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Diverticulitis Claim

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Kuwaitin08

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Hello all.

I am currently SC for IBS at 30%.
With that being said, I have had pretty severe Diverticultis for a few years as well. My diverticulitis presents in such a way that it would classify closely as ulcerative colitis (DC 7323) which the VA uses based on symptoms. My symptoms would easily get me 60%. I’m a huge mess and visit the hospital a few times a year for it not to mention other minor flare ups treated with antibiotics. 

What would be the suggestion on how to get this SC? Would it be best to try to get it as secondary to IBS? I just want to be cautious as to not have them lump it together with IBS. 

Documentation, diagnoses and continuous treatment are not an issue at all. 

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Just apply.  You dont have to make a decision whether or not this is direct SC, primary, Secondary, presumptive, etc.  That part is not your job.  If you go to work for the VA as a rating specialist, you may need to concern yourself with this.  But, to seek benefits, just apply for "Diverticulitis" both direct and secondary to conditions already Service connected.  Let the rating specialist do his job, you need not try to do it for him/her.    You may not want the rating specialist doing your job, say, if your job is babysitting grandchildren, and he may not like it if you try to do his job either.  

If you insist, you can order your medical file, read it over carefully, and see what a doctor says.  Does a doctor say, for example, that your diverticulitus is "at least as likely as not" due to an event in military service?  If so, then its probably direct service connected.  

However, instead, if a doctor states your diverticulitus is "at least as likely as not a result of your UC", then secondary service connection may be in order.  

Remember, tho, you will likely be sent to a c and p examiner.  And, that c and p examiner may or may not agree with your doctor who may have made nexus statements I mentioned, above.  And, you dont want to be "the man in the middle" between 2 doctors who dont agree.  Instead, just seek both direct and secondary SC, since you dont know what the c and p examiner will opine.  

    I get it.  I know its tempting to show off how much you know about direct, primary, secondary SC, etc. etc.  But, when all is said and done, if you showed up to do the rating specialists job (at least without considerable training and experience), you would almost certainly be lost and confused.  I suggest you resist the temptation to tell rating specialists or judges how to do their job.  

Its ok to "plead" for your case, however.  Sometimes, when I plead my case, I plead it as a question, such as:

   "Isnt it true, that, since Dr. james on an exam dated 11-13-2009 stated that my condition "was at least as likely as not related to UC," that this would mean it should be service connected secondary to UC?"

    People LOVE to put "smart alecs" in their place".  But they love to help humble people who ask for help.  Instead of insisting this should be secondary, simply ask for either, and let them decide, because either secondary or primary is good for you.  

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Let us know how it goes.  I have IBS rated at 0% (symptoms closely resemble 30%). I'm 100% with SMC-S so no need for it to be higher or I would've fought it and won.  

I do have diverticulitis now.  It is very common to occur after 50 yo of age (like eyes deteriorating).  This could be an excuse for denial.  I have no doubt diverticulitis is exasperated by IBS, no doubt.  So you may have a case.

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Diverticultis DC code 7323 is rated as same as IBS DC Code 7319 and you can advance two contentions at same time in the same claim as stated by broncovet.  First or number one is that your new severe 7323 is secondary caused by and/or aggravated by your service connected 7319 and Number two contention is that your 7319 should alternatively be increased to 60% due to your new severe Diverticultis  diagnosis.  You must have strong evidence to support your claim for a 60% rating level or increase from 30 to 60%. 

Here is my example as I recently received 60% for GERD but the VA raters used the DC Code for Hiatel Hernia for symptoms and rating of my GERD.

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

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Edited by Dustoff1970
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