DBQ "Remarks" vs Diagnosis - Meniere's Disease (Help)

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So I got copies of my DBQs that were preformed by QTC. I am absolutely dumbfounded by an ENT's response relating to my diagnosis of Meniere's Disease. I was previously diagnosed over 2 years ago with Meniere's and have been taking two different types of medications to help with vertigo and dizziness. Meniere's is one of the conditions I am being boarded for right now. After getting a copy of my DBQ (Ear Conditions including Infectious and Conditions), the QTC ENT annotated in Block 1A: "Does the Veteran now have or has he or she ever been diagnosed with an ear or peripheral vestibular condition?" [Yes]. In Block 1B: [Other: dizziness and giddiness", date of diagnosis: 8/17.

No where on here did he selecte "Meniere's syndrome" or "peripheral vestibular disorder", nor any other option besides the aforementioned in earlier paragraph. In Block 3, "Does the veteran have any of the following findings, signs, or symptoms attributable to Meniere's Syndrome, a Peripherial Vestibular Condition or another diagnosed condition from Section 1?" [Yes] - Hearing impairment with vertigo, more than once weekly, [1-24 hours]. He also checked [Tinnitus] More than once weekly and frequency [1-24 hours]. In Block 6C, he indicated [Other] - Tympanosclerosis. Block 6D: Unsteady, describe: "Wobbly". Block 6F: [Abnormal] - "Nystagmus".

- - From here, it gets odd, based on his comments above - - 10. "Do any of the veteran's ear or peripheral vestibular conditions, impact his or her ability to work?" [Unable to decide until the patient has further testing an (sic) VNG is needed.] Finally, in Block 11, [Remarks], he indicated the following verbiage: "The hearing test are (sic) not consistent with Meniere's Disease. For the claimant's condition of Meniere's (MEB referred condition), there is no diagnosis because there is no pathology to render a diagnosis. For the claimant's claimed condition of vertigo, the diagnosis is already noted in the diagnosis section. Unfortunately the patient's complaints of dizziness or vertigo is totally subjective. Without testing, I am unable to provide a different diagnosis at this time. Patient needs a VNG to rule in or out a vertigo complaint and or diagnosis."

My question is what the heck happened between the questionnaire and his "Remarks" and I've been being treated for Meniere's for over 2 years from my earlier ENT. For rating purposes, I am reading this an a possible, big fat 0 rating! Can someone please help elaborate?

Thank you!
 
Unfortunately the QTC Doc needs the VNG to formulate his own opinion as far as your ability to work. Since your branch of service referred you for this condition, they have already formulated and opinion that you are not fit to serve because of it.

Have you had a Videonystagmography test?

Back to the DBQ, the VA C&P raters should take into account all medical evidence in your file for the purpose of ratings. If they do mess this up, you can submit a VARR (if the condition is unfitting) or you can file a NOD if it is a claimed condition (since you have both)

Based on the comment "Hearing Impairment with Vertigo, occurring more than once weekly" you should be rated 100% for this referred condition.

His reference in block D for unsteady, wobbly will fill in the blank for cerebellar gait.

Here is the verbiage from the CFR:

6205 Meniere’s syndrome (endolymphatic hydrops):
Hearing impairment with attacks of vertigo and cerebellar gait occurring more than once weekly, with or without tinnitus................................ 100

Here is the verbiage from Military Disability Made Easy:

If there is hearing impairment with episodes of dizziness and staggering while walking that occur more than once a week, whether or not there is tinnitus, it is rated 100%.
 
Unfortunately the QTC Doc needs the VNG to formulate his own opinion as far as your ability to work. Since your branch of service referred you for this condition, they have already formulated and opinion that you are not fit to serve because of it.

Have you had a Videonystagmography test?

Back to the DBQ, the VA C&P raters should take into account all medical evidence in your file for the purpose of ratings. If they do mess this up, you can submit a VARR (if the condition is unfitting) or you can file a NOD if it is a claimed condition (since you have both)

Based on the comment "Hearing Impairment with Vertigo, occurring more than once weekly" you should be rated 100% for this referred condition.

His reference in block D for unsteady, wobbly will fill in the blank for cerebellar gait.

Here is the verbiage from the CFR:

6205 Meniere’s syndrome (endolymphatic hydrops):
Hearing impairment with attacks of vertigo and cerebellar gait occurring more than once weekly, with or without tinnitus................................ 100

Here is the verbiage from Military Disability Made Easy:

If there is hearing impairment with episodes of dizziness and staggering while walking that occur more than once a week, whether or not there is tinnitus, it is rated 100%.

Thank you for your reply. It seemsto me he checked the right boxes and put the right verbiage for gait but I am concerned about his "remarks" at the end where he couldn't determine menieres based on his medical opinion that my loss of hearing (or not enough) is not consistent with menieres. My other concern is he didn't check "menieres" in Block 1B. Maybe I'm not reading it right. This condition is huge in my overall potential ratings so I am depending on it heavily.

To answer your question, I have not had Videonystagmography test. I'm not sure why I never had one but the medications I was prescribed have made a huge difference! I've been seeing my new ENT (due to PCS) on a regular basis and he just picked up where my former ENT left off. No mention of further testing.

Appreciate you helping me understand this thing. :)
 
Thank you for your reply. It seemsto me he checked the right boxes and put the right verbiage for gait but I am concerned about his "remarks" at the end where he couldn't determine menieres based on his medical opinion that my loss of hearing (or not enough) is not consistent with menieres. My other concern is he didn't check "menieres" in Block 1B. Maybe I'm not reading it right. This condition is huge in my overall potential ratings so I am depending on it heavily.

To answer your question, I have not had Videonystagmography test. I'm not sure why I never had one but the medications I was prescribed have made a huge difference! I've been seeing my new ENT (due to PCS) on a regular basis and he just picked up where my former ENT left off. No mention of further testing.

Appreciate you helping me understand this thing. :)
Someone else posted a reply but then deleted. Care to repost?
 
I suggest you contact QTC and request the videonystagmography and f/u with ENT examiner.
 
So I was finally notified my package is on way to AFPC. Looking at the IDES timeline, I'm assuming I'm entering the IPEB.

What has been the average timeframe from here (Air Force) been like for other Airmen (barring appeals) and when are ratings typically available from the VA?
 
Just wanted to see how your MEB shook out in the end. I am going through an MEB for Meniere's disease and other complex vestibular conditions (I also have an ear injury that is not covered in any of the VA diagnoses). Any information about how the VA and DoD rated you or any advice you have would be much appreciated. Thank you!
 
I know this is an old post, but I'm still working a claim from 2014 so this may still be of use to you. Please read this and pay close attention: THERE IS NO DEFINITIVE OBJECTIVE TEST FOR MENIERES DISEASE. I've got it too. Diagnosis was very tough because it is episodic. They can try glycerol and see if your hearing improves during an episode - that is accurate 66% of the time. I'll find you a current peer reviewed medical article that supports the above - but I thought a brief statement might make more sense to most people.
Here you go 30 seconds to find it. Meniere’s disease: Still a mystery disease with difficult differential diagnosis
Ann Indian Acad Neurol. 2011 Jan-Mar; 14(1): 12–18.
doi: 10.4103/0972-2327.78043
PMCID: PMC3098516
PMID: 21633608
Meniere’s disease: Still a mystery disease with difficult differential diagnosis
A. Vassiliou, P. V. Vlastarakos,1 P. Maragoudakis,2 D. Candiloros,2 and T. P. Nikolopoulos2

In addition, a January 2019 presentation to the Meniere's Society by Philippa Thompson clearly states that: Ménière’s disease is when a person has Ménière’s syndrome and the cause cannot be identified – idiopathic in other words. Since you have Meniere's DISEASE the cause has not yet been identified. Push to make them find out what's causing it! For all we know, our Meniere's disease could be caused by a brain tumor~!
 
in my experience a qtc doc told me he could only put dizziness instead of vertigo because the objective tests are only valid if i would be having an episode during the exam, then things like nystagmus and vomiting are present.
 
Makes sense. If you think about MD only shows up on such tests during an active episode - and even at an hour 1/week it would be nearly impossible for the episode to occur randomly during a C&P exam. 1 hour vs 7 days times 24 hours - roughly a .6% chance of a C&P exam catching it. BUT, if he opines that the vertiginous sensation is more likely than not service connected, AND you have an existing diagnosis of MD on file - sometimes VA can make that cognitive leap. GOOD LUCK!

Regarding the %, your guess sounds as good as anything I've read.
 
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