No medicine for bladder

[Holllie Greene]

Hi,

I went dark for awhile (cold/flu, appointments, general nonsense) but I am back now.

Perhaps I have new evidence:  per a VA urologist no bladder control medication is appropriate for my Hypotonic bladder.  Those bladder meds we all see on TV are for Hypertonic bladders.  So, in light of this information would it be worth it to put in a NOD?

Have a good day my fellow Veterans.

H

[Vync]

Possibly, but that would depend on how the VA denied your claim. Posting their justification (without any personal or private info) can help others here to try to help you out.

I have talked to some guys who had hypotonic bladder and they mentioned being given Tamsulosin (Flomax). Results were mixed, but I'm no doctor.

[Holllie Greene]

Hi Vync,

Thanks for responding to my question.  Here is the background:  approx. 2.5 years ago I had a C&P done by a neurologist (I was at 40% for neurogenic bladder), the decision came back with a 60% bladder.  Please note I have been 100% P & T for more than 10 years and MS is static...will only get worse.

Last May I had a major exacerbation (still lingers and I am still using a walker), my husband quit his job to take care of me and all the household duties,  and I put in for an increase.  At the C & P I saw a neurologist (D.O.) and a psychologist.  The results were/are the 60% was reduced to 40% (say what...major shocker) and the adjustment disorder was increased to 50% from 30%.

To my lay person's mind it looks like they played with the numbers to keep me at 100%.  But I could be wrong...

Meanwhile, my bladder controls my life.  The VA urologist seems ok and he told me and wrote on a piece of paper I have a hypotonic, flaccid bladder.  He prescribed a mild bladder drug (Trospium) but made the point this is not the drug for me, there are no drugs for my bladder.  Per him, I am only to use the Trospium if I have to leave the house for appt.s.

Thanks for reading this Vync.

H

[Vync]

@Holllie Greene

I have been through a SC rating reduction before, but it was found to have been reduced incorrectly. It might be worth the time to go through the rating letter to see if you might have been reduced incorrectly.

 

I am not too familiar with the rating criteria, so I looked it up:

 

Quote

 

The Genitourinary System

§4.115   Nephritis.
§4.115a   Ratings of the genitourinary system—dysfunctions.
§4.115b   Ratings of the genitourinary system—diagnoses.

 

 

I found "neurogenic bladder" here, which referred me to look up "voiding dysfunction".

Quote

§4.115b   Ratings of the genitourinary system—diagnoses.

Rating

Note: When evaluating any claim involving loss or loss of use of one or more creative organs, refer to §3.350 of this chapter to determine whether the veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.

7542   Neurogenic bladder:

Rate as voiding dysfunction.

 

 

I found "voiding dysfunction" here:

 

Quote

 

§4.115a   Ratings of the genitourinary system—dysfunctions.

Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following section provides descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decisionmaker to these specific areas dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis.

Voiding dysfunction:
Rate particular condition as urine leakage, frequency, or obstructed voiding
Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day	60
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day	40
Requiring the wearing of absorbent materials which must be changed less than 2 times per day	20

 

 

It is important to read the text preceding or following the rating criteria tables. In this case, they are saying there could be other factors. Based on that, I would recommend checking the VA letter and see if they used the "voiding dysfunction" criteria to reduce you from 60% to 40%. To me, it looks like the frequency of changing absorbent materials or wearing an appliance appear to the be criteria.

Additionally, it would be worth double-checking the C&P exam and/or DBQ to see if it lines up with the criteria. I have had instances where the VARO incorrectly interpreted the findings and I have to NOD to get them corrected.

 

I hope this helps.

 

[Holllie Greene]

Hi Vync,

I can't thank you enough for your help.  The time, effort, explanations, and research is very much appreciated.  Thank you.

After studying the letter three times, I found the rater(s) have in the letter that my neurogenic bladder shows improvement.  Really?  Stop the presses...alert the world that MS related hypotonic bladder can improve.  This is untrue.

I also found the frequency and changing of absorbent materials  information (the frequency and changing part) to be incorrect on VA's part.  VA also got it wrong with the voiding dysfunction...my bladder is of the urgency type not the stress incontinence type.

Mega shout out to my husband who buys the pads at the commissary each week.

Vync, you have been a terrific help, I am very grateful to you.  Thank you from the bottom of my heart.  I know what I have to do now.

Happy Friday and have a good weekend.

H 

[Vync]

@Holllie Greene

Thank you very much for the kind feedback. Glad to be able to help you out. It's just about knowing how the red tape works and were to look to find answers. With the VA, they tell us to trust them, but I say we can only if it has been verified by us.

It might be worth it to have your husband write a buddy letter on your behalf. Include objective details of the frequency if changes, how often they are purchased. If he was with you at the exam, he could also attest to what you told the examiner. He could even go so far as to indicate how many are in a package and how long a package lasts given your frequency of changes.
  Just keep it objective (fact based), not subjective (opinionated).

Since the exam was about a year ago, I assume you received the decision letter a month or so later. Consider filing a NOD challenging the reduction. Also, it is worth the time to look up on Hadit details of how to write a good buddy letter, correct forms, and recommended affidavit-like statements.

Good luck!

[Holllie Greene]

Hi Vync,

oh I totally agree with the trust but verify way of thinking.

My husband is willing to write a buddy letter with all the details.  He accompanies me to every appointment and despite this, there are still inaccuracies when I check the treatment/appointment notes.  Can these folks ever get it right?  He will keep the letter objective for sure, just the facts.

Yes, the exam was about one year ago and he will be on this site to learn how a good letter is composed.  Hadit is the best site for sure.

Well, have a good rest of the weekend Vync and thank you again for your help.