Immunosuppressive drugs

RayH

PEB Forum Regular Member
PEB Forum Veteran
Is taking immunosuppressive drugs ratable when taking them for Arthiritic diseases as they are for skin diseases?

7816 Psoriasis:

More than 40 percent of the entire body or more than 40 percent
of exposed areas affected, or; constant or near-constant systemic
therapy such as corticosteroids or other immunosuppressive drugs
required during the past 12- month period................................................................... 60
 

Jason Perry

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RayH,

A review of the rating criteria for arthritic conditions under diagnostic codes 5002-5010, does not show any similar criteria.

If you think that is unfair, the VASRD has been criticized as arbitrary, outdated, and not reflective of advances in medicine. In many case, the criticism rings true.

In the vast majority of the cases, this would be the end of the inquiry. Though, if the treatment caused extreme symptoms on its own, I can see a theory for getting a rating on the residuals or for extra-schedular reasons.
 

RayH

PEB Forum Regular Member
PEB Forum Veteran
Jason,
Thanks for the response. I will be one to say that they are not keeping up with medicine since a lot of people with disabling arthiritis are being treated with the same immunosuppressive drugs that treats those with skin diseases.
 

xeno

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Jason,
Thanks for the response. I will be one to say that they are not keeping up with medicine since a lot of people with disabling arthiritis are being treated with the same immunosuppressive drugs that treats those with skin diseases.

Rightfully so, because it is your immune system that is attacking your joints.

X
 

maparker

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PEB Forum Veteran
Registered Member
I have reactive arthritis which is an autoimmune form of arthritis. I filed a NOD in September 2007 making the argument that this condition should be rated at 60% becuase it requires continuous treatment with immunosuppresive drugs (Enbrel). I argued that the 5002 criteria has not kept up as have other conditions rating criteria and that extra schedular consideration should be given to this situation. I have not heard back yet from the VA but will let you know how this plays out.

Mike
 

RayH

PEB Forum Regular Member
PEB Forum Veteran
Jason, Mike, anyone,

During the process I will have a chance to submit a statement as it is written in the regs......

You will be provided a copy of the board’s report unless the information contained in the report might have an adverse effect on your physical or mental health. At this point, you are afforded an opportunity to submit a statement in rebuttal to any portion of the MEB's report [PDES Manual, Chapter 3.H]. Your rebuttal must be made within 15 working days (not counting weekends and holidays) after you receive the MEB report.

Do you think that it would be advisable in this statement to point out about the immunosuppressive drugs and they are the same used for Psoriasis? If I put it in, how would this be looked at?
I figure that the Doc isn't going to place this info in the report.
What say you?
Thanks
Ray
 

Jason Perry

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Reasonable people may disagree on this. I don't think there is a "right" answer. That said, this is what I think.

You want the NARSUM to accurately list all of your disqualifying conditions, including the history, diagnosis, prognosis, treatment, and how the condition impacts your function. If it hits these high points, to me, you should be satisfied.

What you are talking about submitting does not really apply to the MEB. You want to ensure the NARSUM lists that you are taking this drug. But the argument about the rating really is something that the PEB would address.

Still, that leaves the question of when to submit. The argument for extra-schedular rating is a tough one to win at the Board level. I have seen it happen once out of several hundred cases. So, I think you have an uphill battle with getting the board to grant an award under this theory. However, I think you have much better chances if you were to fight this in federal court.

Given that, you (and your attorney) need to make a tactical decision of when to raise this. I think the answer to that depends on the strength of the rest of your case. If you have a better argument for an acceptable rating, I would go with that at the Formal Board level. You could then submit the argument on appeal. I, again, don't have much confidence that the Board or the CG would get it right on their own. But it creates the issue for BCMR whether the Board or the agency correctly decided the issue. This would then keep the issue alive for court review. On the other hand, if you have nothing else, I might argue this directly at the Formal. It is really a judgment call and hard to know with out assessing the strength of the case overall.

Hope this made sense. If you have any questions, as always, ask away!
 

RayH

PEB Forum Regular Member
PEB Forum Veteran
Jason,
As always, thanks. Once I get my copy of the NARSUM, I will review and see what is placed in it. Most likely I will have questions?
 

RayH

PEB Forum Regular Member
PEB Forum Veteran
Robs42,
Thanks for the support. Thanks for moving the link.
Ray
 
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