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    • Almost Done
      Have you checked your AB8 letter on ebenefits? I think it all depends on when your VARO updates your claim information. 
    • Appeal Closed in Ebenefits
      Hello,   I had three apeals for effective dates close on Jan 29, 2016. I received a letter from BVA on Feb 8, 2016 stating they were granting an earlier effective date for my 100% service connection. The original effective date was 2/03/2013 and now it's 2/04/2012. So my question is how long should I expect it to take for retroactive to hit my account? I've won one other appeal through BVA in 2010 for my 50% rating and retroactive hit within 3 weeks of the claim closing. My claim is flagged with hardship. Any advice would be appreciated.    Thank you!
    • New guy...active duty...C&P question
      Got my account upgraded and can read my C&P notes. No where for any of my conditions does it ask is it likely or not for service connection...think that is because I am still active? Every claim was noted as abnormal, with reduced range of motion, except my wrists claim. Also my fatigue and sleeping issue was noted to have been taken care of under my mental health questionarre...Im guessing those are not going to be separate claims, just rolled into the one?
    • TKR; Arthritis and in service fracture
      bronco, wouldn't this warrant a CUE?
    • TKR; Arthritis and in service fracture
      That's what I thought, when he said it, Iceturkee.  It sounded like he wanted me to sabatoge my 2005 effective date, giving VA and excuse to make it later.  Why dont they just adjuticate it now, and admit they made a mistake overlooking it for 11 years?  
    • Car Loan Disability Insurance
      That looks like you got the loans before you were disabled, so maybe.  
    • PTSD with questions
      Do you have a SA DX? If so, linking it to a Future PTSD DX, won't work. The SC causative DX must be in place prior to the Secondary DX. Does your VMC MHV Medical Record indicate PTSD as one of your issues? Do you have a long history of MH treatment that could help in laying a Paper Trail back to your MSA? Is there anyone you confided in or who noticed and commented on a perceived personality or mood change about that time? A New PTSD claim, based on a both non-treated & non-reported MSA from the early 90's, is going to be very difficult. The PTSD Forensic C & P Psychiatrist/Psychologist PhD will be the final arbiter, as to your PTSD DX. Review the VA PTSD DBQ. Semper Fi  
    • Knee Condition
      In answer to your second question, No.  Many/most conditions get worse after service.  This is what applying for an increase is about.  Its not unusual for your conditions to deteriorate after service.  Once service connected, you can always apply for an increase.  It doesnt need to get worse in service to be service connected, tho there is something called aggravation.  Aggravation normally means you had it before service, but it got worse in service, that is, military service aggravated your condition.   Aggravation has no bearing on your claim, once you are service connected.  
    • Knee Condition
      YOu need to get records corrected.  It will save you time to do it now.  Yes, this can negatively affect your claim.  I would bring it to the docs attention, first.   1.579 Amendment of records. (a) Any individual may request amendment of any Department of Veterans Affairs record pertaining to him or her. Not later than 10 days (excluding Saturdays, Sundays, and legal public holidays) after the date or receipt of such request, the Department of Veterans Affairs will acknowledge in writing such receipt. The Department of Veterans Affairs will complete the review to amend or correct a record as soon as reasonably possible, normally within 30 days from the receipt of the request (excluding Saturdays, Sundays, and legal public holidays) unless unusual circumstances preclude completing action within that time. The Department of Veterans Affairs will promptly either: (1) Correct any part thereof which the individual believes is not accurate, relevant, timely or complete; or (2) Inform the individual of the Department of Veterans Affairs refusal to amend the record in accordance with his or her request, the reason for the refusal, the procedures by which the individual may request a review of that refusal by the Secretary or designee, and the name and address of such official. (Authority: 5 U.S.C. 552a(d)(2)) (b) The administration or staff office having jurisdiction over the records involved will establish procedures for reviewing a request from an individual concerning the amendment of any record or information pertaining to the individual, for making a determination on the request, for an appeal within the Department of Veterans Affairs of an initial adverse Department of Veterans Affairs determination, and for whatever additional means may be necessary for each individual to be able to exercise fully, his or her right under 5 U.S.C. 552a. (1) Headquarters officials designated as responsible for the amendment of records or information located in Central Office and under their jurisdiction include, but are not limited to: Secretary; Deputy Secretary, as well as other appropriate individuals responsible for the conduct of business within the various Department of Veterans Affairs administrations and staff offices. These officials will determine and advise the requester of the identifying information required to relate the request to the appropriate record, evaluate and grant or deny requests to amend, review initial adverse determinations upon request, and assist requesters desiring to amend or appeal initial adverse determinations or learn further of the provisions for judicial review. (2) The following field officials are designated as responsible for the amendment of records or information located in facilities under their jurisdiction, as appropriate: The Director of each Center, Domiciliary, Medical Center, Outpatient Clinic, Regional Office, Supply Depot, and Regional Counsels. These officials will function in the same manner at field facilities as that specified in the preceding subparagraph for headquarters officials in Central Office. (Authority: 5 U.S.C. 552a(f)(4)) (c) Any individual who disagrees with the Department of Veterans Affairs refusal to amend his or her record may request a review of such refusal. The Department of Veterans Affairs will complete such review not later than 30 days (excluding Saturdays, Sundays, and legal public holidays) from the date on which the individual request such review and make a final determination unless, for good cause shown, the Secretary extends such 30-day period. If, after review, the Secretary or designee also refuses to amend the record in accordance with the request the individual will be advised of the right to file with the Department of Veterans Affairs a concise statement setting forth the reasons for his or her disagreement with the Department of Veterans Affairs refusal and also advise of the provisions for judicial review of the reviewing official's determination. (5 U.S.C. 552a(g)(1)(A)) (d) In any disclosure, containing information about which the individual has filed a statement of disagreement, occurring after the filing of the statement under paragraph (c) of this section, the Department of Veterans Affairs will clearly note any part of the record which is disputed and provide copies of the statement (and, if the Department of Veterans Affairs deems it appropriate, copies of a concise statement of the Department of Veterans Affairs reasons for not making the amendments requested) to persons or other agencies to whom the disputed record has been disclosed. (5 U.S.C. 552a(d)(4)) (38 U.S.C. 501)

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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.

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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.

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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?

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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.

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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

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Thanks,

I will call the VAMC and inquire.

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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.

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