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      How to get your questions answered. A few observations, and requests of all members. All folks who come here are volunteers who do this on their own time and their own dime.To avoid burning out our best contributors please follow these guidelinesf you are reading a post and it reminds you of a question you want to ask, start a new topic, if you place your question in someone thread it will be difficult to distinguish your question from the original poster, you will get better results posting a new topic with your question. 1. Before Posting please do a search and see if your question has already been answered. If you find the answer print it out and put it in a file to use as a reference file, I find this helpful myself. 2. If you can not find the answer and you do post a question, please print out those answers and refer to them to avoid duplicate questions. 3. Refer to the Frequently Asked Questions4. Duplicate questions will come up from time to time but the keeping them to the minimum will lighten the load on the regular volunteers.5. Respect folks privacy do not request their personal phone numbers for claims help, it is inappropriate and not why they are here.6. Keep the topics focused on veterans issues, in closing Search first Search ... Ask second.it may save a lot of time or at the very least enlighten you.
    • Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests.

      Listen Live Every Wed 5:30 PM CST to SVR Radio, Veterans Issues are discussed with various guests. Please check the little home I am carving out for our SVR partners. http://www.hadit.com/svr.html
    • A bit about Tbird and HadIt.com for those who've asked...

      The following is on my About page, but some have been asking how this all happened. So here is my little story. Tbird US Navy 1983 – 1990 E-6 HadIt.com the website domain registered Jan 20, 1997 the domain is registered and paid for through Jan 21, 2023 at which time I plan to register it for another 15 years Lord willing and the creek don't rise. I guess the best place to start is Jan 1991; I had gotten out of the navy Dec 1990. At my separation seminar, there was a DAV rep Jim Milton he told us to bring our medical records in and he would look through them for us and let us know if we should file a claim with the VA. Well, bless his heart, he opened my medical file, reads the first insert, looks me straight in the eye, and says you will be 50% for the rest of your life and he would file the claim for me. 50% was for surgery I had in the service. True to his word he met with me and talked with me for a long time filled out my paper work and urged me to file for PTSD. I would not file the PTSD claim, nor even discuss it. By Feb 1991 I had moved to the San Francisco bay area and was staying at a friends apartment and pretty much I was just a puddle. In desperation one night I called suicide hot line, I had no job, no idea about going to the VA. They talked with me for a long time and explained to me that I could go to the local VA hospital even if I did not have insurance. Now, I know what you are thinking if I was 50% why didn't I just go to the VA in the first place, two reasons 1, this was Feb 1991 and the 50% didn't come till May and 2, even if it had come through it is unlikely that I would have had the mental acuity at the time to put the two together. I relate this here because it is where so many of our brothers and sisters are coming from, perhaps where you started. Fuzzy and unsure, in pain and sometimes homeless they come to the VA hospital for help. And that is where I ended up. Up to the pysch ward I went, blah, blah, blah, a few days later I was released with a promise of a call from the out patient program, which I would soon be entering. Blah, blah, blah, after many missed communications, and no call backs I was at the Day Hospital everyday M-F. And this brothers and sisters is where I began to learn and formulate my plan for HadIt.com. Veterans, veterans everywhere…I spent a year in the day hospital and about another year at a sheltered workshop before I got back on my feet. So I just talked to veterans everyday waiting for appointments, waiting for prescriptions, waiting for a vet rep and I started to learn the system. While in the navy I was data analyst and had to learn a 5 volume manual and just about anything you were suppose to do was in that manual. So I figured there must be a manual on how to do a VA claim or at the very least regulations. So I found out about the Code of Federal Regulations, United States Code, Veterans Affairs Manuals and so on and so forth. Of course this was 1991/1992 I was living in a tiny studio apartment in a particularly bad neighborhood, working in a sheltered workshop making a nickel per envelope I stuffed throw in PTSD and you will see that it was a difficult task for me to get somewhere where they had copies of these, let alone that they would let me look at. And there was so much knowledge around me, it was like the gold rush in those days, I could just sit on a bench a veteran would sit down next to me a little conversation later I had another nugget, I made copious notes. Phone numbers to call, ask for this guy or that guy he'll give you the straight scoop and they'd slip me a piece of paper with a number on it. You want to read this regulation or that one and another slip of paper into my hand. I spent a lot of time on those benches watching the squirrels they gathered their nuts and I gathered mine :) So I'm thinking I could put a little handbook together print it out and hand it out at the VA. Or perhaps fliers. Still formulating, time goes by, 1994/1995 I am being treated for PTSD regularly and doing and feeling much better and I go to work for a company as a marketing systems analyst and I discover the internet. Well let me tell you that was perhaps one of the most significant life changing events I have ever experienced. And I might add finally a positive one :) It seemed only natural to me that surely there must be a website that contained all the knowledge I wanted, well as it turned out not so much, lots of stuff but I wanted to get straight to the claims information and there was a lot of stuff to wade through to get to it. So taking my lesson from the squirrels earlier I started to gather, gather, gather…and learn HTML and work as a marketing systems analyst and work my claim. 1996/1997 major PTSD cork blows and unemployed. Working my claim, working the website. 20 Jan 1997 register HadIt.com domain name right after getting off the phone with the VA and saying I've had it with this. As fate would have it the old DAV board goes down just as mine opens up and folks start to wander in. So HadIt.com has two main components the website which supports the discussion board with links, articles, research resources etc. The website starts to grow, I can't tell you how many times I had to switch servers for space and features. I continue on a downward trend and in 1998 ended up back home in St Louis living in my sisters basement in therapy and working it, I swear I would have swung a dead chicken around my head at midnight naked if I thought it would have helped. The website continued to do great during this time, I just stayed in the basement bought new software, new books, and learned how to make things work and I continued to use this knowledge to make HadIt.com better. My 100% finally came through from the VA and I had a friend who is an advocate who helped me thru my SSDI claim, he was literally at my side thru the entire process and that came through for me. My therapist and sister continued to try and get me to leave the basement, but to no avail. At some point in 1998 or 1999 I put a counter on the website and was shocked to discover how many visitors we were getting. Time goes by my sister gets married and I move from the basement to the upstairs, there is much celebration that Aunt T is living in the light again. More time goes by and I settle into my life in St Louis and spend more time on the site trying new things, finding more information. 2003 I buy my own home VA loan. For years now I have just considered HadIt.com my job and I get up every morning go to the office and work for several hours, take an afternoon break and see where the rest of day takes me. I have a place in the office to use the computer and a comfortable to place to read journals and articles and take notes. Blah, blah, blah so that is my story and HadIt.com's intertwined.
    • HadIt.com Pass It On Cards

      Hi I've updated our HadIt.com Pass It On Cards. They are in a PDF format you can print them out cut them there are 12 to a page. If you have found HadIt.com helpful and would like to pass it on to other veterans this is an easy way to do it.I hope you find them helpful, feel free to leave a few anywhere veterans gather, veterans centers, veterans hospitals, public libraries, be creative. Please make sure though, that if you want to leave some at any business you ask permission first.Here you go http://www.hadit.com...it_on_cards.pdf
    • VA Training and Fast Letter Forum Index

      VA Training and Fast Letter Forum Index The following is the index with links to the various Training and Fast Letters plus a few miscellaneous. These letters are not necessarily in the original formatting. I have tried to present them in an easy-to-read form instead of some forms as originally presented. Some of the paragraphs were WAAAAYYY too long. lol - HadIt.com Member fanaticbooks Something to be aware.... Some of these letters may be rescinded, outdated, or otherwise no longer viable. I have still included them because sometimes they provide additional insight or just plain more information than the newest version. Use them wisely. The oldest letters will display at the bottom with the latest letters displayed at the top, all in sequential numbers. Coding of the letters... FL = Fast Letter TL = Training Letter First two numbers = last two digits of year of origin Training Letter http://www.hadit.com/forums/index.php?/topic/40694-va-tl-00-07/ http://www.hadit.com/forums/index.php?/topic/40693-va-tl-00-06/ Fast Letter Number Title http://www.hadit.com/forums/index.php?/topic/44262-va-fl-11-15/ http://www.hadit.com/forums/index.php?/topic/44260-va-fl-11-13/ http://www.hadit.com/forums/index.php?/topic/44261-va-fl-11-11/ http://www.hadit.com/forums/index.php?/topic/44310-va-fl-11-09/ http://www.hadit.com/forums/index.php?/topic/42151-va-fl-11-03/ http://www.hadit.com/forums/index.php?/topic/40957-va-fl-10-49/ http://www.hadit.com/forums/index.php?/topic/40958-va-fl-10-46/ http://www.hadit.com/forums/index.php?/topic/40959-va-fl-10-45/ http://www.hadit.com/forums/index.php?/topic/40960-va-fl-10-42/ http://www.hadit.com/forums/index.php?/topic/40961-va-fl-10-39/ http://www.hadit.com/forums/index.php?/topic/40962-va-fl-10-35/ 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Respiratory Disability To Include Asthma And Copd

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Posted (edited) · Report post

my question is will they rate them both as one claim or separately because they both are separately diseases found out they have remanded the sinusitis but are going ahead and rating the asbestos exposure for the copd and asthma i could have sworn the guy at va told me they were counting them both as one or rating them both as one is that possible or will they both be rated separately is there any way to find out when asking them at the va they suddenly get forgetful or their computers are down and they can only see what you just mentioned.

and in the event they do rate them both as one how would they decide the percentage i know whey have a rating procedure they use or a way of doing things

Edited by ammodad

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Posted · Report post

They COPD and Asthma, I believe will be rated as one under

Respiratory.

They should apply the medical evidence of record to the diagnostic code

in the schedule that will provide the highest rating per the medical evidence.

JMHO

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=a38557b7a2cd96d2ba7924852468ed7b&rgn=div8&view=text&node=38:1.0.1.1.5.2.102.46&idno=38

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Posted · Report post

They COPD and Asthma, I believe will be rated as one under

Respiratory.

They should apply the medical evidence of record to the diagnostic code

in the schedule that will provide the highest rating per the medical evidence.

JMHO

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=a38557b7a2cd96d2ba7924852468ed7b&rgn=div8&view=text&node=38:1.0.1.1.5.2.102.46&idno=38

thank you for your response to my post it helped me understand it allot better and the link helped me as well i am presently rated at 60% i had and initial 20% they awarded me 50% for sleep apnea. they said they saw granduloma in the right helium and infiltrates this is along with the history copd , dyspnnea and asthma from looking at the chart it could go either way either the 60 or 100 {6602 Asthma, bronchial)6604 Chronic obstructive pulmonary disease)with the 60 i already have what would that take me to and by chance i get the 100 how would i figure that and what would that be haven't wrapped my head around that Chinese math yet i am sorry to seem to be asking you so many question do you get tired of ppl picking through your brain ???

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if your already rated at 50% for sleep apnea ... your not going to get another rating for asthma and copd. You will get one rating for all three

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.

ratings are listed here:

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=c130ec487ea61b8a40ad0836188b94bc&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38#38:1.0.1.1.5.2.102.46

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if your already rated at 50% for sleep apnea ... your not going to get another rating for asthma and copd. You will get one rating for all three

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.

ratings are listed here:

http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=c130ec487ea61b8a40ad0836188b94bc&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38#38:1.0.1.1.5.2.102.46

ok i think i understand what your saying, but i am at 60% not 50% i had a previous rating at 20% and was awarded 50% for sleep apnea which took me to 60%now if i understand you correctly me being at 60% they aren't gonna rate my claims individually they are gonna rate them as one adding them to the 60% i already have and following the rating table they will rate it to the next highest int he category that reflects the medical evidence, which means what, whats the next possible rating for a person more than likely doomed to die sucking on oxygen tanks waiting to drown in my own juices .. not taking it out on you and not trying to give you a hard time brother just gets frustrating some times how do you place a value on a life and why do we have to be staring at death before they see us ????????????thanks for your advice and have a blessed day

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Posted · Report post

ok i think i understand what your saying, but i am at 60% not 50% i had a previous rating at 20% and was awarded 50% for sleep apnea which took me to 60%now if i understand you correctly me being at 60% they aren't gonna rate my claims individually they are gonna rate them as one adding them to the 60% i already have and following the rating table they will rate it to the next highest int he category that reflects the medical evidence, which means what, whats the next possible rating for a person more than likely doomed to die sucking on oxygen tanks waiting to drown in my own juices .. not taking it out on you and not trying to give you a hard time brother just gets frustrating some times how do you place a value on a life and why do we have to be staring at death before they see us ????????????thanks for your advice and have a blessed day

Hey, I know where you are coming from I am rated for asthma/COPD at 100% due to oxygen use, I also have sleep apnea that I haven't even request service connection for... If your rated for the asthma/copd and on oxygen you will be bumped up to 100%.

best of luck.....

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Your rating will be based on your results of a PFT.

To get 100 percent you need real low PFT readings or Be on 02 or Right side Heart Failure (Cor Pumonole) or Pulmonary HTN and I promise you Brother you dont want the last 2 conditions.

Basser

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Posted (edited) · Report post

Your rating will be based on your results of a PFT.

To get 100 percent you need real low PFT readings or Be on 02 or Right side Heart Failure (Cor Pumonole) or Pulmonary HTN and I promise you Brother you dont want the last 2 conditions.

Basser

Not trying to be nit picky, but with COPD a finding of right ventricular hypertrophy will get you the 100% also(but not Asthma). It is an important distinction. I have right ventricular hypertrophy(on ECG), but do not have a medical diagnosis of Core Pumonole. I have SC for arthritis and lumbosacral/cervical strain with kyphoscoliosis on x-ray and MRI and am fighting for the Respiratory service connection for a seperate 100% under kyphoscoliosis with right ventricular hypertrophy. My PFT's are un-remarkable, but the ratings schedule does not require a bad PFT in conjunction with RVH.

If Ammodad has right ventricular hypertophy or is on O2 and can prove/or has service connection for COPD he should be rated under that code instead of sleep apnea. Sleep apnea does not get the 100% rating for O2 or RVH.

Best regards,

Edited by 71M10

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I left the RVH out.

Oh well cant win them all can we.

Your spine rating should due to respitory insufficiency.

Mine is related to the Cervical spine. Nerve Paralysis. Diaphragm.

My problem is Pulmonary HTN.

Good Luck on your claim.

Basser

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I left the RVH out.

Oh well cant win them all can we.

Your spine rating should due to respitory insufficiency.

Mine is related to the Cervical spine. Nerve Paralysis. Diaphragm.

My problem is Pulmonary HTN.

Good Luck on your claim.

Basser

Patiently waiting, they are just about out of dodges and will soon have to address the issue. They screwed up because all of it was listed as evidence in prior decisions.

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ammodad,

This is late but if you are still waiting for your decision, Teac and jbasser are correct. All of those conditions; sleep apnea 6847, dyspnea (a symptom), asthma 6602 and chronic obstructive pulmonary disease 6604, will be rated together and you will get the highest from all conditions. Usually based on the results of a PTF pulmonary function test. So you are not maxed at 50% for sleap apnea, you may rate higher for your COPD.

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hello , once again. just got back from va exam feb 27th for sinusitus and Allergic rhinitis. they approved my claim for the asthma and copd do to asbestos exposure now awaiting rating on the sinus and rhinitus portion now that i am at the 70 % was tryin to figure next posible rating withthem thats kind of hard to do thanks for all of you guys support and knowledge it means allot and i truely mean that without you guys would have freaked out along time ago and my wife thanks you all also if we stand as one they cant iggnor us

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My question is why wasn't I rated with both COPD and Asthma in 1992 when diagnosed? Also any other insights into this situation would be appreciated. I have yet to file a nod etc.. Just trying to figure out where I'm at. Thanks

My Compensation was raised from 10% to 60%, going from just a 10% asthma rating to a combined rating of asthma/COPD 60%.

Asthma was diagnosed in 1988 two years prior to discharge with an ICD code of 493..90.

COPD was diagnosed in 1992 with an ICD code of 496.

This C & P exam was the first time I had ever heard COPD mentioned during the exam. I cannot find it in my medical records but the information was noted that it was taken from my C-File.

PFT results from C & P April 5, 2012

Pre-bonchodilator: Post-bronchodilator, if indicated

FVC: 70 % predicted FVC: 84 % predicted

FEV-1: 60 % predicted FEV-1: 74 % predicted

FEV-1/FVC: 78 % predicted FEV-1/FVC 68 % predicted

DLCO: 102 % predicted DLCO: % predicted

For this C & P they used the FEV-1% Predicted to determine level of disability.

As far as Medications: Oral or parenteral corticosteroid medication. (intermittent), inhalation bronchodilator therapy daily, anti-inflamatory medication daily, albuterol, Symbicort, Albuterol nebulizer as well as oral bronchodilators daily.

If anyone could shed any light on this information or explain why I did not have a combined rating since 1992 I would appreciate it. Thanks for your time.

Edited by casscntyman

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Hello Casscytman,,,,,, There may be an issue with the rating because of the pyramiding rules of VA to keep the lung issues to a minumum for the higher ratings. It is possible to have more than one disease of the respiratory system and if you have core pulmonale or Pulmonary hypetension then the COPD jumps to 100 percent so keep an eye out on your heart. You may be able to file an NOD back to your Earliest Effective Date but it may take an IMO linking that to move it.

Jbasser and Teac are smmoooooth right.

Also some of the problems that many Veterans face with diseases is the possibility that SECONDARY issues can be linked to rateable diseases. That will take IMOs and strong evidence but we have seen that with many of our members so don't forget that track of direction. NEVER GIVE UP . God Bless, C.C.

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My question is why wasn't I rated with both COPD and Asthma in 1992 when diagnosed? I cannot tell you why you think that you were not service connected for both in 1992. However, I suspect that the narrative in the Rating Decision from 1992 stated that both were service connected, with the 10% evaluation based on the then current tests.

Also any other insights into this situation would be appreciated. As another poster noted, there may be (actually, read that there is) a problem with pyramiding (38 CFR 4.14 http://www.benefits....PART4/S4_14.DOC ).

Additionally, I direct you to 38 CFR 4.96.a. http://www.benefits....PART4/S4_96.DOC . The Diagnostic Code (DC) for Asthma is 6602 and the DC for COPD is 6604. So, you will not receive two separate ratings, though the next higher step per 4.96a may be coming into play here.

Whether or not there was an incorrect evaluation back in 1992 depends on the Rating Criteria in effect then. Although I don't care to dig that up, I suspect they would be very similar to today's criteria.

I have yet to file a nod etc.. The current evaluation appears to be correct. If you are contemplating a Notice of Disagreement for the 1992 evaluation, you are far, far too late: that window closed in 1993.

Your only other recourse would be the Clear and Unmistakable Error (CUE). Though, before you go firing that gun, you need to find the 1992 Rating Criteria and review the examination or other data that justified that 10% award in 1992.

My question is why wasn't I rated with both COPD and Asthma in 1992 when diagnosed? Also any other insights into this situation would be appreciated. I have yet to file a nod etc.. Just trying to figure out where I'm at. Thanks

My Compensation was raised from 10% to 60%, going from just a 10% asthma rating to a combined rating of asthma/COPD 60%.

Asthma was diagnosed in 1988 two years prior to discharge with an ICD code of 493..90.

COPD was diagnosed in 1992 with an ICD code of 496.

This C & P exam was the first time I had ever heard COPD mentioned during the exam. I cannot find it in my medical records but the information was noted that it was taken from my C-File.

PFT results from C & P April 5, 2012

Pre-bonchodilator: Post-bronchodilator, if indicated

FVC: 70 % predicted FVC: 84 % predicted

FEV-1: 60 % predicted FEV-1: 74 % predicted

FEV-1/FVC: 78 % predicted FEV-1/FVC 68 % predicted

DLCO: 102 % predicted DLCO: % predicted

For this C & P they used the FEV-1% Predicted to determine level of disability.

As far as Medications: Oral or parenteral corticosteroid medication. (intermittent), inhalation bronchodilator therapy daily, anti-inflamatory medication daily, albuterol, Symbicort, Albuterol nebulizer as well as oral bronchodilators daily.

If anyone could shed any light on this information or explain why I did not have a combined rating since 1992 I would appreciate it. Thanks for your time.

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I was discharged in January 1990 with 10% SC Asthma. I believe I should have been at least 30%. I also had an issue with passing out/seizures over the course of time beginning 1988 forward. I was given a consult towards the end with Neurology but never received the exam before discharge. I now have sleep apnea with possible Narcolepsy which was mentioned by a doctor in 1988. Is all of this too long ago to be considered. I had a young wife and brand new baby at the time and was just confused by all of this going on to put it all in perspective. Any thoughts on this. I would appreciate it.

I was discharged on Jan. 01, 1990. On Nov 3rd, 1989 taking Theodore, Azmicort and Alupent, for Bronchial Asthma. Give round of Prednisone 40, 35, 30, 25, down to 10. My record was closed December 26 for medical discharge.

During last the period of 1989-1990 had several rounds of Prednisone.

16 Oct 1989 PFT's after Proventil inhaler.

Baseline

FVC 3.41 5.22

FEV 2.88 4.19

FEF 25-75 2.7OLPS 3.78

Note: Considerable cough during PFT's.

***Prescribed in home Nebulizer for daily home use with Alupent solution.

Oct 5th, 1989

Clinic Consult Wheezing and Sub S/P, Mild improvement on Alupent, Theodore, Humibid and E-Mycin. Peak flow-420

Throughout the period of 1988-1990 when discharged was repeatedly in the clinic for treatment for bronchitis, Asthma etc.

December 2nd, 1988 consult for passing out 5 times that year. Given Neurology Consult with provisional diagnosis of seizure disorder.

June 28,1988 another episode of passing out, Dr. thinks Narcolepsy which my current sleep disorder lab listed as highly likely with sleep apnea and put on CPAP.

October 15th 1984 Rolled down 30 foot stone hill in 29 Palms, California. Abrasion/Head Trauma with mild concussion.

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While researching my files and medical records I believe I should have been rated completely differently on medical discharge. My original rating is scratched out and hand written in is the 10% rating. (I have quoted material that leads me to this conclusion in this forum previously)

While going to the CFR on your pyramiding concerns I am still a bit confused. COPD and Asthma are very different things. Yes both involve the lungs and do have some of the same symptomatology . In asthma air flow issues are reversible. In COPD partially reversible. Age is significant, asthma is generally diagnosed early in life. COPD is diagnosed much later in life with a history of smoking. In asthma differences in FEV-1 return to normal between attacks. In COPD they generally do not.

At the date of my medical discharge at the age of 26 my FEV-1 is the same as my last PFT/CP Exam taken in 2011. Which is the basis for a COPD diagnosis.

I guess what I am confused about is why after all of these many PFT exams did not an examiner note, notice or figure it out. It wasn't diagnosed till 1988 but I was still given all the meds related to the COPD, several of which are almost exclusively for COPD since almost the date of discharge.

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On an aside, there's a great deal of Peculiar stuff going on in Cass County. Now, on to you ...

While researching my files and medical records I believe I should have been rated completely differently on medical discharge. My original rating is scratched out and hand written in is the 10% rating. (I have quoted material that leads me to this conclusion in this forum previously)

You cannot always use the current Rating Schedule for a Rating Decision done in 1992. While Rating Criteria for some conditions have not changed at all through the years, some/many have.

For example, 38 CFR Pt 4 Appendix A http://www.benefits....pp_a.DOC shows that criteria for DC 6602 were changed in 1975 and 1996. And, COPD (DC 6604) as a separate issue was not even in the Rating Schedule until 1996.

If you want to see the DC 6602 criteria in effect in 1990/1992, I suggest you look at 40 FR 42539, Sept. 15, 1975; or, perhaps 41 FR 11300, Mar. 18, 1976.

Whether that 10% evaluation was correct or incorrect depends upon, guess, the Rating Criteria in effect way back when.

And, as I earlier wrote, the door for an NOD closed sometime in 1993.

While going to the CFR on your pyramiding concerns I am still a bit confused. COPD and Asthma are very different things. (snip)

Thank you so very much for the education. However, it is moot.

Although you refer to pyramiding, you apparently did not consider the other reference I provided, 38 CFR 4.96a. http://www.benefits....PART4/S4_96.DOC . Now remembering that the Diagnostic Code (DC) for asthma is 6602 and COPD is 6604, here are the salient points of 4.96a:

(a) Rating coexisting respiratory conditions. Ratings under diagnostic

codes 6600 through 6817 and 6822 through 6847 will not be combined

with each other. ... (snip) ... 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. (snip)

If you have a problem with this, I suggest you contact your Senators and or Representatives, share your knowledge with them, and ask that they propose changes to the law.

At the date of my medical discharge at the age of 26 my FEV-1 is the same as my last PFT/CP Exam taken in 2011. Which is the basis for a COPD diagnosis. Again, you need to refer to the criteria in the Rating Schedule in effect in 1990. To restate what I mentioned earlier, I see no purpose for me to find that for you.

I guess what I am confused about is why after all of these many PFT exams did not an examiner note, notice or figure it out. It wasn't diagnosed till 1988 but I was still given all the meds related to the COPD, several of which are almost exclusively for COPD since almost the date of discharge. The fact that DC 6604 was not a separate DC until 1996 may be a clue. Also, I believe that 38 CFR 4.96a has some bearing.

While researching my files and medical records I believe I should have been rated completely differently on medical discharge. My original rating is scratched out and hand written in is the 10% rating. (I have quoted material that leads me to this conclusion in this forum previously)

While going to the CFR on your pyramiding concerns I am still a bit confused. COPD and Asthma are very different things. Yes both involve the lungs and do have some of the same symptomatology . In asthma air flow issues are reversible. In COPD partially reversible. Age is significant, asthma is generally diagnosed early in life. COPD is diagnosed much later in life with a history of smoking. In asthma differences in FEV-1 return to normal between attacks. In COPD they generally do not.

At the date of my medical discharge at the age of 26 my FEV-1 is the same as my last PFT/CP Exam taken in 2011. Which is the basis for a COPD diagnosis.

I guess what I am confused about is why after all of these many PFT exams did not an examiner note, notice or figure it out. It wasn't diagnosed till 1988 but I was still given all the meds related to the COPD, several of which are almost exclusively for COPD since almost the date of discharge.

Edited by jvretiredvet

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Well it appears that I am not the only one that was kinda shafted on medical retirement. I was medically retired at age 32 after having over 15 years service for asthma... at the time of my retirement physical I was diagnosed with COPD secondary to Asthma. At 32 years old I neither knew or cared that Asthma and COPD were separate diseases. I was given 10% for the Asthma and a couple of other medical issues insured a total of 30% for the medical retirement. ( I normally would do a return and start a new paragraph here but for some reason return does not work in hadit anymore since I went to win8) so.... when I went to the va I was awarded 30% just for the asthma. This is a prime example of why congress now makes it possible for those discharged under 30% to get a second look at the medical record and appeal the initial finding as the military was and still does low ball veterans on retirement. Any way it wasn't until almost 20 years after my retirement that I realized that COPD was a different condition apart from the asthma. I applied for a rating for the COPD and it was granted as a separate award of 30%. Ironically, by 2006 I was rated 60% for the asthma, and as has been pointed out legally the va can not grant two separate ratings for asthma and Copd. I appealed the decision under CUE and it was corrected granting 60% for asthma with COPD combined. ................................................................................ I am now at 100% because of the use of oxygen... You can still try to appeal the initial decision using CUE but it will not do you any good because as was stated the cannot be rated separately, and regardless about bumping the asthma rating up to the next rating that is only done on a case by case basic, and only if you meet the qualifications of the next higher rating... Also COPD is not decided base on the PFT alone. you would need to show that bronco dilators do not have any effect .. ( that is if your inhaler doesn't work or relieve the symptoms) and that the before and after inhaler use is the same on PFT's.... There are also other test for this such as blood oxygen etc. As far as why you were not rated for both on discharge wll your guess is as good as ours...... ( as a side note, if I was not diagnosed with copd on retirement I am not so sure I would have gotten a combined rating 20 years later.. and for the record I never smoked).

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I realize this is an Asthma/COPD venue but this speaks to my previous posts in a way. I apologize in advance,

First this is a 2002 claim that I did through the DAV rep at the KCMO VA. I really did not know anything so I just went in filled out the paperwork and forgot about it. That being said, this decision is not making a lot of sense to me.

They stated that I wasn't going to the VA and wasn't taking my meds to warrant the increase to 30%. I was in the VA that month and I reordered my meds. I was taking Flunisolide 2x day, Albuterol as needed, Montelukast, Raberazole, Prozac. I was also using a Nebulizer twice a day and always.

have.

It also stated I continue to smoke cigarettes. I never have. They also stated I hadn't been to the pharmacy since 1989 which is good because I was still serving in the Marine Corps in Norfolk Va. till I was discharged in Jan. of 1990.

All of this information I have from my old SMR's I pulled out of the barn. It should have been easily available at the KCVA.

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I realize this is an Asthma/COPD venue but this speaks to my previous posts in a way. I apologize in advance,

First this is a 2002 claim that I did through the DAV rep at the KCMO VA. I really did not know anything so I just went in filled out the paperwork and forgot about it. The decision is not making a lot of sense to me. They stated that I wasn't going to the VA and wasn't taking my meds to warrant the increase to 30%. I was in the VA that month and I reordered my meds. I was taking Flunisolide 2x day, Albuterol as needed, Montelukast, Raberazole, Prozac. I was also using a Nebulizer twice a day and always have.

It also stated I continue to smoke cigarettes. I never have. They also stated I hadn't been to the pharmacy since 1989 which is good because I was still serving in the Marine Corps in Norfolk Va. till I was discharged in Jan. of 1990.

For that matter I should have been 30% at discharge. I know that now of course.

Also since I was diagnosed with COPD in 1992, does the Veterans Claims Assistance Act come into play for me. Do I need to follow that process or wait or am I even eligible.

Edited by casscntyman

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Welcome to the Club! You appear to have had the same mentality I did when I left the service. You (as did I) thought you were dealing with the VA, and the VA was there to do the right thing for veterans. You had a young family - needed to move on- so like a good Marine (or Soldier) you sucked it up and dealt with it, accomplish the mission (raising family and providing for family). I suspect the decision they gave you was very light on details and they made it sound as if the minimal rating they gave you for Asthma was very generous. 20 years down the road, your body is going to Hell in a handbasket, so you start finding out whats wrong and Doctors start indicating this didn't happen overnight. You dig into your service medical records and your initial VA Decision/s (that was a wait to get the details on those wasn't it), and you see that 20 years ago they wern't concerned with doing the right thing, they were concerned with making you go away quitely with as little as possible. What angers you is that it is quite apparent they lied, besmirched your character, and invented stuff to make thier decision look reasonable!

My story:

In 88 they SC me for a "Bone Condition" rated it 0%. On my exam paperwork I had asked them for a chest xray, ekg and stress test because of multiple physician appointments with specialists done before they would release me.

20 years later I find out, my VA Xrays showed arthritis through-out my thoracic spine. (by regulation they were supposed to survey all major joints and groups of minor joints -THEY DIDN'T). My SMR's had a definative diagnosis of Hypertension and Two physicians were arguing on the margins of my xray report whether I had right atrial enlargment and I had a bad EKG(middle of service). The exit physical with three sets of xrays and a visit to a cardiologist....It is no where to be seen. Detroit VARO signed for those records ---but they are gone!

I sure wish some of these new veterans charities -- the ones advertising on TV, would spend some of that advertising time while they are fundraising to point out the VA isn't doing the JOB and we have to step in to help. I sure wish they would would take 15-20 seconds of that commercial to say we need your help because when Sgt John Smith injured his lungs in combat the VA told him that they couldn't award his claim for a hysterectomy. Or we can't award you for the peice of hand grenade shrapnal lodged in your spine because you don't have any service medical records proving the injury. Some of this STUPID stuff the VA is doing needs broad exposure.

I wonder if John Stuart would add a Segment to his show, he could call it VA Logic, or I'm from the Government and here to help!

Sorry long post and Im all over the map --- must be the pain meds!

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I realize this is an Asthma/COPD venue but this speaks to my previous posts in a way. I apologize in advance,

First this is a 2002 claim that I did through the DAV rep at the KCMO VA. I really did not know anything so I just went in filled out the paperwork and forgot about it. The decision is not making a lot of sense to me. They stated that I wasn't going to the VA and wasn't taking my meds to warrant the increase to 30%. I was in the VA that month and I reordered my meds. I was taking Flunisolide 2x day, Albuterol as needed, Montelukast, Raberazole, Prozac. I was also using a Nebulizer twice a day and always have.

It also stated I continue to smoke cigarettes. I never have. They also stated I hadn't been to the pharmacy since 1989 which is good because I was still serving in the Marine Corps in Norfolk Va. till I was discharged in Jan. of 1990.

For that matter I should have been 30% at discharge. I know that now of course.

Also since I was diagnosed with COPD in 1992, does the Veterans Claims Assistance Act come into play for me. Do I need to follow that process or wait or am I even eligible.

Not sure about what you me " do I need to follow that process or wait ".

If you presently have copd and you have never requested service connection, do not wait on the va or that matter anyone to do anything for you.

I was diagnosed with asthma in 1972, COPD in 1986

I was medically retired in 1986 and never received rating for COPD until 2005 . I reviewed my active duty medical records in 2005 after a doctor told me I had copd. I never realized in 1986 that asthma and COPD were different diseases. I had to go for another C/P exam, but gave the doctor a copy of my retirement exam and he indicated in the va medical record that COPD was diagnosed on active duty in 1986. In 2007 I went on oxygen.

If you wait to get rated for COPD than you could lose thousand of dollars in compensation. For years I had copd, and no-one ever questioned why half of my meds never worked. It was a smart doctor in Fort Gordon that determined I needed oxygen ..prior to that I was told being short of breath was normal for some one with asthma.

So like I said if you haven't been rated for COPD... you need to file a claim. You will still only have one combined rating asthma/copd.. but depending on the complicaitons you have could be the difference between a 30% rating and a 100% rating....

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I finally received my C-File in the mail. What there is of it. As I have said earlier I should have been discharged 30% at discharge in 1990. Enough of that.

Respiratory (Obstructive, Restrictive, and Interstitial) Exam. December 17, 2002

Examining Provider: Vanbuskirk, Terry

Examination Results

"The patient's C-file and, in particular, his compensation and pension March 1994 examination was reviewed. The patient is 10% service-connected reference bronchial asthma. The Kansas City VA hospital progress note of May 2002 indicates that the patient is on Combivent with a sig of 2 qid (however, the patient used to use approximately two to six times a day) from the Kansas City VA Hospital plus Singulair 10 one in the AM plus Advair (from his private physician) one bid; however, for financial reasons the patient has not been on any inhalers for the past one month. The patient states that his dyspnea requires more medication to control same. The patient can breathe in but he cannot breathe out. The patient has minimal cough except at night. The patient denies ever smoking. The patient's weight has increased 40 lbs in the past one year. The patient has chronic chest tightness however, if he exercises (or with summer allergies), he has exacerbations approximately once a day.

Auscultation and percussion of the patient's lungs discloses slight inspiratory and particularly expiratory, wheezing. The patient has no typhoscoliosis or pectus excavatum.

Today we will obtain pulmonary function tests and chest x-ray.

Diaganosis: Bronchial asthma."

The C-file I received has none of the information in it concerning the above. There is one page where Dr. Charoac acknowledges I was a patient. I have had numerous PFT's since my discharge in 1990 COPD has been mentioned twice in PFT's and C & P's in regards to Diagnosis. The radiologist almost all say yes. The doctors interpreting the PFT'S say yes. The final time was in 2012 when Dr. Johnson Underwood stated on

07-26-2012 Addendum

"The veteran has COPD onset in 1992. The Veteran is a non smoker according to the VA records. The Veteran has Asthma. It is at least as likely as not that the Veterans asthma condition is the cause of his COPD."

During this C & P it asks if I was diagnosed with sleep Apnea and/or Narcolepsy and if so complete the Questionnaire. He stated I wasn't. I was diagnosed with Sleep Apnea on 10/27/11 by a sleep study at an independent hospital the VA sent me two. I was prescribed a very expensive CPAP machine at that time.

In my C-file there is no mention of this 1992 C & P PFT that this doctor as well as the one above is reading. They state they have read my civilian doctors notes. They are non-existent in my file. It hasn't been that long ago. I don't believe I was given the COPD rating until this C & P when this doctor stated it is more likely than not. Then they combined the rating and gave me 60%, which still has some pyramiding issues. In 1994 the rater said there was no evidence I was taking my meds etc. when obviously the letters must have been there because as recently as 2012 during my last PFT they noted them. So the information is there, then its gone, then it reappears.

There is nothing in my C-file but copies of PFT's and Rating decisions, my original discharge information and a few tests. There is not one handwritten note of any kind. No work product that would allow you to make any sense out of the material if you didn't already have all of your records from 1990 forward (for the most part).

I'm not sure how to put this all together where it is easy to understand and follow. My original representative wasn't that interested. He even said "you know you can get in serious trouble for lying about smoking". I can just file a NOD the best way I can and then get a lawyer I suppose.

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It seems to me since the examiner stated "as likely as not" you should be rated for the copd & asthma together.

Of course the actual rating would depend on what medications your are using oral steroids( not to be confused with inhalant steroids), and PFT. IN the case of COPD the DCLO part of the PFT will help determine how bad the copd component is... No matter how hard you try or what you may think you are still only going to get one rating for the asthma & COPD. If you use oxygen or have other more serious complications you will be rated at 100%.

Presently, it seems you have not been rated for the COPD , you do have a valid claim for CUE, that is clear and unmistakable error, because based on the statement " likely as not" you should received the benefit of doubt by law and be rated for the COPD if you have not already been rated.

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I finally received my C-File in the mail. What there is of it. As I have said earlier I should have been discharged 30% at discharge in 1990. Enough of that.

Respiratory (Obstructive, Restrictive, and Interstitial) Exam. December 17, 2002

Examining Provider: Vanbuskirk, Terry

Examination Results

"The patient's C-file and, in particular, his compensation and pension March 1994 examination was reviewed. The patient is 10% service-connected reference bronchial asthma. The Kansas City VA hospital progress note of May 2002 indicates that the patient is on Combivent with a sig of 2 qid (however, the patient used to use approximately two to six times a day) from the Kansas City VA Hospital plus Singulair 10 one in the AM plus Advair (from his private physician) one bid; however, for financial reasons the patient has not been on any inhalers for the past one month. The patient states that his dyspnea requires more medication to control same. The patient can breathe in but he cannot breathe out. The patient has minimal cough except at night. The patient denies ever smoking. The patient's weight has increased 40 lbs in the past one year. The patient has chronic chest tightness however, if he exercises (or with summer allergies), he has exacerbations approximately once a day.

Auscultation and percussion of the patient's lungs discloses slight inspiratory and particularly expiratory, wheezing. The patient has no typhoscoliosis or pectus excavatum.

Today we will obtain pulmonary function tests and chest x-ray.

Diaganosis: Bronchial asthma."

The C-file I received has none of the information in it concerning the above. There is one page where Dr. Charoac acknowledges I was a patient. I have had numerous PFT's since my discharge in 1990 COPD has been mentioned twice in PFT's and C & P's in regards to Diagnosis. The radiologist almost all say yes. The doctors interpreting the PFT'S say yes. The final time was in 2012 when Dr. Johnson Underwood stated on

07-26-2012 Addendum

"The veteran has COPD onset in 1992. The Veteran is a non smoker according to the VA records. The Veteran has Asthma. It is at least as likely as not that the Veterans asthma condition is the cause of his COPD."

During this C & P it asks if I was diagnosed with sleep Apnea and/or Narcolepsy and if so complete the Questionnaire. He stated I wasn't. I was diagnosed with Sleep Apnea on 10/27/11 by a sleep study at an independent hospital the VA sent me two. I was prescribed a very expensive CPAP machine at that time.

In my C-file there is no mention of this 1992 C & P PFT that this doctor as well as the one above is reading. They state they have read my civilian doctors notes. They are non-existent in my file. It hasn't been that long ago. I don't believe I was given the COPD rating until this C & P when this doctor stated it is more likely than not. Then they combined the rating and gave me 60%, which still has some pyramiding issues. In 1994 the rater said there was no evidence I was taking my meds etc. when obviously the letters must have been there because as recently as 2012 during my last PFT they noted them. So the information is there, then its gone, then it reappears.

There is nothing in my C-file but copies of PFT's and Rating decisions, my original discharge information and a few tests. There is not one handwritten note of any kind. No work product that would allow you to make any sense out of the material if you didn't already have all of your records from 1990 forward (for the most part).

I'm not sure how to put this all together where it is easy to understand and follow. My original representative wasn't that interested. He even said "you know you can get in serious trouble for lying about smoking". I can just file a NOD the best way I can and then get a lawyer I suppose.

cass,

I had to delete the file you uploaded as it had your real name and SSA # on it.

You are welcome to make a copy of the upload - mark out personal info like name claim / SSA

number etc . . . and re-attach the file.

Too bad you missed the C&P appointment that the VA had scheduled,

it more likely than not would have been helpful.

§ 3.655 Failure to report for Department of Veterans Affairs examination.

(a) General. When entitlement or continued entitlement to a benefit cannot be established or confirmed without a current VA examination or reexamination and a claimant, without good cause, fails to report for such examination, or reexamination, action shall be taken in accordance with paragraph (b) or © of this section as appropriate. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. For purposes of this section, the terms examination and reexamination include periods of hospital observation when required by VA.

(b) Original or reopened claim, or claim for increase. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a reopened claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied.

© Running award.

(1) When a claimant fails to report for a reexamination and the issue is continuing entitlement, VA shall issue a pretermination notice advising the payee that payment for the disability or disabilities for which the reexamination was scheduled will be discontinued or, if a minimum evaluation is established in part 4 of this title or there is an evaluation protected under § 3.951(b) of this part, reduced to the lower evaluation. Such notice shall also include the prospective date of discontinuance or reduction, the reason therefor and a statement of the claimant's procedural and appellate rights. The claimant shall be allowed 60 days to indicate his or her willingness to report for a reexamination or to present evidence that payment for the disability or disabilities for which the reexamination was scheduled should not be discontinued or reduced.

(2) If there is no response within 60 days, or if the evidence submitted does not establish continued entitlement, payment for such disability or disabilities shall be discontinued or reduced as of the date indicated in the pretermination notice or the date of last payment, whichever is later.

(3) If notice is received that the claimant is willing to report for a reexamination before payment has been discontinued or reduced, action to adjust payment shall be deferred. The reexamination shall be rescheduled and the claimant notified that failure to report for the rescheduled examination shall be cause for immediate discontinuance or reduction of payment. When a claimant fails to report for such rescheduled examination, payment shall be reduced or discontinued as of the date of last payment and shall not be further adjusted until a VA examination has been conducted and the report reviewed.

(4) If within 30 days of a pretermination notice issued under paragraph ©(1) of this section the claimant requests a hearing, action to adjust payment shall be deferred as set forth in § 3.105(h)(1) of this part. If a hearing is requested more than 30 days after such pretermination notice but before the proposed date of discontinuance or reduction, a hearing shall be scheduled, but payment shall nevertheless be discontinued or reduced as of the date proposed in the pretermination notice or date of last payment, whichever is later, unless information is presented which warrants a different determination. When the claimant has also expressed willingness to report for an examination, however, the provisions of paragraph ©(3) of this section shall apply.

(Authority: 38 U.S.C. 501)

Cross References: Procedural due process and appellate rights: See § 3.103. Examinations: See § 3.326. Reexaminations: See § 3.327. Resumption of rating when veteran subsequently reports for VA examination: See § 3.330.

[55 FR 49521, Nov. 29, 1990; 58 FR 46865, Sept. 3, 1993]

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=d19bf832eb2c623d379c46f29dc37be8&rgn=div8&view=text&node=38:1.0.1.1.4.2.73.206&idno=38

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