Sign in to follow this  
Followers 0

Gerd Claim

10 posts in this topic


Service connection for hiatal hernia with gastroesophagal reflux disease (claimed as stomach problems and acid reflux secondary to medication for right shoulder separation with impingment and degenerative joint disease) as secondary to the medication used for the service-connection disability of right shoulder disability is denied


We have denied entitlement to service connection for hiatial hernia and gastro esophageal reflux disease as this condition did not occur in service nor is shown to be secondary to the medication used for your service connection right shoulder condition.

Service treatment record are negative for complaints, findings or treatment for Haitian hernia or gerd while in military service.

Private treatment records were reviewed and show complaints of dyspepsia and gerd. A relationship between this condition and your right shoulder condition is not shown.

VA outpatient treatment reports show complaints and treatment for your right shoulder condition, for which you are on diclofenac and methocarbol for pain and muscle symptoms. Complaints of reflux systems are also shown, however, a relationship between these two condition is not of record.

VA examination of Date was reviewed . The Nurse Practitioner indicated that your claim file and medical records were reviewed. For the examination. You

Reported taking ranitidine for stoma problems, acid reflux,and heartburn. You

Reported symptoms of epigastria pain, nausea, vomiting, and indigestion. Physical examination found no signs of significant weight loss or malnutrition. There were no signs of anemia. Upper GI series revealed a fixed Haitian hernia with associated

GERD . In a medical opinion, the examiner stated is as least likely as not that your current complaints of stomach problems and acid reflux are related to the medication prescribed for your service connected shoulder disability. The rational is that the methocarbamol is used as a skeletal muscle relaxant , with side effects of nausea, vomiting, and dyspepsia. Diclofenac is a NSAID that has antipyretic, analgesic, and anti-inflammatory properties. It’s side effects include

Dyspepsia, peptic ulcer disease, and bleeding. Ranitidine is a histamine H2 antagonist that is used to treat heartburn, acid indigestion, and sour stomach, which could prevent

Systems and damage to the gastro esophageal tract caused by stomach acid or infection.

THE NURSE Practitioner stated that a review of the existing data revealed that you developed gastro esophageal problems following taking the prescriptions of diclofenac

And methocarbamol. You were eventually placed on ranitidine to control gastrointestinal effects.

And here’s the bad part known after reading this you will say why did you take another C&P exam answer I didn’t.

On March another VA examination was performed by a staff physician. The

Physician noted that your claims file and medical records were reviewed for the examination. Symptoms reported included daily heartburn, regurgitation, and esophageal

Distress. Physical examination found your overall general health to be fair There were no signs of anemia or significant weight loss/malnutrition. The physician diagnosed you with hiatal hernia with Gerd. The examiner provided an opinion that it was not likely that your current muscle relaxer(mwthocarbamol) and /or pain medication(diclofenac)

Caused the hialat hernia or GERD . He noted that this is based on the fact that the lexi-

Comp online (medication information) shows gastrointestinal adverse effects of methocarbol are nausea,vomiting,metallic taste and dyspepsia. It shows adverse

Gastrointestinal effects of diclofenac are abdominal pain, nausea, and vomiting. The examiner indicated that the statements by the nurse Practitioner are incorrect.

A request was made for the physician to clarify his statement from March > The

Physician responded on June and indicated that he thinks there are two different things. The “stomach problems” such as burning pain, nausea, etc. He agreed that it is at least as likely as not that these symptoms are related to the muscle relawer and pain medications. That opinions based on the face that those things are listed as possible adverse effects of both medications. gastro esophageal junction. Frequently

GERD is found in association with a hiatal hernia. There in nothing in the medical

Literature that supports a claim of pain medications

Causing a hiatal hernia. Therefore, it is the Physicians contention that your hiatal hernia

And sddociated gastro esophageal reflux is not caused by the muscle rexlaxer and/ or pain medications.

The evidence of record shows two competing opinions from a nurse Practitioner and a staff physician.

Probative weight must be assigned for each opinion. The Nurse Practitioner gave a 50/50

Probability that your current complaints of stomach problems and acid reflux are related to the medications used for your right shoulder, based on published side effects listed for those medications . However, the staff physician indicated that you have a hiatal hernia with associated gerd. He indicated that this is a structural problem/ abnormality and there is nothing in the medical literature that shows muscle relaxants or pain medication causing a hiatal hernia. He state that your hiatal hernia and associated Gerd is not caused by medications for the right shoulder. The physician’s opinion is given greater weight based on the educational background of the examiner and the rational provided regarding the etiology of your hiatal hernia and associated reflux.

The available evidence does not show that a hiatal hernia with GERD was treated for or

Diagnosed in service. Additionally, no evidence was submitted to show that hiatal hernia

With GERD is the result of military service or the result of medication used for your

Service connected right shoulder condition. The benefit of the doubt rule does not apply because the preponderance of evidence is unfavorable. Therefore, entitlement to service connection is denied.

Service connection may be granted for a disease or injury which result from a service connected disability or was aggravated thereby. The evidence does not show that hiatal

Hernia with gastro esophageal reflux disease (claimed as stomach problems and acid reflux secondary to medication for right shoulder separation with impingement ) is related to the medications used for the service-connected condition of right shoulder injury nor is there any evidence of this disability during military service.


Share this post

Link to post
Share on other sites

Have you ever been treated by a internal medicine doctor (gastroenterologist), you need an IMO to review your records and write a statement on your behalf. I am confused because VA stated:

A request was made for the physician to clarify his statement from March > The

Physician responded on June and indicated that he thinks there are two different things. The "stomach problems" such as burning pain, nausea, etc. He agreed that it is at least as likely as not that these symptoms are related to the muscle relawer and pain medications. That opinions based on the face that those things are listed as possible adverse effects of both medications. gastro esophageal junction. Frequently

GERD is found in association with a hiatal hernia.

What type of physician was he? Was he an internal medicine specialist?

Share this post

Link to post
Share on other sites

I agree with Pete you need a IOM that addresses the questions raised in the denial.

I would suggest you take the docs you posted and have the doc read them and if he/she will write a rebuttal and back it up with rationale. That is the only way I feel a appeal will work.

In dealing with the VA you have to fight the written word with the written word. If your doc will not do it then you will have to find either some medical report that supports your contentions or some other health evidence that will.

I would also point out that you want a MD to check you at your next C&P and NOT a NP.

Share this post

Link to post
Share on other sites

I do not recall seeing anyone other than a NP . The VA gave only one official C&P exam in Feb and they say that in March i was given a second unofficial C&P exam because I was'nt aware of a second C&P Exam .

Share this post

Link to post
Share on other sites

I would have to concur with these gentlemen, you need someone in your corner. Just because these clowns at the VA say it so, does not make it so. Get the IMO from the best doctor your can afford and have him write an opinion. Many Doctors write these letters very often and if you tell them it's for the VA that they are denying reality they will wirte them with a special relish. One Board Certified doc of mine really enjoyed picking the VA doc apart and generally with a good IMO the VA docs will back down and not argue a wrong point. You just have to challenge the madness.

Share this post

Link to post
Share on other sites

First. have you gotten copies of your C&P in February and March. Does the paperwork "match-up" (do the names, claim number, etc. match-up), because I have seen several C&P's and medical Progress Notes, SMR's and SMT's, that are for TWO (and one I saw was for THREE) different veterans.

Check this out before you do anything.

Then, request a DRO review/hearing.

There is a plethora of medical evidence on the internet that attests to the fact that GERD is MOST CERTAINLY associated with medications such as NSAIDS, etc. (I KNOW, personally, about that). Print all this evidence off, AND, as has been suggested, get an IMO, preferably from a Internal Medicine doctor. Get this in to the VARO ASAP, by doing so you may eliminate the hearing, when the DRO gets a chance to look at your evidence. And, don't let them BS you into thinking that you had TWO C&P's...........because they didn't like the FIRST C&P......they just got a MORE FAVORABLE to the VA, opinion from their SECOND examiner (who, most probably, read the ONLY C&P that you had, and picked it apart as he was instructed to do). Doctor shopping for a better denial is AGAINST VA Policy...............and, I'd damn sure make sure that that fact is placed before the DRO and let the DRO know that it will be the first thing brought to light IF, IF, your claim goes to the BVA. Fill out a form #21-4138 making this statement your number ONE on the page, then list the evidence that you have uncovered on the internet (itemized list to match your attachments) and then list the opinion of your IMO along with his/her speciality training, etc.

And, don't let the year run out on filing an NOD, if you haven't had your DRO review/hearing.

Share this post

Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  
Followers 0





  • Topics

  • Member Statistics

    • Total Members
    • Most Online

    Newest Member
    wife of a veteran
  • Forum Statistics

    • Total Topics
    • Total Posts
  • Posts

    • I apologize Firewalker I Have to clarify my statements about about THE EVIDENCE  TO SHOW ON RECORDS Most survivors are very unlikely to have any documentation showing that the sexual assault or harassment occurred. There is a significant stigma against reporting such assaults, and because assaults are often are not reported right away, the military has often taken no disciplinary action at all against those who perpetrated these assaults. This often means there is no record at all of what happened. The VA understands this and does not require that service medical records contain proof of the assault or harassment. Other forms of proof of the incident(s) that will be accepted include: police records and/or records from rape crisis centers pregnancy tests or tests for sexually transmitted diseases statements from your friends in service, family members, counselors, or clergy, or journals or diaries that you kept at the time of the trauma. Proof of behavioral changes will also be accepted, such as: documentation that you requested a transfer evidence of a drug or alcohol problem changes in job performance and/or changes in your social or economic behavior for which there is no other explanation marital and/or sexual difficulties, or incidents of depression or anxiety for which no other cause has been identified. There's is no diagnoses for MST  VA says its an experience!   ..............................Buck    
    • you want to delete your previous post or the entire topic?
    • OK So I filed a NOD for an earlier effective date on the claim of my service related claim of Asthma.  I received a rating decision dated May 5, 2016, of established service connection for asthma from September 9. 2014. That was the date the VA received my claim.  This was a reopened claim.  Now they knew this.  I had forgotten that back in 1984 soon after I was discharged I had filed a claim for Bronchial Asthma and was denied in 1985.  I never appealed it, and there are far too many reason why to get into them at this point in time.  But this rating decision in May gave me 60% right after I had a C&P exam done.  I was rather surprised at the time how fast the claim was processed and approved which all the news about appeals and denials.  Before this approval reached me I was told to go on line and join ebenefits because it was the best way to communicate with the VA and if my claim was approve I would be able to enter my banking information thereby making it possible to receive my benefits electronically.  I did join ebenefits eventually found out that back in 1984 I had filed an initial claim for Bronchial Asthma it was denied in 1985. I had also signed the form for the DAV to represent me back then.  SO this is where my claim starts to get really screwed up.  In September of 2014 of course the VA didn’t know I had previously filed a claim for SR Bronchial Asthma, however by the time I was sent for the C&P exam they did know.  Yet at that time they still were not referring to this claim as my reopened claim.  Whenever I spoke with anyone regarding this claim it was always as if it was a new claim.  It wasn’t referred to as a reopened claim until my memory was refreshed when they FINALLY decided to grant me the privilege (what was actually my right and I to have to demand) of providing me with a copy of all my military files!! And at that point the Gig was up!!! Whereas the individual at the Boston VA office when I finally got through to someone there told me I should speak with my representative (For several weeks I had left messages at a number which stated it was the DAV Boston) I told Nicole, who also happen to have been the person who had scheduled that HORRIBLE PTSD/MST C&P exam and so conveniently did not send or provide all the statements in support of my claim to the examiner.  (NICE? Huh?) Anyway she told me I should be speaking with the DAV.  I told her that I had been trying to reach them for several weeks, that I had left messages everyday but never got a call back.  Nicole said she would make sure someone from the DAV called me.  Funny how within an hour I did hear from the DAV.  (Found out the Boston DAV is not only in the same building but on one of the same floors of the Boston Veterans Administration.)  (Anyone thinking conflict of interest here??? Because that is what I have begun to think) Anyway if I don’t watch it I will go off subject and never get out the questions I have.  So eventually I pushed for a 2nd PTSD C&P exam that was granted and in July I was awarded compensation at 100% which was a combined rating with the Asthma and the PTSD and the UE rating.  But I had also filed the NOD for a EED on the Asthma.  SO here is my first question.  I know when I filed my NOD that I asked for a person to person hearing.  I remember that being a choice and one that I did mark off.  So I was rather curious why I wouln’d be granted one?  I got the SOC on my NOD around the same time as the approval came and I called the DAV representative because there was a problem with the SOC and her attitude was really shocking to me and it really pissed me off to.  I mean she got pissed at me because I asked if there was anyway to talk to the individual who had done the review and written up the SOC, because it was wrong!! At first she said don’t make waves that I should just let it be!??  But as I read it over again I was like NO WAY!!!  This is WRONG!! SO I called her back and out right asked about speaking to the reviewer or possibly his supervisor?  That is when she got all pissy with me!!!  SO I sent her an email that basicly let her know that she hadn’t done any thing for me any way so what the hell I’ll come in to the Boston VA and ask to speak to someone there, myself.  She sent me an email back that basically indicated she was no longer going to represent me.  So I sent an email to the DAV main Boston Office asking them for the forms that I needed to get rid of them and find someone that actually wanted to represent me in this matter.  I ended up getting an email from the 2nd in charge who said they were still my reps and that he would handle my case.  Sounds good right??? NOPE it’s not.  He is every bit as evasive as the last person was.  The only reason the Boston VA issues a SSOC is because when it seemed after I was approved for the 100 percent the local VA was Fing with my case and no mater how many forms I gave them they kept pushing back the date that they would settle and send out the notification letter then start at least paying me the 100% monthly amount. The first date was the end of June then July some time, then the end of July then August, until it got moved all the way back to January 2017.  So I had enough and wrote an email to Secretary McDonald.  And believe it or not I got a response back from so one in Washington out of his office who said someone would contact me.  A week later the 2nd in charge of the Boston VA called me and we had a long talk.  He got the problem with the benefit taken care of like he said he would and I got the retroactive and pay by July.  He also said he would talk to the people in the review office about what I saw as an error and he would have them take care of it.  Unfortunately he was transferred before they took care of the whole issue so only part of that was taken care of.  Hence the SSOC was issued.  But it was issued on the same date that my appeal was certified and sent to the BVA.  So my 2nd question I have is this. Does anyone know if my case could have been settled on a local level had I not filed the Form 9 if I have officially reopened the case instead of continuing on with what appears to be a new case filed in 2014?   And my 3rd Question is, what exactly is a medical Nexus???   See I thought that was a connection between the in service condition and the current disability???  So below is a statement made by the VA Doctor who performed the last C&P exam that was requested by the individual who did the review and this Doctor I believe absolutely creates this so called Nexus!!  SO if he has why didn’t they settle it and why would they deny their own Nexus???  Oh and part of this is the problem I found where there is a typo that the person who transcribed the Doctors notes left out ONE word in a sentence.  However it is a vital word for the sentence and the whole paragraph to make sense.  To date it still is NOT fixed!!!  Tell me if you catch it.  The word that is left out is “NOT”.    SO the following is the VA doctors report PLEASE give an opinion or suggestion!!  I think I am about to go MAD!!!  Aileen M Dodge       ACE and Evidence Review     -----------------------     Indicate method used to obtain medical information to complete this document:       [X] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional         relevant evidence.     Evidence Review     Evidence reviewed (check all that apply):     [X] VA e-folder (VBMS or Virtual VA)     MEDICAL OPINION SUMMARY     RESTATEMENT OF REQUESTED OPINION: a.       Opinion from general remarks:   Active duty service dates:        Branch: Navy     EOD: 03/30/1980     RAD: 03/30/1984     Branch: Marine Corps     EOD: 03/07/1978     RAD: 03/24/1978     OPINION: Direct service connection     Does the Veteran have a diagnosis of   (a) asthma that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) respiratory complaints during service?     POTENTIALLY RELEVANT EVIDENCE:     Tab TAB A (Veteran's statement in VBMS): Veteran's application for service connection dated 09/09/2014     Tab TAB E (STRs in VBMS): service treatment records show respiratory complaints to include bronchitis and asthma dated 01/16/2015     Tab TAB B (Outpatient treatment records in VBMS): VA respiratory DBQ dated   04/18/2015     Tab TABS F-K (Private treatment record in VBMS): Multiple records from     Beverly Hospital showing treatment for respiratory condition dated 04/25/2015     Tab TAB C (Outpatient treatment records in VBMS): VA pulmonary function test  dated 05/04/2015     Tab TAB D (Veteran's statement in VBMS): Veteran's statement dated 06/10/2016     b. Indicate type of exam for which opinion has been requested: respiratory     TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE     CONNECTION ]     a. The condition claimed was at least as likely as not (50% or greater  probability) incurred in or caused by the claimed in-service injury, event or illness.       c. Rationale: I have reviewed all relevant documentation in the claims file, with particular attention to the documents cited in the 2507 and tabbed. The  period of service that seems relevant to this opinion is that of the  veteran's second enlistment, from 1980 to 1984. Her enlistment examination dated 11JAN1980 makes no note of respiratory disease. In her separation examination dated 20MAR1984, veteran reports having asthma and shortness of breath.  In the interval, the veteran compiled a substantial record of  respiaratory signs and symptoms, beginning May 1980 and intensifying during     June 1980. She was variously given diagnoses of asthma or bronchitis, and treated for both. Wheezing was heard on physical examination more than once. Chest radiographs were non-diagnostic, and were normal at time of separation.     Pulmonary function testing was abnormal as early as 06/26/1980, with marked  reductions of FEV1 and peak flow, both minimally responsive or unresponsive  to inhaled bronchodilator. By 2013, her pulmonary function had deteriorated  even farther, and chest imaging showed transient ground-glass opacities.  Pulmonary function testing at VA Boston in 2015 showed additional  deterioration, with no response to inhaled bronchodilator (I cannot determine  whether she was already maximally bronchodilated from medication).     This veteran has a pulmonary disorder characterized by asthma-like symptoms and by moderately severe airflow limitation with inconsistent response to  bronchodilator. The correct diagnosis may not be asthma, but as a working  diagnosis asthma is adequate. It is clear that the veteran's condition began shortly after her re-enlistment in 1980, and has worsened since then. The condition was noted on her entrance examination. In my opinion, this veteran  has asthma or a similar chronic respiratory disorder that more likely than not was incurred in her military service from 1980 to 1984.     *************************************************************************  
    • So you got service connected for it, that is good right?  I am totally confused now. 
    • Good question Buck. I ask myself that alot. WHY was I arrested at the scene? FUBAR!!! Assault and Battery I believe. I was covered in blood......and the assailant was too....I fought for my LIFE! He was trying to kill me...That's what people never talk about with rape and I dont get rape experience was extremely violent and rageful,......Granted he wasnt as messed up as I was, but I guess they just wanted to remove us from the scene in the barracks and then question us separately. When they arrived I definitely was not hysterical...I was totally depleted...couldnt even speak....utterly exhausted....could barely walk...they cuffed us both and took us away in 2 separate vehicles and I have no idea what happened after that. I dont remember going to the hospital or talking with the MP's or anything....I remember being sent back to Ft. Hood and what transpired later. At the time I was traveling in a performing show....Army Soldiers Show and we were going to many different bases up and down the east coast at the time. I believe I was in Ft. Belvoir, VA but Im not sure...some base in Virginia...I remember seeing boats...Anyway.....the assailant was a 'friend' and castmember of the show. The whole think was a scene from a David Lynch film...Firewalk With Me...bizarre! My disgust with this examiner is her repeated attempts at negating the event EVER EVEN HAPPENED!!!....  : The veteran reported that she was raped (see statement for details) and that it was reported during service. There were no records found in VBMS.   then  she does it again....  . There is no significant evidence of a military sexual trauma.  She then goes on to contradict herself....  Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: Rape in 1989 Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes ... Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No If yes, please describe the markers that may substantiate the stressor. there are no markers of the assault ....infuriating!!  By definition...markers are the weakest form of residuals.... Therefore, for PTSD claims relatedtoMST VA has relaxed the evidentiary requirements and looks for “markers” (i.e., signs, events, or circumstances) that provide some indication that the traumatic event happened. These include, but are not limited to: • Records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians • Pregnancy tests or tests for sexually transmitted diseases • Statements from family members, roommates, fellow Servicemembers, clergy members, or counselors • Requests for transfer to another military duty assignment • Deterioration in work performance • Substance abuse • Episodes of depression, panic attacks, or anxiety without an identifiable cause • Unexplained economic or social behavioral changes • Relationship issues, such as divorce • Sexual dysfunction After reading her statements I really wanted to get a thick lead pipe and do to her what was done to me....then when I was finished with her I'd tell her it was all in her never really happened....condascending _unt....she would have never survived  Im so angry I have to stop.... Anyway, I did get a rating of 50% for PTSD/MST 10 days later despite this examiner's ineptitude.  I really feel like she needs to be held accountable for all the horrible things she said and her assumptions and insinuations after skimming over my life. Disgusting POS I filed my NOD 4 months after the decision and now my appeal is at the DRO's office awaiting a decision.