Ad free subscription.


This eBook will teach you how to get C-Files (paper and electronic) from the VA Regional Office.
How to Get your VA C-File




  • Topics

  • Forum Statistics

    • Total Topics
      60,116
    • Total Posts
      388,082
  • Topics

  • Posts

    • Dro Review Processing Time
      Gastone, yes I believe I did.  In addition to the form I submitted 12 pages of new evidence to include comments that statements made by RO and CP examiner were erroneous.  For instance, to contradict the RO's statement that outside medical records noted that chemicals and infection caused me to black out and fall off a ladder resulting in TBI, my treating physician wrote a statement on which he stated that he thoroughly reviewed all treatment records from the date of the incident and 6 months later and found no mention of chemical exposure and the only comment about infection, was that there was NO infection present at the time of the incident.   He also submitted another statement where he concluded that it was more likely than not a causal relationship between my service connected diabetes and my subsequent diagnosis of sleep apnea. I assume that 12 pages of attachmentS should constitute new and material evidence
    • 25 Year Long Service Connected Disability Denied After C/p Exam.
      Dont worry about being a non combat vet, and dont put yourself through the "other vets deserve it more than me".   We serve when where and how the military requires.  We dont have a say into whether or not we go to combat.  I assumed I would go to combat and did not.  It was not my fault that the military thought I would serve them better in non combat, and they had good reasons for that.  If you get injured, it does not matter if its training, combat, non combat.  The military takes huge risks on its personnel.  You did as you were told so you deserve benefits for your injuries. As far as other vets deserve it more, well, of course that is true.  You dont have to be the most injured Vet in the military to get benefits..that would mean only 1 vet for each branch of service would get benefits, and no need for VA.  The VA has criteria for service connection. If you meet that criteria you should get benefits.  Often you meet the criteria but VA denies anyway, sometimes on "non" criteria.   As an example, I was denied SC for hearing loss because of "the length of time since service".   However, "length of time since service" is NOT a criteria.    All that means is I struggled with progressively worse hearing loss for many years, until I finally had to get hearing aids.  The audiologist made a medical opinion:  "my hearing loss is  at least as likely as not due to noise exposure from aircraft, guns and other loud noise in military service".   That is a solid nexus.  A competent medical professional examined me, and made that opinion.  A rating specialist decided it was too long, substitution their own unsubstantiated medical  opinion for that of a medical professional. I appealed to the board.  The board awarded but left it up to RO to determine disability percentage.  The RO decided it was 0 percent.  I appealed that...it still rages on.  They fight you tooth and nail for every nickel.   If you feel like you deserve benefits never give up.   
    • 100% IU P&T Question
      interesting....Asknod's recent CUE posting here covers some of the same situation but this is a vet who had a high level of SMC. The VA now says "moot and academic" regarding TDIU if there is already a 100% SC standing. But the GREAT CUE decision here Alex posted might explain that better....... "My bva decision made it clear they would not award IU when I was already 100%, but indicated I could seek same at different periods of time." Yes, the BVA gives us clues sometime. They gave me a clue in a old BVA decision....that claim's theory of entitlement was denied , and I didn't really pursue it with evidence, because I had subsequently won on a different theory of entitlement at the RO level and thus BVA rendered the case moot because of the RO award and I didn't know I could have withdraw the BVA appeal. In the decision they gave me a clue....a legal clue..... I used that decision to fight another claim I had. It was a legal BVA clue. I already explained that here. The clue became $59,700 bucks in 2010. Boy was my RO pissed. Because I called the OGC and they, like the BVA, can read.
    • A Tid bit of good news
      Good comes to those who fight for it.
    • Sleep apnea secondary to diabetes
      I am brand new to this group and was surprised not to find any posts about claiming sleep apnea as secondary to diabetes type 2.  Perhaps I'm just not looking hard enough.  My claim for diabetes was approved as presumptive  due to agent orange exposure  My sleep apnea was disapproved as not being service connected.  I submitted an NOD claiming my sleep apnea as secondary to my service connected disability.  I did a lot of research in this area and found several articles which clearly stated that diabetes can cause sleep apnea. I submitted excerpts from these articles acknowledging that these articles address the general population and not my particular case.  I also submitted a statement from my physician who has been my treating physician for over 20 years.  In his statement he said that I was diagnosed with diabetes while under his care and subsequently diagnosed with severe sleep apnea requiring the wear of a CPAP machine.  He clearly stated that he's in the best position to comment on my medical history and current situation.   He concluded that based on well known studies and based on his personal knowledge if my medical situation, he can eliminate possible causes of sleep apnea such as obesity, neck and throat characteristics, smoking, and alcohol consumption and conclude that is more likely than not that there is a causal relationship between my service connected diabetes and my subsequent diagnosis of sleep apnea. I did a search on BVA decisions on this subject and was surprised to see so few and was even more surprised about the win loss ratio.  Of 6 cases, only one was approved and that one was based on the veteran claiming that because he was diabetic, he was prescribed medication that caused him to become obese and because of his obesity, he developed sleep apnea.  He also submitted doctors statements from several doctors supporting his contention. I believe two cases were remanded and all the remaining cases were quite weak on my opinion.  The reason I'm posting this is because I'm trying to find that glimmer of hope while I await the decision of the DRO. Anyone out there have any advice or encouraging words for this guy.  
    • How to get from SMC L to R2 in six months
      BEAUTIFUL Asknod!!!!!!!! Yowweeeee, lots of CUEs ,as you said........ And this reminds of what I say here about malpractice...... one small medical error can ,in time cause more and more medical errors, as there is a snowball affect to malpractice... CUE is often the same thing. My original CUE in a 1998 decision, brought at least 5-6 other CUEs to light....all explained here in our CUE forum..... because if the VA commits one legal error, others are often sure to follow. This is a superb example of how CUE can work..... And my 1998 decision was an award letter, not a denial so we all have to carefully assess award letters as well as denials, because they still might owe us cash....and hope we never take the time to figure that out. Congrats Asknod for helping this veteran! Many Years ago we had a pt at the local VAMC who was at the highest level of SMC, and they gave him lots of special accommodations while he was hospitalized, single bed room, PC adapted to his disabilities, etc etc . all which didn't go over  well with many other VAMC patients...until they learned his high SMC amount was solely due to a Section 1151 award. I never found out what VAMC actually buggered him up with that high level of malpractice. Asknod , you are one superb Veteran's advocate. I hope you get the VA  agent accreditation soon.   (maybe you did already?)                  
    • 100% IU P&T Question
      Va is highly unlikely to award 100 percent schedular when you are IU.  They regularly deny and say its moot.  Im in appeals at the CAVC, in part, because of the obverse:  Im already 100 percent schedular and seeking IU as that will mean an earlier effective date.   So far it looks like VA will win in that I wont get both at the same time.  However, since mine involves an EED, I could get IU up until xx date and then 100%.   My bva decision made it clear they would not award IU when I was already 100%, but indicated I could seek same at different periods of time.  
    • service connection granted
      That is great!.....I assume they granted TBI and residuals but do you mean there is still a remanded item , the skull fracture, that they might still be working on? Then again would that not be included in the TBI rating???not sure .....your lawyer would know You don't owe anyone here or at VA any apology at all, in my opinion, because an award, that was generated by the BVA ,means VA should apologize to You because they couldn't do this right in the first place.! I wish more claimants would show your perseverance....... and be willing to do the leg work you did. Time for you to relax!!! Let's hope the actual cash does not take too long to arrive.      
    • Dro Review Processing Time
      Tomio, have you sent the Mandatory New & Material Evidence that is required for either the DRO Review or DRO Hearing? Failure to do so, will guarantee an Administrative Denial of your Appeal, next stop BVA. Semper Fi
    • Code Sheet
      What NOD said. I've had (2) Secondary Claims recently, 14 & 15. No re-exam's were ordered for the Primary SC, only C & P's for the Secondary issue. When I reviewed the C & P DBQ's, the Dr's indicated that the Primary Condition was already "SC'd," no further discussion. The 2015 Secondary FDC, was Awarded 07/15 SC 0%. Unknown to me, A VA Phantom SR Rater, review the Award, although the Secondary remained at 0%, he/she bumped the Primary SA SC from 50 to 100% 12/15, based on the Secondary Award. Semper Fi

  • HadIt.com Veteran to Veteran providing FREE information and community to veterans since 1997.

    I am proud that I've been able to offer all that HadIt.com has for free for 19 years and continue to do so. HadIt.com does accept contributions to help with costs we also offer paid ad free subscriptions. None of the paid options are required. The forum, the website, news site and podcast are free and will remain so. If you choose to support the site with a contribution or a subscription it is appreciated but never required. If you choose to make a contribution or purchase an ad free subscription, you can do so here. 

Sign in to follow this  
Followers 0
RayH

Enbrel And Humira Prescriptions

7 posts in this topic

I am currently on Active duty and going through a MED Board. I take Humira shots for my AS. Does the VA cover these? They are taken every two weeks and cost about $700.00 ea. I was wanting to know because when I get out and if the Board doesn't rate me high enough (>3 0%)to keep tricare I would like to get them through the VA.

Share this post


Link to post
Share on other sites







I am currently on Active duty and going through a MED Board. I take Humira shots for my AS. Does the VA cover these? They are taken every two weeks and cost about $700.00 ea. I was wanting to know because when I get out and if the Board doesn't rate me high enough (>3 0%)to keep tricare I would like to get them through the VA.

I'm not sure if the VA will cover Embril, but I have was diagnosed with AS for over 38 years ago. I have a good if not the best private Rheumatologist and he suggested Embril right after it was approved for AS (Ankylosong Spondylitis-Rheumatoid arthritis mostly involving spine and larger joints.) I was curious as to whether you started soon after the diagnosis, and how it works for you. My Blue Cross did approve the shots or me, but at that time Embril had on their website a chat on discussions of how well it worked....there were many with SERIOUS side effects and many saying it woked great, but stopped working after a short while. I researched the drug and even called the Manufacturer who had an on-duty Registered Nurse. I have had skin cancers and problems with chronic sinus infections and quite a few kidney-urinary tract infections. The Nurse would NOT tell me not to try Embril, but after expalining all my chronice infection problems(whcih the drug manufacturer reccomends NOT taking it if you have chronic infections of any type) well I asked the Nurse if she were me, would she take it and she said NO. Also the fact that I have NO confidence in the FDA approving ANY drug, made my decision to not take it. My Doctor pushed it, I'm SURE he got a good kick-back on prescribing it, but it scared me.

Share this post


Link to post
Share on other sites

I too was hesitant on taking the Enbrel. I decided to start taking it after I got severe IRITIS twice. My Optamologist recommended it after my Rheumy did. It worked very well for about a year then I was having a lot of painful flareups in my hips, shoulders, etc,........ My Rheumy(Navy Doc) offered to switch me to Humira. I did so a few months ago. I am having less flareups. We shall see how long (hopefully a long time) this works. I am currently going through a MED Board and would like to leave knowing that I can get the medicine cheaper than paying for the whole cost out of my pocket.

I hope you are doing fine w/o taking it. I would probably feel the same way you do if I had the health issues you did.

Are you rated by the VA with your AS?

Share this post


Link to post
Share on other sites

I started having problems while in the service with AS and within a week after I got out, I was hospitalyzed for over a week...not being able to walk because of the pain. Back then, 1969-70, no one could diagnose what my problem was....I went to approx 15 Doctors. I know AS is supposededly a genetic thing and I have a positive HLBA 27, but not one out of 8 siblings had this. I just worked around it with lots of OTC pain medications for several years until I was sent to a specialist who diagnosed it in 1980. I knew I still carried schrapnel from a booby trap in Nam and some say AS is caused from bacteria etc and I sure had enough of that in Nam, so I filed and went all the way to the BVA with my claim for AS and was denied...this was before we had the COVA... so I had no where to go. I waited awhile and filed again under joint pain etc and was awarded 20% which was later moved up to 40% to include degenerative disc disease. I didn't know at the time, but the 4 or 5 denials that my AS was service-related was a blessing in disguise. I worked for about 18 years as a Postal City Carrier until I just plainly could not do it anymore, and anyone who has worked for the Postal Service knows there is NO help at all for a disabled worker, I applied for over 40 jobs with a low score of 105 on the Civil Service exam, because I had 10 points added for Purple Heart, anyway EVERY single one was turned down and as they say, they just plain wore me out. I had been having more problems with Supervisors etc and the VA had awarded me 50% PTSD. I finally got fed up and asked for a raise on the PTSD, the C&P Psychiatrist wrote in his Report, "I am ordering this patient to stop work immediately, he is totally and permanently disabled from PTSD." Meanwhile, my Board Certified Rheumatologist had gotten my AS approved as permanently aggravated by my job duties. He had been trying to get me to stop work for some time....so the day I came home from the VA C&P, I turned in papers to the Postal Service for Civil Service Disability, OWCP related total Disability from AS, and I filed for SS Disability. The key is you CANNOT draw Federal OWCP and VA Disability for the SAME condition, so I never mentioned my PTSD on the OWCP application. I also filed for an upgrade to 100% from the VA. The SS approved me within 30 days..no examination..actually I talked to them and told them I knew I had enough quarters for SS Disability, but since I had not paid into SS for the 18 years I had worked under Civil Service, hence not enough RECENT quarters for SS, but I wanted the free Medicare Part A. OWCP and Civil Service approved within 60 days for AS Disability and I chose OWCP since it paid more and the VA approved 100% PTSD within 60 days. So their screwing me all those years turned into my benefit financially, since I then had 100% for AS under OWCP and 100% for PTSD under VA and by law they both had to pay. OWCP and Blue Cross, which I kept, both agreed to pay for the Embril, but I go for 6 weeks physical therapy about 3 times a year, OWCP paid to add a room on to my my house and paid for the hotub to go in it, they bought me an adjustable, raise up and down, and massage type bed. They purchased a tens unit, and I still take nsaids and approx 4 percocet a day...the pain gets old and at times it's very very hard, but I keep holding on...I can't do anything, but that grows on you too. I was told that AS sometimes settles down after some years, but I have had it since 1970, diagnosed in 1980 and it has never faded out with me. I still say it was from the bacteria, nasty water, chemicals, etc etc and or either from the schrapnel, but now it doesn't matter anymore where it came from...I'm stuck with it. Good luck with your treatments! The best thing to do is probably contact your VAMC and talk to the Cheif of Pharmacy and see what he says about it, since it FDA approved treatment, if your doctor pushes it, it can probably be gotten through the VA.

Share this post


Link to post
Share on other sites

You can call any VAMC and ask the Pharmacy what their policy is. Cause it is so expensive I bet that they will either require a specific Doc to write your prescription or will say no it is not on the formulary. In that case if you have your treating Doc write that a substitute is not acceptable and you need the med they will have to prescribe it to you. When you get out no matter what your rating I think the VA has to treat you with no copays.

Good Luck

Share this post


Link to post
Share on other sites

Thanks,

I will call the VAMC and inquire.

Share this post


Link to post
Share on other sites

I am assuming all VA's are the same but I believe that may not be incorrect. I know the Tampa VA carries both. You have to have tried and failed all other meds it takes about 4 weeks to get approved.

I got it but decided not to use it. I am a diabetic and have frequent infections with another disease process.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
Sign in to follow this  
Followers 0