garion

I just got rated 100% SMC-S1 yesterday but I am not P&T. I would like to know what steps I would need to take to get my P&T? Also, being 100% without P&T, do I get commissary ID Card and Dental?

I will once I get the denial letter. Thanks Flores97!

Good day everyone! Could anyone answer me this question? If VA deny service connection to a disability that two different doctors from two different VA C&P's states is service connected, what is my options? I claimed pancreatitis in my original claim and the C&P doctor stated it was service connected but VA denied the claim. I did a reconsideration and the VA sent me to another C&P exam and the new doctors stated that my pancreatitis is service connected. I also submitted medical records from my private doctors stating the same. Below is BOTH C&P notes from the doctors. These are the note from the doctor who performed my last C&P Exam.a. The condition claimed is at least as likely as not (50% or greater probability) proximately due to or the result of the Veteran's service connected condition .c. Rationale: Well documented, long standing history of GI issues including chronic cholecystitis and cholecystecomty x 2 with residual complications, GERD (already SC for these conditions), chronic pancreatitis, among other GI conditions. Patient remains symptomatic and continues to have GI follow up and treatment. There is sufficient evidence of record (which was extensively reviewed as part of this exam), and per today's exam, that pancreatitis was at least as likely as not due to or the result of the SC condition. Here is the C&P exam notes from my FIRST exam. Completely different doctors.Does the Veteran's gallbladder and/or pancreas condition(s) impact on his or her ability to work? [X] Yes [ ] No If yes, describe the impact of each of the Veteran's gallbladder and/or pancreas conditions, providing one or more examples: Veteran states he has to leave early from work due to Abdominal pain. Veteran states on his worse days he has to go to bathroom at least 3 to 4 times during the work day(30 to 45 minutes).8. Remarks, if any------------------1. Veteran's current claimed and diagnosed GI symptoms is at least as likely as not (50 percent or greater probability)a continuation and/or progression of the Veteran's already service connected Chronic Cholecystitis, S/P Cholecystectomy with Acid Reflux.2. C&P Recommendation: Veteran's previous documented abnornomal clinical findings were discussed with Veteran. Veteran is advised to follow-up with his primary medical provider for evaluation and treatment of his ongoing and chronic GI symptoms.

I see what you are talking about my sister...(: You have a legitimate complaint if your denial was decided on the wrong medical information. I hope you have a VSO which would make fixing the issue much easier...

navy4life - How are you doing today brother? I know what you mean. The VA was requesting records of treatment at the Fort Monroe facility for the dates of April to June of 2001. The kicker is I wasn't even stateside doing that time... I was still in Europe. Requesting those records from a place I never been held up my claim for at least 4 months! They kept sending out request after request until they met their quota of 6 request. Even though I told them I never been to that facility before! To make matter even worse, Fort Monroe closed down years ago! I still don't understand how the VA didn't know one of their facilities closed down?

I will flores97. The minute I get know something, I will share it with the group.

Thanks allan1351. I been dealing with them a long time. Hopefully it will come to an end soon...

You right Gastone... That was a stupid mistake on my part. I got the records late and my claim was already in "ROE"... I didn't want to slow the claim down by uploading new evidence. Since getting my medical records, I have 3 different doctors and my Gastro specialist stating I have Chronic Pancreatitis. I have an additional 10 pages of evidence all stating chronic pancreatitis in addition to the C&P doctor stating the same thing. Gastone, I need to mail the evidence in to the SR Rater or DRO to review? Could I do this through eBenefit or do I need to mail the information? Do you have the address if I need to mail the information?

Navy4 - Thanks for your response. I meet the criteria for 100% if rated for pancreatitis. The minimum I would receive is 60% which still would put me at 100%. Below is the ratings... This is what the VA rated me on... Code 7314: Chronic cholecystitis is the constant swelling of the gallbladder most often caused by gallstones. The most common symptom is severe pain near the bottom of the ribs on the right side. In most people, the gallbladder can be removed without serious side effects. If there are frequent severe attacks of pain, it is rated 30%. If there is heartburn and occasional attacks of severe pain, it is rated 10%. If there are only occasional mild symptoms, it is rated 0%. This is what the VA should have rated me on at 100%... Code 7347: Pancreatitis is the swelling of the pancreas that occurs because the enzymes it produces become active while still in the pancreas. If diabetes and pancreatitis are both present, both cannot be rated. Rate only the one that gives the highest rating. If the whole or part of the pancreas is surgically removed, then rate any continuing symptoms on the following ratings, with the minimum rating of 30%. Ratings: If there are seriously disabling attacks of stomach pain with very few pain-free periods, significant amounts of fat in the feces, the inability of the small intestine to absorb the necessary nutrients, diarrhea, and severe malnutrition, it is rated 100%.

Thanks guys! I was shocked that the rater looked right pass what the C&P examiner reported.

I got my rating back. I went from 60% to 90%. The problem is they denied my pancreatitis that would have given me 100%. I want to know the quickest way to get them to correct this? The VA stated "medical evidence of record fail to show that this disability has been "clinically diagnosed". The evidence does not show a current diagnosed disability". This is wrong! The C&P doctor diagnosed me with pancreatitis and this statement is directly from her notes 8. Remarks, if any 1. Veteran's current claimed and diagnosed GI symptoms is at least as likely as not (50 percent or greater probability) a continuation and/or progression of the Veteran's already service connected Chronic Cholecystitis, S/P Cholecystectomy with Acid Reflux. Also this as well... 4. Pancreas conditions: signs and symptoms - a. Does the Veteran have any of the following symptoms attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Abdominal pain, confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies If checked, indicate severity and frequency of attacks (check all that apply): [X] Severe (disabling) Indicate number of attacks of Severe (disabling) abdominal pain in the past 12 months: [ ] 0 [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 [ ] 7 [X] 8 or more [X] Other symptoms, describe: Veteran states he awakens at night he awaken and loses his bowel(defication) . b. Does the Veteran have any of the following signs or findings attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Steatorrhea If checked, describe frequency and severity: Veteran states greacy foul smelling stools 3 times per week. [X] Diarrhea If checked, describe frequency and severity: Veteran states has loose and watery diarrhea. Veteran states his last severe episode was 4 days ago. Also, I have additional clinical diagnoses from a private specialist which I didn't submit to the VA because I thought the C&P exam would be enough. I haven't had these records long. This is what the Gastroenterology studies reported. DATE OF PROCEDURE: 09/03/2012 Operative Report The patient underwent an endoscopic ultrasound today. PREOP DIAGNOSIS: History of abdominal pain, high pancreatic enzymes. POSTOP DIAGNOSIS: Chronic pancreatitis. Prior consent was obtained from the patient after the alternatives, benefits and risks were explained including, but not limited to the risk of bleeding, infection, perforation, aspiration, missed lesion, drug reaction, death and surgery. Patient was placed in the left lateral position. Bite block was placed. Versed and Demerol were used for this test. A radial endoscopic ultrasound scope was used and advanced into the small bowel without complication. This was limited study with his history of gastric bypass. Parts of pancreas that were evaluated grossly appeared normal except for multiple hyperechoic strands and foci and lobularity of the gland suggestive of chronic pancreatitis. IMPRESSION: As above. Continue low fat diet. I would get a follow up MRCP to further evaluate the pancreatic biliary ductal system. In the future if his symptoms persist in spite of medical management, further and therapy would be an option. Unfortunately his presentation is compounded with history of gastric bypass and if the symptoms persist and above has to be undertaken it has to be through a gastrostomy tube placement. Again, time will tell where his symptoms take us. SA/NB

I got my rating back. I went from 60% to 90%. The problem is they denied my pancreatitis that would have given me 100%. I want to know the quickest way to get them to correct this? The VA stated "medical evidence of record fail to show that this disability has been "clinically diagnosed". The evidence does not show a current diagnosed disability". This is wrong! The C&P doctor diagnosed me with pancreatitis and this statement is directly from her notes 8. Remarks, if any 1. Veteran's current claimed and diagnosed GI symptoms is at least as likely as not (50 percent or greater probability) a continuation and/or progression of the Veteran's already service connected Chronic Cholecystitis, S/P Cholecystectomy with Acid Reflux. Also this as well... 4. Pancreas conditions: signs and symptoms - a. Does the Veteran have any of the following symptoms attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Abdominal pain, confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies If checked, indicate severity and frequency of attacks (check all that apply): [X] Severe (disabling) Indicate number of attacks of Severe (disabling) abdominal pain in the past 12 months: [ ] 0 [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 [ ] 7 [X] 8 or more [X] Other symptoms, describe: Veteran states he awakens at night he awaken and loses his bowel(defication) . b. Does the Veteran have any of the following signs or findings attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Steatorrhea If checked, describe frequency and severity: Veteran states greacy foul smelling stools 3 times per week. [X] Diarrhea If checked, describe frequency and severity: Veteran states has loose and watery diarrhea. Veteran states his last severe episode was 4 days ago. Also, I have additional clinical diagnoses from a private specialist which I didn't submit to the VA because I thought the C&P exam would be enough. I haven't had these records long. This is what the Gastroenterology studies reported. DATE OF PROCEDURE: 09/03/2012 Operative Report The patient underwent an endoscopic ultrasound today. PREOP DIAGNOSIS: History of abdominal pain, high pancreatic enzymes. POSTOP DIAGNOSIS: Chronic pancreatitis. Prior consent was obtained from the patient after the alternatives, benefits and risks were explained including, but not limited to the risk of bleeding, infection, perforation, aspiration, missed lesion, drug reaction, death and surgery. Patient was placed in the left lateral position. Bite block was placed. Versed and Demerol were used for this test. A radial endoscopic ultrasound scope was used and advanced into the small bowel without complication. This was limited study with his history of gastric bypass. Parts of pancreas that were evaluated grossly appeared normal except for multiple hyperechoic strands and foci and lobularity of the gland suggestive of chronic pancreatitis. IMPRESSION: As above. Continue low fat diet. I would get a follow up MRCP to further evaluate the pancreatic biliary ductal system. In the future if his symptoms persist in spite of medical management, further and therapy would be an option. Unfortunately his presentation is compounded with history of gastric bypass and if the symptoms persist and above has to be undertaken it has to be through a gastrostomy tube placement. Again, time will tell where his symptoms take us. SA/NB

Thanks Vync! I went and got a better understanding of how they rate Pancreatitis. The reason they did multiple criteria is because if you had a Total or Partial Pancreatectomy, the minimum the VA can rate you is at 30%. Read below. It explain things better with the rating. 7347 Pancreatitis: With frequently recurrent disabling attacks of abdominal pain with few pain free intermissions and with steatorrhea, malabsorption, diarrhea and severe malnutrition........................................................................................ 100 With frequent attacks of abdominal pain, loss of normal body weight and other findings showing continuing pancreatic insufficiency between acute attacks........................................................................................... 60 Moderately severe; with at least 4-7 typical attacks of abdominal pain per year with good remission between attacks....................................................... 30 With at least one recurring attack of typical severe abdominal pain in the past year..................................................................................................... 10 Note 1: Abdominal pain in this condition must be confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies. Note 2: Following total or partial pancreatectomy, rate under above, symptoms, minimum rating 30 percent.

Thanks for your response, Vync! I think they mean they are rating on Pancreatitis, Total pancreatectomy and Partial pancretectomy... I am guessing they recognize them as different forms/degrees of pancreatitis. They have been giving me all kind of medicines to try to get my Pancreatitis in control. They keep increasing my medications and adding new ones. I have been on 5 different medication so far. Below is the C&P remark. 8. Remarks, if any ------------------ 1. Veteran's current claimed and diagnosed GI symptoms is at least as likely as not (50 percent or greater probability)a continuation and/or progression of the Veteran's already service connected Chronic Cholecystitis, S/P Cholecystectomy with Acid Reflux. 2. C&P Recommendation: Veteran's previous documented abnornomal clinical findings were discussed with Veteran. Veteran is advised to follow-up with his primary medical provider for evaluation and treatment of his ongoing and chronic GI symptoms.

From my C&P exam, it looks like I fall under the 100% for Pancreatitis. I also have Anemia and Diabetes. Have anyone on the board been rated for Pancreatitis? Does the Veteran have any of the following symptoms attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Abdominal pain, confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies If checked, indicate severity and frequency of attacks (check all that apply): [X] Severe (disabling) Indicate number of attacks of Severe (disabling) abdominal pain in the past 12 months: [ ] 0 [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 [ ] 7 [X] 8 or more [X] Other symptoms, describe: Veteran states he awakens at night he awaken and loses his bowel(defication) . b. Does the Veteran have any of the following signs or findings attributable to any pancreas conditions or residuals of treatment for pancreas conditions? [X] Yes [ ] No If yes, check all that apply: [X] Steatorrhea If checked, describe frequency and severity: Veteran states greacy foul smelling stools 3 times per week. [X] Diarrhea If checked, describe frequency and severity: Veteran states has loose and watery diarrhea. Veteran states his last severe episode was 4 days ago. Below is the Criteria for 100%... Pancreatitis, total pancreatectomy, and partial pancreatectomy: With all of the following ..... 100% Daily or near-daily debilitating attacks of pancreatitis with few pain-free intermissions; Two or more signs of pancreatic insufficiency (such as steatorrhea, diabetes, malabsorption, diarrhea, and malnutrition); and Unresponsive to medical treatment. ~With the following .. 60% Seven or more documented attacks of pancreatitis per year with at least one sign of pancreatic insufficiency (such as steatorrhea, diabetes, malabsorption, diarrhea, or malnutrition) between acute attacks. ~With any of the following .. 30% Three to six documented attacks of pancreatitis per year with at least one sign of pancreatic insufficiency (such as steatorrhea, diabetes, malabsorption, diarrhea, or malnutrition) between acute attacks;