Ibs Presumptive Nod.

[Scout Swimmer]

This is my rating decision followed by my NOD in response to my denial for IBS presumptive to Gulf War. I never have written one of these before but decided that its time to be my own advocate.

Hopefully I didnt screw this up.

Thanks again,

Phil

Service connection for Irritable bowel syndrome (IBS) due to undiagnosed illness.

Service connection may be granted for a disability which began in military service or was caused by some event or experience in service.

While your service treatment records reflect complains, treatments, or a diagnosis similar to that claimed, the medical evidence supports a conclusion that a persistent disability was not present in service. The VA medical opinion found no link between your medical condition and military service.

You are claiming current IBS as related to Gulf War exposures. The Persian Gulf War Veterans Benefit Act authorizes VA to compensate any Gulf veteran suffering from a qualifying chronic disability, resulting from an undiagnosed illness or combination of undiagnosed illnesses, appearing either during active duty in the Southwest Asia theater of operations during the Gulf War, or to a degree of 10% or more within a presumptive period following service in theater. Section 202 of the Veterans Education and Benefits Expansion Act of 2001, expanded the definition of "qualifying chronic disability" to include (1) a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms and (2) any diagnosed illness that the Secretary of the VA determines in regulations warrants a presumptive of service connection.

The VA examiner noted all references in your service treatment records were to gastroenteritis, which is self-limited. There is no evidence that you were treated for IBS while on active duty, also, while you have a current diagnosis of IBS, current symptoms do not warrant a compensable evaluation.

Service connection for IBS is denied since this disability neither arose during service in the Gulf theater, nor was it manifested to a compensable degree after the last date of service in the Gulf theater during the Gulf War,

....NOTICE OF DISAGREEMENT.....

After reviewing all information pertaining to my rating decision claimed as Irritable Bowel Syndrome presumptive to Gulf War", I would like to request reconsideration for the following reasons.

The C&P examiner did not find that my IBS diagnosis was at least 10% disabling thus presumptive status to gulf war exposure was denied on the basis of not warranting a compensatable evaluation of at least 10% disabling.

At no time during the C&P examination did the examiner discuss my IBS issues. She never questioned me about my symptoms, frequency of irritability, over the counter medications used, or incapacitating episodes, even after I presented an IBS diagnosis from a Gastroenterologist that listed my symptoms. Also I currently take medications for this condition, (Dulcolex, magnesium citrate).

It is important to note that my IBS diagnosis from my Gastroenterologist is listed as chronic in the area of constipation. "stools once every 4 to 5 days that are hard and scybalous. The patient states that with time he notes progressive abdominal bloating, discomfort, and cramping. The cramping is always in the lower quadrants. Because of persistent symptomatology we are asked to see and assist in this patients future evaluation and management".

The 30% criteria is "alternating constipation with more or less constant abdominal distress". I fit the criteria because it takes nearly a week for me to have a bowel movement which leaves me in constant abdominal distress.

I am also requesting a new C&P examination based on the specific reasons stated in this report.

Respectfully Submitted,

P Grenier

Edited December 13, 2014 by Philgrenier

[FormerMember]

What is missing here is a statement from your doctor stating that it is more likely than less likely that the current IBS you suffer is the same disease process you were seen for while in service. I.E. the "gastroenteritis " was merely the beginning onset of your IBS. He then needs to cogently reason why he believes this. Any evidence of continuity of symptomatology is further proof of chronicity of the original tummy ache. Once you have this, you can win. I have told Vets a million times that DBQs do not have a box for the doctor to write the nexus in so they don't. VA receives it and promptly adds theirs in there for you. Mighty thoughtful of them to do so and also mighty funny how they all say "not service connected" . When you get your own doctor to say it, magic things happen. When magic things happen, you win. When you win you have money to get cable TV. No mystery here, Phil.

[Gastone]

Phil: What NOD said. I,ve talked to a good number of Vets that think they got short changed at the C & P exam. Down the road, your probably going to be able and look back and see that the evidence you supplied wasn't quite as compelling as you thought it was. I know I did, and when I got the "Nexus Evidence" necessary submitted, Denials were reversed.

You recently requested a "Reconsideration" without supplying any New & Material Evidence, good luck with that. I certainly hope you don't plan on setting back and waiting for the VA to see the error in the original decision. The "Request for Reconsideration" of a recently Denied Claim has been discussed in great depth on this as well as other Blogs. It isn't an official VA step in your claims decision process at the VARO level. Your really just asking the same rater to look at his decision again, probably a waste of your time. Now if you or someone else supply's the VARO with "New & Material Evidence" that was not available to the VA rater, that is supposed to trigger an "Automatic VARO Review of your Decision" by a Senior VA Rater or DRO. If at the end of the "Official Review" your Denial is continued, a VA Supplemental Statement of Case is sent to you and your Representative. That S-SOC will give you a good idea of the weakness of you evidence that needs to be rectified.

I don't recall you mentioning the use fof the VA Official NOD form or not. Just keep in mind the (1) year from Award/Denial letter date for filing an official NOD. CYA, Right? The VA should take your recent letter as an Official NOD and not just a request for reconsideration. To be safe, complete an official NOD and tell the VA you DISAGREE with the Decision Dated XX/XX/XXXX. Send it and everything else, US Mail CERT Return Recpt. Your VA Claims Education is just beginning, just like all the other Vets that have preceded you.

Remember, everyone on this blog, unless they ID themselves as a DR-Attorney or VA Rater is just a Vet like you. The opinions and advice is from lay people, some with years of experience. All meant to do you no harm. As always, the Final Decision is yours. Hopefully you can learn from our mistakes and successes. Good Luck!

Semper Fi

Gastone

[Berta]

"It is important to note that my IBS diagnosis from my Gastroenterologist is listed as chronic in the area of constipation. "stools once every 4 to 5 days that are hard and scybalous. The patient states that with time he notes progressive abdominal bloating, discomfort, and cramping. The cramping is always in the lower quadrants. Because of persistent symptomatology we are asked to see and assist in this patients future evaluation and management".

The 30% criteria is "alternating constipation with more or less constant abdominal distress". I fit the criteria because it takes nearly a week for me to have a bowel movement which leaves me in constant abdominal distress.

I am also requesting a new C&P examination based on the specific reasons stated in this report."

Did they, in the decision, list the diagnosis from your Gastroenterologist?

Are you 100% they had it?

Did they list it but make some BS remarks about it?

If you can prove you sent this to them or they themselves acquired this probative evidence,

and they never considered it, you could also raise in the NOD that they commnitted a CUE under 38 CFR 4.1 et al, specifically 4,6.

Those regs are here at hadit.

It also looks to me that they parsed the Gulf War regulations:

In part:

"These "presumptive" illnesses must have appeared during active duty in the Southwest Asia theater of military operations or by December 31, 2016, and be at least 10 percent disabling. These illnesses include:

Chronic Fatigue Syndrome, a condition of long-term and severe fatigue that is not relieved by rest and is not directly caused by other conditions.

Fibromyalgia, a condition characterized by widespread muscle pain. Other symptoms may include insomnia, morning stiffness, headache, and memory problems.

Functional gastrointestinal disorders, a group of conditions marked by chronic or recurrent symptoms related to any part of the gastrointestinal tract. Functional condition refers to an abnormal function of an organ, without a structural alteration in the tissues. Examples include irritable bowel syndrome (IBS), functional dyspepsia, and functional abdominal pain syndrome.

Undiagnosed illnesses with symptoms that may include but are not limited to: abnormal weight loss, fatigue, cardiovascular disease, muscle and joint pain, headache, menstrual disorders, neurological and psychological problems, skin conditions, respiratory disorders, and sleep disturbances."

- See more at: http://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp#sthash.BVcCW42l.dpuf.

BTW all,Many expect the GW cut off date of December 31, 2016 to be extended again.

The Gulf War is not officially over yet.

[Scout Swimmer]

Thank you all for these responses.

I did use the official form for my NOD. I don't believe a nexus letter is needed because I claimed it as a "presumptive", which from what I understand you just need the diagnosis with symptoms at least 10% disabling.

They made mention of my diagnosis from my gastro specialist, but as I'm reading it, they seemed to miss that my condition and symptoms were considered chronic. Almost like they just skipped that part and went with the C&P examiners findings (not 10% disabling) who happens to be only a nurse practitioner. I also resubmitted my Diagnosis from my gastro specialist just in case. I will be seeing him in 2 weeks and he is going to do a write up to my symptoms as moderate to severe.

[FormerMember]

85% of all claims are denied the first time out. Welcome to the club. "Presume" nothing-ever. Once upon a time in 1970, I "presumed" I was bulletproof. A gook proved that was all wrong.

[georgiapapa]

Phil,

When you go to see your gastroenterologist, take a copy of the ratings schedule for IBS from 38 cfr 4 with you, highlight the symptoms listed on the ratings table you are experiencing and ask the doctor to incorporate the exact language reflecting your symptoms from the ratings table in his diagnosis letter. If the doctor's letter contains the same language as the ratings table for IBS and the doctor's letter leaves no doubt you meet the criteria for a disability of at least 10% disabling, your doctor's letter should trump any report from a VA nurse practitioner.

Although, I thought presumptive diseases required a medical diagnosis but not a nexus statement, I would hesitate to go against the advice given by Asknod. I do not consider his advice to be that of a lay person. Why take a chance. I would follow his advice and ask your doctor to also include in his letter the type of comments he suggested in his response to you. If a nexus was not required, no harm done. JMO

Good luck to you.