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


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    • New Va Pain Medication Policy
      I've responded on this thread in the past, and would like to update.  After 7 years of successful pain management; I took some advice from the message board and reached out to various "up the chain" types...and thought the Director of Pain Management at VA Palo Alto, CA had actually re authorized me back into Veteran's Choice program where I was being treated for my pain for 3 subsequent visits, was on the road for treatment for a procedure that VAHC had not even mentioned, (all of this after VA had "red flagged me as DRUG SEEKER")understand I have never deviated from requesting increase, missed appointments. Nothing.  Today, I get call from same Director of Pain Management, since I have not heard from Vet Choice about the reauthorization, that I was mistaken, he could offer me nothing but traveling the 40 miles to his clinic and of course that would be NO Opioids. I cannot travel the normal transportation route, and he assured me he had listed me, as Undue Travel Burden, but he would still not reauthorize. Have a nice Day! So, you tell me- how with all these qualifiers; and my Severe Pain that the Spine Specialist in my Community has agreed to treat Veterans, is only 3 miles from my home; has more compassion than those treating Veterans? Did I mention, that my Opioid meds has not changed in 7 years? Is anyone in Washington listening? Honorable Dr. DavidJ. Shulkin, your New Veteran's Choice guidelines don't mean anything to these people that have to care for us Veterans.  I was a Medical Officer for 9 years caring for thousands of brave Men and Women who served this Wonderful Country and I am appalled at the service and the way I am spoken to by the staff at the VAHC and told if you want Narcotics "Go Buy a Health Care Plan."  I say to them- without my Service to this Great Nation they would not have a job, and now they are talking to us like we are their BURDEN? If not for us, willing to Wear the Uniforms and guarantee their freedoms, they couldn't get a job except working at a County Teaching Hospital. 
    • Choice Program
      I've responded on this thread in the past, and would like to update.  After 7 years of successful pain management; I took some advice from the message board and reached out to various "up the chain" types...and thought the Director of Pain Management at VA Palo Alto, CA had actually re authorized me back into Veteran's Choice program where I was being treated for my pain for 3 subsequent visits, was on the road for treatment for a procedure that VAHC had not even mentioned, (all of this after VA had "red flagged me as DRUG SEEKER")understand I have never deviated from requesting increase, missed appointments. Nothing.  Today, I get call from same Director of Pain Management, since I have not heard from Vet Choice about the reauthorization, that I was mistaken, he could offer me nothing but traveling the 40 miles to his clinic and of course that would be NO Opioids. I cannot travel the normal transportation route, and he assured me he had listed me, as Undue Travel Burden, but he would still not reauthorize. Have a nice Day! So, you tell me- how with all these qualifiers; and my Severe Pain that the Spine Specialist in my Community has agreed to treat Veterans, is only 3 miles from my home; has more compassion than those treating Veterans? Did I mention, that my Opioid meds has not changed in 7 years? Is anyone in Washington listening? Honorable Dr. DavidJ. Shulkin, your New Veteran's Choice guidelines don't mean anything to these people that have to care for us Veterans.  I was a Medical Officer for 9 years caring for thousands of brave Men and Women who served this Wonderful Country and I am appalled at the service and the way I am spoken to by the staff at the VAHC and told if you want Narcotics "Go Buy a Health Care Plan."  I say to them- without my Service to this Great Nation they would not have a job, and now they are talking to us like we are their BURDEN? If not for us, willing to Wear the Uniforms and guarantee their freedoms, they couldn't get a job except working at a County Teaching Hospital. 
    • getting run-around by dental clinic
      In part, I agree, and in part do not! Turns out that the VA has a mantra about least cost when it comes to treating veterans. Private providers do have a profit goal to attain. It comes down to what the patient prefers, and what is the best for the patient. (Not the VA, provider, etc.)  
    • PTSD with questions
      I was actually thinking the sleep apenea and fibro secondary  to the back, I can't sleep but about 3 to 4  hours  a night my pain increases.  I know it is from being overweight  that once I hurt my back in the AF I was not able to exercise and the weight joined me so with the sleep apenea and fibro has made life almost miserable an then two months ago I was diagnosed with type 1 diabetes. Can the c-file be requested from ebenefits? Thank you for your quick response.  
    • PTSD with questions
      Rita, Welcome to hadit. You are at the right place.  There are NO dumb questions other than questions about how to succeed with a false/fraudulent claim. PTSD due to MST is covered by several knowledgeable veterans here.  They will chime in shortly. The evidence requirements are different than combat PTSD.  I don't believe they are any easier or harder, but they are different.  If you are suffering from PTSD resulting from events that occurred during your military service, file a claim for it.  I have never even heard of SA or fibro being secondary to PTSD. I am not certain if either could be an adequate stressor for PTSD.  Increased chronic pain from a SC condition can certainly be the basis for an increased rating. I did not claim PTSD until 40 years after I left active duty.  I was "boots on the ground" in Vietnam with combat awards, so my claim was really a walk in the park for me.  The 30% award did nothing to my monthly compensation, but I wanted all of my bases covered so that my wife will have no problems with DIC when I croak. C-File is your DVA claim folder.  It would be wise to request a copy right away because it takes a while for the VA to provide c-file copies.  Your military records may well contain evidence in the manner of behavioral changes after the event regardless of whether or not you reported it.
    • Aortic valve /ihd
      He also has an appeal in for increase in diabetes ,. He is on Lantus solar star pen and humalog quick pen.  Private dr filled out DBQ and wrote a prescription for restricted diet and activity.  Also filled for renal failure third stage secondary to diabetes.  Private nephrologist filled out DBQ with a diagnosis of diabetic renal failure type2. And diabetic nephrology.  Both were denied.  I don't think they read anything .  They said they did not feel his diabetes had progressed that much.  His aid 8.1.  They said renal failure was denied because he had no proteinuria in his urine sample.   And you had to have proteinuria in your urine to be renal failure.  I was reading online kidney foundation, that you do not always drop proteinuria.  And we were reading over the cp file again and it ask if the veteran had diabetes on it and they did not even check it. And on one spot on it it said his bun was 19 and said it was high.  Then on another spot it said bun was 19 and said it was normal.  It did have gfr at 40 and said low.  But it is like the gfr was just kind of over looked or ignored completely.  And that is the number one way, according to national kidney foundation,  to check if kidneys are dysfunctioning.  They said there was NO dysfunction of the kidneys.  Now on the DBQ from private dr says there is kidney dysfunction.    I picked up all his labs since he has had renal failure, and all the gfr are to low.  Some as low as 34.  Thanks everyone .  And Berta I'm so sorry you had to go thru all that stuff with the va..  And sorry for your loss.
    • Knee Condition
      Can the va refuse to increase my rating since my issue has worsened outside of the military? I am in a profession which requires carrying equipment and a vest. So without a doubt the weight has had an effect on my knee. I reported the injury to my work as well. Not sure if this can effect my claim. I'm thinking about revoking my claim through my employer. Since it is cared through from the VA. At the time I wasn't sure if it was related to my previous patellar injury. 
    • Aortic valve /ihd
      Berta he was seeing a private cardio.  And I kept asking him if he had ihd and he kept saying no.  And after the surgery I saw on his one piece of paper said cad, so I ask if it was the same, and he said yes.  You are right he did not get to 60 overnight.  But maybe his mets were lower because of the valve problem .  I know the surgeon told me and our daughter his heart was enlarged.    Now I think it was in 2009 he had lung embolism, and they could not say where the clot came from.  I'm suspecting it came from the heart.  He only goes to va for cp exams.  We have tricare and Medicare?  
    • PTSD with questions
      I have been going to mental health care at my local VA, I have been out of the service for 20 or more years and he recommended that I file for PTSD, based on what I have told him. I do not have anything in my medical records from active duty to confirm this nor witnesses since I did not report being raped. How in the world do I file for this? I am also service connected for my back and am seeking an increase due to excessive pain and wanting to include sleep apenea and fibro as secondary conditions would that go with my back or would I list as secondary to the PTSD. Dumb question but what exactly is a c-file is that my military health file?   Thank you all in advance for your help.
    • C&P Re-Exam - REPHRASED
      Your ok   Good news is coming

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USSOkiewife

Va Using Ssd Disability Rating

8 posts in this topic

We recently learned the VA has used an original SSD records for disability to establish a low SC rating for PTSD. My husband has all the criteria for SC PTSD - combat ribbons, etc. He was given a low 10% SC for PTSD as the SSD records hold no evidence of PTSD, but determine his serious mental health condition to be Schizoaffective disorder. Later medical evidence ( C&P) discovered the PTSD and established it as being the main mental health condition, even pointing out that without the trauma piece a correct diagnosis was possible. The VA agree his condition is severe but points to the SSD records done before his claim for SC PTSD as being the major mental health issue - one which, due to its lack of earlier connection - to be non-service connected. Has anyone elsehad this problem? He is appealing the low rating and it looks to be in his favor.

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Does the VA have your husband rated for PTSD or is it using Social Security to award to claim his PTSD is after his service?

What is 20% rating for?

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If your husband served in combat and got honorable discharge for a full period of service I think the schizoaffective disorder DX is suspect. He probably needs a private doctor to rebutt the VA's contention that PTSD is a minor % of his total disability. Was he ever treated for any mental health condition in the service? I think it is impossible to separate out MH disorders if there is a stressor like combat service. This stress could be the ultimate trigger for any MH condition. Probably many vets got medical discharges for MH conditions before PTSD was even recognized. When soldiers have complete nervous breakdowns due to acute combat fatigue what are the residuals of that in later life? No one knows.

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I have encountered several claims where the VA used reports from outside agencies to discredit a veterans claim. I was successful in having the reports from the outside agencies thrown out by a DRO. The reason the DRO will throw out the reports is because reports from the outside agency were not developed in accordance VA evidence rules.

You need to file an appeal for an increase in the 10% PTSD rating if you disagree. Have a service officer assist you. To support your appeal you can take a full attack. You need to discredit Social Security report and strengthen the claim for PTSD. It is most important to strengthen the claim for PTSD. In the long run the Social Security report should have no bearing on the claim. It is entirely possible that the Social Security report was not really the reason the claim was low balled. They could be citing Social Security report just to confuse you. You'll spend so much effort discrediting Social Security report that you will forget to strengthen the PTSD rating. You can file an appeal with no new evidence and hope a DRO will see through the problems. However, I would obtain new reports from clinicians as described later in this post.

Your first attack will be to identify exactly how the PTSD was rated. The exact language in the rating decision is important. Raters do not use any single criteria, measurement or descriptive language of the disability for the purpose of assigning a percentage. They are allowed to base their rating determination on what they perceive as the overall diagnostic picture. This incorporates GAF scores, records of hospitalizations, treatments, and negative impact on social and industrial functioning.

It appears that there have been no treatments or hospitalizations. You did not discuss any inability to obtain or maintain employment. You did not discuss any difficulties in interpersonal relations. You do say that the VA agrees his condition is severe. Who at the VA told you this? Was it some guy sitting behind a desk? What does the C&P exam say in regards to the disability.

It is hard to rely on reports from examining physicians. This includes Social Security and VA compensation and pension exams. The strongest evidence would be from treating doctors. I would recommend that your husband enter a treatment program either at a VA hospital or a veteran’s center. They pretty much know what to do. However, they need to assign a new GAF score. They need to identify how the disability affects employment and social functioning. The best way to advance a claim is with new and stronger evidence.

It should be fairly easy to shoot down for Social Security report. Especially since the C&P examiner commented that the schizoaffective disorder did not take into consideration the criteria for PTSD. The schizoaffective disorder diagnosis appears to me to have been based on a single exam. Did Social Security have any treatment notes available to them prior to the exam they performed?

It also appears that the rater may have over used or abused their discretionary power. The weight given to each diagnosis in a case which involves multiple diagnoses of mental conditions is performed by a clinician on a mental health exam. The C&P examiner should have identified how much of the disability is attributed to the schizoaffective disorder and how much of the disability is attributed to the PTSD. These questions are asked on the exam worksheet. It appears to me that this comparison was not performed because the C&P examiner thought that the schizoaffective diagnosis was based on incomplete information. In the absence of such a comparison by the C&P examiner I do not feel the rater has the authority or discretionary power to fill in the blanks.

Once again, I want to restate the importance of strengthening the evidence for the PTSD diagnosis. I do not see how you can obtain a high rating for PTSD if the C&P examiner did not identify a significant impact on employment and interpersonal relations. The exact terminology could very. However, a low GAF score combined with the identification of the impact on employment and interpersonal relations would be necessary. Hospitalizations and treatment programs also add to the diagnostic picture.

I am pretty sure that there is a link on hadit to an explanation of how mental health disability is rated.

Edited by Hoppy

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Excellent info Hoppy!

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I have encountered several claims where the VA used reports from outside agencies to discredit a veterans claim. I was successful in having the reports from the outside agencies thrown out by a DRO. The reason the DRO will throw out the reports is because reports from the outside agency were not developed in accordance VA evidence rules.

You need to file an appeal for an increase in the 10% PTSD rating if you disagree. Have a service officer assist you. To support your appeal you can take a full attack. You need to discredit Social Security report and strengthen the claim for PTSD. It is most important to strengthen the claim for PTSD. In the long run the Social Security report should have no bearing on the claim. It is entirely possible that the Social Security report was not really the reason the claim was low balled. They could be citing Social Security report just to confuse you. You'll spend so much effort discrediting Social Security report that you will forget to strengthen the PTSD rating. You can file an appeal with no new evidence and hope a DRO will see through the problems. However, I would obtain new reports from clinicians as described later in this post.

Your first attack will be to identify exactly how the PTSD was rated. The exact language in the rating decision is important. Raters do not use any single criteria, measurement or descriptive language of the disability for the purpose of assigning a percentage. They are allowed to base their rating determination on what they perceive as the overall diagnostic picture. This incorporates GAF scores, records of hospitalizations, treatments, and negative impact on social and industrial functioning.

It appears that there have been no treatments or hospitalizations. You did not discuss any inability to obtain or maintain employment. You did not discuss any difficulties in interpersonal relations. You do say that the VA agrees his condition is severe. Who at the VA told you this? Was it some guy sitting behind a desk? What does the C&P exam say in regards to the disability.

It is hard to rely on reports from examining physicians. This includes Social Security and VA compensation and pension exams. The strongest evidence would be from treating doctors. I would recommend that your husband enter a treatment program either at a VA hospital or a veteran's center. They pretty much know what to do. However, they need to assign a new GAF score. They need to identify how the disability affects employment and social functioning. The best way to advance a claim is with new and stronger evidence.

It should be fairly easy to shoot down for Social Security report. Especially since the C&P examiner commented that the schizoaffective disorder did not take into consideration the criteria for PTSD. The schizoaffective disorder diagnosis appears to me to have been based on a single exam. Did Social Security have any treatment notes available to them prior to the exam they performed?

It also appears that the rater may have over used or abused their discretionary power. The weight given to each diagnosis in a case which involves multiple diagnoses of mental conditions is performed by a clinician on a mental health exam. The C&P examiner should have identified how much of the disability is attributed to the schizoaffective disorder and how much of the disability is attributed to the PTSD. These questions are asked on the exam worksheet. It appears to me that this comparison was not performed because the C&P examiner thought that the schizoaffective diagnosis was based on incomplete information. In the absence of such a comparison by the C&P examiner I do not feel the rater has the authority or discretionary power to fill in the blanks.

Once again, I want to restate the importance of strengthening the evidence for the PTSD diagnosis. I do not see how you can obtain a high rating for PTSD if the C&P examiner did not identify a significant impact on employment and interpersonal relations. The exact terminology could very. However, a low GAF score combined with the identification of the impact on employment and interpersonal relations would be necessary. Hospitalizations and treatment programs also add to the diagnostic picture.

I am pretty sure that there is a link on hadit to an explanation of how mental health disability is rated.

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We just learned his SC-upgrade for pTSD is to be heard by the traveling VA review board - we had to make this request last year due to an approaching dead line - the latest C&P test once again came back supporting a High PTSD rating - 2 diviants above what is required by the VA for PTSD in Viet Nam Vets. He is now listed as severe PTSD and fits the criteria for 70% SC. He has been hospitalized twice at different VAMC treating pTSD. Will he still need to see this review board from Washington DC? The latest examiner explained where he percieved the confusion to be that led to husband's being diagnosed earlier as nc schizoaffective disorder - his repressing the trauma - which is documented and acknowledged by the VA which forced them to at least give him the rating of 10% SC ptsd- the first C&P rater fell in line with SSD and said the majority of husband's mh symptoms were non service connected - agreed though that they were severely debilitating in nature. The following C&Ps explained why the PTSD was not listed - simply because he would not talk about the event. Those C7Ps clearly state the real culprit is PTSD. How do we get this upgraded? We have been told there is a two year wait at least to be seen by this review board?

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We just learned his SC-upgrade for pTSD is to be heard by the traveling VA review board - we had to make this request last year due to an approaching dead line -

USSO,

Are your referring to a BVA Hearing ?

carlie

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