Symptoms (Do You Have To Have Every Symptom.

[Reddit]

Do a veteran have to have every symptoms and everything list to get that percentage or service connected .

Example. Gerd: pyrosis,vomiting ,regurgitate,substernal pain,impairment to your health. Do you have to have everyone that listed.

[Chuck75]

In theory, no. The VA is "required" to rate to the closest rating, which translates more or less into "most" of the symptoms or conditions associated by the rating schedule with a particular rating.

Practice, however, is another story. The VA often assigns a lower rating given any excuse to to so. Obviously, one of the excuses is that you don't meet "all the criteria" for the rating.

Again, a favorable IMO can really help by saying that a set of symptoms are the result of an illness or condition that is service connected or connectible.

[Reddit]

Chuck, Well, what happen is that i had every symptoms excepted impairement to my health. On one exam, Va said i did not say it was impairement to my health. this is for 30 percent GERD.

[71M10]

I would in a statement in support of claim, state or pose the question isn't "pyrosis,vomiting ,regurgitate,substernal pain" objective evidence of impairment to my health?

Impairment to Health is such a subjective standard. This shouldn't cause to much of a problem. Is it even a defined term (beyond the english dictionary)??

Edited April 11, 2013 by 71M10

[Vync]

7346 Hernia hiatal:

Symptoms of pain, vomiting, material weight loss and hematemesis or

melena with moderate anemia; or other symptom combinations

productive of severe impairment of health......................................................... 60

Persistently recurrent epigastric distress with dysphagia, pyrosis, and

regurgitation, accompanied by substernal or arm or shoulder pain,

productive of considerable impairment of health............................................... 30

With two or more of the symptoms for the 30 percent evaluation of

less severity......................................................................................................... 10

The 10% and 30% rating differ only based on severity of impairment of health. Definitely sounds subjective to me, but take a look at some potential definitions for the terminology:

epigastric = middle to upper abdomen

Dysphagia = difficulty swallowing

Pyrosis = heartburn

Regurgitation = like the reverse of swallowing

considerable = significant

Also, the 'AND' in the 30% rating requirement could be the gotcha. Sounds like they are saying you have to have everything with the only optional item being where the accompanied pain is situated.

[Reddit]

So, if it mostly closely to the high the lower, shouldn't it be the higher on.

Check this out.

We have assigned 10 percent for GERD based on

1. Persistently recurrent epigastric distress

2. Pyrosis

3. Regurgitation

4. Substernal pain

5. Vomiting

A higher evaluation of 30 percent is not warranted unless there is all the above and productive of considerable impairment of health.

No I know this warranted 30 percent. Am I right about this.

[Vync]

Reddit,

I'm also preparing to fight this same battle as you. I'm rated 10% and am preparing to request an upgrade to 30%.

Vomiting is one of the symptoms for 60%, but they are fussing about the "productive of considerable impairment of health" part. But the real question what qualifies for this specific criteria? This sounds like something that a C&P examiner or doctor would have to add to their evaluation.

I just got back from talking with my VSO and presented my situation to him. I have been to the emergency room three times in the last few months because the burning pain was so bad that I just couldn't take it. I am maxed out on preventative meds like zantac, protonix, and nexium. They hospitalized me for one night for observation. Later this week I am having an endoscopy. My VSO said that it sounds to him like my condition has worsened and recommended I file for an increase. Again, the big question centers around the VA categorizing it as "productive of considerable impairment of health".

I did some digging and found a ton of BVA denials for increases from 10% to 30%. But here's one which was granted. The Veteran was diagnosed with Barrett's esophagus:

http://www.va.gov/vetapp10/files4/1035946.txt

For the entirety of the appeal period extending from June 1, 2006, the evidence, both lay and clinical, reflects that the Veteran's symptoms of GERD with hiatal hernia and Barrett's esophagus have included: recurrent epigastric distress, regurgitation, and pyrosis, with occasional substernal and/or arm pain, all of which are consistent with the assignment of a 30 percent disability rating under DC 7346. It is also the judgment of the Board that the Veteran's symptoms, as reported by him and documented in the record, may be found to be productive of considerable impairment of health.

(here's the meaty part):

In this regard, the Board has taken into account the increased amount of medication (essentially a daily double dosage of Prevacid) which has been prescribed and is necessary to control Veteran's symptoms, and the fact that he has Barrett's esophagus, a pre-cancerous condition associated with GERD, which requires the increased medication and regular monitoring through endoscopy in order to try to prevent the condition from increasing in severity. Accordingly, with the application of the provisions of 38 C.F.R. § 4.7, the Board finds that he is entitled to an increased rating of 30 percent under Diagnostic Code 7346.

And then I found this one. The Veteran didn't have Barrett's esophagus and the part about "considerable impairment of health" was not explicitly stated.

http://www.va.gov/vetapp97/files4/9735664.txt

The June 1997 rating decision awarded service connection for gastroesophageal reflux as part of the veteran’s chronic gastrointestinal pathology. A 10 percent rating was assigned to include all of the gastrointestinal problems suffered by the veteran. The next higher evaluation, a 30 percent evaluation, requires persistently recurrent epigastric distress, with dysphagia, pyrosis and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health.

(Here's the meaty part):

The veteran reported daily and severe heartburn and epigastric burning sensation, nausea and nightly regurgitation requiring that he sleep in a chair and the physicians at MIMA described the veteran’s GERD as severe. Private medical records dated in October 1996 report abdominal cramps and watery diarrhea believed attributable to an endoscopy. The Board is of the opinion that the symptomatology associated with the veteran’s gastroesophageal disability reflects increased severity, warranting higher evaluation, notwithstanding the absence of dysphagia. As the veteran has had persistent and recurrent nausea, heartburn, epigastric distress with regurgitation and substernal pain, the Board finds that the veteran’s hiatal hernia warrants a 30 percent evaluation. The clinical evidence did not include symptoms of vomiting, material weight loss and hematemesis or melena with moderate anemia, to warrant a schedular evaluation higher than 30 percent.