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

[Scout Swimmer]

Thanks guys! I will start getting everything I'm reading here in order. I never have much luck getting nexus statements from doctors but I will still try!

[Gastone]

Phil: Nexus Smexus. As long as you get your Board Certified Specialist to address in his Clinicain notes that it is his opinion that your current condition "is at least as likely as not" caused or aggravated by a Service related exposure or injury, you'll be good to go. Some Dr's balk at the request for a separate "Nexus" letter but you can use copies of his Clinician notes from your Med file either private or VA to make your case. I believe that a DX from a Specialist "Board Certified" will trump or bolster the DX of a GP MD/DO VA or Private.

Semper Fi

Gastone

[K9MAL]

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.

You don't need a nexus statement and you don't need a "at least as likely as not" statement either. All of the people posting are knowledgeable, more so than myself, and have good intentions, but in this case I believe they're mistaken. The reason I think this is because I was just awarded service connection for IBS due to being a Gulf War presumptive and didn't need any of that stuff.

I had my gastro's notes with a diagnosis of active IBS, and an IBS DBQ signed off and faxed in by him (as required) for redundancy, done deal. Nothing more needed as IBS is a presumptive condition for Gulf War vets. I don't know if I just got lucky but that is all I submitted and it went through without a hitch.

Fill out a 21-4138 describing how your IBS impacts your daily life such as constipation, how often this occurs, cramping, pain, involuntary and immediate need to toilet, etc. You need to paint a picture for the person who's reading your file and determining if you meet the criteria for IBS. Don't just say I'm a GW vet and I have IBS, that won't fly.

I would use something like this to start... I am filing a claim for irritable bowel syndrome as a presumptive illness due to my service in the Gulf War as per section 3.317 of title 38 of the CFR.

VA DBQ (IBS) http://www.vba.va.gov/pubs/forms/VBA-21-0960G-3-ARE.pdf

Edited December 28, 2014 by K9MAL

[FormerMember]

Not to put too fine a point to it, but reading a denial is often the route to a reversal. K9MAL makes a good point but glosses over the rater's rationale for Mr. Grenier's denial. Therein lies the secret to success...

<<<<<<<<<<<<<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.>>>>>>>>>>>>>>>>>>>>>>

This is why you need the nexus. I don't blow bubbles here when I give advice. I've been doing this since 1989. The reason I finally started winning at it is probably the same reason Bertha encountered such continued success. I read each VA document completely and discerned the real meaning of the phrases. Giving advice to others about how you, Johnny Vet, won your claim is unique to your circumstances. Each Vet's are equally unique and subtly different. This is why you cannot cite to a bunch of BVA decisions and say "See, he won and he had the same thing as me."

Winning a claim and being remunerated properly requires a little more finesse than licking the envelope flap and adding postage. In my book, I described this as a recipe not unlike baking a cake. You cannot substitute baking soda for baking powder and expect the same results. Beating the VA is really childs play as any here can see. Time consuming-yes- but not impossible. Their raters work off an antique Adobe Acrobat II (2, not eleven) program tied into the M21-1MR and have a finite choice of denial language. Denials are simply a necessary first phase in a long battle if you are not properly prepared initially. Everything I, and indeed some of the other knowledgeable souls who inveigh here offer, is the shortest distance between two points-filing and a win. Unfortunately, as most of you can also see, a large number arrive here after a denial rather than strapping on the parachute and filing a flight plan before turning onto the active runway.

85% of you will lose the first time out because you think the VA and your VSO rep are your BFFs. The statistics bear me out. But what the hell do I know? I'm just the resident "content contributor". My daddy once said "Advice is like weeds in the garden in early spring. Sometimes it's hard to ascertain the vegetables you planted." Many offer advice here and some of it is outstanding and well-reasoned. Pick and choose based on your own unique situation. Avoid the group mindthink that all claims are alike. Trust me. They are not.

Weapons are free, gentlemen. Cleared in hot on heading 275, over.

Edited December 28, 2014 by asknod

[lotzaspotz]

It takes practice to learn how to objectively read a denial, especially when you also are dealing with the emotions involved in being denied. Thinking back, most of the holes I've found in denials, once I settle down enough to dissect the denial into is various parts, are based on the following:

1. Evidence I submitted was not listed on "Evidence" list and not discussed under Reasons and Bases.

2. Evidence I submitted would be listed under "Evidence," but not addressed under the Reasons and Bases section in any way, shape or form.

3. Evidence I submitted would be listed under "Evidence" and "discussed" in Reasons and Bases, but only superficially mentioning its existence, without providing an explanation WHY it was being dismissed.

4. Lack of evidence being treated as negative evidence.

5. C & P exams that are flawed due to the procedures followed or not followed to properly evaluate a condition, or the examiner was not qualified to conduct such an exam.

6. In the case of Board remands, the C & P examiner did not answer the Board's questions, and the Board denies the appeal instead of addressing the fact that the RO didn't follow directions.

Asknod has written about these issues in depth.

[FormerMember]

Hoo, doggies. You want to come to work for us?