Rating Error or Not, anyone know?

[Armyfor9]

Hi,

I am hoping someone with a lot more knowledge than me can figure out if I am misinterpreting the rating descriptions or if someone made an error. I will copy and post from what I read at the end of this. I will omit just one section that is irrelevant.(actually I will include it, just in a small font. I have highlighted the areas I feel are important.

 I have cystitis with recurrent UTI's causing constant (pain, discomfort, urgency) 

I also have incontinence (aka voiding dysfunction)

My claim I stated bladder urinary problem. I wasn't sure how to state it. Clear medical evidence and documents provided to be approved service connection at 40%. My question is that I felt it should be 2 separate ratings. #1 Chronic Cystitis causing frequency meeting 40% AND

#2 Voiding Dysfunction meeting requirements for 60% (Or at minimum 1 rating at the higher of the 2 at 60%.

 

I'm curious as to your take on my rating for the "Urinary System" 

 

Facts: I have a diagnosis of Cystitis 7512(Interstitial Cystitis) which causes pain, frequent urination, urgency, etc.

 also I have recurring and frequent UTI's

 I also have  Urinary incontinence 7542(which is not technically a symptom of cystitis, I suppose unless due to urgency, which is different than mine.)

 

On my claim I claimed "Bladder Condition" Note I was rated at 40% My question is looking at this couldn't I have two ratings? One for the Cystitis at 40% under frequency and also one for Voiding dysfunction at 60%. If not at least rating at the higher 60%????? What do you think? Please let me know if I'm mistaken or if I should submit in hopes of correcting and by what method. Thank You

 

 

Urinary Rating Systems

 

There are three different urinary rating systems.

 

Urinary Frequency: A condition is rated under this system if it causes the body to urinate more often than normal. If you have to urinate 5 or more times during the night, or if you have to urinate more than every hour during the day, it is rated 40%. If you have to urinate 3 or 4 times during the night, or if you have to urinate every 1 to 2 hours during the day, it is rated 20%. If you have to urinate 2 times during the night, or if you have to urinate every 2 to 3 hours during the day, it is rated 10%.

 

Obstructed Voiding: A condition is rated under this system if there is something in the way that makes it hard to urinate, like a kidney stone. If the condition makes it so you cannot urinate at all and must always use a catheter, then it is rated 30%.

If there are obvious symptoms (slow or weak stream, hesitancy to start urinating, etc.) and if there is one or more of the following: 1) more than 150 cc (cubic centimeters) of urine left over in your bladder after you urinate, 2) less than 10 cc of urine per second are passed through the ureter, 3) there are regular urinary tract infections because of the obstruction, or 4) the urethra becomes narrow because of an infection and requires regular dilatation (stretching) treatments every 2 to 3 months—then it is rated 10%.

If there are only obvious symptoms (slow or weak stream, hesitancy to start urinating, etc.) but none of the other 4 conditions listed above, then it is rated 0%. This 0% rating is still given even if there is narrowing of the urethra that requires regular dilatation (stretching) treatments only once or twice a year.

 

Voiding Dysfunction: All urinary conditions that cannot be rated as urinary frequency or obstructed voiding are rated by this system. If the condition requires the use of a catheter to remove urine from the bladder, or if the condition requires the use of absorbent materials (like pads or Depends) that must be changed more than 4 times a day, then it is rated 60%. If it requires absorbent materials that must be changed 2 to 4 times a day, then it is rated 40%. If it requires absorbent materials that must be changed only once a day, then it is rated 20%

 

 

 

Code 7512: Chronic Cystitis is the swelling of the bladder most often due to infections, but it can be caused by other things as well. If it is caused by a urinary tract infection, then it is rated as described for that condition. All other causes of this condition are rated under this code.

 

Code 7542:A Neurogenic Bladder occurs when a person looses control over urination because of damage to the nerves or the brain.

 

Edited January 9, 2016 by Armyfor9
error

[R3dneck]

I'm not an expert but I think the pyramid laws are in effect for this. Since it's one organ it would pay the highest of the two conditions.

[Armyfor9]

So then in your opinion they should have rated it 60% instead of the 40%? That was my initial thought, then as I kept reading I wasn't sure if they were actually two separate. Do you know what the best way to have that corrected? Would that be considered a "CUE" since it is SC and symptoms are well documented.

My honest opinion of how it likely happened is the 1st category maxes at 40%. I believe they saw I maxed and stopped. The only problem was the 3rd one would have rated at 60% which was not an option for the Cystitis. I can see how that could have easily happened by mistake.

[broncovet]

The Va has a duty to maximize your benefit per Roberson, that is, to grant you every benefit to which you are entitled by law.   While its true that interpretive doubt is to be resolved in favor of the VEteran, unfortunately the BOD (benefit of the doubt) does not apply in CUE cases.  

Was your decision more than a year ago?  If it was less than a year, then you should file a NOD.  

Secondly, did VA consider all your evidence?  What did the decison say (reasons and bases)?  Did it list all of your evidence in the evidence section?  If not, you may be able to reopen with N and m evidence under 38 CFR 3.156.  

Its a Colvin Derwinski violation for VA to substitute its own unsubstantiated opinion for that of a competent medical professional.  

The VA is required to give a "reasons and bases" as to why a lower rating was awarded if there are 2 possible interpretations.  If you post the reasons and bases, then it may help us help you.  

[Buck52]

This has to be SC First..if you are SC for this  then do what broncovet mention above.

I have this problem my self and need pads   use about 5 or 6 a day...but I can't prove SC for it...so I don't bother to file a claim..lucky for me the VA  gets me the Depends Pads. and medication to take to help my swollen prostate/also I can't ejaculate  well I can but nothing comes out  Dr says it goes into my bladder and I pee it out..(no pun intended)...I think AO would cause this but I can't prove it  although I was a Vietnam Veteran 2 tours.

 

...........Buck

[Armyfor9]

I am service connected. The reason stated it was the highest allowable. That's why I feel it was simply human error and they did not realize that unlike cystitis, void dysfunction maxes at 60. This was decided on a partially completed claim. Began early last year. Completed some conditions this past September, but others are still open.

 

[Armyfor9]

Another condition rated (SC) painful joints/Arthritis at multiple sites. They rated at 10%. When I filed the claim I was unaware but have recently last week! been diagnosed with fibromyalgia. I'm fairly certain that's why my pain is so severe. I am aware of a condition caused by a SC condition being rated as a secondary. What I have no idea how to address developing a "non-service" condition which aggravates an existing SC.

I am aware that several of my SC(IBD,PTSD,Migraines) are common with fibromyalgia. I just feel getting Fibro SC is too much of a battle. The pain it causes to my SC arthritis seems like somehow it should be considered and allow a rating above 10%.  ANY SUGGESTIONS!!!!! I'm in chronic pain.