Asthma and sleep apnea rating issues

Jen09_2005

PEB Forum Regular Member
Registered Member
Hello! I have been searching threads that might give me some answers but have been unable to locate them. I am currently undergoing a med board for chronic bilateral foot pain following bunionectomy surgery and also for moderate persistent asthma. During my QTC exams, I was diagnosed with sleep apnea and have not received any further treatment for my sleep apnea (CPAP study, pulmonary consult, etc). I have been told that my asthma and my sleep apnea will be lumped and rated together and that's just how it is, so sad. Has anyone had this happen to them? How will having no CPAP and a new OSA diagnosis affect my asthma rating? Has anyone successfully argued/appealed this and had the two respiratory conditions rated separately? Thanks for all of your help!
 

trini123

Active Member
PEB Forum Veteran
Registered Member
I saw where they rated them together with the verbiage below which is from the rating manual. I've also saw where some folks were able to get them rated separately.

4.96 Special provisions regarding evaluation of respiratory conditions.

(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.
 

chaplaincharlie

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1. Ask your PCM for a sleep study. C&P examiners do not provide treatment.

2. OSA and respiratory are rated separately.
 

Jen09_2005

PEB Forum Regular Member
Registered Member
Thanks everyone. I checked today and my VA Ratings are complete and everything is in the PEB Findings phase. I'll update and let everyone know what they initially say. I hope to get to see my ratings soon.
 

StellarAirman

PEB Forum Regular Member
Registered Member
Thanks everyone. I checked today and my VA Ratings are complete and everything is in the PEB Findings phase. I'll update and let everyone know what they initially say. I hope to get to see my ratings soon.
Please keep us updated since I am in a similar situation! Thank you.
 

Jen09_2005

PEB Forum Regular Member
Registered Member
So, I met with my PEBLO on Monday. As far as the Asthma and OSA, they were rated together and looking at the codes and such, they normally get rated together. I have seen posts where people have successfully argued with the help of JAG and gotten them separated. I received 50% DOD -- 30% for Asthma/OSA and the additional percentage from my bilateral unfitting feet conditions. I am meeting with legal tomorrow and will see what they say (got 100% VA). When my ratings were given I had not received my CPAP from Tricare and so it appeared that I was not receiving treatment for OSA. Another reason for the 30% was stated that I did not have signs of hyper-somnolence, which is incorrect because it is in my original diagnosis from the sleep center. The OSA should be at 50% and therefore, raise my Asthma/OSA DOD rating to 50% + feet, equaling about 60% DOD or something similar. I'm not sure if this would move me into a TDRL since I have only had and been using my CPAP for about a week. I am tired. I want to move on. Since I got Permanent Retirement and 100% VA, I am wondering if the attorney will recommend going with it since 100% VA is higher anyhow and 30%, 50%, for 60% doesn't matter on the DOD side as long as you break 30%.

Updates to follow.
 

StellarAirman

PEB Forum Regular Member
Registered Member
So, I met with my PEBLO on Monday. As far as the Asthma and OSA, they were rated together and looking at the codes and such, they normally get rated together. I have seen posts where people have successfully argued with the help of JAG and gotten them separated. I received 50% DOD -- 30% for Asthma/OSA and the additional percentage from my bilateral unfitting feet conditions. I am meeting with legal tomorrow and will see what they say (got 100% VA). When my ratings were given I had not received my CPAP from Tricare and so it appeared that I was not receiving treatment for OSA. Another reason for the 30% was stated that I did not have signs of hyper-somnolence, which is incorrect because it is in my original diagnosis from the sleep center. The OSA should be at 50% and therefore, raise my Asthma/OSA DOD rating to 50% + feet, equaling about 60% DOD or something similar. I'm not sure if this would move me into a TDRL since I have only had and been using my CPAP for about a week. I am tired. I want to move on. Since I got Permanent Retirement and 100% VA, I am wondering if the attorney will recommend going with it since 100% VA is higher anyhow and 30%, 50%, for 60% doesn't matter on the DOD side as long as you break 30%.

Updates to follow.

Congratulations! That's great news for the most part and I'm sure you will receive what you are entitled to, so as long if you keep fighting for it.
 
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