[Is a NP ok for IMO?]

I am very confused. I have a NP as a PCP. I also see a NP most of the time when I can't see my Spine DR. I am having my Spine NP write an IMO because the DR refuses. I was told by a DAV rep that I should not have a NP write the letter even though she is experienced with nerve and spinal conditions. He said the VA will give it as much weight as if I wrote it... Any ideas?

[What do I do next? Denied Acid reflex/GERD 2nd time]

4 hours ago, GBArmy said:

Ronnieusmc0311 I would not bother with HLR. I would go BVA. If you think you want to get additional medical evidence regarding the nexus, apply with additional evidence. Otherwise, you are saying the VA simply isn't giving adequate weight to your evidence.If you choose additional, get a specialist's opinion to support your PCP. The rational should state specifically what medical articles/findings you are referencing and include them in your appeal, rather than just say "it is well known from literature."  In other words, give it to them on a silver platter. I believe you have a good shot,  IMHO. Certainly worth a try.

Ok, thanks again GBARMY. I will need to see specialist.

[What do I do next? Denied Acid reflex/GERD 2nd time]

Hello again, I just received my letter for my supplemental claim for Acid Reflex/GERD and it was denied.

When I started this claim, I initially tried to link asthma medications to Acid Reflex/GERD. I had an IMO form my PCP. That was shot down and eventually I was denied because the VA had 2 negative opinions, one from the C&P examiner (who wasn't a specialist) and a DR. who was tasked to clarify on the claim.

After I received the denial the first time, I filed a Supplemental claim. In this supplemental claim I stated that I believe that my Acid Reflex/GERD could be a combination of medications I take for service connected disabilities (An IMO was provided) I.E.: Lorazepan (anti-anxiety), Flovent (cortecosteroid),  Albuterol (Beta-2 antagonist), Long term use of NSAIDS for Migraines, Ketorolac (Potent NSAID) etc. I also mentioned I was deployed to the Gulf of Aden on a West-PAC Marine expeditionary Unit, I told them I was on the USS Bonhomme Richard (LHD-6), which I was. The reasons for their denial: They found I was in East Timor when on deployment and not in the Gulf of Aden (this was only one stop, we ended up in the Gulf Of Aden and DJibouti) they also did not acknowledge that I was on the USS bonhomme richard, they said they could not find evidence.  They acknowledged I was in the Gulf. They said no evidence shows the disability is related to a service connected disability, nor that it was claimed while in service (which it was not). 

Remarks: The VA did not take into account that I had said that my GERD was caused by the many medications I take for service connected disabilities which caused my my GERD. They kept it as I was trying to Service connect my GERD to my Asthma medications like before in the original claim which I was not. They also claimed I did not serve in the Gulf of Aden but confirmed that I was in the Gulf. Here is the letter that my PCP wrote for this supplemental:

I am writing on behalf of RONNIE REDACTED, born on 04/03/88 who is under my medical care. I have been asked to write a statement in support of the veterans claim. I have reviewed Mr. Jaques medical history and noted the circumstances and events of his military service, which include his service-connected asthma and migraine headaches. Mr. Jaques has been my patient since July 2019. Per the patients verbal report he has been diagnosed at the VA with moderate persistent asthma, migraine headaches and PTSD. Mr. REDACTED suffers from symptoms of heartburn, dysphagia and indigestion frequently while taking asthma medications Flovent, Albuterol and multiple rounds of prednisone for asthma exacerbations which increases his symptoms. My Patient has also used ibuprofen and ketorolac to control his service-connected migraine headaches for several years.

Based on the above it is at least as likely as not that Mr. REDACTED symptoms of Acid reflex (GERD) is a result combination of the long-term use of asthma medications and long-term use of NSAlDs. It is known from literature that beta 2 antagonists such as Albuterol have a relaxing effect on the Lower esophageal sphincter (LES) which contribute to Acid Reflex/GERD symptoms. Long-term use of NSAlDs has also been shown to irritate the lining of the esophagus causing symptoms of acid reflex/GERD.

Where do I go from here? Do I file another Supplemental? Do I need more information? what would be my easiest route? Thank you.

 

[Veteran Friendly DRs in Arizona?]

Hello! I was wondering if anyone knew veteran friendly DRs in Arizona, as a PCP or those who do Evaluations and IMOs? I am aware of DR. Anaise, but I don't have the money to pay for an IMO and he does not do physical evaluations. I am looking more for a PCP (I have tricare prime).

[I have an IBS question]

4 hours ago, Buck52 said:

There are 3 main elements to submit when filing a claim (21-526ez)

It is most important that a veteran understand the basic elements he must prove.

For service connection, he must be able to establish (1) an in-service event or occurrence; (2) a present disability; and (3) a link between his present disability and the event in military service.

So I meet criteria # 1 ( 2 incidents with stomach issues). Does number 2 have to be diagnosed by my PCP, cause I also have that. How Would I go about with #3? An example would be good.

[I have an IBS question]

Hello, My question is, How do I go about getting my IBS service connected?

I just went through my SMR and found that in 2009 I was experiencing "Fever, chills, and the inability to hold down food" after Eating. My wife prepared food and I ate, felt sick and vomited for hours. Mind you, none of my family got sick. Then when I was on Deployment to the Gulf (USS Bonhomme Richard LH-6) I had Acute Gastroenteritis (thats whats labeled on the paper) after departing from Thailand a month prior, we ended up in the Gulf Of Aden. Then in 2015 when I had already got out, I had a stomach issue which resulted in me being constipated and bloated for 2 months which is documented in a Private Medical file from my old PCP. Ever since the issue on Deployment I have suffered with gas, pain, and bloating which also causes Acid Reflex/ Gerd (which the VA denied me for). That is all the records I have. Where do I go from here? Thank you.

[Can someone Give me advice?]

6 hours ago, GBArmy said:

ronnieusmc0311 Well it doesn't sound good, I admit. Don't see the reason why a rep would have a dialog with you and then set you up impling a denial. But they really aren't supposed to tell you anything before you get your letter. In any case , you have to see what is in your letter for your next move, as pacmanx1 suggests. It could be supplemental or, BVA. Personnally, I doubt HLR would work, but then I haven't seen the denial letter either. As long as you keep within 1 year, no need for an intent to file; not needed. What happened in the process, going back and forth isn't so unusual. Happens a lot and ebenefits isn't reliable anyway on reporting status, so it is what it is. Get your letter. On your back issues, yes it is supplemental for an increase, and also if you were denied once before. Just remember, you need medical evidence from a doc that they are service connected. Once you get a denial on something, you need new evidence from a doc, not your opinion, that it is "at least as likely as not" s-c, and why. So you want your specialist to have rationale that your condition is related to your L5s1, since that was already shot down.

The Spine Specialist has agreed that my Sciatica is indeed connected to my L5-S1 narrowing and which is putting pressure on the nerves. She has said she will state that my sciatica on both legs is "more likely than not" due to my Spinal Stenosis (narrowing of spine and disc deterioration). My lower back injury is service connected at 10%, if she says my sciatica issues are the caused due to my lower back injury, is that enough or does she need to say "service connected" as the VA already knows about my service connected lower back.? thank you.

[Can someone Give me advice?]

24 minutes ago, pacmanx1 said:

Your post is a little confusing, first you said that you talked to Peggy today (Peggy is anyone at the 1 (800) 827-1000) , then later you stated you called Peggy last week and she said your claim was pushed back to development. You can either file an intent to file a claim or you can go the supplemental claim route, it is your choice. In reference to your acid reflux claim, unfortunately, wait for the rating decision before you get too upset. As for your back condition, keep in mind that with a new IMO will come a new effective date unless you can prove you had this same ratable condition with medical evidence proving it back in 2014.

What I meant was, I spoke to "Peggy" today and she told me a packet is on the way, kinda hinted it was denied and ebenefits shows nothing. I also mentioned I called last week and they said it was back in the developmental phase, which is quick because they went from Developmental phase, to decision, back to developmental phase to completion within a week. In refernce to my back, when you say "a new effective date" do you mean that the date will be when the new claim was filed? and what is the problem with that? Thank you!

 

[VA Second Opinion?]

On 5/14/2020 at 5:21 PM, Hucast21 said:

This seems to be a common tactic by the VA, which is why I immediately sought legal representation when my initial claim was denied.

If a veteran goes at it alone, even with an IMO with nexus, submitting the IMO too early just gives the VA more time to come back with a second opinion. The way my attorney explained it to me was like this:

1. Have a board-certified specialist look at your claims file and render an IMO with nexus.

2. Sit on the IMO and submit until the very last, so the VA doesn’t have time to come back and ask for a second opinion.

3. More than likely, the rater or DRO will uphold the previous denial because the VA wasn’t given enough time to refute the strong probative evidence (IMO with nexus) in favor of the veteran.

4. Appeal to the BVA, and at the hearing, point out the ridiculous decision of how the rater/DRO gave more weight from a NP than a board-certified specialist.

VA disability attorneys/lawyers learned their lesson many years ago when they submitted favorable evidence for their clients too early, only for the VA to turn around and ask for a second opinion.

WHo do you suggest I speak to? in terms of Lawyers, I think they did what you just said, the guy on the Phone (VA) kinda hinted to me my claim was denied, even after everything was in my favor... Man, I never had trouble with claims back in washignton state, as soon as I moved to Arizona, DENIED DENIED DENIED!.

[Can someone Give me advice?]

Ok, So I called the VA regarding my Supplemental Claim for Acid Reflex secondary to Multiple medications for Multiple service connected disabilities. As I spoke to the gentleman on the phone, we got along and talked about infantry stuff etc. After our chit chat, he told me my claim was finished and a decision was made as of today. He said a packet would be out tomorrow. I said "well, usually I see something on Ebenefits, so I guess its not a good decision", he said "legally I cannot tell you anything because you don't have the packet, but if you disagree with it you can always appeal". I took that as, I was denied, even after All the information from my PMC, a note from a specialist and a positive phone exam from a Dr.. I called the VA last week and they said my claim was pushed back to the developmental phase because they wanted a opinion from another DR. At that time I figured they were trying to deny me. So, what is my next step in this process? Do I go straight to BVA?

Last question, I just had an MRI for my Lower back, turns out I have Spinal Stenosis (narrowing of the spine) which is causing pain everyday and incapacitation episodes every few months (I am service connected for Lumbar degenerative disc disease 10%). I believe I rate an increase so should I go the supplemental claim route? Also, Back in 2014 I was trying to get my Sciatica service connected due to my back, well I was denied as the examiner said it wasn't service connected, I was dumb and younger and didn't really bring info or disagree with the decision. My Specialist for my Back says it is related to my L5s1 injury which is already service connected and she is writing me a letter, Do I also do a supplemental claim on that? thank you, I know its alot.

[VA Second Opinion?]

6 hours ago, 1454th Solider said:

They maybe deciding your claim through ACE (acceptable clinical evidence) due to COVID-19. Your phone examination was done by a VHA examiner for DBQ information and the VA contracted doctor is assisting in the DBQ but not service connection opinion, the rater may have already established that, but the VHA doctor's DBQ wasn't fully filled out or they didn't know how to rate it so they need a second opinion.

The ACE process involves C&P clinicians completing Disability Benefit Questionnaires (DBQs) using the medical evidence currently in existence and a Veteran's claims file or medical records, supplemented by a telephone interview with the Veteran if necessary, instead of requiring some Veterans to be examined in-person.

https://www.navao.org/wp-content/uploads/2017/01/DMA-Fact-Sheet-16-005-ACE-Process-12-16-16.pdf

Make sense, Well I guess I'll know soon enough, I have 3 other things that need upgrading in terms of service connected disabilities, so its only a matter of time for me to rate 100% (i am at 94%)

[VA Second Opinion?]

Hello, I have been persuing a VA claim for over a year now in regards to Acid Reflex/GERD. I was medically retired from the Marine Corps for Asthma (30%). When I filled this claim, I was trying to Service connect Acid reflex/GERD to ASthma medications. I had a my private NP-C write a letter and added some information that shows connection between my meds and Acid Reflex. I then saw a VA P.A. for an examination. She wrote against me and the VA followed up with a second opinion from a DR at the VA. When I received this decision, I filed a supplemental claim. I had my private NP-C write a stronger letter with more substance to back up my claim. I also had my Asthma specialist DR write a quick note stating my inhaler "may" cause Acid reflex symptoms (I tried to get a substantial letter but he refused). I also typed a letter stating that I do not know (this is why I did a supplemental) if the asthma meds were the only thing causing my acid reflex/GERD. I stated that I also use Lorazepam for PTSD (service connected), I take Acid reflex medication prescribed from the VA, and I have been taking NSAIDS long term for service connected Cervical neck strain/Migraines. I also stated these symptoms manifested during my Sea service deployment to the gulf of Aden. At that time, I was prescribed Advair for asthma and still deployed. I basically connlcuded with, I believe it may be a combination of these medications that have contributed to AcidReflex/GERD.

So, for the second part. I was ordered to see (I spoke on the phone due to COVID-19) with a DR. from Veteran Examination Services. The DR. asked me some straight forward questions then after 5-10 minutes said "I think I heard enough, I have reviewed your letter and I have all the info I need" (he seemed very nice and attentive). Two weeks later, I call the VA and they say that they received the examination notes but my claim was sent back to gathering info because they are going to ask another DR due make an opinion. This happened last time, so I am a bit worried they are trying to find a way of denying me again...Anyone have experience with something like this? Thank you!

[Long-term NSAID usage and Acid reflex/GERD]

Can someone point me in the right direction when it comes to medical literature or any information linking Acid reflex/ GERD to long-term NSAID usage? I am doing a supplemental to a denied secondary service claim for GERD and I'm trying to make sure my letter and my Doctors IMO are on point. Thank you!

I also take Albuterol and Prednisone, and Lorazepam (Anti-anxiety) so if you have information on those, I would appreciate it. I am also doing my own research.

[Supplemental Claim question]

Cause the claim started out as Acid Reflex/GERD secondary to Asthma, that was the title but I said Asthma Meds, now Im saying it could be something from Gulf War syndrome..

[Supplemental Claim question]

58 minutes ago, shrekthetank1 said:

Are you ready to appeal? If so you can fix it there. Redirect them!  Make sure you have checked all presumptive conditions and put them all In!  

What stage are you at?

Well, I dunno what to do next. I'm thinking I should do a supplemental claim to clarify things and add lay evidence. Like I said, I'm not sure if I should say that I believe it is my meds and or something that developed after deployment (OEF). I know I meet the presumptive conditions its all there. Some people say I should do a supplement claim others say go to appeals...I was hoping appeals would be my last resort. Can you see the cluster I'm in? lol. Thanks for the responses Shrek!

[Supplemental Claim question]

31 minutes ago, shrekthetank1 said:

Ok so I think this is a case of making it too pointed at one thing.  I am going after mine just as a whole and letting them figure out where it fits.  I believe I have seen a bunch of people from OIF/OEF who have gotten claims for GERD.  either secondary to IBS or a direct connection.  Do you have it documented in your C-FIle of where you got checked for the symptoms of GERD?  If so then this would be a direct connection and not a secondary.  

Check you file and see if you do and try to go at it from the front and not the back. 

I agree, i think it crashed because of being to specific to one thing. It definitely is in my c-file. When I medically retired in 2012, I mentioned it and they gave me omeprazole. I took it only for a couple months. I have brought it up multiple times at Va appointments. They did see that info and brought it up at my C&P exam. I have never brought up IBS but I have and sometimes do experience it even with a healthy diet I'm on. My wife is gonna write a lay evidence letter, so will I and I will mention I believe it is a combination of the meds I am on and have taken for long periods and my deployment. I don't know if this is the right way but at this point the whole claim is a mess.

[Supplemental Claim question]

Hello everyone,  I was denied a secondary service connection for Acid reflex/GERD. I made it secondary to Asthma (medications). The nexus letter from my private doctor kinda screwed things up along with the VA examiner saying that my Asthma was not the cause of my Acid reflex/GERD (I was basing it off of medications not Asthma). At the moment, I am having trouble from my Asthma specialist and GI specialist with getting a nexus letter, they both are saying my meds do not or seldomly contribute to the development of acid reflex/GERD. I have showed them multiple studies that prove otherwise and they still refuse to right a substantial letter, only willing to write a one sentence letter....jeez. I have researched the Gulf War syndrome claim, I have deployed to OEF in 2010-2011, in which I was diagnosed with Asthma when I returned. My acid reflex/Gerd symptoms started shortly after that, I always assumed the medications I was taking, from albuterol, prednisone and constant ibuprofen and Toradol (NSAIDS). I am now thinking to go the Gulf war syndrome route. My question is, I plan on submitting new information in a supplemental claim, what should I do if the claim was asthma meds secondary to GERD but now I wanna include it could be the meds and or my time overseas? I feel like this is a cluster F.  Any help is appreciated.

[Denied Acid Reflex Claim???]

3 hours ago, Vync said:

Welcome to Hadit!

The VA's justification for denying your GERD claim should be in the rating decision under the REASONS AND BASES section. They are required to tell you explicitly why they grant or deny each claim. If you are not certain, you can post the content from that section for other members to review and offer their opinion, just be sure to redact/omit any personal information.

As you already know, you need these three things to get something SC:
1. Event/injury in service, existing SC disability, or presumptive condition
2. Current diagnosis
3. Medical nexus connecting 1 and 2

Sounds like you already have all three. The only potentially legitimate reason for a denial if you have 1 and 2 would be an issue with the IMO nexus. It might be a case where the doctor did not use the VA's favorite jargon:
100% = "due to", "caused by", etc...
75% = "more likely than not", "most likely", etc...
50% = "least as likely as not", etc...

It could also be weakly phrased medical rationale, failure to review medical records, etc...

I had an IMO denied because the doctor used words like "possibly" or "probably". I talked with a guy a while back who's GERD was denied because the doctor did not test for heliobacter pylori bacterial infection. Once he got it ruled out, he succeeded.

My GERD was SC secondary to 20+ years of daily NSAID use to treat SC disabilities..

Keep in mind if the evidence is equal for and against, the VA is supposed to concede SC per the relative equipoise rules (i.e. benefit of the doubt).

Regarding the asthma increase, make sure the VA gave you the correct effective date. For increases, medical records going back 12 months prior to the date you filed the intent claim can be used to get an earlier effective date. Also, going from 30% to 60% for asthma often triggers a follow up examination about a year later. If this is the case, the decision letter should indicate "your condition is expected to improve". If you got 60% due to the breathing tests, expect them to bring you back for more PFTs. If you got 60% due to 3+ ingested/injected steroids within 12 months to treat asthma, they may almost certainly bring you back. If your doctor notes that your condition is not expected to improve, the rating continues for 5+ years, or if you are 55+ years old, they probably will not bring you back. Just be sure you have your medical treatment records handy. If you send them in proving the rating needs to be continued, they may not bring you back for another year.

You can also explore other disabilities to boost your schedular rating. If you suffer from pain, stress, anxiety, or depression caused by your SC disabilities, consider filing a mental health claim. 

Good luck!

 

Thank you for the reply also! I will be recieivng the letter this week about the denial on my Acid reflex claim. As I was explaining to Alotzaspots, the DAV VSO in Phoenix told me that it was denied because the PA who examined me at the C&P exam stated my acid reflex was not due to my asthma and asthma meds. They then had a MD write a lengthy paper about how my Asthma meds are not the cause. I had my Private NP write a letter stating that my Acid Reflex is due to my service connected asthma and asthma meds, she stated "more likely than not". The problem was, she did not give a reasoning. I have already set up an appointment with my NP and will be getting that letter revised with a possible study to back up my claim.

After reading the Asthma increase letter, through and through. I do not see "your condition is expected to improve",  I know this means nothing because they can make an exam any time. Since I have been out, I have not had one examination of any disabilities yet, just my basic appointments with he VA, but most of that time was living in Washington state. I have spoke with fellow vets at work, and it seems like phoenix is a hot bed for the VA to call for exams and they suck at treating vets good down here. I was increased due to Steroid use 3 or more times in the year since I moved here, it fluctuates yearly, some years twice, others once, and like this year 4 times.

I also have a mental health percentage 50% for ptsd. So I don't know where I would go with that. As I mentioned, I am sitting at 94% total, this would have pushed me to 95 which would round to 100. Its like they knew this, lol. Well, the VSO tells me to go straight to Board, is this the right route? I will be getting a new evidence letter to submit, and maybe see a gastroenterologist to get an expert to write something.

[Denied Acid Reflex Claim???]

"

5 hours ago, lotzaspotz said:

On what basis did the VA find your independent medical opinion inadequate to link your GERD to the treatment you take for service connected asthma?  If your private doctor can address that point, you can submit a supplementary review request if you want to try to keep it local at the Regional Office.

If you can’t or don’t want to get new and relevant evidence, you can file a higher level review request with the Regional Office.

If you no longer want the RO to handle it,, you can file a Notice of Disagreement, with or without new evidence, to the Board of Veterans Appeals in Washington, DC.

Personally, we have had more success with the Board correcting the RO’s lack of thoroughness and accuracy with many of my husband’s appeals.  My husband had two DBQ’s by treating physicians completed and submitted for secondary service connection for GERD linked to pain meds taken for service connected conditions.  The RO denied with no C&P exam.  We were under the old system pre-AMA, so we submitted a DRO review request.  This resulted in a Rubber stamp denial, again with no C&P exam.  We then appealed to the Board.  The Board granted the claim for GERD without a C&P exam.

Thank you for the response! I am waiting for the packet this week. I spoke to my local DAV regional office (they still take care of my claims but I did this one on my own) and the VSO told me they denied because the PA who examined me did not believe my inhaler meds did not cause my Acid reflex/GERD. My Private NP believed that my Asthma meds "more likely than not" contributed to me developing Acid Reflex. The VSO said that along with the PA, they had a MD write a lengthy statement about how my meds due not contribute to the development of Acid reflex, which is just bogus because there are studies that reject that claim. The VSO also said, if my NP would have gave her reasoning, then it probably would have worked out better. So now I'm going back to my NP and I'm going to ask that she give reasoning and possibly add a study onto it.  I feel like they really did not want me at 100%, lol.

The VSO at the DAV tells me that I should go straight for a board appeal, this is where I'm conflicting.

[Denied Acid Reflex Claim???]

Hello, I have a question regarding a Claim for Acid Reflex/GERD denial, but first I will start with my story: Letter for intent to file sent on FEB 2019, Filed claim for Acid Reflex July 2019, sent another claim for increase in Asthma (was at 30% for this) on September 2019. Increase in Asthma was granted 1 month later with increase to 60%, Acid Reflex Gerd was deferred. 2 weeks later, Acid Reflex/GERD claim was denied and was stated as "not service connected" with an arrow connecting it to my Asthma. When I sent medical documentation from my Private doctor, she connected my Acid/Reflex/GERD to my Asthma and  corticosteroids inhaler usage. When I had the C&P exam, I stated the exact same thing that it started in the Marine Corps after being prescribed  corticosteroids inhalers, I have been on them since and was Medically retired for Asthma. This rating would have put me at 95% thus rounding to 100%, so as you can tell I am bummed but determined to set this right, I feel as If someone made a mistake somewhere. What should be my next step? NOD? I'm not to experienced on the process, I will be faxing the Claims intake center for my C-FIle, but what should I do next? Thank you!