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"Denied because disability not clinically diagnosed"

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AFMedic09

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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?

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Andyman do you have a copy of your care at the VAMC? If not get one.  I you can't go to the VAMC do it via eVet. Not sure whether your care is strictly VA or not.

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Don't concentrate on the diagnosis in my opinion.  Documented symptoms which it seems you have.  AFmedic09 that crap is a literal pain in the throat and ass.  

For me change in diet, positional therapy when sleeping, vast amounts of rx and OTC.  It helped for a while but got worse these last few years so I had a fundiplication done.  It works for some and for a while but I would talk about these things and ask the Gastro specialist.  Don't let the VA schedule you 90 days out either, if you can't be seen in 30 days try the Choice program or something.  

JMO

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Andyman do you have a copy of your care at the VAMC? If not get one.  I you can't go to the VAMC do it via eVet. Not sure whether your care is strictly VA or not.

I can get it easy enough.  I do have a complete print out of all the meds prescribed by the VA since the start of my active treatment with them.  I have a pretty good chunk of time where I was getting ibuprofen through the VA, for SCDs, and it shows where I ordered refills, month after month after month.  I used it to show chronic pain for a claim, recently.

Whenever they asked if it was causing stomach issues, I never connected the heartburn/acid reflux with stomach issues.  I was switched to tylenol for hypertension reasons.

I go to my VAMC quite often, so I will stop in at the info release office to get treatment records from my PCP.

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Andy you can get a copy at the VAMC if you stop by the records office, most places, the personnel are courteous and helpful, especially if its quick like a specific report or procedure.

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Yessir, my local records office is very useful indeed.  The ladies that run that ship keep it tidy and serviceable. 

Now, a question, I have an appointment for my PCP sometime in January...if I tell him that I've been suffering from acid reflux/GERD symptoms for sometime now, and he puts in the request for treatment...can I use that as my basis for initiating a claim for NSAID useage side effects? 

My PCP is one of the MDs that prescribed them to me over the years.

Thanks,

Andy

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Andyman, absolutely, if you have been on NSAIDS like ibuprofen and naproxen for long periods of time, they are well known to cause gerd and stomach issues. AFMed09, I would take a DBQ into your doctor for GERD and see if they will complete it for you, only problem with that could be they approve your claim but start it effective the date of the DBQ. I have been on NSAIDS myself daily for about 10 years now, for the past year, it has gotten to the point where the GERD/IBS is almost as much of a problem as the systemic lupus. I have daily severe nausea, abdominal cramping, i vomit if i eat certain tomato based foods, heart attack like chest pain, etc. Andyman, if you have been on NSAIDS for over tweny years i would definitely file a claim for GERD as secondary to those meds, send in pertinent records and an article describing how those meds cause GERD, along with your precribed medication lists going back as far as possible with the NSAIDS highlighted. I wish both of you success and hope this helps.

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