Deleted

[Guest rickb54]

deleted

Edited February 19, 2007 by rickb54

[Objee]

Rick,

My guess is that you'll be scheduled for a sleep study for apnea. If so, do it! A PAP machine that's SC is an automatic 50%. Add another 10% to that and you could eventually wind up 100% schedular + 60% and get 100% + SMC S (About $247 a month more!) I'm looking at 100% + 50%. No joy for SMC "S" at that level for me.

Ralph

Today I had an appointment with my pulomonary doctor. I have been having a lot of shortness of breath lately. and have had a lot of problems sleeping. I am already rated for Asthma 60% since 1986 and COPD 30% since 2005. I presently have a De Novo appeal pending because who ever rated me for the COPD failed to consider Title 38, § 4.96 Special provisions regarding evaluation of respiratory conditions. which states the following:

(a) Rating coexisting respiratory conditions. Ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 will not be combined with each other. Where there is lung or pleural involvement, ratings under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic codes 6600 through 6817 or 6822 through 6847. A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. However, in cases protected by the provisions of Pub. L. 90–493, the graduated ratings of 50 and 30 percent for inactive tuberculosis will not be elevated.

Today at my appointment I had to take another chest xray and Pulomonary fuctions test. The x-ray was about the same as it has been for the last couple of years. The pulomonary fuctions test was slightly worse than it was in November 2006. My blood oxygen was at 84. The doctor informed me that I have to go on oxygen because my blood oxygen is border line. He explained that I would not need oxygen all the time just some of the time. He indicated I needed to use it when I sleep and anytime I exert myself or am short of breath. I am only 52 (53 in Feb). I knew that someday I would end up on oxygen but at my age... this sucks... (I feel depression setting in bad)

I am scheduled for a sleep apnea test on 28 Feb but there is no doubt in my mind that I have apnea especially now that I have to use oxygen when I sleep.

I am having problems deciding how to write up my request for an increase, especially since I already have a De Novo review pending for this problem. Do I just write a letter with the new evidence and request it be considered as part of the DE Novo, or do I submit it as a new claim for increased disability, since I now require the use of oxygen, and in all likely hood I have apnea. And what rating should I ask for since the rating schedule really isn't specific as to the oxygen use, and even though my Pulmonary Fuctions were slightly less they still fall into the 60% range.

Here is the rating guides for asthma and COPD. ( At this point I am not even concerned about the sleep apnea because under the Special provisions regarding evaluation of respiratory conditions it cannot be rated seperately). I suspect that the asthma and COPD with a 53% FEV requiring oxygen use will get me to 100% without consideration of sleep apnea.

What are your opinions.....????? Thanks

6602 Asthma, bronchial:

FEV-1 less than 40-percent predicted, or; FEV-1/FVC less 100

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 medications............................

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 60

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) corticosteroids...............................

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 30

to 70 percent, or; daily inhalational or oral

bronchodilator therapy, or; inhalational anti-inflammatory

medication................................................

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 10

to 80 percent, or; intermittent inhalational or oral

bronchodilator therapy....................................

Note: In the absence of clinical findings of asthma at time

of examination, a verified history of asthmatic attacks

6604 Chronic obstructive pulmonary disease:

FEV-1 less than 40 percent of predicted value, or; the 100

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............................................

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 60

to 55 percent, or; DLCO (SB) of 40- to 55-percent

predicted, or; maximum oxygen consumption of 15 to 20 ml/

kg/min (with cardio respiratory limit).....................

FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 30

to 70 percent, or; DLCO (SB) 56- to 65-percent predicted..

FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 10

to 80 percent, or; DLCO (SB) 66- to 80-percent predicted..

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

Chronic respiratory failure with carbon dioxide retention 100

or cor pulmonale, or; requires tracheostomy...............

Requires use of breathing assistance device such as 50

continuous airway pressure (CPAP) machine.................

Persistent day-time hypersomnolence........................ 30

Asymptomatic but with documented sleep disorder breathing.. 0

[Vike17]

Rickb54,

If my memeory is right, I think the we had this discussion before about your asthma/COPD and the probability that the DRO will catch this mistake and pull the COPD rating and maybe awarding the "next higher evaluation for asthma, or something to that affect. Is this correct? As far as your question to either reqest an increase or bring the issue up at the DRO hearing, this could go both ways. The DRO has "limited jurisdiction over a rating issue raised during an informal conference or formal hearing, provided the issue was part of the rating decision that is the subject of the hearing." But my thinking is if you were to raise this issue at the hearing, the DRO would need to develope the increase as would the pre-determination team would with a normal request for increase. So, I don't know which would be faster and more effective. Maybe this would be a question for the DRO himself. Does this make sense?

Vike 17

[Vike17]

Rickb54,

Like I said, it could go both ways as far as time required to resolve the issue. If you bring it up at the DRO hearing, the DRO has "limited jurisdiction over a rating issue raised during an informal conference or formal hearing, provided the issue was part of the rating decision that is the subject of the hearing," and I would think this is a part of the 'rating' so to speak. If the DRO decides they do indeed have jurisdiction over the matter, he/she may have to develope the issue as would the Pre-Determination Team would with a request to re-open. Then again, the DRO may decide that there is sufficient evidence on hand to resolve it righ then and there without having to further develope the matter. I guess it's 6 to one, half dozen to another in this case as far as possible time is concerned. I would go ahead and bring it up to the DRO and first let them decided whether they have jurisdiction over the issue, and I would also ask them if the oxygen would have an effect on the matter. Like you said, if you're granted the 100%, the whole thing becomes moot.

Vike 17