Multiple Issues In The Works

[justrluk]

For those elders out there, I would appreciate your opinions. I have two issues in process with the VARO, and one waiting an appeal. Issues as they stand today:

1) Request for increase for Psoriasis due to weekly immunosuppressive medications

2) Request for service-connection for GERD

3) Appealing arthritis rating, specifically knees being reduced from 40% to 20% (not including the bilateral factor) due to pre-service condition.

My questions are:

1) I am prescribed and take immunosuppressive medication injections weekly, but they were prescribed by my rheumatologist for the psoriatic arthritis, not by my dermatologist. These two conditions are medically connected, however, and the CFR for Psoriasis rates this at 60% if weekly immunosuppressive drugs are taken.

Question: if prescribed by another treating physician for a separately rated but medically connected condition, does this request for increase have merit? What have others experienced with a similar conditions and similar requests?

2) I was diagnosed with GERD in 2003, prior to my discharge and treated by an off-base physician through a Tricare referral. It was missed in my initial claims filing with the DVA. I've recently (March 2010) had my C&P. The examiner watched the condition on the screen while swallowing that god-awful barium solution, and confirmed the condition. I also provided an IMO from the treating physician and all records from his office highlighting the dates and notes from which the initial diagnosis was made. I continue to receive periodic gastroscopic exams while getting my colonoscopies from the same physician also since 2003. In the IMO, he directly related the condition as having been caused by the right hemicolectomy.

Questions: What is the probability this will be granted, and what should I expect the date of award to be? If awarded with a March 2010 date, should I NOD for a 2003 date?

3) I'm appealing the reduction of the rating for psoriatic arthritis from 40% to 20%. I have initial enlistment documents from 1984 that do not mention any problems with knees, yet the DVA rated this as described.

Question: What has been the success rate of others with similar appeals? Also, if this issue is in appeal, does it stall the request for increase for psoriasis as they are technically related conditions?

Any help in trying to understand what may or may not be realistic, and help in forming a strategy with regards to the questions asked would be greatly appreciated!

[Berta]

1. I think that claim has merit if the prescribing doctor connects the dots there. VA wont.

2."It was missed in my initial claims filing" if you formally filed for it and the VA "missed" it this cold still be an open claim possibly.

The date for the EED is almost always the date the actual claim was filed.

3."I'm appealing the reduction of the rating for psoriatic arthritis from 40% to 20%"

Did you file a response ASAP on this? I think proposed reductions have only 30 days to respond to.

Would the rheumatologist be able to provide you with an IMO?

I see this proposed reduction as the prime issue you have before an increase in your rating could be determined.

Do I get this right? They proposed to reduce you and you immediataly appealed that?Then you also asked for increase as well?

[Cruinthe]

Well, last time I gave advice to a fellow veteran I was arrested, but here we go anyway.

First, do you know the actual and exact diagnostic codes for the disorders you have, and second have you found the actual rating scale for these disorders in 38 CFR? I would begin there, to be honest.

*ducks and runs before the VA sends the police*

Good luck!

[stillhere]

Not sure from your post but if you are SC for PTSD this paragraph I copied below may help your claim or others that suffer from psoriasis. I found this while reading the other day and it appears it has been known for a while.

Psoriasis has long been recognized to be associated with potentially adverse effects on mental health. In the 1960s, a popular ad campaign labeled the emotional burden of this skin disease as the 'heartbreak of psoriasis.'

[justrluk]

1. I think that claim has merit if the prescribing doctor connects the dots there. VA wont.

2."It was missed in my initial claims filing" if you formally filed for it and the VA "missed" it this cold still be an open claim possibly.

The date for the EED is almost always the date the actual claim was filed.

3."I'm appealing the reduction of the rating for psoriatic arthritis from 40% to 20%"

Did you file a response ASAP on this? I think proposed reductions have only 30 days to respond to.

Would the rheumatologist be able to provide you with an IMO?

I see this proposed reduction as the prime issue you have before an increase in your rating could be determined.

Do I get this right? They proposed to reduce you and you immediataly appealed that?Then you also asked for increase as well?

Ms. Berta, thanks so much for looking at this.

First issue: I have not asked the rheumatologist or dermatologist for a letter connecting the two disorders, using one treatment - I'll take care of that quick. If anyone out there has a sample, I'd be most grateful.

Second issue: As I read your response, the claim should be good to go, and the date will be the date of the claim vs. the 2003 date. I can live with that as long as the DVA grants service-connection and rates appropriately. I'm not looking for a huge rating, just the right rating.

Third issue: I didn't really notice this reduction from the initial rating and am certain I missed the required dates. The only reason I noticed it was because I was looking through past decisions (after reading this forum) for another issue, and came across the actual text describing why they reduced the rating from 40% to 20%. I sent an IRIS question in, and they confirmed the decision (to my misfortune). Had I been wiser, read through the documents (as many elders here foot-stomp frequently) and caught this, I would have done it ASAP. I didn't - shame on me - and that's why I'm trying to at least appeal the decision. I have service records that make no mention of a 'previously existing condition', so I guess I begin the silent vigil waiting for a hearing and hope the evidence has merit enough to refute the decision. Either way, the condition is getting worse, and I'll probably end up filing for an increase anyway. Like I said above, I'm not looking for a huge payout, just a correct rating.

I'm most concerned about the immunosuppressive medications. If this pushes my rating for psoriasis to 60%, my overall rating goes over 100%. I can live with the others as they'll have little impact on my overall rating - the max rating for them and my current conditions would most likely keep me at 90%.

Again, many thanks and respect for your time. I'm a daily reader, and always see your posts.

[justrluk]

stillhere -

I have filed for PTSD, but am waiting (as usual) for any response. Bad accident in 2000 that started the MEB that led to all this mess. Again, how to look at the emotional/TBI-type issues. Should I try to "umbrella" these under TBI?? I just don't know how to approach the combination of mental issues due to the TBI from the accident, and don't know about "messing with the apples in the apple cart" (as another elder put it somewhere in the forums - credit unknown).

[justrluk]

Update as the claim for increase for psoriasis progresses:

I asked for a letter from my Dermatologist in support of the rheumatologist using immunosuppressive drugs weekly for the past two years and their collateral impact and treatment for psoriasis. She wrote me a letter stating that: "We don't write letters supporting claims for increase. My treatment records should suffice and I cannot change a treatment put in place by rheumatology."

Not at all what I asked forn or expected, even after explaining both verbally and in writing that treating the Humira ALSO treats the psoriasis and therefore should be considered as required for keeping the psoriasis under control.

I had my C&P for the request last week, and brought in all medications to include the Humira, stated that the medication is known and used for treating both conditions even though prescribed by rheumatology. The practitioner took measurements, life history, medication list, etc. and that was it. I have no idea what to expect now. The examiner said she had 3 days to turn the evaluation, but couldn’t comment on the time to rate. I told her I was well aware of the time it takes to rate, and that I appreciated her listening and being thorough. We’ll see what happens now….