Supplemental claim denied ‘gerd’

[SergeantQ]

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Edited August 7, 2022 by SergeantQ
post removed (see edit history)

[broncovet]

My eyes are not good, so I had trouble reading this.  So, please dont fault me if I read something wrong, because I cant read it all..its blurry, and I need cataract surgery.  

However, it appears you were denied because you lack a nexus.  A nexus is a statement from your doctor that your Gerd is "at least as likely as not" related to medications or otherwise related to Service connected anemia.  

DBQ, or NO DBQ, you have to have a nexus.  If your doctor did not say pretty much what I put in quotes, above, you are gonna likely be denied.  

To fix this you need a nexus.  

It sounds like you have made similar mistakes to those I made.  You start figuring percentages, and then forget all about the nexus.  Thats like expecting a win if you go to the race track, and forget to bring your race car.  

So, if your doctor DID provide a nexus statment, and I could not read it because it was blurry, then you should appeal.  

If your doctor did NOT provide a nexus statement, then you should appeal AND likely get an IMO/IME doc that will provide a valid nexus statement.  Maybe others can read this.

[Vync]

@SergeantQ The VA does not recognize anemia as a cause of GERD. However, if you are SC for another condition (especially musculoskeletal disabilities), check the side effect listing of meds used to treat it. NSAIDs like ibuprofen (the Army's favorite) or naproxen are common causes if used long term. They jack up the GI tract. Just use some caution because they are also not the best thing for your heart. GERD can also be caused by heliobacter pylori bacterial infection which is easily treated. Sometimes the VA will test for that test to deny vets.

[SergeantQ]

Thanks, yes I have a nexus but I didn’t upload it. I’m in my mobile phone. 
 

Seems off putting if the examiner completed the dbq in this way for the rater to only deny. Usually, the examiner makes the call then the rater cosigns. 

[Dustoff1970]

If for some reason you cannot get the important doctor's nexus opinion to support your GERD claim then you will and should anyway provide proof in the form of medical treatise and research studies from reputable institutions such as MAYO Clinic and many others that the side effects of the VA medications you take cause and aggravates your GERD symptoms.  I just did this successfully.

I have successfully used this contention along with other arguments to win at least one appeal and a very recent GERD at 60% claim due to the VA PTSD medications and my long-term PTSD.  From start to finish the claim took only 20 days and was based upon my long term VA medical records to include strong VA PTSD medication prescriptions for both MY PTSD and GERD of many many years.  I had no doctor's nexus opinion to support my claim.

I submitted the above evidence (copies only) and treatise research studies with both my claim and to the QTC nurse examiner in writing and oral statements at the exam that was only one hour with a review of my medical records.  Done and finished.  Again, I had no doctor's nexus statement connecting me to the research studies I submitted with the claim or to the examiner.  

Here is just one of several CAVC court decisions granting a vet's appeal based upon these research studies and without a doctor's nexus opinion. See below

I have for over a period of 30 years also read many BVA appeal decisions granting a vet his claim based on these research studies and without a doctor's nexus statement connecting him or her to the studies.

Anyone who tells you this is not possible is being deceitful.  A Google search will reveal these studies and also side effects of your particular medications.

By all means get a doctor's nexus opinion if you can but all is not lost without one. 

1.BVA Decision: Citation No: 1644123 Date 11/21/16 
"The United States Court of Appeals for Federal Circuit (the Federal Circuit) held that "[a] veteran with a competent medical diagnosis of a current disorder may invoke an accepted medical treatise in order to establish the required nexus; in an appropriate case it should not be necessary to obtain the services of medical personnel to show how the treatise applies to his [or her] case."  Hensley v. West, 212 F.3d 1255, 1265 (2000)". 
2. Court of Appeals for Veterans Claims(CAVC):  Wallin v. West,11 Vet.App. 509,514 (1998). 
3. CAVC: Sacks v. West,11 Vet.App. 314,317(1998)
4. Federal Circuit: Hensley v. West, 212 F.3d,  
"A veteran with a competent medical diagnosis of a current disorder may invoke an accepted medical treatise in order to establish the required nexus; in an appropriate case it should not be necessary to obtain the services of medical personnel to show how the treatise applies to his case." 

My comment is not legal advice as I am not a lawyer, paralegal or VSO.
 

Edited August 3, 2022 by Dustoff 11 (see edit history)

[SergeantQ]

You just took me off life support! I have been revived! Thanks so much for the advice. I’m headed to do more research.

Edited August 3, 2022 by SergeantQ (see edit history)

[Dustoff1970]

Yes Sarge you have a doctor's nexus medical favorable opinion that is great but sometimes the VARO and BVA require the doctor also give medical references to treatise and research studies to support their nexus opinion.  I will give you an example below.  Dr. David Anaise who helped me obtain 50% for Sleep Apnea due to PTSD provided a list of medical treatise and studies to support his opinion.  Therefore, if you provide a list of studies to support your doctor's nexus then this is extra strong evidence to help with your claim or appeal if you have to appeal.  Your doctor may have already done this so review his opinion.

The example nexus statement is not the one pertaining to my Sleep Apnea appeal but to another vets appeal.

Private Doctor Anaise nexus letter for vet.ipb - Copy.pdf

My comment is not legal advice as I am not a lawyer, paralegal or VSO.

[SergeantQ]

I see. That makes sense. 

[SergeantQ]

I see. That makes sense.  
 

That nexus ltr you uploaded was spot on. I see why you won! 

[MilvetHD]

Just a bit of house keeping, another potential issue I see is that box 2b is checked no for taking continuous medication, yet in your statement you mentioned you have faithfully taken the prescribed medication for over 10 years. I would have used this opportunity to reiterate the known medications and any associated side effects. Secondly, your diagnosis is dated 2012, yet again going back to 2b there is no medications listed specific to GERD or otherwise. The VA always wants to see records and treatment. 

[SergeantQ]

Good point about the examiner checking this box. It's definitely an error in checking it because I'm still taking it and never stopped. Unfortunately, I could not reiterate here because i only saw the exam after the fact. However, post exam, I did provide a solid statement with a line by line description of what's happening with me. I will post it here shortly. 

 

[SergeantQ]

My VSO suggested we submit a reconsideration right away. I completed the VA form today and provided the nexus letter from GI doctor. Additionally, I noted the case below compliments of hadit 

BVA Decision: Citation No: 1644123 Date 11/21/16 

"The United States Court of Appeals for Federal Circuit (the Federal Circuit) held that "[a] veteran with a competent medical diagnosis of a current disorder may invoke an accepted medical treatise in order to establish the required nexus; in an appropriate case it should not be necessary to obtain the services of medical personnel to show how the treatise applies to his [or her] case."  Hensley v. West, 212 F.3d 1255, 1265 (2000)". 

2. Court of Appeals for Veterans Claims(CAVC):  Wallin v. West,11 Vet.App. 509,514 (1998). 

3. CAVC: Sacks v. West,11 Vet.App. 314,317(1998)

4. Federal Circuit: Hensley v. West, 212 F.3d,  

"A veteran with a competent medical diagnosis of a current disorder may invoke an accepted medical treatise in order to establish the required nexus; in an appropriate case it should not be necessary to obtain the services of medical personnel to show how the treatise applies to his case." 

 

patient letter redacted.pdf

[SergeantQ]

9 minutes ago, SergeantQ said:

Good point about the examiner checking this box. It's definitely an error in checking it because I'm still taking it and never stopped. Unfortunately, I could not reiterate here because i only saw the exam after the fact. However, post exam, I did provide a solid statement with a line by line description of what's happening with me. I will post it here shortly. 

FYI: See below VBA-21-4138

 

VBA-21-4138-ARE statement for secondary final_Redacted.pdf

[SergeantQ]

On 8/2/2022 at 11:48 PM, SergeantQ said:

post removed

 

 

 

Edited August 7, 2022 by SergeantQ (see edit history)

[Whodat]

Your VSO may be at  likely as less related to or least as likely more concerned about you as the vet. That's their job security. Can't fire you just yet. Can't afford to pay you if we give you paid admin leave for your bad rational or decision. Stay home, telework and be prepared for the questions that pertains to you. Shut your mouth, you are still getting paid, and sick leave. 

[MilvetHD]

1 hour ago, SergeantQ said:

Good point about the examiner checking this box. It's definitely an error in checking it because I'm still taking it and never stopped. Unfortunately, I could not reiterate here because i only saw the exam after the fact. However, post exam, I did provide a solid statement with a line by line description of what's happening with me. I will post it here shortly. 

 

 

1 hour ago, SergeantQ said:

My VSO suggested we submit a reconsideration right away. I completed the VA form today and provided the nexus letter from GI doctor. Additionally, I noted the case below compliments of hadit 

BVA Decision: Citation No: 1644123 Date 11/21/16 

"The United States Court of Appeals for Federal Circuit (the Federal Circuit) held that "[a] veteran with a competent medical diagnosis of a current disorder may invoke an accepted medical treatise in order to establish the required nexus; in an appropriate case it should not be necessary to obtain the services of medical personnel to show how the treatise applies to his [or her] case."  Hensley v. West, 212 F.3d 1255, 1265 (2000)". 

2. Court of Appeals for Veterans Claims(CAVC):  Wallin v. West,11 Vet.App. 509,514 (1998). 

3. CAVC: Sacks v. West,11 Vet.App. 314,317(1998)

4. Federal Circuit: Hensley v. West, 212 F.3d,  

"A veteran with a competent medical diagnosis of a current disorder may invoke an accepted medical treatise in order to establish the required nexus; in an appropriate case it should not be necessary to obtain the services of medical personnel to show how the treatise applies to his case." 

 

patient letter redacted.pdf 219.22 kB · 1 download

In my opinion, I would suggest that you hold off because the attached nexus letter is insufficient in that it does not offer a medical opinion that your GERD is " proximately due to (caused by) your original SC condition. This letter simply states that you have a diagnosis which is of course required, but fails to make the necessary medical link, to include any statement saying that it is likely because of your prescribed medication taken for XYZ.

[SergeantQ]

6 minutes ago, MilvetHD said:

 

In my opinion, I would suggest that you hold off because the attached nexus letter is insufficient in that it does not offer a medical opinion that your GERD is " proximately due to (caused by) your original SC condition. This letter simply states that you have a diagnosis which is of course required, but fails to make the necessary medical link, to include any statement saying that it is likely because of your prescribed medication taken for XYZ.

I understand. Too late now. I’ll just have to prepare for a appeal at this point. 

[MilvetHD]

3 minutes ago, SergeantQ said:

I understand. Too late now. I’ll just have to prepare for a appeal at this point. 

Sorry to hear but keep the faith and I truly hope it all works out in your favor eventually. 

[SergeantQ]

43 minutes ago, Whodat said:

Your VSO may be at  likely as less related to or least as likely more concerned about you as the vet. That's their job security. Can't fire you just yet. Can't afford to pay you if we give you paid admin leave for your bad rational or decision. Stay home, telework and be prepared for the questions that pertains to you. Shut your mouth, you are still getting paid, and sick leave. 

Sure seems that way. I’m just hoping that collectively I’ve done enough. If not, to the appeals board I go.