In my last blog post, I gave a broad overview of Irritable Bowel Syndrome (IBS) and the connection of that condition to Gulf War Veterans. After reading the many Facebook comments in response to that post, I believe it is imperative for me to emphasize that although some may view this condition as insignificant, for those people who actually live with IBS on a day-to-day basis, they know from firsthand experience, that at the very least, this condition is life altering, and in some cases, IBS can truly be debilitating.
At the outset, it is important to know that there is more than one type of IBS. In fact, medical literature reveals that there are 3 main types of IBS:
- IBS with constipation (IBS-C)
- IBS with diarrhea (IBS-D)
- IBS with alternating constipation and diarrhea (IBS-A)
According to the American Gastroenterological Association, IBS is frequently misunderstood and doctors often have to go through a process of medical elimination in order to properly diagnosis this condition. Therefore, in the context of VA disability law, this struggle underscores the need for Gulf War Veterans to ensure that their doctors do the proper work-up, so that a current diagnosis of IBS is documented and actually of record.
After winning the fight to obtain service connection for IBS, the next hurdle for Gulf War Veterans then becomes making sure that the VA gets the disability rating correct. And in my view, making sure that the VA gets the rating correct in an IBS case is much like opening a Pandora’s Box.
To recap from my previous post, the VA generally rates IBS based on the rating criteria for irritable colon syndrome, 38 C.F.R. § 4.114, Diagnostic Code (DC) 7319, which states as follows:
7319 Irritable colon syndrome (spastic colitis, mucous colitis, etc.):
Severe; diarrhea, or alternating diarrhea and constipation, with more
or less constant abdominal distress………………………………………………………. 30
Moderate; frequent episodes of bowel disturbance with abdominal
distress……………………………………………………………………………………………… 10
Mild, disturbances of bowel function with occasional episodes of
abdominal distress……………………………………………………………………………….. 0
Based on the above DC, it is clear that the VA does not like to award greater than a 30% rating for IBS. In my experience, I’ve seen that once the 30% rating has been awarded, it is very difficult and requires some out of the box thinking, in order for a veteran to have a chance at obtaining a higher rating.
As a VA advocate, when I look at the rating criteria for IBS, I think about all of the symptoms and residual effects from this condition, that are not contemplated by DC 7319. For example, when the American Gastroenterological Association recently published its “IBS in America” study in December 2015, the most troublesome symptom reported by the individuals with IBS-D, was loss of bowel control and fecal incontinence. However, DC 7319, which is the diagnostic code most commonly used by the VA to rate IBS, notably does not mention these symptoms.
Upon careful review of the VA’s rating schedule for the digestive system, I note that there are other VA diagnostic codes which take into consideration fecal “leakage” and impairment in sphincter control. One example is DC 7332, which provides a 60% rating for “extensive leakage and fairly frequent involuntary bowel movements” and a 100% rating for “complete loss of sphincter control.” However, on the first go around, the VA normally never looks at other diagnostic codes outside of 7319 in order to completely evaluate and properly rate IBS.
Another discrepancy in the procedure for rating IBS, concerns the VA’s failure to recognize the interplay between IBS and unemployability. In the “IBS in America” survey, IBS sufferers reported that their GI symptoms interfered with their productivity and performance an average of 9 days per month. Survey participants also reported that their IBS symptoms caused absenteeism from work and from school, an average of 2 days per month. These statistics are significant, because we all know that in a competitive workplace, any sort of loss of productivity or excessive absenteeism, would very likely result in termination of employment.
Similarly, the majority of the survey participants with IBS-D reported that they avoid situations where a bathroom is not nearby. In other words, immediate access to a bathroom is essential. Again, this is another area where it should be clear to the VA, that if a person has to have constant access to a restroom and if IBS results in the need for unscheduled and excessive bathroom breaks, no employer is realistically going to tolerate that, which again, results in an inability to sustain a gainful occupation.
In sum, the sad reality is that the VA is out of touch with many things, which includes being out of touch with how IBS negatively impacts the lives of Gulf War veterans. The take away, is that if your IBS is severe and prevents you from working, it is critical that you continue fighting for your benefits. Don’t let the VA tell you that your IBS is insignificant or not severe enough for unemployability benefits.
