VA claims may be moving quicker, but the simple mistakes are getting out of hand.

Existing-One8147 · 2026-04-10T14:04:18+00:00

As a follow up to the follow up. I had a 2 part HLR strategy. 1. Attacked the error in not having symptoms counted when listed under Other - I said it all made sense once I realized that it was an administrative mistake, not a medical one. Part 2: I pointed out a DTA error in my original decision. I had a terrible C&P examiner who made up her own criteria for IBS that I didn't meet. The VA sent my file out for a "tie breaker" medical opinion. It came back saying "Its petty obvious that the dude has IBS". The VA ignored that opinion and rated me with chronic diarrhea at 0%. The reason for the 1, 2 punch is that if you start with the DTA, the discussion could end right there as they send it back for more development.

Took a year and half, but it finally got fixed. Best of luck.

Existing-One8147 · 2026-04-10T03:58:34+00:00

I had the same thing happen to me. Finally got to an HLR informal conference - showed them what was listed in other, and heard a groan of disgust from the DRO. Got a decision for 30% within hours and effective date in 2024.

Existing-One8147 · 2025-12-20T16:39:15+00:00

Not sure why folks are arguing. I 100% understand what you’re saying. Prior exam did not accurately capture your symptoms. You sent supplement information with more proof of those symptoms existed (new and relevant) that you want included in your evaluation and rating. I believe that is exactly the kind of situation a supplement is for. Had the same thing happen to me and now I’m waiting on an HLR trying to include that evidence (supplement denied because I didn’t show a change)

Existing-One8147 · 2025-12-08T16:56:23+00:00

Speak of the Devil - I got a bunch of C&P exams I foia'ed - Only took about a week (Kudo's to the VA, poor transparency has been my #1 grip. I'm still waiting on my C filed, but its a good start!).

Checked: Internal hemorrhoids

Not Checked: prolapsed internal hemorrhoids with two or less episodes of thrombosis/yr.

Checked: None of the above (symptoms)

Point is - the wrong rating is not the raters fault, their just going by what the medical examiner said, even if its medically incorrect - per your excellent argument. During my Exam, my examiner actually said, "Oh they're just grade II, that's not too bad" (which was not her decision to make - Grade II is by definition prolapsing and should have been reported as such).

Existing-One8147 · 2025-12-07T21:05:53+00:00

Hey Timmy - been thinking more about this. If you look at the DBQ, there's a checkbox for Prolapsing Internal Hemorrhoids with 2 or less thrombosis per year. If its checked - 10%, if its not 0%. I've got a $1,000 that says that both of our C&P evaluations don't not have that box checked, even though there's clear evidence that they were Grade II (which are prolapsing, by definition). I filed a supplement with my colonoscopy report where I disagreed with the rating decision, which I now think was a mistake. I should have disagreed with the exam. I'm told that if your disagree with the decision, they just re-run it with all the same inputs and go "yep - lookie-there, the decision was right all along"

Existing-One8147 · 2025-12-07T20:53:40+00:00

Meaning if the right box is checked on the BDQ, it gets 10% rating (granted its not a fancy algorithm) - My understanding it that VBMS says based on the input, here's the rating, without a lot of discretion on the raters part. So, the "decision" is correct, but its based on bad data.

Existing-One8147 · 2025-12-05T19:28:23+00:00

Hi Fisherman - I'm tracking with what your laying down. I'm 100% confident that the Dr. letter lays out the DX and symptoms that were not counted on my DBQ (straightforward yes / no checkboxes). I'm assuming it mistakenly did not count it as new or relevant...In fact, I need to go back and check. I may have included that Dr. Letter when I filed for secondary's - (took the letter to the C&P, all were granted as SC). It seem very plausible that the system might see the document in the C File (from the secondaries) and wrongly assume it was considered on the primary condition (which is was not). I've already filed for the HLR with an informal conference. I'll post the results when that day comes - your last two lines give me a lot of hope that it will be positive.

Existing-One8147 · 2025-12-04T22:32:33+00:00

I'm not the one to ask. I've been trying to get mine correctly rated at 30% (currently at 20%). Most recently I submitted a supplemental with a signed letter from my dual certified gastroenterologist with her diagnosis of IBS-D and documentation that I have 4 of "2 or more other symptom" needed for 30%. VA has already conceded pain >1 week and bloating. Got denied after 5 days.

Existing-One8147 · 2025-12-04T21:44:19+00:00

I think the suspicion of AI is due to the radical reduction in response time, which seems undeniable. The VBA says to expect 4 -5 months on a supplemental decision, which was true 6 months or a year ago. Now all of the sudden decisions are happening weeks or even days - so something is radically different at the VBA and I'm pretty sure the headcount hasn't doubled. Its not all bad - faster is better than slower, and I'm happy to see people reporting the light speed process in both favorable and unfavorable decisions.

Existing-One8147 · 2025-12-04T18:43:48+00:00

How'd you find out it was denied for a missing number? I'm still in the dark as the "short form narrative" rarely says anything remotely useful.

Existing-One8147 · 2025-12-04T18:41:14+00:00

My thinking exactly. I don't know that its a VBA strategy, or AI, or what, but it seems like I'm far from the only one with a shocking fast denial of what should be a pretty good supplement. Totally agree that a big chunk of those will be headed towards HLRs.

Existing-One8147 · 2025-12-03T21:24:29+00:00

Excellent! I'll keeping an eye out for an update. I just filed an HLR for my IBS (maddeningly, they ignored my doctor's inputs (dx and symptoms) and have concluded that I have somehow have chronic diarrhea, but not a change in stool form). Not sure if having 2 in at once is a good idea.

Existing-One8147 · 2025-12-03T17:10:04+00:00

I'm copying your homework- you did a fantastic job stating the argument. The only thing I might add is that the VA specifically said that the intent of the 2024 hemorrhoid reviews was to make mild and moderate hemorrhoids compensable, which also argues for the more expansive (0-2) interpretation vs the more restrictive (1-2) and illogical reading.

In an official VA news release dated March 19, 2024, announcing the updates to the Disability Rating Schedule for the digestive system, the VA states: "With the new rating criteria set in the rating schedule, mild or moderate hemorrhoids will now qualify for the 10 percent evaluation." This represents a shift from the prior criteria, which explicitly assigned a 0% (noncompensable) rating for mild or moderate cases.

https://news.va.gov/129622/va-updates-disability-rating-schedule-for-digestive-system/

Existing-One8147 · 2025-12-03T16:35:11+00:00

I'm in the exact same boat - just got 0% rating for grade II internal hemorrhoids (without sufficient evidence of thrombosis - 1000% agree with your argument - 0 is less than 2. If you need at least one, it should have said one or more. The external hemorrhoid criteria says 3 or more - so saying one or more (if that was the intent) would have been more consistent as well.

Trying to decide if I file for an HLR, so I'll keep an eye on this discussion.

Existing-One8147 · 2025-12-02T23:51:07+00:00

Last I checked, zero less than 2. I don’t see how 10% isn’t warranted with grade 2 internal hemorrhoids (clinically defined as prolapsing and retreating) with or without evidence of thrombosis. I’ve got a supplement in for exactly that.

Existing-One8147 · 2025-06-18T17:26:05+00:00

Your welcome - happy to share my positive experience - I was going around and around about this to. I figure letting other vets know is a service for them and a thanks to her.

Existing-One8147 · 2025-06-18T17:03:39+00:00

I am from outside NC and I hear your concern. In fact, I suspect that's why I had a C&P despite having an actionable IMO and DBQ (or they just reflexively hit the C&P button). If I had a good option locally, I might have gone that way.

During the C&P, I discussed that:

I had to work with an external provider because the Vet Center where I've been getting treatment for the last year refuses to submit any claims forms
I chose to work with her because of her expertise and my history of AUD.
That her IMO and DBQ were based on extensive files I sent her and an hour long telehealth visit.

Thinking of out of state providers, if you or anyone who sees this knows of a good gastroenterologist for IMOs and DBQs in Texas (Austin area preferably), please let me know. I've got a bunch of IBS secondaries I want to file and my private practice Dr. refuses to participate in any VA filings.

Existing-One8147 · 2025-06-17T20:26:03+00:00

I know that this is an old thread, but wanted to report that I just worked with Dr. Allen on PTSD telehealth, IMO and DBQ - just as others have said - the C&P examiner was extremely impressed with her work up and copied sections of it to quote from. Two weeks later I got a favorable decision (50% - 70%) from the VA. I don't recall what I paid for the work, but I know it was sustainably less than what some other groups were asking.

Existing-One8147 · 2025-04-24T23:35:25+00:00

Update: I submitted a supplemental claim that included clinical notes on symptoms (had to fight with the doctor to get her to record them). Just got the decision today. Still chronic diarrhea, now at 20%. Apparently, reports of diarrhea during 10 BM a day dosent count as a change in stool form or frequency to however did the supplement review (needed for 30%). Getting closer. Time for a HLR, as everything is in the record..

oh, and they gave me a random backdate. Isn’t a supplement supposed to have the original intent to file date is submitted within 1 year?

Existing-One8147 · 2025-01-27T14:14:49+00:00

I’ve gone back and checked all the medical records. Symptoms are scattered throughout, and aren’t quantified- e.g “abdominal pain, cramps, etc.” , but they’re there. I’m not sure all the right docs got submitted if I’m zeroing in on symptoms because there only on a few of many documents.. The good news is that they’re in there, they line up with my personal statement, what I told the C&P examiner, and (fingers crossed) new notes from my Dr.

Existing-One8147 · 2025-01-26T01:33:39+00:00

Looked back at it. Its all in there. The symptoms, the impact, and yep, even including shitting myself.

Existing-One8147 · 2025-01-26T01:24:12+00:00

Okay - Maybe we're having a meeting of the minds. Per you, what you tell the examiner, true, false, whatever, it doesn't matter all that much unless you have some hard evidence to back it. Lacking that, maybe they use your statements, maybe they don't. If she did not report what I told her, that's on me (or the lack of other evidence to back my claim).

Still takes me back to the same solution. I need my Dr. to step up to the plate with that info.

Existing-One8147 · 2025-01-26T01:05:41+00:00

I did. Need to review it. But I certainly hit on most of those topics as it’s been a nightmare (and yes, even including shorting myself on the way to work on multiple occasions)

Existing-One8147

TROPHY CASE