Psoriatic Arthritis Claim

[Sirstrikealot]

New to the forum.  Have a few questions about my psoriatic arthritis claim.  Here is a little of my back story:

Discharged from the Army in 1995.  I had problems with psoriasis on legs, chest and scalp when discharged.  Also had documented foot, hand and back issues when I discharged.  I was given a 10% rating on my back, 0% for both hands and feet.  No mention of psoriasis in the award letter in 1998.  So that process took 3 years.  In 2001 while getting treatment in a VA hospital for psoriasis the doctor asked why  was limping and I told him about my problems I've had since discharging.  He ended up picking up the phone and arranged to have me meet a Rheumatologist that day.  That day changed my life when he told me I was suffering from Psoriatic Arthritis.  He started me on an infusion therapy called Remicade.  Within 2 months the psoriasis was gone and no more pain.  I was happy to finally feel normal again.  In 2012 I made the switch to Humira which worked great because it saved me from having to go the the VA hospital every 6 weeks for the infusion therapy.  So I've been on Humira every 2 weeks since.

About a year ago my condition has finally started to rear its ugly head again.  I really don't know if I've built up some immunity to the Humira or maybe need to take something else along with it  My VA doctor told me to look into getting my rating increased because she was afraid this is only going to get worse and may not be able to work in the next 5 years. Plus all of her patients all had ratings higher than mine.  So I came on this site to research and read everyone's battles with claims and filed an intent to file in August 2018.  I immediately requested my medical records and signed up with a local VSO.  Fast forward 11 months later I had one month to get my claim uploaded.  Still didn't have my service medical records.  I was worried that I was going to miss the one year deadline so I submitted my claim in July 2019.  We decided to go the secondary claim route and attach it to the listed disabilities I already had on record because I didn't have the service medical records to prove I dealt with all the symptoms of PSA while in service.   The day of my C&P exam I get a call from my VSO saying my service medical records finally showed up.  Great timing huh?  I picked them up before the appointment, luckily he made me a couple sets of copies. Went to my exam and I think it went extremely well.  I was able to go over all the service records and VA care records with my examiner and we went over everything that was being affected body wise and how much work I've missed this last year because of the flare ups.  She did range of motion on the affected body parts.  At the end I gave her several buddy statements, copies of all the medical records detailing what has happened in 20 years.  Her last question to me was why I waited 20 years to file a claim?  I told her I felt like since the VA was treating me for the condition and I was not getting a bill for all the medications and I was doing so well and I could work when there were many veterans that needed it more then I at the time.  But now that the condition is threatening to take away that job, I needed to do something.  She then said she would take care of me and thanked me for my service.  

My question to everyone here is will she? How much power does she have?

I've noticed on EBen its in the "Prep for decision" with a finish date for next week.  My exam was last Thursday so isn't that a little fast?  I'm somewhat confident that it's going to get approved because of all the documented episodes from service but  I've also seen many fellow soldiers get denied because the raters don't read everything.  If I do get awarded an increase I'm not sure how it would look.  Since I filled it as a secondary condition will it be 3 different ratings or just one all encompassing rating for PSA?  Would it be dated back to the intent to file date or the date I finally filled the claim?  I'm guessing it will be in the 60 to 70% range because of being on constant therapy and the number of flareups causing me not to be able to walk the past year.  Anyone here have any advice? 

[broncovet]

Ok.  Do you want to put your Entire future in the hands of a VSO you barely met, because "she" told you she would take care of you?  

If she "truly had your back", she would have done things differently IMHO.  

1.  Your VSO is not a doc, and "she" should not decide if your claim is primary, secondary, presumptive, etc.  Instead, she should apply for benefits "to include" primary, secondary, presumptive, and to seek the max benefit allowable by law.  

 2.  Then, eventually you would need to see a doc.  The doc would then opine:

a.  Your diagnosis is a new condition unrelated to psoriatic arthritis OR

b.  Your condition is secondary to your psoratiatic arthrits.

c.  Your condition is something else and it is/is not, in his opionion related to service. 

    You are going to have to have "medical evidence" to substantiate your claim..not a VSO opinion.  

     You need the Caluza elements:  Current diagnosis, in service event, and nexus.  For secondary conditions, you need only a diagnosis and a doc opinion that condition a was at least as likely as not a result of a sc condition.  

     You dont need to worry about whether its primary secondary or presumptive, let the doc figure that out.  Dont burn down bridges that you have not crossed, because the river looks easier to cross somewhere else.  

[Sirstrikealot]

Sorry.  I guess I didn’t get my acronyms correct.  It was my C&P examiner who said she would take care of me. Not my VSO.  My VSO really didn’t do anything but get my service medical records almost a year after requesting them.  I’ll be the first to admit I should have switched to a VSO that would have had more knowledge and given me more guidance in this claim. 

[vetquest]

The power that the medical authority that did your C&P rests in how well they document and give the caluza events in your medical opinion.  A doctor that goes to bat for you is a great opportunity to get service connection.  You may not get the rating that you want but it is a start in the right direction.  Now a VA rater will read your SMR's and the medical writeup and decide if you in fact get benefits or service connection.  Sometimes they do not read the whole record and deny and we are left wondering what the heck happened.  You can usually expect them to low ball you the first time out and you will appeal.

That is all for another day though.  Let us know how the rater decides and we can help you from there.

[bigoc]

I have a similar situation with psoriasis and psoriatic arthritis.  I got service connected shortly after discharge.  As soon as you go on a DMAR which is disease modifying something something, The VA will rate you at 60% if its for treatment of a service connected condition.  You need to be currently on   Could be used for psoriasis or the arthritis and sometimes both.  I forget the exact rating requirement but something along the line of near constant use of the medication for the last 12 months.  

As for the joints you may have a bit of a fight or not, but psoriatic arthritis is a poly-arthritic condition.  Meaning the disease progresses to other areas of the body.  As you have more joint involvement you will want to put in for it how ever minor.  I was fortunate enough to have a rheumatologist state that my condition was the pervious statement.  I say fortunate because I did not ask for the statement but it was very helpful as I would find out.  Helped with joints that showed involvement a few years after discharge.  

Just remember Arthritis rated under 5002 as an active process is very different and sometimes allows for a more favorable rating than the degenerative type.  The individual joints are rated independently rather than added to get a rating.  They are only combine as if any other group of separate conditions would be for a final overall rating decision.

   

[Mikey]

On 10/13/2019 at 5:53 PM, bigoc said:

I have a similar situation with psoriasis and psoriatic arthritis.  I got service connected shortly after discharge.  As soon as you go on a DMAR which is disease modifying something something, The VA will rate you at 60% if its for treatment of a service connected condition.  You need to be currently on   Could be used for psoriasis or the arthritis and sometimes both.  I forget the exact rating requirement but something along the line of near constant use of the medication for the last 12 months.  

As for the joints you may have a bit of a fight or not, but psoriatic arthritis is a poly-arthritic condition.  Meaning the disease progresses to other areas of the body.  As you have more joint involvement you will want to put in for it how ever minor.  I was fortunate enough to have a rheumatologist state that my condition was the pervious statement.  I say fortunate because I did not ask for the statement but it was very helpful as I would find out.  Helped with joints that showed involvement a few years after discharge.  

Just remember Arthritis rated under 5002 as an active process is very different and sometimes allows for a more favorable rating than the degenerative type.  The individual joints are rated independently rather than added to get a rating.  They are only combine as if any other group of separate conditions would be for a final overall rating decision.

   

I apologise to piggyback off the main post, I do have a question. Im SC for multiple joint arthritis.(osteoarthritis,DJD) Just a yr ago diagnosed with PSA. I've been on otezla for over a year. Have had treatment for psoriasis after service. If I were to file for PSA would it be possible for a secondary or new claim.  Could the VA change my diagnosis. My understanding is can not be rated for PSA. and lost range of motion. 

[GBArmy]

Mikey To answer your question can the VA change your diagnosis, well, if they get their own doc to argue it they can propose something else. But if you are S-c for a disability, it's not that easy. I'm thinking what you meant to say is can the VA change the diagnostic code they identify as your symptoms? Yes. Actually, that is a basic part; the VA is to apply the highest possible rating if more than one can be applied. So if osteoarthritis gets you 30%, but PSA, for example, can get you to 50%, that is what they are supposed to do. (I don't know if that would work for you specifically; don't have a lot of facts) One other thing. If you are taking a VA prescribed drug, say Otezla, be sure to look up any negative effects it can have on you. If you have any of those negative symptoms and can get an IMO saying it caused X, then you have a clear path to a secondary condition. Example, say drug abc can lead to headaches, if you have headaches (migrain), then bingo. Many veterans don't do their homework. You have to be your own best advocate.