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AshMur

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Hello! Long-time lurker, first-time poster. I've gained a lot of valuable information from this site in the past, and I am hoping to gain some insight on my particular issue/question.

I went through an MEB in 2013/2014. I was found UNFIT for a neurogenic bladder condition (complication during a total colectomy) and rated at 40%. I had several other conditions claimed and rated as part of the MEB. Ulcerative Colitis (they combined it with GERD and a permanent ileostomy) rated at 20% and many other minor conditions related to my joints and scars at 10% each. This all added up to 80% (a year later, I was summoned for a C&P exam to check on my bladder which resulted in an increase from 40% to 60% which raised my overall rating to 90%). At the time, I was confused as to why my UC was only rated at 20% since it led to me losing my colon completely, but I was urged by a Senior Chief working alongside my PEBLO to accept the findings since it granted me a medical retirement and to appeal anything after I was out of the military. Hindsight 20/20--I probably should have appealed the findings when I was still active duty and made sure things were correct before signing anything. However, I didn't know anything about the Schedule for Rating Disabilities/VASRD/38 CFR, so I didn't know any better back then.

Fast forward several months, and I now realize that the VA may have made a mistake in my claim (or that there was important information missing from my medical records). According to the VASRD, ostomies are rated under code 7333 (which is for colostomies) making it look like my permanent ostomy should have been rated at 100% from the start. I met with a DAV rep at the North Chicago VA who helped me submit a claim including a DBQ filled out by a GI noting the reason for my ostomy, the fact that it's permanent, and the date that I had it created. My rep didn't seem interested in hearing about how I felt the original rating was probably incorrect. He kept interrupting me to tell me to just get the DBQ filled out and that we would submit the claim. "Let's keep this simple," he kept saying. He either knows that the VA will see my claim for an ostomy, review my current ratings and see that I have had this ostomy for a while, and will notice the error (is this likely? I'm asking honestly), or he didn't understand what I was saying. I haven't received a return call from him in weeks and he is always out of the office when I make the 45-minute drive up to the VA where he works. I have been following my claim on eBenefits and taking the info with a grain of salt. It's being worked on in the National Work Queue (mostly out of San Diego), and I've been at PFD since the end of June and it's past the ECD of July 15, 2016, with no new ECD listed. It would have surprised me to have a closed claim by July 15th, so I am trying to be patient and see how long this takes.

Anyway, my main question is this: since I've had this ostomy since the original award letter, do I have a reason to make sure the results of this current claim has an effective date of that original rating decision from 2014? Or, have I missed that window because I didn't appeal the VA's decision within one year? Also, I'm curious to know if there are any other veterans with ostomies here and how the VA rated theirs.

Thanks in advance for any info/discussion on this topic!

Edited by AshMur
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I think you are right and that they made an error.

"According to the VASRD, ostomies are rated under code 7333 (which is for colostomies) making it look like my permanent ostomy should have been rated at 100% from the start. "

I helped a friend with a colostomy claim. He was rated 100% P & T right off the bat

Are you employed? If not have you applied for SSDI?

Can you scan and attach their Reasons and Bases part of their last decision as to their rationale for the 60%  Ostomy rating?

Do you have a copy of the C & P exam that warranted the 60 but not 100%?

"He ( DAV reps)either knows that the VA will see my claim for an ostomy, review my current ratings and see that I have had this ostomy for a while, and will notice the error (is this likely? I'm asking honestly)"That is highly unlikely in my opinion , unless this was a re -opened claim or a CUE claim. "or he didn't understand what I was saying." Possible.

Maybe he filed a re-opened claim for you? 

He could have filed, from what I see here, a CUE claim for you.

CUE Clear and unmistakable error in a past VA decision...lots of info on CUE here.

 

"DAV rep at the North Chicago VA who helped me submit a claim including a DBQ filled out by a GI noting the reason for my ostomy, the fact that it's permanent, and the date that I had it created."

Did the GI ( is this a non VA doctor who is familiar with your type of disability?) Did this doctor also make the point that this is a total disability?

What was the new claim actually for....to re-open the older claim? or was it a TDIU claim?

Cover your C file, name, address prior to scanning and attaching the documents here.

 

Edited by Berta
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I would not trust your REP, and he sounds a lot like the one I have, every time I needed him he would be out of the office  GRrrrr

I agree with Ms berta

send copy of the reason & bases...that will give us more information to help you.

black out your name and claim No.  and any personal info.

 

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

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Thanks for the replies so far! Wanted to check in quickly to let you know I've read your responses and am going to be working on getting my C file and reading up on CUE claims and such. Ebenefits won't load my dashboard today so that I can check my status today, but a few days ago I was still sitting at PFD. Letters still say 90% with date of last increase I received so no change there it seems.

Thanks again!

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You had stated:

 

"DAV rep at the North Chicago VA who helped me submit a claim including a DBQ filled out by a GI noting the reason for my ostomy, the fact that it's permanent, and the date that I had it created."

Are you sure VA got this info?

If you need a CUE claim on this, we can help prepare the wording ,as so far it seems like a no brainer, but still we would need to see the  C&P exam and the decision that rendered only 60%.

 

 

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Hey, Berta!

All of that info that the GI wrote down was filled out in the DBQ forms and submitted to the VA as part of my claim on May 31, 2016. I would be able to see if they got that DBQ when I ask to see my C-File, correct? I don't currently have any C&P Exam paperwork from the initial claim that was submitted when I was Med-boarded out of the Navy, but I do have the code that was used and the blurb on the decision packet:
 

"7346-7305: ULCERATIVE COLITIS, WITH S/P PROCTO COLECTOMY AND ILEOSTOMA, NOW INCLUDES GASTROESOPHAGEAL REFLUX DISEASE (GERD), HIATAL HERNIA [Disability Evaluation System (DES)/PEB Referred]

Service Connected, Gulf War, Incurred
Static Disability

20% from 06/28/2014

Reviewer note: code sheet corrected to combine 7305 ulcerative colitis, with s/p procto colectomy and ileostoma with 7346 gastroesophageal reflux disease (GERD), hiatal hernia in accordance to CFR 4.114 schedule of ratings for digestive system to avoid pyramiding.

Although Veteran meets schedular to be eligible for Total Disability based on individual Unemployability (TDIU), review of current evidence does not show service connected conditions precludes Veteran from obtaining or maintaining gainful employment. TDIU is not invited."

 

So, there's that. I'll be requesting my C-File ASAP. As soon as I can get a hard copy of that, I will be consulting with a VA accredited lawyer in Chicago. Do you happen to know if I can initiate a CUE claim before this current claim is completed, or will I need to wait? Thanks!

 

UPDATE: Checked my claim today (August 25, 2016), and it has moved back from "Preparation for Decision" to "Gathering of Evidence" with a new ECD of November 2016-February 2017. Under "Needed from Others" it just says <VA Medical Facility> with a due date of 9/24/2016. How vague haha. I wish it would state what they need specifically so that if it's something I have, I can upload it to eBenefits ASAP but I will probably just try to reach my DAV rep. It also says that a Development Letter has been sent. Guess this may take longer than I expected...

One good thing about this change in my status is that where it says Disabilities Claimed, it used to say this:

  • Disabilities Claimed: intestinal surgery initial (diagnosed as Permanent) (New)
  •  

...but now it says this:

 

  • Disabilities Claimed: intestinal surgery initial (diagnosed as Permanent) (Increase)

 

So, it seems whoever has been working on my case noticed that I've had this diagnoses of a permanent ostomy already and what I need is for the rating to change. Hopefully, the change is in my favor :D

Edited by AshMur
Update on eBenefits
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