Bethanie Spangenberg: 0:00

Love Talk Radio.

J Basser: 0:04

It's time for the Exposed Vet Radio Show. The Exposed Vet Radio Show, we discuss issues affecting today's veteran. Now here's your host, john M Ray. Welcome, ladies and gentlemen, to another episode of the Exposed Vet Radio Show on this crazy first day of August 2024. You're flying by and it could be good, it could be bad. Today we've got our co-host, mr Ray Cobb. How are you doing, ray?

Ray Cobb: 0:33

I'm doing good. How are you today?

J Basser: 0:36

I'm doing wonderful, Wonderful. A little past note I was reading a story earlier this afternoon before I got started here. The VA has went to the congressional committee asking for some money because I think they got a bad case of too much money spent on the PAC-TAC and they're broke, so hopefully they get some funding.

Bethanie Spangenberg: 0:55

You know what, bethany, I hadn't heard about that, I appreciate you bringing that to my attention, but I'm not surprised.

J Basser: 1:01

They broke PAC-TAC. They passed that PAC-TAC and didn't give us no money.

Ray Cobb: 1:05

You know, I don't know, I think you better get straight figured out, you know as of July the 1st, there were 2.8 billion dollars in the red.

J Basser: 1:16

They just asked 15 billion yeah, billion, billion, now that that sheds a little bit of light billion Billion, yeah, billion Billion.

Bethanie Spangenberg: 1:29

Now that sheds a little bit of light of what we're seeing and what we're talking about tonight.

J Basser: 1:33

Right, guys, if you haven't recognized this voice, this young lady is Bethany Spangenberg. She owns a company called. Do you hear me? She owns a company called Violet Prevette. She's a regular on the show Bethany's, one of the people that goes really in-depth and detailed on some of these issues, and tonight we're going to talk about the changes in GERD gastro. I can't pronounce that word. I'm from Kentucky. Come on, gastroenterology, come on.

Bethanie Spangenberg: 2:18

Gastroenteritis, there you go. Reflux disease Okay, I'd get tongue-tied on there. Next thing, you know, I'd break into my hillbilly and you'd all be speaking hillbilly and I'd get fired. Just to say you know, my family, since Friday, has had several unfortunate, negative energy around us is what I'd like to say. Family members in three different incidents, two have required surgery, one was paralyzed in all four extremities and had emergency surgery and then one is pending surgery for tomorrow. And just three different incidents and I don't know what's going on. But if you're the praying kind, I would appreciate it. If you're not, I'll take positive energy or even burning some sage for that negative energy. I would be much appreciated.

Bethanie Spangenberg: 3:09

So you know, I know every family has its struggles, but when they come in threes so rapidly out of nowhere, it kind of hits your.

J Basser: 3:20

That's the kind of way it goes. Things happen in threes.

Bethanie Spangenberg: 3:23

Yeah, and it's just wild, totally three I mean two are hospitalized in the same big hospital in Columbus.

J Basser: 3:30

That's like oh you go to visit one, you visit them both Dad's doing.

Bethanie Spangenberg: 3:35

Okay, he's his new normal.

J Basser: 3:39

I got a story for you, then we got some bad karma here too.

Bethanie Spangenberg: 3:43

Hmm, I don't like it. I got a story for you.

J Basser: 3:45

Then we got some bad karma here too. Hmm, I don't like it. I lost our curfew last week. He had his pacemaker battery replaced. Then he went home and got to feeling 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 and they let him out. They put everybody out of the hospital on Wednesday real quick. They sent him home with a blood pressure cup on and we're like what's going on with that? We took him all the way back home.

J Basser: 4:16

Two days later he fell on the floor and couldn't get up. We went and got him and brought him back down and he had COVID. Oh, so this week we've all had COVID. Oh, no, oh, so this week we've all had COVID, oh no. Did they know that before they let them go. Oh, they knew that. Yeah, I guarantee you that.

Bethanie Spangenberg: 4:34

They knew it. That sounds like why they were rushing to get them out.

J Basser: 4:38

Yep, that's a fact. It sucks. I'm about over it, but the other two ain't. So it's just. I know I've had a hard time talking Me and Ray talked to him this week. It didn't really feel like it. But if you want to, we'll pray for you people, for your family, We'll get them lined up.

Bethanie Spangenberg: 4:55

I appreciate it. I appreciate it. So tonight we're talking about GERD gastroesophageal reflex disease and I'm going to throw in there a little bit about esophageal strictures and hiatal hernias. We've talked about GERD a couple times with me on the show, about the DBQs and a little bit about the DBQs and what to expect and about the disease itself. But as of May 19th of this year they made some changes and we'll talk about those changes and then I'm going to talk about what they commented in the Federal Register and kind of maybe you can help me make sense of it. But I think this whole you said 2.1 billion in the red.

Bethanie Spangenberg: 5:43

That might be part of what this is and I think veterans and attorneys are going to have some work to do if if they want to see change on this. So we'll talk about that. But, um, so as of may 9th of this year, gerd has its own diagnostic code. It is 7206. And with that it has its own criteria. It is no longer rated under hiatal hernia. Previously, prior to May 19th of this year, they were trying to do ratings or they would take the GERD ratings and say, oh well, it's similar to hiatal hernia and so they would rate the GERD under the hiatal hernia rating schedule. They've also made changes to the hiatal hernia rating schedule and those are now rated under 7203, which is esophageal stricture, and of course they have changed the rating criteria for esophageal stricture. And of course they have changed the rating criteria for esophageal stricture. So those three upper gastric changes that they've made, they're going to impact a lot of veterans.

Bethanie Spangenberg: 6:58

As far as the GERD claims go, and I think it's important that we discuss what that looks like and some things you may need to do to prepare your claim or maintain your current rating so previously GERD was rated on symptoms such as reflux, regurgitation, nausea, vomiting, sleep disturbance, difficulty swallowing, but now they're not even asked symptoms anymore. It's not about symptoms. They're saying that a veteran must have documented esophageal stricture or must have documented objective documentation of esophagitis in order to meet a compensable rating for GERD. So let's read or I'm going to read exactly what they're saying about GERD and I've got like five packets because I'm OCD about the research stuff. So okay, so 7206 gastroesophageal reflux disease. So if you have a documented history without daily symptoms or require daily medication, you get a 0%. So I think that's going to be the new standard for any claim that occurs or comes in after May 19th.

Bethanie Spangenberg: 8:30

If you have a documented history of esophageal stricture, again we're under GERD. If you have a documented history of esophageal stricture that requires daily medication to control difficulty swallowing but are otherwise asymptomatic, you get a 10% rating. So now they're using the esophageal stricture as a requirement to be rated for GERD, which is interesting because esophageal stricture has its own rating schedule. So to me it looks like we're referencing the same disease in two areas. So I don't I'm not following it. So let me read the rating criteria for 10% of esophageal stricture. It also says documented history of esophageal stricture that requires daily medications to control difficulty swallowing. That's 10%. So to be compensable for either esophageal stricture or GERD. You must have an objective test to show that you have an esophageal stricture. Now, that is completely different than what it was before.

J Basser: 9:57

I don't know if you're familiar. That would take an endoscopy.

Bethanie Spangenberg: 10:02

Yes. So, based off the new rating criteria, it seems that they are forcing veterans to have either a barium swallow to objectively document their condition they're requiring an EGD or an EGD to document it. So you have to have some type of testing to even qualify for a compensable rating that shows the objective information. They don't care about your symptoms 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 fluoroscopy done, 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 go down your throat and you're getting a pretty good dose of radiation with that. Yep. That's kind of the basis of my opinion.

Bethanie Spangenberg: 11:01

So I don't necessarily. So I don't agree with that. I think that they should have done a better job at picking their rating criteria, and when I talk about what they mentioned in the Federal Register it'll kind of confuse you too, I think. But the rating criteria for GERD also includes esophagitis. So if you have irritation at the bottom of your esophagus from the reflux, it would still be rated under the same diagnostic code for GERD. So if it's any type of esophageal irritation so like if you have like drug-induced where it's irritated if you have some type of food allergy that causes that irritation, it's going to be rated under the same criteria 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 stomachs throwing up and slowly got, you know, slow to get the food down your 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 any esophageal condition that requires treatment with sclerotherapy. So I don't think the autonomic or the motility issue would be under that criteria. I think it would be somewhere else in the rating schedule. But if that motility issue causes irritation of the esophagus or causes reflux, then of course you're going to fall into that criteria. So I just found it fascinating that they're now requiring document and in the schedule it says that the findings must be documented.

Bethanie Spangenberg: 13:08

This is word for word. Findings must be documented by barium swallow computerized tomography, which is a CT scan or hang with me esophageogastroduendoscopy, gastroduendoscopy that's the EGD. That's why we say EGD. So they're requiring you to have some type of exposure to radiation or sedation with a scope down your throat to meet the criteria for a rating. So to me what that does is now we're going to have veterans coming in and say well, I've had these symptoms, I've had them, you know this long, and they're going to start pushing to have an EGD. And then we're going to have veterans coming in and say, well, I've had these symptoms, I've had them, you know this long, and they're going to start pushing to have an EGD and then we're going to get a backlog of consults to the GI specialists and they're going to have all this stuff. I just there's better ways to gather objective information than these expensive tests and I'm not following why they did that, these expensive tests and I'm not following why they did that, so you wouldn't like to refrain from ordering expensive tests

Bethanie Spangenberg: 14:18

like that you would think, yeah, if you have, or if you develop an esophageal stricture from GERD, you have a significant GERD issue. It is not a minor issue, it is a significant issue because that has been there for a period of time. It has caused significant damage to your esophagus and you will require repeated testing every six months to a year in order to monitor that esophageal stricture. You're likely to have emergency room visits if anything gets stuck, because if you get food stuck in that esophageal stricture it can cut off the blood supply and it can cause a rupture of your esophagus. So when I'm looking at this and it says, oh, documented history of esophageal stricture that requires daily medications, you get 10%. I'm like, clinically you have to be to a severe degree of GERD to develop esophageal structure, so why are we giving 10%? I'm not following that and I just wonder how many clinical people you put out a new rating schedule. How many clinical people were there?

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 talk about, because their justification for some of their stuff is just really sloppy, to be kind, and I think I've read every medical article that they've referenced and there wasn'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 last two weeks, ever since I heard about this $2.8 billion deficit and in looking at it we found that, you know, I have found a lot of 10% cases for several little things that's been going on in our area down here to the sea.

Ray Cobb: 16:46

The guys are well, I got a 10% and our County Service Officer oh, that's good, you have a little extra money now, but yeah, you can go to McDonald's, you know. But basically what the VA is doing, because they know for a fact, they did it with Senator Blackburn. They called her and told her how many veterans they had approved for disabilities and how they had reduced the amount of claims. Now, by saying that they did not, from my understanding from her aide, who I talked with, they did not go into any details to what those decisions were. They could have been made a decision we're going to grant your claim at 0% or we're going to grant your claim at 10%. And now they say, oh well, we've granted 75,000 claims this last six months, but to what point? And then what's happening to those that have more severe situations?

Bethanie Spangenberg: 17:57

And it's almost like they're patting themselves on the back, but not telling the whole truth about it, and I think that's what you're about to get into now yeah, and it's kind of um, like I said it's sloppy and I and that's why I kind of said, you know, off off line before we went live, like if I get too, too harsh you might have to reel me in because some of this stuff is just not making sense in my head. But who am I? So what's interesting with the change is if you applied and were granted for GERD prior to May 19th, you will fall under the old criteria with the hiatal hernia.

Bethanie Spangenberg: 18:48

You're grandfathered in and you'll be rated under that. If you applied and haven't got a rating decision, or your rating decision came back after May 19th, then you're going to get a little bit of both. You're going to get the old and the new. As far as rating goes is what I was told when I talked to another attorney about it actually today we were talking about it and then if you apply after on or after May 19th, then you're going to fall under the new criteria. So with that, the VA was very quick to update their DBQ to reflect the new changes.

Bethanie Spangenberg: 19:33

So for those who are grandfathered in, they don't ask about that old criteria in. They don't ask about that old criteria. So you have to, in a statement, talk about your symptoms, because they're not going to ask you anymore. You have to talk about recurrent epigastric distress or recurrent abdominal distress or difficulty swallowing or reflux, or if you're bringing food back up, or if you're experiencing pain in the chest or the shoulder, or if you're getting woken up by the GERD, if you're experiencing nausea or vomiting. You now have to talk about all that and how frequently and how long does it last?

Bethanie Spangenberg: 20:18

because when you go to your compensation and pension exam, if you're a grandfathered veteran, 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 no symptomology there. They can't write this stuff down 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 what you're experiencing, because you may have to argue that you're experiencing the symptoms that were on the old rating criteria.

J Basser: 20:57

Mm-hmm. Well, I do encourage any veterans going through this go ahead and I do a 21-41-38 statement. Support a claim and I will go ahead and I will list your symptoms out there on that 21-41-38. Take that with you, since you got it in the record, and let the examiner see it. It's already in the file. They can't tell you not to right.

Bethanie Spangenberg: 21:20

Yeah, say hey, I already put this, or I gave this to the VA, but I wanted to make sure that I brought it to your attention.

J Basser: 21:26

That's right. You play their game with them folks. To them it's a game to use your livelihood Right.

Bethanie Spangenberg: 21:37

So now I have the Federal Register, volume 89, number 55, for Wednesday, march 20th of 2024. And I'm going to read a lot of these little comments through here word for word. And so, when we look at the comments regarding Diagnostic Code 7206, which is the new code for GERD, diagnostic code 7206, which is the new code for GERD, the author which I'm still trying to figure out, who wrote this darn thing, so the VA is saying that the VA proposes to evaluate GERD using rating criteria that are based on predominant picture of disability due to GERD. These criteria consider symptoms of esophageal obstruction and irritation that lead to the esophageal structure, which are consistent with symptoms of GERD. And then they go on to quote a medical literature reference, and the reference is Canadian Consensus Conference on the Management of Gastroesophageal Reflux Disease in.

Bethanie Spangenberg: 22:42

Adults from 2004. Disability due to GERD from a 20-year-old medical document which, if it were Agent Orange and they're referencing something 20 years ago studying the same as we are for GERD.

Bethanie Spangenberg: 23:16

There are thousands, there are thousands of medical studies regarding GERD within the last five years. So why are we trying to use an article that's 20 years old to support the decision that we're making of what symptoms of GERD look like? Of GERD look like. I know that if I'm in the clinic and I'm like, well you know a patient's telling me that they're having these symptoms, could it be GERD? Let me check my reference. I'm not pulling out a 20-year-old textbook. I'm going to go online and find medical literature that's within the last five years and read about what is in that literature that's within the last five years, and read about what is in that literature. So in that statement they're saying that they're facing the criteria to get a picture of disability due to GERD. They're not concerned about the health impact or the health consequences. They're trying to look at disability. So in that instance, they're using the term based on the predominant picture of disability due to GERD, and I want you to remember that phrase because 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 about the disability caused by GERD.

Bethanie Spangenberg: 24:44

In fact, the article doesn't even talk about the words esophageal stricture. So why they're saying that GERD leads to esophageal stricture and that's why they're now rating it comparable to an esophageal stricture and then citing this medical literature? That medical literature says nothing about esophageal stricture. So why are we using this? The article doesn't say anything about obstruction, but in their article they're talking about well, these criteria are considered symptoms of esophageal structure that lead to esophageal structure. If you're referencing a GERD article that doesn't talk about esophageal structure, doesn't talk about esophageal obstruction, it doesn't even talk about a disability associated with GERD, so why are we 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, because there'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 past that 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 related to GERD. Clinically I have seen more Barrett's esophagus related to GERD. Clinically I have seen more Barrett's esophagus related to GERD, and Barrett's esophagus can cause narrowing within the esophagus, but they don't care about that in the rating schedule. As this first paragraph says, they're trying to get a picture of disability and so they don't consider 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 if we go down Pardon, you need to change your camera because I got a bad one.

Bethanie Spangenberg: 26:53

Yes. And then later on they talk about the permanent impairment due to GERD condition. And so they say the purpose of the VASRD is to evaluate the permanent residuals of a disability, and then they cite 38 USC 1155. So first they talk about a picture of disability USC 1155. So first they talk about a picture of disability, now they're talking about now we're trying to reflect the permanent residuals of a disability. That's not how we're supposed to look at it. We're supposed to look at it as it impacts earning capacity, and so I don't know why they're changing that language there. What's interesting is the next article that they state was more recent. I'm trying to find it here.

Bethanie Spangenberg: 27:53

So this second article they talk about, it says even though the symptoms so those prior symptoms related to nausea, vomiting, sore throat, chest discomfort, heartburn, those other symptoms that were previously rated under hiatal hernia in the diagnosis and treatment of GERD, the VA rating schedule bases its evaluations on the permanent impairment due to this condition.

Bethanie Spangenberg: 28:24

Such permanent impairment of function is based on the scarring due to the chronic irritation of the esophagus by acid reflux and consequent development of scar tissue. And then they cite another article, and it doesn't talk about permanent impairment. It doesn't talk about what impact GERD has in the occupational setting. But there are studies out there that look at that information and they did not cite that at all in their reference of why or justification of why they changed the rating schedule to reflect the esophageal structure. And in fact, just within a few minutes of searching, one of the very top articles that popped up was a study where they looked at six countries and they found that there was reductions of productivity up to 26% in those who had experienced GERD either due to absenteeism for medical appointments, uncontrolled symptoms, and that's not cited anywhere. There's no literature in this federal register that talks about the occupational limitations or the functional, the reduction of earning capacity in their references. So I don't understand why they're justifying what they are. Does that make sense? Am I emphasizing how silly this seems?

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 another question next, is these tests that they're requiring now or will be requiring? Aren't they kind of expensive? They are. And so what is the VHA going to do is try to put off from performing these tests because of their expense and say, well, we know what you got, we'll treat that, don't worry about it. I mean, I can see that coming right. I mean, it's just like in the VA dental. You go in and you know they don't like to do caps and they don't like to do implants because they're more expensive. They just soon either do a filling or just, you know, give 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't have them, but they didn't tell me that they would.

Ray Cobb: 31:10

You know would even consider it and just went on and blew right on by it.

J Basser: 31:18

That depends, Ray. That depends on how much clout that 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 during the last few years. Now COVID, you know, va's using their four companies to do their C&P exams, and I've seen heart patients get sent out for ECHOs, and I've seen other things. So this is probably going to be one of them added tests and they'll probably let the examiners at the C&P do that exam, that test, and that's my opinion. They'll have to send them out to a hospital and have it done and they'll pay for it through them.

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 the VBA 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 about the BBA and vice versa. So maybe they don't like each other.

Bethanie Spangenberg: 32:54

And that's a bad thing. So we'll actually there's the very last section of this esophageal, because they updated more than just the few that we're talking about. But towards the end we'll talk about those diagnostic tests and getting them referred out, because there's specific reference to it, and so it'll be interesting. I don't think that the C&P examiner is going to be able to order those tests, especially an EGD. That requires a consult first and then consent and follow-up, and that's you know, if you have a veteran that has cardiac condition and they can't be sedated for an EGD, they can't have it done.

Bethanie Spangenberg: 33:35

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't know 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 your pool, chalk off the table and put it in a grinder and put some milk 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 commenters expressed concern that by changing the VASRD for digestive disabilities, including GERD, va is attempting to save money and create a higher burden to obtain compensable evaluations, which is exactly what we just said. However, and I quote, va disagrees. As stated in the preamble of this proposed rule, the purpose of the rule was to reflect medical and scientific advances in the understanding and treatment of digestive disorders. For example, gerd is more appropriately evaluated as esophageal structure than hiatal hernia, based on objective findings. And then they quote that 2004 article again findings. And then they quote that 2004 article again. So if they are trying to reflect medical and scientific advances, I would not quote an article from 20 years ago. And then I would also say that clinically that's not accurate. I would say that GERD is more appropriately aligned with peptic ulcer disease, which we have a rating schedule for. Both clinically and based off of what's in the current rating schedule, gerd is more appropriately aligned with peptic ulcer disease than it is with esophageal stricture. Now again they're saying well, gerd is less like hiatal hernia and GERD is more like esophageal strictures. But what did they do? They changed the hiatal hernia criteria to reflect the esophageal stricture. So that's nonsense. Reflect the esophageal stricture. So that's nonsense. So if we look at the new rating criteria for a hiatal hernia if I can find it, let's see it's 7346. 7346. 7346.

Bethanie Spangenberg: 36:24

Hiatal hernia. This is the current rating. It says to rate it as a stricture of the esophagus. So why are you saying to rate GERD as an esophageal stricture Because it's more aligned with it than it is hiatal hernia. But now you're saying in the rating schedule that, oh, you should see this other section because hiatal hernia no longer has its own rating. You're referencing the same thing. So GERD is not like hiatal hernia but it is like an esophageal stricture. And now you're taking hiatal hernia. But it is like an esophageal stricture, and now you're taking a hiatal hernia and you're making it rated under esophageal stricture.

Bethanie Spangenberg: 37:07

That doesn't make sense.

J Basser: 37:13

They found their boat. They found their vessel to bring 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 of the vessel.

Bethanie Spangenberg: 37:28

They're going to jump out and change it all. And then, if we go to the next sentence, it says this adjustment from evaluating GERD based on subjective symptoms to objective measurement is consistent with the stated purpose of this rule. So objective measurement is consistent with the stated purpose of this rule. So the purpose of the rule is now to obtain objective measurements rather than the permanent residuals or rather than the picture of disability. Now we're trying to find objective measurements. So there's other ways to capture objective measurements for GERD. Rather than a CT or an EGD, you can do the pH testing. The pH testing is probably the safest and most accurate. They should do that.

J Basser: 38:24

Well, I guess they start measuring throats, right? Yeah, I don't think they'll make 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 how the C&P examiners are likely to refer out for tests, and this also is in line with what I teach to other representatives. I tell them don't wait for the compensation and pension exam to give you a diagnosis. You need to go to that compensation and pension exam with a diagnosis, because the resources 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, but that's only going to tell me the bone structure. It's not going to tell me the soft tissue structure. It's not going to tell me about the ligaments, where an MRI, which is much more expensive, will tell me about the ligaments. But a compensation pension examiner doesn't have the capability of ordering an MRI for a veteran's disability claim. So you need to talk to your doctor before you have that comp and pen exam. And this comment at the end of this volume 89 talks about just that. And it says comments of general disagreement. Comments of general disagreement.

Bethanie Spangenberg: 40:05

One commenter indicated that the current VASRD does not incorporate the most up-to-date and accurate scientific data because its rating criteria do not allow clinicians to more accurately diagnose and therefore to fairly distribute disability services. And here's the VA. The VA says the VASRD is not intended to be utilized in a clinical setting to identify, diagnose or treat injuries, diseases or disorders. Clinicians are urged to utilize standard diagnostic and treatment practices in their respective clinical setting. So that just emphasizes that they don't want these compensation and pension exams to be used to diagnose. They want it to be done in the clinical setting and then that data is gathered and put into the compensation and pension exam for the appropriate rating. So it'll be interesting to see, since they are now requiring objective information for the GERD rating. So it'll be interesting to see, since they are now requiring objective information for the GERD 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 veteran gets diagnosed is going to file a claim.

Bethanie Spangenberg: 41:16

Yep, I actually thought I was talking with my husband about it and we were going back and forth. And when you look at GERD and I talked previously about how the symptoms more readily align with peptic ulcer disease. Peptic ulcer disease is most easily identified on an EGD and if a veteran has to have objective information, an EGD will look at stomach lining to see if there is an ulcer present and if there is, the veteran would benefit from filing for the ulcer versus filing for GERD. And if that diagnosis changes during while their claim is open, it's an esophageal condition. So they need to. In my opinion they need to broadly present their condition that they're claiming. In that aspect you can put GERD slash, peptic ulcer disease or esophageal discomfort or something generic and then in the statement you know support that.

Bethanie Spangenberg: 42:32

But if you compare the rating schedule between GERD and peptic ulcer disease you're going to get a higher rating for the peptic ulcer disease and those conditions often go hand in hand and they're seen more readily than GERD with an esophageal stricture. So I have probably seen in gosh 2000,. So in 15 years I've probably seen maybe 10 esophageal strictures in the primary care clinic 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 provider about getting an EGD or getting one of these tests, you should really talk because there's risks with all of them. So you really need to sit down and talk with them about what most appropriately fits you. But if you do find you know one of those diagnoses on there that you'd probably be better off rated for the ulcer disease than for CURT itself, you can go stage it for example, like Medicare requirements, you know you have to have one test done before you, another one, you know, 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 an EGD, that'll be the next step. But I recommend that's the kind of health insurance you use Medicare Part B to at least find you a good gastroenterologist outside the VA, especially somebody that deals in this stuff, and maybe get a good opinion from him. Let him treat you a little bit. See what you know, look at the difference and see what's going on.

Bethanie Spangenberg: 44:08

You might get a little better handle on it, yeah.

Bethanie Spangenberg: 44:13

I think the rating schedule the way it is doesn't capture the true disability or the impairment of earning capacity. When we're looking at the rating schedule, I think what one of the commenters trying to save money and making it more difficult for the create a higher VA is attempting to save money and create a higher burden to obtain compensable evaluations is spot on. And when you reference medical articles that are 20 years old and don't even talk about esophageal strictures related to GERD or esophageal obstruction related 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 even more when you do if you do hopefully have some medical insurance in your Medicare you're liable to get more of an open opinion of what really is going on. Because I've often felt, since I chose not to go with Medicare, that with the VA, to go with Medicare, that with the VA, sometimes the VA understands what the claims division is trying to do or trying to accomplish and they will kind of lean that way more than to possibly give you a true picture of what's going on. And and I'm thinking from the standpoint of when I went about foot drop, I went to two outside podiatrists. They both use the term total and permanent loss of your use of perineal nerve, but the VA doctors was not put the word total in and they were told. One of the doctors actually said we were told not to use the word total.

Ray Cobb: 46:30

Now, with that being the case, that means if you just went to a VA doctor, you're not going to win your case for foot drop, and I think we see the same thing starting to address and set up right here with this Could be wrong. I mean you know, but it seems to me like you could go and they could leave something out and say it leaves the symptoms out, like we've talked about, and not do any of the tests and you're not going to win your case. You're dead in the water before you ever even turn it in.

J Basser: 47:03

Right, you just actually explained one of the reasons the VA has such a high turnover 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 know supporting their decision. Like, if you're really trying to capture, you know, the impairment of this particular medical condition, can you use a reference that talks about the occupational impact or the impact of earning capacity that it has?

Ray Cobb: 48:06

To me they are just gaslighting, almost in a way you know these arguments and what these people are trying to say. Well, I think you said it best when you said that evidently they did not have any medical professionals in the room helping them with this. You know, it was a bunch of guys and you know, and they threw some stuff up on the wall to see what might stick.

Ray Cobb: 48:26

So we're going to go with what stuck. They might have talked to some medical professions behind closed doors or another time, but as far as having them in the room when they were actually working on this, it sounds to me like they wasn't anywhere around.

Bethanie Spangenberg: 48:48

I don't even think they were involved in the process. Based off the information that I'm seeing, because it's not, it doesn't make any clinical sense and, knowing how the VA and the rating systems work, it's to me I'm not convinced that there was any medical person involved whatsoever in this process. And I will say cause I've seen, I see a lot doing what we do and a lot of the DBQs that we do in-house. We do DBQs for GERD and we do see a lot of veterans talk about how severe their GERD symptoms are. And in the previous radio show we talked about hey, you know, if you really have all these significant symptoms, you should have had some type of testing by now. You should have had a barium swallow, you should have had an ETD. And maybe that's their justification for having the veteran prove that they're having some sort of condition. They're not using the appropriate information to capture the functional impairment related to the condition. So again, I see and for the lack of better terms I'm going to say I see almost an over-exaggeration maybe in order for a veteran to meet that criteria. And then they say, well, I've never had anything done, well, it's like. Well, if you're really having these symptoms, then you really need to go have an EDD or barium swell or something done because you need to make sure you don't have Barrett's esophagus, you need to make sure you don't have an esophageal structure, you need to make sure you don't have these things. So I see that side and I'm thankful for that side, because I think you know it will help to identify some conditions that may arise from these severe symptoms.

Bethanie Spangenberg: 50:47

At the same time, you know you're now you're going to bog down the system. You're going to create a burden within your healthcare system. You're going to need more hands-on, both in the radiology department in your GI department. You're going to need more hands-on both in the radiology department in your GI department. You're going to put out more expenditures into the civilian through outside referrals. You are going to delay the process of claims and granting claims because this just hit. So now all these veterans have to jump through all these hoops to get more evidence and it's just going to throw in more appeal. And so I don't. I think if their aim was to lower their money and their expenditures which, if you read page one, that's actually what they talk about they're doing themselves a favor well, you may have some veterans I know several that if they had to go through all this, I'd say for 10 or 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 100 and 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 it says the same commenter, referencing a previous comment, says the same commenter questioned why VA categorized GERD as having a minor budgetary impact in the ERIA. As stated in the ERIA I don't know if they say that ERA or whatever they call it, but the term minor budgetary a major budgetary impact greater than $100 million over 10 years. I don't know if I think that's a spitting in the ocean, if you're $2.8 billion or $2.1 billion 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, until they get to vote on it. Then they got to pay the clothing allowance. They'd be broke again.

Ray Cobb: 54:11

The clothing allowance didn't go up. It's almost $1,000 for each brace 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 to me now. People will be chopping legs off to get that money, come on. Before we get off oh gosh, no, I'm just kidding we actually. No, I'm just kidding we actually. We've got about five minutes left. Bethany, Did you cover all your material you want to cover?

Bethanie Spangenberg: 54:51

Yeah, and I think the biggest.

Bethanie Spangenberg: 54:52

If I had to summarize the biggest takeaway, you know, for those who are listening is you need to appreciate the new GERD criteria.

Bethanie Spangenberg: 55:02

If you're going to file a new claim or if you have a pending claim, you need to understand what they're looking for, what they're asking for. And then, if you're part of grandfathered in, you really need to make statements on a regular basis of what your symptoms are. And you write the statement and you email it to yourself or you fax it in and you don't ever touch. You know, asking for an increase. You're just trying to continually document those symptoms. So then that way, in four or five years, if they try to come back to reduce you, you can say, well, these are my symptoms and I've put it in a statement every year to you. So I just you need to be aware, because if you go for a comp and pen, they're not going to ask. So we'll put something up on our 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 to put that old DBQ up so you can have that information.

J Basser: 55:59

Put it like the show up too. Yes, I think it's kind of one of those important shows because I think something's kind of rotten in Denmark on this one. They really haven't had an issue. It's kind of like tonight everybody's getting 10% for dirt, we get a lot me at 10%. We got to find a way to, as Barney Papa saying, nip that in the bud, yes again. Well, it's triage, it's claims triage. Stop the bleeding. That's the first thing. Airway breathing what's the other 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's sad. Tell us what you're basically doing. I know you've been doing a lot of different things. Are you staying pretty busy doing 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 VALOR for VET and keeping our providers educated and, on top of things, keeping our numbers turned over. We like to hire veterans, we like to keep veterans involved and we actually have a veteran who's in the National Guard and he was activated about six weeks ago and he's been gone.

Bethanie Spangenberg: 57:30

So we leave that space for him. We love him, but as a team we had a lot more work on our shoulders. So I think we're finally caught back up and got our nexus letters caught up and some of our file reviews all caught up and just appreciate him taking the time to protect the country.

J Basser: 57:53

Well, we wish him the best. I mean, national Guard folks are pretty sharp individuals. Yeah Well, we got a minute left. Ray, I want to thank you for coming 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 past show, you will learn something. She is down to the nitty-gritty on the DBQs and everything. We're going to be doing one every month here until the end of the year and most well in the next year. With that, this will be John Basher, jay Stacy on behalf of the Exposant Radio Show, bethy Spanglberg and Mr Ray Cobb. We'll be signing off for now. You have been listening to the Exposed that Podcast. Any opinions expressed on the show are the opinions of the guest speakers and not necessarily the opinions of Exposed that, exposedthatcom or BlogTalkRadio. Tune in next week for another episode of the Exposedet Podcast. Thanks for listening.