so
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 and 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 information about how va rates ibs
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 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 the
uh 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
sure well the first thing you want to do is file a claim you can do that online you can contact your
local veterans service organization they can assist you with that um 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 ideas
um 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 uh 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 there are no symptoms and so it's really important um
that you make clear to the examiner how severe and how frequent your uh your symptoms are um
veterans may also be able to get service connection for ibs's 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 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 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 frequent 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 at title 38 in section 4.114 so again
it's diagnostic code 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's 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 um but there is the possibility for a zero percent
rating a ten percent rating or a thirty percent rating under that code i'm going to start with the
zero percent criteria so if va grants us a service connection and a zero 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 zero
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 symptoms are only occurring occasionally but
it's important to note 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
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 sure so moving on to the 10 the 10
is defined as when a veteran's ibs is moderate with quote frequent episodes of bowel disturbance
with abdominal distress um similar to morris point about the zero percent criteria the term frequent
episodes is not specifically defined in the rating um and bowel disturbances may include episodes of
diarrhea or severe gas and bloating moving on to the 30 rating this is characterized as severe with
diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress
the 30 is the highest available rating for irritable bowel syndrome in order to
receive a 30 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 rating as corresponding with near constant pain
contemplated by that criteria that's really helpful and i don't mean to repeat myself too
much but i think and 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
or flare-ups or periods of symptoms and i think that you know for a claimant who's 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 um 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 higher ratings or the the potential for a higher evaluation
it's always difficult when va's rating criteria is undefined it happens a lot in different diagnostic
codes that they 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 really 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 um ibs is 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 um how
gulf war veterans that experience ibs how they might go about trying to prove that their
conditions related to service or what different filters va puts on when looking at those claims
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 uh
the statute the persian gulf war continues even today so because southwest asia covers iraq
and kuwait and qatar and abroad geographical area veterans who surge 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 it's a veteran well in the in the 90s veterans were coming home from southwest asia
from operation desert shield desert storm with um unexplained symptoms and some gastrointestinal
symptoms and that couldn't be explained by any actual disease um 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 the law will step in and provide that relationship there's no evidence needed
a couple years after that congress made clear that ibs is one of these constellation of symptoms
um that qualifies for this presumption of service connection
um 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 was our this ibs is
actually caused by the veterans 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 to have been related to service
in vietnam i'm sorry service in southwest asia include chronic fatigue syndrome and
fibromyalgia chronic fatigue syndrome fibromyalgia and functional gastrointestinal disorders such as
ibs is what we call in the business muck knees 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 or ibs the law will step in to presume the relationship to
your service in in southwest asia you need not um submit medical evidence of a relationship
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 monk me's 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 going 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 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
well sure i i think one thing that we didn't touch on is how um ibs medication
is figured into the rating and the answer to that question is it's not um 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 really 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 va will have enough information to make a determination about what
your rating should be without considering the effects of medication great thank you
and i think i would just you know double down in our earlier point about how some of the
rating criteria isn't really explicit in terms of defining what you know frequent episodes and that
type of thing really is um so i think that we would just suggest you know take a hard look at
the symptoms you are experiencing the frequency they're occurring and the severity um that they're
causing you in terms of symptoms and functional impairment and really try and you know take those
things into consideration when thinking whether or not you may qualify for a higher rating um
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 specific 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 increased
rating appeal or increase 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 really 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
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