"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?

[Andyman73]

flores97,

I plan to, I have a few claims floating around the merry go round of my VARO at the moment.  I'm thinking I'll wait until the new year for this one.

I did have a complete list printed out of all my VA prescriptions which also showed how often I ordered refills and such.  I still have it.

[Vync]

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

Hey Buck,
All pharmacies give out the medication fact sheets to protect themselves. Of course, the VA does this too because it is the law, otherwise they probably would never do it. The fact sheets usually list side effects to varying degrees, such as "common", "rare", and "call your doctor immediately". All the C&P doc has to do is compare your long history of treatment [whatever condition caused by med side effect], look to see the highlighted side effect, and then write a nexus. Well, that is unless you get one of those anti-veteran docs.

[ArNG11]

AFMedic09 Hopefully you won't have to go through the hassle. However, most likely you might.  Absence of evidence is NOT negative evidence.  Symptoms in service is obvious from what you wrote.  That is the essence of the validity of the claim that the disease occurred in service, it is a problem now and you are continuing to get treatment whether by VA or private doc.  Diagnosis is horse crap. Verifiable symptoms, diagnosis is a plus but not necessary.

 Am I mistaken or isn't GERD a presumptive on Gulf War Vets/Iraq/OIF OEF. ?  

Hopefully you won't have to get an IMO/IME but if you do make sure to get one and don't put up with that crap.  VA raters are so full of it I'm surprised that the crap doesn't change their eye color and just spews out their mouths onto their desks.    

Sorry not feeling to hot and having problems of my own too close to the LZ.  Give them hell!

[ArNG11]

Eligibility Requirements

• Qualifying undiagnosed illnesses or diagnosable chronic disability patterns, that appeared either during a qualifying period of active service or prior to December 31, 2016, 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 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.
• Diagnosable 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.
• Diagnosable Chronic Fatigue Syndrome
• Diagnosable Fibromyalgia

Certain presumptive diseases, which 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 asterisks), 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

Evidence Requirements

• The evidence must show you served in the Southwest Asia theater of military operations, as defined by regulation or served in Afghanistan on or after September 19, 2001,for benefits associated with certain presumptive diseases.
• Medical evidence of treatment of the claimed disability or illness.
• If there is no medical evidence that you have been previously treated for a disability pattern and the only significant evidence is a lay statement describing the disability pattern, a VA examination may be needed (VA will request an examination).
• • For undiagnosed illness claims, the evidence may be medical evidence or nonmedical indications that can be independently observed or verified such as lost time from work, changes in appearance, changes in physical abilities, and changes in mental or emotional attitudes (Note: Independently verified means it must be possible for VA to obtain verification of the nonmedical indicators from an independent source).

[ArNG11]

Did any of this change recently?

[AFMedic09]

On 12/21/2015 at 5:47 PM, ArNG11 said:

AFMedic09 Hopefully you won't have to go through the hassle. However, most likely you might.  Absence of evidence is NOT negative evidence.  Symptoms in service is obvious from what you wrote.  That is the essence of the validity of the claim that the disease occurred in service, it is a problem now and you are continuing to get treatment whether by VA or private doc.  Diagnosis is horse crap. Verifiable symptoms, diagnosis is a plus but not necessary.

 Am I mistaken or isn't GERD a presumptive on Gulf War Vets/Iraq/OIF OEF. ?  

Hopefully you won't have to get an IMO/IME but if you do make sure to get one and don't put up with that crap.  VA raters are so full of it I'm surprised that the crap doesn't change their eye color and just spews out their mouths onto their desks.    

Sorry not feeling to hot and having problems of my own too close to the LZ.  Give them hell!

Still fighting....had a second C&P exam Nov. 11th. and now movement in ebene.(see below)

I'm guessing they have denied me again despite my evidence and being on Prilosec all these years...unbelievable. I have just signed up for representation through DAV as I have been doing all of this myself up until this point. I have completed the POA for them...I will call them and see what they can tell..

Table of Claims

Latest Progress	Status	Description	Received
03/02/2016	Appeal Pending - Statement of the Case (SOC)	VA has received your Form 9 and will begin completing final actions regarding your appeal before it is sent to the Board of Veterans’ Appeals.	Date not available