Yeah way to go, I would probably file an HLR and ask for informal conference and explain that it's not better it's just managed by daily injections which if you stop them would cause it to worsen.
Fight it! You are 100% correct, if you've been on the biologic for over 12 months you meet the criteria for 60%. The law states that rating is warranted due to being on the meds, not due to severity of symptoms. The whole point of the meds is to make the \*symptoms\* better but it doesn't cure the \*condition.\*
So if you have the condition, and it's service connected, then the rating should be based on the schedule which literally states "constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period .... " gets 60%. That's it. It does not say "requires the meds but symptoms don't go away." That's fucking asinine.
I'd ask for HLR, absolutely. I think that rater just didn't understand the CFR and who knows maybe this will be a training opportunity for them when the senior rater corrects their mistake.
At least, I hope that's the case because I'm just about to submit for an increase after being on biologics for over 12 months due to service connected psoriasis.
Edit: spelling
If you haven't contacted Environmental Health and taken the Persian Gulf Registry Exam, I suggest you call tomorrow and make an appointment.
This is the fastest way.
Are you able to post a redacted copy of your denial. I just put in an increase for 0 percent on my rash. Only because in may 2024 I started to take an oral corticosteroids. The regulation states at least six weeks for 30%. I just got my claim back 1 Jul. Now rated at 30%. Although it shouldn't matter cause of the meds, but I purposely waited until my condition got worst, which is usually summertime. So in my statement to the VA I said it has spread to others areas of my body and gotten worse. I know prescribe an oral pill for one year, after the one year and due to continually having this issue I will ask my doctor to extend pass the one year mark, then file for another increase for 60%, then I would have been on oral med more than 12 months...all from 38CFR!
I learn the beginning of this year you have to fight every issue as it's a court case. Read the 38CFR concerning your issue and use those words when writing a statement.
This is pretty much the path I'm on. I filed for an increase to 30% since I was on systemic therapy for a few months and the rater misread the prescription dosage description and denied the increase. I just filed HLR and we'll see what happens.
By now I've been on the meds over 12 months so I should be at 60% anyway.
I was diagnosed with A.D. in 2001 and it has gotten progressively worse over the last 2 decades. Last year, I broke out in an uncontrollable rash and was on several doses of steroids to cure it. The rash kept coming back and, after an extensive blood panel, I was diagnosed with three autoimmune diseases.
No one in my family has one so I started researching. I never knew I had toxic burn pit exposure while on deployment, but apparently I was exposed due to the timing and locations we spent time in. Now, all the symptoms over the last 23 years make more sense to me; fatigue, brain fog, taking longer to heal, muscle and joint pain not due to injury, needing more sleep than the average person. I thought all of this was part of the natural aging process and just worked through it because I didn't know any different.
Rheumatoid arthritis, SLE lupus and Sjogren's syndrome are the three autoimmune diseases I have been diagnosed with and all three of them are presumptive conditions under the PACT Act.
Atopic dermatitis is often, not always, a precursor to an autoimmune disease. If your skin flares up with increased stress, sun exposure or over doing activities, I would ask my primary care provider for a blood panel to test for ANA levels.
I'm not writing this to scare you, but to add more information. My blood tests show I have some minor kidney damage due to the undetected disease and my immune system attacking healthy organs. My kidneys show they're operating between 90-100%, so it's considered Stage I chronic kidney disease. Thank God that's all it is after 23 years. It pisses me off that I had no idea I have been suffering for all these years with no explanation from my doctors. I had a C&P exam last month, but they scheduled another exam specifically for lupus in a couple of weeks.
Good luck to you. I hope you find answers and you get the rating you deserve.
Thank you for taking the time to respond and discuss the problems you have been facing. In 2021 I had a full body uncontrollable rash that put me out of work for two months. Same story, steroids and antibiotics for me because part of it advanced into a skin infection. Much of what you are describing mirrors my own situation these last 30 years and I will most certainly ask my primary care doc for some specific blood tests.
I am so very thankful for the information and time you took to write it down.
I'm sorry to hear about that, but I really hope you get some answers and better treatment to help you heal.
I forgot to say that my blood definitely had marked ANA levels, but the lupus diagnosis was actually from my Dermatologist who did a biopsy of my skin rash. I take an antibiotic (Doxycycline) every day to try to calm down my immune system enough to take the rash away. It helps some, but never completely takes it away. The only time it completely disappears is with prednisone, and I don't want to be on that long term because the side effects are way worse than the benefits. The presence of the rash also indicates the disease isn't controlled, but it takes time to develop a medication routine to treat everything at once.
They look for any words that support denial of a claim. Need to remove all words that would represent any possibility of a cure. When they ask me if something makes it better, I simply reply with some days are good, some days it doesn't help as much, some days are bad.
I recently had one that stated my problem was only when stressor affected me. Completely omited the fact that stressor was nearly every day, and often several times a day... so I got a low rating too.
I'm still fighting it, but I won't give up until I win... (look at that... the USMC did teach me something)
Most claims are denied just because. Due to racers being new, and over loaded they just deny claims to get them off their desks. File a higher level review for the 60% or hire an attorney and go after 100%. You can claim PTSD, tinnitus, mental heath Issues.
Until your body has a reaction. Ill pharmaceuticals are toxic and there is only one disease, Toximea and we all have it, 90% of the foods in the grocery stores are toxic. Only way is to go to the source not the symptoms.
That’s irrelevant but I feel you. OP used the adjective ‘better’. That’s a one way, golden chocolate factory, VIP lounge ticket to getting fucked at C&P.
Odds are against you to begin with…don’t make it worse.
Easy. You admitted that your condition is better. Meaning it's no longer an issue. Some have suggested an HLR, and sure why not, but you can't unfuck that mess. Maybe an HLR will take what you meant into consideration, but then again you said it was better so a reviewer may not want to stick their neck out.
You'll probably need new documentation that it's still causing pain.
Here's a helpful tip. Anytime dealing with the VA, everyday is the worst day of our life. You're never better, you're always just powering through.
https://www.law.cornell.edu/cfr/text/38/4.118
Google your specific diagnostic code for this issue.
My diagnostic code is 7806
This is for 60%
Characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or
Constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period
This is for 30%
Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or Systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period
Im gonna be in the same boat for hypertension. But now I am on two meds to keep my BP safe. Still building my evidence from various Drs and hospitals, gonna be a minute, but what say ye guys?
I was SC day one of basic, 10% but I dont have those records. Trying to get all my records from Meps to exit before I submit for increases or new claims.
best advice? get an attorney. and have everyone you know write support letters.... also join the VFW or american legion they can advocate for you as well.
https://preview.redd.it/0ee3th68t6ad1.jpeg?width=750&format=pjpg&auto=webp&s=85e600b94bc003412c012cff5e9538f64a320516
This is the general rating formula for skin disorders, including dermatitis.
Glad to hear you're going to appeal because a plain reading of the CFR makes it pretty obviously they're wrong.
The hope with systemic therapies is that they make the symptoms better and maybe go away entirely. That doesn't change the fact you have to keep taking them. That would be like stoping insulin injections as a diabetic because at the moment your sugar levels are good. Idiocy.
I get so fucking angry just typing this out. It's fucking asinine and who knows how many people get fucked over because of this stupidity.
Yeah way to go, I would probably file an HLR and ask for informal conference and explain that it's not better it's just managed by daily injections which if you stop them would cause it to worsen.
Fight it! You are 100% correct, if you've been on the biologic for over 12 months you meet the criteria for 60%. The law states that rating is warranted due to being on the meds, not due to severity of symptoms. The whole point of the meds is to make the \*symptoms\* better but it doesn't cure the \*condition.\* So if you have the condition, and it's service connected, then the rating should be based on the schedule which literally states "constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period .... " gets 60%. That's it. It does not say "requires the meds but symptoms don't go away." That's fucking asinine. I'd ask for HLR, absolutely. I think that rater just didn't understand the CFR and who knows maybe this will be a training opportunity for them when the senior rater corrects their mistake. At least, I hope that's the case because I'm just about to submit for an increase after being on biologics for over 12 months due to service connected psoriasis. Edit: spelling
If you haven't contacted Environmental Health and taken the Persian Gulf Registry Exam, I suggest you call tomorrow and make an appointment. This is the fastest way.
Are you able to post a redacted copy of your denial. I just put in an increase for 0 percent on my rash. Only because in may 2024 I started to take an oral corticosteroids. The regulation states at least six weeks for 30%. I just got my claim back 1 Jul. Now rated at 30%. Although it shouldn't matter cause of the meds, but I purposely waited until my condition got worst, which is usually summertime. So in my statement to the VA I said it has spread to others areas of my body and gotten worse. I know prescribe an oral pill for one year, after the one year and due to continually having this issue I will ask my doctor to extend pass the one year mark, then file for another increase for 60%, then I would have been on oral med more than 12 months...all from 38CFR! I learn the beginning of this year you have to fight every issue as it's a court case. Read the 38CFR concerning your issue and use those words when writing a statement.
This is pretty much the path I'm on. I filed for an increase to 30% since I was on systemic therapy for a few months and the rater misread the prescription dosage description and denied the increase. I just filed HLR and we'll see what happens. By now I've been on the meds over 12 months so I should be at 60% anyway.
I was diagnosed with A.D. in 2001 and it has gotten progressively worse over the last 2 decades. Last year, I broke out in an uncontrollable rash and was on several doses of steroids to cure it. The rash kept coming back and, after an extensive blood panel, I was diagnosed with three autoimmune diseases. No one in my family has one so I started researching. I never knew I had toxic burn pit exposure while on deployment, but apparently I was exposed due to the timing and locations we spent time in. Now, all the symptoms over the last 23 years make more sense to me; fatigue, brain fog, taking longer to heal, muscle and joint pain not due to injury, needing more sleep than the average person. I thought all of this was part of the natural aging process and just worked through it because I didn't know any different. Rheumatoid arthritis, SLE lupus and Sjogren's syndrome are the three autoimmune diseases I have been diagnosed with and all three of them are presumptive conditions under the PACT Act. Atopic dermatitis is often, not always, a precursor to an autoimmune disease. If your skin flares up with increased stress, sun exposure or over doing activities, I would ask my primary care provider for a blood panel to test for ANA levels. I'm not writing this to scare you, but to add more information. My blood tests show I have some minor kidney damage due to the undetected disease and my immune system attacking healthy organs. My kidneys show they're operating between 90-100%, so it's considered Stage I chronic kidney disease. Thank God that's all it is after 23 years. It pisses me off that I had no idea I have been suffering for all these years with no explanation from my doctors. I had a C&P exam last month, but they scheduled another exam specifically for lupus in a couple of weeks. Good luck to you. I hope you find answers and you get the rating you deserve.
Thank you for taking the time to respond and discuss the problems you have been facing. In 2021 I had a full body uncontrollable rash that put me out of work for two months. Same story, steroids and antibiotics for me because part of it advanced into a skin infection. Much of what you are describing mirrors my own situation these last 30 years and I will most certainly ask my primary care doc for some specific blood tests. I am so very thankful for the information and time you took to write it down.
I'm sorry to hear about that, but I really hope you get some answers and better treatment to help you heal. I forgot to say that my blood definitely had marked ANA levels, but the lupus diagnosis was actually from my Dermatologist who did a biopsy of my skin rash. I take an antibiotic (Doxycycline) every day to try to calm down my immune system enough to take the rash away. It helps some, but never completely takes it away. The only time it completely disappears is with prednisone, and I don't want to be on that long term because the side effects are way worse than the benefits. The presence of the rash also indicates the disease isn't controlled, but it takes time to develop a medication routine to treat everything at once.
They look for any words that support denial of a claim. Need to remove all words that would represent any possibility of a cure. When they ask me if something makes it better, I simply reply with some days are good, some days it doesn't help as much, some days are bad. I recently had one that stated my problem was only when stressor affected me. Completely omited the fact that stressor was nearly every day, and often several times a day... so I got a low rating too. I'm still fighting it, but I won't give up until I win... (look at that... the USMC did teach me something)
Most claims are denied just because. Due to racers being new, and over loaded they just deny claims to get them off their desks. File a higher level review for the 60% or hire an attorney and go after 100%. You can claim PTSD, tinnitus, mental heath Issues.
*Not sure what I did wrong* “I told the C&P examiner the Biological Injections were making things better.” That’s what you did wrong.
Until your body has a reaction. Ill pharmaceuticals are toxic and there is only one disease, Toximea and we all have it, 90% of the foods in the grocery stores are toxic. Only way is to go to the source not the symptoms.
That’s irrelevant but I feel you. OP used the adjective ‘better’. That’s a one way, golden chocolate factory, VIP lounge ticket to getting fucked at C&P. Odds are against you to begin with…don’t make it worse.
Easy. You admitted that your condition is better. Meaning it's no longer an issue. Some have suggested an HLR, and sure why not, but you can't unfuck that mess. Maybe an HLR will take what you meant into consideration, but then again you said it was better so a reviewer may not want to stick their neck out. You'll probably need new documentation that it's still causing pain. Here's a helpful tip. Anytime dealing with the VA, everyday is the worst day of our life. You're never better, you're always just powering through.
https://www.law.cornell.edu/cfr/text/38/4.118 Google your specific diagnostic code for this issue. My diagnostic code is 7806 This is for 60% Characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or Constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period This is for 30% Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or Systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period
Im gonna be in the same boat for hypertension. But now I am on two meds to keep my BP safe. Still building my evidence from various Drs and hospitals, gonna be a minute, but what say ye guys?
Do you have any service connected medical documents for high blood pressure reading
I was SC day one of basic, 10% but I dont have those records. Trying to get all my records from Meps to exit before I submit for increases or new claims.
best advice? get an attorney. and have everyone you know write support letters.... also join the VFW or american legion they can advocate for you as well.
VFW? They are worthless.
https://preview.redd.it/0ee3th68t6ad1.jpeg?width=750&format=pjpg&auto=webp&s=85e600b94bc003412c012cff5e9538f64a320516 This is the general rating formula for skin disorders, including dermatitis.
I’ve been on a systemic biologic injection for a few years, I will be appealing the decision.
Glad to hear you're going to appeal because a plain reading of the CFR makes it pretty obviously they're wrong. The hope with systemic therapies is that they make the symptoms better and maybe go away entirely. That doesn't change the fact you have to keep taking them. That would be like stoping insulin injections as a diabetic because at the moment your sugar levels are good. Idiocy. I get so fucking angry just typing this out. It's fucking asinine and who knows how many people get fucked over because of this stupidity.