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?

[tdubya82]

[deleted]

Edited July 21, 2016 by tdubya82

[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

[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