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Hey all. Hoping you guys can help me out with what to expect.
In 2010 while I was active duty I went to medical over what I thought was a potential hernia. They did an ultrasound and felt around but told me they didn't see anything and that if it continued to hurt come back. I got my honorable in January of 2011.
A couple months ago, the pain occasionally still persisted so I filed a claim for a hernia/groin condition and they scheduled me within a few weeks. I just went to my appointment and the Dr. asked me if I had the hernia taken care of yet. I told him that I was never diagnosed with a hernia which is why I also choose "groin condition" on the drop down menu. He help up a paper from my file and said that back in 2010 I was diagnosed with a inguinal hernia and that It says that I never made an appointment to meet with a surgeon. I told him that wasn't the way that I remember the scenario going, I believe I was told they found nothing and to come back if it still consisted or got worse. So we spoke for a few moments and he said that he's going to put that it is service connected, as I WAS diagnosed while I was still active duty. He also said since it's considered elective surgery if I wanted to have it taken care of I would need to talk to my private doctor.
Has anybody had any experience in how this would be rated? He told me that it is service connected but he wasn't sure how the rating would go.
I'm currently at 30% disability. I also recently received my C-file so I put it in my computer and found the page the doctor referenced and yes, it does say that I was diagnosed back in 2010.
I would really appreciate some guidance on next steps. Please let me know if I forget any useful information. I had 2 items go to the BVA. I had a claim for tenosynovitis of right hand/wrist/forearm which was originally denied connection and the other issue was for scar.
The BVA said my tenosynovitis was service connected so that was taken care of.
The scar was remanded because of a incomplete c&p exam. Pretty sure when I filed NOD I also said I did not agree with the exam because I complained of scar pain and the examiner never mentioned it at all. So my initial rating for scar was 0%.
Like I said I filed NOD after initial 0% assignment. Couple weeks back they gave me another c&p exam like the BVA ordered. This time the examiner actually wrote down that I complained of pain so they rated me at 10%. However they changed my effective date from 2013 to Oct this year because the previous exam didn't mention pain
I'm obviously going to appeal this again but what do I say? What's best way to go about it?
Second part of question is about VA duty to assist. I had no idea there was a rating possible for hernias. Because of the surgery for tenosynovitis which is service connected and where the scar is which is service connected I have a hernia where muscle bulges through and raises the skin. That hernia has always been there. Should the VA have included that? Any examiner can see it clearly when looking at forearm and my last c&p examiner for scar said she would note it. Can I get that connected with a effective date of 2013 which is when the tenosynovitis is and my original 0% scar was?
By glenda h
I am currently appealing to the US court for my denial of increase in GERD to include Class C esophagitis, erosive gastritis. I am currently being rating for 10% since 2007, up from 0% in 1998 or over 13 years, even though Ive had GERD, gastris with H pylori in service and then again with the claim I made in 2007. I didnt know of the bad C&P until I got my C-file in 2018. It is very important to get yours, as you can find out a lot of things. Like they didnt forward your VA file and your civilian paperwork to the examiner. I was very lucky the examiner noted this, as rater said he did in the decision. Had an ACE in 2019 which examiner stated she reviewed, but omitted what was found on the EGD in 2019 and ignored the 2007. There are articles pertaining to the use of Zantac that contains NDMA as well as other medications such as Nexium. For the 30% rating for GERD it included the wording "impairment of health" I used this same information in my argument concerning this. I dont have cancer, but long term I could have. Ive also included in my argument about the long term use of Nexium-I dont have long term kidney issues, but I could have. I took Rabeprazole for a few times, which can cause fundic gland polyps (growth on stomach lining) which I had one. I listed the side effects of my current meds Im taking now, which IS joint pain, stomach pain, headaches. So...Im giving it a try, as with these medications we are taking, and NOW finding out serious side effects, I would think it would cause a considerable impairment of health.
I was hoping to get a second opinion on a potential claim. While in service I had a radical tenosynovectomy which is service connected. I am also service connected for the scar from said surgery. That surgery caused a hernia on my forearm. The size of muscle coming through is about 2.5 inches long by about 1 inch wide.
I was wondering if this should be a pretty straight forward claim or what I might need to consider or prepare for?
I believe this claim would fall under 38 CFR § 4.73, Schedule of Ratings – Muscle Injuries, Diagnostic Code 5326.
Seems pretty straight forward to me but again it's the VA and there always seems to be something to complicate things.
So, I am SC'd on GERD 10% and IBS 30% which they grant at a 30% combined rating since (according to the VA) codes 7319 and 7346 (Hiatal hernia is what they use for GERD) fall in the inclusive rating categories according to this:
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.
I would argue that, that's not what that says..
It actually says codes 7301 - 7329 are inclusive and then
7331. 73342, and 7345 - 7348 are inclusive
which would actually mean codes 7319 and 7346 are in their own categories and should be rated exclusively.
However, my actual question is about code 7204 Esophagus, spasm (cardiospasm). I submitted a claim for this, but it was not rated separately. Instead, I was given:
Evaluation of IBS and GERD with esophagus spasm of (cardiospasm) (claimed as esophageal condition):
The evaluation of IBS and GERD with esophagus, spasm of (cardiospasm) (claimed as esophageal condition) is continued as 30 percent disabling.
We have reviewed the evidence received and determined your service-connected condition(s) hasn't/haven't increased in severity sufficiently to warrant a higher evaluation. We have continued a 30% evaluation for your IBS and GERD with esophagus, spasm of (cardiospasm) based on:
-Alternating diarrhea and constipation
Additional Symptoms Include:
-Disturbances of bowel function
-Frequent episodes of bowel disturbance
This is the highest schedular evalution allowed under the law for IBS. (38 CFR 4.114)
A higher evaluation of 60% is not warranted unless there are symptoms of pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. (38 CFR 4.112, 38 CFR 4.113, 38 CFR 4.114)
A 10% evaluation would be warranted for your GERD with esophagus, spasm of (cardiospasm) (claimed as esophageal condition) based on:
-Pyrosis (Heartburn and/or Reflux)
-Persistently recurrent epigatric distress
A higher evaluation of 30% is not warranted for hiatal hernia unless the evidence shows persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. (38 CFR 4.114)
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 the elevation to the next higher level evaluation where the severity of the overall disability warrants such evaluation. (38 CFR 4.114)
So in reading that, I do not see how
7204 Esophagus, spasm of (cardiospasm).
If not amenable to dilation, rate as for the degree of obstruction (stricture).
falls in to that rating criteria. Does anyone have any experience in getting a separate rating for 7204? I'm now at 92.23% SC'd with 1 rating on appeal and an increase on remand. Both of which (if granted at what the reg actually says) would kick me to 95.29% (or rounded to 100). This one, I really expected to be at 30% on its own...so I'm confused as to why it was rolled in to another rating.
rebabevets posted a question in VA Disability Compensation Benefits Claims Research Forum,I already get compensation for bladder cancer for Camp Lejeune Water issue, now that it is added to Agent Orange does it mean that the VA should pay me the difference between Camp Lejeune and 1992 when I retired from the Marine Corps or do I have to re-apply for it for Agent Orange, or will the VA look at at current cases already receiving bladder cancer compensation. I’m considered 100% Disabled Permanently
Ddsr posted a question in VA Disability Compensation Benefits Claims Research Forum,The 5, 10, 20 year rules...
Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.
Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.
Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.
If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"
At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.
NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.
Example for 2020 using the same disability rating
1998 - Initially Service Connected @ 10%
RESULT: Service Connection Protected in 2008
RESULT: 10% Protected from reduction in 2018 (20 years)
2020 - Service Connection Increased @ 30%
RESULT: 30% is Protected from reduction in 2040 (20 years)
broncovet posted an answer to a question,While the BVA has some discretion here, often they "chop up claims". For example, BVA will order SERVICE CONNECTION, and leave it up to the VARO the disability percent and effective date.
I hate that its that way. The board should "render a decision", to include service connection, disability percentage AND effective date, so we dont have to appeal "each" of those issues over then next 15 years on a hamster wheel.
Ztmiller8 posted a question in Appealing Your Veterans Compensation Disability Claims NOD, DRO, BVA, USCAVC,Finally heard back that I received my 100% Overall rating and a 100% PTSD rating Following my long appeal process!
My question is this, given the fact that my appeal was on the advanced docket and is an “Expedited” appeal, what happens now and how long(ish) is the process from here on out with retro and so forth? I’ve read a million things but nothing with an expedited appeal status.
Anyone deal with this situation before? My jump is from 50 to 100 over the course of 2 years if that helps some. I only am asking because as happy as I am, I would be much happier to pay some of these bills off!
Joey Ross posted an answer to a question,I told reviewer that I had a bad C&P, and that all I wanted was a fair shake, and she even said, that was what she was all ready viewed for herself. The first C&P don't even reflect my Treatment in the VA PTSD clinic. In my new C&P I was only asked about symptoms, seeing shit, rituals, nightmares, paying bills and about childhood, but didn't ask about details of it. Just about twenty question, and nothing about stressor,
Picked ByJoey Ross,