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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey guys, it's Leah B from Prestige Veteran Medical Consulting. I am a US Army veteran, physician assistant, and former compensation and pension examiner. So welcome back to the Prestige podcast. I wanted to welcome everybody for a chat on COPD and VA disability. So here we try to simplify the complex world of VA disability from a medical expert standpoint and give you some pearls on some things to look at.
Leah Bucholz:So today's topic again hits on the lungs. So we're gonna talk about COPD or chronic obstructive pulmonary disease. So if you're a veteran who has struggled with breathing issues, chronic cough, fatigue, especially after exposure to things like burn pits, dust, chemical fumes, then this episode is definitely for you. So let's start off by talking about the basics. So what is COPD?
Leah Bucholz:Right? So chronic obstructive pulmonary disease or COPD is an umbrella term that includes conditions like emphysema, chronic bronchitis, or a combination, in some cases, combination of both, sometimes even refractory asthma. It causes long term airflow limitation that makes it difficult to breathe. Symptoms usually include things like shortness of breath, cough, chronic cough, right? So there's bronchitis and acute bronchitis is sort of like the common cold, right?
Leah Bucholz:But we're talking about chronic bronchitis or COPD, wheezing, excessive mucus production in many cases, fatigue, chest tightness. COPD is not reversible, but it can be managed. However, for many veterans, the condition progresses over time, especially when left untreated or misdiagnosed early on. So let's talk about some medical literature. I always like to talk about medical literature that you guys can bring to your treating providers to see if they can support you in your pursuit of VA disability.
Leah Bucholz:So let's dig into some of that because it's just not a coincidence in veterans. So let me pull up this literature. So a 2020 study published in the Journal of Occupational and Environmental Medicine found that veterans exposed to burn pits, diesel exhaust and desert dust had significantly higher rates of COPD compared to non exposed populations. The VA airborne hazards and open burn pit registry continues to show a clear link between service in Iraq, Afghanistan, and Southwest Asia, and the development of chronic respiratory conditions, including COPD. Another major study in CHEST Journal, show that even veterans without a smoking history developed COPD at higher rates if they were exposed to environmental toxins during service.
Leah Bucholz:And let's not forget older veterans. So research shows that Vietnam era veterans exposed to Agent Orange are also at risk not only for cancer, but for other types of diseases, right? So if you're thinking, well, I never smoked, so why do I have this? You're not alone. Because smoking is like one of the number one risk factors, but you don't have to just be a smoker.
Leah Bucholz:So military environmental exposures are well documented contributor to COPD. So how do veterans get service connected for COPD? So to get COPD service connected, you have to establish that your condition is linked to your military service. And that can be done in a few different ways, right? So there's direct service connection or primary service connection.
Leah Bucholz:So if you were diagnosed while on active duty, that can be pretty straightforward, right? So secondary and and it's still going on, right? So secondary service connection, if COPD is caused or worsened by another service connected condition, you might be able to get service connected for the condition. So presumptively, again, if you had some toxic exposures like burn pits that might make it sort of easy. So starting in 2021, the VA began recognizing particulate matter exposure in Southwest Asia and Afghanistan as presumptively linked to respiratory conditions, including COPD and asthma, which can evolve into COPD.
Leah Bucholz:So again, I'm sorry, chronic bronchitis and asthma. So COPD itself, again, it will always maintain that COPD is gonna be strongly related to smoking, but I've seen veterans, not all the time, but if your mental health condition forces you to do these unhealthy mechanisms like smoking or drinking, sometimes disorders related to those things can also be service connected. So again, not always, if you're just choosing to smoke because you want to, that's different. But if it's a stress mechanism that you're smoking and that's helping with your PTSD, there might be something there, right? And I have another full video on smoking and mental health and alcohol and mental health related disorders as sort of an intermediate link that you might wanna look at.
Leah Bucholz:So the VA uses 38 code of federal regulation 4.97 diagnostic code 6,604 to rate this base. And they look at things like pulmonary function testing, FEV1, FVC. So here's a quick breakdown of those ratings. So at ten percent, a person might have mild airflow limitations. At thirty percent, the person has moderate impairment and there's some FEV1 ratings that go into that as well.
Leah Bucholz:Sixty percent moderately severe impairment. And at a hundred percent, it's severe impairment with the FEV1 less than 40% or the need for oxygen therapy. These ratings are based on how well your lungs are functioning, not just your symptoms. So if your test results aren't done properly or aren't submitted properly or whatever, if the VA can't see them, it might impact things, right? So medical evidence.
Leah Bucholz:So of course you should probably have a diagnosis if you wanna get service connected for COPD or if you're appealing a denial or whatever with your accredited representative. So again, that current diagnosis from a pulmonologist or whatever doctor is treating you, You've probably had pulmonary function testing, which are results that are gonna show that FEV one and some other values that go into the rating. Documentation, if you have any documentation of environmental exposures, like the burn pit stuff or any other toxic chemicals, Those TERA exams show stuff often. A nexus letter is not required but can sometimes be helpful. But you can also get a nexus letter as simple as just a few sentences from your treating provider if they're willing to provide it to explain a cause effect relationship between your service and COPD.
Leah Bucholz:This can be especially helpful if you weren't diagnosed in service or if it wasn't till many years after service. So remember also that just because you were a smoker doesn't mean that you can't be service connected. Sometimes these things you know, work in tandem and make things worse. Right? Those chemical contaminants.
Leah Bucholz:So, things that can kinda make things troublesome if you don't include or don't have PFP results, that can be kinda tough. They may order those for you. Overlooking secondary conditions like sleep apnea, heart disease, if those are related to your COPD. You know, making sure that you discuss the impact on your daily life and work. If you've gotta use oxygen or you have other physical limitations, assuming that no smoking history automatically disproves things.
Leah Bucholz:Like I mentioned, that's something that's there's never an always or never, right? So if you're a veteran and you're struggling to breathe and you served in areas where there were toxic exposures that were common, don't just brush it off, right? COPD can be absolutely be connected to your service. If you're having trouble or you've been denied before, always check out a VSO that are, you know, in your local area. You can also get with an accredited claims agent or an accredited attorney.
Leah Bucholz:I've got some really great videos on, the tools va.gov has to go search one in your area. I think you can search by zip code. So I hope this was helpful. Please drop some comments and let me know if you guys what your experiences have been. Always like hearing back from you guys if these videos are helpful.
Leah Bucholz:And, if there's anything else you want me to talk about or you wanna hear about, just again, drop some comments. As always, thank you for watching and I will talk to you guys soon. Okay? Bye.