Gerd & Ibs Considered Pyramiding ?

[ArNG11]

I'm not trying to be ungrateful here but I am having a hard time understanding how these two would be considered that. By physical locations they have to do with two different ends. GERD has to do with the esophagus and hiatus. The dyspepsia (diarrhea) has to do with the bowels, the lower intestines and anus. So if there are two independent systems how is it considered pyramiding ? Yes it is part of the whole digestive tract however, and I misreading the regs. As of right now it has been proposed to raise the GERD up to 10% and IBS remain at 0%, even though from reading the CFR and matching my symptoms, regardless of the recent surgery, the GERD could arguably have warranted a 30% with the hiatal hernia, dyspaghia, medication,vomiting, no arm pain though and at current be a proposed 10%. The IBS, chronic runs 6-10 times a day with a raw butt and chronic abdominal distress should net a 10% on its own but will return a 0% due to pyramiding. No decisions yet, but this is the information that my rainmaker has given me. Am I missing something?

[Navy04]

I totally understand bud. I am 30% for Crohns, GERD and Barretts Disease, even though I am going to have my Colon removed soon. Total different conditions with separate medications, and I have a small hiatal hernia in that area too. I have also had 2 blood transfusion due to my Crohns and just diagnosed with severe internal and external Hemorroids. Just like my TBI rated 30% with Migraines. That is just how the VA formula works my friend. Atleast you got to Vent on here.

By the way I just had my Crohns review, and it looks like the VA will make my 30% permanent now for the Crohns.

[JT24usn]

I'm in the same boat with small bowel resection and cholecystectomy. I am on 20 for both. thanks to good ol pyramiding. 20 for small bowel and 10 gallbladder

https://www.law.cornell.edu/cfr/text/38/4.14

§ 4.14 Avoidance of pyramiding.

The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided.

Edited March 1, 2015 by JT24usn (see edit history)

[ArNG11]

I don't have a gall bladder either. I had mine removed when it nearly ruptured. That was back in 1998. I've been dealing with a modified diet since then. I was fine until, I guess about mid tour in Iraq. I knew I should have stayed away from food from Iraq. Oh well things happen. There's a lot of co existing factors. Diet, stress, medications, and so on. You kind of have to experiment with different things. For me diet changes helped, they still help. I just got tired of the high cost meds and fiery throat. After so long you have to go for more aggressive treatments.

Anyways, I would just like to find a clear cut references in the CFR's that refers to these conditions.

[JT24usn]

38 CFR Book C, Schedule for Rating Disabilities

4.114-​§4.114Schedule of ratingsdigestive system​ 4.114-

§4.114 Schedule of ratingsdigestive 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.

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

7319 ​Irritable colon syndrome (spastic colitis, mucous colitis, etc.):

​Severe; diarrhea, or alternating diarrhea and constipation, with more

​or less constant abdominal distress​30

​Moderate; frequent episodes of bowel disturbance with abdominal

​distress​10

​Mild, disturbances of bowel function with occasional episodes of

​abdominal distress​0

Edited March 1, 2015 by JT24usn (see edit history)

[ArNG11]

Thats what I read as well so I don't understand how it would be pyramiding. Except the description here is Irritable Colon Syndrome. Irritable Bowel Syndrome is really just another name for the disease. The kicker is with my case is that they are calling 6-8 times a day mild. I can assure you it is not mild. Of course I know that they are not going to reference my private medical records. It states it there both in 2010-2014. The reason they are calling it mild is because there are notations in my SMR of having diarrhea. Never mind that a Gastro-entronnologist opinions and records should far outweigh a Gynecologists' opinion. Ahh that is the funny part. I actually have a log with pictures that I will be bringing with me to the DRO hearing. I'm still debating it, yes it is gross, but another hadit member had a good result with that tactic so I may just give it a try. On a good day 6 times is normal for me. Ahh the things we must do. I've seriously thought about having the VA pay for my toilet paper. I don't think I would get very far but I would love to see the raters face on that one. : )

Here's mud in your eye"

[ArNG11]

I guess it bothers me that I meet all the criteria for the 30% with the exception of subternal shoulder or arm pain. Every now and then yes, it feels like I'm having a heart attack but I monitor my pulse and heart rate and I know it's not when the arm starts bothering. Until I knew that though it sure felt like I was, still does every now and then.

[tdubya82]

[deleted]

Edited July 21, 2016 by tdubya82 (see edit history)

[JT24usn]

Yes 7346 is GERD and I believe GERD can be rated up to 60 and IBS higheay can only be 30. Apparently the powers that be think GERD is the prevalent of two and vet was awarded 60. Jmho

Edited March 12, 2015 by JT24usn (see edit history)

[georgiapapa]

tdubya82,

In regards to your swallowing problems, I have GERD and swallowing problems and recently had an esophageal dilation. My gastro doctor advised me that swallowing problems often return which necessitates the need for additional dilation procedures as often as every six months. You may be one of those patients requiring frequent dilation procedures.

I wish you good luck with your health and your claims.

GP

[ArNG11]

I think I responded here:

 

Thats how they have done it with my decision and others?  There is a separate code that with GERD,  IBS, ICS  can be rated separately without pyramiding. I have been looking into some CAVC cases on it.

§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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§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.

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

and 

7319   Irritable colon syndrome (spastic colitis, mucous colitis, etc.):
Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress	30
Moderate; frequent episodes of bowel disturbance with abdominal distress	10
Mild; disturbances of bowel function with occasional episodes of abdominal distress	0

 

This is my argument in my claim for the digestive problems then add in the Nissen fundiplication repair but again I may be reading to much into the regs. The difference in my claim is that my private docs records indicate moderate problems where as the the VA raters and VA docs state mild