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justrluk

Heard The Va Is "re-Doing" My Claim?

Question

Hello to all:

Two issues I'm not quite sure what happened:

1. Found out that a claim I had in for asthma secondary to Humira use for psoriatic arthritis went from being in Development to Administrative Review. I've sent in additional documents, and still have more records to collect, so I'm wondering what's going on??

2. The VARO ADDED a claim to the Asthma claim: an increase for psoriasis. Not that I mind this so much, but I've already had an increase just last year. In the initial claim for this, though, I mentioned that I was on weekly injections of Humira for both psoriasis and psoriatic arthritis.

§4.118—Schedule of ratings–skin

7816 Psoriasis:

More than 40 percent of the entire body or more than 40 percent

of exposed areas affected, or; constant or near-constant systemic

therapy such as corticosteroids or other immunosuppressive drugs

required during the past 12-month period............................................................... 60

so I'm wondering if this is where the added claim came from?? Any clues out there? I've emailed my VSO but as usual, no response.

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Any takers????

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Humira has been found to cause some serious adverse affects.

"asthma secondary to Humira use for psoriatic arthritis"

If you have proven this drug had a medical consequence of causing asthma, then the VA should service connect the asthma as secondary to the Humira usage.

"The VARO ADDED a claim to the Asthma claim: an increase for psoriasis. Not that I mind this so much, but I've already had an increase just last year. In the initial claim for this, though, I mentioned that I was on weekly injections of Humira for both psoriasis and psoriatic arthritis."

Either something caused the VA to re evaluate the psoriasis claim's rating or they are adding into the SC psoriasis -a percentage for the asthma and in this way they are considering an increase for the psoriasis as due to the effect of the Humira.

Does that make sense to you?

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Personally, I like it when the VA "adds to the claim". While I dont see it very often, it usually means someone READ your claim, and saw some sort of evidence of an "inferred" or informal claim.

The ultimate result should be more conditions and a higher combined rating. All too often I see the reverse, where the VA overlooks half the claims and the VEteran winds up spending decades in appeals.

My opinion is that this is good news for you, as you may wind up with a higher rating. The other thing is, too, are they gonna "add other things" to your claim only to deny you? That does not make sense. I mean think about it. You send in a claim for something. They say..oh, you forgot this and this...and we are denying those too. No, if they say, gee..you forgot this claim, then that means THEY think it is a valid claim. I mean do you think they are going to recommend you file a bogus claim?

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Ms. Berta - Thanks for the reply. This has really been getting to me lately. Bronc- I agree, I'd rather have overlooked the link and have them add it than to miss an opportunity.

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Humira has been found to cause some serious adverse affects.

"asthma secondary to Humira use for psoriatic arthritis"

If you have proven this drug had a medical consequence of causing asthma, then the VA should service connect the asthma as secondary to the Humira usage.

"The VARO ADDED a claim to the Asthma claim: an increase for psoriasis. Not that I mind this so much, but I've already had an increase just last year. In the initial claim for this, though, I mentioned that I was on weekly injections of Humira for both psoriasis and psoriatic arthritis."

Either something caused the VA to re evaluate the psoriasis claim's rating or they are adding into the SC psoriasis -a percentage for the asthma and in this way they are considering an increase for the psoriasis as due to the effect of the Humira.

Does that make sense to you?

I think so. I'm just worried that they'll order a C&P which will show how well the Humira controls the psoriasis. I only have a few patches, so I'm well controlled (now) but when they let the refill run late as they are prone to do, flare-ups start as does the selling in joints and tissues. Also, they awarded 30% for Asthma due to Humira use. I was a bit surprised at this; it only took a year, an IMO from my family doc and the drug warning sheet (packed with each box). I thought for sure I’d have to go the distance to the BVA at least!

I asked over the #800 and through IRIS what the added contention was, and no one can tell me. eBenefits errors every time I try to click the link of the added claim (under review). I received a letter yesterday to the effect that someone would be getting in touch to tell me what the condition/contention was. I thought since my last claim was completed, they'd press on with the appeals (at DRO's desk, or so I'm told). Now, I wait even longer (since 2009) for yet ANOTHER claim to clear the system.

BTW: I was also just diagnosed with fatty liver. I've been on Depakote and steroids for years, and they're not really monitoring my liver enzymes the way my private rheumatologist did (monthly). I could file another claim I guess, and without other causes the symptoms of fatty liver are really rough.

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      The VA DRO denied my claim for an earlier effective date for my sleep apnea. They originally denied it in 2008 but granted it in Nov 2019 secondary to my GERD. I was rated for GERD in 2001. So I had it in 2008. I have attached the 2008 denial, 2018 approval, and the NOD SOC. All of my medical files and the medical articles and VA Citations referenced were in existence in or before Jan 2008. The only new items were the NEXUS letter from Dr Bash and a few extra buddy letters. The original denial states that my medical records show no diagnosis or treatment and only isolated complaints of symptoms. The denial does not even list my wife's or my lay statements as evidence reviewed. I have symptoms listed numerous times in my SMRs:

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      b. Physical exam dated 24 Jan 79 listed frequent/severe headaches" dizziness, and
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      c. Physical exam dated 07 Nov 83 listed frequent/severe headaches.
      d. Physical exam dated 16 Jan 85 listed frequent/severe headaches.
      e. Admitted to hospital 05 Aug 86 for chest pains and anxiety.
      f. Medical visit dated 14 Jul 87 for problem sleeping and morning confusion.
      g. Physical exam dated 25 Feb 88 listed dizziness.
      h. Physical exam dated 07 Oct 91 listed frequent/severe headaches
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      kind in each of my nostrils that went down into my throat to keep rny airway
      open and stop my disruptive snoring.
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