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How to Get your VA C-File


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    • IME and Physician conflict of interest
      Instead of continuing a thread that dealt with CUE and beating a dead horse I thought it wise to start a new thread. In the pursuit trying to fixed my messed up claim I finally have found a physician that does IMEs Here is how he responded to my email explaining my situation: <...> "I read your email. It does sound like you could use some assistance.  A bit about myself. I do perform IMEs for civilian cases but I am also employed by a company that is contracted by the VA to perform similar disability assessments. I will have to check with my employer to see if your case presents a conflict of interest." <...> Of, all the flipping luck!!! I responded and explained further my situation. Hopefully he responds soon. That said, I need any advice possible on what I should do next.  I know this could be a blessing or this could be a curse, I don't know which...
    • Gulf War undiagnose illnesses and Chronic multisymptoms
      http://www.ngwrc.org/docs/2016 SelfHelp Guidedraft.pdf    this is a really good resource.  read it.
    • Should I file a CUE or leave NOD in place?
      Peggy is the name of the Eastern European accented dude on that tv commercial, someone calls a service center for some issue, and he answers the phone "Hello this is Peggy" or something like that. Semper Fi.
    • VSO
      E-Benefits never seems to have the most correct status's for claims. A lot of the time, it is just wrong.  I am a CVSO, I log into the systems and in SEP or VVA, I can see who looked at the Efile last, where it is, and what is going on. I will NEVER be able to tell you anything, when it comes to a timeline as the VA has no timeline.  As a CVSO, I advise and assist. I don't work at the VARO, so I cant speak for the VSO's at the VARO's but the AL, VFW and DAV folks there are very much so overworked. Many of them are great but if you want someone who can dedicate 20 or more hours on just your claim, you need to go to a CVSO or someone else. They don't have the time to dedicate that much time in one sitting and as such, it takes a long time to get all of the research done.  2. MOST vets just bring us a page or two OR several hundred pages of medical records and say they want to file a claim for something and they left the service more than 20 years ago. AYFKM?  You want ME to do ALL of the work?  These claims, I will sit on. I will work them when I can.  YOU as a vet, should go through your medical records and pull out the pages that are pertinent to your claim. You should also go ahead and already have/have requested the records from NON VA care. I cant start your claim and then wait for you to get them...whenever... and then dedicate all sorts of time finishing it. Bring me something at least partly done. This will save me considerable time. You know your injuries and what happened in service far better than me. I will never put less than my maximum in claims preparation. However, if your claim requires a weeks worth of labor, it might take a while as I have TONS of other things to do as well. You are your best advocate but you also need to be responsible for your stuff as well. NO VSO knows everything....we are trained in most things. the rest, we learn as we are exposed to it. No two claims are identical and require significantly different things, even if both are 'ischemic heart disease' they will still have everything else different. Yes, some VSO's are better than others and the good ones have stacks and stacks of files on their desk and in their drawers. If you want an excellent claims prep, you need to do some of the busy work yourself first. We can look at what you have and help by making changes and telling you what you should find or how your doc should write your nexus or current diagnosis letters. But your doc and I cant talk about you to each other. This is where you need to take charge.   Your successful claim is just as much your responsibility and time as it is your VSO's. If you have unrealistic expectations, ie. they will dedicate ridiculous time to you alone, then you already lost your claim. am I a jerk..yes. Do I sit on some claims? yes. they take time and with a 0966 filed, I have a year to get it in. Will I put best effort into your claim? YES!. Can you, the vet, help? You MUST...     I'm good, I get claims passed (~60%). BUT...Many are denied. I can only send in what you give me. If you give me garbage and expect a miracle, you will be disappointed.
    • Mental Health C&P
      Thanks to all of you for your input.  I am really grateful.  As an update, I had my C&P yesterday.  The Dr had a copy of my evaluation that I had when I was seeking a diagnosis for my chronic pain.  The Dr back in 2012 did tell me that she did not think my pain was all in my head.  What she failed to tell me was that "the patient is suffering from depression and anxiety and should begin treatment.  Will follow up with her in 2 weeks".  I was never told to schedule an appointment or that I was suffering (in the clinical sense) from anxiety or depression.  I never went back to Mental Health and I definitely would have if I had been told.  I guess that is neither here nor there, but, I suppose that is my service connection right there.  The Examiner also told me that I should seek therapy which indicates to me that he thinks I am still having some difficulty with life, etc.   As far as his questions go, there was a pretty in depth framework he was required to follow with specific questions.  He was really open and empathetic.  He stated up front that it wasn't a therapy session and that I might feel rushed.  He also said that he would move on the next question once he felt he had enough info to answer one.  He also said he wanted me to feel heard, so if I had more to add that I needed to assert myself and make sure I told him.  He did start at birth and moved forward from there.  Asked about my family unit growing up. If I suffered any abuse?  If I could maintain social relationships?  He asked how school was for me both socially and academically.  He asked about my deployments and about my current family situation.  He asked how many children I have and what # marriage I am on.  It was a rather in depth interview.  At the end, he asked if I had any other symptoms or information to add. He also gave me the opportunity to ask him questions about the exam.  
    • Fully Developed Cue
      There are no in service treatment records of bipolar disorder.  My first hospitalization for it was 5 months after discharge.  PTSD is the only way to service connection because of it being presumed.  Direct SC for bipolar would be a hard fight indeed.
    • Sleep Apnea Granted
      Because if one of us dies from SC in our sleep and its not service connected our spouses do not qualify for DIC. We are well aware that our other claims are subject to scrutiny but once they have been SC'd once its a lot harder for the VA to reduce without evidence, even without any protections- they still have to produce medical rationale to justify a reduction.      CAS  
    • Sleep Apnea Granted
      Most of you responding in the comments that are saying that this is great news, how you want to get your Apnea SC'd are all already reporting that your at 100%.  WHY???? Your at 100% already. Leave it alone else you run the risk of losing that rating. By filing a new claim, unless your at the 20 year protection, you run the risk of EVERYTHING being re-evaluated and reduced. You can't get more than 100%. Yes, there are some special schedulers out there, but unless you are missing limbs or eyes, ED is about the only one you should ask for. For those at less than 100%, it might be worth pursuing, but my warning applies to you too. You file a new claim, you run the risk of a reduction. I assist vets as a job. yes, I'm 100% and working. I would get fat and more lazy and then die a quick death if I didn't work, and by work, I sit on my butt behind a computer. I see reductions all of the time. PLEASE...think before you file, then file smart.
    • Bells Palsy
      I have documented evidence in my service medical record that I had numerous episodes of Bells Palsy while I was in service and the VA denied the SC!!! Their reasoning is that I did not have any residual effects from the from the Bells Palsy episodes... WTF!!! How can I be denied for something that was CLEARLY evident in my medical records and is evident on the right side of my face as being a little bit droopy!!!  But, anyway I also filed a NOD in Feb 2015 to appeal the decision (still waiting on the VA) and I sought and got a medical exam for the condition. The neurologist performed the medical exam and he stated that the results of the neurology test does show that there is some residual effects still present from the Bells Palsy. Which is what I thought because you will never completely recover from paralysis on one side of the face and I don't know how the VA don't know that! Will the VA SC me for based on the Neurology test or would I have to get a nexus letter from him to further substantiate my the bells palsy condition? Any information will be helpful in determining what my chances are with getting SC.
    • Confused --- what am I covered for?
      Hi, new to the forums. I wish I had know about this before I filed my claims. Anyway, I have chronic shoulder and neck pains that are documented in my medical file. I got denied "service connected" on it and now I'm wondering if I can still get 'help' from the VA or do I need to go to a private medical insurance. I'm a twice deployed OIF vet and I was told I had 5 years after discharge for coverage. The VA representative said that 5 years applies to ANY symptom -I- think is service related. Also, I'm rated in 'Priority 1', does that mean I get coverage without co-pays for ANY condition or only conditions that are service connected? Basically, ten years down the road, can I still go to the VA for my shoulder/neck pain as a priority 1 patient or am I out of luck? Do I still have a co-pay? I plan to appeal the neck and shoulder pain. I'm actually quite shocked it was denied. The examining doctor acted like I was making it up but I was getting treatment for it for 6 years before I was 'involuntary separated' due to force reductions. So my plan was to go 20 years and I wasn't even aware I could get VA disability payments until the mandatory VA briefings I had to attend. Thanks in advance.    

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gousto64

Gerd Claim

10 posts in this topic

DECISION

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

REASONS FOR DECISION

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.

I NEED HELP WHAT SHOULD I DO NEXT?

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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?

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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.

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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 .

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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.

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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.

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These folks are exactly right! I was awarded 10% for the same conditions you have (hiatal hernia/gastritis) secondary to medication prescribed to treat chronic pain from service connected cervical spine condition. All NSAIDs. The VA C&P examiner (a PA) of course found against my claim and said it was not caused by NSAIDs, but I have private insurance (TRICARE) and had the doc that performed my endioscopy sign a letter that he believed NSAIDs were " at least as likely as not" a causual factor and that he instructed me to have my primary physician discontinue the use of Mobic or Motrin and try tramadol. Bottom line is get an IMO like this from a DR. Hope this helps. s/Mags

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I have the first C&P exam from the NP for the month of Feb ,but no one at the VA hospital or the C&P exam unit has any record of a second C&P exam for the month of March.

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I have the first C&P exam from the NP for the month of Feb ,but no one at the VA hospital or the C&P exam unit has any record of a second C&P exam for the month of March.

YOU GOTTA BE Kidding, puulease, tell me you jiven' me!

You were given a C&P, that was FAVOURABLE to your claim in February, then the VA denies your claim, based on what they told you was an "UNOFFICIAL" claim, done by some UNKNOWN doctor, supposedly in MARCH and the VA bases their DENIAL upon this MARCH C&P.

And, yet, NO ONE HAS A COPY? THE VA HOSPITAL NOR THE C&P EXAM "UNIT" HAS NO COPY OR RECORD OF THIS C&P!

AND, the VA Wonders Why we Veterans have NO RESPECT for the VA?

OKAY, ALL YOU VA FOLKS, WHERE THE HECK ARE YOU? "LUCY, YOU GOT SOME 'SPLAININ' TO DO!

This, is ALMOST the most ASSANINE thing that I have heard of, YET!

I AM SO P.O'd...............SOOOO MAD.......I was working on a couple of claims for a new friend of mine and I've gotta just stop........before my "Inner-Demons" begin to show up in HIS claim!

I gotta go turn a goat over!

There is NO excuse for this..........this is out and out FRAUD!

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And another thing the only law listed for their decision is the 38 cfr cowards nothing to challenge.

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