Pancreatitis, an inflammation of the pancreas, can lead to severe and debilitating symptoms, making daily life challenging for veterans suffering from this condition. There are two main types of pancreatitis: acute, which occurs suddenly and is usually short-term, and chronic, which is long-lasting and can cause permanent damage to the pancreas. Chronic pancreatitis often leads to complications such as diabetes, malnutrition, and an increased risk of pancreatic cancer.
As of May 2024, the VA has updated its rating criteria for chronic pancreatitis, offering veterans more accurate and fair compensation for their condition.
VA Disability Ratings for Chronic Pancreatitis
As of May 19, 2024, the VA rates chronic pancreatitis under 38 CFR § 4.114, Diagnostic Code 7347.
- 100%: Daily episodes of abdominal or mid-back pain that require three or more hospitalizations per year; and pain management by a physician; and maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation
- 60%: Three or more episodes of abdominal or mid-back pain per year and at least one episode per year requiring hospitalization for management either of complications related to abdominal pain or complications of tube enteral feeding
- 30%: At least one episode per year of abdominal or mid-back pain that requires ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites
Notes: Appropriate diagnostic studies must confirm that abdominal pain in this condition results from pancreatitis. Separately rate endocrine dysfunction resulting in diabetes due to pancreatic insufficiency under DC 7913 (Diabetes mellitus).
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What the New Rating Means
The introduction of the new rating for chronic pancreatitis is significant because it acknowledges the ongoing and debilitating nature of the condition. Previously, many veterans with chronic pancreatitis struggled to receive appropriate compensation due to the limitations of the old rating system. The new criteria ensure that veterans receive a rating that accurately reflects the severity of their condition and its impact on their quality of life.
Winning a VA Claim: An Example
A veteran who was initially awarded a 30% disability rating for chronic pancreatitis successfully appealed for a higher rating of 60%. The veteran argued that the severity of his condition, characterized by frequent abdominal pain, nausea, vomiting, and other symptoms, was more disabling than the initial rating reflected. His appeal was supported by comprehensive medical evidence and consistent documentation:
- Medical Records: The veteran provided thorough medical records from both private healthcare providers and VA doctors, showing intermittent but significant complaints of abdominal pain, nausea, vomiting, and elevated liver enzymes, indicating ongoing pancreatic insufficiency.
- VA Examinations: The veteran underwent multiple VA examinations, which documented frequent attacks of pancreatitis, with few pain-free intervals. The exams noted additional symptoms such as elevated enzyme levels, diarrhea, and fatigue, further supporting the severity of his condition.
- Symptom Documentation: The veteran consistently reported severe and frequent symptoms throughout the appeal period. The documentation included emergency room visits and treatment records, which illustrated the ongoing impact of the condition on his daily life.
The Board of Veterans’ Appeals decided to increase the veteran’s rating to 60% because the evidence demonstrated that his condition was more severe and had a greater impact on his health and quality of life than initially assessed.
Strengthening Your Pancreatitis VA Claim
When filing a VA disability claim for pancreatitis, especially under the new rating criteria for chronic pancreatitis, you’ll need comprehensive medical documentation that demonstrates the severity and impact of your condition. Here are some steps to strengthen your claim:
- Detailed Medical Records: Ensure your medical records include detailed accounts of the frequency and severity of pancreatitis attacks, any hospitalizations, and complications such as weight loss or diabetes.
- Medical Nexus: If your pancreatitis is secondary to another service-connected condition, provide a clear medical nexus statement linking the conditions.
- Appeal if Necessary: If your initial rating does not accurately reflect the severity of your condition, consider appealing the decision with additional evidence. Contact us here for a free evaluation of your case.
Filing a VA Claim for Pancreatitis
To file a claim for pancreatitis or chronic pancreatitis, follow these steps:
- Gather Medical Evidence: Collect all relevant medical records, including documentation of your symptoms, hospitalizations, and any complications related to pancreatitis.
- Complete VA Form 21-526EZ: Use this form to apply for disability compensation.
- Submit Your Claim: Submit your claim online through the VA’s eBenefits portal, by mail, or in person at a VA regional office.
- Seek Assistance: Consider working with a Veterans Service Officer (VSO) or legal representative to help navigate the claims process and ensure your claim is comprehensive.
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Content Reviewed by
Cassandra, an Accredited Agent and claims advocate for Matthew Hill & Shelly Mark’s teams, reviewed the information provided in this post.
