Rated at 0% - I need advice

[wrldtravlr]

I'm a Gulf War veteran and I applied for disability for Irritable Bowel Syndrome (IBS).  The rating schedule is as follows:

7319 Irritable colon syndrome (spastic colitis, mucous colitis, irritable bowel, etc.):

Severe; diarrhea, or alternating diarrhea and constipation, with more
or less constant abdominal distress..................................................................... 30

Moderate; frequent episodes of bowel disturbance with abdominal
distress............................................................................................................ 10

Mild, disturbances of bowel function with occasional episodes of
abdominal distress.............................................................................................. 0

After waiting months I was rated at 0%.  Here is what I received:

1.  We have assigned a noncompensable evaluation for your irritable bowel syndrome based on:  Alternating diarrhea and constipation; Diarrhea; Frequent episodes of bowel disturbance.

2.  A higher evaluation of 10 percent is not warranted for irritable bowel syndrome unless the evidence shows moderate symptoms demonstrated by frequent episodes of bowel disturbance with abdominal distress.

I have most of the language of 30% and some of the language of 10% but was ultimately rated at 0%.  I don't understand.  Am I correct in saying that the 0% establishes my service connection?  If that is correct, then do I need a doctor to be more clear about my level of IBS (which would be in the 30% category).  My DAV representative says I need to go to a civilian doctor and get him to write a nexus statement and have him write out my symptoms to clearly show that I am at 30%.  However, I don't think the nexus statement is needed unless I misunderstand what it is for.  Isn't a nexus statement used to connect a current diagnosis with military service?  If that is correct, then why would he recommend a nexus statement as the 0% rating should already establish service connection.

Anyway, I know that is a lot to take in, but I'm just now trying to figure out how all of this works.  If anyone with experience has suggestions on how I should proceed it would be greatly (and I mean greatly) appreciated.

Thank you,

JT  (U.S. Army 1984-2004)

[Vync]

3 hours ago, wrldtravlr said:

I'm a Gulf War veteran and I applied for disability for Irritable Bowel Syndrome (IBS).  The rating schedule is as follows:

7319 Irritable colon syndrome (spastic colitis, mucous colitis, irritable bowel, etc.):

Severe; diarrhea, or alternating diarrhea and constipation, with more
or less constant abdominal distress..................................................................... 30

Moderate; frequent episodes of bowel disturbance with abdominal
distress............................................................................................................ 10

Mild, disturbances of bowel function with occasional episodes of
abdominal distress.............................................................................................. 0

After waiting months I was rated at 0%.  Here is what I received:

1.  We have assigned a noncompensable evaluation for your irritable bowel syndrome based on:  Alternating diarrhea and constipation; Diarrhea; Frequent episodes of bowel disturbance.

2.  A higher evaluation of 10 percent is not warranted for irritable bowel syndrome unless the evidence shows moderate symptoms demonstrated by frequent episodes of bowel disturbance with abdominal distress.

I have most of the language of 30% and some of the language of 10% but was ultimately rated at 0%.  I don't understand.  Am I correct in saying that the 0% establishes my service connection?  If that is correct, then do I need a doctor to be more clear about my level of IBS (which would be in the 30% category).  My DAV representative says I need to go to a civilian doctor and get him to write a nexus statement and have him write out my symptoms to clearly show that I am at 30%.  However, I don't think the nexus statement is needed unless I misunderstand what it is for.  Isn't a nexus statement used to connect a current diagnosis with military service?  If that is correct, then why would he recommend a nexus statement as the 0% rating should already establish service connection.

Anyway, I know that is a lot to take in, but I'm just now trying to figure out how all of this works.  If anyone with experience has suggestions on how I should proceed it would be greatly (and I mean greatly) appreciated.

Thank you,

JT  (U.S. Army 1984-2004)

Welcome to Hadit!

Hey JT,
You'll find that the VA often screws up initial ratings. The majority of veterans have had to file a notice of disagreement (NOD) to get rated correctly.

A "nexus" is needed to establish "service connected" (SC) status. Carefully read your letter to determine if the VA granted SC status, even though they assigned the rating at 0%. The reason why this is important is that you can be 0% SC (which is good) or 0% non-SC (which is bad). The latter would require a nexus.

If you are 0% non-SC, do what your DAV rep said - go to another doctor and get a nexus. Because the DAV said this, I have a feeling you might have actually been rated 0% non-SC. Also, continue and read below because it will help you learn more about the VA system.

 

If they did grant SC, you do not need a new nexus and should instead focus on getting getting the rating percentage corrected.

 

1. If you do not already have them, get copies of a copy of the C&P exam results and the disability questionnaire (DBQ). Sometimes these are on my health vet's blue button feature.

2. See which check boxes were checked and then look at the rest of the exam findings.

The VA raters are human beings and they often view their job as routine. They frequently screw up on ratings and percentages. In fact, the majority of initial VA ratings are overturned by filing a NOD or later on appeal.

I looked at a C&P exam the other day where the doctor skipped the check boxes and wrote out his findings and the VA screwed up. The VA rater failed to read it properly and assigned an incorrect rating.
 

Let's compare the rating criteria vs. your rating findings:

 

Quote

 

7319 Irritable colon syndrome (spastic colitis, mucous colitis, irritable bowel, etc.):

Severe; diarrhea, or alternating diarrhea and constipation, with more
or less constant abdominal distress..................................................................... 30

Moderate; frequent episodes of bowel disturbance with abdominal
distress............................................................................................................ 10

Mild, disturbances of bowel function with occasional episodes of
abdominal distress.............................................................................................. 0

 

 

Quote

1.  We have assigned a noncompensable evaluation for your irritable bowel syndrome based on:  Alternating diarrhea and constipation; Diarrhea; Frequent episodes of bowel disturbance.

For a rating percentage, it would be between "with more or less constant" (30%) compared to "frequent" (10%).

However, take a look at the semicolon. That means "either/or, but not both". If your doctor diagnosed you with "severe" symptoms, that should be good enough to qualify you for 30%. You don't have to have "severe" plus everything else on the rest of the line. See if any of your medical treatment records diagnose your symptoms as "severe". If they do, make sure the VA knows this. If you want to see a good example of semicolons used in rating percentages, look up the rating tables for spine or mental health.

 

Additionally, read the content on this link: http://www.veteranslawblog.org/zero-percent-va-rating/
 

[Gastone]

We need to see a redacted copy of your C & P DBQ. Was the Dr a Gastroenterologist?

Do you have SMR's, Private Dr or VA Clinician Notes indicating the severity of your condition? Something that would back-up the Moderate rating.

The important thing is, you got the ICS SC, right. If you think your Medical Records currently contain substantiating evidence, you could file for an "Official Review" immediately, probably won't work but worth a shot. You still have the remainder of the 12 months from the date of the Award Letter to file you NOD. Keep in mind, to use the DRO Appeal Process Review or Hearing, you MUST submit New & Material Evidence, that was not available to the original Rater. Do you have anything that would be considered, compelling N & M Evidence?

As time progresses, you can file for increases if evidence shows a worsening condition.

Semper Fi

[Navy4life]

IBS is very hard to get S/C so at least you are 0% and can now either appeal or request an increase.  I am S/C 30% for IBS because the evidence was evident.  Some times the rater misses the issues so if you have the SMR's showing the issues, been seen by a Gastro doctor, have the colonoscopy's, and any and all documents to warrant a hire rating, submit them.

[wrldtravlr]

Vync,

Thank you for your reply.  I feel fortunate that there are vets out there that have experience in this that are willing to give advice. 

After looking at my rating, my DAV rep said the 0% meant that I was service-connected, but that I also should get a nexus statement from my civilian doctor.  I took your advice and downloaded my VA medical record using the "blue button."  Here is what the C&P doctor wrote:  

"The veteran does not have an undiagnosed illness,but DOES HAVE a diagnosible but medically unexplained chronic multi-system illness of unknown etiology,specifically IBS. He does not have a diagnosible chronic multi-system illness with a partially explained etiology.He does have other issues with his shoulder and back with a clear and specific etiology and diagnosis.The veteran DOES HAVE a SW Asia chronic disability pattern,specifically irritable bowel syndrome."

Additionally, I thought that gulf war veterans with IBS were automatically given presumptive service-connection.

I went to my civilian doctor and he is doing the VA Form 21-0960G-3 and a nexus statement (just in case).  After reviewing my C&P exam that I downloaded from Blue Button I believe I know why the rater gave me a zero.  I think the doctor checked the wrong box.  As you can read above it is clear that my doctor says I have IBS.  He writes about my 3-4 instances each day.  He writes about alternating diarrhea and constipation. Then, inconsistent with the above he checks NO for the following question:

Does the Veteran have episodes of bowel disturbance with abdominal distress, or exacerbations or attacks of the intestinal condition?

I hope that this can be cleared up by my civilian doctor checking the correct boxes on the form and clearly stating my symptoms.

After getting my feet wet with all of this I realized (and my civilian doctor mentioned) that my hemorrhoids and my diverticulosis may be secondary conditions caused by my IBS.  He said he is willing to fill out the appropriate paperwork for those ratings as well.

My question is should I also turn in the paperwork for the diverticulosis and hemorrhoids with the IBS reconsideration or do it separately after my IBS reconsideration?  

Thanks,

JT

U.S. Army (1984-2004)

Edited July 16, 2016 by wrldtravlr

[broncovet]

Since you are "service connected", even at zero percent, you need not worry about a nexus, it has already been provided sufficient for VA to SC you.  

YOu need to show that you meet the criteria for the next higher rating, in your medical records.  If you feel you do meet said criteria, then you should appeal the disabilty percentage.  

You can also "ask for an increase" if your symptoms have worsened, but, to preserve your effective date, you need to appeal the percentage.  Of course I dont know "when" your symptoms reached 30% or whatever, but you probably do.  You can also appeal AND ask for an increase, they are not mutually exclusive.  

[Carl the Engineer]

You are service connected.  Thats the good (great) news.

Now fight for the right %.  What he said ^^^^^^^^^.  NOD to keep the date, or increase to get a better %.

Also, learn about your disabillity (I know nothing about IBS) and develop a stratagy for recongnizing conditions that you can claim as secondary to you IBS, etc...  Thats where the money is (not literally, but yes).  I recieved two 20%'s secondaries from an original 10%.

Good luck,

Hamslice