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Digestive Diseases And Ratings


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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I recommend sending it directly to the VA ( Priority or Certified) with a copy to your SO-

In the NOD I would add - "I know that BVA decisions are not binding on VAROs however, the enclosed BVA decision ( Citation and date) supports my claim as to the fact that there are separate considerations for these separate conditions. The VA has provided no rationale as to a finding that, in my case, they are not separately ratable.

I have highlighted those parts of the enclosed decision ( The Order statement) for your attention and, if this claim remains denied, I fully intend to continue to appeal until the benefits sought are granted.

(I would attach the BVA decision )

(Also if you have any other medical evidence that could help support this you could refer to it in NOD and attach it-)

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I would like some advice and suggestions that would help this NOD go through as smooth as the VARO will let it. Thanks.

Not Sure who to address,

The following is a notice of disagreement with the VA rating I received in Dec of 2005 concerning the grouping of esophagus stricture with digestives diseases rated under hiatal hernia. They have all been currently grouped under diagnostic code 7346 Hernia Hiatal as per sections § 4.113 and § 4.114 of the CFR.

The esophageal stricture is secondary to Eosinophilic esophagitis and not GERD or hiatal hernia should be rated under diagnostic code 7203 Esophagus, stricture of.

Section § 4.114 does not require the combination of diagnostic code 7203 with other digestive diseases.

Based on the allergic etiology of Eosinophilic Esophagitis with esophagus stricture and pursuant to Section §4.114 a separate rating would avoid pyramiding.

I am seeking a separate rating for Esophagus stricture which has been deemed severe by at least 4 attending physicians. Medical evidence supports this rating and demonstrates my inability to swallow solids throughout treatment of this uncurable disease.

If the benefits sought are not granted, the veteran and his representative will continue to appeal until the benefits are granted. Attached is a copy of the federal regulations which were violated during the RO's decison.

Thanks.

Scott Davis

VA Number XXXXXXXXX

§ 4.113 Coexisting abdominal conditions.

top

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.

top

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.

top

(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,

I will be following your case closely as I too have the hiaital hernia, GERD, and a ''Shatzki's Ring", and what I believe to be IBS but as yet not diagnosed. At this time I have the GERD acknowledged so will have to work on the ring and hernia. I feel confident the hernia will be SC, hope springs enternal.

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Scott- I think this NOD is excellent-

Mail it to the VARO that gave you the decision,and under the date of your letter put your c file number (make sure that is on anything else you send) and put any referral initials there under the c file number-any initials that might be on the upper right hand corner of the decision letter.like 307/21/62 etc

I always put NOTICE OF DISAGREEMENT

in caps after their address- and I advise mailing certified or by priority with a tracking slip- you can check the USPS right on line to see that they got it.

I believe in what you are doing here-as I always see the NOD as the first avenue of attack-

a successful NOD can turn things around, especially with more evidence or by expanding on what they have.

You spelled it all out very well for them.

This NOD from Scott should be a template for anyone here who needs one!

Great touch with the legalise-38 CFR stuff---as to the proper diagnostic code,etc.

That will get their attention.

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