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Respiratory Disability To Include Asthma And Copd

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ammodad

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my question is will they rate them both as one claim or separately because they both are separately diseases found out they have remanded the sinusitis but are going ahead and rating the asbestos exposure for the copd and asthma i could have sworn the guy at va told me they were counting them both as one or rating them both as one is that possible or will they both be rated separately is there any way to find out when asking them at the va they suddenly get forgetful or their computers are down and they can only see what you just mentioned.

and in the event they do rate them both as one how would they decide the percentage i know whey have a rating procedure they use or a way of doing things

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I finally received my C-File in the mail. What there is of it. As I have said earlier I should have been discharged 30% at discharge in 1990. Enough of that.

Respiratory (Obstructive, Restrictive, and Interstitial) Exam. December 17, 2002

Examining Provider: Vanbuskirk, Terry

Examination Results

"The patient's C-file and, in particular, his compensation and pension March 1994 examination was reviewed. The patient is 10% service-connected reference bronchial asthma. The Kansas City VA hospital progress note of May 2002 indicates that the patient is on Combivent with a sig of 2 qid (however, the patient used to use approximately two to six times a day) from the Kansas City VA Hospital plus Singulair 10 one in the AM plus Advair (from his private physician) one bid; however, for financial reasons the patient has not been on any inhalers for the past one month. The patient states that his dyspnea requires more medication to control same. The patient can breathe in but he cannot breathe out. The patient has minimal cough except at night. The patient denies ever smoking. The patient's weight has increased 40 lbs in the past one year. The patient has chronic chest tightness however, if he exercises (or with summer allergies), he has exacerbations approximately once a day.

Auscultation and percussion of the patient's lungs discloses slight inspiratory and particularly expiratory, wheezing. The patient has no typhoscoliosis or pectus excavatum.

Today we will obtain pulmonary function tests and chest x-ray.

Diaganosis: Bronchial asthma."

The C-file I received has none of the information in it concerning the above. There is one page where Dr. Charoac acknowledges I was a patient. I have had numerous PFT's since my discharge in 1990 COPD has been mentioned twice in PFT's and C & P's in regards to Diagnosis. The radiologist almost all say yes. The doctors interpreting the PFT'S say yes. The final time was in 2012 when Dr. Johnson Underwood stated on

07-26-2012 Addendum

"The veteran has COPD onset in 1992. The Veteran is a non smoker according to the VA records. The Veteran has Asthma. It is at least as likely as not that the Veterans asthma condition is the cause of his COPD."

During this C & P it asks if I was diagnosed with sleep Apnea and/or Narcolepsy and if so complete the Questionnaire. He stated I wasn't. I was diagnosed with Sleep Apnea on 10/27/11 by a sleep study at an independent hospital the VA sent me two. I was prescribed a very expensive CPAP machine at that time.

In my C-file there is no mention of this 1992 C & P PFT that this doctor as well as the one above is reading. They state they have read my civilian doctors notes. They are non-existent in my file. It hasn't been that long ago. I don't believe I was given the COPD rating until this C & P when this doctor stated it is more likely than not. Then they combined the rating and gave me 60%, which still has some pyramiding issues. In 1994 the rater said there was no evidence I was taking my meds etc. when obviously the letters must have been there because as recently as 2012 during my last PFT they noted them. So the information is there, then its gone, then it reappears.

There is nothing in my C-file but copies of PFT's and Rating decisions, my original discharge information and a few tests. There is not one handwritten note of any kind. No work product that would allow you to make any sense out of the material if you didn't already have all of your records from 1990 forward (for the most part).

I'm not sure how to put this all together where it is easy to understand and follow. My original representative wasn't that interested. He even said "you know you can get in serious trouble for lying about smoking". I can just file a NOD the best way I can and then get a lawyer I suppose.

cass,

I had to delete the file you uploaded as it had your real name and SSA # on it.

You are welcome to make a copy of the upload - mark out personal info like name claim / SSA

number etc . . . and re-attach the file.

Too bad you missed the C&P appointment that the VA had scheduled,

it more likely than not would have been helpful.

§ 3.655 Failure to report for Department of Veterans Affairs examination.

(a) General. When entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination, or reexamination, action shall be taken in accordance with paragraph (b) or © of this section as appropriate. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. For purposes of this section, the terms examination and reexamination include periods of hospital observation when required by VA.

(b) Original or reopened claim, or claim for increase. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a reopened claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied.

© Running award.

(1) When a claimant fails to report for a reexamination and the issue is continuing entitlement, VA shall issue a pretermination notice advising the payee that payment for the disability or disabilities for which the reexamination was scheduled will be discontinued or, if a minimum evaluation is established in part 4 of this title or there is an evaluation protected under § 3.951(b) of this part, reduced to the lower evaluation. Such notice shall also include the prospective date of discontinuance or reduction, the reason therefor and a statement of the claimant's procedural and appellate rights. The claimant shall be allowed 60 days to indicate his or her willingness to report for a reexamination or to present evidence that payment for the disability or disabilities for which the reexamination was scheduled should not be discontinued or reduced.

(2) If there is no response within 60 days, or if the evidence submitted does not establish continued entitlement, payment for such disability or disabilities shall be discontinued or reduced as of the date indicated in the pretermination notice or the date of last payment, whichever is later.

(3) If notice is received that the claimant is willing to report for a reexamination before payment has been discontinued or reduced, action to adjust payment shall be deferred. The reexamination shall be rescheduled and the claimant notified that failure to report for the rescheduled examination shall be cause for immediate discontinuance or reduction of payment. When a claimant fails to report for such rescheduled examination, payment shall be reduced or discontinued as of the date of last payment and shall not be further adjusted until a VA examination has been conducted and the report reviewed.

(4) If within 30 days of a pretermination notice issued under paragraph ©(1) of this section the claimant requests a hearing, action to adjust payment shall be deferred as set forth in § 3.105(h)(1) of this part. If a hearing is requested more than 30 days after such pretermination notice but before the proposed date of discontinuance or reduction, a hearing shall be scheduled, but payment shall nevertheless be discontinued or reduced as of the date proposed in the pretermination notice or date of last payment, whichever is later, unless information is presented which warrants a different determination. When the claimant has also expressed willingness to report for an examination, however, the provisions of paragraph ©(3) of this section shall apply.

(Authority: 38 U.S.C. 501)

Cross References: Procedural due process and appellate rights: See § 3.103. Examinations: See § 3.326. Reexaminations: See § 3.327. Resumption of rating when veteran subsequently reports for VA examination: See § 3.330.

[55 FR 49521, Nov. 29, 1990; 58 FR 46865, Sept. 3, 1993]

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=d19bf832eb2c623d379c46f29dc37be8&rgn=div8&view=text&node=38:1.0.1.1.4.2.73.206&idno=38

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I would like to say that you are right ma'am I should have made that first C & P appointment in 2002. I should have realized much earlier that it was my responsibility to take care of my health and pursue any avenue available to me to prevent further harm to my body. For my sake and my children's. I regret that and hope I don't appear like I am not thankful for what the VA has done for me, what the people in the forums do for me. I am thankful and all of you have my gratitude, you really do.

Having missed the first C & P Exam I received a Rating Decision dated 11/15/2002. I have had to reproduce them by typing. I don't have a scanner or a means to get it done.

"Issue: Evaluation of bronchial asthma currently evaluated as 10 percent disabling.

Evidence:

Statement from S. Charochak D.O. received 09-23-2002.

You failed to report for a VA examination scheduled at VA Medical Center Kansas City on 10-18-02.

Evidence expected from this examination which might have been material to the outcome of this claim could not be considered.

Evidence from VA Medical Center Kansas City for the period 05-14-02 to 05-31-02.

Decision:

Evaluation of bronchial asthma, which is currently 10 percent disabling, is continued.

Reasons and Basis:

You did not report for the scheduled VA examination.

Dr. Charochak indicated that he did not have treatment reports for you for the period you indicated, June 1999 to June 2000.

The evidence from VA Medical Center shows that you continue to have complaints of shortness of breath, for which you continue to use inhalant therapy. You continue to smoke cigarettes.

The evidence fails to show this condition has increased in severity to the point where the next higher evaluation of bronchial asthma is continued as 10 percent disabling.

An evaluation of 10 percent is granted whenever there is forced expiratory volume in one second (FEV-1) of 71-80 percent of predicted value; or intermittent inhalation or oral bronchodilator therapy.; or inhalation anti-inflammatory medication."

______________________________________________________________________________

Pulmonary Function Test Scores

FEV1 3.28 4.56 72% 3.82 84% 16% change

FEV1/FVC 69 80 75 9% change

Physician Interpretation: FVC is normal, FEV1 is reduced, FEV1/FVC ratio is reduced, Midflows

are reduced.

Post-Bronchodilator Spirometry was improved.

Rv is increased, TLC is normal, Diffusing capacity is normal

Impression: Spirometry and lung volumes consistent with mild obstructive defect, mild air trapping and mild improvement after.

Naresh K Kodwani Staff Physician

Findings: PA and lateral views of the chest were obtained at 9:44 am on 12/17/2002. The heart is normal in size and configuration and both lungs are clear. No Pleural Effusion or Pneumothorax is seen. There is flattening of the diaphragms bilaterally consistent with chronic obstructive pulmonary disease.

Impression: Chronic Obstructive Pulmonary Disease with no acute Pulmonary infiltrate seen.

Primary interpreting Staff:

Craig M. Watts MD, Staff Radiologist (Verifier)

Medications:

My feelings, not VA Law, Regulations or Rules.

1. Failure to report to an examination was a routine appointment with my primary care physician, no

more than that.

2. There is no information in my C-File other than a VA Form 21-4142 typed up with my

information and Dr. Charochak's information asking for records between 06/00 and 06/99. The

form hasn't been signed by myself or a VA Representative. One other related letter dated Aug

19, 2002 simply states the need for any records of treatment. One small note on that page has

a star next to it stating "patient was first seen her 9-22-00. My first thought is why such a limited

length of time for inquiry. Even if they had some medical records for the other period of time

restrict the from and to dates, why not restrict the nature of the request in regards to pertinent

medical records relating to my disabilities.

3. Medical evidence from the VA period 05-14-02 to 05-31-02. On 05-14-02 I had a consult for an

appointment for an evaluation for Alcohol abuse (problem drinking). During that period of time I

had some of my prescriptions expire.

4. The Rater also stated that I continued to smoke cigarettes. I never have and it is plainly stated

throughout my SMR. I do not believe there is any possible way that the rater was objective in

his application of law and regulation to my case. Given the statement made in regards to my

continuous habit of smoking in spite of my poor health and continuous use of inhalers, which to

his thinking I am not using because I don't get them from the VA pharmacy.

5. Due to having COPD they determined FEV 1% predicted would be the test that most accurately

measures my disability.

6. Dr. Underwood is the first physician doing my C & P's and PFT's all these years to openly say

I was diagnosed with COPD in 1992. I have gone through my SMR's, all of my PFT's and all of

my rating decisions and it is always referred to as an obstructive defect either mild, severe or

chronic. Then rated at 10% asthma. To my knowledge and research through my medical

records C-File it has never been rated until this last C & P exam. The rater stated "

The Veteran has COPD. Onset in 1992. The Veteran is a non smoker. The Veteran has

asthma. It is at least as likely as not that the Veterans asthma condition is the cause of

his COPD. It is at this point, that they decided to give me a combined rating of 60%.

They denied me for Sleep Apnea, Gerd/Barrets Esophagus, Gout, Bi-Polar disorder; etc..

Current Medications: Symbicort Two Puffs x 2 day

Nebulizer w Albuterol Sulfate 0.083% 2.5 mg/3ml (4 x day)

Proventil HFA 90 MCG CFC-F 200D Oral Inhl (as needed)

Omeprazole 20 Mg x 2 a day

Abilify 20 Mg x 1 a day

Trazadone 50 Mg as needed for sleep

Resmed S9 Elite Used nightly

Prednisone As needed/prescribed last round early

January 2013

7. There has never been one time since about 1991 that I haven't had to take Corticosteroid

medicine along with oral steroids like Prednisone. I have been on Omeprazole since 1992.

___________________________________________________________________________

Second Rating Decision dated 01/07/2003

Issue:

Evaluation of bronchial asthma currently evaluated as 10 percent disabling.

Evidence:

VA examination dated 12-17-02 from VA Medical Center Kansas City.

Report from VA Medical Center Kansas City for the period 08-20-99 to 05-14-02.

VA rating decision dated 11-15-02 and the evidence upon which it was based.

Entire VA claims file all evidence contained therein.

Decision:

Evaluation of bronchial asthma, which is currently 10 percent disabling, is continued.

Reasons and Bases:

We received your claim for increased evaluation for this condition on 07-03-02. You did not report for the scheduled VA examination on 10-18-02, nor did you respond to the request for medical evidence to support your claim. Your claim was decided based on the evidence of record. We received information on 11-19-02 that you would be willing to report for an examination and one was ordered, the results of which are the basis for this instant decision.

The current VA examination shows you have inspiratory and expiratory wheezing. You were not shown to have changes in posture due to the asthma. Pulmonary Function test results showed FEV-1 of 84%, FVC of 89% and FEV-1/FVC of 94%. You were stated to have been prescribed medication for this condition, however there is no evidence that you have had such medication filled at a VA pharmacy since approximately 1989.

The evidence fails to show that you are currently taking any medication for this condition. You have, however, been prescribed medication for treatment of the asthma. There is no showing of the need for daily inhalation therapy.

Consequently, the evaluation of bronchial asthma is continued as 10 percent disabling.

An evaluation of 10 percent is granted whenever there is forced expiratory volume in one second (FEV-1) of 71-80 percent of predicted value; or the ratio of FEV-1 to forced vital capacity (FEV1/FVC) of 56 to 70 percent; or daily inhalation of Bronchodilators therapy; or inhalation anti-inflammatory medication.

1. This PFT is the best one out of about 12 or so that I have had. I believe that since COPD is

on the table now and they are doing FEV-1 predicted that all of my PFT's would fall under this

rating. At least back to 2002. Not counting the med's. That alone would do it since 1990.

2. The rater stated that I haven't been to the VA pharmacy since approximately 1989. I was still

serving in the United States Marine Corps at that time. I would not be discharged till 01/02/90

and even then we followed my wife's parents to Ormond Beach when they moved from the Bronx.

I would not make it back here till late 91 or 92.

3. I did respond to there request for records. How would they know which doctor to contact if I had

not advised them of his where about. I have records from Florida and I will forward those to the

the proper destination. Since this is so long I will not list all the medications that are documented

and the appointments and ER visits during this time frame. The fact is the rating decisions

changed a great deal. Yes they both up held the 10%. Then on reflection the rater had another

bite at the apple, he had a window of opportunity to rethink his position. Upon doing so he

removed the smoking portion knowing that it may not affect the the VA but it would for sure

bother the Veteran After that he realized he should shore up his timeline, broadening his scope

from the original 16 days to almost three years. Why do that if all he needed was the PFT's?

4. On 100202 I was refilling my prescriptions at the KCVA:

Albuterol 90 2 puffs four times a day

Fexofenadine HCL one tablet three times a day.

Flunisolide four puffs twice a day .

Fluoxetine Hcl one capsule in the morning

Hydroxyzine one tablet by mouth bedtime

Montelukast one tablet at bedtime

Rabeprazole one tablet before breakfast

Ranitidine Hcl one tablet twice a day.

5. From January of 1995 to 2006 I worked at Southwestern Bell which became SBC Which bought

it's momma in 2005 at&t. During those years I utilized both Corporate insurance and the VA

so far as to provide the VA with my insurance information so they could be compensated for my

care. The insurance provider is still handling the account and they hope they can provide me

with what I need.

if not I can prove I had the coverage from there it's a simple leap of faith, if a Marine was

prescribed Prednisone 40 down to 5 by 5;s, Theodore 300, Azmacort, Alupent, Alupent

Solution for his nebulizer, Afrin and Emycn in Oct/Nov 1989 with the Prednisone being the

second round in as many months. Then discharged SC DNEPTE RC-3P Seperation Code JFL1

on 01/02/1990. Then continued to use a very similar prescription regimine for the next 22 years

I would hope he would conclude that the Marine obviously needs them and it is more likely than

not that he got his medications. I might even go as far as to call him and ask him "where you

getting your med's?"

In reference to the discharge I never realized it what it was. It is Honorable, I was recommended

for re-enlistment. I'm not sure what to think of it. I haven't looked into it fully yet.

In defense: Shortly before discharge I ran my last PFT. Maxed Sit-ups, 18 pull ups, 21 minute

three mile run. I almost died but it was my last. I was a a fourth award expert with a high of 231

on the Rifle Range. Navy Unit Commendation, Good Conduct Medal (2nd award) Sea Service

Deployment Ribbon, three Certificates of Commendation, 4 Meritorious Masts, 3 letters of

Appreciation. Proficiency and Conduct Marks in Grade 4.6 4.6, in service 4.6 4.5. I had a

Top Secret Clearance. Marine of the Quarter, at least 4 or 5 Meritorious Boards etc. etc..

I know, no hazardous duty, no combat nothing but easy duty I suppose. I guess i felt the need

to defend that although I'm not sure why. Is this a problem for me, can I do something about

this?

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Ok.. it appears the best thing that you can do for yourself is to request an increase again, and supply all the newest medical records as evidence of a continuing problem. And make sure you make it to the C/P exam.....

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As I understand it, if you are service connected for a respiratory condition and it requires home oxygen, that is supposedly* an automatic 100% rating. See the rating: "episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy 100".

This 100% rating does not mean someone is P&T by itself as the need for home oxygen therapy may be only temporary, say because someone later received a lung transplant and then didn't need supplemental O2.

How the need for home oxygen is determined by your the doctor, be it based on a PFT, Arterial Blood Gas or Pulse Oximeter reading of SpO2 below 90%, isn't all that important...just that the need can be documented by a means acceptable to the VA that outpatient home O2 therapy is needed.

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I was diagnosed with Asthma after two months and five days after in training. I was given a convience of the government discharge for asthma. Which states that my Performance deteriorated. I decided to get service connected. I went to a cmp and a pft then two weeks later i got a denial. The Cmp examiner reworded what I said and omitted my pft test even though the person giving it expressed how bad it was. She claimed my condition existed prior to service even though she had no evidence claiming that it did...what do I do...I'm facing a 5 year appeal

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