Respiratory Disability To Include Asthma And Copd

[ammodad]

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 November 13, 2011 by ammodad

[Capt.]

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.

[jvretiredvet]

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.

[casscntyman]

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.

[casscntyman]

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.

[jvretiredvet]

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 November 19, 2012 by jvretiredvet

[Teac]

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).