The VA Proposed Rule


Hi Jim, thank you for the VA proposed rule on Disability Ratings for the Digestive System. Some ratings have changed, others stay the same. What stands out to me is that a Rater can no longer combine conditions to rate. but rate on only one DC, i.e. DC 7323 severe ulcerative colitis is rated at 60 %, while DC 7332 complete loss of sphincter control is rated at 100%. I think this ruling opens the door for a rater to rate 7323 60% and ignore 7333 100%. Both conditions almost always are there. Digestive disorders are some of the most debilitating and disabling conditions in the body. It really interferes with quality of life. As to so called modern medicine, it hasn't really helped the digestive system that much. For Crohn's and UC the new meds can cause serious side effects, even death. This proposed rule is just to lowball disability ratings. If approved, would this new rule be effective for "Grandfathering" ratings or apply to new applications for disability? What are your thoughts about this whole array of changes?


Jim's Reply:

You're way ahead of me. That massive document was just released and you're this far into it? I've known for a long time you're pretty intense but wow, I'm impressed! Now I have to take a moment and catch up.

I hadn't yet begun to consider all the implications of the proposed rule changes but I suspect that you're correct. However, here we are and we can talk about how severe ulcerative colitis is rated at 60% and complete loss of sphincter control is rated at 100%. 

I mostly disagree with the UC classifications. I was diagnosed with ulcerative colitis in 2002 and at the time I was very ill. When I read, "VA therefore proposes to assign a 10-percent evaluation for minimal or mild symptomatic disease that is managed with oral or topical agents (other than immunosuppressants or other biologic agents) and is characterized by recurrent abdominal pain with 3 or less daily episodes of diarrhea and no signs of systemic toxicity", I understand that nobody associated with this proposal has ever had rapid onset explosive, bloody and uncontrollable bowel movements 3 times a day.

A 10% evaluation for that sort of debilitating effect is beyond absurd as is most of the rest of it.

The 100% rating for loss of sphincter control is a bit more accurate in the description of the cause and effects of the condition. Sphincter control and retention or expulsion of contents is a different beast than the explosive and sudden diarrhea caused by UC...the etiology of each is based on different criteria. When we consider the practical effect of each condition on our activities of daily living, it's much the same for those conditions.

Each condition will have an end effect of greatly altering the lifestyle of the veteran patient. The 'mild' disease that indicates that 3 bouts of bloody diarrhea each day really isn't too bad is way off course. 

I'll plow through the rest of this publication soon and I'm sure I'll find a lot more to disagree with as we go along. 

For what it's worth, I'm still upset that VA renamed Coronary Artery Disease as Ischemic Heart Disease a few years back. As a former health care professional who practiced in the cardiovascular arena, I assure you that not once was the condition ever called ischemic heart disease. VA has the propensity to abuse the language to make it their own and they set silly standards to go along with that.

Keep an eye on this one for us, won't you? Be sure to comment to VA