Systemic Therapy 7819-7821

[ShrekTheTank]

I need some help here.  

The Basic Rating System below is used to rate many (but not all) of the skin conditions on this page. Find your condition first to see if it is rated under this system.

It is vital that you understand how the VA defines systemic and topical treatments in order to determine your correct rating.

– Systemic Therapy: Any treatment that is injected, or taken by mouth, through the nose, or anally. This includes, but is not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, and other immunosuppressive drugs.
– Topical Therapy: Any treatment applied directly to the skin, regardless of the type of drug.

The Basic Rating System

If the lesions cover more than 40% of total body or more than 40% of exposed divisions, or if it required the constant or near-constant use of systemic therapy for the past 12 months, it is rated 60%.

If the lesions cover 20 to 40% of total body or 20 to 40% of exposed divisions, or if it required the use of systemic therapy for a total of 6 weeks or more over the past 12 months, it is rated 30%.

If the lesions cover 5 to 19% of total body or 5 to 19% of exposed divisions, or if it required the use of systemic therapy for a total of less than 6 weeks over the past 12 months, it is rated 10%.

If the condition only required the use of topical medications over the past 12 months and the lesions cover less than 5% of total body or less than 5% of exposed divisions, it is rated 0%.

 

So I have a rare disease called Dercum's Disease.  I am finally at the BVA and am in the remand stage.  They have changed the rating schedule and I now fall under the basic skin rating.  

My question is what counts as Systemic Therapy? or Topical Therapy?  The reason I am asking is I have been on pain killers since 2004 and topical cream that is also a pain reliever for over 10 years.  I am also taking a drug called nortriptyline which helps my pain subside so I can sleep at night.  

If I am reading this correctly anything that is used to treat the condition would count correct?  Any help is greatly appreciated!

 

Randy

 

[vetquest]

If I were to read your letter correctly I would say you have a systemic and a topical therapy going.  Unfortunately the VA might not count pain medication as systemic therapy.  I use pain medications and the first rater who noted I took them called me an addict.  You might be able to declare nortriptyline as systemic therapy but it is an antidepressant, not a skin treatment per se.  Right now you can only wait and see what they do.  Once you have a decision let us know which side of the fence they chose to sit on.

[ShrekTheTank]

I guess here is another question.  If I do not get prescribed topical medication does it still count if I get it on my own?  As the verbiage has changed with the rating, before it only said for very certain things and now it is far more open.  

Edited September 27, 2018 by shrekthetank1

[vetquest]

Whether you get your medication from the VA or a private doctor it should make no difference.

[ShrekTheTank]

Does it matter if they were OTC meds?  Just wondering as I was told at the VA they would not cover Topical creams.  So I have been buying my own.  Not sure how the VA views this as meds that are being taken?

[vetquest]

Just make sure that in your C&P notes that you are using topical cream every day and why.

[David Anderson]

Hello...my question pertains to code 7818...I have been granted service connected by the VA for actinic keratoses, basal cell carcinoma, squamous cell carcinoma...does Fluoricil (topical chemotherapy) meet the requirement of 7818? Thank you