Asthma

[Vync]

Please review my logic regarding an increase in SC rating. I am currently SC (6602) 10% for asthma bronchiole and would like to increase it above 10%.

Here is a snippet from 4.97 - Schedule of ratings - respiratory system

6602 Asthma, bronchial

FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications

100 %

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids

60 %

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication

30 %

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy

10 %

Note: In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record.

Here are the corticosteroid I was prescribed in my medical records

2009-12-16 Aristospan corticosteroid (Non-VA, for lumbar epidural injection)

2009-12-11 Asmanex 220 mcg - Mometasone furoate corticosteroid inhaler (VA)

2009-12-11 Nasonex 50 mcg - Mometasone furoate corticosteroid nasal spray (VA)

2009-11-03 Aristospan corticosteroid (Non-VA, for lumbar epidural injection)

2009-10-23 Asmanex 220 mcg - Mometasone furoate corticosteroid inhaler (VA)

2009-09-03 Asmanex 220 mcg - Mometasone furoate corticosteroid inhaler (VA)

2009-09-03 Prednisone corticosteroid (VA) *** 1 ***

2009-08-28 Nasonex 50 mcg - Mometasone furoate corticosteroid nasal spray (VA)

2009-04-07 Nasonex 50 mcg - Mometasone furoate corticosteroid nasal spray (VA)

2009-02-13 Nasonex 50 mcg - Mometasone furoate corticosteroid nasal spray (VA)

2009-01-15 Prednisone corticosteroid (VA) *** 2 ***

2009-01-06 Medrol corticosteroid (Non-VA) *** 3 ***

2008-12-01 Decadron corticosteroid (Non-VA)

2008-10-02 Prednisone corticosteroid (VA)

2008-09-10 Decadron corticosteroid (Non-VA)

2007-11-09 Prednisone corticosteroid (VA)

2005-05-24 Prednisone corticosteroid (VA)

2002-03-27 Prednisone corticosteroid (VA)

Note: I was prescribed Prednisone and Medrol corticosteroids orally three times within the last 12 months.

I also take a Singulair pill and a puff from my Albuterol inhaler daily.

Regarding Mometasone Furoate

The Asmanex 220 mcg instructions say to inhale once daily at bedtime.

The Nasonex 50 mcg instructions say to spray twice in both nostrils twice daily.

Inhaled

220 mcg

Nasal

50 mcg x 2 sprays x 2 nostrils x 2 times per day = 400 mcg

I'm getting 620 mcg of this stuff per day!

Without taking my Albuterol inhaler, I can blow about a 350-400 l/min on my peak flow meter. For my age (38) and height (68"), I should be normally pushing about 650 l/min, placing my lung capacity at about 54-61% of normal. If I take my Albuterol inhaler, things improve a good bit.

Please review and offer your recommendation as to the appropriate SC percentage.

Edited December 18, 2009 by Vync

[Teac]

Would I just fill out the regular claim form and then attach copies of my prescription lists from the VA and Wal-mart?

Just write a letter and include the prescription list as well doctor treatment notes should also be submitted as evidence.

I know the VA has the doctor's Allergy exam notes in their computer (just got them about a week ago). Should I put together a list (like I did for the meds) of my recent doc visits?

You could but it is not necessary

I am beginning to recall the prednisone/medrol being given for something other than asthma (which actually helped my asthma too), but regardless, they got my on some strong inhaled/nasaled steroids which should warrant an increase anyhow.

Unless the steriods were prescribed for the asthma they will not help your case... I am asthmatic with COPD, rated 100% just for my lungs, so I know what your saying as far as the steriods helping the asthma but the va will likely refuse an increased in rating because you have to prove that the asthma has gotten worse and it required the steriods. From what your now saying the asthma was not treated with steriods. Best of luck but I now think you will not get an increase. Also, Nasal administerd steriods or inhaled steriods are not oral or parential and will not help qualify for an increased rating.

What do you think?

Edited December 18, 2009 by Teac

[Vync]

The Asmanex daily inhaled steroid was prescribed for my asthma on 2009-09-03, a bit more than three months ago, so I would definitely consider this daily use. I will need to research the purpose of the prednisone and medrol. Usually, they give it to me in conjunction with antibiotics to help clear up my sinuses. However, a few weeks after the treatment, it's all stopped up again. It used to be a lot worse without the nasonex.

[akwidow]

hmmm. My late husband filed for asthma in 2000 and was denied. They said he didn't have enough history to make it sc. they looked at two years of THEIR treatment to him, when there was SMR's back to 1968 in their records, along wth private records that they gave me when I asked. He was hospitalized about 8 times in between heavy medication treatments....

He didn't challenge it. I found CUE in his case.

You keep on them!

[Teac]

The Asmanex daily inhaled steroid was prescribed for my asthma on 2009-09-03, a bit more than three months ago, so I would definitely consider this daily use. I will need to research the purpose of the prednisone and medrol. Usually, they give it to me in conjunction with antibiotics to help clear up my sinuses. However, a few weeks after the treatment, it's all stopped up again. It used to be a lot worse without the nasonex.

Let me clearify what I ment when I said inhaled steriods do not help an award, because that was not entirelly true. What I should have said was that only oral steriods (pills) or parenteral steriods (shots) are considered for the 60 or 100% award.

While any inhalational (steriod or not) or oral bronchodilator qualifies for the 30% award....

but the medication must be prescribed because of the asthma, a steriod medication prescribed for sinusitis, or back injury will not help you asthma claim.

[carlie]

Vync,

Prednisone and a Medrol dose pack are the same thing.

The Medrol, to my knowledge is just a handy,tirated (sp) package.

Example:

Day 1 = 6 pills

Day 2 = 5 pills

Day 3 = 4 pills

Day 4 = 3 pills

etc...

jmho,

carlie

[Vync]

Carlie,

Yes, I am very familiar with prednisone. It makes me hungry and irritable as it tapers off.

Teac/Carlie,

The VA gives me immunotherapy (IT, a.k.a. allergy shots) and have for years. Here's the doctor's entry regarding adding the Asmanex inhaler. I have an extremely long history of asthma and allergy treatments with the VA. It even dates back to 1991 in the Army. Big paper trail. I hope this entry sheds some additional light to the situation.

PROBLEMS:

1. Asthma

2. Allergic Rhinitis

CURRENT RESPIRATORY MEDICATIONS:

1. Albuterol metered odse inhaler as needed

2. Singulair 10 mg every day

3. Opticrom drops as needed

4. Nasonex

5. Immunotherapy

HISTORY OF PRESENT ILLNESS:

The patient returns having had a couple recent exacerbations of his asthma and sinus symptoms. 5-6 weeks ago was seen by outside doctor who noted sinus infection (by sinus film) and asthma exacerbation. He was placed on bactrim and prednisone shot, with some relief, but symptoms soon returned and saw {VA Doctor} who offered 7 day course of augmentin; Symptoms completely resolved.

Today, he reports 3-4 days of returning symptoms: increased cough (productive of scant yellow sputum, albuterol use BID, with sinus congestion and white-yellow drainage.

Otherwise, he continues to use his albuterol for exercise with benefit, and continues to report satisfaction with nasonex, claritin and singulair.

PHYSICAL EXAMINATION:

He is alert, in no distress, good mood, normotensive, afebrile. Canals are clear. Tympanic membranses intact. Conjunctivae and sclarae. Nasopharyngeal mucosa with bilaterally enlarged turbinates with white/yellow drainage. Chest with expiratory wheeze.

DATA:

Peak flow historic best 550

Peak flow pre bronchodilator 425

Peak flow post bronchodilator 425 (unchanged)

IMPRESSION:

1. Asthma with acute exacerbation. Suspect etiology 2/2 viral illness having already cleared previous infection. Given recent episodes of exacerbation, will add another controller medicine.

2. Viral URI/ acute sinusitis

3. Chronic allergic rhinitis

PLAN:

1. Continue nasonex

2. Hold IT today

3. Short prednisone buest 30/30/20/20/10/10

4. Add mometasone 22mcg QHD (for improved control)

5. Continue albuterol PRM, and before exercise. Continue singulair and nasonex.

6. Sinus rinse prm

7. I would like to see him in one month. If improved, can resume IT.

This shows

- The steroid inhalers were prescribed for "improved control" of my asthma.

- Also, the doc indicated "bilaterally enlarged turbinates" (see below).

Enlarged turbinates

Enlarged turbinates and nasal congestion can also contribute to headaches and sleep disorders such as snoring and obstructive sleep apnea, as the nasal airway is the normal breathing route during sleep. Once turbinate enlargement becomes chronic, it is irreversible except with surgical intervention.

I am hoping for a good chance for the 30% SC award for increase in asthma. Also, I have a sleep study coming in February for OSA. If they say I have OSA, then it is likely because of the enlarge turbinates, which could hopefully be connected secondary to my SC rhinitis... Good to have these notes in the record. Also, my girlfriend said I woke her up last night a couple of times with my loud snoring.

Thanks!

Edited December 18, 2009 by Vync