Asthma and "high dose" corticosteroids definition

brianmatt31

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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.
Not sure but I think from reading your post StealthscrapE. For me I have Reactive airway disease/asthma due to allergens and particulate matter (according to the burn pit env Doctors). So my asthma/allergist/sinus doctor has me on 2 corticosteroid inhalers daily. Now I looked up the difference on these compared to what is listed in the VASRD to see how this is rated. When I seen that it said "HIGH DOSE" it made me curious. So I did an internet search on those two medications and it shows for one of them (Arunity Ellipta) that there are a few different doses of that one. I am taking the max dose at 200mcg. For the Flovent Disckus inhaler I take 250mcg of that one twice a day. For this Flovent one there are three different doses and I am taking the max dose for it also. With that being said on my DBQ for this I ensured that my Allergist/Asthma doctor listed that verbiage from the VASRD that I am on the max dose/highest dose of these two corticosteroids due to my condition.
So with that being said not sure if that was your meaning but I also never could find the meaning of high dose so to me seeing that there are different doses of the same medicines I'm on and I am taking the highest level of that I ensured that means I am taking the max dose or high does when it comes to the VA looking/rating this stuff. To all of us on here if it sounds like a duck it's probably a duck but it's sad that we have to be really specific when we talk to the VA. Hope this helps.
 

KSBear

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Section III part 2b will define how your medication is viewed as I understand it.

2B. DOES THE VETERAN'S RESPIRATORY CONDITION REQUIRE THE USE OF ORAL OR PARENTERAL CORTICOSTEROID MEDICATIONS?  YES  NO (If “Yes,” complete the following): 
Requires chronic low dose (maintenance) corticosteroids 
Requires intermittent courses or bursts of systemic (oral or parenteral) corticosteroids (If checked, indicate number of courses or bursts in past 12 months):  0  1  2  3  4 or more 

(mine was marked as this one) Requires systemic (oral or parenteral) high dose (therapeutic) corticosteroids for control

Requires daily use of systemic (oral or parenteral) high dose corticosteroids 

Requires daily use of systemic (oral or parenteral) immuno-suppressive medications 
Other, describe:


I am Post MEB awaiting IPEB and ratings for asthma caused by exposure during an IED blast with 7 years of documented treatment and how it got worse along with 57 other claimed and evaluated conditions.
 

KSBear

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My fault I marked the wrong one I am marked as Requires daily use of systemic (oral or parenteral) high dose corticosteroids.
 

brianmatt31

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Section III part 2b will define how your medication is viewed as I understand it.
.
KSBear, when you get your VA Ratings can you let me know the % they gave for Asthma. I'm still fighting to get mine rated properly. I've looked around on here and just haven't seen others ratings so I'm unsure on if the VA Ratings will actually rate for it and it should. On my VA Ratings I got back in July it showed they rated my rescue inhaler as 10% BUT those tricky VA guru's instantly put my objective sleep apnea and asthma together for only one rating when I gave the doc all the proof they needed to show mine is actually separate.
 

KSBear

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No problem, I haven't seen the ratings for anyone's asthma either except when people say they got less than expected. Though searching this entire forum I think I am the first to actually post what the DBQ was marked as for medications. On my PFT my FEV1/FVC is 57% with taking the daily high dose corticosteroids to get it that high. There is also a box the Dr checks on the DBQ that asks which PFT number accurately reflects the condition. If my DBQ is followed IAW the VSARD rating requirements I should be 100%, However I am mentally prepared to get 30% which is the lowest unarguable amount IAW the VSARD.

Second to that, my NARSUM states:
5. Medical Retention Determination Point (MRDP) Statement:
The Soldier, due to asthma, will not be capable of returning to duty within one year.

and
e. Prognosis statement: SFC XXX had persistent symptoms despite treatment. His condition will not likely improve to the point where it will meet retention standards. It is not likely he will be able to return to full duty over the next five years.

It seems to me the information is there its just spread out throughout the different documents, once I found all the pieces I compare it to the VSARD and the disabilitymadeeasy site.
 

KSBear

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After scanning this thread again I have one thing to offer the group. Daily inhaler use is not always steroids. There are anti-inflammatory medications, bronchodilators, long acting bronchodilators, immunosuppressive, and corticosteroids. Some low dose corticosteroids are classified as immunosuppressive or anti-inflammatories. There are not as many “high dose” corticosteroid inhalers as one may believe. You need to research what you take and how the medical community classifies it. Not just if it has a corticosteroid in the mixture. I believe that this may clear up a misunderstanding of what your medication rates you for percentage. However, if you are on a daily inhaler you are, almost, always, most likely, at least 30%. This may clear up some misunderstanding. Again check your DBQ to see how your evaluation physician marked your medication use and does that match what the inhaler is classified as in the medical community as well.
 

brianmatt31

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After scanning this thread again I have one thing to offer the group.
Hi. thanks for your insight. You are also correct in your comment on 30% for a "daily" inhaler. It's "daily" that is the key to that like in the VASRD. My ratings had that listed but they was incorrect as they noted my inhaler at that time was when needed but not daily. when needed equaled 10% and that is what my VA ratings had but it also stated that if it required "daily" use then they would bump it up to 30%. I would also like to TRUST lol, that for any one that has to take the cortico steroid inhaler daily that they would get 100% like the VASRD or at least 60%. For me, my FEV1/FVC was 70% but the VA ratings was based on medications as they noted in their way they rate.
So with me at 17 years active I'm hoping my VARR gets mine straightened out as I am actually on two different cortico steroids (max/highest dose) daily. We'll see and I'll post back on here for everyone to see. KSB not sure your status and if you are close to 20 or not, but I am just past the PEB stage doing an VARR reconsideration and then will do a PEB Appeal so I have submitted my COAD packet to try and get three more years so I could get my retirement then also get VA concurrent. So I have a sample COAD that I put on the site today. If you search COAD and look for the brianmatt31's you'll find it if you need it. If not just let me know and I'll send you them.
Good luck and thanks again for your thoughts. God speed!
 

arp166

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All I was on on 4 inhalers and 30 mg of prednisone (oral steroid) and the board still only game me 60% after an appeal.
 

brianmatt31

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All I was on on 4 inhalers and 30 mg of prednisone (oral steroid) and the board still only game me 60% after an appeal.
arp166 was any of your Asthma unfitting or the 60% only on the VA side and not the DoD side?

In the way my legal says things to me it feels like he is blowing off even trying to add or make the case to get asthma added to my PEB and even get my asthma updated with a VARR.
 

arp166

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Sorry for the delayed response... my asthma was considered unfitting but only because they combined it with the diagnoses of constrictive bronchiolitus. The 60% was both VA and DoD.
 

KSBear

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KSBear, when you get your VA Ratings can you let me know the % they gave for Asthma. I'm still fighting to get mine rated properly. I've looked around on here and just haven't seen others ratings so I'm unsure on if the VA Ratings will actually rate for it and it should. On my VA Ratings I got back in July it showed they rated my rescue inhaler as 10% BUT those tricky VA guru's instantly put my objective sleep apnea and asthma together for only one rating when I gave the doc all the proof they needed to show mine is actually separate.
I just heard from MSC 50%DOD 100%VA, Asthma is my only disqualifying condition for DOD. 57 claimed conditions for VA. So my Asthma PFT and meds got me 50%. Waiting on VA notification letter with the breakdown and for 199 now.
 

KSBear

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Signed my 199 on the 7th. 30% for my asthma, you can see post 22 and 23 for my evaluation. The VA gave me 50% by combining my CPAP and asthma but PEB separated them.
 

citiboiboi13B

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Is anyone here who is/has been through a MEB for asthma; was prescribed xolair (injections), Advair (500/50) and spariva? My current PCM is currently telling me, I most certainly will be MED boarded due to the fact that I have to take injections monthly. Just trying to see if anyone has dealt with the injections for asthma. Thanks in advance.
 

AmyMo

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Is anyone here who is/has been through a MEB for asthma; was prescribed xolair (injections), Advair (500/50) and spariva? My current PCM is currently telling me, I most certainly will be MED boarded due to the fact that I have to take injections monthly. Just trying to see if anyone has dealt with the injections for asthma. Thanks in advance.
Citiboi did your MEB ever get finalized? I’m currently anxiously awaiting my board results.
 

AmyMo

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I’m pending MEB results now. Would you mind sharing what your DOD/VA rating was? I was previously on NUCALA and XOLAIR and neither worked for me. Now I’m on Facenra. I’m trying to get an idea of my rating.
 

citiboiboi13B

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80% DoD 100% VA. Keep in mind most people receive 60% for the asthma as I did, but I had additional issues that I was referred for.
 

AmyMo

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Good to know. I also have additional issues as well. Thank you for sharing.
 
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