Peritoneal Adhesions C&P Exam Prep

Abdominal Physical Examination

What it measures: Palpable tenderness, guarding, distension, bowel sounds, and signs of obstruction or peritoneal irritation on physical exam of the abdomen.

What to expect: The examiner will press on various areas of your abdomen to assess for pain, tenderness, and rigidity. They may listen with a stethoscope for bowel sounds. Inform the examiner of all areas that are tender, including areas that are only tender on deeper palpation.

Pain considerations: Peritoneal adhesion pain can be intermittent and may not be fully apparent during a single exam. Clearly state that pain levels vary and describe your worst episodes accurately. Mention if you have taken pain medications prior to the exam that may be masking your typical pain level.

Dietary Assessment and Nutritional Status Review

What it measures: Whether you require medically-directed dietary modifications due to adhesion-related symptoms, or whether total parenteral nutrition (TPN) has been prescribed for obstructive symptoms.

What to expect: The examiner will ask about your diet, any dietary restrictions prescribed by your physician, and whether you have ever required TPN. They will review your medical records for documentation of these interventions.

Pain considerations: Dietary changes are often driven by fear of pain or obstruction. Explain how eating certain foods predictably triggers abdominal pain, colic, nausea, or vomiting so the examiner understands the functional necessity of dietary restriction.

Hospitalization History Review

What it measures: Whether you have been hospitalized for recurrent bowel obstruction at least once per year, which is a key threshold for the 80% rating level.

What to expect: The examiner will review your treatment records and ask about emergency room visits, hospitalizations, and procedures related to bowel obstruction caused by adhesions.

Pain considerations: Hospitalizations often represent your worst episodes. Describe what each hospitalization involved - pain severity, inability to keep food or liquids down, IV fluids required, nasogastric tube placement - so the examiner understands the severity of your obstructive episodes.

Bowel Obstruction Assessment

What it measures: Whether you have a persistent partial bowel obstruction that is inoperable or refractory to treatment, which drives the highest rating tier.

What to expect: The examiner will review imaging (CT scans, X-rays), surgical records, and notes from treating physicians to determine if obstruction is persistent, inoperable, and refractory to treatment.

Pain considerations: Refractory bowel obstruction episodes involve severe pain. Describe the intensity (scale of 1-10), duration of episodes, what you cannot do during an episode, and how long recovery takes after each episode.

80%

Persistent partial bowel obstruction that is either (a) inoperable AND refractory to treatment, OR (b) requires total parenteral nutrition (TPN) for obstructive symptoms. Alternatively: symptomatic peritoneal adhesions persisting or recurring after surgery, trauma, inflammatory disease, or infection; AND clinical evidence of recurrent obstruction requiring hospitalization at least once per year; AND medically-directed dietary modification other than TPN; AND at least one of: abdominal pain, nausea, vomiting, colic, constipation, or diarrhea.

From 38 CFR: A veteran whose adhesions from a prior appendectomy cause recurrent small bowel obstructions requiring hospitalization three times per year, is on a medically-prescribed liquid diet, and has been told by their surgeon that further surgery is not advisable would meet the 80% criteria.

50%

Symptomatic peritoneal adhesions persisting or recurring after surgery, trauma, inflammatory disease process (such as chronic cholecystitis or Crohn's disease), or infection, as determined by a healthcare provider; AND medically-directed dietary modification other than TPN; AND at least one of: abdominal pain, nausea, vomiting, colic, constipation, or diarrhea.

From 38 CFR: A veteran with adhesions following abdominal surgery who experiences frequent abdominal cramping and nausea, has been placed on a low-residue diet by their gastroenterologist, but has not required hospitalization for obstruction in the past year, would meet the 50% criteria.

30%

Symptomatic peritoneal adhesions persisting or recurring after surgery, trauma, inflammatory disease process (such as chronic cholecystitis or Crohn's disease), or infection, as determined by a healthcare provider; AND at least one of: abdominal pain, nausea, vomiting, colic, constipation, or diarrhea. No medically-directed dietary modification required at this level.

From 38 CFR: A veteran with post-surgical adhesions who reports intermittent abdominal cramping and alternating constipation and diarrhea confirmed by their physician, without a specific medically-directed dietary plan in place, would meet the 30% criteria.

10%

History of peritoneal adhesions, currently asymptomatic. The veteran has a documented history of peritoneal adhesions but reports no current symptoms attributable to the condition.

From 38 CFR: A veteran with a history of adhesions following service-connected abdominal surgery who currently reports no abdominal pain, nausea, vomiting, colic, constipation, or diarrhea attributable to adhesions would be rated at 10%.

0%

No current peritoneal adhesions diagnosis or the condition does not meet the threshold for any compensable rating. May apply when the examiner cannot confirm a current diagnosis or the veteran has no symptoms and history is not clearly established.

From 38 CFR: A veteran who had a suspected adhesion-related episode that resolved completely with no residual symptoms and no confirmed current diagnosis would receive a 0% non-compensable rating.

Abdominal Pain

How to describe it: Describe the location (right lower quadrant, periumbilical, diffuse), character (cramping, sharp, dull, constant vs. intermittent), severity on a 0-10 scale, duration of episodes, and what triggers or worsens the pain (eating, physical activity, bowel movements, positional changes). Be specific about how often you experience pain per week or month.

Example: On my worst days, I experience severe, cramping abdominal pain rated 8-9 out of 10 that lasts several hours. The pain is so intense that I cannot stand upright and I have to lie still in bed. I cannot work, drive, or care for myself during these episodes. I have missed work multiple times because of this pain.

Examiner listens for: The examiner is documenting whether abdominal pain is present as one of the qualifying symptoms under DC 7301, and assessing its impact on functioning. They need to confirm it is adhesion-related, not from an unrelated cause.

Avoid: Do not say 'it's not that bad' or minimize your pain to seem stoic. Do not describe only your average days - describe your typical range including your worst episodes. Do not attribute pain to something unrelated to avoid 'complaining.'

Nausea

How to describe it: Explain how frequently you experience nausea, what triggers it (eating, pain episodes, physical activity), how long episodes last, and whether it interferes with eating, working, or daily activities. Note if nausea is associated with specific foods or times of day.

Example: On my worst days, I feel intensely nauseated from the moment I wake up. I cannot eat a full meal without becoming severely nauseated within 30 minutes. On these days I may not be able to eat at all and have lost significant weight during prolonged flare-ups.

Examiner listens for: Nausea is one of the six qualifying symptoms under DC 7301. The examiner will note its presence, frequency, and whether it leads to vomiting or significantly impairs nutrition and daily function.

Avoid: Do not say 'just a little nausea' if it significantly disrupts your day. Quantify how many days per week or month you experience nausea and how it affects your ability to eat, work, and function.

Vomiting

How to describe it: Describe frequency (times per week or month), whether it is projectile or effortless, whether it is triggered by eating or pain, whether it contains bile or blood, and whether it has led to weight loss, dehydration, or hospitalization.

Example: During my worst flare-ups, I vomit multiple times a day for two to three days in a row. I cannot keep any food or liquid down, become dehydrated, and have required IV fluids in the emergency room on several occasions.

Examiner listens for: Vomiting is a qualifying symptom under DC 7301. The examiner also uses this to assess severity - repeated vomiting leading to hospitalization or dehydration supports higher rating levels.

Avoid: Do not omit ER visits for dehydration related to vomiting. These hospitalizations may count toward the annual hospitalization criterion for the 80% rating level.

Colic (Intestinal Cramping/Spasm)

How to describe it: Colic refers to severe, wave-like cramping pain typically associated with intestinal spasm or partial obstruction. Describe the intensity, wave-like nature, duration, frequency, and whether it is accompanied by bloating, distension, or inability to pass gas or stool.

Example: The colic episodes come in waves every few minutes and are absolutely debilitating. My abdomen visibly distends and becomes board-like hard. I cannot pass gas or have a bowel movement during these episodes, which can last for hours. I have called 911 during the worst episodes.

Examiner listens for: Colic is specifically listed as one of the six qualifying symptoms under DC 7301. The examiner will document its presence and severity, and assess whether it represents signs of partial bowel obstruction.

Avoid: Do not confuse colic with general stomach upset and downplay it. This is a specific, severe symptom. If you experience wave-like intestinal cramping, use the word 'colic' and describe it fully as it directly maps to the rating criteria.

Constipation

How to describe it: Describe how many days you go without a bowel movement, whether you strain significantly, whether you take laxatives or stool softeners (prescribed or OTC), and whether constipation alternates with diarrhea. Note if constipation has ever led to obstipation (complete inability to pass stool or gas).

Example: During my worst periods, I go 7-10 days without a bowel movement. I take prescription laxatives daily but they often provide little relief. The constipation causes severe abdominal bloating and cramping that prevents me from wearing fitted clothing, sitting comfortably, or working a full day.

Examiner listens for: Constipation is one of the six qualifying symptoms under DC 7301. The examiner will note its frequency and severity and whether it requires prescribed treatment, which may support the medically-directed dietary modification criterion.

Avoid: Do not omit that you take laxatives or have dietary restrictions specifically to manage constipation. These interventions support the medically-directed modification criterion needed for the 50% and 80% rating levels.

Diarrhea

How to describe it: Describe frequency of loose or watery stools per day, urgency (whether you have accidents or near-accidents), whether it is related to eating, and whether it alternates with constipation. Note any dietary triggers you avoid and whether anti-diarrheal medications are prescribed.

Example: On my worst days, I have 8-10 episodes of watery diarrhea. I am afraid to leave my home because I cannot predict when an episode will hit. I have had accidents on the way to the bathroom and have stopped going out socially because of the unpredictability and embarrassment.

Examiner listens for: Diarrhea is one of the six qualifying symptoms under DC 7301. The examiner will note frequency, severity, and functional impact including social and occupational limitations.

Avoid: Do not underreport the frequency or omit social and occupational limitations caused by diarrhea. Functional impact on employment and quality of life is directly relevant to the examiner's functional impairment documentation.

Dietary Modifications

How to describe it: Be very specific about what dietary changes you make, whether they were prescribed by a physician, and what happens when you deviate from the diet. Bring written documentation such as a physician's note, dietitian instructions, or medical records referencing dietary restrictions.

Example: My gastroenterologist prescribed a strict low-residue diet. When I accidentally eat a high-fiber food, I experience severe cramping and colic within hours that can progress to a full obstruction episode requiring emergency care. I carry a list of forbidden foods everywhere I go.

Examiner listens for: Medically-directed dietary modification is a gating criterion that separates the 30% from the 50% and 80% rating levels. The examiner must document that dietary modification was directed by a healthcare provider, not merely self-imposed.

Avoid: Do not say you 'watch what you eat' without specifying it is medically directed. Bring a copy of the dietary prescription or physician note. Distinguish between general healthy eating and a medical necessity diet prescribed for your adhesions.

Functional Impact on Daily Life and Work

How to describe it: Describe specific activities you cannot do or have difficulty with: work duties missed, inability to lift, bend, or perform physical tasks, inability to eat at restaurants or social events, disruption of sleep, impact on personal relationships, and any accommodations required at work.

Example: My adhesion flare-ups have caused me to miss an average of 3-4 days of work per month. I cannot perform any job that requires physical activity, prolonged standing, or travel because I cannot predict when a severe episode will occur. I have been written up at work for absences and fear losing my job.

Examiner listens for: The examiner completes DBQ field 96 documenting functional impact of each condition. This narrative directly influences the overall disability picture and is used by raters to consider a higher evaluation under 38 CFR 4.7 (benefit of the doubt) and TDIU considerations.

Avoid: Do not say your condition 'doesn't really affect work' if it does. This field is your opportunity to paint an accurate picture of how the condition impacts your ability to maintain gainful employment and perform daily activities.