C & P Exam Referral

[gs106]

Question for some of the experts. I requested an increase for GERD and had an initial C & P exam. When I received the decision notification, the GERD had been deferred and I was scheduled for another C & P exam. The second doctor (wife of the first one) ask me a few questions and sent me to the lab for a blood sample for H. pylori bacteria. The lab result was equivocal (unable to determine). The nurse practitioner who wrote the report stated that the lab result was negative. I was told verbally that, based on the NPs report, a decision has been made and the GERD rating was not increased.

The second C & P doctor referred me to have x-rays of my esophagus and stomach. The radiology report showed up on eBenefits this morning and says I have a "small reducible hiatal hernia". My question is: will they determine that the hernia is a contributing factor to GERD or will it be considered separately. My guess is that it will be left as is because the symptoms are the same for both. I am rated 10% for GERD. My symptoms match those for the 30% rating shown below.

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

[Vync]

It is a good thing that you tested negative for H. pylori. If you tested positive, they would have just medicated you until it was eradicated and then blamed your GERD on it.

The hernia and GERD will be considered the same. In fact, when you are rated for GERD, they don't have a special rating for GERD because they use the rating criteria for hiatal hernia.

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

You indicated that your symptoms match the 30% criteria, but double-check your C&P/DBQ results and verify they match. The raters are supposed to rate an increase based on symptoms of record. If it is in your records, but the raters deny your increase, file a reconsideration (keep an eye on timeframes) and/or an NOD based on the facts of record.

[gs106]

Thanks Vync, I have an appointment with my real doctor next month. I'm going to ask her to refer me for an endoscopy because I am still having a lot of abdominal pain. The H. pylori test wasn't negative, it was equivocal. The nurse practitioner saying it was negative doesn't change the test result.