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How to Get your VA C-File




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    • CUE? Not using SMR?
      Yes, if they notice the CUE they can adjust on their own.  I just had the EED adjusted on my initial claims for asthma and left ankle, the rater looked at my entire record while processing my unadjudicated claim for diabetes.  He immediately file a cue and adjusted the EED.  I didn't have to do anything for the EED/CUE. However, my ED was actually a CU they started them in 98 vs. 97.  
    • C&P Exam Results, WTH is going on, Please Help!!!
      Agree with killemall. You got this Navy04, we can't wait for you to come back here and say DONE!    
    • Code Sheet
      Thanks Asknod My problem is finding out the code for the disability.?? PTSD Code has it at 9411&9435 Code for Unspecific Depresssive Disorder VA Notes from  PCP  has PTSD  As : SCT47505003  My Sleep Apnea Notes has the code as SCT 73430006, Some of these I get confused with Insurance Codes  for Insurance Purposes. Jbasser & Jerrel Cook had a blog talk radio show on these rating codes Last year some times Maybe I'll recheck the Archives Shows. I tried to look up the code for OSA but never found it. just the SCT #73430006..?  And I have a Boo-Coo List of NSC disability's/contentions.  with the SCT# at the end of them
    • Auto Adaptive Reimbursement
      Update. My friend talked to the head of prosthetics in Tucson(kristine) and she informed him that the VA will not cover some items like power options,automatic transmissions and a few others.(I can't remember the list of things he told me).These were all covered by the VA previously.
    • NOD / DRO or TARP?
      All, Thank you for the response's. Due to me posting all of my documents intermittently, there seems to be some confusion with the timeline and issues. I will attempt to run thru this chronologically and repost all documents including my 2015 decision which I had not previously posted and answer all questions. March 2009- Filed original Claim for the following issues and received results October 2009 (see 2009 - Rating Sheet below) I do not have the entire decision packet: TBI - 10 % SC Residuals, gallbladder removal - 0% SC Back Condition - declined SC Psoriasis - declined SC PTSD - declined SC / Stressor conceded as combat action badge. October 2010 - Filed NOD / DRO for PTSD March - 2011 - Appeal decision received. I never stated that PTSD was due to MST. The paragraph on page 2 of 2011Appeal decision below is just the last part of 10 pages that I cut out covering rules and US code that they sent in the letter. The actual decision starts at the bottom of that page. Results: PTSD declined - I did not submit any new evidence. Diagnosed as "adjustment disorder with mixed anxiety and depressed mood". Blamed on me worrying about my husband returning to Iraq, even though he had just returned??? October 2014  - Initiated following claims: (I had transferred to the North Texas VA and had finally began receiving treatment after being fed up with OKC VA. I live in southern Oklahoma, so its a drive for me to go to either one) PTSD - Re-open Claim. TBI - Request for increase. May 2015 -  I reported for C&P exams at the Dallas VA clinic for PTSD and TBI. I'm not sure if this is relevant, but I received a call while my husband and I were driving there stating that the TBI examiner had to leave early and they would have to re-schedule that exam. I protested because it is a 3 hour drive. They called me back 10 minutes later stating that he would conduct the exam. He seemed pissed the whole time. His notes stated that No TBI residuals were present.  This is also the exam where the PTSD screener stated "However, it should be pointed out that most of the symptoms the veteran described during today's MH examination certainly those common to a PTSD diagnosis- she also described during her 7/8/09 Initial PTSD examination, in Oklahoma City, three years PRIOR to her son's illness."  ( see 2015 C&P exam notes below) June 2015 - Latest decision received. Results (see 2015 - decision part 1 &2 below): TBI - Decreased to 0% SC PTSD - 50% SC May 2016 - Wondering what my best next COA should be? Would like to get PTSD effective date back to 2009 and get TBI increased to at least percentage it was before. I have about 50 days to file my NOD. Q&A: Berta: What did the C & P doc diagnose you with? 2009 - TBI (SC) and adjustment disorder with mixed anxiety and depressed mood (not SC) 2015 - No TBI residuals and PTSD w/ major depressive disorder.   Berta: Have you googled the doctor who did the C & P? I do not know the Doctor's name from 2009. But I have found several articles referring to a Dr. Gail Poyner who was conducting PTSD exams at OKC VA at the time. She was fired from the VA in 2010 for applying test to Veterans to see if they were malingering or faking. Her research paper can be found here: http://link.springer.com/article/10.1007%2Fs12207-010-9076-x?LI=true I would like to have my C-File to see if she conducted the evaluation.   Gastone: What did you claim as the PTSD Stressors in your 09 app for PTSD? Combat Action Badge   Gastone: The 1st Denial, discussed "No Evidence of Personal Assault," MST? No MST ever claimed. The paragraph that covers PTSD due to MST was just the last paragraph of 10 pages of regulations that they sent with the decision. Actual decision starts at the bottom of that page.   Gastone: Did you know anything about the DRO Process Requirement, for the N & M Evidence? I did. My fault I didn't send any. I was fed up with OKC VA and assumed they would send me for a new C&P exam. Stupid on my part.   Gastone: Did you ever get a copy of your 09 PTSD C & P DBQ? No, I did not. Blue button records do not go back that far. I have requested a copy of my C-File. EBenefits states that I will get it between NOV 2017 and NOV 2018.   Gastone:  Do you currently have a VA MH Psychiatrist/Psychologist that treats you on a regular basis? I was being seen at Bohnam, TX VA. After they kept switching Dr's a few times, I now just get my meds re-filled thru my family physician. My husband is active duty, so we are on tri-care prime remote. I also qualify for VA choice, but have not used it.   Gastone: Have they given you an official PTSD DX? I have a PTSD diagnosis and receive 50% SC in 2015.   Berta: Did they have the incident reports? I faxed in two incident reports. They do not show on the evidence list, but stressor was conceded with CAB.   Flores97: Email congressman for C-File. Thank You for the advice. I emailed my congressman today and reiterated the time crunch I am under.     2011 - Appeal decision.pdf 2015 - C&P exam Notes.pdf 2015 - decision part 1.pdf 2015 - decision part 2.pdf 2009 - Rating Sheet.pdf
    • Full Knee Replacement
      I just came back from the Ortho doctor in town he said I need a full knee replacement for my service connected injury after looking at past 11 years of x-rays from the VA and what he just took today. The Marine Corps. somehow don't keep x-rays after a certain period of time. The VA says they will not do one until I'm 60 years old, all they wanted to do was give me injections for the pain. What I have now is a Torn ACL and I'm running bone on bone, and my knee cap is just about gone so here is the question. I already receive 20% for my left knee, due to the past 3 surgery's. So after having the knee replacement what will I be looking at? for an increase? Does the VA have to pay for this since I live 178 miles from the Nearest VA hospital? because they are still telling me if you were injured on active duty you must go to the VA hospital even through the VA says They will not do a knee replacement until I'm 60? I already talked to two Veterans in town at the Vet center and they had the same problem but they paid for it out of their own pocket for the surgery then filed for an increase award. So far they are still waiting for the VA to answer them back. any ideals on the best route to take? I hate to get this done out in a local hospital then fine out the VA will not pay and give me an increase for the full knee replacement. Thank for any information on this subject.
    • CUE? Not using SMR?
      I'm trying to piece together every decision and the docs from the c-file. I cannot for the life of me find the evidence listed as "treatment records from VAMC dated Sept 2003 and received 10-23-03.  Are they required to have the actual document/documents in the c-file as evidence? Also, there certainly were more progress notes about the foot conditions outside of Sept 2003. Would they have been required to get all records on condition from the VAMC?     Thanks as usual!
    • Code Sheet
      A filing for a disease secondary to an existing one is not an increase. Each disease that evolvves as a secondary is a stand alone claim. If you win, the rating diagnostic code will be an amalgam of the primary rating such as DC 7354 for hepatitis C and the second disease such as Porphyria cutanea tarda. The rating sheet would read 7354-7815. I have two like that. the other one is 7354-7700 ( 60% anemia -old 1994 DC 7700). I appealed for 100% for it based on the similarity to 4.115a (dialysis) because there was no 100% rating for porphyria phlebotomies-just 40% under DC 7704. It's called rating by analogy when there is no specific code for a disease/injury. Look at 38 CFRs 4.20 and 4.27   § 4.20 Analogous ratings. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin § 4.27 The diagnostic code numbers appearing opposite the listed ratable disabilities are arbitrary numbers for the purpose of showing the basis of the evaluation assigned and for statistical analysis in the Department of Veterans Affairs, and as will be observed, extend from 5000 to a possible 9999. Great care will be exercised in the selection of the applicable code number and in its citation on the rating sheet. No other numbers than these listed or hereafter furnished are to be employed for rating purposes, with an exception as described in this section, as to unlisted conditions. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” as follows: The first 2 digits will be selected from that part of the schedule most closely identifying the part, or system, of the body involved; the last 2 digits will be “99” for all unlisted conditions. This procedure will facilitate a close check of new and unlisted conditions, rated by analogy. In the selection of code numbers, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With diseases, preference is to be given to the number assigned to the disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. Thus, rheumatoid (atrophic) arthritis rated as ankylosis of the lumbar spine should be coded “5002-5240.” In this way, the exact source of each rating can be easily identified. In the citation of disabilities on rating sheets, the diagnostic terminology will be that of the medical examiner, with no attempt to translate the terms into schedule nomenclature. Residuals of diseases or therapeutic procedures will not be cited without reference to the basic disease.
    • CUE? Not using SMR?
      He had 3 0% disabilities that were combined to make the 10%. I guess that ended when he was awarded 30% PTSD IN 2003. 
    • Auto Adaptive Reimbursement
      He deals with a rep in Tucson but I think that falls under Phoenix.It was the Tucson rep that told him that they stopped doing it.I found the link you posted before I asked the question on here.I just wanted to make sure it was still an active program.I will pass this on to him.Thanks.

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troyez

Calcified Granuloma In Lung

4 posts in this topic

After a chest X-ray for a respiratory infection, and subsequent CT scan, I found out that I have a calcified granuloma in my right lung. I've heard that it is caused by some foreign body that was inhaled into the lung (mold, asbestos, etc.), and that it may or may not be serious. I've had moderate pain in the area for the last 2+ years, but thought it was from an old rib injury. I lived in several different barracks (old) while in the Army, and the last building had black mold growing on all the air ducts, above the dropped ceiling tiles there was asbestos tape on the pipes, and rats infested the building. I am not exaggerating one iota; it was B quad of Schofield Barracks (the old buildings), in case you're wondering. I lived in the barracks the entire 3 yrs I was in the Army, so I breathed whatever was in my room(s). We who lived in the barracks complained to our chain of command about the mold, asbestos, and rats, but our 1SG told us we could always stay in tents instead of the rooms.

Before I was discharged I filmed the black mold on the vents, and did a home mold test on the room, and have kept the tape and the mold test results.

My question is, do I have a case with the VA for calcified granuloma in my lung?

I'm pretty worried about whether it is from asbestos or mold (or rat crap!). Ideas?

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I would file a claim if I were you.

http://www.mayoclinic.com/health/granuloma/AN00830

It doesn't sound serious but then again could it cause additional problems? I dont know.

Histoplasmosis - the calcification- can come from mold.

There are many other problems but if you have inservice proof of black mold exposure ( which made me ill once-that stuff is awful) you could use the inservice photos as evidence of exposure.

It is possible VA wll try to say that post service exposures to mold etc caused this. I dont know how soon the calcfication would show up in an Z ray.Or after exposure but if you do a little research on the net , it will help you determine if this is a ratable condition and if yo had any other inservice exposures that could cause it.

Even if they award but only at "0' or 10 % if this somehow aggravates any further lung conditions (which I hope you never get) then the SC would have been established for it and VA would have to rate the level of aggravation.

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This BVA decision gives some rating information for this disability.

http://www4.va.gov/vetapp00/files3/0029081.txt

Did you have any bronchial or respiratory problems noted in your SMRs? DO you have those problems now?

A search under your condition at the BVA web site will reveal about 400 claims with this condition noted.

If I were you I would read some of the most recent ones to see what evidence the VA might need.

Edited by Berta

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After a chest X-ray for a respiratory infection, and subsequent CT scan, I found out that I have a calcified granuloma in my right lung. I've heard that it is caused by some foreign body that was inhaled into the lung (mold, asbestos, etc.), and that it may or may not be serious. I've had moderate pain in the area for the last 2+ years, but thought it was from an old rib injury. I lived in several different barracks (old) while in the Army, and the last building had black mold growing on all the air ducts, above the dropped ceiling tiles there was asbestos tape on the pipes, and rats infested the building. I am not exaggerating one iota; it was B quad of Schofield Barracks (the old buildings), in case you're wondering. I lived in the barracks the entire 3 yrs I was in the Army, so I breathed whatever was in my room(s). We who lived in the barracks complained to our chain of command about the mold, asbestos, and rats, but our 1SG told us we could always stay in tents instead of the rooms.

Before I was discharged I filmed the black mold on the vents, and did a home mold test on the room, and have kept the tape and the mold test results.

My question is, do I have a case with the VA for calcified granuloma in my lung?

I'm pretty worried about whether it is from asbestos or mold (or rat crap!). Ideas?

You really need to stay on top of this, it is something that cuold be caused by any number of things none of which are good. You will probably need a biopsy to determine the exact cause, for this they will do a bronchoscopy. I recommend you ask for a referal to pulmonology, they are the ones whowill do the bronch. If you don't mind would you keep me posted of the outcome.

Bergie

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