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Charlieg

Gulf war vet denied presumptives

Question

Denied Shoulder impingement syndrome with nexus letter.

Denied IBS that was diagnosed by va and preferred choice gastro doctor

Denied Psorisis that C&P doctor admitted is Psorisis.

 

Maybe I don't understand the rules of the presumptives?   How should I proceed?  Here is the actual denials.

DIAGNOSIS:
1. Left shoulder impingement [Icd10 code: m75.40]. Veteran has claimed a
disability pattern related to (left shoulder pain) that meets TL10-01 criteria
for a disease with a clear and specific etiology and diagnosis. Not caused by or
related to GW environmental exposure. Not caused by rotator cuff weakness
documented in 1991 and that pre-existed to deployment and active service at the
time, as per medical records documentation. Veteran denied any shoulder
condition
on physical examination dated 1993. No functional limitations. Normal x rays.
Condition is due to re
petitive activity at or above the shoulder during work or
sports as per medical literature. Dr. Herzog assessment/note, although full of
advocacy, is inconsistent with objective documented data in medical records
(STR's), and hence delegated to a personal speculation.

2. Claimed condition: "Irritable Bowel Syndrome". There is insufficient
evidence
to warrant or confirm a diagnosis of an acute or chronic Irritable Bowel
Syndrome
condition or its residuals. No medical opinion can be rendered as no condition
is
diagnosed. Veteran does not meet Roma III criteria for diagnosis. Veteran denied
any gastrointestinal condition on physical examination dated 1993. Veteran
reported symptomatology as likely as not 2ry to dietary variations, although the
possibility of functional diarrhea, celiac or other malabsorption condition has
not being entirely ruled out.

3. Psoriasis [Icd10 code: L40.0]. Veteran has claimed a disability pattern
related to (skin condition) that meets TL10-01 criteria for a disease with a
clear and specific etiology and diagnosis. Not caused by or related to GW
environmental exposure. Not caused by or related to nickel allergy, nor by rash
documented on 1991 that resolved after Lidex treatment. Veteran denied any skin
condition on physical examination dated 1993. Condition as per medical
literature, is genetically determined by the psoriasis-susceptibility (PSORS1)
locus within the major histocompatibility complex (MHC) on chromosome 6p21
(location of the HLA genes)

 

I admit I may have said I had no issues out processing in 1993 but I was wanting to leave the airforce at the time and didn't want anything to stop that and did not know anything about compensation.  I was told to go the the va and get treated for rashes from the gulf war and the va did treat until I stopped going.

 

 

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When did you receive the denial?  

Just curious as you have a year from their decision to file your NOD.  I'm sure others will chime in, so FWIW, my thoughts are you can and should file a timely NOD after and only after:

  • careful examination of what they determined, how/why they denied the claim.
  • development of additional evidence to substantiate the claims/refute the denial.
  • gaining a thorough understanding of some things you can glean from Had it and other sources.
  • getting your C file to determine what evidence is in there.

Sorry to say but my .02 is the shoulder condition and the Psoriasis are ineligible for the GW presumptive list.  You can see the list on the VA web page for GW vets.  Both are diagnosed conditions that are not specifically listed by the VA in 38 CFR and that basically makes them ineligible for that route of service connection.  Doesn't mean you don't have them or can't win but it's just not the correct route for service connection.    

The IBS however, if you meet the criteria, is a GW presumptive and can be claimed as such with some additional documentation.  From the denial, it appears your claim didn't include a diagnosis of IBS.  You can start gathering evidence for your appeal by getting either a private doctor or the VA to dx you with IBS.  I'd recommend the private doc if you can.  It will involve a colonoscopy, multiple visits, testing to rule out other conditions,  dietary logs etc...

Did you have C&P exams for any/all conditions?  If so , get those results and see what the C&P doc wrote.  In the shoulder decision they refuted your nexus letter.  So you may have to fine tune that with some visits to the doc that detail the condition and how is related to service, i.e you worked overhead on c-130 engines for 5 years.

Hope this helps.

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It sounds to me like Dr Herzog did not follow the IMO criteria here at hadit. And this is not presumptive as SincityCJ stated. But it was pre existing.

Maybe a better IMO from the doctor would help more...if it follows the IMO criteria here at hadit.

The IBS claim seems to not have had enough documentation medically  to render a diagnosis.

You need to read the IBS criteria in the VA schedule of ratings.

On the psoriasis (not presumptive)

“Condition as per medical

literature, is genetically determined by the psoriasis-susceptibility (PSORS1)

locus within the major histocompatibility complex (MHC) on chromosome 6p21

(location of the HLA genes)”

I bet the C & P doc got that by googling psoriasis.It does say the condition was resolved by Lidex.

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Was able to get the preferred choice doctors diagnosis.  Which was 

  • K92.1
Hematochezia
  • K58.9
IBS (irritable bowel syndrome)

Hopefully this helps when I go the my vro in a few weeks.  So even tho I hurt my shoulder in desert storm I cant claim it.  It was not pre-existing before desert shield/storm.  Also the psorasis that he says I have now is not the same thing I was treated for in the gulf.  I had pustules oozing out of my feet and hands that lasted for years and was treated by the va in the early 90s.  It is gone now but I wonder if it will ever come back. 

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On 10/10/2016 at 3:47 PM, Charlieg said:

Was able to get the preferred choice doctors diagnosis.  Which was 

  • K92.1
Hematochezia
  • K58.9
IBS (irritable bowel syndrome)

Hopefully this helps when I go the my vro in a few weeks.  

The DX for IBS will certainly help the appeal.  You now need to collect any documentation you have for that claim to file with the NOD.  You have 12 months from the date of notification.   IBS is listed on the GW presumptives. 

 

Quote

So even tho I hurt my shoulder in desert storm I cant claim it.  It was not pre-existing before desert shield/storm

You absolutely can claim the shoulder, because it occurred while in service.  It is a standard claim.  

What you cannot do is claim it as a GW presumptive.  Just because it occurred during DS doesn't automatically make it a presumptive. The GW presumptives are for totally different conditions that are specific to the exposures. 

See the link below:

http://www.benefits.va.gov/COMPENSATION/claims-postservice-gulfwar.asp

 

Quote

Also the psorasis that he says I have now is not the same thing I was treated for in the gulf.  I had pustules oozing out of my feet and hands that lasted for years and was treated by the va in the early 90s.  It is gone now but I wonder if it will ever come back. 

The skin condition you mention may qualify if it was undiagnosed.  This one will likely take some serious work including an IMO as Berta mentioned above to get sorted out.

 

 

 

 

 

 

 

 

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