Transcription
According to the 2023 VBA annual report, over 1.3 million digestive system conditions have been service connected, with a 7% increase from 2021 to 2022. While it is sometimes an uncomfortable subject to talk about, it's an important topic for veterans.
Hi, I'm Mackenzie Payne Crow, a VA accredited attorney at Woods and Woods, a law firm that represents veterans in VA Disability appeals. Today, we will talk about VA claims for conditions that affect the digestive system. Hopefully, after watching this video, you will have a better understanding of how the VA rates for different digestive conditions.
Let's start out by discussing one of the most common digestive disorders veterans experience: irritable bowel syndrome. Does it seem like your stomach hurts all the time? If you aren't running to the bathroom, you have so much gastric distress that you feel like you need to. You feel bloated and uncomfortable. Most of the time, it makes you not want to leave the house or be far from the bathroom. While you're not alone, IBS affects 10 to 15% of the U.S. population. The most common symptoms of IBS are abdominal pain, often related to bowel movements or changes in bowel movements. These changes may be diarrhea, constipation, or both, depending on the type of IBS. These symptoms range in severity and are at best inconvenient and at worst debilitating. And unfortunately, many veterans experience these symptoms every day.
Doctors aren't really sure what causes IBS, but they believe it can be related to stress, environmental exposures to bacteria or exposures to pollutants, mental disorders such as depression, anxiety, and somatic symptom disorder, and food intolerances and sensitivities. As you're probably aware, many veterans experience stress and were exposed to various toxins during their time in service. Additionally, veterans are more likely than the general population to develop mental health conditions. These are contributing factors as to why so many veterans have IBS.
According to the VA's annual benefits report for the 2022 fiscal year, almost 200,000 veterans have a rating for IBS. That makes it the third most common digestive disorder among veterans. So, how does one connect their IBS to service? Well, there are a couple of ways to do it. Depending on the suspected cause, veterans can be service connected in three different ways for IBS: presumptive, direct, and secondary. We're going to explore each one of them a little more closely.
First is presumptive service connection, which means the VA automatically presumes that certain disabilities were caused by military service. This type of service connection is relatively easy to prove. Essentially, the VA has lists of different chronic conditions that are clearly linked with different periods of service and service locations. If you want a more detailed description of what this means, look at the description box for a link to our video, "Types of Service Connection for VA Benefits." If a condition is very common among specific groups of veterans, the government may add it to a presumptive list of conditions. Keeping this in mind, veterans who served in the Gulf War are especially prone to IBS. One study found that up to 25% of Gulf War veterans who participated had IBS. IBS is a common symptom of Gulf War syndrome, and Gulf War Syndrome is a presumptive condition for Gulf War service. Gulf War Syndrome is used to describe a range of chronic, unexplained symptoms affecting Persian Gulf War veterans. To learn about the other symptoms of Gulf War syndrome, go to the description. There will be a video link and an article that explains them in full detail.
However, you don't need to have served in the Gulf War or have Gulf War Syndrome to service connect IBS. The second avenue is direct service connection, which means that a current disability or disease is directly linked to active duty service. Unlike presumptive service connection, this avenue requires evidence that shows how an event in service resulted in an IBS diagnosis. An example may be that you received the IBS diagnosis while in service. Or maybe you contracted a bacterium in service that caused excessive diarrhea later diagnosed as IBS. Another example may be that a combat injury or vehicle collision may have caused damage to the nerves that control the muscles that move food through the bowel, therefore resulting in IBS. However, sometimes IBS develops after service as a result of a mental health condition or some other service-related ailment. These cases can still be service connected, though.
The third type of service connection is secondary service connection. IBS can also be connected to military service on a secondary basis, meaning it was caused by or permanently aggravated by another service-connected condition. For example, if you suffer from IBS because of the medication you are taking to treat your service-connected PTSD, you may qualify for secondary service connection for IBS. To learn more about any of these ways to connect a condition to service, click the link that I mentioned earlier.
So, those are the ways a veteran can connect IBS to service. But you may be wondering how the VA will rate IBS. The VA's disability ratings for IBS are set forth in the VA's schedule of ratings for the digestive system, known as CFR 38 Section 4.114. The VA rates it under diagnostic code 7319, what used to be labeled as irritable colon syndrome, spastic colitis, and mucous colitis – alternative names for IBS. IBS is rated depending on the severity of symptoms. To receive a rating, a veteran must experience two or more of the following symptoms: a change in stool frequency, change in stool form, constipation or diarrhea, mucous discharge, abdominal bloating, or subjective distension. Veterans who experience an episode once during the previous three months are eligible for a 10% rating. Those who have at least three monthly episodes for at least three months receive 20% ratings, and those with weekly episodes receive 30%. The veteran always needs to address his or her symptoms on a compensation and pension exam, or simply to be rated accurately. For more information on C&P exams, please refer to the Woods and Woods C&P video link below. It has many great tips on how to prepare you for an exam.
It's important to keep in mind that IBS can only receive up to a 30% rating. It is still worth it to file a claim. Sometimes IBS can lead to other conditions which can be connected on a secondary basis. An IBS rating may also contribute to a veteran receiving TBI U. TBI U is for veterans who are unable to work due to their service-connected conditions but are not receiving a 100% rating. Having to make frequent trips to the restroom can impact a veteran's performance at work. This, in combination with other conditions, could result in the veteran becoming unemployable. For more information on TBI U, I would direct you to Woods and Woods' TBI U video. And to learn more about IBS, check the description below for a link to an article about IBS and VA claims.
The second condition we're going to discuss is gastroesophageal reflux disease, or GERD. Many people might have some heartburn or acid reflux after eating spicy food or fatty food, but GERD is a more serious form of acid reflux. It is a relatively common disorder and affects numerous veterans. So, let's begin with what causes GERD. Some things that may increase your risk of GERD are physical trauma, stress or stressors, some sleep disorders, medications, and so on. There are several ways a veteran may be able to service connect GERD, such as medications, physical trauma, or stress and sleep disorders, to name a few. Let's look at each one of these categories individually.
First are medications. Here, I specifically want to focus on medications, as many veterans are on some sort of medication. An example would be if a veteran takes medication for one of his or her already service-connected conditions, then the veteran develops GERD. That veteran may be able to get a secondary service connection. Some of the main medications to focus on are medications prescribed for overactive bladder, IBS, antidepressants, nitrates and calcium channel blockers for high blood pressure and heart disease, narcotics, progesterone, sedatives, and or tranquilizers like Valium. While they help one issue, they may exacerbate another, like GERD. This is not an all-inclusive list, but probably hits the medications most veterans take for different medical issues.
Next is some sort of physical trauma to the veteran. The esophagus may become weakened or damaged because of some physical trauma. For example, an injury sustained in combat training or a vehicle collision, which would be cause for direct service connection. Then the veteran may experience some sort of stress from a mental health condition like PTSD. The stress causes an increase in the production of stomach acid. Medical evidence establishes that mental health issues can lead to the overproduction of stomach acid, leading to a secondary service connection of GERD.
So, how does the VA rate GERD? GERD used to be rated anonymously to hiatal hernias, but now appears in the rating schedule as diagnostic code 7206. The condition is rated at 0, 10, 30, 50, and 80%. The more severe the symptoms and the more often the veteran requires dilation to widen their esophagus, the higher the rating.
The next topic is hemorrhoids. Hemorrhoids are another common digestive condition veterans experience. What exactly are hemorrhoids? Well, they are swollen veins in the anus and lower rectum. They may cause pain and discomfort during bowel movements or when sitting down in general. Most times, hemorrhoids are temporary. However, they tend to reoccur in those who have chronic digestive problems that result in constipation or diarrhea. The VA assigns a 10% rating for prolapsed internal hemorrhoids with two or fewer episodes of thrombosis per year and a 20% rating for internal or external hemorrhoids with persistent bleeding and anemia, or for continuously prolapsed internal hemorrhoids with three or more episodes of thrombosis a year.
Next, we're going to discuss liver conditions. Conditions impacting the liver tend to be severe and sometimes require intense treatment. We will review some of the liver conditions that may be service connected. First, we are going to cover cirrhosis. Cirrhosis is a medical term for severe scarring of the liver. Unfortunately, cirrhosis has no symptoms until the condition is too advanced. Some symptoms that one may experience with cirrhosis are fatigue, easy bleeding or bruising, loss of appetite, swelling in the legs, feet, and ankles, itchy skin, jaundice, and or fluid collection in the abdomen. This serious condition can be caused by many forms, such as hepatitis or chronic alcoholism. Unfortunately, drug-induced liver injury is a common cause of liver damage as well. Nearly all classes of medication can cause some sort of limited liver damage. Cirrhosis is usually service connected because of the medications the veteran takes, drinking excessive amounts of alcohol to cope with service-connected mental disorders, and or the veteran's cirrhosis was caused by a prior liver disease related to service, such as hepatitis.
Cirrhosis can be rated from 10 to 100%, depending on the severity of the symptoms, under diagnostic code 7312. The VA now uses MELD scores to rate cirrhosis. MELD stands for Model for End-Stage Liver Disease. Doctors typically consult these scores when deciding who to prioritize for liver transplants. The VA will use the score to determine how advanced a veteran's cirrhosis is and ultimately assign a rating. In the absence of a MELD score, the VA will assign a rating based on the severity of symptoms.
Next, we are going to talk about hepatitis A, B, and C. While all three viruses affect the liver, they have different routes of transmission and different effects. Additionally, they are handled differently by the VA for rating purposes. Service connecting hepatitis may be difficult because the VA does not regularly test for it, and many cases of hepatitis are asymptomatic. Veterans may not even know they have hepatitis until years after service. During the Vietnam era, if hepatitis was even tested for, the test would not have revealed the specific type. Therefore, it may cause issues trying to prove what type of hepatitis a veteran had in service. Let's discuss each type in more detail.
Hepatitis A is a virus that is easily transmitted from person to person and almost always clears up without treatment. This is not a ratable virus but can be service connected. This is important because it can lead to other conditions such as gastroparesis, which could be ratable under as a secondary service connection condition. Unlike hepatitis A, hepatitis B is an incurable virus that causes chronic illness. If service connected, it can be rated from 0 to 100%, depending on the severity and frequency of the symptoms. Lastly, hepatitis C is another blood-borne virus. Symptoms of hepatitis C are rated similarly as hepatitis B. However, hepatitis C is curable. However, chronic hepatitis C can result in liver damage, liver failure, cirrhosis, liver cancer, thyroid cancer, and even death. Hepatitis C is more common in Vietnam veterans because of the wounds and blood transfusions. Blood was not screened the way it is now, so the virus was more widely spread. Unfortunately, infected military personnel infected other military members. That is one possible avenue for service connection. Additionally, hepatitis C could be spread through intravenous drug use or sexual activity. It's important to note that conditions contracted through sexual activity or drug use during service are still eligible for service connection. However, blood-borne illnesses can be spread from any blood cross-contamination. For example, if a veteran with hepatitis shared a razor with a fellow soldier, they might have unknowingly spread the virus. Refer to the articles linked in the description to learn more about service connecting hepatitis and conditions related to the virus.
The final portion of this video will cover three digestive system cancers. I want to start this section by discussing how the VA rates cancers across the board. Service-connected cancers will receive a 100% rating during treatment and six months post-treatment. Usually after this time, the VA will reevaluate the veteran for a new rating based on the veteran's residuals of the cancer. Residuals are symptoms of the lasting impact the cancer or treatment has had on your health.
Hepatocellular carcinoma accounts for about 90% of all primary liver cancers. So, what can cause this common form of liver cancer? While there are many causes, such as chronic infection with hepatitis B and C, cirrhosis, diabetes, nonalcoholic fatty liver disease (also called NASH), and or exposure to aflatoxins, which are molds that can grow on crops. Because some of the causes could be linked to service, so could hepatocellular carcinoma.
Bile duct cancer is a rare disease in which malignant or cancer cells form in the bile ducts. Bile ducts are tubes that connect the liver, gallbladder, and small intestine. Bile is a fluid that breaks down fats during digestion. Causes of bile duct cancer include cirrhosis, chronic liver disease, a liver parasite, and or diabetes. While rare, some Vietnam veterans may be at higher risk for developing this cancer than the general population. This is because veterans who consumed raw fish while serving in Southeast Asia were susceptible to contracting a liver parasite, a liver fluke infection. If an infection results in the development of bile duct cancer, then the cancer can be connected to service.
Esophageal cancer is a disease in which malignant cells form in the tissues of the esophagus. The esophagus is a hollow, muscular tube that moves food and liquid from the throat to the stomach. Causes of esophageal cancer include tobacco use, heavy alcohol use, and Barrett's esophagus. Barrett's esophagus is a condition in which the cells lining the lower part of the esophagus have changed and been replaced with abnormal cells that could lead to cancer of the esophagus. Veterans who have Barrett's esophagus with esophageal strictures are rated from 0 to 80% under diagnostic code 7203. Without strictures, they are rated under diagnostic code 7207 and receive ratings of 10 or 30%. Gastric reflux or GERD is the most common cause of Barrett's esophagus. So, if a veteran's service-connected GERD resulted in Barrett's esophagus and eventually cancer, that cancer may also be connected to service.
This video was just an overview of the digestive disorders that may be service connected. You can learn more about VA benefits for digestive disorders by following the links in the description box in this video. If you have more questions about VA benefits in general, I encourage you to watch some of the other videos on our YouTube channel. You can also leave your questions in the comments section below. If you are wondering if you qualify for an increased rating, try to contact Woods and Woods for a free consultation. Click on the contact page in the description below this video, or call us at the number on your screen.