Psoriasis Decrease rating??

[ArmyVet1981]

Hello everyone!

 this is my first post on this site, but I have been stalking it for a while now.

I have a question that maybe someone can address.

I'll try and make it short and sweet....

I received my SC disability for psoriasis 30% in 2009.  At the time I was only on topicals that did nothing for me... For the last 2 years I have been on Humira which has been a blessing!   I just received a phone call from a rep stating that I was coming up for an exam on my psoriasis... I told them I was on auto-immune suppressants, so of course my skin is clearer.. She stated that would drop my rating.....??  My issue is this... if they take away my 30% for my psoriasis... who would pay for my Humira?? And isn't the fact that I am on auto-immune suppressants enough to keep my rating as is??

 

any advice would be greatly appreciated:)

[Chuck75]

Just because the % decreases as the result of treatment does not remove the SC classification, unless the condition was "temporary", and totally eliminated

by treatment. The C&P exam will be a governing factor. Eliminating the symptoms does not always eliminate the cause.

Even so, successful treatment may result in a no compensation rating. 

 

[ArmyVet1981]

Thank you for the fast response!  So just to clarify, even though they might decrease my %, they still have to treat me? 

Also I looked up the rating for psoriasis and it states ; Seems to me I should be increased, not decreased.... or I can be reading this wrong.....

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

20 to 40 percent of the entire body or 20 to 40 percent of exposed
areas affected, or; systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of six weeks
or more, but not constantly, during the past 12-month period................................ 30

At least 5 percent, but less than 20 percent, of the entire body, or at
least 5 percent, but less than 20 percent, of exposed areas affected,
or; intermittent systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of less than
six weeks during the past 12-month period.......................................................... 10

[Chuck75]

7 hours ago, ArmyVet1981 said:

Thank you for the fast response!  So just to clarify, even though they might decrease my %, they still have to treat me? 

Also I looked up the rating for psoriasis and it states ; Seems to me I should be increased, not decreased.... or I can be reading this wrong.....

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

20 to 40 percent of the entire body or 20 to 40 percent of exposed
areas affected, or; systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of six weeks
or more, but not constantly, during the past 12-month period................................ 30

At least 5 percent, but less than 20 percent, of the entire body, or at
least 5 percent, but less than 20 percent, of exposed areas affected,
or; intermittent systemic therapy such as corticosteroids or other
immunosuppressive drugs required for a total duration of less than
six weeks during the past 12-month period.......................................................... 10

Going just from the reg cited, you are correct! The VA often seems to fail to read the more veteran favorable portions of the schedule.  As I previously mentioned, the C&P Examiner's report will have a great deal to do with what happens. If you feel that you meet the 60%, go for it, and mention it to the examiner.

[Rx7mike]

43 minutes ago, Chuck75 said:

Going just from the reg cited, you are correct! The VA often seems to fail to read the more veteran favorable portions of the schedule.  As I previously mentioned, the C&P Examiner's report will have a great deal to do with what happens. If you feel that you meet the 60%, go for it, and mention it to the examiner.

Chuck75 is right. But the ultimate descision is up to the rater. If you can get a statement from the outside provider stating that if you are off the meds your condition will worson. Also it would be good to have them state your flare ups ect as the more info you have to back your claim the better. Get with Your VSO and request a continuence for another reveiw or request another C&P if you are not liking the outcome from the C&P you are having.

Go for what is in there criteria if you meet it get all the information you can to support your claim and be ready. Wish you the best.

[broncovet]

First, the VA can not reduce you until they send you a "proposal to reduce" 60 days in advance for said reduction.  You must be given an opportunity for a hearing.  If they do send a reduction proposal, then I recommend you request a hearing.  

Next, since you have had a rating since 2009, you have passed the "5 year" protection mark.  See reg below:

3.344 Stabilization of disability evaluations.

(a) Examination reports indicating improvement. Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and Department of Veterans Affairs regulations governing disability compensation and pension. It is essential that the entire record of examinations and the medical-industrial history be reviewed to ascertain whether the recent examination is full and complete, including all special examinations indicated as a result of general examination and the entire case history. This applies to treatment of intercurrent diseases and exacerbations, including hospital reports, bedside examinations, examinations by designated physicians, and examinations in the absence of, or without taking full advantage of, laboratory facilities and the cooperation of specialists in related lines. Examinations less full and complete than those on which payments were authorized or continued will not be used as a basis of reduction. Ratings on account of diseases subject to temporary or episodic improvement, e.g., manic depressive or other psychotic reaction, epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Ratings on account of diseases which become comparatively symptom free (findings absent) after prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart disease, etc., will not be reduced on examinations reflecting the results of bed rest. Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. When syphilis of the central nervous system or alcoholic deterioration is diagnosed following a long prior history of psychosis, psychoneurosis, epilepsy, or the like, it is rarely possible to exclude persistence, in masked form, of the preceding innocently acquired manifestations. Rating boards encountering a change of diagnosis will exercise caution in the determination as to whether a change in diagnosis represents no more than a progression of an earlier diagnosis, an error in prior diagnosis or possibly a disease entity independent of the service-connected disability. When the new diagnosis reflects mental deficiency or personality disorder only, the possibility of only temporary remission of a super-imposed psychiatric disease will be borne in mind.

(b) Doubtful cases. If doubt remains, after according due consideration to all the evidence developed by the several items discussed in paragraph (a) of this section, the rating agency will continue the rating in effect, citing the former diagnosis with the new diagnosis in parentheses, and following the appropriate code there will be added the reference “Rating continued pending reexamination ___ months from this date, §3.344.” The rating agency will determine on the basis of the facts in each individual case whether 18, 24 or 30 months will be allowed to elapse before the reexamination will be made.

(c) Disabilities which are likely to improve. The provisions of paragraphs (a) and (b) of this section apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating.

[ArmyVet1981]

Thank you all for your responses!  It's nice knowing I can come onto a site where everyone is so inviting, and helpful