Gulf War Presumptive Illness

[ForThem]

My husband had his gulf war exam and the examiner stated that his Sleep Apnea was not a presumptive illness nor was his chronic sinusitis/respiratory illnesses.  From my research, I found that they were.  Additionally, he had several years of medical records removed and shredded from his file by someone trying to be helpful.    In the denial that he got, it stated he had no records when that was removed from his medical file.

Additionally, he told the examiner that he generally uses pads for his anal leakage but was not wearing one that day.  She gave him 10% because he doesn't need one all the time.  Anyway to fight that?

If this is not the right place to post this, please let me know.  If you need me to post the C&P exam notes, I can.  

 

Thank you for any insight you can give me.

 

[Vync]

Definitely fight these. Even if he does not have records, but has the conditions NOW, the presumptive rules should allow for service connection.

Some C&P doctors are not what I would call "veteran friendly". The vague wording "neurological" + "sleep disturbances" could indicate sleep apnea. "Respiratory disorders" is self descriptive, but some docs interpret this solely as pertaining to the lower respiratory (lungs), even though it could also apply to the upper respiratory (sinus, throat).

If you can get an IMO, it could really help. If you have not done so already, also include a "buddy letter" from yourself that states what you have seen. These don't carry a lot of weight, but can help tip the scales. If it has not been very long since you receive the denial, a reconsideration (along with an IMO) could help, but it the VA drags their feet, be sure to convert it to a NOD/appeal before the time limit runs out.

See below, I hope this helps:

http://www.benefits.va.gov/COMPENSATION/claims-postservice-gulfwar.asp

Eligibility Requirements

• Diagnosed or undiagnosed conditions that appeared either during a qualifying period of active service or prior to December 31, 2016, to a degree of 10 percent or more must meet the following conditions:
  • There must be no other cause for your disability or illness than service in the Southwest Asia theater of military operations.
  • your disability existed for 6 months or more, AND
  • If your disability or illness did not appear during active duty in the Southwest Asia theater of military operations, then it must have appeared prior to December 31, 2016, to a degree that is at least 10-percent disabling (for VA rating purposes).

The disability must have existed for 6 months or more, AND

The disability must be one or more of the following:

Undiagnosed illnesses. These are illnesses that may include but are not limited to: abnormal weight loss, fatigue, cardiovascular disease, muscle and joint pain, headache, menstrual disorders, neurological and psychological problems, skin conditions, respiratory disorders, and sleep disturbances

...

It is not uncommon for the VA to low-ball ratings. In my opinion, someone who needs to use a pad should get a minimum of 30%.

7332   Rectum and anus, impairment of sphincter control:
Complete loss of sphincter control	100
Extensive leakage and fairly frequent involuntary bowel movements	60
Occasional involuntary bowel movements, necessitating wearing of pad	30
Constant slight, or occasional moderate leakage	10
Healed or slight, without leakage	0

[USMC_VET]

Here is the info on gulf war illness compensation information.

 

Eligibility Requirements

• Diagnosed or undiagnosed conditions that appeared either during a qualifying period of active service or prior to December 31, 2016, to a degree of 10 percent or more must meet the following conditions:
  • There must be no other cause for your disability or illness than service in the Southwest Asia theater of military operations.
  • your disability existed for 6 months or more, AND
  • If your disability or illness did not appear during active duty in the Southwest Asia theater of military operations, then it must have appeared prior to December 31, 2016, to a degree that is at least 10-percent disabling (for VA rating purposes).

The disability must have existed for 6 months or more, AND

The disability must be one or more of the following:

• Undiagnosed illnesses. These are illnesses that may include but are not limited to: abnormal weight loss, fatigue, cardiovascular disease, muscle and joint pain, headache, menstrual disorders, neurological and psychological problems, skin conditions, respiratory disorders, and sleep disturbances.
• Functional gastrointestinal disorders. Functional gastrointestinal disorders are a group of conditions characterized by chronic or recurrent symptoms that are unexplained. These disorders may include but are not limited to irritable bowel syndrome, functional dyspesia, functional vomiting, functional constipation, functional bloating, functional abdominal pain syndrome, and functional dysphagia.
• Chronic Fatigue Syndrome
• Fibromyalgia

Presumptive disorders will be considered to have been incurred in or aggravated by service even if there is no evidence of such disease during active service. With three exceptions (see astericks), one of the following must have become manifest to a degree of 10 percent or more within 1 year of the date of separation from a qualifying period of active service:

• Burcellosis
• Campylobacter jejuni
• Coxiella burnetii (Q fever)
• Malaria* (if not 10 percent or more within one year of separation, may be 10 percent or more at a time when standard or accepted treatises indicate that the incubation period commenced during qualifying period of service)
• Mycobacterium tuberculosis* (no time limit)
• Nontyphoid Salmonella
• Shigella
• Visceral leishmaniasis* (no time limit)
• West Nile Virus

 

Those illnesses above are the total list of the presumptive conditions recognized by the VA under GW.

sleep apnea and sinusitis are not specifically listed, but could be under the general "respiratory disorders" or "sleep disturbances".

 

Post the C&P notes so we can see what they wrote, DC codes, etc.

I have to disagree with Vync on the rating criteria based on what you stated. 30% would indicated that BECAUSE of occasional times where there are full bowel movements a pad is worn, and this would indicate because of the involuntary nature you would need the pad at all times since there is no precursor or warning.  if you told the examiner that you generally wear them, but not today or on other days, even if its 6 days a week this would not hit the 30% rating.  i dont have all the information so im just going off what i read.

i dont have that much experience with the GW side of things, although i did file for chronic fatigue, but since my sleep doctor at the VA is convinced it is apnea, i am going to wait to see what the results are.

The main thing with the respiratory is whether is is a diagnosed illness or not, by that i mean was the respiratory issues found to be "caused" by anything, anyting at all in your medical records.  with the undiagnosed condition specification for GW it has to be a issue, but undiagnosed and NOT related to anything at all.  reading over the C&P would help alot as well as the decision letter (if available) to see what the VA says it is from.

 

Quote

7332   Rectum and anus, impairment of sphincter control:
Complete loss of sphincter control	100
Extensive leakage and fairly frequent involuntary bowel movements	60
Occasional involuntary bowel movements, necessitating wearing of pad	30
Constant slight, or occasional moderate leakage	10
Healed or slight, without leakage	0