"Denied because disability not clinically diagnosed"

[AFMedic09]

I filed a claim for GERD in April of this year.  I had a C&P last month.  I loaded medical records from service of an upper GI that was done and the reason it was ordered according to the medical form filled out by the doctor was "DYSPHAGIA HX GERD" .  I just received my denial letter stating "the medical evidence of record fails to show that this disability has been clinically diagnosed".  I don't know what more I could have sent to them to prove this was diagnosed in service?  I have been treated by the VA since I got out of the military in 2009 with Prilosec daily, and still have some days when the reflux is terrible. I sleep with 5 pillows under me so that my head is elevated to keep the acid from waking me up.  Just wondering what I should do now to appeal? I found some medical evidence today that was not included when I filed this claim where I was seen for a cold, but it shows my medications of prilosec at that time (2004), and others show I was taking Prilosec, Tums, and that list problem list of GERD. I cannot find the medical note where I was diagnosed with GERD, but I have been treated for it since I was in service, and the scope showed an irregular Z-line which the doctor explained to me after the procedure was likely due from my history of reflux.  Any advice?

[Vync]

There are two basic sections to a clinical report:

Subjective: Your complaints

Objective: Doc's assessment

If they say "HX GERD", it just means you either complained about having GERD or have a history of being diagnosed with GERD. 

Sounds like "lazy rater syndrome". They don't prescribe prilosec because you want it. I recommend you go through your medical records, in service, VA, and civilian, and make a list where the doc diagnosed you with GERD, dysphagia, or other reflux-related event. Send in the list of dates, diagnosis, medication history, treatment given, tests, etc... and summarize it in your submission. Keep the this submission limited solely to your GERD claim. If you already submitted the medical evidence, you might consider resending copies (never send originals). If you "spoon feed" the VA exactly what they need, it makes it hard for them to accidentally not read it. You connect the dots for them and then cross your fingers and hope they don't be stupid. Kindly let them know their assessment was jacked up.

Also, if you were given NSAIDs (ibuprofen, advil, naproxen, etc...), like the military likes to prescribe like candy, GERD is just one of the common problems that it causes. Almost everyone I personally know who served in the military has GERD because of this.

[Andyman73]

AFMedic09,

I agree totally with Vync.  And for what it's worth, at least you have in your STR where you were prescribed the Prilosec.  Some of us, who where/are on a daily regimen of some type of pain reducer, have no listed GERD type ailment or treatment there of, in our records.

I've been on NSAIDs or tylenol, for 23 years, now, but not sure if or how I can file a claim for the side effects of that long term usage.

Vync is correct saying about spoon feeding the VA.  They give no quarter, and you must prove everything, guilty until proven innocent, such as it is.

Semper Fi.

Andyman

[Andyman73]

Vync,

I will have to look up the side effects of the NSAIDs, since my PCP has switched me to tylenol, within the past 2 years, due to the effects on my bp.  Tylenol doesn't effect bp. 

I will make an appointment with my private MD for GERD/GERD like symptoms, but will have to be after the new year, since I'm pretty tied up with a lot of stuff going on, at the moment.

This heliobacter pylori, what other symptoms are known associates?

Thanks,

Andyman

[Vync]

Vync,

I will have to look up the side effects of the NSAIDs, since my PCP has switched me to tylenol, within the past 2 years, due to the effects on my bp.  Tylenol doesn't effect bp. 

I will make an appointment with my private MD for GERD/GERD like symptoms, but will have to be after the new year, since I'm pretty tied up with a lot of stuff going on, at the moment.

This heliobacter pylori, what other symptoms are known associates?

Thanks,

Andyman

You can look them up online, but when I filed I used the papers that came with my meds. That way it came straight from the VA horse's mouth. They couldn't argue with that!

If you took NSAIDs for long term, it is likely the damage might have already been done to your digestive system to one degree or another. If you had any treatments for gastritis, consider including those also.

Here is a link to h. pylori: http://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori
 

[Andyman73]

Well, since my PCP switched me to tylenol, @ 2 years ago, I no longer have any of the paperwork that came with the ibuprofen, or motrin, or naproxin.  So Google it is, for me.  He switched me around the same time I was DXd with SA, and started using my CPAP.  So most of my acid reflux GERD symptoms went away.

So, I will use the google provided NSAID side effect info with my 20 plus years of NSAID prescriptions. 

Thanks for the link for H. pylori, wery interesting indeed.

Semper Fi.

Andyman

[Buck52]

Vync ,

That's a good Ideal to use the Meds Fact sheets & high-light the parts for them to read.

Since I was a victim of Identity Theft...I shred all my med fact sheets.

or I let my 5 year old grand daughter have fun with it.

...Buck