Re-Filing Claim for Gerd, Stomach Ulcer, and Chronic Sinusitis

[chieft]

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 diagnosis with gastroesophageal reflux disease without esophagitis.  The evidence shows that a qualifying event, injury, or disease had its onset during your service, then it repeats 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?

 

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[Rattler]

Sorry, no one has seen this or replied to it. hears a quicky on my thoughts. 

The VA should directly connect you for gastroesophageal reflux disease as you have both an in-service event and a current diagnosis.. The question is should you refile as a direct connection or request an HLR because they failed to maximize your benefits? 

I would file a secondary claim for your ulcer due to the meds you are/were on. 

[pacmanx1]

7 minutes ago, Rattler said:

Sorry, no one has seen this or replied to it. hears a quicky on my thoughts.

Rattler, if you look through the veteran's other post, he rephrased/retitled his question and received others replies. not sure how this got through, but it looks like a duplicate post.  

 

[broncovet]

Sorry I missed this.  You need not choose what "flavor" of claim you file under, such as direct, secondary, presumptive, etc.  Its the VARO rating specialist to figure that out, you are not required to have intimate knowledge of these VA regulations to be SC.  

My advice is, yes, to file an appeal to the BVA since it sounds like its been less than 1 year.  IDK if you qualify under "presumptives", since I dont know your periods of service, or what country you served in.   You can look those up, and check to see if your condiiton is presumptive.  Dont take VA's word for it that they did same.  It would not be the first mistake VA ever made, guaranteed, if they did mistakenly think you were not presumptive when you were.  

While I have not read your file, based on your post,  YOU SHOULD WIN THIS DENIAL UPON APPEAL.  

https://www.hillandponton.com/service-connecting-gerd-need-know/#:~:text=GERD is not considered a,GERD as a secondary condition.

While Gerd does not look like a presumptive, I have not yet checked PACT ACT.  

If its not a presumptive, you should still get it, at least unless you had it before service and it was documented on your entrance physical.  

If you did not have it before service, and get symptoms in service, then its presumed you got it in service!  

I did not spend a lot of time looking up case law for you, but AI found this:

If you did not have a medical condition before entering the military but received treatment for it while serving, you can still be considered a Veteran with a service-connected disability, meaning your condition is considered to have been aggravated or caused by your military service, making you eligible for VA benefits. 

 

 

Key points to remember: 

 

 

• "Presumption of Soundness":

  When you join the military, it's assumed you were in good health, so if a condition develops during service, it's likely considered service-connected. 

   

   
• Evidence is key:

  To claim service connection, you need medical records from both before and during your service to demonstrate the condition did not exist prior to enlistment and was treated while on active duty. 

   

   
• Claiming a disability:

  You can file a claim with the VA to establish service connection for your condition and potentially receive disability compensation. 

To be safe, you could get an IMO, but Im not completely sure its necessary in all cases because of the presumptive of soundness.  

Edited 5 hours ago by broncovet

[Rattler]

Here is where broncovet and I differ in our approach to filing claims.  His experience is to go straight to the BVA. The two-year backlog of claims. Depending on the claim you sometimes have no choice but to go to the BVA. (It really depends on the Regional office you are at) 

I always request a HLR, and I always request a phone interview with it. At the most, it will hold your claim up two months to 120 days and as of lately, you may have a better chance of winning at the HLR. In a case like yours where they failed to maximize your benefits by connecting the dots to your service records

Here is two examples of how an HLR saved me and Tbird the two-year wait at the BVA.  (Note you can sometimes request a records review and it will go through quicker)

In 2022 I filed an HLR on an EED because the RO got the EED wrong and cut me out of 3 years back pay. I filed it on September 28, 2022. By September 30, 2022, the VA scheduled the phone interview for October 7, 2022. The HLR person said they would get a decision out as soon as possible. By October 13, 2022 the VA droped the 3 years of back pay into my bank account before I even got the decision letter.

If I remember right Tbird filed a claim because of a recent Court of Appeals decision that affected her SMC. It took 9 days for a decision and the RO CUE it's self without her requesting it. I think she filed an HLR because they did not give her the correct step up to the next level. We will see how long it takes.

57 minutes ago, broncovet said:

Sorry I missed this.  You need not choose what "flavor" of claim you file under, such as direct, secondary, presumptive, etc.  Its the VARO rating specialist to figure that out, you are not required to have intimate knowledge of these VA regulations to be SC.  

 broncove is a 100% correct that it's the VARO rating specialist's job to figure out for you if your claim is direct, secondary, or presumptive. This doesn't mean they will so if I know I will always point it out to them. ( This is a secondary claim for XXXX related to PTSD, Meds, etc.)

Most of us here have been doing this a long time. And you don't know what you don't know. There are no dumb questions.