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

[mountain tyme]

well just an update...regarding the Gerds...We finally went in and talked to his primary care doctor and brought the schedaul of rating in regards to both the 7203 and the 7436 (hernia) criteria...he felt that the rating should have been under the 7203 due to the cronic nature of the GERDS where as the sliding hitatal hernia did not cause the GERDS and there two seperate issure's with that said ...since he has both they will rate them together...

Now...they did grant him 10% s/c since he was diagnoised with GERDS during his military career...the hernia was found about one month prior to the C/P but the exam was not done by the VA but his private medical insurance due to the GERDS problem becomeing worse.

So here is the problem that I am in a fog over...

Rentalguy1 wrote: (in a differnt thread) "They wouldn't be able to rate both due to pyramiding. They'll have to rate one or the other. It is better to have the GERD rated than the hiatal hernia, because GERD can lead to esophogeal cancer, which of course can kill you. If he died due to a SC condition, then you are entitled to DIC. "

Since they rated my husband under 7436 should we do a NOD as to where they rated it or is that a lost cause...I would not know how to word a NOD for that...also he asked his primary care doctor if he could write a IMO as to why it should have been rated under the 7203 he said that it was the VA's call as to what area to rate it under even though the GERDS is a more serious problem.

I feel the only reason he will not write up a letter is due to the fact that he is Military and he may find it a conflict of interest so to speak...go figure.

Also I asked the doctor why he did not put in my husband medical records that during his reflux he can not swollow anything for a few hours due to the burning pain he has...yet he had everything else in there ...and I feel the only thing that prevented he higher rating was due to there was no "hx. of Dysphagia" that was recent only was mentioned once back in 2004 by another doctor prior to him. So he said he will put it in his records that during episodes of reflux he has difficulty swolling due to the burning sensation.

what a mess...

I was present durning his c/p and the doctor asked him that if he had Dysphagia and he told her yes...and out of all the questions that was the only one she put no!

AT this point should I put in a NOD or a reconsideration...the one year mark will be Oct 2008...

and if I put in for a reconsideration will that one DX of dysphagia back in 2002 be suffiecent for a higher rating along with the note the doctor said he will put in my husband record...(not going to hold my breath)

Thanks for all your help

MT

[rentalguy1]

MT...it's not necessarily the dx code that matters (except for the rating criteria) in regards to my previous comments. I have what is called "patella femoral syndrome," or runner's knees. I am rated under dx code 5257 "Knee, other imapairment of." But in every SOC I get, they always state "patella femoral syndrome." What I'm getting at is so long as the VARO states it as GERD, dx code "XXXX," in a SOC then you're ok. That way they are admitting to sc'ing the GERD.

By the way. I just got a VCAA letter regarding my claims and I had requested a rating of 30%, under the appropriate dx code, for GERD. The VARO chose dx code 7399-7346 Hernia, hiatal. This is the dx code that most closely approximates the conditions of GERD, and it's the one that will always be used. It is too established at this point to change (those raters don't like to have their cheese moved...lol).

Good luck!

[mountain tyme]

Hello rentalguy1...thank you I understand now...as long as the s/c say's gerd if any thing arrise due to the Gerds it should be covered...

now as far as the % is concern...the only barrier to the higher % was the DX for Dysphagia...which boggles my mind...the doctor has been told and knowns that after he regeritates that not only the remants are brought up but also the acid that burns his thoart making it very difficult to swollow even water anything that is not of a honey consistance he can to get down for a few hours after his reflux episode...would a statement from him and I be enough besides that mention of Dysphagia in 2004 be effiecent to bring the rating up?

this is what the C/P said..

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

the VA rating schedual states under 7346 Hernia hiatal:

Persistently recurrent epigastric distress with dysphagia, 30

pyrosis, and regurgitation, accompanied by substernal or arm

or shoulder pain, productive of considerable impairment of

health.......................................................

in the c/p he meets or exceeds all the criteria with the exception that she marked no for dysphagia and I don't know why since he told her that during episodes of refulx he can't swollow because of the sticking feeling he gets he actally will choke up the food hence more pain.

as far as the considerable impairment goes...she stated it had Significant Effect in his employment due to the fact he can not wear his reparator due to the reflux at work...which has become a problem at the present.

Also we told the c/p doctor that not only can he not wear his repirator at work he also can not use his CPAP machine as he should due to the reflux which he needs to wear do to his health...

so in this case should we do a NOD or a reconsideration...

thanks for any insight on what you read into this...I think I am too frustrated over this to see a clear picture of what is needed it is too close to home for me to be objective.

Thanks You again

MT

[rentalguy1]

If it were me, I would write get an appointment either with VA PCP or a civillian dr. and have them state in the medical records that he does have trouble swallowing. Then I would write a NOD pointing this fact out and the fact that the C&P examiner made a mistake by writing "no" regarding dysphagia. In the NOD, I would ask for a personal hearing with the DRO. Be very clear that you want this hearing in person, not just a DRO review. I would also search BVA cases for GERD where 30% was granted without one or more of the symptoms listed in the rating criteria. I don't know if any of these will exist, because that criteria is fairly clear on what is needed. Good luck!