Appealing My Denial For Joint Pain

[Trigirl13]

Just wanted to post on here and let you all know where I am at with my claim now. I currently was awarded 100% for hypothyroidism/bradycardia and 50% for depression. I was denied joint pain, which really is ridiculous, since half of my service medical record states chronic joint pain in it. So I have a lawyer helping with all this. My biggest concern is getting the medication that I need for my condition, out of pocket costs range from $2500 to $3000, and I just don't have the money to pay for that. I am currently getting samples from the my local doc office ( I have an amazing none VA doc.) and have put in a request through the company to receive assistance with the cost, so I will be covered for at least a year. I will be happy when all this is done, but understand that it is a long waiting game at this point. Thank you for all the support I have received so far and will receive in the future.

[john999]

The reason they are not giving you Enbrel is the cost factor. I know the VA does prescribe it for severe arthritis. It is a drug with many side effects. That could be another factor. If your PCP really wants you to get it they can make it happen. What is your exact diagnosis?

[Trigirl13]

Ankylosing Spondylitis, I have a few fused vertebrae and my lumbar spine is straight instead of curved. Without the medication I am pretty much useless, it takes me a couple of hours after waking in the morning before any stiffness starts to go away and my ability to do basic everyday things becomes very hard without the medication, this medication has literally given me my life back.

[john999]

Do you have medicare?

[Trigirl13]

No I don't qualify for it, I am too young . We were on medicaid. My hubby finally has a stable job, so we don't qualify for that either. He should have insurance by sept. sometime, but we don't know if the insurance will even cover me. My doctor was talking about needing surgery in the next year or two, and I just don't want that, I can still walk and get around (even if it is painful at times). I just get really nervous thinking about surgery on my spine.

[71M10]

The VA clinic said they are not taking new patients???? If you are a 100% service connected vet you should be top priority. You also need to be aware if they want you to travel to a VA hospital for treatments you are entitled to travel pay. Did you not qualify for SSDI? If you qualify for SSDI you should qualify for Medicare.

[Trigirl13]

I havent applied for it. To be honest I really didn't know what all my options were. It wasn't until I found this website, that I realized what was there to help me out. And when I called they told me no new patients at all. I am in the process of figuring out the non-va care program. The closest clinic is a 2 hour trip one way and I have little ones that I would need to find child care for a full day for a trip like that trip (4 hours worth of travel for one trip). Besides the child care, being in a car for that long has always been very painful for me, my joints get really sore and I usually am out of commission for 3-4 days after a trip like that. So far it looks like I will be able to see someone local, I just have to get the authorization.