IBS VA Disability Ratings

Video Transcription

Maura Black: Hi, everyone. Thank you so much for joining us today for our CCK Live discussion. My name is Maura Black. I’m joined today by Amy Odom and Matt Fusco. We are all members of the team here at Chisholm Chisholm & Kilpatrick. Amy and I are attorneys, and Matt is an Accredited Claims Agent. All of us work on veterans’ cases and we’re very happy to be here with you today talking about VA disability ratings for IBS.

So, that’s our topic for the day. We’ve got a couple of different points that we want to hit surrounding this topic. I’m first going to start with you, Matt. Can you give everyone a quick overview of what IBS is just so that we’re all on the same page about what type of disability this is before we get into the information about how VA rates IBS?

Matt Fusco: Sure. So irritable bowel syndrome, or IBS, is a common gastrointestinal condition that affects the large intestine. It is a chronic condition, which means that its symptoms can persist for years even with treatment and adjustments to things like diet and lifestyle. Some of the common symptoms of IBS can include things like stomach cramping, diarrhea, gas, constipation, and pain. And it’s really important to note that the exact causes of IBS are not known, but triggers that are understood can include things like stress, eating certain foods, and medication. On the topic of medication, sometimes IBS can occur as a side effect of some specific medications.

IBS is common among veterans and like other disabilities, they can receive compensation for the condition if they can prove it was caused or exacerbated by their military service.

Maura: Great. And I think that’s a good segue into the next question that we have, which is: initially, if a veteran is suffering from IBS and they believe that their IBS is somehow related to service or even to a service-connected condition. Amy, can you go over just the highlights about how someone might go about seeking service connection for IBS, and what information VA is going to want to see in adjudicating that claim?

Amy Odom: Sure. Well, the first thing you want to do is file a claim. You can do that online. You can contact your local veteran service organization. They can assist you with that. And you want to if you know you already have a diagnosis of IBS, you can go ahead and let the VA know that that’s what you’re seeking service connection for.  But if you just have symptoms that no doctor has actually attributed to a diagnosis of IBS or anything else but you suspect that it might be IBS, you can just list the symptoms that you are seeking service connection for like the diarrhea and gas and stomach bloating.

Once VA receives your claim, they’ll most likely send you for a VA compensation and pension examination that will be through a VA contractor. And it’s really important when you get to this exam that you really provide the examiner with a lot of details about the severity and frequency of your symptoms. You want to be very sure to explain to the examiner what happens when your symptoms are their most severe because IBS can sometimes be really, really severe and at other times completely disappear and there are no symptoms. And so, it’s really important that you make clear to the examiner how severe and how frequent your symptoms are.

Veterans may also be able to get a service connection for IBS is secondary to another already service-connected disability. So, Matt kind of touched on that, where we often see this is when IBS is caused by psychiatric medications that a veteran might take for something like PTS. So, keep that in mind as well.

Maura: Great. Thank you. And I think Amy’s points about the episodic nature of IBS and how sometimes symptoms can be particularly severe and other times not so much is a really helpful one as we pivot to talking about how VA rates to IBS.

So, let’s assume that a veteran has filed a claim for service connection for IBS, and they’re successful in getting VA to recognize that their IBS is due, in some way, to service. The next question is, how is VA going to rate that disability and how will that rating correspond to a monthly compensation amount, if any, for the veteran who’s just been granted service connection?

So, to Amy’s point, one of the first things we always like to remind people when thinking about ratings is it’s really important to be giving as much information as possible to an examiner, if VA does arrange for an exam. As Amy mentioned these are done by VA contractors. But it is important to be thorough with the types of symptoms that you experience due to your IBS; how frequently those symptoms occur; what kind of impairments you might experience because of those symptoms; and how they affect you in your everyday life. That’s really critical information that VA needs to be able to rate your condition. It’s also really critical information for you to have if VA underrates your condition and you want to point to some evidence that would show that you deserve a higher rating.

So, if you are at the stage where you’re thinking about what an appropriate rating might be for IBS or VA is assigning a rating and you’re thinking about appealing it if you’re dissatisfied with it, you want to be looking at diagnostic code 7319, which is a title 38 in section 4.114. So again, its diagnostic code is 7319.

This is the diagnostic code specifically for irritable colon syndrome, but this is the code that VA will use to rate IBS symptoms. And there are different percentages within the IBS rating criteria or the irritable colon syndrome criteria. We’re going to use them interchangeably for the purpose of this discussion. But there is the possibility for a 0 percent rating, a 10 percent rating, or a 30 percent rating under that code. I’m going to start with the 0 percent criteria.

So, if VA grants a service connection in a 0 percent rating for IBS, this is because VA understands IBS to be just to be causing disturbances of bowel function with occasional episodes of abdominal distress. So, I think that’s the biggest key about the 0 percent criteria. VA thinks that symptoms are only occasional in nature and this kind of goes back to Amy’s point about the fleeting nature of symptoms. And so, VA doesn’t define what occasional means. So, they might make a judgment that a claimant’s symptoms are only occurring occasionally, but it’s important to know that that term is undefined. So, if VA is making that assumption, you may want to think about providing evidence that shows that your symptoms are occurring with more than an occasional frequency that might justify a higher rating.

Matt, can you talk to us about the 10 and 30 percent criteria for IBS and how someone who’s maybe getting a zero percent rating or wants a higher rating might try to produce evidence that would qualify for one?

Matt: Sure. So, moving on to the 10 percent. The 10 percent is defined as when a veteran’s IBS is moderate with “frequent episodes of bowel disturbance with abdominal distress.” Similar to Maura’s point about the 0 percent criteria, the term frequent episodes are not specifically defined in the rating, and bowel disturbances may include episodes of diarrhea or severe gas and bloating.

Moving on to the 30 percent rating. This is characterized as severe, with diarrhea or alternating diarrhea and constipation, with more or less constant abdominal distress. The 30 percent is the highest available rating for irritable bowel syndrome. And in order to receive a 30 percent rating, a veteran must show that their IBS causes them near-constant pain. For example, if you experience daily IBS episodes of diarrhea, constipation, or severe gas and bloating, that may be something that qualifies for the 30 percent rating as corresponding with near-constant pain, contemplated by that criteria.

Maura: That’s really helpful. And I don’t mean to repeat myself too much but I think Amy can probably attest to this as can Matt, one of the major issues that we see in IBS rating cases, at least in my experience, has been the undefined nature of the terms that VA uses to gauge the frequency and even the severity, but mostly the frequency of IBS episodes are flare-ups or periods of symptoms. And I think that you know, for a claimant who is experiencing episodic, very severe symptoms, but that VA decides they’re only occurring occasionally, could potentially end up with a zero percent rating which I can imagine is extremely frustrating for people who are experiencing the symptoms of this disability. So, it’s important, I think to be specific about how frequent your symptoms are. And to explain why they are more than occasional if you feel like they’re occurring more than occasionally as a stepping stone to get to those higher ratings or the potential for a higher evaluation.

It’s always difficult when VA’s rating criteria are undefined. It happens a lot in different diagnostic codes that use terms that they don’t contextualize or define. So, it can be difficult to fight the VA for a higher rating on those. But with this particular disability, it’s that frequency element among some other things that I think VA cares about the most and might be most responsive to if you’re making arguments or pleading your case for a higher rating.

There’s a layer of, IBS is important in another context in the VA disability benefits world, and that’s as it pertains to Gulf War veterans. Amy, can you talk to us about how Gulf War veterans experience IBS, how they might go about trying to prove that their conditions are related to service, or what different filters VA puts on when looking at those claims?

Amy: Sure. Well, let’s start with talking a little bit about, who are Gulf War Veterans. Gulf War Veterans are people who served in Southwest Asia during the Persian Gulf War. And so when you hear that, you might think, okay, so like 1991, 1990 Desert Storm/ Desert Shield era. But actually, under the statute, the Persian Gulf War continues even today. So, because Southwest Asia covers Iraq, and Kuwait, and Qatar, and a broad geographical area, veterans who served in OIF recently, Operation Iraqi Freedom in the early 2000s, are also considered Gulf War veterans. Veterans who served in Afghanistan, however, are not because they are not considered to have served in Southwest Asia.

So, if a veteran, well in the 90s, veterans were coming home from Southwest Asia from Operation Desert Shield/Desert Storm with unexplained symptoms and some gastrointestinal symptoms that couldn’t be explained by any actual disease. So, Congress passed a law that said veterans who served in Southwest Asia and have these symptoms are entitled to a presumption that those symptoms are related to service in Southwest Asia. And presumption means that instead of having to prove with medical evidence, a relationship between your disability and your service, a law will step in and provide that relationship. There’s no evidence needed.

A couple of years after that Congress made clear that IBS is one of this constellation of symptoms that qualifies for this presumption of service connection. So, where that leaves us is that if you are a veteran who served in Southwest Asia between, I don’t remember the exact date but some like 1990 and now, and you have IBS, the law will step in to presume that the IBS is related to your service in Southwest Asia.

Unless that there’s some evidence that rebuts that presumption. Like a doctor says no, this IBS is actually caused by the veteran’s PTS medication. In that case, you might have a secondary service connection claim but you’re probably not going to get that presumption of service connection.

Other diagnosed disabilities that VA and Congress have recognized that have been related to service in Vietnam, I’m sorry service in Southwest Asia, includes chronic fatigue syndrome and fibromyalgia. Chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders such as IBS are what we call in the business MUCMIs. The medically unexplained chronic multi-symptom illness. The long and the short is, if you have a diagnosis of any of these conditions, chronic fatigue syndrome, fibromyalgia, IBS, the law will step in to presume the relationship to your service in Southwest Asia. You need not submit medical evidence of a relationship.

Maura: That’s super helpful, Amy. Thank you. We do have other content on our website cck-law.com, videos, blog postings, some written content about both Gulf War presumptions, MUCMIs, and also separately about secondary service connection. I know that that’s a topic that’s come up a little bit today.

Please feel free to access all of that content. If you think that it applies to an issue that you’re through or a pending claim or appeal that you have. But that was all really helpful, especially with the Gulf War angle, Amy. So, thank you.

That wraps up most of what we had planned, I believe. But Matt and Amy, do either of you have any additional closing thoughts, tips, or advice to people out there who are either seeking service connection for IBS or maybe are fighting to get a higher rating for IBS?

Amy: Well, sure. I think one thing that we didn’t touch on is how IBS medication is figured into the rating. And the answer to that question is, it’s not. Your rating is supposed to be based on what your level of severity and frequency would be without your medication. So, that’s something else to make sure that you’re describing in detail to the examiner. What the disability was like before you started medication and how it was after the medication. That way, the VA will have enough information to make a determination about what your rating should be without considering the effects of medication.

Maura: Great. Thank you.

Matt: And I think I would just, you know, double down on an earlier point about how some of the rating criteria is in, really, explicit in terms of defining what your frequent episodes and that type of thing really is. So, I think that we would just suggest you, you know, take a hard look at these symptoms you are experiencing, the frequency they are occurring and the severity that they’re causing you in terms of symptoms and functional impairment, and really trying and you know, take those things into consideration when thinking whether or not you may qualify for a higher rating.

You know, to Amy’s point about being open with the examiner and really kind of talking about how your symptoms have been impacting you. I think that’s really helpful for veterans to keep in mind when they’re trying to determine whether or not they may be entitled to one of those higher ratings for IBS specifically.

Maura: I totally agree. I think the two most important things to think about, at least in my experience when dealing with the rating part of things, is really looking at the diagnostic code. I think this is advice that transcends, you know, any specific disability you might have.  Really looking at the diagnostic code for the language about how VA, what kind of symptoms? What kind of severity VA is looking for to be able to assign a certain rating? That can be helpful in any way increased rating appeal or increased rating claim context.

And also being aware of what’s happening during compensation and pension exams. And also, if you’re able to get a copy of the exam after the fact, if they’re able to provide one to you, they won’t do so automatically, but you can always ask. And that can give some good insight into what kind of evidence VA is relying on to adjudicate your increased rating claim. It can be really helpful information if you need to rebut something the examiner said or correct something that the examiner may have recorded incorrectly.

But great. Thank you both so much. I really appreciate your time today. Thank you all for tuning in. We hope that this information was helpful. Please don’t forget to subscribe to our channels and to follow us on cck-law.com for more helpful content. And we hope to see you all again soon. Have a great day.