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Schmoll74

Psoriatic arthritis

Question

Hello I am looking for some help with understanding how the VA rates one disability to another and why receiving medicine for one is not the same as receiving it for the primary disability.

I retired in 2013 from the Navy with documented psoriasis and was awarded a 0% rating. Within a year I was diagnosed with psoriatic arthritis. I filed a claim and was awarded service  connection at 0%. I was shorty thereafter  placed  on methotrexate and humira. I filled my appeal in December of 2014. I just received my letter and was awarded 10% for my psoriasis but denied anymore since the immune suppressive drugs were not prescribed for psoriasis but for the psoriatic arthritis.  How do I get them to realize the meds are for both issues when I file my appeal to the appeal?   

 

Thanks.

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You basically need to appeal, and base your appeal on evidence, not your opinions.  Remember, pyramiding prevents you from receiving benefits for symptoms of both.  

You only get compensated ONCE for an applicable set of symptoms.   Lets try an example.  Lets say you have ptsd and depression.  Since both of these may have some of the same symptoms, you only get paid for one set of symptoms.  In other words if you were compensated for anger issues, you would not get compensated for "anger issues" with both ptsd and depression.  

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I realize the compensation can only be for one issue however I am looking to get the humira applied to my psoriasis. My regular Dr did not put me on humira due to other symptoms and I was being evaluated. Once the specialist prescribed the meds my normal Dr said all is good it treats the  cause of both issues which is the psoriasis. I have heard of getting a Dr to write a nexus letter to tie everything together, is that what I need to show this?

 

Thanks

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I have psoriatic arthritis and psoriasis. It took several years for the VA to recognize the PsA and the level of acute symptoms. When were you diagnosed? Did you have any symptoms while on active duty? Also, when did you notice the start of psoriasis outbreaks? Mine were relatively close together, and PsA was rated separately from psoriasis. I thought this was odd, but either way was happy with the rating. I ended up having to provide the documents that linked PsA directly to psoriasis (believe me, I thought this was stupid). The C&P doc also documented the comorbidity of psoriasis and PsA. I am also on Humira and Leflunomide. I had a serious infection (perforated colon) and had to stop taking humira for a year. I took pictures of what happened to my skin and joints when not taking it. I wouldn't recommend this to anyone, though. It took several years an a complaint to the VA Secretary's office, but finally had the condition rated correctly during a severe flare-up. It took several years, but has been worth it. I would suggest going to WebMD or other reliable healthcare site and finding the research that supports the link between the two diseases. Also, if you were symptomatic before being rated for psoriasis, I would claim the PsA as having been missed by the C&P doc. Then, you need to document your symptoms (which joints, bilateral?, etc.) and take pictures of flares. I don't know about you, but I still have flare-ups that require steroids even with Humira (bi-weekly) and Leflunomide (daily).

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I was diagnoses with Psoriasis for the last 6 years in the navy but remained on steroid cremes since there was a chance I could be disqualified in my rating field if I was prescribed any biologic. I was diagnosed with PsA about a year and half after retirement and started on methotrexate but no change in PsA or my psoriasis. After I added the Humira my pain went away and so did my skin spots. I am  working on my appeal to explain that the PsA which is rated as a secondary disability and the psoriasis are treated by the same drug and normally one Dr will not prescribe medicine you are already on. I have 30 days left on the 60 day appeal to get faster movement on the appeal. To top off all of that I now have a complication from the humira (latent TB) that puts me on antibiotics for 9 months.

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So sorry to hear about TB - the ads on TV aren't there for nothing. Also, regardless of who prescribed your Humira, the fact that it works on both diseases (one in the same, really) should be what counts. Have you stopped taking the Humira due to the TB?

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