Asthma and "high dose" corticosteroids definition

StealthscrapE

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Doesn anyone have a definitive answer on what is considered daily high dose corticosteroid use? I currently use prednisone daily along with multiple burst treatments per year. I was rated at 60% and I am trying to decide if I should do the one time ratings reconsideration to the VA. I have until Monday to make my decision and turn in my paperwork.

The statement from the VA reads "a requirement for daily use of systemic (oral or parenteral) high dose corticosteroids or immunosuppressive medications". Prednisone is also classified as an immunosuppressive medication and I don't know if the big dose requirement applies to that as well. Thanks for any help.
 

inpain2424

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Go to militarydisabilitymadeeasy.com search asthma and you will see the rating categories.

Inpain2424
 

StealthscrapE

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Go to militarydisabilitymadeeasy.com search asthma and you will see the rating categories.

Inpain2424
Thanks for the link. I have read the 'VASRD for Code 6602 - Asthma' many times so I am aware of the rating criteria that the VA requires. That site does have some useful information so I will definitely keep it handy but it still doesn't help me clarify what is considered "high dose" for daily corticosteroid treatment.

http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html#obstruct
 

inpain2424

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Prednisone is high dose if taken multiple times over the course of year.

inpain2424
 

StealthscrapE

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Prednisone is high dose if taken multiple times over the course of year.

inpain2424
That's not correct. Sorry. I'm only saying this so that someone doesn't come in here and think that the question was answered, or search for the answer in the future and think that is it.

6602 Asthma, bronchial:

FEV-1 less than 40-percent predicted, or; FEV-1/FVC less than
40 percent, or; more than one attack per week with episodes of
respiratory failure, or; requires daily use of systemic (oral or
parenteral) high dose corticosteroids or immuno-suppressive
medications
............................................................................................. 100

FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55
percent, or; at least monthly visits to a physician for required
care of exacerbations, or; intermittent (at least three per year)
courses of systemic (oral or parenteral) corticosteroids
.............................. 60


The portion in bold for 100% states "daily use of high dose". This does not match up with what you said. The portion in bold for 60% mentions what you said, but makes no mention of high dose. I do appreciate the responses though. Thank you.
 

inpain2424

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From: http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html

Code 6602: Asthma is a condition where the airways and bronchi swell, causing them to close up.

This condition has slightly different rating requirements than the Respiratory Rating System. These are outlined in the table below.

It is important to note that it is difficult to get a proper test for asthma since the tests must be run while an attack is happening. An FEV-1 test done when there is not an attack will give normal results that will not properly define the condition. A methacoline challenge test is often done instead since the methacoline triggers an asthma attack. Once the methacoline is inhaled and an asthma attack begins, the spirometry tests are performed. After the tests are done, medications are given to treat the asthma attack. If spirometry is done with and without methacoline, the condition is rated on the methacoline results.

If FEV-1 and FVC tests with methacoline are not performed, then asthma can be rated based on the kind of medication that is used to treat the condition or on the severity of the condition based on the number of ER visits. In these cases, however, the physician must clearly record a thorough history of asthma attacks.

Test

Result/Condition

Rating

FEV-1

Less than 40%

100%

FEV-1

40-55%

60%

FEV-1

56-70%

30%

FEV-1

71-80%

10%

FEV-1/FVC

Less than 40%

100%

FEV-1/FVC

40-55%

60%

FEV-1/FVC

56-70%

30%

FEV-1/FVC

71-80%

10%

ER visits

2 or more attacks per week with respiratory failure thatrequires ER visits to save life

100%

ER visits

Requires monthly ER visits to save life

60%

Medication

Requires daily high doses of steroids or immunosuppressive medications taken by mouth or by injection*

100%

Medication

Requires the use of steroids or immunosuppressive medications taken by mouth or by injection 3 or more times a year*

60%

Medication

Requires occasional use of inhaled anti-inflammatory medication*

30%

Medication

Requires daily bronchodilator therapy taken by mouth or inhaled*

30%

Medication

Requires occasional bronchodilator therapy taken by mouth or inhaled*

10%

*A definition of these medications is listed below.

Swelling is the biggest problem with asthma, and so the majority of medications that treat asthma are for controlling swelling.

Swelling is often a reaction of the immune system to things it doesn’t like. Immunosuppressive medications suppress this response, allowing the airways to remain open in an asthma attack. Similarly,steroids taken by mouth or injection are able to greatly reduce swelling. Both of these treatments are only used for the most severe cases of asthma and only when all the other medications listed below do not satisfactorily treat the condition. Some of the most common medications in these categories are Prednisone, Prednisolone, Decadron, Deltasone, Dexamethasone, Medrol, Orasone, Pediapred, and Prelone.

Inhaled anti-inflammatory medications are steroids, but a smaller dose than oral or injected steroids. These reduce swelling and mucus production. They are used to prevent asthma attacks. Some of the most common medications in this category are Aerobid (Flunisolide), Flovent HFA (Flutocasone HFA), Azmacort (triamcinolone), Ipratropium Bromide (Atrovent), Asmanex, Pulmicort, and Qvar. The following are a combination of an anti-inflammatory medication and a bronchodilator (discussed next), but they are rated as anti-inflammatory medication: Advair (Fluticasone and Salmeterol), Duleva, and Symbicort.

Bronchodilators are used by pretty much anyone with asthma. These keep the bronchi from swelling and blocking the airway. They are all inhaled, and there are short-acting and long-acting bronchodilators. Short-acting ones are the rescue inhalers that work very quickly and last between 1 hour and 4 hours. Common short-acting bronchodilators include Proventil, Albuterol, Ventolin, Salbutamol, AccuNeb, Levosalbutamol, Levalbuteral, Xopenex, Terbutaline, Bricanyl, Pirbuteral, Maxair, Procaterol, Metaproterenol, Alupent, Fenoterol, Bitolterol mesylate, and Ritodrine.

Long-acting bronchodilators are used to control asthma and prevent attacks. Common long-acting bronchodilators include Sereveut, Salmeterol, Formoterol, Foradil, Symbicort, Bambuterol, Clenbuterol, and Indacaterol


inpain2424
 

StealthscrapE

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PEB Forum Veteran
Requires daily high doses of steroids or immunosuppressive medications taken by mouth or by injection*

100%
Again, I have read all of that from the link you provided earlier but it still does not clarify what is considered high dose for daily corticosteroid use.

I am asking because I am on treatment that requires daily use of corticosteroids (which are also classified as immunosuppressive medications) but I don't know if it falls under the qualification of high dose. I'm hoping someone else has been down this path and might have an idea of what falls under this category.
 

SSgtBravo

New Member
Registered Member
I have been reading that exact same line over and over again for months.
It seems to be an extremely subjective way to write a manual that's supposed to be read very objectively... Frustrating.

I will definitely continue to watch this thread. Thanks for asking the question!
 

poohbear331

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Is the steroid oral or inhaled form?
I know they use high does oral for organ rejection (IV first- multiple times a day) then taper with oral- starting at multiple pills and ween off (example- 600mg to start 3 x day for 3 days, then 500mg for x days) that is the immuno part of it.

I know someone else will have a better answer-


From what I remember- for asthma 40-60mg total per day is considered high dose. that is the oral dose. I don't know what the inhaled form is.
 

StealthscrapE

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PEB Forum Veteran
Is the steroid oral or inhaled form?
I know they use high does oral for organ rejection (IV first- multiple times a day) then taper with oral- starting at multiple pills and ween off (example- 600mg to start 3 x day for 3 days, then 500mg for x days) that is the immuno part of it.

I know someone else will have a better answer-


From what I remember- for asthma 40-60mg total per day is considered high dose. that is the oral dose. I don't know what the inhaled form is.
I used inhaled (symbicort) daily, as well as oral (prednisone) daily. I've had the burst treatments and the shots every time I have an ER visit. The best answer I've received is that having to take it everyday should classify, but that was just an opinion. Would make sense seeing the side effects of daily prednisone. But I'm only at 20mg so I don't know.
 

chaplaincharlie

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Case law

"The rating criterion does not define a "high dose" of
corticosteroids. The supplemental information discusses
"high dose" in terms of a therapeutic dose without
identifying in units per day or otherwise what that dose may
be. See 61 Fed. Reg. 46,720, 23 (Sep. 5. 1996). Absent such
guidance, the Board will infer from the fact of the
administration of the steroid therapy that it was prescribed
at a therapeutic level. Thus, looking from the present back
to the effective date of the new rating criteria, the clear
long-term use of corticosteroid therapy is sufficient to
establish that the veteran's disability is 100 percent
disabling under the criteria effective from October 7, 1996.
38 C.F.R. § 4.97, Diagnostic Code 6602 (2002)."

http://www.va.gov/vetapp03/files/0309777.txt
 

scoutCC

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PEB Forum Veteran
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I like the chaplain's answer best. I think its fair to say any daily use of steroids represents something pretty severe.

My wife started on 10 mg for lupus while they tried out alternative meds because long term steroids aren't fun. Its an effective drug, but long term use is almost guaranteed to have some nasty stuff.
 

asthmahelp

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Registered Member
I'm here looking for some advice, I was diagnosed with moderate asthma in 2011 since then, my condition has worsened and in response, the doctors have upped my medication multiple times. Currently I am taking singulair, advair, and albuterol daily. Recently I PCS'd to a new unit and the doctor here referred me to an airway specialist who also determined I have a vocal chord disfunction that is also blocking off my airways, but I am kinda being shrugged off when I bring up the topic of being med boarded. Since my diagnosis, I've been fighting a med board, doctors at Bragg thought I should be out, but I wanted to stay in and see if I could keep up with it, but it's gotten to the point where ive accepted that it is beyond my ability to keep up with my conditions. How should I go about getting the MEB process started?
 

scoutCC

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How should I go about getting the MEB process started?
Rare is the conversation that contains the word MEB that goes well.

At Bragg you were talking about make this better, make this less obvious, make the problem go away. Now change the conversation to limitations, documentation and permanence. Talk about the profile. Talk to them about things you aren't able to do that are interfering with work, and that you need a profile to cover you so that you aren't making things worse by attempting to do them. Then talk about what treatments will make each limitations better. Once they see what you permanently can't do anymore, that should naturally drive the permanent profile that starts the MEB, or failing that, a set of limitations that make work, well, workable.
 

Thomas91

New Member
Registered Member
Hello,
Today I received my ratings. The army is only giving me 10% for Asthma and VCD . I thought I was gonna receive at least 30% since I take Advair 500/50 twice daily plus a daily pump. Does that sound about right? Should I appeal it ?
 

PsychOfficer

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The Advair should get a rating of 30%. You should at least ask for a reconsideration. Have the attorney write it up point by point to make it easy for them.

best of luck.
 

ezra24

New Member
Registered Member
I am not sure if I read this correctly but based on what is posted, am I currently on "high dose" ?

Advair HFA Eq. Aerosol Powder 230-21 mcg Inhalation 2 puffs twice per day
(Qvar Eq.) Aerosol Powder 80 mcg Inhalation 2 puffs twice per day
(Spiriva CP-Handihaler Eq.) Aerosol Powder 18 mcg Inhalation Once per day
ALBUTEROL SULFATE, 90 MCG, HFA AER AD, INHALATION as needed
Omalizumab, 150mg, Vial, Subcutane. -Xolair shots 3 shots every 2 weeks.


My MEB is for PTSD though.. so I am not sure how this will come into play... but I never had asthma. I never had symptoms up until mid - deployment. I was stationed in LSA Anaconda no more than 100 feet from the burn pit which we had contact with for several hours on a daily basis for almost 16 months.
 

Veterano

New Member
Registered Member
Read the following decision of board on DOCKET NO. 06-33 142.

Among other things the Judge concluded the following:

As noted above, a 100 percent rating is warranted for daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. Regardless of the dosage amount, the Board finds that the daily use of such medication more nearly approximates the criteria for a 100 percent rating as opposed to a 60 percent rating and is therefore is sufficient to warrant the assignment of a 100 percent rating. A 60 percent rating is for application with intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. In this case, the evidence shows that the Veteran takes more than intermittent courses of systemic corticosteroids; rather, she takes such medication daily. Therefore, the Board finds that the Veteran's current disability level is more severe than that contemplated for by a 60 percent rating.
 

DSAMP

New Member
Registered Member
Read the following decision of board on DOCKET NO. 06-33 142.

Among other things the Judge concluded the following:

As noted above, a 100 percent rating is warranted for daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications. Regardless of the dosage amount, the Board finds that the daily use of such medication more nearly approximates the criteria for a 100 percent rating as opposed to a 60 percent rating and is therefore is sufficient to warrant the assignment of a 100 percent rating. A 60 percent rating is for application with intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. In this case, the evidence shows that the Veteran takes more than intermittent courses of systemic corticosteroids; rather, she takes such medication daily. Therefore, the Board finds that the Veteran's current disability level is more severe than that contemplated for by a 60 percent rating.
Thanks for this i am currently taking mometosone steroid inhaler 220 once daily and i applied for an increase. Hopefully this falls in that category. Along with an albuterol inhaler. Currently waiting on my response
 
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