casscntyman

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?

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.

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.

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.

Recently was upgraded from 10% Asthma alone to 60% Asthma/COPD. I am filing a NOD and am working on my case now. They denied Bipolar disorder Axis I, Sleep apnea/Narcolepsy with CPAP machine, Gerd/Barrets Esphagus, Gout. Didn't have in service and no nexus I assume. I basically just sent in a piece of paper signed saying I wanted a review. I was unaware of the complexities involved in the process. I now am going over every thing I can locate with a great deal more attention to detail. (have requested C-File) Now for my Question other than where I should have posted this. At about the same time I was going through the Asthma problem and the medical discharge I was have seizures, I passed out 5-6 times a year for a couple of years or more. Eventually the doc's decided to see what was causing it. Two doctors had different opinions, one thought legitimate seizures of some type the other Narcolepsy. I was referred to Neurology per notes in my SMR. Before I could get to them to do that for me I was discharged and out. I have also continued to pass out or "fall asleep very quickly" off and on for all of these years. I have wrecked several cars and and had numerous problems due to this. I feel like they should have kept me in just a little longer and addressed that issue. My life may have been very different if it had been recognized then. I never had this problem until a fall down a rock embankment in 29 Palms California. At that time I was diagnosed with abrasions and a concussion. It may or may not have anything to do with my issues. It seems if I am diagnosed with Narcolepsy now and it was suspected in the 80's that there should be a concern. I put a lot out there and I am not very skilled and bringing so many things together a solid this or that question. I would just appreciate any thoughts good or bad. It's just that I never recalled or noticed the correlation till the other day and its been bothering me. Thanks for any help given.

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.

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.

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.

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, Sumbicort, 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.

I was discharged in 1990 from the USMC and given a 10% service connected rating for Asthma. I applied for an increase in 2002 and was denied due to smoking and not taking meds. Both are wrong, I have never smoked which is in my medical record from beginning to end, I have also always taken at least three meds daily for my condition usually much more. I also see viewing my medical file that it has always been classified as COPD. Is there really a difference between the two in regards to rating? I am just very confused. All of my xrays also say Copd. Thanks in advance for any input.

I was medically discharged in 1990 at a 10% rating service connected for asthma. I have tried to get the rating increase twice. Once in 2002 and this current situation. All of my medical records state that I have COPD. This is stated by a pulmonary doctor as well as a Radiologist MD. It was denied the first time because they said I continued to smoke and that I wasn't taking my meds both of which are false. I have never smoked and my medical records confirm that. I have also taken at least 3 up to 5 which I am currently taking for this condition. I never got the denial letter etc. but found them when my mother died going through her things recently. I was working and traveling a lot and didn't follow through at that time. Grant a higher rating back to that time. I believe given the facts in my service record I should have been at 30 % at my discharge date. I also have sleep apnea and am Bipolar. I was diagnosed several years after discharge. I appreciate you.

I have just received the results of my PFT for my C & P exam and need help in understanding them. Actual Pred. %Pred FVC 4.05 5.95 68 FEV1 2.50 4.61 54 EV1 62 78 FEF 25% 3.59 3.59 41 FEF 50% 1.59 5.12 31 FEF 75% 0.57 1.88 30 FEF MAX 6.25 11.02 57 FEF 25-75% 1.29 3.99 32 FEF 75-85% .34 DLCO 37.66 39.07 96 Alveolar Volume 6.27 7.97 79 DL/VA 6.01 4.90 123 Any help appreciated, Thanks