VA Disability Ratings and Benefits for Psoriatic Arthritis

Psoriasis, and psoriatic arthritis, are two conditions that are often linked.  Although psoriasis usually leaves a physical mark on the skin, psoriatic arthritis does not, meaning that many people may not even know they have the condition.  Many veterans often struggle with one, or both, of these conditions as a result of their service.

What is Psoriasis?

Psoriasis is a common skin condition that is categorized as an immune-mediated disease, meaning it is caused by dysfunction of the immune system.  Psoriasis can cause swelling in the body as well as raised plaques or scaly patches on the skin.

What is Psoriatic Arthritis?

Psoriatic arthritis is a “chronic, inflammatory disease of the joints and where the tendons and ligaments connect to bone.”  Typically, the condition affects middle to late-aged adults.  Some people may develop psoriatic arthritis before developing psoriasis, or they may not even develop or notice psoriasis at all.  However, for most people, psoriatic arthritis usually begins around 10 years after psoriasis develops.

There is currently no cure for psoriatic arthritis, but there is treatment to alleviate symptoms and cease the progression of the disease.  Early detection can be crucial to limit the amount of joint damage the disease causes.

Symptoms of Psoriatic Arthritis

• Fatigue
• Swelling, specifically near joints
• Tenderness
• Pain or throbbing
• Stiffness, which may be worst in the morning
• Reduced range of motion
• Redness and pain in one or both eyes
• Nail changes, such as the nail separating from the nail bed

Importantly, there is little connection between the physical appearance of one’s psoriasis and psoriatic arthritis.  A person may have very few plaques or patches of psoriasis, but many joints with psoriatic arthritis.

Risk Factors for Psoriatic Arthritis

Only about 30 percent of people with psoriasis also have psoriatic arthritis.  As such, there are certain risk factors that can make a person more susceptible to developing psoriatic arthritis.  Risk factors include:

• Having psoriasis
• Family history and genetics
• Obesity
• Smoking history
• Age
• HIV/Aids diagnosis
• Environmental factors or exposures

Diagnosing and Treating Psoriatic Arthritis

Screening for psoriatic arthritis can be crucial, as the sooner the condition is detected, the quicker treatment can be applied to limit damage to the joints.  Some tests for psoriatic arthritis can include x-rays, CT scans, ultrasound, MRI, or skin biopsies.  If a person also has psoriasis, a dermatologist may examine them to determine the best from of treatment for their skin.

Treatment for psoriatic arthritis may include:

• Oral medication, such as NSAIDs
• Corticosteroids
• Immunosuppressive medicines
• Vitamins or minerals
• Hot and cold compresses
• Increased exercise
• Splints
• Surgery
• UV light therapy

VA Service Connection for Psoriasis

Generally, a grant of service connection for VA disability benefits requires three things:

• An in-service event, injury, or illness;
• A current diagnosis by a medical professional; and
• A medical nexus, or link, between your in-service event, injury, or illness and your current diagnosis.

The most crucial part of a claim for service connection for psoriatic arthritis will be to connect the diagnosis to the veteran’s military service.  There are multiple ways this may be done:

Primary Service Connection—This form of service connection can be achieved if there is evidence that the veteran’s service directly caused their psoriatic arthritis.

Secondary Service Connection—This form of service connection can be achieved if the veteran’s psoriatic arthritis was developed as a result of another service-connected condition.  This could also apply if a veteran’s service-connected psoriasis caused them to develop psoriatic arthritis.

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Compensation and Pension (C&P) Exams for Psoriatic Arthritis

Once a claim has been filed, VA may request a Compensation and Pension exam, or C&P exam.  This exam will usually be performed by a VA physician or VA contracted physician who may physically examine the veteran, as well as ask questions regarding the veteran’s military service, their psoriatic arthritis, or symptoms of their psoriatic arthritis.  If the veteran has both psoriasis and psoriatic arthritis, the examiner may evaluate both.

To schedule a C&P exam, VA will usually call the veteran or send them a letter.  As such, it is crucial to ensure that VA has the veteran’s most up-to-date contact information.  If VA does not have the current contact information, the veteran might miss a C&P request.  When a veteran fails to attend an exam or fails to reschedule one they have missed, their claim could be denied.

Prior to the exam, the examiner should review the veteran’s c-file.  The C-file will usually contain any documentation that has previously been submitted to VA, as well as the veteran’s medical and military service records.

The veteran may also use a DBQ, or Disability Benefits Questionnaire, to bolster their claim.  A Disability Benefits Questionnaire is a form created by VA so that the veteran may address important aspects of their condition, such as symptoms, severity, possible causes, and relation to other disabilities.  The veteran may also have their private doctor fill out a DBQ for them.

How Does VA Rate Psoriatic Arthritis?

Psoriatic arthritic is rated under 38 CFR § 4.71a, schedule of ratings for the musculoskeletal system.  Specifically, psoriatic arthritis falls under Diagnostic Code 5002, which is the diagnostic code used to categorize rheumatoid arthritis and all other forms of systemic arthritis.  Psoriatic arthritis, as well as spondyloarthropathies and other forms of arthritis, can be included under this diagnostic code.

The ratings given for psoriatic arthritis are as follow:

• 100%— This rating is given to veterans who experience totally incapacitating psoriatic arthritis symptoms, no matter how many joints are affected. An example of this may be if the veteran is bedridden by their arthritis.
• 60%— Veterans who suffer from extremely incapacitating episodes four or more times per year or are experiencing weight loss, anemia, and a decline in health can receive the 60 percent rating.
• 40%— The 40 percent rating is generally used for veterans who face ”definitive impairment” in their overall health that is supported by exam findings, or veterans who experience three or more incapacitating episodes each year.
• 20%— Veterans who experience two or more incapacitating episodes per year, with an established diagnosis, are eligible for the 20 percent rating.

If a veteran’s psoriatic arthritis is less severe than the symptoms outlined above, they can be rated under the diagnostic codes for each specific major or minor joint group.  To be rated under these specific diagnostic codes, a limited range of motion must be confirmed by symptoms such as swelling, muscle spasms, or evidence of painful motion.

If a veteran experiences chronic residuals of arthritis, they will be rated under Diagnostic Code 5003 instead.  Ratings cannot be combined for chronic residuals and psoriatic arthritis, however.  In this case, VA will assign the higher rating.

VA’s Painful Motion Rule

38 CFR § 4.59 is known as VA’s painful motion rule.  If you have arthritis in any joint and experience pain on motion, you may be eligible to receive a separate 10 percent rating.

VA examiners are supposed to test for pain on both active and passive motion, weight-bearing and non-weight-bearing, and if possible, within the range of the opposite undamaged joint.  However, VA examiners do not always complete all of these tests, which can result in an inadequate exam and unmet duty to assist.

Again, you are entitled to that testing and can argue against the adequacy of the exam if it is not completed.

Importantly, you can get separate 10 percent ratings for different joints under § 4.59 as long as you are not getting the same rating twice for the same joint.

Joint Replacement Surgery

If a veteran must undergo a joint replacement surgery, VA should adjust compensation accordingly by assigning a temporary total rating.  Temporary total ratings provide benefits for veterans experiencing temporary, severe medical situations related to their service-connected condition(s).  As the name implies, veterans receive monthly compensation at the 100 percent level for the duration of the temporary total period.  There are various types of temporary total ratings, including temporary hospitalization and convalescence.

Hospitalization

Temporary hospitalization ratings are assigned to veterans who have been hospitalized for over 21 days as a result of a service-connected condition.  If a veteran is assigned a temporary hospitalization rating for their joint replacement surgery, their effective date will be that of when continuous hospitalization began.  Benefits will continue until the last day of the month in which the veteran stopped receiving treatment for their service-connected condition.

Convalescence

Convalescence is the third and final form of temporary total compensation assigned to veterans by VA.  The United States Court of Appeals for Veterans Claims (CAVC)  has defined convalescence as “the stage of recovery following an attack of disease, a surgical operation, or an injury” and recovery as “the act of regaining or returning toward a normal or healthy state.”  In order to qualify for a temporary and total convalescence rating, the veteran must have:

• Undergone treatment or surgery with a convalescence time of at least one month; or
• Experienced severe postoperative residuals that resulted from surgery (e.g., surgical wounds are not completely healed, the veteran is rendered housebound, there is a need for continuous use of crutches or wheelchair); or
• Experienced the immobilization of one or more major joints by a cast without surgery.

In the instance of convalescence for joint replacement, veterans will begin receiving the 100 percent recovery rating one month after discharge from the hospital.

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VA Individual Unemployability (TDIU) and Psoriatic Arthritis

If your service-connected arthritis leads to the inability to obtain and maintain substantially gainful employment, then you may be eligible to receive total disability based on individual unemployability (TDIU) benefits.  If granted TDIU, you will receive payment at the 100 percent maximum rate.  You can apply for TDIU on its own, or you can raise it within an appeal for an increased rating.

There are two forms of TDIU, which are outlined below:

• 38 CFR § 4.16a (“Schedular”) – For this form of TDIU, the veteran must have:
  • One condition rated at minimum 60 percent OR
  • two conditions that can be combined to reach 70 percent, where one condition is at minimum 40 percent

• 38 CFR § 4.16b (“Extraschedular”) – This form of TDIU is for veterans who may not be able to achieve the ratings necessary for schedular TDIU but are still unable to obtain substantially gainful employment on account of their conditions.
  • In this instance, the veteran must prove that their condition uniquely hinders their ability to obtain substantially gainful employment and therefore should not be rated on the standard disability rating criteria.

Military Burn Pit Exposure and Psoriatic Arthritis

Military burn pits are large areas of land in which the military and its contractors incinerated all waste generated by military bases, including plastics, medical waste, rubber, human waste, and more.

The U.S. Military used burn pits as part of their waste disposal protocol in places such as Iraq and Afghanistan in the post-9/11 era.  While the practice was effective in reducing large quantities of waste, burn pits emitted plumes of toxic smoke.  This was especially problematic in places such as the Middle East, as the desert wind carried the smoke for miles.

Many U.S. Military veterans have suffered health consequences from burn pit exposure.  Most of the negative effects involve temporary ailments of the respiratory system, though limited evidence suggests a link between burn pit exposure and the long-term deterioration of lung health.

These burn pits were used extensively throughout the Middle East and have affected veterans who served in Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn.

Research continues to be done to link burn pit exposure to a variety of different conditions, such as cancers and respiratory conditions.  In order to fully understand the harm caused by military burn pits, further research will need to be done.  However, research has indicated that one of the known chemical compounds released by burn pits includes the dioxin called TCDD which was also found in Agent Orange.

Some veterans who were exposed to military burn pits may have gone on to develop psoriasis, psoriatic arthritis, or both.  This has led many veterans who were exposed to these pits and have psoriasis or psoriatic arthritis to seek VA disability benefits.

While VA does acknowledge certain conditions as being eligible for presumptive service connection if the veteran can prove exposure to Agent Orange, VA has not established a presumption for veterans exposed to burn pits.  Since there is no presumption, VA adjudicates burn pit claims on a case-by-case basis.

VA does not have a consistent approach to deciding these claims, nor do they have a cohesive way of tracking veterans who served near burn pits.  As such, lay evidence is often the key to winning burn pits claims.  Statements from veterans themselves or buddy statements from fellow servicemembers can help prove exposure.

New Proposed Burn Pit Legislation 2021

As of 2021, there are several major bills currently pending in Congress, that deal with the toxic exposure caused by burn pits.  These bills include:

• Conceding Our Veterans’ Exposure Now and Necessitating Training Act (COVENANT)
• Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2021
• Veterans Burn Pit Exposure Recognition Act
• Toxic Exposure in the American Military Act (TEAM)
• And more.

Any of these bills, if passed, would offer much needed relief to veterans suffering the toxic effects of burn pit exposure.

Was Your VA Disability Claim for Psoriatic Arthritis Denied?

Appealing a VA disability denial can be a frustrating and difficult process.  The experienced attorneys and advocates at Chisholm, Chisholm & Kilpatrick LTD may be able to assist you in the process and help to secure a grant of VA disability benefits for psoriatic arthritis.  Contact our office today for a free case evaluation.