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

[carlie]

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!

Vync,

I can see a probable increase in asthma to 30%.

A future claim as "secondary to my SC rhinitis"

the "enlarge turbinates" might be

denied as pyramiding, so check that out.

jmho,

carlie

[Vync]

Vync,

I can see a probable increase in asthma to 30%.

A future claim as "secondary to my SC rhinitis"

the "enlarge turbinates" might be

denied as pyramiding, so check that out.

jmho,

carlie

No, I am looking to increase my asthma to 30% because I meet the qualifications based on daily inhaled steroids.

If the sleep apnea is diagnosed, I will be seeking it secondary to my rhinitis, due to the enlarged turbinates/limited sinus airway.

Thus, I hope that this will not be considered pyramiding, as they are two completely separate conditions.

[ArmyTexas]

It should be a problem to get at least 30% from the meds alone. I''ve been on Advair 500/50 discus for 4 years. It's one of the most common prescribed bronchial-dialators and that automatically gets you 30%. With the way my PFT's are and 4-5 courses of prednisone I'm at 60%.

With your Prednisone use, check you doctors notes and highlight why it was prescribed. 3 courses or more a year is 60%. The only way to prove it was for the Asthma is thru the notes, unless the doc writes a statement of the dates you were prescribed for Asthma. If your not seeing a Pulmary doc, try to find one. Most really know their stuff and are better than a Primary care.

Hope everything works out for you, especially your health, Asthma problems sneek up on you.

[Vync]

Hello everyone,

Several questions are at the end, but I think I finally have everything together regarding my request to increase SC rating for asthma.

I wrote a cover page which ties all the facts together. All records are from the VA and pertain solely to my asthma treatment. All key information is highlighted, for ease of verification. I realize all of this information is in my VA treatment records, which they can review at will, but I do not want to take any chance that they will miss anything.

For increase to 30%:

- Mometasone furoate prescribed for daily use five months ago

For increase to 60%:

- Two instances where oral prednisone was prescribed

- One instance where IV solumedrol (liquid prednisone) was administered

- All occurred within the last five months

Additional Information:

- Prescription refill history showing asthma medications back to my EED in 1995 (various inhalers, singulair, etc...)

- Last month, I was issued a nebulizer plus albuterol solution for home use

- VA treatment record and letter excusing me from work for almost two weeks last month, due to adverse reaction to high doses of steroids within a short period of time

- VA rating schedule for asthma

- Several BVA reference cases where SC was granted 60% because oral steroids were prescribed for asthma 3+ times within 12 months.

Questions:

1. With evidence that clearly shows I meet the requirements for both 30% and 60%, should I even bother to get an IMO/nexus letter? This is a SC increase request, not an initial SC request.

2. Do I need to write a personal statement describing the worsening of my condition and its impact on my life and work?

3. Do you think they will request a C&P exam or just use the evidence in my records to grant an SC increase? I am not requesting the increase based on FEV reduction, so going in to see a doc seems useless, because my records speak for themselves.

4. Regarding the EED, should I ask for an EED of 30% between the time when I met the 30% requirement and the time I met the 60% requirement? Or should I get SC first, then argue for an EED change afterwards? It seems to make more sense to ask for SC and an EED adjustment at the same time, because it would be less work for me and the VA.

5. Am I missing anything or is there anything else I could do to strengthen my claim?

6. My last question is regarding the SC rating math, if my request is granted. If my asthma rating changes from 10% to 30%, then 30, 20, 10, 10 = 54.64%. Would this round down to 50% or would they round 54.64% to 55%, then round 55% up to 60%?

[ArmyTexas]

Hello everyone,

Several questions are at the end, but I think I finally have everything together regarding my request to increase SC rating for asthma.

I wrote a cover page which ties all the facts together. All records are from the VA and pertain solely to my asthma treatment. All key information is highlighted, for ease of verification. I realize all of this information is in my VA treatment records, which they can review at will, but I do not want to take any chance that they will miss anything.

For increase to 30%:

- Mometasone furoate prescribed for daily use five months ago

For increase to 60%:

- Two instances where oral prednisone was prescribed

- One instance where IV solumedrol (liquid prednisone) was administered

- All occurred within the last five months

Additional Information:

- Prescription refill history showing asthma medications back to my EED in 1995 (various inhalers, singulair, etc...)

- Last month, I was issued a nebulizer plus albuterol solution for home use

- VA treatment record and letter excusing me from work for almost two weeks last month, due to adverse reaction to high doses of steroids within a short period of time

- VA rating schedule for asthma

- Several BVA reference cases where SC was granted 60% because oral steroids were prescribed for asthma 3+ times within 12 months.

Questions:

1. With evidence that clearly shows I meet the requirements for both 30% and 60%, should I even bother to get an IMO/nexus letter? This is a SC increase request, not an initial SC request.

Shouldn't need an IMO, just the records from treating doc should be fine.

2. Do I need to write a personal statement describing the worsening of my condition and its impact on my life and work?

You can, If you mention struggling at work or missing a lot of time, VA may infer IU-They did with me (I'm still working though so I know this one will get denied)

3. Do you think they will request a C&P exam or just use the evidence in my records to grant an SC increase? I am not requesting the increase based on FEV reduction, so going in to see a doc seems useless, because my records speak for themselves.

They will definately call you in for a C&P-They will do a current PFT-They did with me.

4. Regarding the EED, should I ask for an EED of 30% between the time when I met the 30% requirement and the time I met the 60% requirement? Or should I get SC first, then argue for an EED change afterwards? It seems to make more sense to ask for SC and an EED adjustment at the same time, because it would be less work for me and the VA.

5. Am I missing anything or is there anything else I could do to strengthen my claim?

Have your doc tie the steriods to the Asthma so that that there it can't be linked to the sinus. When you go to the C&P. Hand carry the med list. Call Respitory before the PFT to see about taking meds that morning. They called me a week prior and let me know to not take my morning Asthma meds unless in distress.

6. My last question is regarding the SC rating math, if my request is granted. If my asthma rating changes from 10% to 30%, then 30, 20, 10, 10 = 54.64%. Would this round down to 50% or would they round 54.64% to 55%, then round 55% up to 60%?

You are going to get at least 30% and maybe 60% initially. File a NOD for the 60% if you don't get it.

When I received my 60% for Asthma, they listed the evidence as low PFT's and 4 courses of oral steriods, so I know that they look at the meds to consider.

Good luck on your claim.