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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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Cavman

70/iu & 100 Difference?

21 posts in this topic

Is it worth the effort filing an appeal from 70/IU asking for 100 P&t?

Also, my award says 70/IU p & t. I didn`t even know a 70 iu p&t existed.

Cavman

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Caveman,

This came up on my claim many years ago. It is my recollection that if you can get 100% schedular that this is the best way to go. However, if the 100 was to be based on an extra-schedular rating then it is the same process as 70% + IU. They just do the IU rating if you have not worked in a long time. I got the P&T also. When I was rated I had not worked in over ten years and told the DRO their was no way that I would return to work.

It is my understanding that if you are 100% schedular for a medical condition that you can have earnings from employment without risking a reduction in you rating. If you were 100% schedular for a psychiatric condition that was based on employment functioning, returning to work could reduce your rating. Hopefully, other folks have the M-21citings on this readily available.

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It really depends in the situation. But in most cases you will not get to 100% schedular. I guess the question I have for you is what is the addition disability that you have that makes you think you can get to 100% schedular.

Normally unless you have a life threating condition, or loss of use of limbs, it is almost impossible to get to 100%.

Remember too that 100% and tdiu pay the same thing.

I`ve read many BVA cases where vets have been moved from 70 to 100. They all do not have an IU rating though. I guess there really is no advantage to being 100 p & t to being 70 w/IU p & t. They both have the same benefits. My main concern was getting school help for my daughter which because of illness I would not be able to afford. Now I can, so I am a happy man. I have decided to leave well enough alone.

Cavman

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Caveman

It is worth filing an appeal to get the P&T. That is what I did and got P&T one year later. Now my wife has ChampVA. For shcool it would be good and if you appeal and win the P&T status goes back to your initial IU claim date. I was 70% IU and appealed for P&T. Now 5 years later I am up to 80% but never will get 100% because of the reasons Rick expressed. It is only for SMC housebound or A&A that 100% schedular might be useful. I think if you go at it from the back door by being approved for HB they might bump you up to 100% to justify giving you HB. A friend of mine did that.

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rickb54 and

fla_viking

When I got bumped up to 70% with TDIU, for PTSD, I got my P&T at the same time, so it does happen on occasion, then about a year later I put in a claim for panic attacks with Agoraphobia , I had a C&P exam, without the VA telling me I was getting a C&P, so was approved for that, then they bumped me up 100% scheduler for PTSD. I guess it all depend on how bad the VA feels your disability is, in getting the right percentage.

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Caveman

It is worth filing an appeal to get the P&T. That is what I did and got P&T one year later. Now my wife has ChampVA. For shcool it would be good and if you appeal and win the P&T status goes back to your initial IU claim date. I was 70% IU and appealed for P&T. Now 5 years later I am up to 80% but never will get 100% because of the reasons Rick expressed. It is only for SMC housebound or A&A that 100% schedular might be useful. I think if you go at it from the back door by being approved for HB they might bump you up to 100% to justify giving you HB. A friend of mine did that.

john999:

My 70/iu says p & t with chapter 35, champva etc. At least thats the way I read it.

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Caveman

Yes you got the whole thing. Now you can start sleeping at night. Congrats and take a break and wait for the back pay check. Don't spend it all in one place. 100% schedular is something to go for if you thing you can get A&A or are housebound. You have a year to file a NOD so take a break.

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This is what gets me-

The VA granted my husband 100% P & T SC PTSD posthumously for a three year period- sending me 2 years of accrued-the regs where for 2 years only at that time.

He was totally disabled by the Section 1151 disabilties he had- that VA had caused. (documented) 100% for the 1151 stroke and th heart disease and diabetes has not ever been rated-

Nevertheless- it is basic VA case law- 100% SC plus 60% or more SC (even under 1151)as long as this is an independent additional disability- equals SMC.

(OGC Pres Op and BVA statements as well as M21-1 support this legal fact)

My vet rep questioned this in an award letter a decade ago but did not advise filing a NOD-the VA stated they did not consider Rod eligible for SMC consideration.They stated ALL of their malpractice caused his death-but listed his 1151 stuff as 100% under NSC and did not formally acknowledge them further as Sec 1151 100% until they buggered my CHAMPVA but I got that squared away.I was pretty pissed at what they did then but then within a few hours I realised again they had out a foot in their mouths so I sent the CHAMPVA stuff and stuff from their VSM that helped fix it- as evidence for my CUE.

The VA had formally acknowledged (in attempt to stop my CHAMPVA benefits)

that the veteran was 100% or more under Section 1151.

(that is not why I get CHAMPVA-that is due to the 100% P & T SC of PTSD.

They are working on my CUE on this now-

QUESTION- is a vet with TDIU actually supposed to also be considered for SMC with additional 60% SC rating?

I think they are and I think some of you get SMC with TDIU- but now I am not sure-

If the VA says you are not eligible for consideration for SMC and this doesnt seem right-

based on your evidence you might want to challenge their decision and at least get a statement of why you are not eligible for consideration.

Edited by Berta

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caveman,

I TO GOT 70% AND IU P&T. IN MY OPION LEAVE IT WERE IT IS THERE IS NO MORE MONEY FOR 100%. AND THEN YOU DONT HAVE TO DEAL WITH THE VA AGIAN . BESIDES READ THE 100% SCHEDULARE FOR PTSD IT IS VERY HARD TO GET UNLESS YOU DO HAVE THOSE SYPTOMS. AND REMBER JUST BECUASE IT SAYS P&T MAKE SURE STILL GO TO YOUR DOCTOR VISITS AND STILL GET COPYS OF EVERTHING NEVER TRUST THE VA. THEY CAN STILL CALL YOU BACK FOR A C&P FOR THE PTSD.

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On my Chapter 35 my kids were allowed to chose effective date or date of notice. It worked out well for them.

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caveman,

I TO GOT 70% AND IU P&T. IN MY OPION LEAVE IT WERE IT IS THERE IS NO MORE MONEY FOR 100%. AND THEN YOU DONT HAVE TO DEAL WITH THE VA AGIAN . BESIDES READ THE 100% SCHEDULARE FOR PTSD IT IS VERY HARD TO GET UNLESS YOU DO HAVE THOSE SYPTOMS. AND REMBER JUST BECUASE IT SAYS P&T MAKE SURE STILL GO TO YOUR DOCTOR VISITS AND STILL GET COPYS OF EVERTHING NEVER TRUST THE VA. THEY CAN STILL CALL YOU BACK FOR A C&P FOR THE PTSD.

Is this application for uniformed services ID card form (DEERS ENROLLMENT) for getting into a PX? Where did you send yours or turn it in? You and I have the same award exactly.....what have you done that I need to do? We don`t apply for chapter 35 help until the year our children finish high school right?

Cavman

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On my Chapter 35 my kids were allowed to chose effective date or date of notice. It worked out well for them.

Did your kids use your chapter 35 right away or was it years before they applied? It basically pays tuition doesn`t it?

Cavman

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It pays something like 800 bucks a month and that is it.

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yes, chapter 35 only applies after they finish high school. unless it has changed, you need to take the px, commissary id application to an active base, they have a place there where they issue you the card with picture etc...it's been many moons since i got mine, but that's the way it was then and someone has to take the pic for the id card, so i suppose you would still have to apply in person. i can recommend the MyEHealth Vet also, I had been a member for quite awhile, but i signed up last week for the complete deal where you can see and refill all prescriptions online, and in the near future will be able to see and download your medical records from the vamc. it seems this is going to be a great program. you apply at your local va medical center...you will need to apply at the Release of Information Office and it's quicker if you watch this REQUIRED short video before you go in, that way you won't have to wait. you can go ahead and register here and get your password etc set, that way when you go to apply, it will cut down on time. register here: https://www.myhealth.va.gov/mhvPortal/anony...-anonymous.html view video here https://www.myhealth.va.gov/noncmscontent/m...mhv-ipa-vid.wmv

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Cavman, to get the DOD card I called the 800-827-1000 and requested a letter stating my 100% P&T status. It took about 3 weeks. You can use the decision it self but the letter is one page long and is short and sweet. Because of your 100% P&T your card will have an indefinate expiration date. My wife's expires every three years. Web search Deers, Michigan to see where you can get an ID. The Defense Center in Battle Creek does it every work day and the Marine reserve does it only on Fridays. Take care. Terry Sturgis

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Cavman, to get the DOD card I called the 800-827-1000 and requested a letter stating my 100% P&T status. It took about 3 weeks. You can use the decision it self but the letter is one page long and is short and sweet. Because of your 100% P&T your card will have an indefinate expiration date. My wife's expires every three years. Web search Deers, Michigan to see where you can get an ID. The Defense Center in Battle Creek does it every work day and the Marine reserve does it only on Fridays. Take care. Terry Sturgis

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Terry - are you talking about DDform 2765?

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Is this application for uniformed services ID card form (DEERS ENROLLMENT) for getting into a PX? Where did you send yours or turn it in? You and I have the same award exactly.....what have you done that I need to do? We don`t apply for chapter 35 help until the year our children finish high school right?

Cavman

caveman,

I really have not done much i have not applied for my px card yet the closes military base is 90 miles from me so i wont use it that much so iam in no hurry to get it. i did apply for champava for the kids and wife. the chapter 35 benifits i have done nothing my kids are to young to use them and the wife already went to school. I have been busy I just bought my first house and taking care of my kids i saw my va shrink last week i still go atleast 1 every 2 months make sure you still see your shrink caveman. and keep copys. also how far did they back pay your award.

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I live about 5 miles from MacDill AFB and I never go there for anything. I just never go to the trouble of waiting in line at the gate to shop at the over crowed BX. I went there a few years ago and everyone in uniform seemed so young it was amazing.

The military is being operated by high school kids it seemed to me.

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caveman,

I really have not done much i have not applied for my px card yet the closes military base is 90 miles from me so i wont use it that much so iam in no hurry to get it. i did apply for champava for the kids and wife. the chapter 35 benifits i have done nothing my kids are to young to use them and the wife already went to school. I have been busy I just bought my first house and taking care of my kids i saw my va shrink last week i still go atleast 1 every 2 months make sure you still see your shrink caveman. and keep copys. also how far did they back pay your award.

I will always see my doctor monthly. (15 mos. coming)

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I live about 5 miles from MacDill AFB and I never go there for anything. I just never go to the trouble of waiting in line at the gate to shop at the over crowed BX. I went there a few years ago and everyone in uniform seemed so young it was amazing.

The military is being operated by high school kids it seemed to me.

john999:

A few years ago I got onto Ft. Meade, where I was stationed last and went into the PX. I asked a few if my old Cav unit was still there and no one had ever heard of it. I also felt ancient and thought the unit patches looked like some kind of foreign units. I`m not even sure the PX prices are cheaper so I probably won`t even mess with it.

Cavman

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