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recently diagnosed with AS active duty Air Force
#172210 04/16/10 04:16 PM
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beka Offline OP
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My husband was recently diagnosed with AS. he is active duty in the Air Force. the doctors put him on humira and are waiting 4 weeks to see the results and then its to a med board. Is there any chance that he will be able to stay in the Air Force with this disease or does it mean an automatic medical discharge? any advice would be greatly appreciated thanks
beka

Re: recently diagnosed with AS active duty Air Force
beka #172253 04/16/10 08:43 PM
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I am active duty air force as well. I just recently got diagnosed with AS as well. From what the doctor told me, they don't even have to do a med board unless you are missing a lot of work because of AS related problems. Don't know for sure but a lot may depend on the doctor and his interpretation of the regs.
I work in a flying related career field and will have to get a waiver to do the same work but the doctor said we wouldn't have to worry about a med board. Don't know if that will change in the future but you might look into it and have your husband talk to the doctors. Here is the actual verbage,
"MEB required first if individual experiences occupational
limitations or absences from duty because of recurrence
of symptoms".
I would think that this applies to everyone air force wide, but there does seem to be a lot of room for interpretation.
I'm curious what they do though because my rheumatologist wants to put my on Simponi which is similar to humira I think. I think that while on the medicine you can't deploy so that my be a factor. Please le me know what happens because I'm still unsure about my situation.

Re: recently diagnosed with AS active duty Air Force
r01bns #172392 04/18/10 04:48 AM
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beka Offline OP
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my husband deploys as well. I will let you know how it goes he has not ever missed work because of it but cannot run in the pt test because ofthe pain thats why he went to the doctors. I will keep you informed as to what happens he is leaving for two weeks for training and then we have 4 weeks to wait and see if the meds help before going back to the doctor. let me know how things go with you as well

Re: recently diagnosed with AS active duty Air Force
beka #176064 06/01/10 08:03 PM
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Beka, I was just curious what they ended up doing with you husband? I'm still in limbo while they try to treat the AS. They doctor wants to start Simponi this month to see if it helps and I'm just curious how other people are doing as far as air force medical boards are going. Thanks for any info.

Re: recently diagnosed with AS active duty Air Force
r01bns #180966 07/31/10 03:07 PM
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My husband was diagnosed with AS in November. He took prednisone for a while, and is now off of it, and only taking sulfasalazine. The AS is affecting his ankles mostly, but started in the back, moved to knees and ankles. He hasn't had any problems with his back or knees, and the ankles are only tender when he does a lot of activity. Nothing to keep him from exercising or getting around. The informal board recommended discharge with 20%. He is appealing it. He has been in the Air Force for 10 years, is a TSgt, he was in the process of applying to OTS. We need some serious advice about what to do for the appeal. He wants to return to duty, but if they absolutely will not do that, he wants at least 30% for a medical retirement. His aunt, mom, and uncle all have the condition. His aunt has had 3 flare ups in her life, 15 years apart from each other. His mom and uncle have only had one flare up and that was the initial one.
His rheumotologist is writing a letter on his behalf for the appeal, saying he is fully capable of the physical requirements for his job. He is EGRESS, working on the seats. What else do we need?? They know about the family history, but I did read somewhere that anthrax vacc. could be an onset to the condition? How do they know if it would have flared up if he hadn't had the vaccine? He's not on Humera or any of that, just the sulfasalazine.

Please help. Formal board is next.. and that could be anytime this month.

Re: recently diagnosed with AS active duty Air Force
AZteach #181024 08/01/10 01:09 PM
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Perform agility testing to document his ability to perform his work and get it signed by a supervisor?


Diagnosed 2001 after years of joint pain. Remicade started 2002 - 5mg/kg every 7 weeks.
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Re: recently diagnosed with AS active duty Air Force
WhiteCell #181106 08/02/10 08:48 PM
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He is on profile, so he isn't supposed to be doing anything. But they won't lift the profile until the med board stuff is settled.

Re: recently diagnosed with AS active duty Air Force
AZteach #181755 08/10/10 01:48 PM
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I was recently diagnosed while on active duty, too. I'm 30, and my disease for someone my age, has advanced significantly.

I was told that I am being medical boarded, more for the medication, rather than the condition itself. Being on an immuno-suppressant, disqualifies one from being "world-wide-qualified", because if one were to fall ill in a deployed location, there might not be the tools/medication necessary to treat a person taking something like Humira or Enbrel. Also, the profile that I have been place on (because it has been proven that activities (e.g., running, stomach crunches, etc.), exacerbate the disease. Plus, with the new PT test, if you can't test, you're out. I was told by my doctor that the only physical activity I should take part in is brisk walking and swimming.

I am getting a second opinion in 2 weeks; something the AF was very reluctant to provide. I have heard through the grapevine, from people that have been in the AF longer than myself, that I need to make my way to Wilford Hall, because that is where the "real" AF doctors are. But I have no idea how to get referred there.

The Medical Group at my current base is giving me the run around about everything, I think they're attempting to make me sick of fighting the machine, and they're doing a good job. I am almost to the point where I just want to give up on getting answers from the air force, but I know that would be biggest mistake of my life.

I have only been on active duty for 3 years, if someone can please help point me in a direction(s) that I need to take this battle, please, let me know.

On a side note... Does anyone else with AS suffer from chronic fatigue? My body feels like it weighs a thousand pounds, nearly all of the time.

Re: recently diagnosed with AS active duty Air Force
AZteach #181756 08/10/10 01:54 PM
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When I wake in the morning, my ankles, too, feel like they are going to snap in half when they hit the floor. It's a horrible sensation.

I was on Humira for about one month, but I developed a horrible reaction to it (obviously no longer taking). I will tell you this, though, before I had whatever reaction I had, I had not felt that good since I was 18.

Sulfasalazine is an antiquated medication; it was developed in the 1950s.

I have heard that Methotrexate (spelling) works very well, but it is oral chemotherapy, and the side effects can be very harsh.

I think we're all in the same boat. This disease really sucks.

Re: recently diagnosed with AS active duty Air Force
RobertD #182230 08/16/10 06:00 PM
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beka Offline OP
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My husband is currently being reffered to the PEB because he is on the Humira and isn't world wide qualified because of it. we are just waiting to see what there decision is. they said we should know something in about 4 months. then if the rating isn't high enough appeal I guess.

Re: recently diagnosed with AS active duty Air Force
beka #182361 08/17/10 08:22 PM
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Beka and others. If you haven't I would look at the website pebforum.com. It explains the MEB/PEB process really well. The biggest thing I've seen from being on there is making sure everything gets documented. You also have to right to counsel, whether civilian or military (especially, useful if you appeal to the formal PEB). I'm in the same boat but they haven't started the MEB even yet. That website has given me a lot of info about the process though.

Re: recently diagnosed with AS active duty Air Force
r01bns #185632 09/24/10 02:20 PM
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Hello everyone, I am Beka's husband. We recieved the documentation from the informal board two days ago. It came back as accured while recieving basic pay, and in the line of duty. The disability rating the VA gave me is 10% under code 5240. At 10% I am going to push for a formal board with my case being miss codeing. My wife and I have been doing research and I found a letter from this forum site (Spondylitis Association of America)that was posted by user name mmparker. It is quite long, but incase nobody else has seen it, I want to get it out there. I hope this helps everyone.

Department of Veterans Affairs
VA Regional Office
210 Franklin Rd., SW
Roanoke, VA 24011


April 25th, 2006


Dear LTC Parker,

This is in response to your letter to Secretary of Veterans Affairs, R. James Nicholson concerning disability ratings. Your letter was referred to the Department of Veterans Affairs Roanoke Regional Office because this office has jurisdiction of your address.

Beginning in 2003, the VA evaluates limitation of motion of the spine due to ankylosing spondylitis under diagnostic code 5240 in the Schedule for Rating Disabilities. However, where there is additional impairment of health due to the active disease process, VA will rate this condition under the diagnostic code that is most advantageous to the veteran. VA will also take into account limitation of a veteran's joint function caused by pain (including pain on repeated use), fatigue, weakness, and lack of endurance or coordination. X-ray evidence is not required for us to apply the Deluca criteria.

Questions about how the Department of Defense interprets VA's Schedule of Rating Disabilities would have to be addressed to the Department of Defense.


For Further Information of Assistance

If you have any more questions or concerns, please feel free to contact the VA Regional Office located at the address shown above, telephone toll-free 1-800-827-1000, or contact us via https://iris.va.gov. A representative will be happy to assist you.


JOHN W. SMITH

Director.

________________________________________________________________________

The Honorable R. James Nicholson
Secretary of the Department of Veterans’Affairs
810 Vermont Street, NW
Washington, DC 20420


Dear Secretary Nicholson,

For the past few months, I have been trying to get specific answers to specific questions from your department without success. The questions deal with how to properly rate the inflammatory arthritic condition, Ankylosing Spondylitis, per the Veterans’Administrations Schedule for Rating Disabilities (VASRD). These questions are relevant to both VA and military disability ratings. My specific questions are:

Is Ankylosing Spondylitis still evaluated under criteria for diagnostic code 5002 and applicable residual codes like all the other forms of inflammatory, autoimmune arthritis (e.g. reactive arthritis, psoriatic arthritis, seropositive rheumatoid arthritis)?

Given the Deluca criteria for limitation of motion (LOM) ratings, is it appropriate to deny a LOM rating because it is not based on X-Ray evidence of “mechanical limitation”? Does the VASRD currently allow LOM ratings when the motion is limited by pain or other causes?

Prior to 2003, there was universal agreement that Ankylosing Spondylitis should be rated under VASRD code 5002 for the active disease process and well as applicable codes for any chronic residuals. Per the VASRD, the ratings for the active disease process and the chronic residuals are not to be combined; rather the higher rating is applied. In 2003, the VA enacted revised VASRD criteria for evaluating residual effects due to diseases and injures of the spine. The new criterion includes rating code 5240, Ankylosing Spondylitis. The Department of Defense has interpreted this change to mean that the VASRD no longer requires them to rate Ankylosing Spondylitis under the active disease process (5002) criteria as well. The effect of this interpretation has had a devastating affect on service members found unfit for further military service due to this condition. Many service members with this disease have been denied medical retirement or have had existing medical retirements terminated because this interpretation of the VASRD lowers their DoD assigned disability ratings.

While it makes no sense that Anklylosing Spondylitis would be singled out by the VA as the only inflammatory arthritic condition no longer rated under the criteria for active disease process, the military has held steadfast to their “new” interpretation of the VASRD. My research from VA sources has reinforced, rather than eliminated, the requirement to continue rating Ankylosing Spondylitis under the 5002 criteria. A summary of this research is enclosed for your review.

I respectfully request that your department clear up this issue as soon as possible to ensure our current service members and veterans with this condition are properly adjudicated for disability benefits from both the Veterans’ Administration and the Department of Defense. Please feel free to have your staff contact me if further information or background material is required.


Enclosure as stated

Sincerely,




Michael A. Parker
Lieutenant Colonel
United States Army


cc:
Senator Larry E, Craig, Chairman, United States Senate Committee on Veterans’Affairs.

Senator Lindsey O. Graham, Chairman, Personnel Subcommittee, United States Senate Committee on Armed Services.


Enclosure

Research Findings on VASRD Ratings of Ankylosing Spondylitis

a. There are numerous VA Board and Court of Appeal rulings citing "Ankylosing Spondylitis is a form of Rheumatoid Arthritis" and many rulings rebuke raters that failed to use 5002 criteria for active Ankylosing Spondylitis. http://www.index.va.gov/search/va/bva.html, http://webisys.vetapp.gov/isysmenu.html.

b. The VASRD states 5240 criteria is for residuals: "For rating codes 5235-5243...With or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease." The VA's Federal Register publication explaining the new disease/injury of the spine criteria: "The rating formula would be used when any of these conditions results in symptoms such as pain (with or without radiation) stiffness or aching of the spine due to residuals of injury or disease." (Federal Register, Sep 4th, 2002,Volume 68, number 28, pages 6997-7035)

c. While the VA was updating the spinal residual criteria described in paragraph b, they also released proposed criteria in the Federal Register for rating Ankylosing Spondylitis. "We propose to retitle diagnostic code 5009 as "other types of noninfectious arthritis (including ankylosing spondylitis, Reiter’s syndrome, psoriatic arthritis, arthritis associated with inflammatory bowel disease, and other seronegative types of arthritis)”” and, “We propose to continue evaluating other types of noninfectious arthritis under the same criteria and range of evaluation as rheumatoid arthritis....”. (Federal Register Feb 11th, 2003, Volume 68, Number 28, pages 6997-7035).

d. The VA Adjudication Procedures Manual (M-21) calls Ankylosing Spondylitis, Rheumatoid Arthritis of the Spine: “Rheumatoid Arthritis of the spine, also diagnosed as rheumatoid spondylitis, ankylosing spondylitis, or Marie-Stumprell disease..."
The manual goes on to list disability factors of the active disease process to be considered in the rating process. The manual also specifically addresses residuals: “Two diagnostic codes may be used to identify the source of a disability or a residual condition. For example, ankylosing of the spine from rheumatoid arthritis would be rated as 5002-5240.” (Note: The 5002 criteria was written in 1963 a decade before the ankylosing spondylitis became the favored term for the disease.) The VA did an extensive update to it's M-21 manual and released these changes under a manual called M-21MR in December 2005. This manual continues to list Ankylosing Spondylitis under the chapter for rheumatoid arthritis calling it rheumatoid arthritis of the spine, AKA rhuematoid ankylosis, ankylosing spondylits, and Marie-Stumprell disease.

e. The VASRD, paragraph 4.27 now includes the following passage, using ankylosing spondylitis rating codes in the example:

"In the selection of code numbers, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With diseases, preference is to be given to the number assigned to the disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. Thus, rheumatoid (atrophic) arthritis rated as ankylosis of the lumbar spine should be coded “5002–5240.” In this way, the exact source of each rating can be easily identified."

The VA's rationale for the change above was published in the Federal Register in December 2005. The rational stated that this was not a rule change but rather a housekeeping change since the paragraph previously stated, "ankylosis of the lumbar spine should be coded “5002–5287." 5287 was the previous residual code for ankylosis of the spine. (Federal Register: December 20, 2005, Volume 70, Number 243 - Rules and Regulations, Page 75398-75399)

f. A 2005 Board of Veteran Appeals case involving Ankylosing Spondylitis demonstrates that 5002 criteria is still applicable for AS even after the 2003 changes:

"Conclusion of LAW:

The criteria for a rating in excess of 40 percent for ankylosing spondylitis (formerly characterized as spondylolysis with spondylolisthesis of L5, S1) have not been met. 38 U.S.C.A. § 1155 (West 2002);

38 C.F.R. § 4.71a, Diagnostic Codes 5002, 5292, 5293, 5295 (as in effect prior to September 23, 2002);

38 C.F.R. § 4.71a, Diagnostic Code 5293 (as in effect from September 23, 2002 through September 25, 2003);

38 C.F.R. § 4.71a, Diagnostic Codes 5002, 5240, and 5243 (effective from September 26, 2003). "

Citation Nr: 0518317 Decision Date: 07/05/05 Archive Date: 07/14/05

I know that this is a long read, but I feel the information in it is important. Thank you all for your support.

Re: recently diagnosed with AS active duty Air Force
KainCIII #185883 09/26/10 08:03 PM
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please send me a PM. I have VA and Army documentation on the proper rating process for AS which includes the active process under DC 5002.

A diagnoses and an exacerbation leads toa 20% under 5002 so no way it should be rated less than that. A 10% by the AF indicates they missed the boat.

Mike

Re: recently diagnosed with AS active duty Air Force
mmparker #185958 09/27/10 05:51 PM
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After all this time there are still folks not paying attention to VA ratings. Of course some of it is the VA raters themselves. Stay strong and get in touch with Mike. He has been a huge help for me.

Also Mike, the VA just finished finalizing the formal board I had back in 2007 I think it was. So now that the paper work reflects the rating I guess I should go after having my retirement reactivated.....depression, rage & headaches ahead I'm sure.

Also could you add links and suggest the best way to go about this.

Re: recently diagnosed with AS active duty Air Force
RobertD #185959 09/27/10 05:54 PM
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Also Robert D,

I think fatigue is an additional bonus to everything else. Also it's pretty funny that most of the meds for pain and swelling have warning lables stating they can make you tired.......o yeah!! Can we say Mtn. Dew and Coffee.

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