct Marks in Grade 4.6 4.6, in service 4.6 4.5. I had a

Top Secret Clearance. Marine of the Quarter, at least 4 or 5 Meritorious Boards etc. etc..

I know, no hazardous duty, no combat nothing but easy duty I suppose. I guess i felt the need

to defend that although I'm not sure why. Is this a problem for me, can I do something about

this?

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Ok.. it appears the best thing that you can do for yourself is to request an increase again, and supply all the newest medical records as evidence of a continuing problem. And make sure you make it to the C/P exam.....

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As I understand it, if you are service connected for a respiratory condition and it requires home oxygen, that is supposedly* an automatic 100% rating. See the rating: "episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy 100".

This 100% rating does not mean someone is P&T by itself as the need for home oxygen therapy may be only temporary, say because someone later received a lung transplant and then didn't need supplemental O2.

How the need for home oxygen is determined by your the doctor, be it based on a PFT, Arterial Blood Gas or Pulse Oximeter reading of SpO2 below 90%, isn't all that important...just that the need can be documented by a means acceptable to the VA that outpatient home O2 therapy is needed.

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I was diagnosed with Asthma after two months and five days after in training. I was given a convience of the government discharge for asthma. Which states that my Performance deteriorated. I decided to get service connected. I went to a cmp and a pft then two weeks later i got a denial. The Cmp examiner reworded what I said and omitted my pft test even though the person giving it expressed how bad it was. She claimed my condition existed prior to service even though she had no evidence claiming that it did...what do I do...I'm facing a 5 year appeal

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