Need The Rating Code For Gerds

[mountain tyme]

Hello...I need some information regarding the Schedule for rating disabilities for gerds...

I called the 800 number and I was told the number was #7299-7203 and I can not find it on the VA web site.

My husband just received his decision and he was granted service connected due to having been diagnoised with Reflux during his time in service.

His decision was Gastroesophageal Reflux disease 10%...I feel the percent is two low...based on his medical documentation. Also he had one of those procedures done where they send a camera down and it is documented that he has a sliding hiheria..also some of his Symptoms are pain, vomiting, hard time swollowing after reflux takes place..and sometimes his arm will pulsate with pain...but not all the time...he is on maintance medication for the reflux and has 8-9 episodes per week.

esp. at night. so we keep the bed elevated at the head...due to the reflux he can not use his c-pap machine because he does has re-geration with the reflux...so he can not use his machine at all...

I feel a higher percentage is in order...

Also do they rate the sliding herina differnt from the Gerds?

on the decision it states...

1.) Service connection for gastroesophageal reflux disease.

Service medical records show complaint and treatment for this chronic condition.

during the VA exam you reported pyrosis and regurgitation two to three days a week. There is no dysphagia reported. Va exam shows that there are no signs of anemia. You have a normal appearing esophagus. There was no erosive esophagitis or Barrett's esophagus. Diagnosis is gastroesophageal reflux disease.. The Va examiner ipined that it is at least as likely as not that your current gastoesophageal reflux diesease is related to the treatment for gastroesophageal reflux noted during your military service.

Service connection for gastroesophageal reflux disease has been established as directly related to military service.

As evaluation of 10 percent is assigned from FEdxx,xxxx. An evaluation of 10 percent is assigned if there are two or more of the following symptoms: epigastric distress, dysphagia, pyrosis, regurgitation, or substernal or arm or should pain.

A higher evaluation of 30 percent is not warranted unless the record shows persistently recurrent epigastric with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain which is productive of considerable impairment of health.

This disability is not specifically listed in the rating schedule; therefore, it is rated analogous to a disability in which not only the functions affected, but anatomical localization and symptoms are closely related.

What I find distrubing is that the C/P doctor...didn't even ask all the questions because she came running up to us as we were leaving the VA hospital saying she missed a few pages of questions...and she said...oooo I will just fill in the blanks...I couldn't believe it...My husband did tell her about the pain that shoots through his arms...we at one time thought he was having a heart attack until our doctor told us that is caused by the reflux...now if his arm feels that why when he isn't refluxing to go to the ER asap...

so I do not understand why he did not receive a higher percentage...

Also in the evidence that they used to grant s/c they did not use the report we had faxed to them from the Univeristy hospital of his gastro exam that shows the sliding herina...

so we would like to ask for a reconsideration but I don't know how to word it...and should I go get a copy of the gastro exam and diagnosis and attach it to the reconsideration...

and would a statement from me or him help as to the pain he experiances...

Thanks in advance..

MT

[entropent]

the correct rating for GERD is 7399-7346, which is an analogized code for hiatal hernia, which has the same symptoms as GERD, and is often present in patients who have GERD.

an evaluation of 30 percent would require evidence that you have "considerable impairment of health." this would generally include a documented history of unwanted weight loss due to inability to keep food down. it is hard to get a 30 percent for GERD. always worth a try, though.

[mountain tyme]

entropent wrote:"the correct rating for GERD is 7399-7346, which is an analogized code for hiatal hernia, which has the same symptoms as GERD, and is often present in patients who have GERD."

well my husband called the VA 800# and the guy looked at his chart and he said that the code was 7346 that was used...so he patched him through to the VA service officer of the organization he is represented by...

They are going to do a NOD...due to the fact that when we went to the C/P my husband brought up that when he had an upper GI done that it showed that he has a sliding Hiatal Hernia...and the c/p doctor said that she was not rating him on that issue that she was only going to rate him on the Gerds which falls under another catagory.... since the 7203 dx code is what most closely approximates his condition for the Gerds which is under Gastic. Also his medical records do support that he has not only immense heart burn but accompanied by the intense pain and tightening...and of course due to the regergitation he can not wear his c/p mask so they changed him to a nose piece one which due to the reflux it does not work either...so the VA service rep advised my husband to put in a NOD...to see if it can be corrected....

even under the hiatal hernia I would think the medical evidence would support the higher rating...the VA will sometimes lowball the first time...

who knows...

but I appricate your response...and I will update when I find out what they decide...

MT

[mountain tyme]

Update: We finally received the C/p report...

the C/P listed the

Problem: GERD And Hiatal Hernia

Medical History:

Hx of Nausea: weekly

Freq. Of Vomiting: Weekly

hx. of Dysphagia: NO

Hx. of Esophageal Distress: Yes

Freq: weekly

Accompanied by pain: Yes

Location of Pain: substernal

Frequency of Pain: weekly

Serverity of pain: moderate

History of heartburn or pyrosis: yes

Freq of Hartburn or pyrosis: weekly

History of Regugitation:yes

Freq: weekly

Hist. of Hematemesis or Melena: No

Lost time from work during the last 12 months period: 12 days

Gerd Moderate

Effect on Usual Occupation: Significant Effect

other: Acid reflux affects the use of required respirator at work.

Effect of Daily Activity:

Chores: mild

shopping: mild

recreation:moderate

traveling: moderate

feeding: mild

other: acid reflux affects the use of cpap mask due to vomiting

other: acid reflux affects the use of cpap nose piece due to vomiting

other: acid reflux affects sleep pattern due to substernal pain

After receiving the C/P the VA rated his Gerds under code 7346 which is mostly like due to the sliding Hiatal hernia...also when he had the Upper GI done it was discovered that besides the sliding hiatal hernia the GE juntion was patulous..

I do remember him telling the c/p doctor that he has trouble swollowing due to the burning and irritation to his esophagus...he can not swollow solids for a while after the reflux but he can swollow small amounts of milk but even that burns..

So I am at a loss...the only thing that I feel has blocked the higher rating of 30% was she marked NO in regards to the dysphagia...

When he put in for s/c for Gerds he did not list the hiatal hernia he did not know he had one until the Upper GE was done a month prior to the c/p

so anyone have any guildance to what direction would be best...thanks in advance

MT

[mountain tyme]

I think the question I should have asked was should we still do a NOD without a hx of dysphagia I don't think that he will receive a higher evaluation...he has a f/u for his gerds next week...I told him he needs to bring this c/p and a copy of the code of rating to see if his condition warrents a higher evaluation of 30%...he has everything except dysphagia written in his medical records...even though he experiance dysphagia which is intermittened it only occurs after refluxing up (regregatating) and it last for a few hours...my husband thinks if he writes a letter or statement to the VA explaining he has dysphagia that they may do a reconsideration...I don't think the VA will do a reconsideration based on his statement alone.

thanks MT

[Berta]

It might help a lot to go to the BVA web site and access similiar claims to see how the evidence was decided-

you could ask the vet rep to support a Reconsideration request-if the medical evidence appears to warrant a hgher rating than he got-

a reconsideration request in some cases can get a better and faster decision- but then again- it does NOT stop the year NOD clock-

My reconsideration request did certainly get more response from the VA-and I asked for a DRO review- the NOD year was almost up while they were still playing around with this claim-(a CUE claim) so I filed formal NOD days after the attorney for vets regs went through-and days before the NOD deadline and might get an attorney to help with this specific claim-although I just heard from 800# that it is in the rating board again with my other claims-

If the medical evidence warrants a higher rating by all means ask for recon and/or file the NOD.

Dont let the rep file a generic NOD- make sure the reasons for the disagreement are page one and attach any more evidence if you can.

[mountain tyme]

Good Morning Berta..Thank you for the insight...you wrote: "you could ask the vet rep to support a Reconsideration request" I wish it was that easy...the problem is that it has started to effect his health that is why he put in for s/c for gerds and were successful to a point I belive he did get low balled...and as far as the vet rep...he is the same one I went to and as he told him that he does not have time to help develop claims he can only submit paperwork and put in gernaic NOD which do not help the vet...because they do not know the first thing about the process..and I know enough to be dangerous...*laughing...which translates into the blind leading the blind accept I can draw from my mistakes and of course come to the family here at hadit to get some guildance...

So my plan of action will be...1st have him go to his schedule appoint at the base family practice clinic which is his primary care provider...even though he is now s/c for Gerds and can go to the VA clinic he wants to stay with the doctor he has been seening all along..which makes sence...

I will have him bring a copy of the schedual of ratings for Digestive system and have his doctor look at it to determine if he meets the higher rating...he has told his doctor he has a hard time getting water down after he refluxs but it is not stated in his records...and if the doctor can write that down at his appointment and use the proper medical terminolgy then he could have a more then average chance of having the VA give him a 30% eval...

thank you again will update when new information is forthcoming...

MT

Edited February 28, 2008 by mountain tyme