Gut problems (gastric distress) can have many causes, but the VA has identified a link between irritable bowel syndrome (IBS) and military service. Obtaining IBS VA disability benefits can be significantly easier for former POWs and Gulf War veterans than for other veterans. However, any veteran who can establish a service connection to his or her IBS should apply for VA disability benefits.
In this video, VA disability attorney, Sarah Woods, explains how to service-connect IBS claims:
In This Ultimate Guide to IBS VA Disability:
- What Causes IBS and Other Gastrointestinal Problems Covered by VA Disability?
- How to Get Your IBS VA Rating
- Irritable Bowel Syndrome Disability isn’t Just for Gulf War Vets
- VA Ratings for IBS and GERD
- How to Increase the Rating for IBS VA Disability Benefits
What Causes IBS and Other Gastrointestinal Problems Covered by VA Disability?
There is no clear cause for IBS because it can involve the muscles, nerves, lining, and even microflora (bacteria) of the intestines. However, not every case involves every physical system. For example, certain cases are primarily caused by the muscles of the intestines that delay or accelerate bowel movement leading to chronic constipation or diarrhea.
In most cases, IBS is diagnosed by running laboratory tests and eliminating other causes of gastric distress, such as celiac disease, colon cancer, and inflammatory bowel disease, which is a separate condition despite its similar-sounding name. Symptoms that a veteran with IBS might experience include abdominal pain, excessive gas, constipation (also called IBS-C), diarrhea (also called IBS-D), and mucus in the stool.
The logical link between service and IBS is most clear in former POWs who often suffer from hunger, malnutrition, and foodborne illnesses from their time in captivity. Other gastrointestinal problems that can arise in former POWs include pellagra, beriberi, dysentery, and peptic ulcer disease.
Similarly, the evidence shows that Gulf War veterans are more likely to experience IBS than the average person. Although the VA avoids the term “Gulf War Syndrome,” IBS is often associated with the myriad of symptoms experienced by Gulf War veterans.
Gulf War veterans can also suffer from other “functional gastrointestinal disorders.” A functional gastrointestinal disorder is a chronic problem with a digestive organ in which the organ malfunctions, but where the tissues of that organ are undamaged. Examples of functional gastrointestinal disorders include functional dyspepsia and functional abdominal pain syndrome.
How to Get Your IBS VA Rating
All claims for IBS VA disability benefits must include a service connection between your time in the military and the onset of IBS. However, some veterans are entitled to a presumption of service connection, meaning that IBS is presumed to be service-connected for these veterans. The only way a presumptive condition can be denied is if the VA has some proof that the condition was caused by a post-discharge event.
1. IBS Service Connection Presumption for POWs and Gulf War Veterans
Because of the connection between IBS and military service that has been recognized for former POWs and Gulf War veterans, the VA has established a presumptive service connection. This means that when a former POW held for at least 30 days or a veteran who served in the Southwest Asia Theater of Operations during the Gulf War applies for IBS VA disability benefits, the veteran is not required to submit proof that the IBS is connected to the veteran’s service. If you can prove you were a POW or served in the Persian Gulf, your IBS is automatically service-connected.
As a result of this presumption, obtaining IBS VA disability benefits is streamlined for former POWs and Gulf War veterans. This presumption extends to other digestive and gastrointestinal disorders. For POWs, the other conditions are primarily nutritional disorders.
For Gulf War veterans, the other gastrointestinal disorders entitled to the presumption of service connection are “functional gastrointestinal disorders.” Functional gastrointestinal disorders are different from structural gastrointestinal disorders, such as GERD, heartburn, or acid reflux. The presumption of service connection for Gulf War veterans does not apply to GERD.
Due to the presumption of service connection, POWs and Gulf War veterans only need to include records showing a diagnosis of IBS along with service records showing that they served in the Persian Gulf area. The presumption means that the veteran will qualify for IBS VA disability benefits regardless of when the condition manifested itself, even if it was years after the veteran’s discharge.
2. IBS Service Connection for All Other Veterans
Veterans who do not qualify for the presumption of service connection must prove that their IBS is connected to their military service. A service connection can arise under three circumstances:
2a. Service Connection from an In-service IBS Diagnosis
If IBS was first diagnosed or manifested during a veteran’s service, that is a service connection. A difficulty can arise if IBS first manifested during service but was misdiagnosed. In these cases, you would need to show military medical records of your gastrointestinal problems during your time in the military and would likely need a letter from your doctor saying that the gastrointestinal problems were a manifestation of IBS regardless of how it was diagnosed at the time.
For example, if a military doctor misdiagnosed your IBS as a food-borne illness but at a C&P exam for IBS you were correctly diagnosed, you may have a service-connected disability. If your doctor can see that your symptoms during the service were the same as your symptoms now, he or she can show that you’ve had irritable bowel syndrome all along.
We have talked to doctors that know how to review your medical history and your C-File for these kinds of errors. There is no charge to call us and discuss your case with our staff.
2b. IBS Made Worse by Service Or Other Conditions
You can establish a service connection to IBS if you had been diagnosed with IBS before joining the military and your time in the service made your IBS worse. This pathway to IBS VA disability benefits can be complicated because you need to show that your post-service IBS was not a natural progression of your pre-service IBS. It’s not natural in that your condition got worse because of being in the service, not just because you’re getting old.
One way to establish a service connection is to show that some events during your service caused your IBS to accelerate or worsen. For example, a combat injury or vehicle collision may have caused damage to the nerves that control the muscles that move food through the bowel, thereby resulting in IBS. You may be able to show a secondary service connection, like IBS secondary to PTSD or get a va rating for IBS secondary to anxiety.
2c. IBS Diagnosed After Service
To establish a service-connected disability, you need to show that the disability manifested during your service. If your case of IBS occurred during your service but was not diagnosed until afterward, you may still be entitled to IBS VA disability benefits.
Again, you may be able to establish a service connection if you can point to a specific event that occurred during your service that may have caused the IBS. This is where you, your doctor, and your VA disability benefits lawyer may need to do some research.
Scientific research has theorized that exposure to chemicals, radiation, and polluted air can lead to IBS. Similarly, studies show that IBS can be triggered by chronic psychological stress and bacterial contamination. All of these conditions can be experienced during active duty or active training. If you can prove you were in any of that, you may have what is required by the VA to establish a service-connected case of IBS.
Irritable Bowel Syndrome Disability isn’t Just for Gulf War Vets
When looking for a cause for your IBS that may have occurred during your service, it is worthwhile to look at the Gulf War Syndrome research – even if you are not a Gulf War veteran. The VA established a presumption of IBS service connection for Gulf War veterans because it recognized a pattern among disability claims. It is reasonable to assume that anyone exposed to similar conditions who served in Vietnam, Iraq, Afghanistan, or elsewhere would also develop similar medical conditions.
For example, certain psychiatric conditions have been linked to IBS in Gulf War veterans. However, these psychiatric conditions are not limited to one particular conflict and there is no reason that the same research that was used to establish a link between service and IBS for Gulf War veterans would not apply equally to other veterans’ claims for IBS VA disability benefits.
VA Ratings for IBS and GERD
The VA’s disability ratings for IBS are set forth in the VA’s schedule of ratings for the digestive system. (known as CFR 38, section 4.114) The VA’s schedule combines irritable colon syndrome, spastic colitis, and mucous colitis (all alternate names for IBS). This schedule applies regardless of whether the case of IBS is caused by the nerves, muscles, lining, or microflora of the intestine. Rather, the VA disability rating for IBS depends primarily on the level of abdominal distress and whether the IBS is accompanied by diarrhea.
Specifically, mild cases with occasional bowel dysfunction and abdominal distress are not entitled to any disability benefits. That is, mild cases are rated at 0%.
Moderate cases of IBS characterized by frequent episodes of bowel dysfunction and abdominal distress are entitled to a 10% VA disability rating.
Severe cases of IBS characterized by diarrhea, or alternating constipation and diarrhea, and constant abdominal distress are given the highest VA disability rating for IBS at 30%. If you want to get TDIU with IBS, you’re going to have to combine it with some more severe conditions.
The VA doesn’t give a clear VA rating for GERD. That is, the schedule of ratings for the digestive system skips over GERD. Assuming that a veteran establishes a service connection for GERD, the VA would look to a similar disorder or condition to assign a disability rating.
When looking at the symptoms caused by GERD, one condition with analogous symptoms is hiatal hernia. Severe hiatal hernia characterized by vomiting, pain, anemia, and blood in the vomit or stool is rated at 60%. Moderate hiatal hernia that is associated with persistently recurring regurgitation, heartburn, difficulty swallowing, and upper chest pain that radiates to the arm or shoulder is rated at 30%. Finally, mild hiatal hernia is associated with two or more symptoms at the 30% level, but with less severity, and is rated at 10%.
Thus, in assigning a rating to service-connected GERD, the VA would look to the severity of the vomiting or regurgitation and the frequency of the symptoms as outlined in the hiatal hernia ratings table. The VA would then assign a rating based on those symptoms.
You can see how the VA rating for IBS and GERD would be so closely connected.
Here is one of our VA Disability Attorneys talking about how to move your 80% rating to 100%
How to Increase the Rating for IBS VA Disability Benefits
Combining IBS with secondary service-connected disabilities related to IBS or using IBS as a secondary service-connected disability from another condition that causes IBS can increase your VA disability rating.
For example, it is known that IBS often accompanies anxiety states, such as post-traumatic stress disorder (PTSD) and depression. In this case, it may be worthwhile to establish a service connection for PTSD and depression since there is more recognition of the link between military service and these conditions than military service and IBS.
If the primary disability is accepted by the VA as service-connected, you only need to submit a nexus letter from your doctor linking the primary disability to the secondary disability. In this example, there is established medical evidence linking PTSD and depression to IBS. If you get VA disability for IBS secondary to PTSD, you might have enough of a combination to get TDIU.
Working in the other direction, you can also connect IBS to any secondary service-connected disability caused by IBS. For example, GERD and other digestive system disorders can result from the intestinal dysfunction characteristic of IBS. If you can establish a service connection for IBS, you would then be able to obtain a disability rating for anything caused by IBS, such as GERD.
Whether IBS is the primary service-connected disability or the secondary service-connected disability, the individual VA disability percentages for the disabilities would be aggregated using VA math. Bear in mind, however, that VA math does not simply add disability percentages. Rather, a formula is applied to the disability percentages to produce an overall disability rating.
If your overall VA disability rating is lower than you believe to be fair, you can request the VA provide an extra schedular rating. These ratings are provided on a case-by-case basis, but only in extraordinary situations in which the fixed schedules are insufficient to address a veteran’s situation. For example, if your IBS severely affects your ability to work, you may be able to request an extra schedular rating. Be aware that these extra schedular ratings are very rarely granted by the VA. Thus, you may want to consult a VA benefits attorney before requesting an extra schedular rating to determine if you have sufficient grounds to obtain one.
Pathways for Obtaining IBS VA Disability Benefits
The VA is a bureaucracy. This is not necessarily a criticism of the VA. It is merely a fact that the VA can be fairly strict about the application of its rules and regulations. Following those rules and regulations or hiring a VA disability benefits attorney to help you navigate the VA, can often improve both the speed and likelihood of success of a claim for IBS VA disability benefits.
If you have been rejected for disability benefits, give us a call. Sometimes your case is rejected for insufficient evidence. We can try to obtain additional records, letters from doctors, or buddy statements that will satisfy the VA.
Alternatively, your case may have been rejected because the VA either misunderstood the evidence submitted, misinterpreted its own regulations, or misapplied the legal standards when it tried to apply the regulations to your disability. In any of these cases, obtaining legal counsel before requesting a review of your case can improve the chances of a successful outcome.
The VA has acknowledged that IBS can be service-connected under some circumstances. Contact a VA benefits attorney, regardless of where you are currently located or whether you were deployed, so we can help you get VA disability benefits.
The VA classifies irritable colon syndrome, spastic colitis, and mucous colitis as the same IBS condition and rates each diagnosis the same way. You just need a doctor and/or VA attorney to show how that condition was connected to your time in the service or your time in the Persian Gulf.
The only time this would matter is if it would affect your approval in the first place. If you got denied for one, then the other might not hold up as a secondary condition. Someone experienced in VA law should look at your case and determine what your best claim to the VA would be.