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    • C&P Examiner Pushed Me...FORCED
      If you feel your C&P was not evaluated correctly or the Examiner did not meet the qualifications you can request a New C&P from RO. They usually set you up another exam   However it may take longer. jmo .....................Buck
    • Miss Figured EED?
      Questions regarding EED? Vet gets denied claim for  SC 1997...Refiles claim, 1998 vet gets Service Connected  but 0% . Now in 2001 vet refiles claim and is increase to 50%...  (from 0% to 50%)  2003 vet files for increase and has C&P  after the c&p...c&p examiner sends VA letter saying this vet should not been S.C. because he never had any of this disability while in service  or any medical records showing documentation he was seen for it while in service.and furthermore vet was given an exit exam  from military service and was consider healthy and not what he is claiming .  I recommend this Veteran be reduced  at 0%compensation and with draw his Service connection Completely......Sign Dr  xxxxxxx  30 years experienced Medical Dr.  2003 Vet gets letter of Proposal to Reduce him, vet files NOD Request DRO Hearing at his RO, vet goes to his DRO Hearing  with new &material evidence, and letter  from Private qualified Dr receives a favorable  IMO  & letter from Voc rehab declaring this vet unfeasible to retrain because of his S.C. Disability, vet gets notarized lay statements from family and friends...and Veterans own statement! DRO Agrees with this Veteran and sees his disability in person, and initiates an expedition and ask VSO to file TDIU Claim for veteran and is awarded an 10% & 60%  increase to his disability  and with a 90%combined increase  using the  CFR Extra scheduler (b)  Vet is Awarded IU with P&T  and no future exams schedule this disability is of chronic and of nature  an increase is warranted and not  decrease  the examiner that proposed a decrease will not be warranted,  veteran has proved his SERVICE CONNECTED Disability  and  it goes on and state what te DRO used as evidence and with a rating specialist at his hearing  it is Obvious this Veterans disability is REAL. Question  they gave the Vet EED Back to when he filed for increase in 1998 the year he was Service connected? instead from the increase dating back to 2001? ??? After a S.C. is established  don't the EED begin at that date  even if a 0%?? Altho they have is 50% rating at  effective date1998! ...Shouldn't they have went back to 1998  the date the vet was Service Connected?  
    • PTSD Denied NSC - Schizophrenia NSC
      Berta - Here is the rating decision.   We will accept the disabilities granted for his battle wounds, but disagreement is with the PTSD and Schizophrenia being declined as service connected.   They were completely mute on the Agent Orange symptoms we claimed.   The C&P exam performed in April was not included with the VA papers.   I don't know what the Examiner said about his physical and mental condition.   Need help on this: Do I indicate acceptance of the 40% SC ratings decided on his battle wounds and also indicate we're filing a NOD with the NSC decisions for PTSD and Schizophrenia on the same "Statement in Support of Claim"? I need to get an expert involved for our NOD and a new claim for Agent Orange since they completely overlooked that -- A rep at American Legion wants to take it on.   Do I go this route or go to an attorney? Will QTC give me a copy of his exam?  Or do I need to go through the Request for VA treatment records again through Saint Louis Records? I need to get him another dr exam to show evidence of his current Agent Orange symptoms.  Should i get an IMO ? I want to make sure I am chosen as his Fiduciary -  there is a form for this that I presume I send in on line. Rating Decision 5-16-16.pdf
    • C&P Examiner Pushed Me...FORCED
      understand totally i was treated the same way.  does anyone know anything about the c & p ortho doctors in san antonio tx
    • C&P Examiner Pushed Me...FORCED
      understand totally i was treated the same way.  does anyone know anything about the c & p ortho doctors in san antonio tx
    • Sleep Apnea Claim
      Original poster  the VA Should give you a C-PAP to use and all the equipment  hoses.Mask..you need to use distilled water. Anyone that has Sleep Apnea /OSA  needs to be using a C-Pap/Bi-Pap machine. For some  reasons the VA is turtle slow on getting VietNam Veterans their C-File....but some do get their C-File within 3 /4 months. I guess the C-file for us Vietnam Vets got lost in the mail room.  Next Month (June) will be a year for me and I requested it twice during this last year...and not a word from them..I do have the greencard receipts I need my C-file bad  I wonder if it has been didtized and on CD?  Could I make an Unexpected Visit to RO? And  ask for it that way? jmo ....Buck
    • Increase of MRSA from 0%-? unknown, having c&p exam on tuesday
      Do they go back to the date of the original claim? im just curious, ive had this infection, since i was in the army, and it was and is horrible, losing jobs, and such. thanks in advance
    • Osteoarthritis in right knee
      Never say never, but here is your dilemma. In order to get service connected you need either a presumptive condition, which osteoarthritis is not a presumptive condition.Or, you need the following: A service related event or condition, a bridge from that service related event or condition to a current diagnosis that is severe enough to be determined to be disabling. So, if you can get a private doctor to fill out a disability benefits questionnaire  VA FORM 21-0960M-9 then you might have a shot. It would be very helpful if the doctor inserted remarks that stated he believes the condition is directly related to your military service. Even then I wouldn't be surprised if it was denied. As you stated the osteoarthritis is mild. Mild is usually not considered disabling, but all they can say is no.  One other unrelated point, but one worth mentioning. You cannot receive compensation pay and retirement pay at the same time. For example, let's say you get $1100 a month in retirement pay, and $200 a month in compensation. Then you get $900 a month in retirement pay and $200 a month in comp for a total of $1100. The benefit being the $200 is tax free. Now, if you can get the $200 comp as CRDP or CRSC then you could get both the retirement pay and the comp at the same time for a total of $1300 a month.
    • My C&P Results and why i'm disturbed
      In 2012 I EAS from the USMC and began a career in Law Enforcement. Like many of us I started the process of VA disability claims where I had issues which nagged me. Shoulder, knee, and back. I had 2 shoulder surgeries while active on my left shoulder and have been babying my right shoulder due to inflammation issues and restricted ROM.    I met with the VA in Dec 2013 for my initial C&P examination where I explained the symptoms of my issues and conducted a ROM examination. I was provided with a 10% rating for Patello Femoral Syndrome in my Left and Right knee. 10% for my right shoulder and 10% for c-spine bulging disc. This is the minimum rating for pain.    I just recently started a new claim for an increase and was examined a couple of days ago. My initial exam was as follows Knee  Date 2013 a. Right knee flexion Select where flexion ends (normal endpoint is 140 degrees):  [X] 100 Select where objective evidence of painful motion begins: [ ] No objective evidence of painful motion  [X] 80 b. Right knee extension Select where extension ends: [X] 0 or any degree of hyperextension (check this box if there is no limitation of extension) Select where objective evidence of painful motion begins: [X] No objective evidence of painful motion No limitation of extension c. Left knee flexion Select where flexion ends  [X] 90 Select where objective evidence of painful motion begins: [ ] No objective evidence of painful motion [X] 90 No limitation of extension Shoulder a. Right shoulder flexion Select where flexion ends (normal endpoint is 180 degrees):[X] 60  b. Right shoulder abduction Select where abduction ends (normal endpoint is 180 degrees): [ ] 0 [X] 5 Based on the above, I should be at a higher rating for both shoulder and knee. But, I was provided the minimum of 10% for pain. My most recent exam is as follows.    Knee Date 2016 Left Knee --------- [ ] All normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 140): 40 to 55 degrees Extension (140 to 0): 55 to 40 degrees   Shoulder  a. Initial range of motion Right Shoulder -------------- [ ] All Normal [X] Abnormal or outside of normal range [ ] Unable to test (please explain) [ ] Not indicated (please explain) Flexion (0 to 180): 0 to 70 degrees Abduction (0 to 180): 0 to 40 degrees External rotation   I don't know why I was provided the bare minimum. But it is extremely disturbing. I hope they make things right by increasing my percentage this time around. I may have to stop working because I am constantly out due to issues with my knees and shoulder.   

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Pete53

Medicare Prescription Plan Is Confusing

7 posts in this topic

09:17 AM CDT on Monday, September 26, 2005

By BOB MOOS / The Dallas Morning News

The mailboxes of Medicare's 42 million beneficiaries will begin to bulge next week.

That's when seniors will start to receive sales brochures from insurers, pharmacies, pharmaceutical companies and others marketing prescription drug plans.

Medicare's new prescription drug benefit represents the most significant change in the federal program's 40-year history.

Yet, many older adults don't understand the new program, or they worry they won't come out ahead if they enroll in a drug plan.

"Whenever there's change, there's confusion and anxiety," says Khelan Bhatia, an advocate for AARP Texas. "But there's also opportunity."

Medicare administrator Mark McClellan expects the new drug benefit will cut many older Americans' prescription costs in half. And seniors with limited income and few resources will have almost no drug expenses.

The new benefit will come as welcome relief for many, he says. The average prices of dozens of prescription drugs used widely by seniors are rising more than twice as fast as general inflation, according to AARP.

"This coverage will help seniors afford the drugs they need to maintain or recover their good health," Dr. McClellan says.

JoAnn Walters, 78, of Dallas takes four prescriptions but doesn't know what she'll do.

"I have no idea whether the coverage would save me any money today, but you never know what your future will bring," she says.

Like other Medicare beneficiaries, Ms. Walters says she'll compare the drug plans to see if she can reduce her prescription costs.

"I've got some homework to do."

Here are some of the most frequently asked questions about the drug benefit, according to Medicare officials and others who work with seniors.

Must I enroll?

The benefit is voluntary. It's available to anyone on Medicare, regardless of health or income. But if you want the coverage, you'll have to enroll in one of the private insurance plans Medicare has approved.

Senior advocates add this cautionary note: If you wait and sign up for the drug benefit after the initial enrollment period ends May 15, you'll pay a penalty – an extra 1 percent in premiums for each month you delay.

"Even if you're healthy, you may want to get the coverage now," says Paul Zobisch, a Medicare volunteer. "You'd be insuring against what might happen later."

What if I already have prescription drug coverage?

Companies that provide retiree drug benefits will notify you whether their plans are at least as good as Medicare's.

If you have such coverage, you may want to keep it, says Robert Hayes, president of the Medicare Rights Center, a consumer group. As long as it's comparable to Medicare's benefits, you won't pay a penalty if you switch to Medicare later.

Medigap supplemental insurance policies are another story. Most that do cover prescriptions aren't as good as Medicare's coverage, so you'll pay a penalty if you enroll in a Medicare drug plan later, Mr. Hayes says.

"It's important to remember that Medicare's drug discount cards are ending, so you won't be able to rely on those any more," Mr. Bhatia says.

What will the drug benefit cost, and what will I get in return?

Your costs will depend on the plan you choose. Competition is driving premiums down – to less than $20 a month for some plans, from the $37 once projected.

After you pay the first $250 of your annual drug expenses, you'll be responsible for 25 percent of the next $2,000 in bills, all of the next $2,850, and 5 percent beyond that.

Some plans will offer more coverage for higher premiums, says Rod Clark, Medicare's outreach coordinator in Dallas.

Each plan will have its own list of covered drugs, both brand name and generic. Dr. McClellan assures seniors that every medically necessary drug must be covered.

Is extra help available for people with low incomes?

Yes. If your annual income is less than $14,355 and your assets are below $11,500, Medicare will pay almost all of your drug bills. (For couples, income can't be more than $19,245 and assets can't exceed $23,000.) If your income is slightly higher, you'll get a smaller break on your premiums, deductibles and co-payments.

If you now get Medicaid, a Medicare Savings Program subsidy or Supplemental Security Income, you automatically qualify for the additional help. Others on limited incomes will have to apply for it through Social Security.

"This is a no-brainer for anyone who thinks he qualifies," Mr. Hayes said says. "Run, don't walk, to apply."

But keep in mind that requesting the extra help won't enroll you in a plan, he says. You'll still need to select one.

Once I decide on the drug coverage, how do I find the best plan for me?

Texans will select from among 20 plans.

"Having so many choices is a good thing, but it can also be overwhelming," Mr. Zobisch says. "So take it a step at a time."

First, find a plan that covers all or most of your prescriptions.

If the plan you're considering doesn't cover one of your drugs, talk to your doctor to see if your medicine can be switched to one in the plan, AARP suggests.

If not, talk to the plan's sponsor to see if your circumstances make you eligible for an exception that pays for a drug not on the list.

Next, identify a plan that works with a pharmacy near your home. You may also be able to order drugs through the mail.

Finally, make sure you can afford the out-of-pocket expenses.

"Consider your choices carefully, because you generally won't be allowed to change plans for a year," Mr. Bhatia says.

How can I compare plans and enroll in one?

Medicare's Web site will let you compare drug plans' costs and benefits, beginning in mid-October. Visit www.medicare.gov and select the "search tools" option.

You may also call Medicare at 1-800-633-4227. When you do, have at hand your Medicare card, a list of the drugs you take and the name of your pharmacy.

The Medicare & You 2006 handbook will be mailed to every Medicare household in October and will also have a detailed listing of the plans in your area, Mr. Clark says.

Once you decide, you may sign up at Medicare's Web site or through its toll-free number. Or you may directly contact the plan you've chosen.

"Don't rush to judgment," Mr. Bhatia said says. "Even when enrollment begins Nov. 15, you'll still have six months to reach a decision. Consult a family member or trusted friend to help you consider your options."

E-mail bmoos@dallasnews.com

Benefit won't be delayed

A one-year delay in the Medicare prescription drug benefit has been proposed as a way of offsetting some of the rebuilding costs from Hurricane Katrina, but the White House and Republican congressional leaders are ruling that out.

The drug benefit is set to begin Jan. 1.

Fiscal conservatives from the Republican Study Committee proposed the postponement last week, saying it would save $30.8 billion of the estimated $200 billion in Katrina-related costs.

"Congress must ensure that a catastrophe of nature doesn't become a catastrophe of debt for our children and grandchildren," said Rep. Mike Pence, R-Ind., chairman of the GOP study group.

But the Bush administration and House Republican leaders quickly dismissed the idea.

"This is an important benefit for our seniors that will save them significant money on their prescription drugs," White House spokesman Scott McClellan said.

House Majority Leader Tom DeLay, R-Sugar Land, called the proposed delay "a nonstarter."

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I think you can delay taking this plan if you have ChampVA or other drug coverage. I wonder if VA would act in the same way since we have coverage under VA for drugs. In other words you could just hold off on signing up for the plan without penalty.

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Using the VA is penalty enough. My HMO is making us use the plan. It sort of stinks but who knows?

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I don't plan on getting it. I get my Meds from VA and Tricare. Of course I wonder if they will close that loophole and make us take it someday.

Sort of like being forced to take Medicare over Tricare. Paying 3 times as much for the same thing I don't use.

Joy.....

:unsure:

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I don't plan on getting it. I get my Meds from VA and Tricare. Of course I wonder if they will close that loophole and make us take it someday.

Sort of like being forced to take Medicare over Tricare. Paying 3 times as much for the same thing I don't use.

Joy.....

:unsure:

If you have TRICARE or CHAMPVA stay with that. If you join Medicare you will have to pay the premium each month if you use it or not! I was told the premium is $45.00 per month. When you are on Medicare you can join any Medical Insurance Company of your choose. Some Medicare Insurance Companies Premium's are FREE. I have Health America Advantra with is free, I pay for part-B, I get my FREE meds by mail from ChampVA. You know the Medicare prescripton program is just another way for the goverment to help the rich and Drug Companies get richer. Don't you remember how much the Drug Co. spent the first six months, last year to pay the Lobbiest? I read that in ARAP, I think it was around $1,000,000.00. Any senior on medicare and has a limited income could apply for Healthy Herizon, this is a federal program, it passed Congress and became Law around the 1900's. This program provides payment of Medicare Part B premium for persons with limited resources whose incoome is more that 100% but less than 120% of the Federal Poverty Income Guidelines. There are other programs where the income is much higher! In the State of Pennsylvsnia the County Assistance Office is where you apply or you can go to the Area Agency on Aging.

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09:17 AM CDT on Monday, September 26, 2005

By BOB MOOS / The Dallas Morning News

The mailboxes of Medicare's 42 million beneficiaries will begin to bulge next week.

That's when seniors will start to receive sales brochures from insurers, pharmacies, pharmaceutical companies and others marketing prescription drug plans.

Medicare's new prescription drug benefit represents the most significant change in the federal program's 40-year history.

Yet, many older adults don't understand the new program, or they worry they won't come out ahead if they enroll in a drug plan.

"Whenever there's change, there's confusion and anxiety," says Khelan Bhatia, an advocate for AARP Texas. "But there's also opportunity."

Medicare administrator Mark McClellan expects the new drug benefit will cut many older Americans' prescription costs in half. And seniors with limited income and few resources will have almost no drug expenses.

The new benefit will come as welcome relief for many, he says. The average prices of dozens of prescription drugs used widely by seniors are rising more than twice as fast as general inflation, according to AARP.

"This coverage will help seniors afford the drugs they need to maintain or recover their good health," Dr. McClellan says.

JoAnn Walters, 78, of Dallas takes four prescriptions but doesn't know what she'll do.

"I have no idea whether the coverage would save me any money today, but you never know what your future will bring," she says.

Like other Medicare beneficiaries, Ms. Walters says she'll compare the drug plans to see if she can reduce her prescription costs.

"I've got some homework to do."

Here are some of the most frequently asked questions about the drug benefit, according to Medicare officials and others who work with seniors.

Must I enroll?

The benefit is voluntary. It's available to anyone on Medicare, regardless of health or income. But if you want the coverage, you'll have to enroll in one of the private insurance plans Medicare has approved.

Senior advocates add this cautionary note: If you wait and sign up for the drug benefit after the initial enrollment period ends May 15, you'll pay a penalty – an extra 1 percent in premiums for each month you delay.

"Even if you're healthy, you may want to get the coverage now," says Paul Zobisch, a Medicare volunteer. "You'd be insuring against what might happen later."

What if I already have prescription drug coverage?

Companies that provide retiree drug benefits will notify you whether their plans are at least as good as Medicare's.

If you have such coverage, you may want to keep it, says Robert Hayes, president of the Medicare Rights Center, a consumer group. As long as it's comparable to Medicare's benefits, you won't pay a penalty if you switch to Medicare later.

Medigap supplemental insurance policies are another story. Most that do cover prescriptions aren't as good as Medicare's coverage, so you'll pay a penalty if you enroll in a Medicare drug plan later, Mr. Hayes says.

"It's important to remember that Medicare's drug discount cards are ending, so you won't be able to rely on those any more," Mr. Bhatia says.

What will the drug benefit cost, and what will I get in return?

Your costs will depend on the plan you choose. Competition is driving premiums down – to less than $20 a month for some plans, from the $37 once projected.

After you pay the first $250 of your annual drug expenses, you'll be responsible for 25 percent of the next $2,000 in bills, all of the next $2,850, and 5 percent beyond that.

Some plans will offer more coverage for higher premiums, says Rod Clark, Medicare's outreach coordinator in Dallas.

Each plan will have its own list of covered drugs, both brand name and generic. Dr. McClellan assures seniors that every medically necessary drug must be covered.

Is extra help available for people with low incomes?

Yes. If your annual income is less than $14,355 and your assets are below $11,500, Medicare will pay almost all of your drug bills. (For couples, income can't be more than $19,245 and assets can't exceed $23,000.) If your income is slightly higher, you'll get a smaller break on your premiums, deductibles and co-payments.

If you now get Medicaid, a Medicare Savings Program subsidy or Supplemental Security Income, you automatically qualify for the additional help. Others on limited incomes will have to apply for it through Social Security.

"This is a no-brainer for anyone who thinks he qualifies," Mr. Hayes said says. "Run, don't walk, to apply."

But keep in mind that requesting the extra help won't enroll you in a plan, he says. You'll still need to select one.

Once I decide on the drug coverage, how do I find the best plan for me?

Texans will select from among 20 plans.

"Having so many choices is a good thing, but it can also be overwhelming," Mr. Zobisch says. "So take it a step at a time."

First, find a plan that covers all or most of your prescriptions.

If the plan you're considering doesn't cover one of your drugs, talk to your doctor to see if your medicine can be switched to one in the plan, AARP suggests.

If not, talk to the plan's sponsor to see if your circumstances make you eligible for an exception that pays for a drug not on the list.

Next, identify a plan that works with a pharmacy near your home. You may also be able to order drugs through the mail.

Finally, make sure you can afford the out-of-pocket expenses.

"Consider your choices carefully, because you generally won't be allowed to change plans for a year," Mr. Bhatia says.

How can I compare plans and enroll in one?

Medicare's Web site will let you compare drug plans' costs and benefits, beginning in mid-October. Visit www.medicare.gov and select the "search tools" option.

You may also call Medicare at 1-800-633-4227. When you do, have at hand your Medicare card, a list of the drugs you take and the name of your pharmacy.

The Medicare & You 2006 handbook will be mailed to every Medicare household in October and will also have a detailed listing of the plans in your area, Mr. Clark says.

Once you decide, you may sign up at Medicare's Web site or through its toll-free number. Or you may directly contact the plan you've chosen.

"Don't rush to judgment," Mr. Bhatia said says. "Even when enrollment begins Nov. 15, you'll still have six months to reach a decision. Consult a family member or trusted friend to help you consider your options."

E-mail bmoos@dallasnews.com

Benefit won't be delayed

A one-year delay in the Medicare prescription drug benefit has been proposed as a way of offsetting some of the rebuilding costs from Hurricane Katrina, but the White House and Republican congressional leaders are ruling that out.

The drug benefit is set to begin Jan. 1.

Fiscal conservatives from the Republican Study Committee proposed the postponement last week, saying it would save $30.8 billion of the estimated $200 billion in Katrina-related costs.

"Congress must ensure that a catastrophe of nature doesn't become a catastrophe of debt for our children and grandchildren," said Rep. Mike Pence, R-Ind., chairman of the GOP study group.

But the Bush administration and House Republican leaders quickly dismissed the idea.

"This is an important benefit for our seniors that will save them significant money on their prescription drugs," White House spokesman Scott McClellan said.

House Majority Leader Tom DeLay, R-Sugar Land, called the proposed delay "a nonstarter."

The medical industry will make alot of money on a questionable benefit.

B)

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How about a plan that actually guarantees affordable drugs and health care for our senior citizens and not another bureaucracy that just buries our elderly in paper work, quite literally, to death.

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