Hi,
So background - I was dx'd with Crohn's (after a year of undermined colitis) and have failed multiple medications, and am now on maxed out Remicade + 6MP. I'm probably still a year out from MED because my GI wants me stable first, and my command is supportive because i have some family issues that will stabilize at the same time frame.
Questions:
1) Crohn's Ratings - I hear that 30 is the most common, and that many VA sites rate Crohn's as "enterocolitis, Chronic" which maxes out at 30. Despite UC (Inflammatory Bowel Disease) being more accurate and analogous. Other sites use the UC code and thus some patients get 60 or even 100. Is there a way to address this during IDES so they us the UC code, or if they don't can I appeal and ask them to rate me against UC?
In support here is the actual guidance given to the VA in 2011 when they were taking comments on revising GI VASRD: https://www.va.gov/ORPM/docs/20110705_AN12_ScheduleforRatingDigestive.pdf It clearly recommends VA use similar criteria to UC. If I appeal is this kind of evidence enough to support the case?
2) Nothing in the GI VASRD addressed Biologic medications and their immune suppression, despite them being frequent medications of use for over 15 yrs. They are listed in Rheum and Derm conditions and in those case even if current symptoms are resolved they still carry a 30-60 % rating just for the medication because of the know lifelong side effects, and active immune suppression plus monthly hosp visit for infusion.
Is there a way to be rated analogous for the medication use? Can this be done/requested at initial IDES ratings, or do you have to wait to appeal? Has anyone successfully achieved analogous ratings for UC or Crohn's in this case?
3) Can DBQs be used during the IDES VA rating exams? MI GI and a few of my other docs do them for retirees and said they'd be willing to do them, vice sending my to a VA PCM for normal "exam" (as they put it). But they werent sure if they can be used during IDEA or only after discharge.
4) Some VA area's have single point providers for exam/claims (1 stop shop) vice sending you all over town and state for a number of weeks. During IDES can I request PTDY, or use my leave to go to one of these examiners vs the hodge podge of examiners in my general area?
5) Lastly like others I've been told that the 635-40 and 40-501 changes this past winter mean non-deployable is automatic unfit. There will no longer findings of non-deployablity with COAD, you must be world wide deployable. Is this true / accurate? (Remicade is current fully restricted from deployment and even many OCONUS PCS's because of the immune suppression and infusion logistics)
Thanks for any insights.
Joe
So background - I was dx'd with Crohn's (after a year of undermined colitis) and have failed multiple medications, and am now on maxed out Remicade + 6MP. I'm probably still a year out from MED because my GI wants me stable first, and my command is supportive because i have some family issues that will stabilize at the same time frame.
Questions:
1) Crohn's Ratings - I hear that 30 is the most common, and that many VA sites rate Crohn's as "enterocolitis, Chronic" which maxes out at 30. Despite UC (Inflammatory Bowel Disease) being more accurate and analogous. Other sites use the UC code and thus some patients get 60 or even 100. Is there a way to address this during IDES so they us the UC code, or if they don't can I appeal and ask them to rate me against UC?
In support here is the actual guidance given to the VA in 2011 when they were taking comments on revising GI VASRD: https://www.va.gov/ORPM/docs/20110705_AN12_ScheduleforRatingDigestive.pdf It clearly recommends VA use similar criteria to UC. If I appeal is this kind of evidence enough to support the case?
2) Nothing in the GI VASRD addressed Biologic medications and their immune suppression, despite them being frequent medications of use for over 15 yrs. They are listed in Rheum and Derm conditions and in those case even if current symptoms are resolved they still carry a 30-60 % rating just for the medication because of the know lifelong side effects, and active immune suppression plus monthly hosp visit for infusion.
Is there a way to be rated analogous for the medication use? Can this be done/requested at initial IDES ratings, or do you have to wait to appeal? Has anyone successfully achieved analogous ratings for UC or Crohn's in this case?
3) Can DBQs be used during the IDES VA rating exams? MI GI and a few of my other docs do them for retirees and said they'd be willing to do them, vice sending my to a VA PCM for normal "exam" (as they put it). But they werent sure if they can be used during IDEA or only after discharge.
4) Some VA area's have single point providers for exam/claims (1 stop shop) vice sending you all over town and state for a number of weeks. During IDES can I request PTDY, or use my leave to go to one of these examiners vs the hodge podge of examiners in my general area?
5) Lastly like others I've been told that the 635-40 and 40-501 changes this past winter mean non-deployable is automatic unfit. There will no longer findings of non-deployablity with COAD, you must be world wide deployable. Is this true / accurate? (Remicade is current fully restricted from deployment and even many OCONUS PCS's because of the immune suppression and infusion logistics)
Thanks for any insights.
Joe