dermatitis denial

[SANUSCG]

I put in an increase for VA compensation for dermatitis from 30 to 60 percent, and it was denied, by them.  The letter stated that only 20 to 40 percent of entire body affected.  The second part of the 60 percent rating states that you have to have used constant or near constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12 months.  I have used various topical ointment constantly for several years now to treat my dermatitis.  Why would they not have rated me at 60 percent

Thank you

 

[GBArmy]

Hi Coastie, welcome to Hadit. You're right on rating criteria; diagnostic code is 7806 for rating purposes. https://www.law.cornell.edu/cfr/text/38/4.118  You need to get a copy of the C&P exam. Then, most likely, you are going to get a new exam by your doc that agrees with the criteria for the higher rating.  You need medical opinion that supports the claim, not your own evaluation. I'm not saying that you don't have the symptoms, but now you have to have a dermatologist say so.

[SANUSCG]

My complaint is that I used topical medications on a continuous basis, which they didn't address in the decision letter.  

[GBArmy]

As I said, you need an independent medical opinion that says not only it is service-connected and your symptoms and treatments including topicals meet the criteria for the next level. You could waste your time and go for a higher level review but it isn't likely going to change your rating. If you want to skip that, you want the independent opinion in the file prior to appeal to BVA.

[pwrslm]

Alternatively, you know the specific requirements for 60%. Ask your primary care provider to put into your personal medical records specific wording that confirms the requirement. If they put it into the record that confirm "constant systemic therapy with (name the medication) for over 12 (or 36 or 48) months."

Once you have this, submit a secondary claim with new evidence (new evidence = your new medical records confirming the above). This "should" get your increase.

[SANUSCG]

So, the VA is my primary care provider, I submitted the list of ointments used on a daily basis for my skin condition (dermatitis), during the C and P exam, so they are well aware of what I am using and how often, they are used, which is daily / constantly for over 2 years now, at the least.  

[shrekthetank1]

So I also use a Lay statement to get this point accross.  It did work!

[pwrslm]

37 minutes ago, SANUSCG said:

So, the VA is my primary care provider, I submitted the list of ointments used on a daily basis for my skin condition (dermatitis), during the C and P exam, so they are well aware of what I am using and how often, they are used, which is daily / constantly for over 2 years now, at the least.  

The C&P examiner may not have noted the list you gave him. This is why you must document the prescriptions, preferably by a qualified medical professional.

A medical professionals opinion in your medical records about this should put the balance of the evidence in your favor. It is the RO that must be convinced. At this point it sounds like the RO took the word of the C&P examiner. You can pay for an IMO, or try to get your PCP to enter the statement I posted above into your VA Medical Records. I would take the cheapest route first as a common sense measure. Why pay if its free?

[Mr cue]

Man u don't need no independent medical opinion because the va didn't address your evidence.

If the rater didn't address the use of your medicine or it's effective on your disability.

Appeal it and write a statement and give them the va hospital information with it.

Showing you have been using this cream for years and apply for clothing allowance.

The cream mess up your clothing and the va will help 

Good luck

 

 

[deedub75]

Topical steroid ointments are local and not systemic steroids.  What does your letter say?

[SANUSCG]

4 hours ago, deedub75 said:

Topical steroid ointments are local and not systemic steroids.  What does your letter say?

So the VA letter doesn't mention anything about my topical ointments that I am using.  The ointments are used on the entire body basically, to help with the dermatitis.  Especially on the arms, back, trunk and arms. The VA letter states that a higher evaluation of 60 percent is not warranted for dermatitis or eczema unless the evidence shows constant or near- constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12 month period.    I believe there was a rule change in 2018 that addressed ointments that were used topically to treat the disease would qualify, for the increase. I use the ointments on a daily basis on large area of the body / skin.