Obstructive Sleep Apnea (OSA) and COPD

[EODCMC]

I have OSA and receive 50% SC Disibility for it. I just found out that the Naval Hospital San Diego diagnosed me with COPD and chest wall pleural thickening in Jan 2016. They did not notify me of this and I found out by accident. Does the combination of COPD and OSA make the rating at 100% ? Should the VA have known and remarked on this during my C&P exam? If so, is this grounds for a NOD and/or CUE? Thanks in advance for your help.

[Buck52]

EODCMC

I think the diagnostic codes 6600-6817 through 6847 &  will not be combined with each other. or secondary to one or the other  because its all in the respiratory areas, I would file on it tho and see what they say ?

maybe you can get the COPD  S.C. at 0%  

If its a separate condition  just depends on what they rate the COPD for you to get 100%  if your just 50% now?

As for as rating it when they rated you the OSA, unless the examiner didn't check  your COPD at the time of your C&P For OSA. 

You need to go back and check your OSA Grant and see what they mention in Reason & Basses of the decision or look at your OSA C&P Exam.

if your 50% now  and get another 50% for COPD  that will boost your rating to 80%

 Using VA  Math 50% plus another 50% is =75% rounded to the next higher # which is 80%

Edited February 3, 2017 by Buck52

[EODCMC]

Thanks Buck. Does the pulmonary aspects of COPD strengthen the case for prescribing 02 with my CPAP? If so, this would increase the disibilty to 100%. I googled OSA and COPD...combined is an increased and significantly deadly scenario. 

[Buck52]

Yes it should

here is the respiatory ratings  its a little long because there is so many conditions of the respiratory  system.

  check out close to the bottom about the OSA Mixed.

§4.97   Schedule of ratings—respiratory system.

   Rating

DISEASES OF THE NOSE AND THROAT

6502   Septum, nasal, deviation of:

Traumatic only,

With 50-percent obstruction of the nasal passage on both sides or complete obstruction on one side10

6504   Nose, loss of part of, or scars:

Exposing both nasal passages30

Loss of part of one ala, or other obvious disfigurement10

Note: Or evaluate as DC 7800, scars, disfiguring, head, face, or neck.

6510   Sinusitis, pansinusitis, chronic.

6511   Sinusitis, ethmoid, chronic.

6512   Sinusitis, frontal, chronic.

6513   Sinusitis, maxillary, chronic.

6514   Sinusitis, sphenoid, chronic.

General Rating Formula for Sinusitis (DC's 6510 through 6514):

Following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries50

Three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting30

One or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting10

Detected by X-ray only0

Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician.

6515   Laryngitis, tuberculous, active or inactive.

Rate under §§4.88c or 4.89, whichever is appropriate.

6516   Laryngitis, chronic:

Hoarseness, with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy30

Hoarseness, with inflammation of cords or mucous membrane10

6518   Laryngectomy, total.1100

Rate the residuals of partial laryngectomy as laryngitis (DC 6516), aphonia (DC 6519), or stenosis of larynx (DC 6520).

6519   Aphonia, complete organic:

Constant inability to communicate by speech1100

Constant inability to speak above a whisper60

Note: Evaluate incomplete aphonia as laryngitis, chronic (DC 6516).

6520   Larynx, stenosis of, including residuals of laryngeal trauma (unilateral or bilateral):

Forced expiratory volume in one second (FEV-1) less than 40 percent of predicted value, with Flow-Volume Loop compatible with upper airway obstruction, or; permanent tracheostomy100

FEV-1 of 40- to 55-percent predicted, with Flow-Volume Loop compatible with upper airway obstruction60

FEV-1 of 56- to 70-percent predicted, with Flow-Volume Loop compatible with upper airway obstruction30

FEV-1 of 71- to 80-percent predicted, with Flow-Volume Loop compatible with upper airway obstruction10

Note: Or evaluate as aphonia (DC 6519).

6521   Pharynx, injuries to:

Stricture or obstruction of pharynx or nasopharynx, or; absence of soft palate secondary to trauma, chemical burn, or granulomatous disease, or; paralysis of soft palate with swallowing difficulty (nasal regurgitation) and speech impairment50

6522   Allergic or vasomotor rhinitis:

With polyps30

Without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side10

6523   Bacterial rhinitis:

Rhinoscleroma50

With permanent hypertrophy of turbinates and with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side10

6524   Granulomatous rhinitis:

Wegener's granulomatosis, lethal midline granuloma100

Other types of granulomatous infection20

DISEASES OF THE TRACHEA AND BRONCHI

6600   Bronchitis, chronic:

FEV-1 less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit)60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted10

6601   Bronchiectasis:

With incapacitating episodes of infection of at least six weeks total duration per year100

With incapacitating episodes of infection of four to six weeks total duration per year, or; near constant findings of cough with purulent sputum associated with anorexia, weight loss, and frank hemoptysis and requiring antibiotic usage almost continuously60

With incapacitating episodes of infection of two to four weeks total duration per year, or; daily productive cough with sputum that is at times purulent or blood-tinged and that requires prolonged (lasting four to six weeks) antibiotic usage more than twice a year30

Intermittent productive cough with acute infection requiring a course of antibiotics at least twice a year10

Or rate according to pulmonary impairment as for chronic bronchitis (DC 6600).

Note: An incapacitating episode is one that requires bedrest and treatment by a physician.

6602   Asthma, bronchial:

FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy10

Note: In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record.

6603   Emphysema, pulmonary:

FEV-1 less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy.100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit)60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted10

6604   Chronic obstructive pulmonary disease:

FEV-1 less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy.100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit)60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted10

DISEASES OF THE LUNGS AND PLEURA—TUBERCULOSIS

Ratings for Pulmonary Tuberculosis Entitled on August 19, 1968

6701   Tuberculosis, pulmonary, chronic, far advanced, active100

6702   Tuberculosis, pulmonary, chronic, moderately advanced, active100

6703   Tuberculosis, pulmonary, chronic, minimal, active100

6704   Tuberculosis, pulmonary, chronic, active, advancement unspecified100

6721   Tuberculosis, pulmonary, chronic, far advanced, inactive

6722   Tuberculosis, pulmonary, chronic, moderately advanced, inactive

6723   Tuberculosis, pulmonary, chronic, minimal, inactive

6724   Tuberculosis, pulmonary, chronic, inactive, advancement unspecified

General Rating Formula for Inactive Pulmonary Tuberculosis: For two years after date of inactivity, following active tuberculosis, which was clinically identified during service or subsequently100

Thereafter for four years, or in any event, to six years after date of inactivity50

Thereafter, for five years, or to eleven years after date of inactivity30

Following far advanced lesions diagnosed at any time while the disease process was active, minimum30

Following moderately advanced lesions, provided there is continued disability, emphysema, dyspnea on exertion, impairment of health, etc20

Otherwise0

Note (1): The 100-percent rating under codes 6701 through 6724 is not subject to a requirement of precedent hospital treatment. It will be reduced to 50 percent for failure to submit to examination or to follow prescribed treatment upon report to that effect from the medical authorities. When a veteran is placed on the 100-percent rating for inactive tuberculosis, the medical authorities will be appropriately notified of the fact, and of the necessity, as given in footnote 1 to 38 U.S.C. 1156 (and formerly in 38 U.S.C. 356, which has been repealed by Public Law 90-493), to notify the Veterans Service Center in the event of failure to submit to examination or to follow treatment.

Note (2): The graduated 50-percent and 30-percent ratings and the permanent 30 percent and 20 percent ratings for inactive pulmonary tuberculosis are not to be combined with ratings for other respiratory disabilities. Following thoracoplasty the rating will be for removal of ribs combined with the rating for collapsed lung. Resection of the ribs incident to thoracoplasty will be rated as removal.

Ratings for Pulmonary Tuberculosis Initially Evaluated After August 19, 1968

6730   Tuberculosis, pulmonary, chronic, active100

Note: Active pulmonary tuberculosis will be considered permanently and totally disabling for non-service-connected pension purposes in the following circumstances:

(a) Associated with active tuberculosis involving other than the respiratory system.

(b) With severe associated symptoms or with extensive cavity formation.

(c) Reactivated cases, generally.

(d) With advancement of lesions on successive examinations or while under treatment.

(e) Without retrogression of lesions or other evidence of material improvement at the end of six months hospitalization or without change of diagnosis from “active” at the end of 12 months hospitalization. Material improvement means lessening or absence of clinical symptoms, and X-ray findings of a stationary or retrogressive lesion.

6731   Tuberculosis, pulmonary, chronic, inactive:

Depending on the specific findings, rate residuals as interstitial lung disease, restrictive lung disease, or, when obstructive lung disease is the major residual, as chronic bronchitis (DC 6600). Rate thoracoplasty as removal of ribs under DC 5297.

Note: A mandatory examination will be requested immediately following notification that active tuberculosis evaluated under DC 6730 has become inactive. Any change in evaluation will be carried out under the provisions of §3.105(e).

6732   Pleurisy, tuberculous, active or inactive:

Rate under §§4.88c or 4.89, whichever is appropriate.

NONTUBERCULOUS DISEASES

6817   Pulmonary Vascular Disease:

Primary pulmonary hypertension, or; chronic pulmonary thromboembolism with evidence of pulmonary hypertension, right ventricular hypertrophy, or cor pulmonale, or; pulmonary hypertension secondary to other obstructive disease of pulmonary arteries or veins with evidence of right ventricular hypertrophy or cor pulmonale100

Chronic pulmonary thromboembolism requiring anticoagulant therapy, or; following inferior vena cava surgery without evidence of pulmonary hypertension or right ventricular dysfunction60

Symptomatic, following resolution of acute pulmonary embolism30

Asymptomatic, following resolution of pulmonary thromboembolism0

Note: Evaluate other residuals following pulmonary embolism under the most appropriate diagnostic code, such as chronic bronchitis (DC 6600) or chronic pleural effusion or fibrosis (DC 6844), but do not combine that evaluation with any of the above evaluations.

6819   Neoplasms, malignant, any specified part of respiratory system exclusive of skin growths100

Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

6820   Neoplasms, benign, any specified part of respiratory system. Evaluate using an appropriate respiratory analogy.

Bacterial Infections of the Lung

6822   Actinomycosis.

6823   Nocardiosis.

6824   Chronic lung abscess.

General Rating Formula for Bacterial Infections of the Lung (diagnostic codes 6822 through 6824):

Active infection with systemic symptoms such as fever, night sweats, weight loss, or hemoptysis100

Depending on the specific findings, rate residuals as interstitial lung disease, restrictive lung disease, or, when obstructive lung disease is the major residual, as chronic bronchitis (DC 6600).

Interstitial Lung Disease

6825   Diffuse interstitial fibrosis (interstitial pneumonitis, fibrosing alveolitis).

6826   Desquamative interstitial pneumonitis.

6827   Pulmonary alveolar proteinosis.

6828   Eosinophilic granuloma of lung.

6829   Drug-induced pulmonary pneumonitis and fibrosis.

6830   Radiation-induced pulmonary pneumonitis and fibrosis.

6831   Hypersensitivity pneumonitis (extrinsic allergic alveolitis).

6832   Pneumoconiosis (silicosis, anthracosis, etc.).

6833   Asbestosis.

General Rating Formula for Interstitial Lung Disease (diagnostic codes 6825 through 6833):

Forced Vital Capacity (FVC) less than 50-percent predicted, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation, or; cor pulmonale or pulmonary hypertension, or; requires outpatient oxygen therapy100

FVC of 50- to 64-percent predicted, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation60

FVC of 65- to 74-percent predicted, or; DLCO (SB) of 56- to 65-percent predicted30

FVC of 75- to 80-percent predicted, or; DLCO (SB) of 66- to 80-percent predicted10

Mycotic Lung Disease

6834   Histoplasmosis of lung.

6835   Coccidioidomycosis.

6836   Blastomycosis.

6837   Cryptococcosis.

6838   Aspergillosis.

6839   Mucormycosis.

General Rating Formula for Mycotic Lung Disease (diagnostic codes 6834 through 6839):

Chronic pulmonary mycosis with persistent fever, weight loss, night sweats, or massive hemoptysis100

Chronic pulmonary mycosis requiring suppressive therapy with no more than minimal symptoms such as occasional minor hemoptysis or productive cough50

Chronic pulmonary mycosis with minimal symptoms such as occasional minor hemoptysis or productive cough30

Healed and inactive mycotic lesions, asymptomatic0

Note: Coccidioidomycosis has an incubation period up to 21 days, and the disseminated phase is ordinarily manifest within six months of the primary phase. However, there are instances of dissemination delayed up to many years after the initial infection which may have been unrecognized. Accordingly, when service connection is under consideration in the absence of record or other evidence of the disease in service, service in southwestern United States where the disease is endemic and absence of prolonged residence in this locality before or after service will be the deciding factor.

Restrictive Lung Disease

6840   Diaphragm paralysis or paresis.

6841   Spinal cord injury with respiratory insufficiency.

6842   Kyphoscoliosis, pectus excavatum, pectus carinatum.

6843   Traumatic chest wall defect, pneumothorax, hernia, etc.

6844   Post-surgical residual (lobectomy, pneumonectomy, etc.).

6845   Chronic pleural effusion or fibrosis.

General Rating Formula for Restrictive Lung Disease (diagnostic codes 6840 through 6845):

FEV-1 less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit)60

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted30

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted10

Or rate primary disorder.

Note (1): A 100-percent rating shall be assigned for pleurisy with empyema, with or without pleurocutaneous fistula, until resolved.

Note (2): Following episodes of total spontaneous pneumothorax, a rating of 100 percent shall be assigned as of the date of hospital admission and shall continue for three months from the first day of the month after hospital discharge.

Note (3): Gunshot wounds of the pleural cavity with bullet or missile retained in lung, pain or discomfort on exertion, or with scattered rales or some limitation of excursion of diaphragm or of lower chest expansion shall be rated at least 20-percent disabling. Disabling injuries of shoulder girdle muscles (Groups I to IV) shall be separately rated and combined with ratings for respiratory involvement. Involvement of Muscle Group XXI (DC 5321), however, will not be separately rated.

6846   Sarcoidosis:

Cor pulmonale, or; cardiac involvement with congestive heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment100

Pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control60

Pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids30

Chronic hilar adenopathy or stable lung infiltrates without symptoms or physiologic impairment0

Or rate active disease or residuals as chronic bronchitis (DC 6600) and extra-pulmonary involvement under specific body system involved

6847   Sleep Apnea Syndromes (Obstructive, Central, Mixed):

Chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy100

Requires use of breathing assistance device such as continuous airway pressure (CPAP) machine50

Persistent day-time hypersomnolence30

Asymptomatic but with documented sleep disorder breathing0

1Review for entitlement to special monthly compensation under §3.350 of this chapter.

[61 FR 46728, Sept. 5, 1996, as amended at 71 FR 28586, May 17, 2006]

 

Edited February 3, 2017 by Buck52

[EODCMC]

Yes. Disability percentage aside, what gets me is that someone should be looking after my health. They took chest X-rays and the Findings stated "FA and lateral views of the chest were obtained. Heart size normal. COPD with bilateral lateral chest wall pleural thickening left greater than right. Impression: COPD". Unless, they were leaving this out to marginalize the disability compensation, this should have been brought to my attention. Nevertheless, I will bring this to the attention of my Primary Care Doctor.

 

[john999]

You need to get some real doctors. The combo of OSA and COPD is a bad one especially if you have HBP or CAD or anything like that such as enlarged heart.  The least of your worries is getting extra disability.  You need to worry about your life.  I am sort of in the same boat with DMII and CAD, HBP and OSA.   I am surprised I wake up every day.  I would like to get the OSA and HBP service connected but I don't think I have the strength to go through it.

 

 

                                     John