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.
 

trini123

Registered Member
Anyone has updates? I called the PEB @ 2026856422 just to ensure they got my case but that's about it.
 

Rijmus

Registered Member
I don't have any updates to report. My PCM has failed to submit my MEB. I have scheduled ANOTHER appointment to get him to submit my paperwork. I hope that he finally does it. Not knowing how long I'll be stuck in this holding pattern is irritating.
 

trini123

Registered Member
I called my PEBLO and asked for an updated. She told me I was found UNFIT and it's with the VA, not sure how long the wait continues. I need to find cases where two respiratory conditions were rated separately!!!!!!
 

Rijmus

Registered Member
I'm glad you got some news. I'm waiting (still) for my P3 profile to be signed by another physician. Apparently, things move fast here at Fort Sill. Although, from my perspective, they do not. I sure wish I could start planning for my transition but alas I cannot until other people do their jobs.
 

Rijmus

Registered Member
I met with my NCM today. This process is eye-opening. My P3 was referred to the IDES physician today and I am told I will have my P3 (final) within 2-4 weeks. THEN the MEB process can begin. In a fortunate turn of events, I met my PEBLO as well today. I had several questions and some were answered and others left me confounded. She wouldn't discuss ratings because she was concerned if she speculated, I would hate her if it came back lower.

Then I asked about how pay was calculated to validate my assumptions and I was confounded when she told me that since I have less than 20 years, I wouldn't be paid at all by the DoD. She said that I would get to choose between either DoD or VA. I tried to articulate the best I could the VA Waiver but it seemed like it was completely foreign to her. Am I off the mark here? I thought I understood what I was reading on the DFAS website. If I calculate my top 36 it averages to 5300. If I take my anticipated DoD disability rating (for disqualifying condition only) of 60% and calculate it based on method A it comes to 3180. If I am rated at 70% from the VA (1867.90 + 67.00 for additional child it comes to 1934.90). SO... in my mind based on what I've read, 3180-1934 = 1245.10. this is the amount that I will be taxed on. I would receive 1934.90 from the VA and 1245.10 (less tax) from the DoD monthly.

Am I wrong?
 
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