Help With Claim

[roses15534]

long story short am service connected for heartburn at 0% for 11 yrs now was taking meds in service for it total of about 20 yrs now. Just had scope done and they say I have Barrets Esophigus and Hydial Hernia I called my VSO and he said we would have to go with secondary to heartburn but doctor needs to say it is connected to the heartburn and how it is. Will a VA doctor or PA do this? What else can I do I will not back down or give up. Any help is appreciated. If VA won't do this where else can I go and what else can I do? can I request a C&P Exam for this if so how do I do that?

[Hoppy]

After 15 years of assisting veteran with claims here on hadit, it is my opinion that finding a VA clinician who will write any more than a statement as to current diagnosis and fitness for duty is the exception. Most clinicians will not get involved in writing nexus letters. They often refuse to even read a service medical record. They cite VHA directive 2008-71 which specifically states.

d. Medical Statements to Support VA Benefits Claims. When honoring requests for medical statements by veterans for VA claims adjudication, care must be taken to avoid conflict of interest or ambiguity.

(1) Determination of causality and disability ratings for VA benefits is exclusively a function of the Veterans Benefits Administration (VBA). VHA providers often do not have access to military medical records, and may not be familiar with all the health issues specific to military service, such as environmental exposure. As a result, they may not feel comfortable in stating causality of a current condition. However, this does not preclude VHA providers from recording any observations on the current medical status of the veteran found in the medical record, including their current functional status. All pertinent medical records must be available for review by VBA. NOTE: VHA continues to provide compensation and pension (C&P) examinations and reports as requested by VBA, as part of any new disability claims or review process.

(2) Requests by a veteran for assistance in completing a VA disability claim are to be referred to VBA through official channels; however, the clinician, if requested by the veteran, must place a descriptive statement in the veteran’s medical record regarding the current status of the veteran’s existing medical condition, disease, or injury, including prognosis and degree of function. This may then be requested by VBA for the purposes of making a claim determination.

VBA refers to the RO not the hospital staff

The idea that the VA is not there to deny claims is only partially true. The DAV has testified to congressional committees that they are of the opinion that the VBA is adversarial to some types of claims. This was also the subject matter of one of the first posts I read on hadit from the late Alex Humphries. It has been my experience that veterans have run into excessive refusals to develop or assist on mental health claims. This is demonstrated by the VA’s inability to teach their raters that the DSM II was a broken and inaccurate diagnostic model and continuing to allow the raters to cite the DSM II diagnoses as evidence against a claim. It has been 30+ years since the DSM II was replaced. Yet, VA raters continue to cite DSM II diagnoses rather than seek re-evaluations requiring a clinician to review the noted symptoms using the criteria of the DSM IV.

[Hoppy]

After 15 years of assisting veteran with claims here on hadit, it is my opinion that finding a VA clinician who will write any more than a statement as to current diagnosis and fitness for duty is the exception. Most clinicians will not get involved in writing nexus letters. They often refuse to even read a service medical record. They cite VHA directive 2008-71 which specifically states.

d. Medical Statements to Support VA Benefits Claims. When honoring requests for medical statements by veterans for VA claims adjudication, care must be taken to avoid conflict of interest or ambiguity.

(1) Determination of causality and disability ratings for VA benefits is exclusively a function of the Veterans Benefits Administration (VBA). VHA providers often do not have access to military medical records, and may not be familiar with all the health issues specific to military service, such as environmental exposure. As a result, they may not feel comfortable in stating causality of a current condition. However, this does not preclude VHA providers from recording any observations on the current medical status of the veteran found in the medical record, including their current functional status. All pertinent medical records must be available for review by VBA. NOTE: VHA continues to provide compensation and pension (C&P) examinations and reports as requested by VBA, as part of any new disability claims or review process.

(2) Requests by a veteran for assistance in completing a VA disability claim are to be referred to VBA through official channels; however, the clinician, if requested by the veteran, must place a descriptive statement in the veteran’s medical record regarding the current status of the veteran’s existing medical condition, disease, or injury, including prognosis and degree of function. This may then be requested by VBA for the purposes of making a claim determination.

VBA refers to the RO not the hospital staff

The idea that the VA is not there to deny claims is only partially true. The DAV has testified to congressional committees that they are of the opinion that the VBA is adversarial to some types of claims. This was also the subject matter of one of the first posts I read on hadit from the late Alex Humphries. It has been my experience that veterans have run into excessive refusals to develop or assist on mental health claims. This is demonstrated by the VA’s inability to teach their raters that the DSM II was a broken and inaccurate diagnostic model and continuing to allow the raters to cite the DSM II diagnoses as evidence against a claim. It has been 30+ years since the DSM II was replaced. Yet, VA raters continue to cite DSM II diagnoses rather than seek re-evaluations requiring a clinician to review the noted symptoms using the criteria of the DSM IV.

Edited February 25, 2012 by Hoppy

[roses15534]

I do use A VSO Disable American Veterans i was give i think NSAIDS like nexum, omeprizole and radanitine. For fibro was give pain medss and some phyc meds. My VSO siad I need to have a doctor write a statment that the Barrets and hydial hernia is the cause from gerd/heart burn to go after a secondary. Can I just file for barrets alone? If so would they service connect it to gerd/heasrburn or seperatly? I am new to this and very confused can someone walk me through it like a 5th grader?

Attached are my decisions from 2001 for everything and the specific one for chronic heart Gastsitis

[roses15534]

my other claim concern is a claim for Keratoconus that was denied and I now find out I should have won it for 30% due to I had to wear contacts since then I had to have a corneal transplant in each eye cause they progressed to far and burst. Now here is the question if I rated it then can I file and how also since I hade the transplants I am alot better shold I get anythign for them bursting and having to have surgery even though now since surgery I no longer have Keratoconus? Once again tell em I need to do in laymens terms. attached is the decision from 2001

[71M10]

I would characterize the Barretts as a request for increase for your gastritis. In the request I would assert that the Barretts, which represents a change in the lining of your esophagus should be rated as severe. You should be able to get a C&P on this and I would hope the VA will do the right thing (I know an unfounded belief). If you have an outside physician willing to do a nexus letter stating that the Barretts is medical evidence of a worsening of your GERD/Gastritis, and the change in tissue amounts to extensive errosive changes.

Thats what I would do.

Best regards,

[donna68]

roses15534,

The VA doesnt usually SC "symptoms" like heart burn (so if you are actually service connected for a symptom you are very fortunate). They do service connect GERD or gastro esophageal reflux which causes heartburn and is an analogous to hiatal hernia. For VA purposes GERD and hiatal hernia are the same or use they use the same diagnostic code and a hiatal hernia causes GERD.

Yes, the esophagitis can be secondary to GERD or heartburn, so if I were you, I would put in claim for Barretts esophagitis as secondary and put in for an increase for GERD or "heartburn" and hiatal hernia.