Gastrointestinal Diseases and VA Disability Compensation

CCK Law: Our Vital Role in Veterans Law

Gastrointestinal diseases are those that involve the organs of the digestive tract and accessory organs that aid in digestion. The digestive tract and accessory organs include the small and large intestines, gallbladder, stomach, esophagus, rectum, liver, and pancreas, among others. Common gastrointestinal diseases and disorders include constipation, irritable bowel syndrome (IBS), diverticular disease and colitis.

Service Connection for Gastrointestinal Diseases

Veterans who experience gastrointestinal diseases may be entitled to service-connected compensation if their condition is related to their time in service. Importantly, there are several types of service connection that veterans can pursue.

Direct Service Connection

Generally speaking, direct service connection is the most common avenue to receiving VA disability benefits.  Entitlement to direct service connection requires veterans to provide evidence of the following:

• A current, diagnosed gastrointestinal disease;
• An in-service event, injury, or illness; and
• A medical nexus linking their current condition to the in-service occurrence

One common in-service event associated with gastrointestinal diseases involves exposure to environmental toxins.  Regardless of the specific cause, a medical nexus is extremely important as it ties the first two elements of service connection together.

Presumptive Service Connection

Presumptive service connection removes the need for a veteran to provide a nexus between their in-service event and their current disability.  This means that veterans do not need to submit evidence proving that their condition was caused by service, because the presumption provides the nexus.
Persian Gulf War Presumption
Under VA’s presumption for veterans who served in the Persian Gulf War (PGW) (38 CFR § 3.317), veterans who with qualifying service any time from August 1990 through the present day can receive presumptive service connection for functional gastrointestinal disorders.

According to the International Foundation for Functional Gastrointestinal Disorders, “functional GI disorders are disorders of gut-brain interaction” and are “classified by GI symptoms related to any combination of the following: motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, and altered central nervous system (CNS) processing.”

Common functional gastrointestinal disorders include irritable bowel syndrome, functional constipation, functional diarrhea, and functional dyspepsia.  Such conditions qualify for service connection on a presumptive basis.  However, other gastrointestinal conditions such as gastroesophageal reflux disease (GERD), ulcers, or hernias are not included under this category of gastrointestinal disorders.  Therefore, service connection for these conditions must be established on a direct or secondary basis (see below).
Prisoners of War
Former prisoners of war (POWs) who were captive for 30 days or more can receive presumptive service connection for certain digestive disorders, including peptic ulcer disease, chronic dysentery, irritable bowel syndrome, and cirrhosis of the liver.
Camp Lejeune Presumption
VA established a presumption for veterans who served at Camp Lejeune for 30 cumulative days between August 1, 1953 and December 31, 1987, due to veterans’ exposure to contaminated drinking water on the base. The gastrointestinal disease liver cancer is among the presumptive diseases eligible for presumptive service connection for veterans stationed at Camp Lejeune.
Secondary Service Connection
To establish secondary service connection, veterans must show that an already service-connected condition caused a subsequent condition.  If VA agrees that your already service-connected condition led to the development of a secondary condition, then that secondary condition should be subject to compensation.  For example, you are service-connected for anxiety and as a result of that condition, you develop irritable bowel syndrome.  Here, your irritable bowel syndrome should be service-connected on a secondary basis.

Service Connection Based on Aggravation

Service connection based on aggravation is another avenue to receiving VA disability benefits.  This type of service connection occurs when a veteran enters service with an existing condition, but that condition worsens as a result of service.  For example, if you have GERD prior to joining the military, but it is significantly worse following service, you may be entitled to service connection based on aggravation.

How Does VA Rate Gastrointestinal Diseases?

 VA rates gastrointestinal diseases under 38 CFR § 4.114, Schedule of Ratings for the Digestive System.  There are multiple diagnostic codes for the various gastrointestinal conditions that fall under this rating schedule.  VA will compare your symptomatology to that which is listed in the rating criteria in order to assign a disability evaluation.  It is helpful to look up the diagnostic code that corresponds to your condition in order to determine what VA is looking for during the rating process.

Importantly, VA does not allow pyramiding – rating the same disability, or same manifestation (i.e. symptom) of a disability, twice.  A veteran might experience the same, or overlapping, symptoms as a result of two separate gastrointestinal diseases.  This is not uncommon as many gastrointestinal diseases manifest in a very similar way.  However, VA will only compensate the veteran once for each symptom, regardless of how many times it is present across different conditions.  Most often, VA will choose the diagnostic code that (1) is most applicable to the veteran’s gastrointestinal condition and (2) results in the highest disability rating.

Analogous Ratings for Gastrointestinal Diseases

Not every type of condition that a veteran may experience is captured by a diagnostic code. If a veteran has a condition that does not have its own specific diagnostic code, VA will assign an analogous rating. Generally speaking, analogous ratings are based on what condition most closely matches the overall symptoms or treatment of the disability that VA is trying to rate.

Compensation & Pension Examinations for Gastrointestinal Disease

VA will sometimes ask you to undergo a typical procedure for a gastrointestinal disorder, such as a colonoscopy or an endoscopy; however, this does not happen very often.  Typically, VA schedules you for a Compensation & Pension examination (C&P exam), which is much less invasive.  During the exam, a VA examiner will ask questions to determine the symptoms and severity of your gastrointestinal disease.  For example, the examiner may ask about weight loss, the frequency of bowel movements, and any other symptoms you are experiencing.

Veterans are allowed to, and encouraged to, challenge C&P exams that they feel are inadequate or fail to capture the severity of their condition.  To do so, they can go to a physician outside of the VA and supplement the record with a private medical opinion to address and contradict the VA examiner’s opinion.  Veterans should also point out the ways in which the C&P exam is inadequate.

Other Kinds of Evidence for Claims for Gastrointestinal Conditions

It may be beneficial for veterans to submit lay evidence, including statements from you, your family members, or your friends, detailing the severity of your gastrointestinal condition.  Again, the diagnostic codes are based on severity and related to symptoms on which veterans are competent to observe, describe, and explain.  Therefore, lay evidence can help VA gather more information about your full disability picture.

Individual Unemployability (TDIU) for Gastrointestinal Diseases

If your service-connected gastrointestinal disease prevents you from obtaining and maintaining substantially gainful employment, you may be eligible for total disability based on individual unemployability (TDIU).  For example, your gastrointestinal disease may force you to go to the bathroom several times a day, not allowing you to sit at your desk and do your job.  In this case, you can submit VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, along with any other evidence demonstrating that you are unable to work due to your service-connected conditions.

Common Mistakes VA Makes When Adjudicating Claims for Gastrointestinal Diseases

When adjudicating claims for gastrointestinal conditions, VA will often overlook or discount lay testimony with respect to the severity of the condition.  If VA’s decision does not take into account that you submitted detailed statements about your condition, you may want to appeal based on VA’s failure to consider that evidence.