Tricky Situation - Eating Disorder - Too Request An Increase Or Not?

[Navy4life]

Here is my situation:

I am currently 0% S/C for Anorexia Nervosa. I have a laxative abuse history for over two decades. I am currently in out patient therapy weekly through Tri-West paid for by the VA. It is helping to a point....I have my days...

In November of last year I fainted due to my ED and was rushed to the VA ER. I damaged my lower face to include my two upper teeth. I reported this incident to my outside therapist, Chief MH Director of my VA team, and my PCP doctor. Both the MH/PCP doctor's provided consults for me to go to VA dental but Chief Dental Doctor denied all request stating I was not S/C for my teeth...Yes I knew that...So....I had to seek outside dental help and went to my dental doctor and specialist - $4,500 later I got my teeth fixed!

Both dentists provided DBQ's on my behalf and I submitted them along with all my documentation to include ER visit to the VA for an FDC claim. I sit waiting now....

Last month I get a letter (Redacted letter.pdf) from the RO office stating: Due to your dental trauma and passing out from your service connected anorexia nervosa, if you would like to file a claim for increase for anorexia nervosa, please submit your application".

Well I did some digging and the Anorexia Nervosa disability ratings are TOUGH:

9520 Anorexia nervosa

9521 Bulimia nervosa

Rating Formula for Eating Disorders:

Self-induced weight loss to less than 80 percent of expected minimum

weight, with incapacitating episodes of at least six weeks total duration

per year, and requiring hospitalization more than twice a year for

parenteral nutrition or tube feeding.................................................................. 100

Self-induced weight loss to less than 85 percent of expected minimum

weight with incapacitating episodes of six or more weeks total

duration per year ............................................................................................... 60

Self-induced weight loss to less than 85 percent of expected minimum

weight with incapacitating episodes of more than two but less than

six weeks total duration per year ....................................................................... 30

Binge eating followed by self-induced vomiting or other measures to

prevent weight gain, or resistance to weight gain even when below

expected minimum weight, with diagnosis of an eating disorder and

incapacitating episodes of up to two weeks total duration per year ................. 10

Binge eating followed by self-induced vomiting or other measures to

prevent weight gain, or resistance to weight gain even when below

expected minimum weight, with diagnosis of an eating disorder

but without incapacitating episodes..................................................................... 0

Note: An incapacitating episode is a period during which bed rest and treatment by a physician are required. (Authority: 38 U.S.C. 1155)

I spoke to my rep at the RO rating office and she indicated that just b/c the rating guidelines state certain "wording" doesn't mean I shouldn't get an increase. I think I should be at least 10% but I DO NOT have "incapacitating episodes" of two weeks...Look at the above NOTE for incapacitating episodes.

She advised me to consider discussing with both my therapist and my chief MH doctor about writing a letter attesting to my therapy as "incapacitating episodes". Meaning the therapy I am in weekly should be considered...

I am really not sure what to do here???

QUESTIONS:

1) Should I attempt to file an FDC for an increase on Anorexia Nervosa?

2) If so, should I wait until the FDC that is pending for S/C dental (secondary to Anorexia Nervosa) be completed?

3) Is there such a way to get this accomplished?

Thank You!

[glider222]

I agree Navy4life,

The guidelines are tough. I am rated 0% for bulimia. Because I do not purge.

My civilian Psych is so aggravated with the VA criteria.

It sounds like you have some substantial issues because of Anorexia that deserves

A higher rating. But as you know, one has to be careful about opening up claims.

[Navy4life]

Thank you glider222 for responding....

I know the infamous "opening up the can of worms" is what worries me but I am curious as to why I received the letter? I had my therapy session today with my therapist on the outside and she is going to provide me an update on my treatment and I am supposed to see MH Chief Doctor on Monday so I am going to discuss this a bit further.....

Eating Disorder guidelines are really not fair in my opinion BUT then again who am I???