What do I do next? Denied Acid reflex/GERD 2nd time

[ronnieusmc0311]

Hello again, I just received my letter for my supplemental claim for Acid Reflex/GERD and it was denied.

When I started this claim, I initially tried to link asthma medications to Acid Reflex/GERD. I had an IMO form my PCP. That was shot down and eventually I was denied because the VA had 2 negative opinions, one from the C&P examiner (who wasn't a specialist) and a DR. who was tasked to clarify on the claim.

After I received the denial the first time, I filed a Supplemental claim. In this supplemental claim I stated that I believe that my Acid Reflex/GERD could be a combination of medications I take for service connected disabilities (An IMO was provided) I.E.: Lorazepan (anti-anxiety), Flovent (cortecosteroid),  Albuterol (Beta-2 antagonist), Long term use of NSAIDS for Migraines, Ketorolac (Potent NSAID) etc. I also mentioned I was deployed to the Gulf of Aden on a West-PAC Marine expeditionary Unit, I told them I was on the USS Bonhomme Richard (LHD-6), which I was. The reasons for their denial: They found I was in East Timor when on deployment and not in the Gulf of Aden (this was only one stop, we ended up in the Gulf Of Aden and DJibouti) they also did not acknowledge that I was on the USS bonhomme richard, they said they could not find evidence.  They acknowledged I was in the Gulf. They said no evidence shows the disability is related to a service connected disability, nor that it was claimed while in service (which it was not). 

Remarks: The VA did not take into account that I had said that my GERD was caused by the many medications I take for service connected disabilities which caused my my GERD. They kept it as I was trying to Service connect my GERD to my Asthma medications like before in the original claim which I was not. They also claimed I did not serve in the Gulf of Aden but confirmed that I was in the Gulf. Here is the letter that my PCP wrote for this supplemental:

I am writing on behalf of RONNIE REDACTED, born on 04/03/88 who is under my medical care. I have been asked to write a statement in support of the veterans claim. I have reviewed Mr. Jaques medical history and noted the circumstances and events of his military service, which include his service-connected asthma and migraine headaches. Mr. Jaques has been my patient since July 2019. Per the patients verbal report he has been diagnosed at the VA with moderate persistent asthma, migraine headaches and PTSD. Mr. REDACTED suffers from symptoms of heartburn, dysphagia and indigestion frequently while taking asthma medications Flovent, Albuterol and multiple rounds of prednisone for asthma exacerbations which increases his symptoms. My Patient has also used ibuprofen and ketorolac to control his service-connected migraine headaches for several years.

Based on the above it is at least as likely as not that Mr. REDACTED symptoms of Acid reflex (GERD) is a result combination of the long-term use of asthma medications and long-term use of NSAlDs. It is known from literature that beta 2 antagonists such as Albuterol have a relaxing effect on the Lower esophageal sphincter (LES) which contribute to Acid Reflex/GERD symptoms. Long-term use of NSAlDs has also been shown to irritate the lining of the esophagus causing symptoms of acid reflex/GERD.

Where do I go from here? Do I file another Supplemental? Do I need more information? what would be my easiest route? Thank you.

 

Edited May 24, 2020 by ronnieusmc0311

[GBArmy]

Ronnieusmc0311 I would not bother with HLR. I would go BVA. If you think you want to get additional medical evidence regarding the nexus, apply with additional evidence. Otherwise, you are saying the VA simply isn't giving adequate weight to your evidence.If you choose additional, get a specialist's opinion to support your PCP. The rational should state specifically what medical articles/findings you are referencing and include them in your appeal, rather than just say "it is well known from literature."  In other words, give it to them on a silver platter. I believe you have a good shot,  IMHO. Certainly worth a try.

[ronnieusmc0311]

4 hours ago, GBArmy said:

Ronnieusmc0311 I would not bother with HLR. I would go BVA. If you think you want to get additional medical evidence regarding the nexus, apply with additional evidence. Otherwise, you are saying the VA simply isn't giving adequate weight to your evidence.If you choose additional, get a specialist's opinion to support your PCP. The rational should state specifically what medical articles/findings you are referencing and include them in your appeal, rather than just say "it is well known from literature."  In other words, give it to them on a silver platter. I believe you have a good shot,  IMHO. Certainly worth a try.

Ok, thanks again GBARMY. I will need to see specialist.

[Supply Guy]

On 5/24/2020 at 6:19 PM, ronnieusmc0311 said:

Hello again, I just received my letter for my supplemental claim for Acid Reflex/GERD and it was denied.

When I started this claim, I initially tried to link asthma medications to Acid Reflex/GERD. I had an IMO form my PCP. That was shot down and eventually I was denied because the VA had 2 negative opinions, one from the C&P examiner (who wasn't a specialist) and a DR. who was tasked to clarify on the claim.

After I received the denial the first time, I filed a Supplemental claim. In this supplemental claim I stated that I believe that my Acid Reflex/GERD could be a combination of medications I take for service connected disabilities (An IMO was provided) I.E.: Lorazepan (anti-anxiety), Flovent (cortecosteroid),  Albuterol (Beta-2 antagonist), Long term use of NSAIDS for Migraines, Ketorolac (Potent NSAID) etc. I also mentioned I was deployed to the Gulf of Aden on a West-PAC Marine expeditionary Unit, I told them I was on the USS Bonhomme Richard (LHD-6), which I was. The reasons for their denial: They found I was in East Timor when on deployment and not in the Gulf of Aden (this was only one stop, we ended up in the Gulf Of Aden and DJibouti) they also did not acknowledge that I was on the USS bonhomme richard, they said they could not find evidence.  They acknowledged I was in the Gulf. They said no evidence shows the disability is related to a service connected disability, nor that it was claimed while in service (which it was not). 

Remarks: The VA did not take into account that I had said that my GERD was caused by the many medications I take for service connected disabilities which caused my my GERD. They kept it as I was trying to Service connect my GERD to my Asthma medications like before in the original claim which I was not. They also claimed I did not serve in the Gulf of Aden but confirmed that I was in the Gulf. Here is the letter that my PCP wrote for this supplemental:

I am writing on behalf of RONNIE REDACTED, born on 04/03/88 who is under my medical care. I have been asked to write a statement in support of the veterans claim. I have reviewed Mr. Jaques medical history and noted the circumstances and events of his military service, which include his service-connected asthma and migraine headaches. Mr. Jaques has been my patient since July 2019. Per the patients verbal report he has been diagnosed at the VA with moderate persistent asthma, migraine headaches and PTSD. Mr. REDACTED suffers from symptoms of heartburn, dysphagia and indigestion frequently while taking asthma medications Flovent, Albuterol and multiple rounds of prednisone for asthma exacerbations which increases his symptoms. My Patient has also used ibuprofen and ketorolac to control his service-connected migraine headaches for several years.

Based on the above it is at least as likely as not that Mr. REDACTED symptoms of Acid reflex (GERD) is a result combination of the long-term use of asthma medications and long-term use of NSAlDs. It is known from literature that beta 2 antagonists such as Albuterol have a relaxing effect on the Lower esophageal sphincter (LES) which contribute to Acid Reflex/GERD symptoms. Long-term use of NSAlDs has also been shown to irritate the lining of the esophagus causing symptoms of acid reflex/GERD.

Where do I go from here? Do I file another Supplemental? Do I need more information? what would be my easiest route? Thank you.

 

I recommend you file an appeal and say the evidence is in equipoise with your IMO letters vs the VA.  They have to give the benefit of doubt to the veteran.  I won my lumbar spine secondary to my knee appeal that way.

Edited July 9, 2020 by Supply Guy
Grammar

[broncovet]

I agree with GB Army.  Go to the BVA, they have a "rubber stamp" at the VARO which says, "denied again" that they use for HLR's.