August 1, 2024 • 59 mins
The VA has implemented major changes to GERD disability ratings, creating new hurdles for veterans seeking compensation while facing a $2.8 billion budget shortfall.
• As of May 19, 2024, GERD has its own diagnostic code (7206) and is no longer rated under hiatal hernia criteria
• Veterans now need documented esophageal stricture or esophagitis through invasive testing (EGD, barium swallow, or CT scan) for a compensable rating
• Symptoms like heartburn, regurgitation, and sleep disturbance are no longer considered in the new rating criteria
• Veterans with existing GERD ratings are grandfathered under old criteria but must document symptoms in statements since they're no longer on the DBQ
• VA justified changes using 20-year-old medical references that don't discuss disability impacts of GERD
• Veterans may receive better ratings by pursuing peptic ulcer disease claims rather than GERD if they qualify
• Rating specialists seem focused on "disability picture" rather than symptoms that affect daily functioning
• Veterans should obtain necessary diagnostic testing before C&P exams and submit detailed symptom statements
• These changes may be motivated by budget concerns despite VA claims they reflect "medical advances"
If you're affected by these GERD rating changes, document your symptoms regularly in writing and submit them to VA, especially if you have a grandfathered rating. Consider speaking with a VSO or attorney about the best path forward for your specific situation.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Bethanie Spangenberg (00:00):
Love Talk Radio.
J Basser (00:04):
It's time for the Exposed Vet Radio Show.
The Exposed Vet Radio Show, wediscuss issues affecting today's
veteran.
Now here's your host, john MRay.
Welcome, ladies and gentlemen,to another episode of the
Exposed Vet Radio Show on thiscrazy first day of August 2024.
You're flying by and it couldbe good, it could be bad.
(00:29):
Today we've got our co-host, mrRay Cobb.
How are you doing, ray?
Ray Cobb (00:33):
I'm doing good.
How are you today?
J Basser (00:36):
I'm doing wonderful, Wonderful.
A little past note I wasreading a story earlier this
afternoon before I got startedhere.
The VA has went to thecongressional committee asking
for some money because I thinkthey got a bad case of too much
money spent on the PAC-TAC andthey're broke, so hopefully they
get some funding.
Bethanie Spangenberg (00:55):
You know what, bethany, I hadn't heard
about that, I appreciate youbringing that to my attention,
but I'm not surprised.
J Basser (01:01):
They broke PAC-TAC.
They passed that PAC-TAC anddidn't give us no money.
Ray Cobb (01:05):
You know, I don't know , I think you better get
straight figured out, you knowas of July the 1st, there were
2.8 billion dollars in the red.
J Basser (01:16):
They just asked 15 billion yeah, billion, billion,
now that that sheds a little bitof light billion Billion, yeah,
billion Billion.
Bethanie Spangenberg (01:29):
Now that sheds a little bit of light of
what we're seeing and what we'retalking about tonight.
J Basser (01:33):
Right, guys, if you haven't recognized this voice,
this young lady is BethanySpangenberg.
She owns a company called.
Do you hear me?
She owns a company calledViolet Prevette.
She's a regular on the showBethany's, one of the people
that goes really in-depth anddetailed on some of these issues
, and tonight we're going totalk about the changes in GERD
(01:55):
gastro.
I can't pronounce that word.
I'm from Kentucky.
Come on, gastroenterology, comeon.
Bethanie Spange (02:18):
Gastroenteritis , there you go.
Reflux disease Okay, I'd gettongue-tied on there.
Next thing, you know, I'd breakinto my hillbilly and you'd all
be speaking hillbilly and I'dget fired.
Just to say you know, my family, since Friday, has had several
unfortunate, negative energyaround us is what I'd like to
say.
(02:39):
Family members in threedifferent incidents, two have
required surgery, one wasparalyzed in all four
extremities and had emergencysurgery and then one is pending
surgery for tomorrow.
And just three differentincidents and I don't know
what's going on.
(02:59):
But if you're the praying kind,I would appreciate it.
If you're not, I'll takepositive energy or even burning
some sage for that negativeenergy.
I would be much appreciated.
So you know, I know every familyhas its struggles, but when
they come in threes so rapidlyout of nowhere, it kind of hits
(03:19):
your.
J Basser (03:20):
That's the kind of way it goes.
Things happen in threes.
Bethanie Spangenberg (03:23):
Yeah, and it's just wild, totally three I
mean two are hospitalized in thesame big hospital in Columbus.
J Basser (03:30):
That's like oh you go to visit one, you visit them
both Dad's doing.
Bethanie Spangenberg (03:35):
Okay, he's his new normal.
J Basser (03:39):
I got a story for you, then we got some bad karma here
too.
Bethanie Spangenberg (03:43):
Hmm, I don't like it.
I got a story for you.
J Basser (03:45):
Then we got some bad karma here too.
Hmm, I don't like it.
I lost our curfew last week.
He had his pacemaker batteryreplaced.
Then he went home and got tofeeling bad.
They took him back and they say, no, he's doing kind of like a
gallbladder, really bad on him.
He took his gallbladder out andthey let him out.
They put everybody out of thehospital on Wednesday real quick
(04:06):
.
They sent him home with a bloodpressure cup on and we're like
what's going on with that?
We took him all the way backhome.
Two days later he fell on thefloor and couldn't get up.
We went and got him and broughthim back down and he had COVID.
Oh, so this week we've all hadCOVID.
Oh, no, oh, so this week we'veall had COVID, oh no.
(04:29):
Did they know that before theylet them go.
Oh, they knew that.
Yeah, I guarantee you that.
Bethanie Spangenberg (04:34):
They knew it.
That sounds like why they wererushing to get them out.
J Basser (04:38):
Yep, that's a fact.
It sucks.
I'm about over it, but theother two ain't.
So it's just.
I know I've had a hard timetalking Me and Ray talked to him
this week.
It didn't really feel like it.
But if you want to, we'll prayfor you people, for your family,
We'll get them lined up.
Bethanie Spangenberg (04:55):
I appreciate it.
I appreciate it.
So tonight we're talking aboutGERD gastroesophageal reflex
disease and I'm going to throwin there a little bit about
esophageal strictures and hiatalhernias.
We've talked about GERD acouple times with me on the show
(05:23):
, about the DBQs and a littlebit about the DBQs and what to
expect and about the diseaseitself.
But as of May 19th of this yearthey made some changes and
we'll talk about those changesand then I'm going to talk about
what they commented in theFederal Register and kind of
maybe you can help me make senseof it.
But I think this whole you said2.1 billion in the red.
That might be part of what thisis and I think veterans and
(05:49):
attorneys are going to have somework to do if if they want to
see change on this.
So we'll talk about that.
But, um, so as of may 9th ofthis year, gerd has its own
diagnostic code.
It is 7206.
And with that it has its owncriteria.
(06:12):
It is no longer rated underhiatal hernia.
Previously, prior to May 19thof this year, they were trying
to do ratings or they would takethe GERD ratings and say, oh
well, it's similar to hiatalhernia and so they would rate
the GERD under the hiatal herniarating schedule.
They've also made changes tothe hiatal hernia rating
(06:35):
schedule and those are now ratedunder 7203, which is esophageal
stricture, and of course theyhave changed the rating criteria
for esophageal stricture.
And of course they have changedthe rating criteria for
esophageal stricture.
So those three upper gastricchanges that they've made,
(06:56):
they're going to impact a lot ofveterans.
As far as the GERD claims go,and I think it's important that
we discuss what that looks likeand some things you may need to
do to prepare your claim ormaintain your current rating so
previously GERD was rated onsymptoms such as reflux,
(07:20):
regurgitation, nausea, vomiting,sleep disturbance, difficulty
swallowing, but now they're noteven asked symptoms anymore.
It's not about symptoms.
They're saying that a veteranmust have documented esophageal
stricture or must havedocumented objective
(07:46):
documentation of esophagitis inorder to meet a compensable
rating for GERD.
So let's read or I'm going toread exactly what they're saying
about GERD and I've got likefive packets because I'm OCD
about the research stuff.
(08:08):
So okay, so 7206gastroesophageal reflux disease.
So if you have a documentedhistory without daily symptoms
or require daily medication, youget a 0%.
So I think that's going to bethe new standard for any claim
that occurs or comes in afterMay 19th.
(08:30):
If you have a documented historyof esophageal stricture, again
we're under GERD.
If you have a documentedhistory of esophageal stricture
that requires daily medicationto control difficulty swallowing
but are otherwise asymptomatic,you get a 10% rating.
So now they're using theesophageal stricture as a
(08:58):
requirement to be rated for GERD, which is interesting because
esophageal stricture has its ownrating schedule.
So to me it looks like we'rereferencing the same disease in
two areas.
(09:18):
So I don't I'm not following it.
So let me read the ratingcriteria for 10% of esophageal
stricture.
It also says documented historyof esophageal stricture that
requires daily medications tocontrol difficulty swallowing.
That's 10%.
(09:39):
So to be compensable for eitheresophageal stricture or GERD.
You must have an objective testto show that you have an
esophageal stricture.
Now, that is completelydifferent than what it was
before.
J Basser (09:57):
I don't know if you're familiar.
That would take an endoscopy.
Bethanie Spangenberg (10:02):
Yes.
So, based off the new ratingcriteria, it seems that they are
forcing veterans to have eithera barium swallow to objectively
document their conditionthey're requiring an EGD or an
EGD to document it.
(10:24):
So you have to have some typeof testing to even qualify for a
compensable rating that showsthe objective information.
They don't care about yoursymptoms anymore.
It's not even on the DBQ.
J Basser (10:40):
A barren swallow is done in a fluoroscope and any
time you guys have a fluoroscopydone, you've got to realize
that it's not like an x-ray,it's a live x-ray.
It films.
It takes to watch that fluid godown your throat and you're
getting a pretty good dose ofradiation with that.
Yep.
That's kind of the basis of myopinion.
Bethanie Spangenberg (11:01):
So I don't necessarily.
So I don't agree with that.
I think that they should havedone a better job at picking
their rating criteria, and whenI talk about what they mentioned
in the Federal Register it'llkind of confuse you too, I think
.
But the rating criteria forGERD also includes esophagitis.
(11:26):
So if you have irritation atthe bottom of your esophagus
from the reflux, it would stillbe rated under the same
diagnostic code for GERD.
So if it's any type ofesophageal irritation so like if
you have like drug-inducedwhere it's irritated if you have
(11:47):
some type of food allergy thatcauses that irritation, it's
going to be rated under the samecriteria for the GERD.
J Basser (11:57):
So what about neurological Pardon?
What about neurological?
Would it be the same?
Bethanie Spangenberg (12:08):
Did you say neurological?
J Basser (12:12):
Yeah, like people with autonomic issues, you know,
because of their stomachsthrowing up and slowly got, you
know, slow to get the food downyour stomach and dryness from
you know.
Bethanie Spangenberg (12:28):
So it may they're saying any well, I don't
know, because it says or anyesophageal condition that
requires treatment withsclerotherapy.
So I don't think the autonomicor the motility issue would be
under that criteria.
I think it would be somewhereelse in the rating schedule.
But if that motility issuecauses irritation of the
(12:51):
esophagus or causes reflux, thenof course you're going to fall
into that criteria.
So I just found it fascinatingthat they're now requiring
document and in the schedule itsays that the findings must be
documented.
This is word for word.
Findings must be documented bybarium swallow computerized
(13:13):
tomography, which is a CT scanor hang with me
esophageogastroduendoscopy,gastroduendoscopy that's the EGD
.
That's why we say EGD.
So they're requiring you tohave some type of exposure to
(13:35):
radiation or sedation with ascope down your throat to meet
the criteria for a rating.
So to me what that does is nowwe're going to have veterans
coming in and say well, I've hadthese symptoms, I've had them,
you know this long, and they'regoing to start pushing to have
an EGD.
And then we're going to haveveterans coming in and say, well
, I've had these symptoms, I'vehad them, you know this long,
and they're going to startpushing to have an EGD and then
we're going to get a backlog ofconsults to the GI specialists
and they're going to have allthis stuff.
I just there's better ways togather objective information
(13:59):
than these expensive tests andI'm not following why they did
that, these expensive tests andI'm not following why they did
that, so you wouldn't like torefrain from ordering expensive
testslike that you would think, yeah,
(14:20):
if you have, or if you developan esophageal stricture from
GERD, you have a significantGERD issue.
It is not a minor issue, it isa significant issue because that
(14:47):
has been there for a period oftime.
It has caused significantdamage to your esophagus and you
will require repeated testingevery six months to a year in
order to monitor that esophagealstricture.
You're likely to have emergencyroom visits if anything gets
stuck, because if you get foodstuck in that esophageal
stricture it can cut off theblood supply and it can cause a
rupture of your esophagus.
So when I'm looking at this andit says, oh, documented history
(15:11):
of esophageal stricture thatrequires daily medications, you
get 10%.
I'm like, clinically you haveto be to a severe degree of GERD
to develop esophageal structure, so why are we giving 10%?
I'm not following that and Ijust wonder how many clinical
(15:32):
people you put out a new ratingschedule.
How many clinical people werethere?
J Basser (15:39):
And we'll talk about that I wonder how many?
Responses they got from that.
Ray Cobb (15:45):
Well, that's an interesting thing.
J Basser (15:51):
This might have to be challenged, and cold I guess, I
don't know.
Bethanie Spangenberg (15:55):
Did you say how many comments they got?
J Basser (15:57):
Yeah, how many comments.
Bethanie Spangenberg (16:00):
They got several.
That's what I want to talkabout, because their
justification for some of theirstuff is just really sloppy, to
be kind, and I think I've readevery medical article that
they've referenced and therewasn't a medical person there
talking about this stuff.
Ray Cobb (16:22):
So Ray what?
Bethanie Spangenberg (16:22):
were you saying?
What were you asking?
Ray Cobb (16:24):
Well, I think that something's kind of you know,
I've been looking into the lasttwo weeks, ever since I heard
about this $2.8 billion deficitand in looking at it we found
that, you know, I have found alot of 10% cases for several
little things that's been goingon in our area down here to the
(16:46):
sea.
The guys are well, I got a 10%and our County Service Officer
oh, that's good, you have alittle extra money now, but yeah
, you can go to McDonald's, youknow.
But basically what the VA isdoing, because they know for a
fact, they did it with SenatorBlackburn.
(17:09):
They called her and told herhow many veterans they had
approved for disabilities andhow they had reduced the amount
of claims.
Now, by saying that they didnot, from my understanding from
her aide, who I talked with,they did not go into any details
(17:31):
to what those decisions were.
They could have been made adecision we're going to grant
your claim at 0% or we're goingto grant your claim at 10%.
And now they say, oh well,we've granted 75,000 claims this
last six months, but to whatpoint?
(17:52):
And then what's happening tothose that have more severe
situations?
Bethanie Spangenberg (17:57):
And it's almost like they're patting
themselves on the back, but nottelling the whole truth about it
, and I think that's what you'reabout to get into now yeah, and
it's kind of um, like I saidit's sloppy and I and that's why
I kind of said, you know, offoff line before we went live,
like if I get too, too harsh youmight have to reel me in
(18:22):
because some of this stuff isjust not making sense in my head
.
But who am I?
So what's interesting with thechange is if you applied and
were granted for GERD prior toMay 19th, you will fall under
(18:46):
the old criteria with the hiatalhernia.
You're grandfathered in andyou'll be rated under that.
If you applied and haven't gota rating decision, or your
rating decision came back afterMay 19th, then you're going to
get a little bit of both.
You're going to get the old andthe new.
As far as rating goes is what Iwas told when I talked to
(19:08):
another attorney about itactually today we were talking
about it and then if you applyafter on or after May 19th, then
you're going to fall under thenew criteria.
So with that, the VA was veryquick to update their DBQ to
(19:29):
reflect the new changes.
So for those who aregrandfathered in, they don't ask
about that old criteria in.
They don't ask about that oldcriteria.
So you have to, in a statement,talk about your symptoms,
because they're not going to askyou anymore.
(19:50):
You have to talk aboutrecurrent epigastric distress or
recurrent abdominal distress ordifficulty swallowing or reflux
, or if you're bringing foodback up, or if you're
experiencing pain in the chestor the shoulder, or if you're
getting woken up by the GERD, ifyou're experiencing nausea or
(20:11):
vomiting.
You now have to talk about allthat and how frequently and how
long does it last?
because when you go to yourcompensation and pension exam,
if you're a grandfatheredveteran, they're not asking
those questions.
It's not on the DBQ anymore.
Does that make sense?
J Basser (20:35):
Disappearing.
Yeah, so there's nosymptomology there.
They can't write this stuffdown right Right.
Bethanie Spangenberg (20:42):
So then they go oh well, you don't have
these symptoms.
0%.
No, you put it in a statement.
You tell them exactly whatyou're experiencing, because you
may have to argue that you'reexperiencing the symptoms that
were on the old rating criteria.
J Basser (20:57):
Mm-hmm.
Well, I do encourage anyveterans going through this go
ahead and I do a 21-41-38statement.
Support a claim and I will goahead and I will list your
symptoms out there on that21-41-38.
Take that with you, since yougot it in the record, and let
the examiner see it.
It's already in the file.
(21:17):
They can't tell you not toright.
Bethanie Spangenberg (21:20):
Yeah, say hey, I already put this, or I
gave this to the VA, but Iwanted to make sure that I
brought it to your attention.
J Basser (21:26):
That's right.
You play their game with themfolks.
To them it's a game to use yourlivelihood Right.
Bethanie Spangenberg (21:37):
So now I have the Federal Register,
volume 89, number 55, forWednesday, march 20th of 2024.
And I'm going to read a lot ofthese little comments through
here word for word.
And so, when we look at thecomments regarding Diagnostic
Code 7206, which is the new codefor GERD, diagnostic code 7206,
(22:05):
which is the new code for GERD,the author which I'm still
trying to figure out, who wrotethis darn thing, so the VA is
saying that the VA proposes toevaluate GERD using rating
criteria that are based onpredominant picture of
disability due to GERD.
These criteria considersymptoms of esophageal
obstruction and irritation thatlead to the esophageal structure
, which are consistent withsymptoms of GERD.
(22:27):
And then they go on to quote amedical literature reference,
and the reference is CanadianConsensus Conference on the
Management of GastroesophagealReflux Disease in.
Adults from 2004.
Disability due to GERD from a20-year-old medical document
(23:05):
which, if it were Agent Orangeand they're referencing
something 20 years ago studyingthe same as we are for GERD.
There are thousands, there arethousands of medical studies
regarding GERD within the lastfive years.
(23:25):
So why are we trying to use anarticle that's 20 years old to
support the decision that we'remaking of what symptoms of GERD
look like?
Of GERD look like.
I know that if I'm in theclinic and I'm like, well you
know a patient's telling me thatthey're having these symptoms,
(23:46):
could it be GERD?
Let me check my reference.
I'm not pulling out a20-year-old textbook.
I'm going to go online and findmedical literature that's
within the last five years andread about what is in that
literature that's within thelast five years, and read about
what is in that literature.
So in that statement they'resaying that they're facing the
(24:10):
criteria to get a picture ofdisability due to GERD.
They're not concerned about thehealth impact or the health
consequences.
They're trying to look atdisability.
So in that instance, they'reusing the term based on the
predominant picture ofdisability due to GERD, and I
(24:30):
want you to remember that phrasebecause it changes throughout
this article.
J Basser (24:37):
When.
Bethanie Spangenberg (24:38):
I read the article that they referenced.
The article doesn't talk aboutthe disability caused by GERD.
In fact, the article doesn'teven talk about the words
esophageal stricture.
So why they're saying that GERDleads to esophageal stricture
(24:58):
and that's why they're nowrating it comparable to an
esophageal stricture and thenciting this medical literature?
That medical literature saysnothing about esophageal
stricture.
So why are we using this?
The article doesn't sayanything about obstruction, but
in their article they're talkingabout well, these criteria are
(25:18):
considered symptoms ofesophageal structure that lead
to esophageal structure.
If you're referencing a GERDarticle that doesn't talk about
esophageal structure, doesn'ttalk about esophageal
obstruction, it doesn't eventalk about a disability
associated with GERD, so why arewe using this 20 year old
article?
Does that make sense?
What?
J Basser (25:37):
about Barrett's?
What about Barrett's?
Let?
Bethanie Spangenberg (25:41):
me look, I've got it in front of me.
Let me do the expanded, becausethere's the abstract it does.
It does talk about Barrett's,okay.
J Basser (25:55):
That's better, because that's a major pathway to
cancer.
You know, once it gets pastthat note, you've got esophageal
cancer.
You're probably done.
Bethanie Spangenberg (26:06):
Yes, and what's interesting is they look
at esophageal strictures relatedto GERD.
Clinically I have seen moreBarrett's esophagus related to
GERD.
Clinically I have seen moreBarrett's esophagus related to
GERD, and Barrett's esophaguscan cause narrowing within the
esophagus, but they don't careabout that in the rating
(26:29):
schedule.
As this first paragraph says,they're trying to get a picture
of disability and so they don'tconsider that part of the
disability.
J Basser (26:40):
So I guess that's one part that I started first
scratching my head on, and so ifwe go down Pardon, you need to
change your camera because I gota bad one.
Bethanie Spangenberg (26:53):
Yes.
And then later on they talkabout the permanent impairment
due to GERD condition.
And so they say the purpose ofthe VASRD is to evaluate the
permanent residuals of adisability, and then they cite
(27:15):
38 USC 1155.
So first they talk about apicture of disability USC 1155.
So first they talk about apicture of disability, now
they're talking about now we'retrying to reflect the permanent
residuals of a disability.
That's not how we're supposedto look at it.
We're supposed to look at it asit impacts earning capacity,
(27:36):
and so I don't know why they'rechanging that language there.
What's interesting is the nextarticle that they state was more
recent.
I'm trying to find it here.
So this second article they talkabout, it says even though the
(28:00):
symptoms so those prior symptomsrelated to nausea, vomiting,
sore throat, chest discomfort,heartburn, those other symptoms
that were previously rated underhiatal hernia in the diagnosis
and treatment of GERD, the VArating schedule bases its
evaluations on the permanentimpairment due to this condition
(28:24):
.
Such permanent impairment offunction is based on the
scarring due to the chronicirritation of the esophagus by
acid reflux and consequentdevelopment of scar tissue.
And then they cite anotherarticle, and it doesn't talk
about permanent impairment.
It doesn't talk about whatimpact GERD has in the
(28:48):
occupational setting.
But there are studies out therethat look at that information
and they did not cite that atall in their reference of why or
justification of why theychanged the rating schedule to
reflect the esophageal structure.
And in fact, just within a fewminutes of searching, one of the
very top articles that poppedup was a study where they looked
(29:11):
at six countries and they foundthat there was reductions of
productivity up to 26% in thosewho had experienced GERD either
due to absenteeism for medicalappointments, uncontrolled
(29:34):
symptoms, and that's not citedanywhere.
There's no literature in thisfederal register that talks
about the occupationallimitations or the functional,
the reduction of earningcapacity in their references.
So I don't understand whythey're justifying what they are
(29:56):
.
Does that make sense?
Am I emphasizing how silly thisseems?
J Basser (30:04):
Yes you are.
Ray Cobb (30:04):
Does that?
J Basser (30:05):
make sense, am I emphasizing?
Ray Cobb (30:06):
how silly this seems.
Yeah, you are.
It's going to be challenging,it's crazy.
Well, and that's anotherquestion next, is these tests
that they're requiring now orwill be requiring?
Aren't they kind of expensive?
They are.
And so what is the VHA going todo is try to put off from
(30:34):
performing these tests becauseof their expense and say, well,
we know what you got, we'lltreat that, don't worry about it
.
I mean, I can see that comingright.
I mean, it's just like in theVA dental.
You go in and you know theydon't like to do caps and they
don't like to do implantsbecause they're more expensive.
They just soon either do afilling or just, you know, give
(30:57):
you some normal false teeth.
And when I ask about those,about implants, they stated,
well, they're kind of expensive.
They didn't tell me I couldn'thave them, but they didn't tell
me that they would.
You know would even consider itand just went on and blew right
on by it.
J Basser (31:18):
That depends, Ray.
That depends on how much cloutthat the person over oral
surgery has.
Bethanie Spangenberg (31:30):
Usually if he's a good one, then he can
get it done for you.
No-transcript.
J Basser (31:56):
So they don't have a choice, they have to have it.
I've seen several things duringthe last few years.
Now COVID, you know, va's usingtheir four companies to do
their C&P exams, and I've seenheart patients get sent out for
ECHOs, and I've seen otherthings.
So this is probably going to beone of them added tests and
they'll probably let theexaminers at the C&P do that
(32:17):
exam, that test, and that's myopinion.
They'll have to send them outto a hospital and have it done
and they'll pay for it throughthem.
Bethanie Spangenberg (32:26):
Which is going to be interesting.
J Basser (32:29):
I don't think the VHA will do it.
I don't think the VHA and theVBA I don't think they actually
communicate very well together.
Ray Cobb (32:36):
I don't think they communicate at all.
J Basser (32:39):
I think they do some, but I think there's some
animosity between each area,because you can tell just the
way people at the VA talk aboutthe BBA and vice versa.
So maybe they don't like eachother.
Bethanie Spangenberg (32:54):
And that's a bad thing.
So we'll actually there's thevery last section of this
esophageal, because they updatedmore than just the few that
we're talking about.
But towards the end we'll talkabout those diagnostic tests and
getting them referred out,because there's specific
reference to it, and so it'll beinteresting.
I don't think that the C&Pexaminer is going to be able to
(33:16):
order those tests, especially anEGD.
That requires a consult firstand then consent and follow-up,
and that's you know, if you havea veteran that has cardiac
condition and they can't besedated for an EGD, they can't
have it done.
Or they're having issues.
J Basser (33:36):
They'll be doing band swallow U8.
Bethanie Spangenberg (33:39):
I can see that They'll be doing barium
swallow.
You wait, I can see that.
Of the three, that's I don'tknow if barium swallow is less
harmful or CT is.
J Basser (33:50):
Well, folks, you have to go through that at barium.
It's some good tasting stuff,man, I tell you.
I like that yeah, go get yourpool, chalk off the table and
put it in a grinder and put somemilk in with it and drink it.
You're good.
Bethanie Spangenberg (34:13):
So if we look at the next paragraph here,
it says two commentersexpressed concern that by
changing the VASRD for digestivedisabilities, including GERD,
va is attempting to save moneyand create a higher burden to
obtain compensable evaluations,which is exactly what we just
said.
However, and I quote, vadisagrees.
(34:35):
As stated in the preamble ofthis proposed rule, the purpose
of the rule was to reflectmedical and scientific advances
in the understanding andtreatment of digestive disorders
.
For example, gerd is moreappropriately evaluated as
esophageal structure than hiatalhernia, based on objective
(34:56):
findings.
And then they quote that 2004article again findings.
And then they quote that 2004article again.
So if they are trying toreflect medical and scientific
advances, I would not quote anarticle from 20 years ago.
And then I would also say thatclinically that's not accurate.
(35:19):
I would say that GERD is moreappropriately aligned with
peptic ulcer disease, which wehave a rating schedule for.
Both clinically and based offof what's in the current rating
schedule, gerd is moreappropriately aligned with
peptic ulcer disease than it iswith esophageal stricture.
(35:40):
Now again they're saying well,gerd is less like hiatal hernia
and GERD is more like esophagealstrictures.
But what did they do?
They changed the hiatal herniacriteria to reflect the
esophageal stricture.
So that's nonsense.
Reflect the esophagealstricture.
(36:00):
So that's nonsense.
So if we look at the new ratingcriteria for a hiatal hernia if
I can find it, let's see it's7346.
7346.
(36:23):
7346.
Hiatal hernia.
This is the current rating.
It says to rate it as astricture of the esophagus.
So why are you saying to rateGERD as an esophageal stricture
Because it's more aligned withit than it is hiatal hernia.
But now you're saying in therating schedule that, oh, you
(36:43):
should see this other sectionbecause hiatal hernia no longer
has its own rating.
You're referencing the samething.
So GERD is not like hiatalhernia but it is like an
esophageal stricture.
And now you're taking hiatalhernia.
But it is like an esophagealstricture, and now you're taking
a hiatal hernia and you'remaking it rated under esophageal
(37:07):
stricture.
That doesn't make sense.
J Basser (37:13):
They found their boat.
They found their vessel tobring it in Bethany.
That's what they did.
It's a vessel to bring it in.
You know, it's a Trojan horse.
It's a vessel to bring you in.
It's a Trojan horse.
They've got it all on top ofthe vessel.
Bethanie Spangenberg (37:28):
They're going to jump out and change it
all.
And then, if we go to the nextsentence, it says this
adjustment from evaluating GERDbased on subjective symptoms to
objective measurement isconsistent with the stated
purpose of this rule.
So objective measurement isconsistent with the stated
purpose of this rule.
So the purpose of the rule isnow to obtain objective
measurements rather than thepermanent residuals or rather
(37:51):
than the picture of disability.
Now we're trying to findobjective measurements.
So there's other ways tocapture objective measurements
for GERD.
Rather than a CT or an EGD, youcan do the pH testing.
The pH testing is probably thesafest and most accurate.
(38:16):
They should do that.
J Basser (38:24):
Well, I guess they start measuring throats, right?
Yeah, I don't think they'llmake a tool for that yet they
will.
Bethanie Spangenberg (38:39):
So then let me jump to that very last
section that I was talking about.
So you were talking about howthe C&P examiners are likely to
refer out for tests, and thisalso is in line with what I
teach to other representatives.
I tell them don't wait for thecompensation and pension exam to
(39:03):
give you a diagnosis.
You need to go to thatcompensation and pension exam
with a diagnosis, because theresources to obtain certain
testing is limited.
J Basser (39:15):
So I always talk about the knee analogy.
Bethanie Spangenberg (39:18):
If I have a patient with knee pain, yes, I
can start with an x-ray, butthat's only going to tell me the
bone structure.
It's not going to tell me thesoft tissue structure.
It's not going to tell me aboutthe ligaments, where an MRI,
which is much more expensive,will tell me about the ligaments
.
But a compensation pensionexaminer doesn't have the
(39:38):
capability of ordering an MRIfor a veteran's disability claim
.
So you need to talk to yourdoctor before you have that comp
and pen exam.
And this comment at the end ofthis volume 89 talks about just
that.
And it says comments of generaldisagreement.
Comments of generaldisagreement.
(40:05):
One commenter indicated that thecurrent VASRD does not
incorporate the most up-to-dateand accurate scientific data
because its rating criteria donot allow clinicians to more
accurately diagnose andtherefore to fairly distribute
disability services.
And here's the VA.
The VA says the VASRD is notintended to be utilized in a
clinical setting to identify,diagnose or treat injuries,
(40:26):
diseases or disorders.
Clinicians are urged to utilizestandard diagnostic and
treatment practices in theirrespective clinical setting.
So that just emphasizes thatthey don't want these
compensation and pension examsto be used to diagnose.
They want it to be done in theclinical setting and then that
(40:48):
data is gathered and put intothe compensation and pension
exam for the appropriate rating.
So it'll be interesting to see,since they are now requiring
objective information for theGERD rating.
So it'll be interesting to see,since they are now requiring
objective information for theGERD rating.
J Basser (41:06):
You'd be talking to VHA then, because they don't
like to diagnose anyway.
They just like to treat.
Because they know a veterangets diagnosed is going to file
a claim.
Bethanie Spangenberg (41:16):
Yep, I actually thought I was talking
with my husband about it and wewere going back and forth.
And when you look at GERD and Italked previously about how the
symptoms more readily alignwith peptic ulcer disease.
(41:37):
Peptic ulcer disease is mosteasily identified on an EGD and
if a veteran has to haveobjective information, an EGD
will look at stomach lining tosee if there is an ulcer present
and if there is, the veteranwould benefit from filing for
(42:01):
the ulcer versus filing for GERD.
And if that diagnosis changesduring while their claim is open
, it's an esophageal condition.
So they need to.
In my opinion they need tobroadly present their condition
that they're claiming.
In that aspect you can put GERDslash, peptic ulcer disease or
(42:27):
esophageal discomfort orsomething generic and then in
the statement you know supportthat.
But if you compare the ratingschedule between GERD and peptic
ulcer disease you're going toget a higher rating for the
peptic ulcer disease and thoseconditions often go hand in hand
and they're seen more readilythan GERD with an esophageal
stricture.
So I have probably seen in gosh2000,.
(42:51):
So in 15 years I've probablyseen maybe 10 esophageal
strictures in the primary careclinic versus 100 or more with
peptic ulcer disease.
So just for veterans listening,keep that in mind that if in
fact you talk to your providerabout getting an EGD or getting
(43:16):
one of these tests, you shouldreally talk because there's
risks with all of them.
So you really need to sit downand talk with them about what
most appropriately fits you.
But if you do find you know oneof those diagnoses on there
that you'd probably be betteroff rated for the ulcer disease
than for CURT itself, you can gostage it for example, like
(43:39):
Medicare requirements, you knowyou have to have one test done
before you, another one, youknow, because it would just
cover cost.
J Basser (43:46):
So usually they'll probably do a barren swallow and
then if they think you need anEGD, that'll be the next step.
But I recommend that's the kindof health insurance you use
Medicare Part B to at least findyou a good gastroenterologist
outside the VA, especiallysomebody that deals in this
stuff, and maybe get a goodopinion from him.
Let him treat you a little bit.
See what you know, look at thedifference and see what's going
(44:07):
on.
Bethanie Spangenberg (44:08):
You might get a little better handle on it
, yeah.
I think the rating schedule theway it is doesn't capture the
true disability or theimpairment of earning capacity.
When we're looking at therating schedule, I think what
(44:28):
one of the commenters trying tosave money and making it more
difficult for the create ahigher VA is attempting to save
money and create a higher burdento obtain compensable
evaluations is spot on.
And when you reference medicalarticles that are 20 years old
and don't even talk aboutesophageal strictures related to
(44:50):
GERD or esophageal obstructionrelated to GERD or even the fact
that GERD can cause disability,it's supporting that
commenter's perspective.
J Basser (45:10):
That's true.
Ray Cobb (45:11):
You know, john, you just made a good point that I'd
like to emphasize it even more.
I'd like to emphasize it evenmore when you do if you do
hopefully have some medicalinsurance in your Medicare
you're liable to get more of anopen opinion of what really is
(45:34):
going on.
Because I've often felt, sinceI chose not to go with Medicare,
that with the VA, to go withMedicare, that with the VA,
sometimes the VA understandswhat the claims division is
trying to do or trying toaccomplish and they will kind of
lean that way more than topossibly give you a true picture
(45:57):
of what's going on.
And and I'm thinking from thestandpoint of when I went about
foot drop, I went to two outsidepodiatrists.
They both use the term totaland permanent loss of your use
of perineal nerve, but the VAdoctors was not put the word
(46:21):
total in and they were told.
One of the doctors actuallysaid we were told not to use the
word total.
Now, with that being the case,that means if you just went to a
VA doctor, you're not going towin your case for foot drop, and
I think we see the same thingstarting to address and set up
(46:43):
right here with this Could bewrong.
I mean you know, but it seemsto me like you could go and they
could leave something out andsay it leaves the symptoms out,
like we've talked about, and notdo any of the tests and you're
not going to win your case.
You're dead in the water beforeyou ever even turn it in.
J Basser (47:03):
Right, you just actually explained one of the
reasons the VA has such a highturnover rate with doctors and
medical professionals.
Ray Cobb (47:13):
Hmm.
J Basser (47:18):
You can't do your job if your hands are tied behind
your back.
Ray Cobb (47:20):
Is that right, Jeffrey .
Bethanie Spangenberg (47:28):
I just wish they would have quoted or
done something you knowsupporting their decision.
Like, if you're really tryingto capture, you know, the
impairment of this particularmedical condition, can you use a
reference that talks about theoccupational impact or the
impact of earning capacity thatit has?
Ray Cobb (48:06):
To me they are just gaslighting, almost in a way you
know these arguments and whatthese people are trying to say.
Well, I think you said it bestwhen you said that evidently
they did not have any medicalprofessionals in the room
helping them with this.
You know, it was a bunch ofguys and you know, and they
threw some stuff up on the wallto see what might stick.
So we're going to go with whatstuck.
(48:27):
They might have talked to somemedical professions behind
closed doors or another time,but as far as having them in the
room when they were actuallyworking on this, it sounds to me
like they wasn't anywherearound.
Bethanie Spangenberg (48:48):
I don't even think they were involved in
the process.
Based off the information thatI'm seeing, because it's not, it
doesn't make any clinical senseand, knowing how the VA and the
rating systems work, it's to meI'm not convinced that there
was any medical person involvedwhatsoever in this process.
(49:10):
And I will say cause I've seen,I see a lot doing what we do
and a lot of the DBQs that we doin-house.
We do DBQs for GERD and we dosee a lot of veterans talk about
how severe their GERD symptomsare.
And in the previous radio showwe talked about hey, you know,
(49:35):
if you really have all thesesignificant symptoms, you should
have had some type of testingby now.
You should have had a bariumswallow, you should have had an
ETD.
And maybe that's theirjustification for having the
veteran prove that they'rehaving some sort of condition.
They're not using theappropriate information to
(50:08):
capture the functionalimpairment related to the
condition.
So again, I see and for thelack of better terms I'm going
to say I see almost anover-exaggeration maybe in order
for a veteran to meet thatcriteria.
And then they say, well, I'venever had anything done, well,
it's like.
Well, if you're really havingthese symptoms, then you really
need to go have an EDD or bariumswell or something done because
(50:30):
you need to make sure you don'thave Barrett's esophagus, you
need to make sure you don't havean esophageal structure, you
need to make sure you don't havethese things.
So I see that side and I'mthankful for that side, because
I think you know it will help toidentify some conditions that
may arise from these severesymptoms.
At the same time, you knowyou're now you're going to bog
(50:51):
down the system.
You're going to create a burdenwithin your healthcare system.
You're going to need morehands-on, both in the radiology
department in your GI department.
You're going to need morehands-on both in the radiology
department in your GI department.
You're going to put out moreexpenditures into the civilian
through outside referrals.
You are going to delay theprocess of claims and granting
(51:13):
claims because this just hit.
So now all these veterans haveto jump through all these hoops
to get more evidence and it'sjust going to throw in more
appeal.
And so I don't.
I think if their aim was tolower their money and their
expenditures which, if you readpage one, that's actually what
they talk about they're doingthemselves a favor well, you may
(51:47):
have some veterans I knowseveral that if they had to go
through all this, I'd say for 10or 200, they'd say to heck with
it.
Ray Cobb (51:50):
I'm not going to fool with that, you know it's not
like you might get you to 100and and get you, you know,
$3,800.
I mean, we're talking at a 10%rating.
We're talking somewhere around$200 a month, if I remember
correctly.
Am I right about that, john?
J Basser (52:11):
You're right, buddy.
Bethanie Spangenberg (52:16):
So I found the reference to money when it
comes to the GERD changes and itsays the same commenter,
referencing a previous comment,says the same commenter
questioned why VA categorizedGERD as having a minor budgetary
impact in the ERIA.
As stated in the ERIA I don'tknow if they say that ERA or
(52:57):
whatever they call it, but theterm minor budgetary a major
budgetary impact greater than$100 million over 10 years.
I don't know if I think that'sa spitting in the ocean, if
you're $2.8 billion or $2.1billion in the red, that's July
1st.
J Basser (53:18):
Look at what I sent you guys.
Bethanie Spangenberg (53:28):
Hmm, va claim errors result in $100
million in incorrect payments.
J Basser (53:38):
Yep.
Bethanie Spangenberg (53:44):
VA urges lawmakers to approve a $15
billion to fund budget gap.
J Basser (53:51):
Yeah, that is the job on October 1st.
I think this is August 1st,guys.
We got 61 days, I guess, untilthey get to vote on it.
Then they got to pay theclothing allowance.
They'd be broke again.
Ray Cobb (54:11):
The clothing allowance didn't go up.
It's almost $1,000 for eachbrace now.
Bethanie Spangenberg (54:20):
Really.
J Basser (54:22):
Yeah, don't be saying for each brace now.
Really Don't be saying that tome now.
People will be chopping legsoff to get that money, come on.
Before we get off oh gosh, no,I'm just kidding we actually.
No, I'm just kidding weactually.
(54:46):
We've got about five minutesleft.
Bethany, Did you cover all yourmaterial you want to cover?
Bethanie Spangenberg (54:51):
Yeah, and I think the biggest.
If I had to summarize thebiggest takeaway, you know, for
those who are listening is youneed to appreciate the new GERD
criteria.
If you're going to file a newclaim or if you have a pending
claim, you need to understandwhat they're looking for, what
they're asking for.
And then, if you're part ofgrandfathered in, you really
(55:11):
need to make statements on aregular basis of what your
symptoms are.
And you write the statement andyou email it to yourself or you
fax it in and you don't evertouch.
You know, asking for anincrease.
You're just trying tocontinually document those
symptoms.
So then that way, in four orfive years, if they try to come
(55:33):
back to reduce you, you can say,well, these are my symptoms and
I've put it in a statementevery year to you.
So I just you need to be aware,because if you go for a comp
and pen, they're not going toask.
So we'll put something up onour website relating to the old
question.
So that way, if you're like,hey, what did she say I need to
talk about, well, we're going toput that old DBQ up so you can
(55:55):
have that information.
J Basser (55:59):
Put it like the show up too.
Yes, I think it's kind of oneof those important shows because
I think something's kind ofrotten in Denmark on this one.
They really haven't had anissue.
It's kind of like tonighteverybody's getting 10% for dirt
, we get a lot me at 10%.
(56:20):
We got to find a way to, asBarney Papa saying, nip that in
the bud, yes again.
Well, it's triage, it's claimstriage.
Stop the bleeding.
That's the first thing.
Airway breathing what's theother one?
Abc.
Bethanie Spangenberg (56:42):
Airway breathing Cir.
What's?
J Basser (56:44):
the other one, abc Airway.
Breathing circulation, yeah,circulation.
Stop bleeding, yeah, but it'ssad.
Tell us what you're basicallydoing.
I know you've been doing a lotof different things.
Are you staying pretty busydoing the health and rent work,
or are you doing something else?
Bethanie Spangenberg (57:02):
Yeah, we got a whole team and right now
my focus is really just VALORfor VET and keeping our
providers educated and, on topof things, keeping our numbers
turned over.
We like to hire veterans, welike to keep veterans involved
and we actually have a veteranwho's in the National Guard and
(57:24):
he was activated about six weeksago and he's been gone.
So we leave that space for him.
We love him, but as a team wehad a lot more work on our
shoulders.
So I think we're finally caughtback up and got our nexus
letters caught up and some ofour file reviews all caught up
(57:45):
and just appreciate him takingthe time to protect the country.
J Basser (57:53):
Well, we wish him the best.
I mean, national Guard folksare pretty sharp individuals.
Yeah Well, we got a minute left.
Ray, I want to thank you forcoming on and co-hosting, as
usual.
Ray Cobb (58:09):
No, I enjoyed it and learned something.
Every time I do it.
J Basser (58:14):
Anytime this young lady comes on, we're going to
learn something, folks.
That's what it's good.
If you don't listen to her pastshow, you will learn something.
She is down to the nitty-grittyon the DBQs and everything.
We're going to be doing oneevery month here until the end
of the year and most well in thenext year.
With that, this will be JohnBasher, jay Stacy on behalf of
(58:37):
the Exposant Radio Show, bethySpanglberg and Mr Ray Cobb.
We'll be signing off for now.
You have been listening to theExposed that Podcast.
Any opinions expressed on theshow are the opinions of the
guest speakers and notnecessarily the opinions of
Exposed that, exposedthatcom orBlogTalkRadio.
(58:58):
Tune in next week for anotherepisode of the Exposedet Podcast
.
Thanks for listening.
Love Talk Radio.
J Basser (00:04):
It's time for the Exposed Vet Radio Show.
The Exposed Vet Radio Show, wediscuss issues affecting today's
veteran.
Now here's your host, john MRay.
Welcome, ladies and gentlemen,to another episode of the
Exposed Vet Radio Show on thiscrazy first day of August 2024.
You're flying by and it couldbe good, it could be bad.
(00:29):
Today we've got our co-host, mrRay Cobb.
How are you doing, ray?
Ray Cobb (00:33):
I'm doing good.
How are you today?
J Basser (00:36):
I'm doing wonderful, Wonderful.
A little past note I wasreading a story earlier this
afternoon before I got startedhere.
The VA has went to thecongressional committee asking
for some money because I thinkthey got a bad case of too much
money spent on the PAC-TAC andthey're broke, so hopefully they
get some funding.
Bethanie Spangenberg (00:55):
You know what, bethany, I hadn't heard
about that, I appreciate youbringing that to my attention,
but I'm not surprised.
J Basser (01:01):
They broke PAC-TAC.
They passed that PAC-TAC anddidn't give us no money.
Ray Cobb (01:05):
You know, I don't know , I think you better get
straight figured out, you knowas of July the 1st, there were
2.8 billion dollars in the red.
J Basser (01:16):
They just asked 15 billion yeah, billion, billion,
now that that sheds a little bitof light billion Billion, yeah,
billion Billion.
Bethanie Spangenberg (01:29):
Now that sheds a little bit of light of
what we're seeing and what we'retalking about tonight.
J Basser (01:33):
Right, guys, if you haven't recognized this voice,
this young lady is BethanySpangenberg.
She owns a company called.
Do you hear me?
She owns a company calledViolet Prevette.
She's a regular on the showBethany's, one of the people
that goes really in-depth anddetailed on some of these issues
, and tonight we're going totalk about the changes in GERD
(01:55):
gastro.
I can't pronounce that word.
I'm from Kentucky.
Come on, gastroenterology, comeon.
Bethanie Spange (02:18):
Gastroenteritis , there you go.
Reflux disease Okay, I'd gettongue-tied on there.
Next thing, you know, I'd breakinto my hillbilly and you'd all
be speaking hillbilly and I'dget fired.
Just to say you know, my family, since Friday, has had several
unfortunate, negative energyaround us is what I'd like to
say.
(02:39):
Family members in threedifferent incidents, two have
required surgery, one wasparalyzed in all four
extremities and had emergencysurgery and then one is pending
surgery for tomorrow.
And just three differentincidents and I don't know
what's going on.
(02:59):
But if you're the praying kind,I would appreciate it.
If you're not, I'll takepositive energy or even burning
some sage for that negativeenergy.
I would be much appreciated.
So you know, I know every familyhas its struggles, but when
they come in threes so rapidlyout of nowhere, it kind of hits
(03:19):
your.
J Basser (03:20):
That's the kind of way it goes.
Things happen in threes.
Bethanie Spangenberg (03:23):
Yeah, and it's just wild, totally three I
mean two are hospitalized in thesame big hospital in Columbus.
J Basser (03:30):
That's like oh you go to visit one, you visit them
both Dad's doing.
Bethanie Spangenberg (03:35):
Okay, he's his new normal.
J Basser (03:39):
I got a story for you, then we got some bad karma here
too.
Bethanie Spangenberg (03:43):
Hmm, I don't like it.
I got a story for you.
J Basser (03:45):
Then we got some bad karma here too.
Hmm, I don't like it.
I lost our curfew last week.
He had his pacemaker batteryreplaced.
Then he went home and got tofeeling bad.
They took him back and they say, no, he's doing kind of like a
gallbladder, really bad on him.
He took his gallbladder out andthey let him out.
They put everybody out of thehospital on Wednesday real quick
(04:06):
.
They sent him home with a bloodpressure cup on and we're like
what's going on with that?
We took him all the way backhome.
Two days later he fell on thefloor and couldn't get up.
We went and got him and broughthim back down and he had COVID.
Oh, so this week we've all hadCOVID.
Oh, no, oh, so this week we'veall had COVID, oh no.
(04:29):
Did they know that before theylet them go.
Oh, they knew that.
Yeah, I guarantee you that.
Bethanie Spangenberg (04:34):
They knew it.
That sounds like why they wererushing to get them out.
J Basser (04:38):
Yep, that's a fact.
It sucks.
I'm about over it, but theother two ain't.
So it's just.
I know I've had a hard timetalking Me and Ray talked to him
this week.
It didn't really feel like it.
But if you want to, we'll prayfor you people, for your family,
We'll get them lined up.
Bethanie Spangenberg (04:55):
I appreciate it.
I appreciate it.
So tonight we're talking aboutGERD gastroesophageal reflex
disease and I'm going to throwin there a little bit about
esophageal strictures and hiatalhernias.
We've talked about GERD acouple times with me on the show
(05:23):
, about the DBQs and a littlebit about the DBQs and what to
expect and about the diseaseitself.
But as of May 19th of this yearthey made some changes and
we'll talk about those changesand then I'm going to talk about
what they commented in theFederal Register and kind of
maybe you can help me make senseof it.
But I think this whole you said2.1 billion in the red.
That might be part of what thisis and I think veterans and
(05:49):
attorneys are going to have somework to do if if they want to
see change on this.
So we'll talk about that.
But, um, so as of may 9th ofthis year, gerd has its own
diagnostic code.
It is 7206.
And with that it has its owncriteria.
(06:12):
It is no longer rated underhiatal hernia.
Previously, prior to May 19thof this year, they were trying
to do ratings or they would takethe GERD ratings and say, oh
well, it's similar to hiatalhernia and so they would rate
the GERD under the hiatal herniarating schedule.
They've also made changes tothe hiatal hernia rating
(06:35):
schedule and those are now ratedunder 7203, which is esophageal
stricture, and of course theyhave changed the rating criteria
for esophageal stricture.
And of course they have changedthe rating criteria for
esophageal stricture.
So those three upper gastricchanges that they've made,
(06:56):
they're going to impact a lot ofveterans.
As far as the GERD claims go,and I think it's important that
we discuss what that looks likeand some things you may need to
do to prepare your claim ormaintain your current rating so
previously GERD was rated onsymptoms such as reflux,
(07:20):
regurgitation, nausea, vomiting,sleep disturbance, difficulty
swallowing, but now they're noteven asked symptoms anymore.
It's not about symptoms.
They're saying that a veteranmust have documented esophageal
stricture or must havedocumented objective
(07:46):
documentation of esophagitis inorder to meet a compensable
rating for GERD.
So let's read or I'm going toread exactly what they're saying
about GERD and I've got likefive packets because I'm OCD
about the research stuff.
(08:08):
So okay, so 7206gastroesophageal reflux disease.
So if you have a documentedhistory without daily symptoms
or require daily medication, youget a 0%.
So I think that's going to bethe new standard for any claim
that occurs or comes in afterMay 19th.
(08:30):
If you have a documented historyof esophageal stricture, again
we're under GERD.
If you have a documentedhistory of esophageal stricture
that requires daily medicationto control difficulty swallowing
but are otherwise asymptomatic,you get a 10% rating.
So now they're using theesophageal stricture as a
(08:58):
requirement to be rated for GERD, which is interesting because
esophageal stricture has its ownrating schedule.
So to me it looks like we'rereferencing the same disease in
two areas.
(09:18):
So I don't I'm not following it.
So let me read the ratingcriteria for 10% of esophageal
stricture.
It also says documented historyof esophageal stricture that
requires daily medications tocontrol difficulty swallowing.
That's 10%.
(09:39):
So to be compensable for eitheresophageal stricture or GERD.
You must have an objective testto show that you have an
esophageal stricture.
Now, that is completelydifferent than what it was
before.
J Basser (09:57):
I don't know if you're familiar.
That would take an endoscopy.
Bethanie Spangenberg (10:02):
Yes.
So, based off the new ratingcriteria, it seems that they are
forcing veterans to have eithera barium swallow to objectively
document their conditionthey're requiring an EGD or an
EGD to document it.
(10:24):
So you have to have some typeof testing to even qualify for a
compensable rating that showsthe objective information.
They don't care about yoursymptoms anymore.
It's not even on the DBQ.
J Basser (10:40):
A barren swallow is done in a fluoroscope and any
time you guys have a fluoroscopydone, you've got to realize
that it's not like an x-ray,it's a live x-ray.
It films.
It takes to watch that fluid godown your throat and you're
getting a pretty good dose ofradiation with that.
Yep.
That's kind of the basis of myopinion.
Bethanie Spangenberg (11:01):
So I don't necessarily.
So I don't agree with that.
I think that they should havedone a better job at picking
their rating criteria, and whenI talk about what they mentioned
in the Federal Register it'llkind of confuse you too, I think
.
But the rating criteria forGERD also includes esophagitis.
(11:26):
So if you have irritation atthe bottom of your esophagus
from the reflux, it would stillbe rated under the same
diagnostic code for GERD.
So if it's any type ofesophageal irritation so like if
you have like drug-inducedwhere it's irritated if you have
(11:47):
some type of food allergy thatcauses that irritation, it's
going to be rated under the samecriteria for the GERD.
J Basser (11:57):
So what about neurological Pardon?
What about neurological?
Would it be the same?
Bethanie Spangenberg (12:08):
Did you say neurological?
J Basser (12:12):
Yeah, like people with autonomic issues, you know,
because of their stomachsthrowing up and slowly got, you
know, slow to get the food downyour stomach and dryness from
you know.
Bethanie Spangenberg (12:28):
So it may they're saying any well, I don't
know, because it says or anyesophageal condition that
requires treatment withsclerotherapy.
So I don't think the autonomicor the motility issue would be
under that criteria.
I think it would be somewhereelse in the rating schedule.
But if that motility issuecauses irritation of the
(12:51):
esophagus or causes reflux, thenof course you're going to fall
into that criteria.
So I just found it fascinatingthat they're now requiring
document and in the schedule itsays that the findings must be
documented.
This is word for word.
Findings must be documented bybarium swallow computerized
(13:13):
tomography, which is a CT scanor hang with me
esophageogastroduendoscopy,gastroduendoscopy that's the EGD
.
That's why we say EGD.
So they're requiring you tohave some type of exposure to
(13:35):
radiation or sedation with ascope down your throat to meet
the criteria for a rating.
So to me what that does is nowwe're going to have veterans
coming in and say well, I've hadthese symptoms, I've had them,
you know this long, and they'regoing to start pushing to have
an EGD.
And then we're going to haveveterans coming in and say, well
, I've had these symptoms, I'vehad them, you know this long,
and they're going to startpushing to have an EGD and then
we're going to get a backlog ofconsults to the GI specialists
and they're going to have allthis stuff.
I just there's better ways togather objective information
(13:59):
than these expensive tests andI'm not following why they did
that, these expensive tests andI'm not following why they did
that, so you wouldn't like torefrain from ordering expensive
testslike that you would think, yeah,
(14:20):
if you have, or if you developan esophageal stricture from
GERD, you have a significantGERD issue.
It is not a minor issue, it isa significant issue because that
(14:47):
has been there for a period oftime.
It has caused significantdamage to your esophagus and you
will require repeated testingevery six months to a year in
order to monitor that esophagealstricture.
You're likely to have emergencyroom visits if anything gets
stuck, because if you get foodstuck in that esophageal
stricture it can cut off theblood supply and it can cause a
rupture of your esophagus.
So when I'm looking at this andit says, oh, documented history
(15:11):
of esophageal stricture thatrequires daily medications, you
get 10%.
I'm like, clinically you haveto be to a severe degree of GERD
to develop esophageal structure, so why are we giving 10%?
I'm not following that and Ijust wonder how many clinical
(15:32):
people you put out a new ratingschedule.
How many clinical people werethere?
J Basser (15:39):
And we'll talk about that I wonder how many?
Responses they got from that.
Ray Cobb (15:45):
Well, that's an interesting thing.
J Basser (15:51):
This might have to be challenged, and cold I guess, I
don't know.
Bethanie Spangenberg (15:55):
Did you say how many comments they got?
J Basser (15:57):
Yeah, how many comments.
Bethanie Spangenberg (16:00):
They got several.
That's what I want to talkabout, because their
justification for some of theirstuff is just really sloppy, to
be kind, and I think I've readevery medical article that
they've referenced and therewasn't a medical person there
talking about this stuff.
Ray Cobb (16:22):
So Ray what?
Bethanie Spangenberg (16:22):
were you saying?
What were you asking?
Ray Cobb (16:24):
Well, I think that something's kind of you know,
I've been looking into the lasttwo weeks, ever since I heard
about this $2.8 billion deficitand in looking at it we found
that, you know, I have found alot of 10% cases for several
little things that's been goingon in our area down here to the
(16:46):
sea.
The guys are well, I got a 10%and our County Service Officer
oh, that's good, you have alittle extra money now, but yeah
, you can go to McDonald's, youknow.
But basically what the VA isdoing, because they know for a
fact, they did it with SenatorBlackburn.
(17:09):
They called her and told herhow many veterans they had
approved for disabilities andhow they had reduced the amount
of claims.
Now, by saying that they didnot, from my understanding from
her aide, who I talked with,they did not go into any details
(17:31):
to what those decisions were.
They could have been made adecision we're going to grant
your claim at 0% or we're goingto grant your claim at 10%.
And now they say, oh well,we've granted 75,000 claims this
last six months, but to whatpoint?
(17:52):
And then what's happening tothose that have more severe
situations?
Bethanie Spangenberg (17:57):
And it's almost like they're patting
themselves on the back, but nottelling the whole truth about it
, and I think that's what you'reabout to get into now yeah, and
it's kind of um, like I saidit's sloppy and I and that's why
I kind of said, you know, offoff line before we went live,
like if I get too, too harsh youmight have to reel me in
(18:22):
because some of this stuff isjust not making sense in my head
.
But who am I?
So what's interesting with thechange is if you applied and
were granted for GERD prior toMay 19th, you will fall under
(18:46):
the old criteria with the hiatalhernia.
You're grandfathered in andyou'll be rated under that.
If you applied and haven't gota rating decision, or your
rating decision came back afterMay 19th, then you're going to
get a little bit of both.
You're going to get the old andthe new.
As far as rating goes is what Iwas told when I talked to
(19:08):
another attorney about itactually today we were talking
about it and then if you applyafter on or after May 19th, then
you're going to fall under thenew criteria.
So with that, the VA was veryquick to update their DBQ to
(19:29):
reflect the new changes.
So for those who aregrandfathered in, they don't ask
about that old criteria in.
They don't ask about that oldcriteria.
So you have to, in a statement,talk about your symptoms,
because they're not going to askyou anymore.
(19:50):
You have to talk aboutrecurrent epigastric distress or
recurrent abdominal distress ordifficulty swallowing or reflux
, or if you're bringing foodback up, or if you're
experiencing pain in the chestor the shoulder, or if you're
getting woken up by the GERD, ifyou're experiencing nausea or
(20:11):
vomiting.
You now have to talk about allthat and how frequently and how
long does it last?
because when you go to yourcompensation and pension exam,
if you're a grandfatheredveteran, they're not asking
those questions.
It's not on the DBQ anymore.
Does that make sense?
J Basser (20:35):
Disappearing.
Yeah, so there's nosymptomology there.
They can't write this stuffdown right Right.
Bethanie Spangenberg (20:42):
So then they go oh well, you don't have
these symptoms.
0%.
No, you put it in a statement.
You tell them exactly whatyou're experiencing, because you
may have to argue that you'reexperiencing the symptoms that
were on the old rating criteria.
J Basser (20:57):
Mm-hmm.
Well, I do encourage anyveterans going through this go
ahead and I do a 21-41-38statement.
Support a claim and I will goahead and I will list your
symptoms out there on that21-41-38.
Take that with you, since yougot it in the record, and let
the examiner see it.
It's already in the file.
(21:17):
They can't tell you not toright.
Bethanie Spangenberg (21:20):
Yeah, say hey, I already put this, or I
gave this to the VA, but Iwanted to make sure that I
brought it to your attention.
J Basser (21:26):
That's right.
You play their game with themfolks.
To them it's a game to use yourlivelihood Right.
Bethanie Spangenberg (21:37):
So now I have the Federal Register,
volume 89, number 55, forWednesday, march 20th of 2024.
And I'm going to read a lot ofthese little comments through
here word for word.
And so, when we look at thecomments regarding Diagnostic
Code 7206, which is the new codefor GERD, diagnostic code 7206,
(22:05):
which is the new code for GERD,the author which I'm still
trying to figure out, who wrotethis darn thing, so the VA is
saying that the VA proposes toevaluate GERD using rating
criteria that are based onpredominant picture of
disability due to GERD.
These criteria considersymptoms of esophageal
obstruction and irritation thatlead to the esophageal structure
, which are consistent withsymptoms of GERD.
(22:27):
And then they go on to quote amedical literature reference,
and the reference is CanadianConsensus Conference on the
Management of GastroesophagealReflux Disease in.
Adults from 2004.
Disability due to GERD from a20-year-old medical document
(23:05):
which, if it were Agent Orangeand they're referencing
something 20 years ago studyingthe same as we are for GERD.
There are thousands, there arethousands of medical studies
regarding GERD within the lastfive years.
(23:25):
So why are we trying to use anarticle that's 20 years old to
support the decision that we'remaking of what symptoms of GERD
look like?
Of GERD look like.
I know that if I'm in theclinic and I'm like, well you
know a patient's telling me thatthey're having these symptoms,
(23:46):
could it be GERD?
Let me check my reference.
I'm not pulling out a20-year-old textbook.
I'm going to go online and findmedical literature that's
within the last five years andread about what is in that
literature that's within thelast five years, and read about
what is in that literature.
So in that statement they'resaying that they're facing the
(24:10):
criteria to get a picture ofdisability due to GERD.
They're not concerned about thehealth impact or the health
consequences.
They're trying to look atdisability.
So in that instance, they'reusing the term based on the
predominant picture ofdisability due to GERD, and I
(24:30):
want you to remember that phrasebecause it changes throughout
this article.
J Basser (24:37):
When.
Bethanie Spangenberg (24:38):
I read the article that they referenced.
The article doesn't talk aboutthe disability caused by GERD.
In fact, the article doesn'teven talk about the words
esophageal stricture.
So why they're saying that GERDleads to esophageal stricture
(24:58):
and that's why they're nowrating it comparable to an
esophageal stricture and thenciting this medical literature?
That medical literature saysnothing about esophageal
stricture.
So why are we using this?
The article doesn't sayanything about obstruction, but
in their article they're talkingabout well, these criteria are
(25:18):
considered symptoms ofesophageal structure that lead
to esophageal structure.
If you're referencing a GERDarticle that doesn't talk about
esophageal structure, doesn'ttalk about esophageal
obstruction, it doesn't eventalk about a disability
associated with GERD, so why arewe using this 20 year old
article?
Does that make sense?
What?
J Basser (25:37):
about Barrett's?
What about Barrett's?
Let?
Bethanie Spangenberg (25:41):
me look, I've got it in front of me.
Let me do the expanded, becausethere's the abstract it does.
It does talk about Barrett's,okay.
J Basser (25:55):
That's better, because that's a major pathway to
cancer.
You know, once it gets pastthat note, you've got esophageal
cancer.
You're probably done.
Bethanie Spangenberg (26:06):
Yes, and what's interesting is they look
at esophageal strictures relatedto GERD.
Clinically I have seen moreBarrett's esophagus related to
GERD.
Clinically I have seen moreBarrett's esophagus related to
GERD, and Barrett's esophaguscan cause narrowing within the
esophagus, but they don't careabout that in the rating
(26:29):
schedule.
As this first paragraph says,they're trying to get a picture
of disability and so they don'tconsider that part of the
disability.
J Basser (26:40):
So I guess that's one part that I started first
scratching my head on, and so ifwe go down Pardon, you need to
change your camera because I gota bad one.
Bethanie Spangenberg (26:53):
Yes.
And then later on they talkabout the permanent impairment
due to GERD condition.
And so they say the purpose ofthe VASRD is to evaluate the
permanent residuals of adisability, and then they cite
(27:15):
38 USC 1155.
So first they talk about apicture of disability USC 1155.
So first they talk about apicture of disability, now
they're talking about now we'retrying to reflect the permanent
residuals of a disability.
That's not how we're supposedto look at it.
We're supposed to look at it asit impacts earning capacity,
(27:36):
and so I don't know why they'rechanging that language there.
What's interesting is the nextarticle that they state was more
recent.
I'm trying to find it here.
So this second article they talkabout, it says even though the
(28:00):
symptoms so those prior symptomsrelated to nausea, vomiting,
sore throat, chest discomfort,heartburn, those other symptoms
that were previously rated underhiatal hernia in the diagnosis
and treatment of GERD, the VArating schedule bases its
evaluations on the permanentimpairment due to this condition
(28:24):
.
Such permanent impairment offunction is based on the
scarring due to the chronicirritation of the esophagus by
acid reflux and consequentdevelopment of scar tissue.
And then they cite anotherarticle, and it doesn't talk
about permanent impairment.
It doesn't talk about whatimpact GERD has in the
(28:48):
occupational setting.
But there are studies out therethat look at that information
and they did not cite that atall in their reference of why or
justification of why theychanged the rating schedule to
reflect the esophageal structure.
And in fact, just within a fewminutes of searching, one of the
very top articles that poppedup was a study where they looked
(29:11):
at six countries and they foundthat there was reductions of
productivity up to 26% in thosewho had experienced GERD either
due to absenteeism for medicalappointments, uncontrolled
(29:34):
symptoms, and that's not citedanywhere.
There's no literature in thisfederal register that talks
about the occupationallimitations or the functional,
the reduction of earningcapacity in their references.
So I don't understand whythey're justifying what they are
(29:56):
.
Does that make sense?
Am I emphasizing how silly thisseems?
J Basser (30:04):
Yes you are.
Ray Cobb (30:04):
Does that?
J Basser (30:05):
make sense, am I emphasizing?
Ray Cobb (30:06):
how silly this seems.
Yeah, you are.
It's going to be challenging,it's crazy.
Well, and that's anotherquestion next, is these tests
that they're requiring now orwill be requiring?
Aren't they kind of expensive?
They are.
And so what is the VHA going todo is try to put off from
(30:34):
performing these tests becauseof their expense and say, well,
we know what you got, we'lltreat that, don't worry about it
.
I mean, I can see that comingright.
I mean, it's just like in theVA dental.
You go in and you know theydon't like to do caps and they
don't like to do implantsbecause they're more expensive.
They just soon either do afilling or just, you know, give
(30:57):
you some normal false teeth.
And when I ask about those,about implants, they stated,
well, they're kind of expensive.
They didn't tell me I couldn'thave them, but they didn't tell
me that they would.
You know would even consider itand just went on and blew right
on by it.
J Basser (31:18):
That depends, Ray.
That depends on how much cloutthat the person over oral
surgery has.
Bethanie Spangenberg (31:30):
Usually if he's a good one, then he can
get it done for you.
No-transcript.
J Basser (31:56):
So they don't have a choice, they have to have it.
I've seen several things duringthe last few years.
Now COVID, you know, va's usingtheir four companies to do
their C&P exams, and I've seenheart patients get sent out for
ECHOs, and I've seen otherthings.
So this is probably going to beone of them added tests and
they'll probably let theexaminers at the C&P do that
(32:17):
exam, that test, and that's myopinion.
They'll have to send them outto a hospital and have it done
and they'll pay for it throughthem.
Bethanie Spangenberg (32:26):
Which is going to be interesting.
J Basser (32:29):
I don't think the VHA will do it.
I don't think the VHA and theVBA I don't think they actually
communicate very well together.
Ray Cobb (32:36):
I don't think they communicate at all.
J Basser (32:39):
I think they do some, but I think there's some
animosity between each area,because you can tell just the
way people at the VA talk aboutthe BBA and vice versa.
So maybe they don't like eachother.
Bethanie Spangenberg (32:54):
And that's a bad thing.
So we'll actually there's thevery last section of this
esophageal, because they updatedmore than just the few that
we're talking about.
But towards the end we'll talkabout those diagnostic tests and
getting them referred out,because there's specific
reference to it, and so it'll beinteresting.
I don't think that the C&Pexaminer is going to be able to
(33:16):
order those tests, especially anEGD.
That requires a consult firstand then consent and follow-up,
and that's you know, if you havea veteran that has cardiac
condition and they can't besedated for an EGD, they can't
have it done.
Or they're having issues.
J Basser (33:36):
They'll be doing band swallow U8.
Bethanie Spangenberg (33:39):
I can see that They'll be doing barium
swallow.
You wait, I can see that.
Of the three, that's I don'tknow if barium swallow is less
harmful or CT is.
J Basser (33:50):
Well, folks, you have to go through that at barium.
It's some good tasting stuff,man, I tell you.
I like that yeah, go get yourpool, chalk off the table and
put it in a grinder and put somemilk in with it and drink it.
You're good.
Bethanie Spangenberg (34:13):
So if we look at the next paragraph here,
it says two commentersexpressed concern that by
changing the VASRD for digestivedisabilities, including GERD,
va is attempting to save moneyand create a higher burden to
obtain compensable evaluations,which is exactly what we just
said.
However, and I quote, vadisagrees.
(34:35):
As stated in the preamble ofthis proposed rule, the purpose
of the rule was to reflectmedical and scientific advances
in the understanding andtreatment of digestive disorders
.
For example, gerd is moreappropriately evaluated as
esophageal structure than hiatalhernia, based on objective
(34:56):
findings.
And then they quote that 2004article again findings.
And then they quote that 2004article again.
So if they are trying toreflect medical and scientific
advances, I would not quote anarticle from 20 years ago.
And then I would also say thatclinically that's not accurate.
(35:19):
I would say that GERD is moreappropriately aligned with
peptic ulcer disease, which wehave a rating schedule for.
Both clinically and based offof what's in the current rating
schedule, gerd is moreappropriately aligned with
peptic ulcer disease than it iswith esophageal stricture.
(35:40):
Now again they're saying well,gerd is less like hiatal hernia
and GERD is more like esophagealstrictures.
But what did they do?
They changed the hiatal herniacriteria to reflect the
esophageal stricture.
So that's nonsense.
Reflect the esophagealstricture.
(36:00):
So that's nonsense.
So if we look at the new ratingcriteria for a hiatal hernia if
I can find it, let's see it's7346.
7346.
(36:23):
7346.
Hiatal hernia.
This is the current rating.
It says to rate it as astricture of the esophagus.
So why are you saying to rateGERD as an esophageal stricture
Because it's more aligned withit than it is hiatal hernia.
But now you're saying in therating schedule that, oh, you
(36:43):
should see this other sectionbecause hiatal hernia no longer
has its own rating.
You're referencing the samething.
So GERD is not like hiatalhernia but it is like an
esophageal stricture.
And now you're taking hiatalhernia.
But it is like an esophagealstricture, and now you're taking
a hiatal hernia and you'remaking it rated under esophageal
(37:07):
stricture.
That doesn't make sense.
J Basser (37:13):
They found their boat.
They found their vessel tobring it in Bethany.
That's what they did.
It's a vessel to bring it in.
You know, it's a Trojan horse.
It's a vessel to bring you in.
It's a Trojan horse.
They've got it all on top ofthe vessel.
Bethanie Spangenberg (37:28):
They're going to jump out and change it
all.
And then, if we go to the nextsentence, it says this
adjustment from evaluating GERDbased on subjective symptoms to
objective measurement isconsistent with the stated
purpose of this rule.
So objective measurement isconsistent with the stated
purpose of this rule.
So the purpose of the rule isnow to obtain objective
measurements rather than thepermanent residuals or rather
(37:51):
than the picture of disability.
Now we're trying to findobjective measurements.
So there's other ways tocapture objective measurements
for GERD.
Rather than a CT or an EGD, youcan do the pH testing.
The pH testing is probably thesafest and most accurate.
(38:16):
They should do that.
J Basser (38:24):
Well, I guess they start measuring throats, right?
Yeah, I don't think they'llmake a tool for that yet they
will.
Bethanie Spangenberg (38:39):
So then let me jump to that very last
section that I was talking about.
So you were talking about howthe C&P examiners are likely to
refer out for tests, and thisalso is in line with what I
teach to other representatives.
I tell them don't wait for thecompensation and pension exam to
(39:03):
give you a diagnosis.
You need to go to thatcompensation and pension exam
with a diagnosis, because theresources to obtain certain
testing is limited.
J Basser (39:15):
So I always talk about the knee analogy.
Bethanie Spangenberg (39:18):
If I have a patient with knee pain, yes, I
can start with an x-ray, butthat's only going to tell me the
bone structure.
It's not going to tell me thesoft tissue structure.
It's not going to tell me aboutthe ligaments, where an MRI,
which is much more expensive,will tell me about the ligaments
.
But a compensation pensionexaminer doesn't have the
(39:38):
capability of ordering an MRIfor a veteran's disability claim
.
So you need to talk to yourdoctor before you have that comp
and pen exam.
And this comment at the end ofthis volume 89 talks about just
that.
And it says comments of generaldisagreement.
Comments of generaldisagreement.
(40:05):
One commenter indicated that thecurrent VASRD does not
incorporate the most up-to-dateand accurate scientific data
because its rating criteria donot allow clinicians to more
accurately diagnose andtherefore to fairly distribute
disability services.
And here's the VA.
The VA says the VASRD is notintended to be utilized in a
clinical setting to identify,diagnose or treat injuries,
(40:26):
diseases or disorders.
Clinicians are urged to utilizestandard diagnostic and
treatment practices in theirrespective clinical setting.
So that just emphasizes thatthey don't want these
compensation and pension examsto be used to diagnose.
They want it to be done in theclinical setting and then that
(40:48):
data is gathered and put intothe compensation and pension
exam for the appropriate rating.
So it'll be interesting to see,since they are now requiring
objective information for theGERD rating.
So it'll be interesting to see,since they are now requiring
objective information for theGERD rating.
J Basser (41:06):
You'd be talking to VHA then, because they don't
like to diagnose anyway.
They just like to treat.
Because they know a veterangets diagnosed is going to file
a claim.
Bethanie Spangenberg (41:16):
Yep, I actually thought I was talking
with my husband about it and wewere going back and forth.
And when you look at GERD and Italked previously about how the
symptoms more readily alignwith peptic ulcer disease.
(41:37):
Peptic ulcer disease is mosteasily identified on an EGD and
if a veteran has to haveobjective information, an EGD
will look at stomach lining tosee if there is an ulcer present
and if there is, the veteranwould benefit from filing for
(42:01):
the ulcer versus filing for GERD.
And if that diagnosis changesduring while their claim is open
, it's an esophageal condition.
So they need to.
In my opinion they need tobroadly present their condition
that they're claiming.
In that aspect you can put GERDslash, peptic ulcer disease or
(42:27):
esophageal discomfort orsomething generic and then in
the statement you know supportthat.
But if you compare the ratingschedule between GERD and peptic
ulcer disease you're going toget a higher rating for the
peptic ulcer disease and thoseconditions often go hand in hand
and they're seen more readilythan GERD with an esophageal
stricture.
So I have probably seen in gosh2000,.
(42:51):
So in 15 years I've probablyseen maybe 10 esophageal
strictures in the primary careclinic versus 100 or more with
peptic ulcer disease.
So just for veterans listening,keep that in mind that if in
fact you talk to your providerabout getting an EGD or getting
(43:16):
one of these tests, you shouldreally talk because there's
risks with all of them.
So you really need to sit downand talk with them about what
most appropriately fits you.
But if you do find you know oneof those diagnoses on there
that you'd probably be betteroff rated for the ulcer disease
than for CURT itself, you can gostage it for example, like
(43:39):
Medicare requirements, you knowyou have to have one test done
before you, another one, youknow, because it would just
cover cost.
J Basser (43:46):
So usually they'll probably do a barren swallow and
then if they think you need anEGD, that'll be the next step.
But I recommend that's the kindof health insurance you use
Medicare Part B to at least findyou a good gastroenterologist
outside the VA, especiallysomebody that deals in this
stuff, and maybe get a goodopinion from him.
Let him treat you a little bit.
See what you know, look at thedifference and see what's going
(44:07):
on.
Bethanie Spangenberg (44:08):
You might get a little better handle on it
, yeah.
I think the rating schedule theway it is doesn't capture the
true disability or theimpairment of earning capacity.
When we're looking at therating schedule, I think what
(44:28):
one of the commenters trying tosave money and making it more
difficult for the create ahigher VA is attempting to save
money and create a higher burdento obtain compensable
evaluations is spot on.
And when you reference medicalarticles that are 20 years old
and don't even talk aboutesophageal strictures related to
(44:50):
GERD or esophageal obstructionrelated to GERD or even the fact
that GERD can cause disability,it's supporting that
commenter's perspective.
J Basser (45:10):
That's true.
Ray Cobb (45:11):
You know, john, you just made a good point that I'd
like to emphasize it even more.
I'd like to emphasize it evenmore when you do if you do
hopefully have some medicalinsurance in your Medicare
you're liable to get more of anopen opinion of what really is
(45:34):
going on.
Because I've often felt, sinceI chose not to go with Medicare,
that with the VA, to go withMedicare, that with the VA,
sometimes the VA understandswhat the claims division is
trying to do or trying toaccomplish and they will kind of
lean that way more than topossibly give you a true picture
(45:57):
of what's going on.
And and I'm thinking from thestandpoint of when I went about
foot drop, I went to two outsidepodiatrists.
They both use the term totaland permanent loss of your use
of perineal nerve, but the VAdoctors was not put the word
(46:21):
total in and they were told.
One of the doctors actuallysaid we were told not to use the
word total.
Now, with that being the case,that means if you just went to a
VA doctor, you're not going towin your case for foot drop, and
I think we see the same thingstarting to address and set up
(46:43):
right here with this Could bewrong.
I mean you know, but it seemsto me like you could go and they
could leave something out andsay it leaves the symptoms out,
like we've talked about, and notdo any of the tests and you're
not going to win your case.
You're dead in the water beforeyou ever even turn it in.
J Basser (47:03):
Right, you just actually explained one of the
reasons the VA has such a highturnover rate with doctors and
medical professionals.
Ray Cobb (47:13):
Hmm.
J Basser (47:18):
You can't do your job if your hands are tied behind
your back.
Ray Cobb (47:20):
Is that right, Jeffrey .
Bethanie Spangenberg (47:28):
I just wish they would have quoted or
done something you knowsupporting their decision.
Like, if you're really tryingto capture, you know, the
impairment of this particularmedical condition, can you use a
reference that talks about theoccupational impact or the
impact of earning capacity thatit has?
Ray Cobb (48:06):
To me they are just gaslighting, almost in a way you
know these arguments and whatthese people are trying to say.
Well, I think you said it bestwhen you said that evidently
they did not have any medicalprofessionals in the room
helping them with this.
You know, it was a bunch ofguys and you know, and they
threw some stuff up on the wallto see what might stick.
So we're going to go with whatstuck.
(48:27):
They might have talked to somemedical professions behind
closed doors or another time,but as far as having them in the
room when they were actuallyworking on this, it sounds to me
like they wasn't anywherearound.
Bethanie Spangenberg (48:48):
I don't even think they were involved in
the process.
Based off the information thatI'm seeing, because it's not, it
doesn't make any clinical senseand, knowing how the VA and the
rating systems work, it's to meI'm not convinced that there
was any medical person involvedwhatsoever in this process.
(49:10):
And I will say cause I've seen,I see a lot doing what we do
and a lot of the DBQs that we doin-house.
We do DBQs for GERD and we dosee a lot of veterans talk about
how severe their GERD symptomsare.
And in the previous radio showwe talked about hey, you know,
(49:35):
if you really have all thesesignificant symptoms, you should
have had some type of testingby now.
You should have had a bariumswallow, you should have had an
ETD.
And maybe that's theirjustification for having the
veteran prove that they'rehaving some sort of condition.
They're not using theappropriate information to
(50:08):
capture the functionalimpairment related to the
condition.
So again, I see and for thelack of better terms I'm going
to say I see almost anover-exaggeration maybe in order
for a veteran to meet thatcriteria.
And then they say, well, I'venever had anything done, well,
it's like.
Well, if you're really havingthese symptoms, then you really
need to go have an EDD or bariumswell or something done because
(50:30):
you need to make sure you don'thave Barrett's esophagus, you
need to make sure you don't havean esophageal structure, you
need to make sure you don't havethese things.
So I see that side and I'mthankful for that side, because
I think you know it will help toidentify some conditions that
may arise from these severesymptoms.
At the same time, you knowyou're now you're going to bog
(50:51):
down the system.
You're going to create a burdenwithin your healthcare system.
You're going to need morehands-on, both in the radiology
department in your GI department.
You're going to need morehands-on both in the radiology
department in your GI department.
You're going to put out moreexpenditures into the civilian
through outside referrals.
You are going to delay theprocess of claims and granting
(51:13):
claims because this just hit.
So now all these veterans haveto jump through all these hoops
to get more evidence and it'sjust going to throw in more
appeal.
And so I don't.
I think if their aim was tolower their money and their
expenditures which, if you readpage one, that's actually what
they talk about they're doingthemselves a favor well, you may
(51:47):
have some veterans I knowseveral that if they had to go
through all this, I'd say for 10or 200, they'd say to heck with
it.
Ray Cobb (51:50):
I'm not going to fool with that, you know it's not
like you might get you to 100and and get you, you know,
$3,800.
I mean, we're talking at a 10%rating.
We're talking somewhere around$200 a month, if I remember
correctly.
Am I right about that, john?
J Basser (52:11):
You're right, buddy.
Bethanie Spangenberg (52:16):
So I found the reference to money when it
comes to the GERD changes and itsays the same commenter,
referencing a previous comment,says the same commenter
questioned why VA categorizedGERD as having a minor budgetary
impact in the ERIA.
As stated in the ERIA I don'tknow if they say that ERA or
(52:57):
whatever they call it, but theterm minor budgetary a major
budgetary impact greater than$100 million over 10 years.
I don't know if I think that'sa spitting in the ocean, if
you're $2.8 billion or $2.1billion in the red, that's July
1st.
J Basser (53:18):
Look at what I sent you guys.
Bethanie Spangenberg (53:28):
Hmm, va claim errors result in $100
million in incorrect payments.
J Basser (53:38):
Yep.
Bethanie Spangenberg (53:44):
VA urges lawmakers to approve a $15
billion to fund budget gap.
J Basser (53:51):
Yeah, that is the job on October 1st.
I think this is August 1st,guys.
We got 61 days, I guess, untilthey get to vote on it.
Then they got to pay theclothing allowance.
They'd be broke again.
Ray Cobb (54:11):
The clothing allowance didn't go up.
It's almost $1,000 for eachbrace now.
Bethanie Spangenberg (54:20):
Really.
J Basser (54:22):
Yeah, don't be saying for each brace now.
Really Don't be saying that tome now.
People will be chopping legsoff to get that money, come on.
Before we get off oh gosh, no,I'm just kidding we actually.
No, I'm just kidding weactually.
(54:46):
We've got about five minutesleft.
Bethany, Did you cover all yourmaterial you want to cover?
Bethanie Spangenberg (54:51):
Yeah, and I think the biggest.
If I had to summarize thebiggest takeaway, you know, for
those who are listening is youneed to appreciate the new GERD
criteria.
If you're going to file a newclaim or if you have a pending
claim, you need to understandwhat they're looking for, what
they're asking for.
And then, if you're part ofgrandfathered in, you really
(55:11):
need to make statements on aregular basis of what your
symptoms are.
And you write the statement andyou email it to yourself or you
fax it in and you don't evertouch.
You know, asking for anincrease.
You're just trying tocontinually document those
symptoms.
So then that way, in four orfive years, if they try to come
(55:33):
back to reduce you, you can say,well, these are my symptoms and
I've put it in a statementevery year to you.
So I just you need to be aware,because if you go for a comp
and pen, they're not going toask.
So we'll put something up onour website relating to the old
question.
So that way, if you're like,hey, what did she say I need to
talk about, well, we're going toput that old DBQ up so you can
(55:55):
have that information.
J Basser (55:59):
Put it like the show up too.
Yes, I think it's kind of oneof those important shows because
I think something's kind ofrotten in Denmark on this one.
They really haven't had anissue.
It's kind of like tonighteverybody's getting 10% for dirt
, we get a lot me at 10%.
(56:20):
We got to find a way to, asBarney Papa saying, nip that in
the bud, yes again.
Well, it's triage, it's claimstriage.
Stop the bleeding.
That's the first thing.
Airway breathing what's theother one?
Abc.
Bethanie Spangenberg (56:42):
Airway breathing Cir.
What's?
J Basser (56:44):
the other one, abc Airway.
Breathing circulation, yeah,circulation.
Stop bleeding, yeah, but it'ssad.
Tell us what you're basicallydoing.
I know you've been doing a lotof different things.
Are you staying pretty busydoing the health and rent work,
or are you doing something else?
Bethanie Spangenberg (57:02):
Yeah, we got a whole team and right now
my focus is really just VALORfor VET and keeping our
providers educated and, on topof things, keeping our numbers
turned over.
We like to hire veterans, welike to keep veterans involved
and we actually have a veteranwho's in the National Guard and
(57:24):
he was activated about six weeksago and he's been gone.
So we leave that space for him.
We love him, but as a team wehad a lot more work on our
shoulders.
So I think we're finally caughtback up and got our nexus
letters caught up and some ofour file reviews all caught up
(57:45):
and just appreciate him takingthe time to protect the country.
J Basser (57:53):
Well, we wish him the best.
I mean, national Guard folksare pretty sharp individuals.
Yeah Well, we got a minute left.
Ray, I want to thank you forcoming on and co-hosting, as
usual.
Ray Cobb (58:09):
No, I enjoyed it and learned something.
Every time I do it.
J Basser (58:14):
Anytime this young lady comes on, we're going to
learn something, folks.
That's what it's good.
If you don't listen to her pastshow, you will learn something.
She is down to the nitty-grittyon the DBQs and everything.
We're going to be doing oneevery month here until the end
of the year and most well in thenext year.
With that, this will be JohnBasher, jay Stacy on behalf of
(58:37):
the Exposant Radio Show, bethySpanglberg and Mr Ray Cobb.
We'll be signing off for now.
You have been listening to theExposed that Podcast.
Any opinions expressed on theshow are the opinions of the
guest speakers and notnecessarily the opinions of
Exposed that, exposedthatcom orBlogTalkRadio.
(58:58):
Tune in next week for anotherepisode of the Exposedet Podcast
.
Thanks for listening.
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