To preface, I have not been formally referred to IDES yet, but I expect that may happen soon. My PCM is currently waiting to collect ENT notes before assigning a P3 profile.
I will most likely be referred for probable/suspected Meniere's disease. My concern is whether, during IDES, the unfitting condition could be characterized or rated under a less fitting diagnostic code, such as peripheral vestibular disorder / DC 6204 or vestibular migraines / DC 8100, instead of Meniere's syndrome / DC 6205.
My episodes have followed the same pattern each time:
Left ear fullness
Left ear tinnitus
Left ear muffled/decreased hearing
Spinning vertigo
Ataxia/imbalance during attacks
These symptoms have been documented consistently in my medical records over time. My records also include probable/suspected Meniere's disease as the leading differential diagnosis, with vestibular migraine listed as an alternate “versus” diagnosis because I have had migraines before. I do not have migraine-type symptoms accompanying the vertigo episodes, such as headache during the vertigo, photophobia, phonophobia, aura, nausea/vomiting etc and is documented as such.
One issue is that I have not received a formal Meniere's diagnosis yet because my audiogram showing a low-frequency shift after an attack did not meet the threshold for mild hearing loss, even though there was about a 10 dB shift at 250–500 Hz compared to prior testing. This is noted in my STR as "he had a hearing test performed shortly after an episode that showed very slight decreased hearing in the low-frequency range; interim hearing tests between episodes have been normal."
I understand that medical diagnosis and VA rating criteria are separate issues, but I found the following M21-1 guidance relevant to the rating-code concern:
“Meniere’s Disease is characterized by episodic attacks with subsequent subsiding of symptoms following the attack. A Veteran may be totally deaf during the attack with return to normal hearing when the attack ends. Therefore, in evaluating hearing impairment under 38 CFR 4.87, diagnostic code (DC) 6205, the puretone thresholds or speech discrimination percentages are not required to meet the provisions of 38 CFR 3.385 as hearing impairment associated with Meniere’s Disease is often transient.”
Specifically, I am trying to understand:
1. If I am rated under a less fitting code that does not account for the full symptom pattern and that rating could affect whether I receive medical retirement versus separation, what options would I have during IDES to challenge or correct the diagnostic code/characterization?
2. Can the diagnostic code or unfitting-condition characterization be challenged during the IPEB/FPEB process?
3. Would my hearing test suffice as hearing impairment under M21-1 guidance thus being a definite diagnosis?
Any insight from those who have gone through IDES, especially with vestibular disorders or Ménière’s disease, would be appreciated.
I will most likely be referred for probable/suspected Meniere's disease. My concern is whether, during IDES, the unfitting condition could be characterized or rated under a less fitting diagnostic code, such as peripheral vestibular disorder / DC 6204 or vestibular migraines / DC 8100, instead of Meniere's syndrome / DC 6205.
My episodes have followed the same pattern each time:
Left ear fullness
Left ear tinnitus
Left ear muffled/decreased hearing
Spinning vertigo
Ataxia/imbalance during attacks
These symptoms have been documented consistently in my medical records over time. My records also include probable/suspected Meniere's disease as the leading differential diagnosis, with vestibular migraine listed as an alternate “versus” diagnosis because I have had migraines before. I do not have migraine-type symptoms accompanying the vertigo episodes, such as headache during the vertigo, photophobia, phonophobia, aura, nausea/vomiting etc and is documented as such.
One issue is that I have not received a formal Meniere's diagnosis yet because my audiogram showing a low-frequency shift after an attack did not meet the threshold for mild hearing loss, even though there was about a 10 dB shift at 250–500 Hz compared to prior testing. This is noted in my STR as "he had a hearing test performed shortly after an episode that showed very slight decreased hearing in the low-frequency range; interim hearing tests between episodes have been normal."
I understand that medical diagnosis and VA rating criteria are separate issues, but I found the following M21-1 guidance relevant to the rating-code concern:
“Meniere’s Disease is characterized by episodic attacks with subsequent subsiding of symptoms following the attack. A Veteran may be totally deaf during the attack with return to normal hearing when the attack ends. Therefore, in evaluating hearing impairment under 38 CFR 4.87, diagnostic code (DC) 6205, the puretone thresholds or speech discrimination percentages are not required to meet the provisions of 38 CFR 3.385 as hearing impairment associated with Meniere’s Disease is often transient.”
Specifically, I am trying to understand:
1. If I am rated under a less fitting code that does not account for the full symptom pattern and that rating could affect whether I receive medical retirement versus separation, what options would I have during IDES to challenge or correct the diagnostic code/characterization?
2. Can the diagnostic code or unfitting-condition characterization be challenged during the IPEB/FPEB process?
3. Would my hearing test suffice as hearing impairment under M21-1 guidance thus being a definite diagnosis?
Any insight from those who have gone through IDES, especially with vestibular disorders or Ménière’s disease, would be appreciated.
