Good Morning,
Background: Retired in 2014. Claimed IBS in 2015 but was denied due to no diagnosis. Didn’t fight it. Starting in 2017 to today started having more and more issues. Was diagnosed in 2017 with IBS by Doctors at Naval Hospital.
Leads us to the Decision letter
Oct 29, 2020 – Requested IBS Service Connection via Gulf War Syndrome 38 C.F.R.3.17
1. Received Decision Letter today, 13 Jan 2021.
2. A 10% evaluation is established for IBS and added to the previously established non-compensable evaluation for hiatal hernia/GERD (I did not ask for this or ask to be reevaluated for hiatal hernia. I realize they often combine the two.
3. Examiner provided the opinion that current disability is at least as likely as not (50% or greater probability) incurred in or caused by the in-service injury, event or illness.
4. Service Connection established. Huge Win
However, I think they may have made a mistake.
1. On page 3 of the decision letter:
a. Paragraph 1 – Hiatal hernia warrants non-compensable evaluation
b. Paragraph 2 – Irritable colon syndrome warrants 10% – Moderate symptoms
c. Paragraph 3 – Additional symptoms – Alternating Diarrhea and Constipation
d. Paragraph 4 – I don’t understand what this means
e. Paragraph 5 – they agree and state that I do have alternating diarrhea and constipation in my records. I also have constant bloating and gas in my records as well.
f. Paragraph 6 – Hiatal Hernia 0% I agree with, No argument. I wasn’t trying to get an increase.
g. Paragraph 7 – A higher evaluation of 30 percent is not warranted for IBS unless there are severe symptoms demonstrated by diarrhea, OR alternating diarrhea AND constipation, with more or less constant abdominal distress.
i. In Paragraph 5, they agree and state that I have alternating diarrhea and constipation.
ii. Alternating diarrhea and constipation is the epitome definition of MORE OR LESS CONSTANT ABDOMINAL DISTRESS.
h. Paragraph 8 – Deals solely with the Hiatal Hernia/GERD evaluation
2. I feel like when they combined the two 7319 & 7346 codes, which they often do, I understand that however, I clearly meet the Irritable Colon Syndrome of 30% evaluation in paragraph 7. See below as well.
3. But when they combined both codes, they make it seem like I have to have the other Hiatal Hernia/GERD symptoms as well to qualify for the 30% 7319 IBS Rating.
4. Wanted to get some advice before I figure out how to proceed.
|
7319 Irritable colon syndrome (spastic colitis, mucous colitis, etc.): |
|
|
Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress |
30 |
|
Moderate; frequent episodes of bowel disturbance with abdominal distress |
10 |
|
Mild; disturbances of bowel function with occasional episodes of abdominal distress |
0 |
|
|
|
|
7346 Hernia hiatal: |
|
|
Symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health |
60 |
|
Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health |
30 |
|
With two or more of the symptoms for the 30 percent evaluation of less severity |
10 |
