C&P Exams: GERD

[@MatthewZollmann]

These "walk through the DBQ" videos have been great for me! Thank you for helping veterans!

[@pearleelife]

Got C and P in 2 weeks. TY

[@RabidCycler]

How did C&P exam go?

[@454ssstig]

The most simple and to the point video ever, gracias!

[@VADisabilityGroup]

Glad someone can appreciate the brevity! Thanks for commenting.

[@johnstaab9296]

Thanks for this information and your concise presentation of the facts.

[@VADisabilityGroup]

thank you for taking time out of your day to leave a positive comment!

[@jerrypredmore8793]

Very informational thank you

[@VADisabilityGroup]

Glad it was helpful!

[@ruezart]

Very clear. Thank you. GERD & ISB claimed secondary to my PTSD. Denial based on cited literature being “Pathophysiology.” Cause or certainty is not claimed by vet, only an on going aggravating connection or relationship to PTSD. “Pathophysiology” -or- “meta analysis.” Do you know of any precedents to fighting this rational “Pathophysiology” based denials? Defination: Pathophysiology: the physiology of abnormal states specifically the functional changes that accompany a particular syndrome or disease. Correct me if I’m wrong but this sounds like the evaluator is playing semantics in trying to make it sound like I’m claiming that one causes the other which I am not. A doctor I know offered this… Pathophysioloogy is the study of abnormal changes in body functions that trigger disease processes. Metanalysis is the combination of multiple research findings into a larger summary finding. This is different than a single focused research finding but often more powerful and insightful. A denial of your claim on this basis alone is bogus. Get a highly regarded expert to validate your claim.

[@VADisabilityGroup]

You're correct in your assessment that the VA's use of "pathophysiology" in your denial appears to be a semantic argument, and it seems like they are misunderstanding or misrepresenting your claim by focusing on causation rather than aggravation. In your case, you are claiming that GERD and IBS are aggravated by your PTSD, not that PTSD causes these conditions directly. This distinction is critical because VA law allows for secondary service-connection based on aggravation of a condition by a service-connected disability, rather than requiring proof of direct causation. In your appeal, you will want to address this. You are claiming that PTSD aggravates GERD and IBS, not that PTSD is the direct cause. VA regulations allow for compensation when a service-connected condition (in this case, PTSD) worsens or aggravates another condition. Under 38 CFR § 3.310, secondary service connection can be granted if a non-service-connected condition is worsened by a service-connected condition. You can argue that the pathophysiology of GERD and IBS may not necessarily need to show that PTSD causes them; rather, you need to demonstrate that PTSD exacerbates their symptoms. Here are some steps you can take with your appeal: In your appeal, focus on the aggravation argument and provide evidence such as: A medical nexus letter from a specialist who explains the connection between PTSD and the worsening of your GERD and IBS symptoms. Research or meta-analyses that support the relationship between stress/PTSD and gastrointestinal disorders. Lay statements detailing how your PTSD has worsened your GERD/IBS symptoms over time. Hope this helps!

[@igotthis6529]

My roommate just filed for this & was notified right afterwards that it will be an ACE exam.

[@VADisabilityGroup]

Yeah, acceptable clinical evidence (ACE) exams can be done for conditions that tend to be entirely subjective where physical examination won’t assist in the evaluation. It’s commonly done with GERD and migraines. Often the VA is merely asking whether there’s a diagnosis and if that diagnosis began on active duty or is secondary to an already service connected condition. All the best!