Veterans Evaluation Services C&P

[chieft]

I filed a claim for GERD, Stomach Ulcer and Chronic Sinusitis in March this year 2024 I had my C&P exam in April for all three.  My claim went from decision made and preparation for notification to scheduling me for a PHONE appointment for a records review with another C&P doctor.  What could this mean?

[pacmanx1]

Some may or might say just file a Supplemental or HLR or even a Direct Review Appeal but both Supplementals and HLRs are taken six months to a year, and they may still be rubber stamped denied. Direct Review Appeals are taking about three years and counting.

I would say to file a new claim and get your conditions service connected and then go for a better Earlier Effective Date. Due to the fact that you filed a claim, the VA has a duty to assist you and since they already established (favorable finding) medical evidence, this should be used as facts found and should be your correct effective dates, but you will eventually have to file an appeal to get this corrected. I may be off, but it has been my experience that when a veteran files a claim and it is denied, when the veteran reopens his/her claim the VA would go by the new date of claim for the effective date and not when (favorable findings) facts found in the original claim.

As stated, my opinion would go for getting your service connection first and then go for the better effective dates. The Board (BVA) sides with veterans a lot more than the regional office.

[Rattler]

On 7/31/2024 at 11:59 AM, chieft said:

Well guys I got my decision letter yesterday.  I got service connection for Allergic Rhinitis 10%, Chronic Sinusitis 10% but not service connected for the Stomach Ulcer and GERD.  My VSO thought it was a good ideal to file under presumptive on everything and I think that was the mistake.  On the GERD it stated that service connection based on Toxic Exposure was less likely than not and on the bottom of the page under FAVORABLE FINDINGS IDENTIFIED IN THIS DECISION: you have been diagnosed with a disability.  Your VA examinations dated April 24, 2024 and July 24, 2024 showed you were diagnosed with gastroesophageal reflux disease (GERD).  Your treatment service records (STRs) showed complaints and treatment for abdominal pain, and diagnosed with gastroenteritis on December 10, 1981 in service, your private medical records (PMRs) showed a diagnoses with gastroesophageal reflux disease without esophagitis.  The evidence shows that a qualifying event, injury, or disease had its onset during your service, then it repeat the diagnoses with gastroenteritis during my military service, so can I just refile this as a direct service connection?  The Stomach Ulcer was denied under the same reasoning.  The gastrologist did state that the ulcer was probably caused my my long term use of NAISD (meloxicam) I was on meloxicam for over 5 years for my service connected disabilities for my toe, feet, and ankle they just took me off of it when I developed my digestive problems last year December 2023.  I think both of them were denied because I filed them under the wrong conditions (presumptive for toxic exposure).  Should I refiled under NAISD use for both or just the ulcer and direct service connection for the GERD since service connection have already been established?  Sorry for the length of this?

I would seek a HLR first as you are not going to get the claim reviewed in under 120 days to 6 months as paxmax1 has stated. That beats 2 to 3 years with a BVA records review.

As the VA has stated in there denial of your claim that. "Your VA examinations dated April 24, 2024 and July 24, 2024 showed you were diagnosed with gastroesophageal reflux disease (GERD).  Your treatment service records (STRs) showed complaints and treatment for abdominal pain, and diagnosed with gastroenteritis on December 10, 1981 in service, your private medical records (PMRs) showed a diagnoses with gastroesophageal reflux disease without esophagitis.  The evidence shows that a qualifying event, injury, or disease had its onset during your service." They went on to further state. "The gastrologist did state that the ulcer was probably caused my my long term use of NAISD (meloxicam) I was on meloxicam for over 5 years for my service connected disabilities for my toe, feet, and ankle they just took me off of it when I developed my digestive problems last year December 2023."

The Pact Act requirement for presumptive gastrointestinal is you have to have, "Gastrointestinal cancer of any type." 

https://www.va.gov/resources/the-pact-act-and-your-va-benefits/

Gulf War era and post-9/11 Veteran eligibility

Expand all +

What burn pit and other toxic exposure conditions are now presumptive?

We’ve added more than 20 burn pit and other toxic exposure presumptive conditions based on the PACT Act. This change expands benefits for Gulf War era and post-9/11 Veterans.

These cancers are now presumptive:

• Brain cancer
• Gastrointestinal cancer of any type
• Glioblastoma
• Head cancer of any type
• Kidney cancer
• Lymphoma of any type
• Melanoma
• Neck cancer of any type
• Pancreatic cancer
• Reproductive cancer of any type
• Respiratory (breathing-related) cancer of any type

Learn more about presumptive cancers related to burn pits

These illnesses are now presumptive:

• Asthma that was diagnosed after service
• Chronic bronchitis
• Chronic obstructive pulmonary disease (COPD)
• Chronic rhinitis
• Chronic sinusitis
• Constrictive bronchiolitis or obliterative bronchiolitis
• Emphysema
• Granulomatous disease
• Interstitial lung disease (ILD)
• Pleuritis
• Pulmonary fibrosis
• Sarcoidosis

1. First I would file an HLR as follows. (My last HLR in 2022 took less than 4 weeks. I ask for the phone call it took about 2 weeks to get.) I would point out that in a HLR that your VARO failed to maximize your benefits by not service connecting you gastroesophageal reflux disease (GERD).  I would point out that the VA on its own has stated that you have 2 of the required elements for your claim. 1. An Inservice event. (diagnosis) 2. A current diagnosis. The third element the NEXUS (Connection between the two) is something that is not up to you to make. I would tell the HLR that the C & P Exam doc failed to clearly failed to read you records and make the obvious connection between the two. The VA failed to apply reasonable doubt doctrine in your favor.

The question is what meds did they replace the meloxicam with? How long has it been sense they took you off the meloxicam? Once you get ulcers they just don't go away after 5 years. 

I would wait for the HLR to be decide. (If you file for the ulcers now they may try and combined the two.) 

I would file for the ulcers as a secondary claim service connected your toe, feet, and ankle due to the medication you are on. Because "The gastrologist did state that the ulcer was probably caused my my long term use of NAISD"(Let them figure out the what meds are causing the problem)s.