Search the Community

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.

Hello, I’m looking for some guidance and understanding on one of the Service Connected issues I have. I’ll apologize in advance if I get long winded but will do my best provide the timeline and decisions along the way. Here’s a simple timeline. Jan 2009 - Retired USAF Jun 2009 - VA Received initial VA Claim for Disability Dec 2009 - VA Examination at the VAMC Boston May 2010 - Notified of Decision Apr 2011 - NOD Received at VA Oct 2012 - NOD Decision sent to Claimant I agree with all my SC decisions made by the VA with one exception: PSORIASIS, initially determined to be 30% disabling. My opinion based on evidence provided, it should have been 60%. The May 2010 decision was for 30% disability for Psoriasis was based on 20% of the body and the it goes on to include all the other technical terms related to a Psoriasis decision. The decision noted that my Psoriasis is treated with 50 milligrams of Embrel twice per week which has been effective. The Embrel injections started in Nov 2007. This was after countless treatments with all the cream, suave & solution therapies available. It also included a two regimens of Cyclosporine which worked wonders until stopped and the Psoriasis conditions came back with a vengeance. FYI - My issue with Psoriasis date back to 1994. The following paragraph was included in the decision as well in the initial decison: “an evaluation of 30% is assigned from January 1, 2009. An evaluation of 30% is granted for evidence showing 20 to 40 % for the entire body or 20 to 40% of exposed areas affected, or; systemic therapy such as corticosteriods or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A higher evaluation of 60% is not warranted unless evidence shows more than 40% of the entire body or more than 40% of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteriods or other immunosuppressive drugs required during the past 12-month period.” That was the 30% decision and how to increase to 60% if warranted. My understanding of the decision was something had been missed on the immunosuppressive drug therapy-EMBREL. I had began taking Embrel in Nov 2007 which was nearly 18 months of use at the time I filed the initial VA Claim. Embrel is clearly described as an immunosuppressive drug on the drug manufacturers website and others related to Psoriasis info. My twice weekly injections were constant meaning this was the dosage and use prescribed by my doctor. I felt this was a clear miss on the VA’s part. Embrel was in use for longer that the “constant or near-constant systemic therapy such as corticosteriods or other immunosuppressive drugs required during the past 12-month period” threshold described in the VA decision. So, I decided to file a NOD, requesting the higher 60% decision based on the use of immunosuppressive drug therapy. I’m thinking this is easy, I state the obvious, provide clear dates with evidence and should be a simple correction to the 60% rating. Also, It should be noted between the initial decision and filing the NOD the Embrel stopped working and I began taking STELARA which also decreases and impacts your immunosuppressive system in a negative way too. All this information was provided in the NOD filing and it showed a continuous use of EMBREL and STELARA from Nov 2007 until the date of the filing. Well over the 12-month use threshold required for 60% rating. To date I’m still using STELARA and the VA is currently paying 100% the cost of this therapy via their Foreign Medical Program (VA-FMP). On 22 Oct, 2012 the NOD decision was received the VA decision was to maintain the 30% disability rating based on the exact same reasoning listed in the original decision and also the NOD decision included the same comments about what warranted a higher 60% rating which stated: “constant or near-constant systemic therapy such as corticosteriods or other immunosuppressive drugs required during the past 12-month period”. No progress was by filing the NOD. The VA came to the same decison without clearly stating Embrel use was involved in the decision. Ok, thats the story here’s a few questions I need help on understanding if anyone has a recommendation. I have 60 days to make a decision to appeal, disagree or request a hearing in person. 1. What qualifies as: constant or near-constant systemic therapy such as corticosteriods or other immunosuppressive drugs required during the past 12-month period? Does constant use as prescribed by doctor from 2007-present meet definition of constant or near-constant? 2. EMBREL and STELARA both suppress the immune system this is based on the drug information listed on the manufacturer’s sites. Why does this not meet the VA threshold for immunosuppressive therapy? 3. What am I missing? 4. Am I foolish for thinking I should be at 60%? 5. Would a BVA hearing be a mistake or am I chasing something I can’t catch? Sorry for the long version, hopefully I have provided enough info without clouding the issue too much. Looking forward to the replies. Thanks.

Hello everyone! this is my first post on this site, but I have been stalking it for a while now. I have a question that maybe someone can address. I'll try and make it short and sweet.... I received my SC disability for psoriasis 30% in 2009. At the time I was only on topicals that did nothing for me... For the last 2 years I have been on Humira which has been a blessing! I just received a phone call from a rep stating that I was coming up for an exam on my psoriasis... I told them I was on auto-immune suppressants, so of course my skin is clearer.. She stated that would drop my rating.....?? My issue is this... if they take away my 30% for my psoriasis... who would pay for my Humira?? And isn't the fact that I am on auto-immune suppressants enough to keep my rating as is?? any advice would be greatly appreciated:)