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chrisw

Advice On Claims Decision...possible Nod

Question

I received the decision for the following claims:

GERD

I received an evaluation of 10% for gastroesophageal disease (GERD) with hiatal hernia. The decision stated. A higher evaluation of 30% is not warranted unless the record shows persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain which is productive of considerable impairment of health. Since you suffer from pain during eating, regurgitation, heartburn, and reflux that do not affect your weight or cause malnutrition a 10% evaluation is warranted.

I told the doctor in the C&P exam that my weight has fluctuated. I also told the doctor that I have pain that radiates from my chest to my shoulder. I also mentioned I have difficultly sleeping because my acid reflux is much worse when laying down. I was wondering what I should do here. Should I file a NOD?

The reason I ask is because one thing I didn't stress in the C&P exam is that fact that I can't take my NSAIDS for my knees because it makes by GERD unbearable. Also, I have been suffering from stomach cramps, loose bowels, and gas which has gotten much worse (sorry for the bluntness but that was the easiest way to state it). I suspect it's my GERD medication but I'm going to see the doctor about it.

I was wondering if it would be better to just file a claim for an increase in compensation based on the above information?

Sinusitis

I received service connected for sinusitis but at 0%.

The decision section stated that since my sinusitis is documented by x-ray without evidence of 3-6 non-incapacitating episodes in the past year a 0% evaluation is warranted. I stated in my exam that I suffer from a sinusitis episode every couple of months, some lasting for several weeks. What kind of evidence do they need? Do I need to go to the doctor every time I get sinusitis?

Allergic Rhinitis

This one doesn't make sense to me at all.

The decision stated my SMRs show that I was during a doctor's visit I was give Allegra and Singular for environmental allergies. Another exam at a later date showed I was on Allegra.

Current VA medical records stated I was diagnosed with allergic rhinitus. My C&P exam stated the examiner evaluated my nose and sinuses and found no evidence of rhinitis. The VA examiner stated there was no evidence of rhinitis; therefore, a diagnosis of rhinitis could not be offered. Although you were treated for rhinitis on active duty there is no evidence of any chronic residuals of your condition; therefore, service connection is denied. My separation exam in 2006 noted Allegra for my condition; however, there was no complaints at the VA Medical exam in 2007 and no evidence of further complaints until 2009, two years after active duty.

When I separated from the military I didn't realize allergic rhinitis was something covered so that's why I didn't mention it in my VA medical exam in 2007 although I do recall mentioning allergy medication when the examiner asked me what, if any, medication I was currently taking. The reason I didn't complain or see the doctor from 2006 through 2009 is because I was taking over the counter allergy medication and I knew what the problem was so why would I go to the doctor about it. I did recently go back on prescription allergy medication.

One of the occurrences in the SMR's for allergies was with a civilian medical doctor, I still see the doctor occasionally. I know if he felt my current allergies are directly related to the allergies he treated me for while on active duty he would write a letter stating it. Would this be enough?

Since I'm 0% for sinusitis and hoping to get it increased would allergic rhinitis be considered pyramiding? If not, is there grounds for a NOD?

Thanks for your advice!

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3 answers to this question

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One can file a NOD within a year of a decision. The criteria for each diagnosis does state the % involved with the symptomology. You do need to inform the C&P examiner during the exam, of any other related symptoms you are experiencing, and also medication side effects which may be evaluated as increase the possibility of grant too. We all know how the VA does try to low ball claims. I will try to look up some info regarding the % on these diagnoses but wanted to reply so this would get seen by others more familiar with this and hopefully they can/will reply.

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I received the decision for the following claims:

GERD

I received an evaluation of 10% for gastroesophageal disease (GERD) with hiatal hernia. The decision stated. A higher evaluation of 30% is not warranted unless the record shows persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain which is productive of considerable impairment of health. Since you suffer from pain during eating, regurgitation, heartburn, and reflux that do not affect your weight or cause malnutrition a 10% evaluation is warranted.

I told the doctor in the C&P exam that my weight has fluctuated. I also told the doctor that I have pain that radiates from my chest to my shoulder. I also mentioned I have difficultly sleeping because my acid reflux is much worse when laying down. I was wondering what I should do here. Should I file a NOD?

The reason I ask is because one thing I didn't stress in the C&P exam is that fact that I can't take my NSAIDS for my knees because it makes by GERD unbearable. Also, I have been suffering from stomach cramps, loose bowels, and gas which has gotten much worse (sorry for the bluntness but that was the easiest way to state it). I suspect it's my GERD medication but I'm going to see the doctor about it.

I was wondering if it would be better to just file a claim for an increase in compensation based on the above information?

Sinusitis

I received service connected for sinusitis but at 0%.

The decision section stated that since my sinusitis is documented by x-ray without evidence of 3-6 non-incapacitating episodes in the past year a 0% evaluation is warranted. I stated in my exam that I suffer from a sinusitis episode every couple of months, some lasting for several weeks. What kind of evidence do they need? Do I need to go to the doctor every time I get sinusitis?

Allergic Rhinitis

This one doesn't make sense to me at all.

The decision stated my SMRs show that I was during a doctor's visit I was give Allegra and Singular for environmental allergies. Another exam at a later date showed I was on Allegra.

Current VA medical records stated I was diagnosed with allergic rhinitus. My C&P exam stated the examiner evaluated my nose and sinuses and found no evidence of rhinitis. The VA examiner stated there was no evidence of rhinitis; therefore, a diagnosis of rhinitis could not be offered. Although you were treated for rhinitis on active duty there is no evidence of any chronic residuals of your condition; therefore, service connection is denied. My separation exam in 2006 noted Allegra for my condition; however, there was no complaints at the VA Medical exam in 2007 and no evidence of further complaints until 2009, two years after active duty.

When I separated from the military I didn't realize allergic rhinitis was something covered so that's why I didn't mention it in my VA medical exam in 2007 although I do recall mentioning allergy medication when the examiner asked me what, if any, medication I was currently taking. The reason I didn't complain or see the doctor from 2006 through 2009 is because I was taking over the counter allergy medication and I knew what the problem was so why would I go to the doctor about it. I did recently go back on prescription allergy medication.

One of the occurrences in the SMR's for allergies was with a civilian medical doctor, I still see the doctor occasionally. I know if he felt my current allergies are directly related to the allergies he treated me for while on active duty he would write a letter stating it. Would this be enough?

Since I'm 0% for sinusitis and hoping to get it increased would allergic rhinitis be considered pyramiding? If not, is there grounds for a NOD?

Thanks for your advice!

Sounds like you have Gerd and IBS, if rated together could warrant a higher rating under Gerd symptoms. You might want to ask your doctor for a sleep study to determine if you have sleep apnea related to your gerd or sinusitis problems.

As Always Hope the Best

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I received the decision for the following claims:

GERD

I received an evaluation of 10% for gastroesophageal disease (GERD) with hiatal hernia. The decision stated. A higher evaluation of 30% is not warranted unless the record shows persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain which is productive of considerable impairment of health. Since you suffer from pain during eating, regurgitation, heartburn, and reflux that do not affect your weight or cause malnutrition a 10% evaluation is warranted.

I told the doctor in the C&P exam that my weight has fluctuated. I also told the doctor that I have pain that radiates from my chest to my shoulder. I also mentioned I have difficultly sleeping because my acid reflux is much worse when laying down. I was wondering what I should do here. Should I file a NOD?

The reason I ask is because one thing I didn't stress in the C&P exam is that fact that I can't take my NSAIDS for my knees because it makes by GERD unbearable. Also, I have been suffering from stomach cramps, loose bowels, and gas which has gotten much worse (sorry for the bluntness but that was the easiest way to state it). I suspect it's my GERD medication but I'm going to see the doctor about it.

I was wondering if it would be better to just file a claim for an increase in compensation based on the above information?

Sinusitis

I received service connected for sinusitis but at 0%.

The decision section stated that since my sinusitis is documented by x-ray without evidence of 3-6 non-incapacitating episodes in the past year a 0% evaluation is warranted. I stated in my exam that I suffer from a sinusitis episode every couple of months, some lasting for several weeks. What kind of evidence do they need? Do I need to go to the doctor every time I get sinusitis?

Allergic Rhinitis

This one doesn't make sense to me at all.

The decision stated my SMRs show that I was during a doctor's visit I was give Allegra and Singular for environmental allergies. Another exam at a later date showed I was on Allegra.

Current VA medical records stated I was diagnosed with allergic rhinitus. My C&P exam stated the examiner evaluated my nose and sinuses and found no evidence of rhinitis. The VA examiner stated there was no evidence of rhinitis; therefore, a diagnosis of rhinitis could not be offered. Although you were treated for rhinitis on active duty there is no evidence of any chronic residuals of your condition; therefore, service connection is denied. My separation exam in 2006 noted Allegra for my condition; however, there was no complaints at the VA Medical exam in 2007 and no evidence of further complaints until 2009, two years after active duty.

When I separated from the military I didn't realize allergic rhinitis was something covered so that's why I didn't mention it in my VA medical exam in 2007 although I do recall mentioning allergy medication when the examiner asked me what, if any, medication I was currently taking. The reason I didn't complain or see the doctor from 2006 through 2009 is because I was taking over the counter allergy medication and I knew what the problem was so why would I go to the doctor about it. I did recently go back on prescription allergy medication.

One of the occurrences in the SMR's for allergies was with a civilian medical doctor, I still see the doctor occasionally. I know if he felt my current allergies are directly related to the allergies he treated me for while on active duty he would write a letter stating it. Would this be enough?

Since I'm 0% for sinusitis and hoping to get it increased would allergic rhinitis be considered pyramiding? If not, is there grounds for a NOD?

Thanks for your advice!

You must have seen the same doctor, or C&P examier i had when I first file. What I had to do was, first start going to the doctor for your sinus., Get it documented and keep a listing of your medication.

even though I had the x-rays detected sinus, and diagnose several times with chronic maxially sinuses, i still didn't get 10 percent untill after three tries, and now I am going to file for a cue.

As, for Gerd, I had to take the C&P exam to my civillan doctor and have them to write on their letter head my syptoms and problems using va wording and then I got my rating increase.

You are going to have to do some leg work to get what is due.

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