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Digestive Diseases And Ratings

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Scott D

Question

The following is an excerpt from a letter sent to my SO. He believes that the stricture would still be grouped and I still disagree. Could someone please check to see if I am messed up or give advice on how to approach a NOD. Thanks.

The following issue is one of the concerns I have about the inaccuracy of the VA rating decision. I have been diagnosed with the following digestive diseases, Hiatal Hernia, GERD, IBS, H.Pylori infection, Schatzki Ring, Upper Esophageal Stricture, and Eosinophilic Esophagitis. They have all been currently grouped under diagnostic code 7346 Hernia Hiatal as per sections § 4.113 and § 4.114 of the CFR. I believe that the esophageal stricture which is secondary to Eosinophilic esophagitis and not GERD should be rated under diagnostic code 7203 Esophagus, stricture of. Section § 4.114 does not require the grouping diagnostic code 7203. A similar case decided by the BVA can be found under docket No. 99-18 759. Also section§ 4.25 combined ratings table would allow for the stricture to receive its own separate rating.

§ 4.113 Coexisting abdominal conditions.

There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in §4.14.

§ 4.114 Schedule of ratings—digestive system.

Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.

§ 4.25 combined ratings table.

(B) Except as otherwise provided in this schedule, the disabilities arising from a single disease entity, e.g., arthritis, multiple sclerosis, cerebrovascular accident, etc., are to be rated separately as are all other disabling conditions, if any. All disabilities are then to be combined as described in paragraph (a) of this section. The conversion to the nearest degree divisible by 10 will be done only once per rating decision, will follow the combining of all disabilities, and will be the last procedure in determining the combined degree of disability.

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Scott- what did the rating decisions come with- what I mean is did they SC any of these conditions?

ORDER

Service connection for gastroesophageal reflux disease is

granted.

Service connection for irritable bowel syndrome is granted.

from http://www.va.gov/vetapp03/files/0303462.txt

Seems to me they are granting two separate awards here-

was this the case you found?

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It says:

Service connection for esophageal stricture secondary to espohagitis and GERD, with eosinophilic esophagitis, Schatzki Ring, Hiatal Hernia, H.Pylori infection, and IBS is granted with an evaluation of 30 percent effective April 28th 2005.

I had not seen the case you had referenced.

Thanks.

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Yes, fortunately, I was able to move into a similar job and maintain employment. Should I route the NOD through my SO, since he seems a little unwilling, or send directly to VA with copy to SO?

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