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AFMedic09

NOD granted, Timeline, Need Advice

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Comp. filed 4/2015.

C&P 8/2015

Denied 12/2015

NOD filed 12/2015

8/2018 NOD sent to FARGO RO from St. Pete due to backlog

11/11/2018 New C&P

11/30/18- APPEAL COMPLETE IN EBENEFITS VA.Gov showed Appeal Granted The Veterans Benefits Administration has agreed with you and overturned the previous denial.

12/4/18 - EBENEFITS AB8 updated (at 6 p.m.) to reflect increase rating from 60% to 70%. Ebenefits also updated SC list at this time to reflect new SC'd conditions

 

So, from this I see they combined my IC with my already SC'd TVT bladder sling/incontinence, which was rated 20% and now that they have combined the issues it is 30% even though I have to cath. twice daily and instill bladder medications that I have to draw up and combine myself.The C&P examiner said I use appliances, can't hold bladder more than an hour, waking 5-6 time at night for bathroom, etc. Isn't that 60% or am I reading that wrong?

The GERD (stomach hernia) is rated at 10% even though I have regurgitation, dysphagia, chest pain, and take meds. daily-have for over a decade. (I am already SC'd 0% for anemia as well).

I don't know if I should contact the DAV and see about fighting the low ball ratings or not? Where would I even go from here? BVA? I need some advice. Should I just be happy with my "win" and lay down?

I really do not understand how they come up with their ratings? No BBE yet. 

VA.Gov lists the dates as Dec.1, 2015 - Nov. 30, 2018.

However, the original claim was filed 4/24/2015, denied 12/1/2015, NOD received 2/8/16. Shouldn't effective date (for retro) be April since the VBA overturned it's original decision(12-1-2015)?

Edited by AFMedic09

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44 minutes ago, AFMedic09 said:

Comp. filed 4/2015.

C&P 8/2015

Denied 12/2015

NOD filed 12/2015

8/2018 NOD sent to FARGO RO from St. Pete due to backlog

11/11/2018 New C&P

11/30/18- APPEAL COMPLETE IN EBENEFITS VA.Gov showed Appeal Granted The Veterans Benefits Administration has agreed with you and overturned the previous denial.

12/4/18 - EBENEFITS AB8 updated (at 6 p.m.) to reflect increase rating from 60% to 70%. Ebenefits also updated SC list at this time to reflect new SC'd conditions

 

So, from this I see they combined my IC with my already SC'd TVT bladder sling/incontinence, which was rated 20% and now that they have combined the issues it is 30% even though I have to cath. twice daily and instill bladder medications that I have to draw up and combine myself.The C&P examiner said I use appliances, can't hold bladder more than an hour, waking 5-6 time at night for bathroom, etc. Isn't that 60% or am I reading that wrong?

The GERD (stomach hernia) is rated at 10% even though I have regurgitation, dysphagia, chest pain, and take meds. daily-have for over a decade. (I am already SC'd 0% for anemia as well).

I don't know if I should contact the DAV and see about fighting the low ball ratings or not? Where would I even go from here? BVA? I need some advice. Should I just be happy with my "win" and lay down?

I really do not understand how they come up with their ratings? No BBE yet. 

Getting low-balled sucks. This would actually be a good thing if you were showing symptoms rateable at 10%. But, you do not have symptoms at that rate.

If the C&P examiner noted the appliances and bladder incontinence in the exam and it was administered with a VA C&P examiner. You can look at what the examiner said exactly as you remember what was stated in ebenefits or myhealth.va.gov. You may be able to use the Clear and Unmistakable Error to re-open the claim for the "bladder injury".

Here is how the evidence, law, and ratings should have been applied:

7512 Cystitis, chronic, includes interstitial and all etiologies, infectious and non-infectious:
Rate as voiding dysfunction. 

7517 Bladder, injury of:
Rate as voiding dysfunction.

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 or other urinary assistive appliance 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%.

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%.

 

Clearly and unmistakably someone didn't follow the ratings table. And that is gross incompetence on the VBA AND BVA.

Not even the BVA got it right!! It's a sad day to see this, but not surprising.

 

Gastroesophageal reflux disease (GERD) is a condition where the acid in the stomach travels up the esophagus. It is rated under code 7346, hiatal hernia.

Code 7346: A hiatal hernia is a hernia in the diaphragmdiaphragm.bmp that allows the organs in the abdomen to move up into the chest cavity.

If the hernia causes pain, vomiting, significant weight loss, blood in the vomit or feces, and anemia, or if other symptoms cause a serious overall health disability, it is rated 60%. If there are regular episodes of pain in the upper abdomen, trouble swallowing, heartburn, the return of food into the back of the throat/mouth, and pain in the upper arm or shoulder, it is rated 30%. If two or more of the previous symptoms are present, but are not as severe, it is rated 10%.

On the claim for GERD, at the very least, 30% needed to be granted.

 

You can go the DAV route or hire an experienced Veteran's Law firm. Both have their advantages and some disadvantages.

A veteran's lawyer won't take money upfront, if they do, say see you later. A veteran's lawyer has to submit a form to the VA to pay them to represent you; from my understanding.(Can any forum members correct me if I'm wrong?) They may have an additional fee, but you would have to negotiate with the lawyer representing you. 

DAV kind of tends to jump the gun sometimes and sends letters that have caused veteran's unnecessary stress and confusion. But, they're good at what they do; for the most part.

There's work still left to be done. In the meantime, I suggest  start making appointments with a GI doctor or a Urogynecologist (Urologist for women). You want to keep building on the medical evidence you already have to show that your symptoms are still there or have become worse. Add teeth to the medical evidence. 

"Never Give Up and Never Give In".

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31 minutes ago, doc25 said:

Getting low-balled sucks. This would actually be a good thing if you were showing symptoms rateable at 10%. But, you do not have symptoms at that rate.

If the C&P examiner noted the appliances and bladder incontinence in the exam and it was administered with a VA C&P examiner. You can look at what the examiner said exactly as you remember what was stated in ebenefits or myhealth.va.gov. You may be able to use the Clear and Unmistakable Error to re-open the claim for the "bladder injury".

Here is how the evidence, law, and ratings should have been applied:

7512 Cystitis, chronic, includes interstitial and all etiologies, infectious and non-infectious:
Rate as voiding dysfunction. 

7517 Bladder, injury of:
Rate as voiding dysfunction.

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 or other urinary assistive appliance 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%.

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%.

 

Clearly and unmistakably someone didn't follow the ratings table. And that is gross incompetence on the VBA AND BVA.

Not even the BVA got it right!! It's a sad day to see this, but not surprising.

 

Gastroesophageal reflux disease (GERD) is a condition where the acid in the stomach travels up the esophagus. It is rated under code 7346, hiatal hernia.

Code 7346: A hiatal hernia is a hernia in the diaphragmdiaphragm.bmp that allows the organs in the abdomen to move up into the chest cavity.

If the hernia causes pain, vomiting, significant weight loss, blood in the vomit or feces, and anemia, or if other symptoms cause a serious overall health disability, it is rated 60%. If there are regular episodes of pain in the upper abdomen, trouble swallowing, heartburn, the return of food into the back of the throat/mouth, and pain in the upper arm or shoulder, it is rated 30%. If two or more of the previous symptoms are present, but are not as severe, it is rated 10%.

On the claim for GERD, at the very least, 30% needed to be granted.

 

You can go the DAV route or hire an experienced Veteran's Law firm. Both have their advantages and some disadvantages.

A veteran's lawyer won't take money upfront, if they do, say see you later. A veteran's lawyer has to submit a form to the VA to pay them to represent you; from my understanding.(Can any forum members correct me if I'm wrong?) They may have an additional fee, but you would have to negotiate with the lawyer representing you. 

DAV kind of tends to jump the gun sometimes and sends letters that have caused veteran's unnecessary stress and confusion. But, they're good at what they do; for the most part.

There's work still left to be done. In the meantime, I suggest  start making appointments with a GI doctor or a Urogynecologist (Urologist for women). You want to keep building on the medical evidence you already have to show that your symptoms are still there or have become worse. Add teeth to the medical evidence. 

"Never Give Up and Never Give In".

My NOD never made it to BVA (that I know of). It was transferred from my RO (St. Pete) to Fargo RO and the review officer called me, set up a C&P,  and then made a decision to overturn. (Va.gov said: "Veterans Benefits Administration agreed with you and overturned their initial decision").

I am seeing a VA urogyn. who is treating my IC. I had the best of the best (one who was conducting IC research at Shands until his grant ran out and the VA picked him up), but he retired in 2017. I had to start using catheters in 2015. The cocktail I mix up to instill in my bladder was designed by him. It helps...but it burns like hell.

The only issue I do not have with GERD is weight loss (sigh). But I have every single other one. Frustrating.

I recently signed up for DAV representation and did POA on ebenefits, expecting the fight was not over..

I will call them and set up an appointment to see if they can get my C&P exam results and if we have any recourse here.

Thank you so much for your guidance.

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1 minute ago, AFMedic09 said:

My NOD never made it to BVA (that I know of). It was transferred from my RO (St. Pete) to Fargo RO and the review officer called me, set up a C&P,  and then made a decision to overturn. (Va.gov said: "Veterans Benefits Administration agreed with you and overturned their initial decision").

I am seeing a VA urogyn. who is treating my IC. I had the best of the best (one who was conducting IC research at Shands until his grant ran out and the VA picked him up), but he retired in 2017. I had to start using catheters in 2015. The cocktail I mix up to instill in my bladder was designed by him. It helps...but it burns like hell.

The only issue I do not have with GERD is weight loss (sigh). But I have every single other one. Frustrating.

I recently signed up for DAV representation and did POA on ebenefits, expecting the fight was not over..

I will call them and set up an appointment to see if they can get my C&P exam results and if we have any recourse here.

Thank you so much for your guidance.

I was under the impression it was BVA. My fault. Now that we know it was a DRO review. Move forward and appeal to the BVA. 

DAV or Veteran's lawyer will definitely help with that. I'm about 75% sure the BVA will provide due diligence to your case. 25% I leave it to the possibility that they may still get it wrong. If that happens take it to the Court of Appeals for Veterans Claims (CAVC ) If the CAVC still gets it wrong. Take it to the Supreme Court.

 

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10 hours ago, doc25 said:

I was under the impression it was BVA. My fault. Now that we know it was a DRO review. Move forward and appeal to the BVA. 

DAV or Veteran's lawyer will definitely help with that. I'm about 75% sure the BVA will provide due diligence to your case. 25% I leave it to the possibility that they may still get it wrong. If that happens take it to the Court of Appeals for Veterans Claims (CAVC ) If the CAVC still gets it wrong. Take it to the Supreme Court.

 

You are right. They rated me for bladder injury, which should be rated under voiding dysfunction. In ebenefits it lists interstitial cystitis status post TVT for urinary incontinence. Voiding dysfunction doesn't have a rating schedule for 30%? Not sure why this was even applied? Waiting on my envelope so I can start filing the Form 9. Love your quote, BTW. 😉 Thank you!

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