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IMEF-Gunny

VA added diability to claim-deleted it and simply denied all other contentions - Advice needed

Question

So, I have an interesting situation here that I’m not entirely sure how to approach.

 

I had a C&P exam January 2017. The doc examined my stomach for a contention of gastro-intestinal disturbance (Gulf War vet). The doc also examined my anus/sphincter for hemmoroids.

 

In regard to intestinal/colon: (7319)

3. Signs and symptoms

---------------------

Does the Veteran have any signs or symptoms attributable to any non-surgical

non-infectious intestinal conditions?

[X] Yes [ ] No

If yes, check all that apply:

[X] Alternating diarrhea and constipation

If checked, describe:

Has been having diarrhea and constipation

[X] Abdominal distension

If checked, describe:

Constant bloating.

4. Symptom episodes, attacks and exacerbations

----

If checked, describe typical exacerbation or attack:

Every day episodes.

Indicate number of exacerbations and/or attacks in past 12

months:

[ ] 0 [ ] 1 [ ] 2 [ ] 3

[ ] 4 [ ] 5 [ ] 6 [X] 7 or more

I was awarded 30% SC for Gastro-intestinal disturbances . Doc also noted in his exam notes (DBQ) the following: In Regard to Rectum/Sphincter (7332)

  

3. Signs and Symptoms

---------------------

Does the Veteran have any findings, signs or symptoms attributable to any of

the diagnoses in Section 1?

[X] Yes [ ] No

[X] d. Impairment of rectal sphincter control

If checked, indicate severity (check all that apply):

[X] Leakage necessitates wearing of pad

[X] Occasional involuntary bowel movements

[X] Other, describe:

Usually after bowel movememts leaks feces.

 

My  initial contentions were Gastro-intestinal disturbance, Sleeplessness, Short term memory loss and bi-lateral arm/ shoulder pain. After my C&P results came in, I noticed on Ebenefits that the VSR had deferred all other items and had added “Stool Incontinence” as a separate deferred disability on my claim.

Turned out, the doc was supposed to examine me for all contentions on the initial C&P. It was returned to him as incomplete and he simply answered I denied sleeplessness, memory loss or bi-lateral arm/ shoulder pain (Ludicrous and untrue).

I was denied on all three contentions based on his answer;However, they did not deny stool incontinence, they simply removed it!

Now, stool incontinence is listed as a separate disability under conditions of the anus & sphincter. The VA doc physically examined my anus/sphincter and put the previous comments in my DBQ. He noted in that DBQ that his findings were “undiagnosed illness”.

How would you approach this since they added it to my initial claim and then simply deleted it when they denied the other contentions? Also, since it is listed on the DBQ as being pretty severe and undiagnosed, should I contest it or simply file it as a new claim with the January C&P as evidence for SC? This code 7332 based on his notes would rate a seperate SC%

-Occasional involuntary bowel movements, necessitating wearing of pad      30%

Any advice/opinion is appreciated.

 

Edited by IMEF-Gunny

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I may have just found my answer......If I'm reading this correctly 7319 & 7332 could be combined under one rating. Am I correct in that assumptionbased on this clause?

§4.114  Schedule of ratings—digestive system.

 

            "Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation."

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It sounds like you have done your homework, and Im sure you made sure you had the Caluza elements, right?  

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Yes sir.......by the way, you don't often hear that term Caluza. I have read some of Mario's misadventures......wow!

 

The way I'm reading the combining diagnostic codes though, it appears that they can indeed combine the 7319 and 7332 and these do not qualify for seperate ratings.

 

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