Unprovoked PE with lifelong anticoagulation recommended

Rijmus

Registered Member
Hello! I am new here. I was diagnosed with an unprovoked PE in November 2018 and have been on apixaban since. My hematologists is likely to recommend lifelong anticoagulation due to being unprovoked. I have seen that some people are rated at 30% and some at 60% for similar issues. The 60% rating states: "Chronic pulmonary thromboembolism requiring anticoagulant therapy, or; following inferior vena cava surgery without evidence of pulmonary hypertension or right ventricular dysfunction" while the 30% rating states: "Symptomatic, following resolution of acute pulmonary embolism." I have only had one episode of PE but that is enough for the doctor to recommend anticoagulation for life, she said it is the industry standard for unprovoked because the risk of having another is 50%. My question, would I more than likely be rated at 60% than 30% due to the lifelong anticoagulation even though I didn't have more than one episode? I did, however, have more than one PE in the same lung lobe. Any help here is greatly appreciated.
 

Padgettra

PEB Forum Veteran
Registered Member
Hello! I am new here. I was diagnosed with an unprovoked PE in November 2018 and have been on apixaban since. My hematologists is likely to recommend lifelong anticoagulation due to being unprovoked. I have seen that some people are rated at 30% and some at 60% for similar issues. The 60% rating states: "Chronic pulmonary thromboembolism requiring anticoagulant therapy, or; following inferior vena cava surgery without evidence of pulmonary hypertension or right ventricular dysfunction" while the 30% rating states: "Symptomatic, following resolution of acute pulmonary embolism." I have only had one episode of PE but that is enough for the doctor to recommend anticoagulation for life, she said it is the industry standard for unprovoked because the risk of having another is 50%. My question, would I more than likely be rated at 60% than 30% due to the lifelong anticoagulation even though I didn't have more than one episode? I did, however, have more than one PE in the same lung lobe. Any help here is greatly appreciated.
Rijmus, Welcome to the PE survivors club! It is a great club to be in. I can't comment on any of the rest, yet wish you the best. Ron P
 

x_van

Registered Member
So, Im going through the same thing right now. My board has been going for about 4 months. I had a DVT and bilateral PEs. Nearly died. The way I was explained about PEs and the word usage of "chronic" is when the clot in the lungs becomes a scar and stays long-term (chronic) burden on the longs. Usually Chronic thromboembolic pulmonary hypertension (CTEPH) is a result of this. If you have a PE and your medical provider has resoluted that it has been resolved, thats 0% rating. Now, if you continuously have pain in the area of where the PE was and experience shortness of breath, thats the 30% rating. This is just what I have been told by my PEBLO and VA examiners. Oh, and being on longterm anticoagulant is another 0% lol....kinda crazy consider Acid reflux in 10%. But hey, what do I know.
 

Rijmus

Registered Member
My episode was unprovoked and idiopathic which means there was no know cause. The advised course of action is anticoagulation therapy for life due to the high risk of reoccurrence. If I am still on anticoagulation to prevent a future PE then my condition is only controlled by medication and should therefore be deemed chronic thereby satisfying the entirety of the definition for the 60% rating. It seems counterintuitive to take me off the anticoagulants, allow me to have another episode (which may kill me) only to deem my condition chronic when the end result is anticoagulation for life anyway. Furthermore, how can they deem a PE resolved if you still require anticoagulation medication? I pray the VA examiners who determine my percentages have this same logical thought process.
 

trini123

Registered Member
My episode was found to be provoked (12 hour flight and 8 hour drive) I disagree but it is what it is. 2016 after a 12 hour flight from Japan to ATL followed by pain the left calf was diagnosed with a DVT and PE in both lungs. Had surgery and then thinners for six months. 2018 after an 8 hour drive pain the right calf, diagnosed with another DVT. Now on thinners indefinitely, referred to MEB DEC 2018. Today I signed off on the MEB findings and my info should be off to the PEB today or tomorrow.
 

Rijmus

Registered Member
My episode was found to be provoked (12 hour flight and 8 hour drive) I disagree but it is what it is. 2016 after a 12 hour flight from Japan to ATL followed by pain the left calf was diagnosed with a DVT and PE in both lungs. Had surgery and then thinners for six months. 2018 after an 8 hour drive pain the right calf, diagnosed with another DVT. Now on thinners indefinitely, referred to MEB DEC 2018. Today I signed off on the MEB findings and my info should be off to the PEB today or tomorrow.
Thank you for the reply. I am confident you will achieve a minimum rating of 60%. I would like to follow your case as mine will be similar. I do not have the recurrence factor (nor do I want it) Perhaps we could be battle buddies through this process. I wish you the best of luck and please keep in touch!
 

trini123

Registered Member
Rijmus,
NP. My process should already be at the PEB but i had to wait about a month to get a sleep study to finish up my C&P exams.
 

trini123

Registered Member
If you got sleep apnea don't expect this to be rated separately from your PE. From all the trends I read they rate all respiratory claims as one even though the below verbiage sates other wise......6817 for PE an 6847 for sleep apnea should not be considered pyramiding.

§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.
 
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