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ronnieusmc0311

Denied Acid Reflex Claim???

Question

Hello, I have a question regarding a Claim for Acid Reflex/GERD denial, but first I will start with my story: Letter for intent to file sent on FEB 2019, Filed claim for Acid Reflex July 2019, sent another claim for increase in Asthma (was at 30% for this) on September 2019. Increase in Asthma was granted 1 month later with increase to 60%, Acid Reflex Gerd was deferred. 2 weeks later, Acid Reflex/GERD claim was denied and was stated as "not service connected" with an arrow connecting it to my Asthma. When I sent medical documentation from my Private doctor, she connected my Acid/Reflex/GERD to my Asthma and  corticosteroids inhaler usage. When I had the C&P exam, I stated the exact same thing that it started in the Marine Corps after being prescribed  corticosteroids inhalers, I have been on them since and was Medically retired for Asthma. This rating would have put me at 95% thus rounding to 100%, so as you can tell I am bummed but determined to set this right, I feel as If someone made a mistake somewhere. What should be my next step? NOD? I'm not to experienced on the process, I will be faxing the Claims intake center for my C-FIle, but what should I do next? Thank you!

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3 hours ago, Vync said:

Welcome to Hadit!

The VA's justification for denying your GERD claim should be in the rating decision under the REASONS AND BASES section. They are required to tell you explicitly why they grant or deny each claim. If you are not certain, you can post the content from that section for other members to review and offer their opinion, just be sure to redact/omit any personal information.

As you already know, you need these three things to get something SC:
1. Event/injury in service, existing SC disability, or presumptive condition
2. Current diagnosis
3. Medical nexus connecting 1 and 2

Sounds like you already have all three. The only potentially legitimate reason for a denial if you have 1 and 2 would be an issue with the IMO nexus. It might be a case where the doctor did not use the VA's favorite jargon:
100% = "due to", "caused by", etc...
75% = "more likely than not", "most likely", etc...
50% = "least as likely as not", etc...

It could also be weakly phrased medical rationale, failure to review medical records, etc...

I had an IMO denied because the doctor used words like "possibly" or "probably". I talked with a guy a while back who's GERD was denied because the doctor did not test for heliobacter pylori bacterial infection. Once he got it ruled out, he succeeded.

My GERD was SC secondary to 20+ years of daily NSAID use to treat SC disabilities..

Keep in mind if the evidence is equal for and against, the VA is supposed to concede SC per the relative equipoise rules (i.e. benefit of the doubt).

Regarding the asthma increase, make sure the VA gave you the correct effective date. For increases, medical records going back 12 months prior to the date you filed the intent claim can be used to get an earlier effective date. Also, going from 30% to 60% for asthma often triggers a follow up examination about a year later. If this is the case, the decision letter should indicate "your condition is expected to improve". If you got 60% due to the breathing tests, expect them to bring you back for more PFTs. If you got 60% due to 3+ ingested/injected steroids within 12 months to treat asthma, they may almost certainly bring you back. If your doctor notes that your condition is not expected to improve, the rating continues for 5+ years, or if you are 55+ years old, they probably will not bring you back. Just be sure you have your medical treatment records handy. If you send them in proving the rating needs to be continued, they may not bring you back for another year.

You can also explore other disabilities to boost your schedular rating. If you suffer from pain, stress, anxiety, or depression caused by your SC disabilities, consider filing a mental health claim. 

Good luck!

 

Thank you for the reply also! I will be recieivng the letter this week about the denial on my Acid reflex claim. As I was explaining to Alotzaspots, the DAV VSO in Phoenix told me that it was denied because the PA who examined me at the C&P exam stated my acid reflex was not due to my asthma and asthma meds. They then had a MD write a lengthy paper about how my Asthma meds are not the cause. I had my Private NP write a letter stating that my Acid Reflex is due to my service connected asthma and asthma meds, she stated "more likely than not". The problem was, she did not give a reasoning. I have already set up an appointment with my NP and will be getting that letter revised with a possible study to back up my claim.

After reading the Asthma increase letter, through and through. I do not see "your condition is expected to improve",  I know this means nothing because they can make an exam any time. Since I have been out, I have not had one examination of any disabilities yet, just my basic appointments with he VA, but most of that time was living in Washington state. I have spoke with fellow vets at work, and it seems like phoenix is a hot bed for the VA to call for exams and they suck at treating vets good down here. I was increased due to Steroid use 3 or more times in the year since I moved here, it fluctuates yearly, some years twice, others once, and like this year 4 times.

I also have a mental health percentage 50% for ptsd. So I don't know where I would go with that. As I mentioned, I am sitting at 94% total, this would have pushed me to 95 which would round to 100. Its like they knew this, lol. Well, the VSO tells me to go straight to Board, is this the right route? I will be getting a new evidence letter to submit, and maybe see a gastroenterologist to get an expert to write something.

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@ronnieusmc0311 Yeah, the rationale must be adequate. I found this link below that explains a possible link:

https://www.webmd.com/asthma/guide/heartburn-asthma#2

Quote

How Asthma Affects Heartburn

Some asthma drugs may raise your chances of getting acid reflux because of the way they affect different muscles in your body. Prednisone and albuterol may affect the muscles that control the opening between your esophagus and your stomach. This may allow acid to leak into your esophagus.

Other asthma drugs have an impact on the muscles that make up the walls of your esophagus -- and keep it from working the way it should.

Of course, the article does not cite any scientific studies.

 

However, I found this scientific article stating oral steroids (i.e. prednisone) have been linked to increased stomach acid: https://www.ncbi.nlm.nih.gov/pubmed/11834680

Quote

CONCLUSION:

Prednisone, 60 mg/d for 7 days, increased esophageal acid contact times in this small population of people with stable asthma; however, the mechanism for this finding is unclear.

The "small population" part may look bad unless your NP indicates she feels this is what you have.

Keep in mind too that steroids are great for controlling asthma, but can cause Cushing's either while taken or in long term. 

 

Your condition has to be really bad or has persisted for 5+ years with no persistent improvement for the VA docs to state the condition is not expected to improve.

Phoenix VA has been in the news a lot, especially for the secret waiting list that caused some veterans to die due to lack of diagnosis/treatment.

 

 

 

 

 

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22 hours ago, ronnieusmc0311 said:

Thank you for the response! I am waiting for the packet this week. I spoke to my local DAV regional office (they still take care of my claims but I did this one on my own) and the VSO told me they denied because the PA who examined me did not believe my inhaler meds did not cause my Acid reflex/GERD. My Private NP believed that my Asthma meds "more likely than not" contributed to me developing Acid Reflex. The VSO said that along with the PA, they had a MD write a lengthy statement about how my meds due not contribute to the development of Acid reflex, which is just bogus because there are studies that reject that claim. The VSO also said, if my NP would have gave her reasoning, then it probably would have worked out better. So now I'm going back to my NP and I'm going to ask that she give reasoning and possibly add a study onto it.  I feel like they really did not want me at 100%, lol.

The VSO at the DAV tells me that I should go straight for a board appeal, this is where I'm conflicting.

Glad to help!

If you were denied on an initial claim, going to the board next may not make much sense. Usually veterans go for a supplemental first, then an HLR or BVA if they do not succeed. Yeah, the BVA tends to offer much better results for many veterans because they take the time to supposedly read everything. The drawback is you could be tied up in that lane for years. My initial claim in 1995 got denied quick and my VSO told me to appeal to the board. They never told me I could file for a reconsideration (not available any longer). It took about two years for my board hearing. Then it took them about two more years before I got new C&P exams. After that, it took about two to three months to get everything finalized and approved. BVA might not take that long today, but you need to talk with your VSO and ask them why they feel that way. It never hurts to get a second opinion either. It might be a good idea to ask the VSO if they reviewed the NP's opinion before they sent it off? If they had, they could have seen the medical rationale was sketchy. When I had DAV, I would work up everything on my own and present it to them for their guidance, but I started out very green and didn't engage DAV until around 2008 or so when I learned more about the way things work.

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