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AFMedic09
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Posts posted by AFMedic09
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31 minutes ago, doc25 said:
Getting low-balled sucks. This would actually be a good thing if you were showing symptoms rateable at 10%. But, you do not have symptoms at that rate.
If the C&P examiner noted the appliances and bladder incontinence in the exam and it was administered with a VA C&P examiner. You can look at what the examiner said exactly as you remember what was stated in ebenefits or myhealth.va.gov. You may be able to use the Clear and Unmistakable Error to re-open the claim for the "bladder injury".
Here is how the evidence, law, and ratings should have been applied:
7512 Cystitis, chronic, includes interstitial and all etiologies, infectious and non-infectious:
Rate as voiding dysfunction.7517 Bladder, injury of:
Rate as voiding dysfunction.Voiding Dysfunction: All urinary conditions that cannot be rated as urinary frequency or obstructed voiding are rated by this system. If the condition requires the use of a catheter or other urinary assistive appliance to remove urine from the bladder, or if the condition requires the use of absorbent materials (like pads or Depends) that must be changed more than 4 times a day, then it is rated 60%. If it requires absorbent materials that must be changed 2 to 4 times a day, then it is rated 40%. If it requires absorbent materials that must be changed only once a day, then it is rated 20%.
Urinary Frequency: A condition is rated under this system if it causes the body to urinate more often than normal. If you have to urinate 5 or more times during the night, or if you have to urinate more than every hour during the day, it is rated 40%. If you have to urinate 3 or 4 times during the night, or if you have to urinate every 1 to 2 hours during the day, it is rated 20%. If you have to urinate 2 times during the night, or if you have to urinate every 2 to 3 hours during the day, it is rated 10%.
Clearly and unmistakably someone didn't follow the ratings table. And that is gross incompetence on the VBA AND BVA.
Not even the BVA got it right!! It's a sad day to see this, but not surprising.
Gastroesophageal reflux disease (GERD) is a condition where the acid in the stomach travels up the esophagus. It is rated under code 7346, hiatal hernia.
Code 7346: A hiatal hernia is a hernia in the diaphragm
that allows the organs in the abdomen to move up into the chest cavity.
If the hernia causes pain, vomiting, significant weight loss, blood in the vomit or feces, and anemia, or if other symptoms cause a serious overall health disability, it is rated 60%. If there are regular episodes of pain in the upper abdomen, trouble swallowing, heartburn, the return of food into the back of the throat/mouth, and pain in the upper arm or shoulder, it is rated 30%. If two or more of the previous symptoms are present, but are not as severe, it is rated 10%.
On the claim for GERD, at the very least, 30% needed to be granted.
You can go the DAV route or hire an experienced Veteran's Law firm. Both have their advantages and some disadvantages.
A veteran's lawyer won't take money upfront, if they do, say see you later. A veteran's lawyer has to submit a form to the VA to pay them to represent you; from my understanding.(Can any forum members correct me if I'm wrong?) They may have an additional fee, but you would have to negotiate with the lawyer representing you.
DAV kind of tends to jump the gun sometimes and sends letters that have caused veteran's unnecessary stress and confusion. But, they're good at what they do; for the most part.
There's work still left to be done. In the meantime, I suggest start making appointments with a GI doctor or a Urogynecologist (Urologist for women). You want to keep building on the medical evidence you already have to show that your symptoms are still there or have become worse. Add teeth to the medical evidence.
"Never Give Up and Never Give In".
My NOD never made it to BVA (that I know of). It was transferred from my RO (St. Pete) to Fargo RO and the review officer called me, set up a C&P, and then made a decision to overturn. (Va.gov said: "Veterans Benefits Administration agreed with you and overturned their initial decision").
I am seeing a VA urogyn. who is treating my IC. I had the best of the best (one who was conducting IC research at Shands until his grant ran out and the VA picked him up), but he retired in 2017. I had to start using catheters in 2015. The cocktail I mix up to instill in my bladder was designed by him. It helps...but it burns like hell.
The only issue I do not have with GERD is weight loss (sigh). But I have every single other one. Frustrating.
I recently signed up for DAV representation and did POA on ebenefits, expecting the fight was not over..
I will call them and set up an appointment to see if they can get my C&P exam results and if we have any recourse here.
Thank you so much for your guidance.
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Comp. filed 4/2015.
C&P 8/2015
Denied 12/2015
NOD filed 12/2015
8/2018 NOD sent to FARGO RO from St. Pete due to backlog
11/11/2018 New C&P
11/30/18- APPEAL COMPLETE IN EBENEFITS VA.Gov showed Appeal Granted The Veterans Benefits Administration has agreed with you and overturned the previous denial.
12/4/18 - EBENEFITS AB8 updated (at 6 p.m.) to reflect increase rating from 60% to 70%. Ebenefits also updated SC list at this time to reflect new SC'd conditions
So, from this I see they combined my IC with my already SC'd TVT bladder sling/incontinence, which was rated 20% and now that they have combined the issues it is 30% even though I have to cath. twice daily and instill bladder medications that I have to draw up and combine myself.The C&P examiner said I use appliances, can't hold bladder more than an hour, waking 5-6 time at night for bathroom, etc. Isn't that 60% or am I reading that wrong?
The GERD (stomach hernia) is rated at 10% even though I have regurgitation, dysphagia, chest pain, and take meds. daily-have for over a decade. (I am already SC'd 0% for anemia as well).
I don't know if I should contact the DAV and see about fighting the low ball ratings or not? Where would I even go from here? BVA? I need some advice. Should I just be happy with my "win" and lay down?
I really do not understand how they come up with their ratings? No BBE yet.
VA.Gov lists the dates as Dec.1, 2015 - Nov. 30, 2018.
However, the original claim was filed 4/24/2015, denied 12/1/2015, NOD received 2/8/16. Shouldn't effective date (for retro) be April since the VBA overturned it's original decision(12-1-2015)?
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12 hours ago, doc25 said:
Typically, GERD is rated analogous to a hiatal hernia under 38 C.F.R. 4.114 diagnostic code 7346. Ratings under diagnostic code 7346 range from 10 to 60% disabling, and depend on the presence and severity of a variety of symptoms.
Code 7517: Any Injury of the Bladder is rated under this code. 7517 Bladder, injury of:
Rate as voiding dysfunction.Voiding Dysfunction: All urinary conditions that cannot be rated as urinary frequency or obstructed voiding are rated by this system. If the condition requires the use of a catheter or other urinary assistive appliance to remove urine from the bladder, or if the condition requires the use of absorbent materials (like pads or Depends) that must be changed more than 4 times a day, then it is rated 60%. If it requires absorbent materials that must be changed 2 to 4 times a day, then it is rated 40%. If it requires absorbent materials that must be changed only once a day, then it is rated 20%.
Depending on how the ratings schedulers rate you. If you meet the criteria for the highest rating for both you may be close to a 100% scheduler rating. I went ahead and calculated the highest ratings of 60% for those conditions,if granted + your current SC ratings=94%
All you would need is a 10% rating increase for one of your 0% SC conditions to reach 95% which will round up to 100%.
I do hope they give you the highest ratings. Congrats!!
Thank you! As soon as I receive word, I will post an update. I hope they rate me fairly as well, but after dealing with is appeals process...my faith is very low.
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Adkins7B,
FYI, my ebenefits was updated as appeal complete. Historical Appeals lists it as closed. No updated SC's. The disabilities I was appealing were IC and GERD. I checked VA.gov and saw this:
Current Status
Learn more about the appeals process.The Veterans Benefits Administration granted your appeal
The Veterans Benefits Administration agreed with you and decided to overturn the original decision. If this decision changes your disability rating or eligibility for VA benefits, you should see this change made in 1 to 2 months.
This appeal is now closedThe disabilities (two) they granted are: Stomach hernia and Bladder Injury (Not GERD or IC....but maybe their terms best fit the criteria?)Anyway, neither of those two granted conditions are in my disability list on EBENE. Letters aren't updated either. So, while I know they have been granted...I wait for the letter or someone in ebenefits to update the system.Good luck to you! Hope my timeline helps you.
- raidertone, Kihr and GeekySquid
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It also says, "Appeal of your December 2015 Claim Decision - Granted"
Now I have to wait to find out what their actual decision is...
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31 minutes ago, vetquest said:
Your SOC will tell you where your case stands. I am not sure what you mean about an appeal unless you have appealed an SOC and there was a DRO review. Remember that ebenefits and vets.gov can be unreliable.
Yes, I appealed the original SOC that stated I was not service connected. That was back in 2015. My case was transferred from St. Pete VRO in June of this year to Fargo VRO. I spoke with the case manager in August who set up another C&P, which I completed on Nov. 11th. Ebenefits on Tues. said "Appeal Pending - Statement of Case" and another blurb receiving my form 9 and about sending documents to the BVA (I posted about this earlier in the week).
Thurs. I called Peggy who told me to hang tight for my VA letter and call them again in a week or so if I had not received an update.
When I logged in the ebenefits to see if there was an updated letter I saw "Appeal Complete". No letter or updated SC.
So, I logged into VA.gov, which said
"
Current Status
The Veterans Benefits Administration granted your appeal
The Veterans Benefits Administration agreed with you and decided to overturn the original decision. If this decision changes your disability rating or eligibility for VA benefits, you should see this change made in 1 to 2 months.
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So, last Tues. I logged in to ebenefits and saw they had sent me an SOC for my appeal. My appeal then moved to "Your form 9 has been received we are gathering ...to send to BVA". Anyway, I called the 800# where a kind man told me to keep checking ebenefits and wait to go to the DAV as more information on how to proceed should be updated soon.
I checked today and it said "APPEAL CLOSED" in my disabilities it showed no changes and the two issues I am appealing "Not service connected", which it has stated since I filed the claim in 4/2015.
I decided to check VA.GOV.
It shows my appeal is complete and BOTH issues have been granted. However, they are listed under "stomach hernia and bladder injury"
(Neither of these are listed in E-benefits). It says I will have to wait 1-2 months if there is to be a change in my disability rating...
Will this information be in the SOC ebenefits said they were sending earlier in the week?
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Doc25, I will keep fighting. Ebenefits changed to Appeal complete with no change in my status (IC and GERD still show "not service connected"). I am guessing I was denied again. I will have to file the form 9 and keep pushing on.
The GERD I have no idea how they can deny, because I have EGD results and medical records of visits for this condition and proof of history of medications, plus been treated from VA since separating from service in 2009.
The IC, I have service records for painful urination and incontinence. I had a cystoscopy in service just prior to my TVT bladder sling (which I am SC'd for), but I do not have those results in my records. It really makes zero sense what the VA chooses to deny and grants. I am 0% for restless leg syndrome, which the VA happened to find in my service records and added to my initial claim in 2009 (it was not one I was petitioning for at the time).
Thank you for your input and encouragement. This process is truly disheartening. I have recently given POA to the local DAV, and will set up a meeting with them once I get the SOC.
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Thank you all. I know this will be difficult to be SC'd for, but I believe I should have (and would have) been diagnosed in service if they knew anything about painful urination or painful bladder syndrome back then. They just treated me with medication and antibiotics back then. The specialist at the VA ( who had been working with Shands from a grant to study IC) told me this has likely been my issue all along. I now have to cath twice daily. I will continue the fight until I can't fight any more.
I called the 800 # today and he told me to disregard the "We have received your form 9", because he said he does not see this in his system. He advised that I continue to call back for status updates and wait on the SOC before turning it over to the DAV.
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On 12/21/2015 at 5:47 PM, ArNG11 said:
AFMedic09 Hopefully you won't have to go through the hassle. However, most likely you might. Absence of evidence is NOT negative evidence. Symptoms in service is obvious from what you wrote. That is the essence of the validity of the claim that the disease occurred in service, it is a problem now and you are continuing to get treatment whether by VA or private doc. Diagnosis is horse crap. Verifiable symptoms, diagnosis is a plus but not necessary.
Am I mistaken or isn't GERD a presumptive on Gulf War Vets/Iraq/OIF OEF. ?
Hopefully you won't have to get an IMO/IME but if you do make sure to get one and don't put up with that crap. VA raters are so full of it I'm surprised that the crap doesn't change their eye color and just spews out their mouths onto their desks.
Sorry not feeling to hot and having problems of my own too close to the LZ. Give them hell!
Still fighting....had a second C&P exam Nov. 11th. and now movement in ebene.(see below)
I'm guessing they have denied me again despite my evidence and being on Prilosec all these years...unbelievable. I have just signed up for representation through DAV as I have been doing all of this myself up until this point. I have completed the POA for them...I will call them and see what they can tell..
Table of Claims Latest Progress Status Description Received 03/02/2016 Appeal Pending - Statement of the Case (SOC) VA has received your Form 9 and will begin completing final actions regarding your appeal before it is sent to the Board of Veterans’ Appeals. Date not available -
Hello all. I have been appealing a decision I was given on a compensation claim in 2015. Today I checked ebenefits and the message changed:
Table of Claims Latest Progress Status Description Received 03/02/2016 Appeal Pending - Statement of the Case (SOC) VA has received your Form 9 and will begin completing final actions regarding your appeal before it is sent to the Board of Veterans’ Appeals. Date not available This change occurred 11/26/2018. I had a C&P exam for this appeal on November 11th and mailed in all my supporting documentation. The issues are interstitial cystitis (only service records I have were for multiple visits of painful urination, but to my knowledge this disease is relatively new and unstudied..so it's not something anyone in service would have diagnosed 15 years ago) and GERD (diagnosed in service and treated since service with medication). I have been told SOC's are only for denials. So does this mean my claims have been denied again? When I requested the BVA review I don't remember if I asked for teleconference or not...I have done all of my own claims, but I recently requested representation (POA) by DAV. Any advice about the status change in Ebenefits? My rating has not changed in there, nor have any documents...
My case was transferred from St.Pete -RO to FARGO due to backlog, and that is who ordered my C&P exam. When the examiner from Fargo called, she told me if she was unable to grant my claims she recommended I get with a VSO to represent me moving forward. So, anyone have experience with this stage of the game?
I am service connected:
TVT - 20%
Hyst. - 30%
Migraines - 30%
Anemia -0%
Dry eyes - 0%
Allergic rhinitis-0%
Rectocele - 0%
Restless leg syndrome - 0%
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I filed a claim for GERD in April of this year. I had a C&P last month. I loaded medical records from service of an upper GI that was done and the reason it was ordered according to the medical form filled out by the doctor was "DYSPHAGIA HX GERD" . I just received my denial letter stating "the medical evidence of record fails to show that this disability has been clinically diagnosed". I don't know what more I could have sent to them to prove this was diagnosed in service? I have been treated by the VA since I got out of the military in 2009 with Prilosec daily, and still have some days when the reflux is terrible. I sleep with 5 pillows under me so that my head is elevated to keep the acid from waking me up. Just wondering what I should do now to appeal? I found some medical evidence today that was not included when I filed this claim where I was seen for a cold, but it shows my medications of prilosec at that time (2004), and others show I was taking Prilosec, Tums, and that list problem list of GERD. I cannot find the medical note where I was diagnosed with GERD, but I have been treated for it since I was in service, and the scope showed an irregular Z-line which the doctor explained to me after the procedure was likely due from my history of reflux. Any advice?
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Timeline on my retro in FL in case anyone is curious on timeframes for secondary SC:
Filed claim: 24 Apr. 2015
Up and down the progress chain back and forth for three months, until 5 Aug. 2015 when Preparation for Decision.(again)
ebenefits showed increased rating: 7 Aug. 2015
Retro direct deposited: 18 Aug. 2015
White envelope received: 19 Aug. 2015
Two items deferred, pending VA exams. Totally happy with the speed at which this was decided. Helps to underline, highlight, and connect all the dots for them.
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Others have reported that often when the VA doesn't request C&P's, this is a sign of denial. Of-course C&P's are not ALWAYS needed, but normally they are. I'm hoping the since my case was a case review, maybe someone is really looking into the case and not just stamping DENY to get my claim out of the backlog :P I would like to be an example of an IU claim without C&P success story, we'll see...i'll be sure to update as soon as I get the results.
SemperAye,
Just wanted you to know I posted in the "success" forum. I found out today I am rated 60%, with two contentions (the ones I added after my C&P, GERD and IC) still deferred. Not seeing any information on retro yet, but wanted to let you know. I hope you have gotten good news and haven't got back to let us know yet. :) Keeping my fingers crossed for you.
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My hysterectomy secondary to my SC TVT Bladder sling and Pelvic organ prolapse was approved. I am now: 30% hysterectomy, 30% migraines, 20% TVT Bladder Sling. Deferred items: GERD and Interstitial Cystitis (These were submitted separately after my C&P exam on Aug. 9th). Total rating currently 60% from 40% previously. I noticed also they put in Hysterectomy (Increase) along with the deferred items? I am waiting on the Notification letter. Nothing in the payment area at this time. The letter states effective date is: August 1, 2015, but I filed on April 24th, 2015. I am just thankful for this quick response, and hope that the rest will be positively decided in my favor as well. I have a lot of evidence supporting it, and expect an eventual total rating decision of 70%. Just wanted to update everyone. Good luck and God speed.
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SemperAye,
Not trying to hijack, but we are going through a similar case. I wanted to let you know my ebene. changed to Prep. for Decision today and states "Accepted". However, it says "Requested Documents are Past Due", but when I click the date link for the claim, it shows no pending documents requested, and nothing needed from me. Very confused. Watching your status, because I am hoping it is good news. :)
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I am in the same boat. Just had a C&P in July, and have had continuous treatment from the VA on the issues claimed and not had C&P's for. I'm still Gathering Evidence today. I hope you are close to getting some good news!
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Question SemperAye - Did you have C&P's for all of the conditions you are waiting to hear back on?
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Yes. I spoke with them this morning. My claim (I posted a long detailed layout on this forum earlier today) was in Pending Decision, but then went to Gathering of Evidence when another claim was combined with it. However, ebene. says they need no further information, and "Initial Review Complete". So, I have not seen this before, so I called Peggy. The gentleman informed me my claim is in the Decision phase, and the rater is undergoing a "Complex Exam Review" with the physician at this time. I am guessing this means it was sent for a Decision, but the higher ups had a question and are getting with the physicians to figure it out? I thought I was in the first phase since ebene. shows "Gathering of Evidence", but Peggy said I'm in the decision phase, and even said I should hear something soon. Fingers crossed.
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I am guessing a female would know the answer, but don't mind to talk to an experienced male contributor. Anyone with experience willing to listen, and answer what will (hopefully) be an easy question once the details come out? Would rather send p.m. than to post it all here if possible. (No offense, but personal).
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Just got off the The phone with a Veterans representative who said reopen the claim after surgery and submit hysterectomy as secondary condition (caused by already service connectes disabilities) and it will be service connected
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I moved shortly after being rated and have misplaced my ratings letter. (I requested a new one be sent to me today, but that will take a few days). I found my ratings on this site from when I posted about receiving my letter. My question is that when I was rated the rectocele and cystocele were still pending further development. Since that time I received a letter stating I was given a 0% rating, and that it was connected to my bladder sling rating of 20%. Seeing that the hysterectomy is to correct the cystocele and rectocele, does that mean they will no longer be tied to the bladder sling (Since nothing is changing with the sling, and this is still an issue I have to live with regardless of the hysterectomy) and now the hysterectomy (cystocele/rectocele) become a separate rating?
If I was rated 20% for the bladder sling with cystocele/rectocele pending then a decision rated them at 0% does the bladder sling remain 20% and the cystocele/rectocele (hopefully resolved by hysterectomy) now become a claim for hysterectomy?
cystocele/rectocele are 7623 @ 38 CFR 4.116 I am rated 0% - will this change to 7618 - Uterus removal and be separate from the bladder prolapse for which I am rated 20%? (My confusion is due to the fact that they tied the 0% cystocele/rectocele rating to the TVT sling (7625) which had already been decided at 20%)
Any advice is appreciated. Thank you,
NOD granted, Timeline, Need Advice
in Success Stories
Posted
You are right. They rated me for bladder injury, which should be rated under voiding dysfunction. In ebenefits it lists interstitial cystitis status post TVT for urinary incontinence. Voiding dysfunction doesn't have a rating schedule for 30%? Not sure why this was even applied? Waiting on my envelope so I can start filing the Form 9. Love your quote, BTW.
Thank you!