Veterans often contend with various health challenges stemming from their service-connected disorders, leading to the long-term use of anti-inflammatory medications. Leah delves into the intricate relationship between kidney disease and anti-inflammatory use within veteran populations. She provides insights into the potential risks associated with prolonged anti-inflammatory usage and its implications for veterans seeking disability benefits.
Understanding Anti-inflammatory Use in Veterans
In the United States, over 30 billion doses of non-steroidal anti-inflammatory drugs (NSAIDs) are consumed each year. Anti-inflammatories, including non-steroidal varieties like ibuprofen and naproxen, are commonly prescribed to alleviate pain associated with service-connected conditions among veterans. These medications, while effective in managing pain from musculoskeletal injuries, pose risks when used over extended periods.
A study of 1,250 Veterans found that 32% used non-steroidal anti-inflammatory drugs (NSAIDs) inappropriately, with 14% taking two or more NSAIDs and 13% exceeding recommended daily doses. A smaller group, 5%, did both. Misuse was linked to increased gastrointestinal (GI) symptoms like pain, nausea, and bloating, as well as higher pain levels. Veterans may be self-medicating to manage pain, leading to these adverse effects.
Another study analyzing NSAID prescriptions among U.S. Army active duty soldiers found widespread use from 2006 to 2014, with 69% of soldiers receiving prescriptions in 2006, rising to 82% in 2014. The prescriptions outnumbered the utilizers, indicating frequent multiple prescriptions. Celecoxib use increased over time, and female soldiers received nearly twice the prescriptions as males. The study did not account for over-the-counter NSAIDs, raising concerns due to NSAIDs’ potential negative effects on gastrointestinal, renal, cardiovascular, and bone health.
Leah Bucholz underscores the prevalence of non-steroidal anti-inflammatory drug (NSAID) prescriptions and highlights the need for vigilance due to potential nephrotoxicity, particularly concerning kidney health.
Exploring Kidney Disease
Kidney disease is a serious condition where the kidneys lose their ability to filter waste, regulate blood pressure, and manage fluid balance. Factors contributing to kidney dysfunction are multifaceted, including hypertension, diabetes, cancer, and medication-induced damage. There are two main types of kidney disease: acute and chronic.
Types of Kidney Disease
- Acute Kidney Injury (AKI): This occurs suddenly due to factors like illness, injury, or medication use. Though often reversible with prompt treatment, AKI can cause severe symptoms such as reduced urination, swelling, fatigue, and confusion.
- Chronic Kidney Disease (CKD): A progressive condition where kidney function declines over time, leading to waste buildup in the body. Symptoms often appear late and include changes in urination, swelling, fatigue, and anemia. Chronic kidney disease progresses through five stages, with Stage 5 requiring dialysis or a kidney transplant.
- End-Stage Renal Failure: Usually stage 5 of chronic kidney disease, this condition occurs when the kidneys can no longer filter waste, requiring dialysis or a kidney transplant to survive. Symptoms include nausea, vomiting, swelling, fatigue, muscle cramps, changes in urination, and shortness of breath due to fluid buildup in the lungs.
- Diabetic Nephropathy: A complication of type 1 and type 2 diabetes, this condition damages kidney capillaries, leading to protein leakage and eventual kidney failure. Diabetic nephropathy presents with symptoms like swelling, weakness, and a reduced need for insulin.
Symptoms and Diagnosis
Kidney disease is often difficult to detect as early symptoms may be subtle. These can include changes in urination, swelling, fatigue, and high blood pressure. Diagnosis typically involves urine and blood test to measure protein, creatinine, and the glomerular filtration rate (GFR). A low GFR indicates impaired kidney function. Additionally, albumin (protein) secretion of more than 30mg suggests kidney disease.
Treatment and Veterans’ Benefits
While kidney disease has no cure, early detection and management can slow its progression. Veterans may be eligible for VA disability benefits if their kidney disease is military service-related. Treatment options include medication, lifestyle changes, dialysis, or kidney transplantation in advanced stages. Veterans facing kidney disease linked to anti-inflammatory use can reduce NSAID consumption or switch to safer alternatives that may prevent further complications.
Veterans who qualify for kidney disease VA benefits receive mileage reimbursement for beneficiary travel, dialysis care (regardless of service connection), kidney transplants, and disability benefits. They may also qualify for home dialysis, home improvements, and alterations, as well as geriatrics and extended care.
Insights from Research
Leah references several scholarly articles to elucidate the correlation between non-steroidal anti-inflammatory drugs (NSAIDs) and kidney disease progression. Citing studies such as those published in Pharmaceuticals and the American Journal of Medicine, she highlights the documented risks of renal damage associated with NSAID consumption. These findings underscore the importance of informed medical decision-making and monitoring among veterans prescribed NSAIDs for service-related ailments.
Some of the studies are:
- An article published in 2010 titled “Non-Steroidal Anti-Inflammatory Drugs and the Kidney” explores the inhibitory effects of NSAIDs on COX-1 and COX-2 enzymes, including their implications for renal function, such as sodium and fluid retention, high blood pressure, and an increased risk of acute kidney failure.
- A study outlined in an article titled “Significant Acute Kidney Injury Due to Non-Steroidal Anti-Inflammatory Drugs in Patient Setting” published in Pharmaceuticals. This study highlights the significant risk of renal damage posed by NSAIDs particularly ibuprofen and naproxen, as well as focuses on the underrecognition of acute kidney injury associated with these medications.
- A study titled “NSAID Use and Progression of CKD” published in the American Journal of Medicine in 2007, investigates the impact of nonselective and selective cyclooxygenase-2 specific NSAID use on kidney function and the progression of chronic kidney disease (CKD).
- An article published in the Journal of the American Medical Association in 2019, titled “Association of Non-Steroidal Anti-Inflammatory Drug Prescriptions with Kidney Disease Among Active Young and Middle-Aged Adults.” This study examines the association between higher doses of NSAID prescriptions (more than 7 defined doses per month) and acute kidney failure among active young and middle-aged adults.
- A study titled “Comparative Risks of Nonsteroidal Anti-Inflammatory Drugs on CKD“, published in the Clinical Journal of the American Society of Nephrology, investigates the comparative risks of different NSAIDs like ibuprofen, etoricoxib, diclofenac, naproxen, and celecoxib on chronic kidney disease progression.
These studies collectively contribute to our understanding of the relationship between kidney disease and Anti-inflammatory Use, providing valuable insights for veterans and medical professionals alike.
Kidney Disease and Anti-inflammatory Use in Veterans Disability
In her role as a medical professional, Leah emphasizes the significance of sound medical opinion letters in veterans’ disability claims. She stresses the value of comprehensive documentation backed by empirical evidence, particularly when linking conditions like kidney disease to the use of anti-inflammatory medications. By explaining the connection between service-related injuries, renal disease, and medication use, Leah empowers veterans with crucial insights to strengthen their claims.
To secure VA disability compensation for kidney disease, veterans must establish either a direct or secondary service connection. For direct service connection, veterans need to prove a current diagnosis, an in-service event that contributed to the disease, and a medical nexus linking the disease to military service.
Kidney Disease as a Secondary Condition
Secondary service connection applies when kidney disease results from another service-connected condition, such as diabetes or high blood pressure. Anti-inflammatory drugs, often prescribed for managing chronic pain, can lead to kidney damage with long-term use. If renal disease develops as a result of taking these medications for a service-connected condition, veterans may qualify for compensation through a secondary connection. Submitting medical records, proof of in-service events, and a well-documented medical nexus is essential for improving the chances of receiving a favorable disability rating and compensation.
How VA Rates Kidney Disease
The VA evaluates kidney disease under 38 CFR § 4.115a, which covers Genitourinary System – Dysfunctions, with kidney conditions classified under renal dysfunction. The VA assigns disability ratings for kidney disease based on the severity of renal dysfunction, ranging from 0% to 100%.
These ratings are determined by factors like glomerular filtration rate (GFR), symptoms such as edema (swelling), albuminuria (protein in urine), and hypertension, as well as the overall impact on a veteran’s health.
- 100% rating: Awarded to veterans with GFR less than 15 mL/min/1.73 m² for at least 3 consecutive months, those requiring regular dialysis, or those eligible for a kidney transplant. It can also be granted for severely reduced kidney function affecting other organ systems, especially the cardiovascular system.
- 80% rating: For veterans with GFR between 15 and 29 mL/min/1.73 m², or those suffering from persistent edema, albuminuria, or generalized poor health (e.g., lethargy, weakness, weight loss).
- 60% rating: This kidney disease VA rating is given to those with GFR between 30 and 44 mL/min/1.73 m², constant albuminuria, some edema, or hypertension rated at 40%.
- 30% rating: For veterans with GFR between 45 and 59 mL/min/1.73 m², or mild symptoms like transient edema and hypertension rated at 10%.
- 0% rating: Applied to veterans with GFR between 60 and 89 mL/min/1.73 m² who show minor symptoms such as Red Blood Cell/White Blood Cell casts or structural kidney abnormalities.
These kidney disease VA ratings directly affect the compensation veterans receive, with more severe conditions warranting higher compensation.
TDIU for Kidney Diseases
Veterans with kidney disease may qualify for Total Disability Individual Unemployability (TDIU) if their condition prevents them from maintaining gainful employment. TDIU provides compensation at the 100% disability level, even with a lower rating, if one service-connected disability is rated at 60% or higher, or if there is a combined rating of 70% or more for two or more service-connected disabilities, with at least one rated at 40%.
Preparing for a VA C&P Exam
Veterans may have to undergo a Compensation and Pension Exam to receive a kidney disease VA rating. A VA C&P exam for kidney disease involves a review of your medical history, symptoms, and military service. The doctor will likely conduct blood and urine tests to assess your glomerular functional rate and albumin level. Prepare by listing your symptoms, medical history, medications, and questions for the doctor. These steps help ensure a thorough and accurate evaluation.
Navigating VA Ratings for Renal Dysfunction
Bucholz briefly outlines the VA ratings applicable to renal dysfunction, providing veterans with a framework for understanding how kidney-related disabilities are evaluated. While acknowledging the complexity of these ratings, veterans are encouraged to seek guidance from accredited legal professionals or veteran service officers for personalized assistance. By empowering veterans with knowledge of VA disability evaluation criteria, Bucholz facilitates informed decision-making in their pursuit of benefits.
Conclusion
In conclusion, the intersection of kidney disease and anti-inflammatory use presents significant considerations for veterans navigating the disability claims process. Leah Bucholz underscores the importance of evidence-based medical documentation and highlights the potential risks associated with prolonged NSAID usage. By arming veterans with actionable insights and resources, she endeavors to support their pursuit of disability benefits and ensure they receive the comprehensive care and support they deserve.
As veterans confront the complex challenges posed by service-connected disabilities, it is imperative to prioritize their health and well-being. By fostering greater awareness of the interplay between medication regimens, underlying conditions, and renal health, stakeholders can collaborate to optimize outcomes and enhance the quality of life for those who have served our nation. As veterans confront the complex challenges posed by service-connected disabilities, it is imperative to prioritize their health and well-being. By fostering greater awareness of the interplay between medication regimens, underlying conditions, and renal health, stakeholders can collaborate to optimize outcomes and enhance the quality of life for those who have served our nation.
Also read: Obstructive Sleep Apnea Secondary to TMJ in Veterans Disability
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