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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.
Hello!! I wish I would have found this site before, because WHAT.A.NIGHTMARE the VA disability process is.
Bear with me as I try to explain my thinking:
Okay, so I have had GERD listed as a condition at 0% rating, but, after fighting for an increase, it was given on 1-28-2019 (and as such, I cannot see when the 0% was given). However, even in the notes from endoscopy AND the dr noted epigastric distress, dysphagia, constant pyrosis (heartburn), shoulder pain-ALL things that should get a better increase to 30%. I submitted a claim for increase May 8th, 2019. It was quickly denied, stating not proper forms. Resubmitted with proper forms but still denied July 2019. Took a break from trying, went through my VA files, gathered evidence of all previous endoscopies, VA doctor's notes, medication lists, and resubmitted. Denied on 4-2020. So, now I have for a higher level review. They received that in September, and now I wait.
My question is-I did not know that I could do a CUE form to have the date for GERD go back farther than the date given for 2019. While I do not think I could get earlier than 2019 for the 30%, I believe I could get the 10% rating. I have a endoscopy dated all the way back from Oct. 2006 stating that there is "esophagitisis" and "intermitten small sliding type hiatal hernia" with notes stating that I was complaining of heartburn and shoulder pain as well. Additionally, from an endoscopy from April 22, 2010, it states the reason for the edoscopy was "epigastric pain" and showed "moderate amount of gastroesophageal reflux and intermittent small sliding type hiatial hernia".
So, my question: how long does a Higher Level Review decision take? Also, once a higher level review takes place, and they do grant the increase from 2019 from 10%-30%, is it too late to do a CUE for 10% from at least 2010? Can I do a CUE as the same time as a higher level review, if I am not looking for the 30% in 2010, just the 10%? Does any of this make sense? ANY help/guidance with this would be appreciated. Had I realized there was this website, I would have come here first!!!....
Hello Everyone. I have had a 10 percent rating for GERD since 2013. I applied for an increase on 3 occasions but finally got a copy of my private medical records. I don’t think the VA ever did. I will submit a supplemental claim with new evidence. I had a endoscopy in 2013 and results came back I have chronic gastritis and my stomach is giving me serious problems. I don’t think that is mentioned in my SMR’s. So can I go SWA since am a combat veteran or as a secondary condition to something that is rated? Not trying to beat the system. If I can claim within the rules then I will do that. If that is no rule that will allow me to then drop it. Thank you for your help.
Hello all, A bit about my situation. I was rated TDIU and recently filed for an increase on some issues that the BVA denied. I was increased from 10% to 40% each knee, and 10% to 20% for lower back. This put me in the 100% P&T threshold. I also filed for an increase with my Hiatal Hernia. Below is there reasoning for denying an increase of GERD. They list all but one contention that would need to be met, but what they fail to understand is I have constant arm/ shoulder/ upper chest pain from an AC separation which I am also service connected for. So when asked my symptoms I would have never guessed besides having upper chest pains that my arms and shoulder would be effected by my GURD considering I had considerable pain there regularly. My question is should I file an NOD or just let it go and not "rock the boat" considering I am at 100 P&T?
Hello all, Thanks for adding me as this is my first post. I am an Iraqi Veteran and left service in 2010. I filed my first claims myself between 2010 and 2013 for Obstructive Lung Disease, Tinnitus, and Polyarthralgia linked to Lyme Disease. For each of those claims, I only submitted VA 21-4138's and articles from medical journals supporting my claim. After Extensive C&P exams, I was granted the tinnitus and the Polyarthralgia, but only service connected at 0% for the lung disease. 2 years later I resubmitted for asthma as the symptoms had gotten more severe and I was now on a steroid inhaler daily. I was then granted 30% for asthma.
Moving forward a few years, I have now developed Sleep Apnea, and after a year of CPAP treatment, I decided to use "Vet Comp and Pen" for help for my claim. With all of my civilian medical treatment records, and CPAP prescription, they were successful at combining my Asthma rating with the OSA awarding my 50%. I filed with the new Decision Ready Claim and within 6 day of the VA made their favorable decision.
A few weeks later I attempted to submit a new claim for GERD through "Vet Comp and Pen". I supplied them with medical treatment records showing an Esophagram in 2006, Endoscopies in (2007, 2012, 2016, and 2 in 2017), another Esophagram in 2017, a Bravo PH Monitoring exam in 2017, and an Esophageal Manometry in 2017. All test show Esophagitis Grade B, Gastro-Esophageal Reflux Disease with Esophagitis, Erosive Esophagitis Stage III, Hiatal Hernia, Diaphragmatic Hernia, and Duodenitis. I have been on Omeprazole 40mg since 2012, and have continual heartburn, acid reflux, a persistent cough, arm and shoulder pain, and worst of all, regurgitation of food, and vomiting acid into my mouth while sleeping. I was attempting to file this claim as a secondary service connection attributed to the daily dosage of NSAID's like naproxen, and Ibuprofen along with the Symbicort Inhaler usage. Unfortunately with all of the medical evidence I supplied them, "Vet Comp and Pen" only instructed me to submit a 21-4138 personal statement and a VA 21-256. Basically nothing was submitted in support of my claim, not one shred of evidence, no IMO, no Lay evidence, nothing to establish NEXUS. I even made three phone calls to Vet Comp and Pen confirming this is what they wanted me to do. Needless to say, after submitting it as a Decision Ready Claim as instructed, it was denied after the VA had it in their possession for 6 days.
Correct me if I am wrong, but I think instead of going through a long and lengthy appeal process, it may be more beneficial and easier to file again as a new claim. This time I will be going through the DAV again but this time submitting a 21-4138 personal statement, a VA 21-256, all of my medical procedures, and plenty of medical journal evidence showing the link between NSAID's, Asthma inhalers and GERD. I am also having my Gastroenterologist complete a VA 21-0960G-1for Esophageal Conditions.
The problem that I am running into is the NEXUS. I was in the Army National Guard from 1996 - 2010. I had Lyme disease in 1998 and had chronic arthritis pretty much from that time on continuously taking NSAID's. I saw a civilian Gastroenterologist in 2006 and 2007 prior to my last deployment to Iraq in 2008 - 2009. Unfortunately being a helicopter pilot in the Army, any type of medical issue had the high probability of grounding you rendering you useless to your unit. I self medicated with Prevacid and Tums until I returned home from my deployment and a friend urged me to see a Dr again explaining the problems if left untreated ie, Esophageal Cancer. I am looking for someone that can review all of my evidence and compose a solid Independent Medical Opinion connecting my symptoms to the required usage of NSAID's and Steroidal Inhalers for my Service Connected Polyarthralgia and Asthma.
Any help, suggestions, and input would be much appreciated.
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,
This is the latest Compensation & Pension (C&P) Clinicians Guide dated 20180719. The only other one I've seen is dated 2002, including the one on this website and the VA website. I got this from my claims agent, who got it from the VA.
VA Compensation & Pension (C&P) Clinicians Guide 2 Final Corrected 20180719.pdf
Tbird posted a question in VA Disability Compensation Benefits Claims Research Forum,You, yes you, are the reason HadIt.com has remained a resource-rich resource. Thousands come each month to read, ask questions, or to feel a sense of community.
Last month June 2020, we over 50k visitors they viewed over 160k pages. Veterans and their advocates, spouses, children, and friends of veterans come looking for answers. Because we have posts dating back 15 years and articles on the home page, they usually can find an answer or at least get pointed in the right direction.
You all made that possible. Thank you.