Secondary To

[bakerkd]

I have Hiatal Hernia, GERD, and IBS. I have seen that GERD is rated secondary to Hiatal Hernia. Here is the question; Will irritable bowel and GERD both be rated secondary to the Hernia or will the irritable bowel be rated on its own? I only ask because I havent seen IBS rated secondary to the hiatal hernia, only to the GERD. Is it possible to rate something secondary that is secondary to something else?

[broncovet]

I would like to hear from someone more experienced, but I think once a condition is Service connected it does not matter whether it is secondary or not. Some conditions have a whole list of things..diabetes is one I can think of. If your Diabetes is SC'd, for example, diabetes causes lots of problems..vision problems, often causes foot amputations later in life, circulation problems, blood pressure problems, etc. So, if your diabetes was SC'd secondary to something else and you had to have a foot amputated from the diabetes, then you should be SC for the loss of a foot. Is that not right Berta and others?

[bakerkd]

I'm sure they are all going to be sc'd. I'm still active duty and have everything in my SMR. Just curious how they would do that. There always seems to be overlap with some conditions. I get cervicogenic headaches which are cause by occipital nerve neuritis which is caused by muscle spasm which is caused by a combination of Cervical DDD and focal dystonia. Do they rate as headache, Neuritis, Cervical DDD or dystonia

[sharon]

§3.310 Disabilities that are proximately due to, or aggravated by, service-connected disease

or injury.

(a) General. Except as provided in §3.300©, disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition.

(;) Aggravation of nonservice-connected disabilities. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 CFR part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. (Authority: 38 U.S.C. 1110 and 1131)

© Cardiovascular disease. Ischemic heart disease or other cardiovascular disease developing in a veteran who has a service-connected amputation of one lower extremity at or above the knee or service-connected amputations of both lower extremities at or above the ankles, shall be held to be the proximate result of the service-connected amputation or amputations. (Authority: 38 U.S.C. 501(a), 1110-1131)

[john999]

Even if you have a secondary condition from DMII you need a doctors report to make the connection. The VA will not connect the obvious dots without an exam. I have three secondary conditions to SC DMII and I had to get letters from doctors to SC every one of them.

[carlie]

I have Hiatal Hernia, GERD, and IBS. I have seen that GERD is rated secondary to Hiatal Hernia. Here is the question; Will irritable bowel and GERD both be rated secondary to the Hernia or will the irritable bowel be rated on its own? I only ask because I havent seen IBS rated secondary to the hiatal hernia, only to the GERD. Is it possible to rate something secondary that is secondary to something else?

I read the medical issues to be "Hiatal Hernia, GERD, and IBS".

I feel that getting all 3 of these issues SC'd would involve pyramiding

as all 3 involve the same bodily system.

http://ecfr.gpoaccess.gov/cgi/t/text/text-...7.9&idno=38

§ 4.14 Avoidance of pyramiding.

The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided.

I feel these 3 issues would be adjudicated under,

http://ecfr.gpoaccess.gov/cgi/t/text/text-...7.5&idno=38

§ 4.7 Higher of two evaluations.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned.

jmho,

carlie

[bakerkd]

So let me see if I understand this correctly. The Hiatal Hernia has different ratings based on different degrees of symptoms. GERD and IBS would be used to support a higher rating for the Hiatal Hernia because they represent symptoms of one disability. Hernia causes the GERD which causes the IBS, hence the disbility is Hernia and the other two are symptoms. Am I on the right track?