VA Disability Ratings for Diverticulitis
What is Diverticulitis?
Diverticula are small pouches that bulge outward through weak spots in the colon, often the left side of the large intestine. Diverticula indicate the existence of diverticulosis, a common condition among those over the age of 60. Most people with diverticulosis do not have symptoms, although it can sometimes cause mild cramps, bloating, or constipation.
When diverticulosis worsens, it can lead to diverticulitis. Diverticulitis is a condition that occurs when the diverticula become inflamed or infected. In some cases, it can be a medical emergency, requiring immediate medical attention or admission to the hospital.
Symptoms of Diverticulitis
The most common symptom of diverticulitis is abdominal pain. In more serious cases, diverticulitis can lead to bleeding, tears, or blockages. Other possible symptoms include:
- Fever
- Nausea
- Vomiting
- Chills
- Cramping
- Constipation
Causes of Diverticulitis
The exact cause of diverticulitis is unknown, but some experts believe that intermittent abnormal pressure in the colon due to muscle spasm or straining may cause diverticula to form.
Doctors previously speculated that a low-fiber diet may be a contributing factor to the development of diverticula, but recent studies have indicated that this may not be the case. Recent data also suggests that there may be a genetic predisposition to the condition.
Diagnosing and Treating Diverticulitis
Diagnosing diverticulitis usually requires a physical exam and imaging tests. It is generally discovered through one of three ways:
- Barium enema: An x-ray test that shows the outline of the colon and detects diverticula.
- Colonoscopy: A thin, flexible tube with a light and camera that can view the inside of the colon and identify diverticula.
- CT scan: A radiology test, which takes multiple cross-sectional body pictures, that can also detect diverticula.
To treat this condition, doctors may prescribe antibiotics or dietary changes until symptoms improve. Severe cases of diverticulitis require antibiotics and sometimes hospital care. In especially rare cases, surgery may be needed.
Service Connection for Diverticulitis
To get VA compensation for diverticulitis, veterans must prove their condition was caused by military service. VA typically requires the following three things as evidence of service connection:
- An in-service event, injury, or illness;
- A current diagnosis by a medical professional; and
- A medical nexus, or link, between the in-service event, injury, or illness and current diagnosis.
Diverticulitis may also develop secondary to another service-connected condition, such as post-traumatic stress disorder (PTSD). If this is the case, veterans can file a claim for secondary service connection. To prove secondary service connection, the veteran must have:
- A current diagnosis of the secondary condition (e.g., diverticulitis) by a medical professional; and
- A medical nexus linking the secondary condition to the service-connected condition (e.g., PTSD).
Veterans can submit a claim for VA disability benefits on VA Form 21-526EZ. This can be submitted via mail to the Evidence Intake Center or electronically through VA’s website.
Compensation and Pension (C&P) Exams for Diverticulitis
Once a veteran has filed their claim for diverticulitis, VA may request a compensation and pension (C&P) exam. The exam is usually performed by a VA examiner or VA-contracted physician. For diverticulitis claims, VA may use a C&P exam to gather more evidence on the veteran’s condition before issuing a decision and assigning a diverticulitis VA rating.
It is essential for veterans to attend their C&P exam, as failure to do so could result in a VA claim denial. Veterans who cannot make an exam should inform VA as soon as possible so they can reschedule.
Prior to the exam, the examiner should review the veteran’s c-file. The c-file will usually contain any documentation that has previously been submitted to VA, as well as the veteran’s medical and military service records. During the exam, the C&P examiner typically asks the veteran questions about how their condition affects them on a daily basis. It is important for veterans to be honest and upfront with their C&P examiner about their diverticulitis symptoms and how the condition impacts their life.
Diverticulitis VA Disability Ratings
Diverticulitis is rated under 38 CFR § 4.114, the Schedule of Ratings for the Digestive System, diagnostic code 7327. According to 7327, VA can rate diverticulitis analogous to “irritable colon syndrome, peritoneal adhesions, or colitis, ulcerative, depending upon the predominant disability picture.”
In most cases, VA uses diagnostic code 7319 for irritable colon syndrome to rate diverticulitis. Under this diagnostic code, the condition can be rated at 0, 10, or 30 percent disabling. The rating criteria are as follows:
- 30 percent – Severe, with symptoms such as “diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.”
- 10 percent – Moderate, with “frequent episodes of bowel disturbance with abdominal distress.”
- 0 percent – Mild, with “disturbances of bowel function with occasional episodes of abdominal distress.”
It is important to note that veterans do not have to experience these exact symptoms to qualify for a certain VA rating. The symptoms listed serve as examples of the types and levels of impairment commonly found at that rating.
If the ratings found under 7319 do not accurately convey the symptomology and severity of a veteran’s diverticulosis, diagnostic code 7323 for colitis, ulcerative, which provides different rating criteria, may be useful.
Were You Denied VA Compensation for Diverticulitis?
If VA denied your claim for diverticulitis, you have the option to file an appeal. The attorneys and accredited claims agents at Chisholm Chisholm & Kilpatrick LTD may be able to assist you with the appeal process. CCK has decades of experience successfully representing veterans and their families before VA and the Court of Appeals for Veterans Claims (CAVC).
To schedule your complimentary case review, reach out to CCK today at 800-544-9144.
