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How Will These Be Rated (Avoiding Pyramiding Hopefully)


kevin4998

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I am wondering how these items will be rated (taking in account they are all part of the gastro class)

7319 Irritable colon syndrome (IBS)

7332 Rectum and anus, impairment of sphincter control (Secondary to 7319)

7346 Hernia hiatal (leading too GERD and Barrett’s)

I have documentation in my SMC for each of these issues except Barrett’s.

I was treated for GERD and IBS in the military several times.

I am also a Gulf War Vet, the GERD and IBS was treated in 95 and for the rest of my service time, then after service by private doctors and take otc meds regularly.

Hiatal Hernia was just mentioned in SMC (not treated) due to that fact of my problems with the GERD.

(can’t find a codes for the GERD or Barrett’s).

I had seen a post a while back that a person got separate ratings for IBS and GERD, which from my understanding was a unique rating since both fall under GASTRO problems.

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38cfr 4.14 pyramiding

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.

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Below this post is an additional paragraph on coexisting abdominal conditions. Most likely the GERD will be rated under code 7346 Hiatal Hernia. The symptoms will be checked against the rating criteria for this condition. In my experience they will combine 7346 with 7319 and assigned a rating. 7332 is not listed in the ratings that must be combined so it would warrant a separate rating. They may try and combine this with the two above, and you will have to appeal that decision. I do not know how severe your GERD is, but if during a test like barium swallow or EGD a stricture of the esophagus is noted, you can file a claim for the stricture 7203 and this will warrant a 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.

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