Remand of renal failure and iu

[treysnonna]

Will they rate the renal failure.  Should we send anything in on hubbys stay in hospital o aug 27th with pulmonary embolism.  Since it did effect his Kidney and heart?  They did send us the Iu papers to file.  We did not originally file.  That was their suggestion.  So we did file last week, and got it sent back.    Should we just wait now and see if they are going to approve it quickly.    And will they go back ten yrs on contacting the employer.  We gave them the address.  So it is up to them if they contact his employer.  We are waiting for a referral from our private dr to a private pulmonologist.

[treysnonna]

I’m hoping that they do make a decision fast.  We have not received anything on the retro for increase on diabetes.  And ebenefits does not show any increase and no pending disabilities.  I do not know what to think about that.  Any opinions?

[broncovet]

Yes, they should rate renal failure.  This is a serious, life threatening disorder, and you should contact the VA, and let them know you have renal failure.  It should mean your claim is expidited.  Here are the ratings:  (Of course, I have no idea if your Renal failure is service connected or not)  

 

Quote

 

A. Renal Dysfunction

Currently, VA evaluates renal dysfunction as follows:

A 100 percent evaluation is assigned for any of the following: Requiring regular dialysis, or precluding more than sedentary activity from one of the following: Persistent edema and albuminuria; or, BUN more than 80 mg%; or, creatinine more than 8 mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular.

An 80 percent evaluation is assigned for any of the following: Persistent edema and albuminuria with BUN 40 to 80 mg%; or, creatinine 4 to 8 mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion.

A 60 percent evaluation is assigned for any of the following: Constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 7101.

A 30 percent evaluation is assigned for any of the following: Albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under diagnostic code 7101.

A 0 percent evaluation is assigned for either albumin and casts with a history of acute nephritis; or, hypertension non-compensable under diagnostic code 7101.

Subjective terms such as “markedly,” “some,” and “slight” contribute to inconsistent evaluation of genitourinary disabilities rated under this criteria. Therefore, VA proposes to replace these subjective criteria with specific objective laboratory findings, such as the glomerular filtration rate (GFR). Modern medicine states the “[GFR] is widely accepted as the best overall measure of kidney function in health and disease.” Nat'l Kidney Found., “K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification,” Am. J. Kidney Disease 39:S1-S266, S5 (2002), available at https://www.kidney.org/sites/default/files/docs/ckd_evaluation_classification_stratification.pdf (last viewed Oct. 7, 2016). In clinical practice, subject matter experts have noted an inverse correlation between GFR and functional impairment (e.g., lower GFRs correspond to greater impairment), and individuals with GFRs less than 60 mL/min are considered to have chronic renal disease. Id. at S12. A GFR less than 60 mL/min is also a sign of renal failure. Id. In addition to using the GFR for evaluation purposes, VA also proposes adding a note to the evaluation criteria specifying that GFR, estimated GFR (eGFR), and creatinine based approximations are acceptable for evaluation purposes, as each has been shown to be an adequate indicator of the stage of chronic kidney disease. Id. at S81. The GFR used must be medically appropriate and calculated by a medical professional.

Based on the level of kidney function generally associated with a particular GFR, VA proposes assigning a 100 percent evaluation for a GFR less than 16 mL/min; an 80 percent evaluation for a GFR between 16 and 29 mL/min; a 60 percent evaluation for a GFR between 30 and 59 mL/min; a 30 percent evaluation for a GFR greater than or equal to 60 mL/min with at least one of the following: Albumin/creatinine ratio (ACR) greater than or equal to 2.5 g/gm (nephrotic range proteinuria), or hypertension at least 10 percent disabling under diagnostic code 7101; and a 0 percent evaluation for a GFR greater than or equal to 60 mL/min with at least one of the following: ACR greater than or equal to .03 g/gm but less than or equal to 2.49 g/gm, or hypertension that is non-compensable under diagnostic code 7101. These levels of evaluation correlate to a modified staging classification of chronic kidney disease by the National Kidney Foundation. Id. At the 100 percent evaluation, the designated GFR is associated with kidney failure and, at the 0 percent evaluation, the designated GFR is associated with an increased risk of kidney damage where a diagnosis of chronic kidney disease has been made. Id. Intermediate levels of evaluation at the 30, 60, and 80 percent levels correspond to the remaining stages of chronic kidney disease as they increase in severity as manifest by declining GFR or increasing proteinuria.

Proteinuria is considered in the evaluation of chronic kidney disease at the 30 and 0 percent levels because GFR measures only the ability of the kidneys to filter the blood and does not always provide a complete picture of renal disease. For example, in the early stages of chronic renal disease resulting from kidney damage, GFR may be within the normal range and impairment may be characterized by other diagnostic abnormalities, such as increased secretion of protein in the urine (proteinuria). Id. at S71. Proteinuria, as measured by increased urinary excretion of albumin, is an early and sensitive marker of kidney damage in many types of chronic kidney disease. Id. at S48, S101. Therefore, VA proposes that an ACR of 2.5 g/gm or greater (also called nephrotic range proteinuria) would warrant a 30 percent evaluation and an ACR of at least 0.03 g/gm but no more than 2.49 g/gm—i.e., urinary albumin that does not reach the level of nephrotic range proteinuria—would warrant a 0 percent evaluation. VA would not eliminate reference to hypertension in the 0 and 30 percent evaluation criteria because sustained elevation of arterial blood pressure may be a consequence of chronic kidney disease. Id. at S125-26.

Finally, a 100 percent evaluation would still be assigned for chronic kidney disease requiring regular, routine dialysis. VA intends to also extend this evaluation to individuals requiring a kidney transplant who may not yet require regular, routine dialysis. Often, a patient with rapidly deteriorating chronic kidney disease will be placed on a transplant list before they require regular, routine dialysis, although dialysis may actually be required before the transplant is performed.

 

If the VA wont respond to your requests (as usual)   to expidite this, then contact the white house hotline.  

Edited September 18, 2018 by broncovet