I really need you guys help!

[garion]

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

[Navy04]

Sounds you need to put in a NOD with the new evidence. Fastest way would be just to reopen the denied condition which is what I did multiple times and was awarded SC in the end. Also remember that multiple conditions can be grouped under one. I have a ton of Intestinal, Esophagus and Crohns Disease and they are all under 1 condition at 30%. Also if you are at 90% currently it will still take quite a bit to get to 100%. As you can see from my Signature, it took a lot of bad stuff to reach the 100%. If you reopen the denied condition, then you will be granted back to when you submit the button on ebenefits, if you do a NOD then the VA will back date to when you originally filed, but it will take longer for the claim to complete. Only you can decide what path is best for you. Good luck and keep us posted. God Bless

[garion]

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%.

Edited February 3, 2016 by garion

[broncovet]

Remember, its tough to go from 90% to 100% with the combined rating system.  

If you are at exactly 90% then it takes an additional 50% in ratings to get to 100%, because of VA math, not an additional 10% like your math teacher taught you.  

[Gastone]

Your 1st mistake was thinking the C&P would go a certain way and deciding to sit on your additional evidence.

You could have your VSO at the RO walk this New & Compelling Evidence down to the VA Rater that handled your claim, see if he'll do an on the spot Reconsideration. Good luck with that.

If the above doesn't work, get on the NOD Train. You could ask for a DRO Review based on your New&Material Evidence, that WASN'T Available for review by the original Rater. If you really think this Med Evidence would seal the deal, you don't need the DRO Hearing that can take a couple of years.

Send in your New Evidence with a "Sworn Affidavit." VA has a reg regarding receipt of N&M Evidence post Denial, requiring a SR Rater or DRO to review the Evidence with respect to the Rater's Decision. This could happen well in advance of the Official DRO De Novo Review.

Semper Fi

[garion]

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?