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Showing content with the highest reputation since 02/15/2019 in all areas

  1. 2 points
    No, your doctor seeing you at the VA will not say you have PTSD. But only the VA can diagnosis SC PTSD. What you need to do is file a claim through your VSO and request to be rated for mental health. Depending on your region they may send you to a third party doctor or you will see one of theirs. Do you have a combat ribbon? Is there anything in your records that states you have faced a traumatic event? You need: 1. A traumatic event in your medical records or service record or combat. 2. A continuing mental health issue. 3. A nexus that relates the event to your current mental health issue. Once you have filed the VA will set you up for a C&P exam, bring all of your relevant information to this exam in case the examiner does not have it. After your C&P you will be rated. Do not tell the doctor that you have PTSD, he is there to decide that. Be truthful and forthcoming to the doctor with no dramatics.
  2. 2 points
    File one claim with all existing SC disabilities on the claim. Otherwise you will just delay SC for the disabilities you did not file.
  3. 2 points
    Air1, First of all......Congratulations!!!!!! But I'm confused. In your original post, you showed a denial letter for TDIU from the BVA in August. What happened between August and Now that you received 100% P&T?
  4. 1 point
    dajoker, that is all well and good. Unfortunately most of us vets have the assistance of a VSO who might know what he is doing. We do not all have the experience of someone inside the system and it takes us a while to get it right. Throw in a complicated case and a neurologist or two who are trying to save the VA money and we are sunk before we ever get our ship out of port. The VA closed that neurology department by the way. We wind up having to pay a lawyer 20% of our award dated back ten years when it should have been completed by the RO right the first or second time, so our kid would have had a chance at college. I am not trying to be nasty, it is just that on the other side of the fence there are a lot of veterans getting treated like they are dirt.
  5. 1 point
    The first step is an intake exam, which is an initial evaluation so they can help plan your care accordingly. Sometimes it is performed by nurse practitioners, psychologists, psychiatrist residents, but I have heard of LCSW's doing it in cases where the VA has a large number of patients. After that, LCSW's or psychologists are typical. If medication is necessary, the nurse practitioner and/or psychiatrists may be part of your treatment team.
  6. 1 point
    If you think that the medication you take may be causing additional disabilities, be sure to file for those also. Some medications may cause ED or other disabilities. Below is a link to the VA schedule for rating disabilities: https://www.ecfr.gov/cgi-bin/text-idx?SID=ea5c9546eaccefdc92bb4c976c369ddf&mc=true&node=pt38.1.4&rgn=div5 I recommend you go through your medical records and identify any disability where you have a current or recent diagnosis and match them up with the list. That can help give you a good idea of what you might be able to claim. Because you served in the Persian Gulf, you might have some "presumptive" disabilities. Fibromyalgia is a presumptive, see below. There are a couple of additional links below the quoted material which go into greater detail about presumptives and disabilities which manifest within one year of discharge. https://www.va.gov/disability/eligibility/hazardous-materials-exposure/gulf-war-illness-southwest-asia/
  7. 1 point
    Congratulations on your win! If you are already setup with the VA to get disability payments via direct deposit, then you might see the retro in your bank account before you get anything in the mail.
  8. 1 point
    #1. Request your C-file in it's entirety first. It will take awhile (6months+) to get it which will provide you time to gather all your medical evidence. #2. File an intent to file. This will preserve your effective date for retropay purposes. #3.Gather pertinent evidence for sleep apnea. Request the VA pulmonologist provide an addendum to her note to state "CPAP Medically Necessary" or an equivalent statement. You can request this through a Patient Advocate at your local VA.The va will deny your claim if that little piece of evidence is not present. Dr.Anaise, Dr. Bash, Ellis clinic do nexus of opinions among others. I've researched VA Claims Insider and Brian markets himself and his company well. Apparently, he has a team of claims specialists, dr.s, and lawyers. But, so does comp&pen LLC out of Florida. Use your own discretion on who you want to go with. Some Dr.s nexus of opinions go for hundreds into the thousands of dollars. But that depends on the complexity of your claim. #4. Must meet Caluza factors for direct service connection. 1). Current diagnosis 2). In-service injury, event (diagnosis), illness. 3) Medical nexus stating the minimum threshold of "at least as likely as not (equal to 50% or greater probability) the claimed condition is due to or the direct result of military service. Plus, a rationale. *****This is just a recommendation other experienced forum members have been dealing with the VA for decades and have a wealth of information.*****
  9. 1 point
    Very valid points. One of the big issues here is that raters follow their own rules and there is not set continuity on what is to be followed. There is the M21 that does pretty much spell it out but each rater obviously interprets it differently. Raters are not held accountable for their mistakes. There are hundreds if not thousands of BVA reversals where it is stated that the rater ignored evidence and diagnosis from other doctors and relied only on VA C&P examiners and they are not allowed to do that.
  10. 1 point
    You have got that right. I have had several remands granted after the RO denies. The BVA gives the RO a second chance to make it right and then grants after the RO refuses to do their job.
  11. 1 point
    Thank you for clearing that up for me. It gives us hope that when RO denies a remand, the BVA may still grant! Congratulations!
  12. 1 point
    That's a favorable nexus. You meet the occupational and social impairment criteria for a rating of 70%. Now it's up to the ratings scheduler to rate you correctly. Congrats!
  13. 1 point
    Thank you vetquest and broncovet for your input. I currently have a claim for an EED that has been closed by the VARO because he/she can't "find" the VA form 9 I submitted to appeal the case to the BVA. This is funny because when I log in to e-benefits, I can "see" that it has been clearly received within the 90 day window for submission. The reason I am interested for input in the phrase "the date first filed or facts found" is because of the confusion involved in its interpretation. Both of you stated very good examples of why we need a precedential court case like Jensen v. Shulkin to guide us. I have contacted Peggy twice to help guide the VARO to the Form 9. I was told by Peggy that I have to give him/her 30 days before she releases the "nuclear option" on the VARO. I am not sure whether this phrase has been decided by the CAVC or a higher court setting a precedent. I have not been able to locate it and hence the reason I was asking for help. If there isn't one, perhaps I or another veteran can help get this clarified by a favorable ruling.
  14. 1 point
    The VA will file you disabled at the date you first filed unless they claim that you were not disabled prior to your C&P. The C&P is determined to the date that the facts found you disabled. It is a ruse used to keep from paying back pay to a veteran. What you need is evidence or a sympathic BVA decision. My "main" disability was determined to be preventing employment on the date of my last C&P on a remand. I had medical evidence that I was unable to be employed due to this disability earlier. I needed to file to the BVA and they found in my favor. Do you have a decision that you can post after you redact personal information?
  15. 1 point
    There is a lot of research out there that shows a strong correlation btweeen sleep apnea and: depression, anxiety, ptsd and especially schizophrenia. Submitting a DBQ would have helped with a medical opinion. I have seen it get service connected secondary to ptsd a plurality of times when it was accompanied with a strong rationale. I did not have mine diagnosed while in service. I obtained six buddy statements verifying the symptoms. A dbq and medical opinion from a sleep specialist for a direct service connection. A medical opinion from a psychologist saying that it could equality be direct service connection or secondary to ptsd and that they aggravate one another. No exam necessary. I was service connected for every single contention that I put in for.
  16. 1 point
    You meet the criteria for #2. Please review the information provided. TDIU is subject to having a future exam. The key issue in a TDIU claim is the inability of the veteran to engage in "substantially gainful employment" because of his or her service-connected conditions. "Substantially gainful employment" means to hold a job that pays at least an amount equal to the annual poverty level set by the federal government. In order to qualify for TDIU benefits, a claimant must meet the following requirements: If the claimant has only one service-connected condition, that condition must be schedular rated at least 60% or more; If the claimant has two or more service-connected conditions, at least one of those conditions must be rated at 40% or more, and the veteran's combined disability rating must be 70% or more; and In either case, the veteran must be unemployable because of his or her service-connected conditions. To establish "unemployability" or "inability to substantially maintain gainful employment", the Veteran must provide: evidence of unemployment due to service-connected conditions, employment history records for example, and medical evidence that the veteran's service-connected condition renders him or her totally disabled and unemployable, generally a doctor's opinion letter. Having a paying job does not automatically disqualify a claimant from a TDIU award. If the wages are considered "marginal" (low paying) or "sheltered" (protected from usual requirements) employment are exceptions to the TDIU qualification requirements. Examples of employment that are allowed under TIDU: A job that pays substantially less than the prevailing poverty level, A job that is protected from requirements that someone else in that position would be expected to satisfy, or A job working for a friend or relative, may not be "substantially gainful employment." Although it is always better to submit a specific claim for TDIU. The VA has a duty to look for potential TDIU claims based on the evidence in the claimant's VA claims file, known as a "C-file". The VA is required to review the claims for TIDU, even if not specifically requested by the Veteran, because entitlement to TDIU is part of every claim for disability compensation. Upon reviewing the claim, the VA determines if TDIU is an appropriate award for the claim. Evidence of unemployability can be submitted after an initial decision denying TDIU, if while a claim for schedular benefits is still being processed.
  17. 1 point
    Here is the form to fax in evidence. 2017-01-18+Claims+Intake+Fax+Coversheet-1.pdf
  18. 1 point
    Well then I'm S-O-L. Since you have the nexus then you should be good to go for a favorable decision.
  19. 1 point
    It looks favorable on the DBQ. It will end up getting sent back for an addendum to the examiner for a nexus of opinion and a rationale. It'll delay the decision two weeks or more depending when the examiner does the addendum and if the nexus contains the minimum threshold of "at least as likely as not" the claimed condition is due to or the result of military service. Although, sometimes the raters do use the DBQ only to make their decision. Don't be surprised if you see in ebenefits your claim go from preparation for decision to back to gathering of evidence. It's not uncommon for a claim to go back and forth, but it creates unnecessary frustration and anxiety. I'll be in the same boat and at the mercy of how the rater handles my re-opened flat foot claim. Yay! Good times.lol.
  20. 1 point
    Sounds a lot better than the typical C & P examination. Good luck with your claim. Sgt. Wilky
  21. 1 point
    From what I have seen through my appeal from 2013 if it is and initial rating for a disability and it is approved this will happen in a timely manner(for the VA). For me it what just over a year. As for the appeal, this has taken the longest, and I can understand why. I did not give them the 5 star evidence they needed to award me the correct dyability. I now have a good process to stop this wait, but it has now come at the cost of 6 years+. Another piece I did not realize was if you condition is not laid out straight forward for them to award, this makes it 10 times harder to rate. I have also heard depending on the amount of money about to be awarded, this will take even more time as multiple people must approve it. As for the VA updating, sometimes you can believe Ebenefits or va.gov, but the truth is they just want to put a carrot out so we have something to look at.
  22. 1 point
    Has anyone used him for an IME/IMO. found his name through a directory on Haddit. My ortho C % P exams did not go very well. The first one was by a PA , the 2nd one was by a QTC nurse, with no ortho experience. Vern2
  23. 1 point
    KC3, The response you get from Peggy will just be an update on the current status, it will not resolve what you are looking for. I would say file the complaint, you might get something from that request.
  24. 1 point
    Hey Mikey33T, It sounds like it is moving, but no one can guess how long this part will take. Could be next week could be months. My advice is check weekly as there is no way to speed them up.
  25. 1 point
    Administrative review generally means that a coach aka manager pending review of the claim.
  26. 1 point
    First and foremost, it would always behoove you to write out support of claim statements for each and every contention that you are filing a claim. Make sure to bring a copy of this with you to your exam. It would be highly intelligent to have any paperwork that would be critical for your examiner to have pertaining to your claim on hand with you when at your exam. Case in point, when I went for my sleep apnea exam, my examiner stated that they couldn't find the sleep study. I knew that it was in VBMS (the system that stores all documents and the system that VSRs and RVSRs aka raters use to process claims) as the VA not only sent me out for the sleep study to a third party, but I also submitted the results as part of my evidence that I was building and submitting for my sleep apnea claim. However, there was no issue because I simply handed her a copy of my sleep study because I had it on hand. I literally had a thumb drive with all x rays, MRI images, radiology reports, C File, buddy statements, support of claims etc, and paper copies of any relevant information that could potentially be asked for. For hearing loss and tinnitus exams, know what can and won't give your statement more probative value. Yes, your MOS/Rate will be taken into account. So will combat. If you can prove via DD 214 i.e. Combat Action Bage, Combat Infantry Badge, Combat Medic Badge, Purple Heart..........you get the idea, they are awards that can concede combat exposure. This gives more probative value to any of your statements made concerning hearing loss. However, keep in mind, with regards to hearing loss, they primarily look at audiograms.............entrance and exit audiograms, and any audiograms that you provide up to 12 months after service..........much beyond that, one can't likely connect that to service. If one shoots guns recreationally, rides a motorcycle to work, uses power tools regularly etc, this also throws other factors into the equation that could affect hearing loss. For tinnitus............if you are claiming tinnitus, I honestly don't know why one would show up to the exam and say that their ears aren't ringing, but it happens all of the time. Another common phenomenon is that people didn't complain about it in service or go to get treated for it (there is no treatment really for it other than trying lipoflavinoids or newer hearing aids that can block it out via white noise.) However, there is one little-known thing about tinnitus......it is essentially the only illness that a Veteran can actually diagnose themselves. Here is the most important manual reference for tinnitus claims.............it clearly says that you do not need a diagnosis of tinnitus in service so long as you provide a competent lay statement indicating that you had it while in service AND you get it diagnosed later on (hint hint........get an exam done privately.) III.iv.4.D.3.b. Requesting Medical Opinions for Tinnitus A medical opinion is not required to establish direct SC for claimed tinnitus if STRs document the original complaints and/or diagnosis of tinnitus there is current medical evidence of a diagnosis of tinnitus or the Veteran competently and credibly reports current tinnitus, and the Veteran claims continuity of tinnitus since service or there are records or other competent and credible evidence of continuity of tinnitus diagnosis or symptomatology. Exception: An opinion may be necessary in the fact pattern above if evidence suggests a superseding post-service cause of current tinnitus. A tinnitus examination may also be necessary if the STRs do not document tinnitus but there is evidence establishing noise exposure or another in-service event, injury, or disease (for example ear infections, use of ototoxic medication, head injury, barotrauma, or other tympanic trauma) that is medically accepted as a potential cause of tinnitus, and there is a competent diagnosis or competent report of current tinnitus. Notes: Under Jandreau v. Nicholson, 492 F.3d. 1372 (Fed. Cir. 2007), a layperson may provide a competent diagnosis of a condition when a layperson is competent to identify a medical condition. Tinnitus is a medical condition that a layperson is competent to identify in himself/herself because the condition is defined by what the person experiences or perceives – namely subjective perception of sounds in his/her own ear(s) or head. Therefore, a layperson may establish the diagnosis of tinnitus at any point in time from service to present. However, consider credibility and weight of the evidence in deciding whether to accept lay testimony as proving tinnitus in service or presently. The Hearing Loss and Tinnitus Disability Benefits Questionnaire tinnitus-only examination includes a number of options for examiner opinions on etiology. The examination may be conducted by an audiologist or non-audiologist clinician. Only ask the audiologist to offer an opinion about the association to hearing loss if hearing loss is concurrently claimed or already SC. Know the Disability Ratings before you go into the exam. You will want to check out this website: https://www.law.cornell.edu/cfr/text/38/part-4/subpart-B 38 CFR Subpart B For instance, if you have any issues with bones/joints etc, you will want to check out this: https://www.law.cornell.edu/cfr/text/38/4.71 and https://www.law.cornell.edu/cfr/text/38/4.71a Know the politics.................. There are some good posts on here about PTSD exams, and I agree with most of what has been said. I must add on to some of it, and some of it is very very crucial. We are Veterans.....that is why we are here. Generally speaking, most of us are going to be politically conservative. Guess what, most psychiatrists and psychologists do not tend to be. Statistically speaking, of all of the MDs (yes, a psychiatrist is an MD), psychiatrists are the most politically liberal (left) of all MD fields whereas surgeons are the polar opposite. Guess what might not be a good idea to do in exams? You guessed it.........bring up politics. In fact, I would suggest that going in there acting like a hard ass would not bode well for you. If you walk in there wearing a MAGA hat, you might want to consider writing up your appeal later that evening. If it is a female examiner (and you're a male), I would suggest not grimacing at them during your mental health/PTSD exam. I would suggest not trying to play the examiners; sure, you can roll the dice and try some of the advice about talking about wanting to kill people all of the time and acting super hypervigilant in the room and making sure to sit where you can clearly monitor all exits etc, but I suspect that most of these examiners see 5-8 people a day and have become very astute on picking up on the bull shit artists and won't think twice about drawing a line through your name rather than under it. I would suggest being truthful.......that doesn't mean that you can't elaborate on your worst experiences pertaining to the questions that are asked, but I wouldn't recommend lying or exaggerating. I certainly wouldn't recommend lying about anything pertaining to your military record either, as while the examiner might be none the wiser, the raters reviewing it are more likely than not Veterans are thoroughly adept at combing through military records i.e. don't tell the examiner that you were an Army Ranger when you were a chaplain assistant.
  27. 1 point
    Am I reading this right? I can use the legacy system and have access to the BVA but if I go with higher level review or supplemental claim I do not have access to the BVA. That would be a crime against veterans as the RO's are messing veterans over and it is only at the BVA that claims are correctly adjudicated.
  28. 1 point
    taxntalyr, I am not familiar enough with the exams to tell about the exam/DBQ without seeing it, redacted of course. I would say that the number of stressors should not matter, it is the symptoms that are caused by the stressor.
  29. 1 point
    I agree with everything broncovet has stated. I personally believe that it is now taking longer for things to get updated and monies to be paid because the BVA is clearing so many cases recently. Just remember that your increased disability is like money in the bank though. It accrues while the VA is waiting to get their act together.
  30. 1 point
    You guys are probably right. Makes perfect sense but as I go through the regulations and then look at some of these decisions I wonder that the (bleep) is going through some of these raters minds. It is as if you need to spell out every single detail because they are too dense to follow their own regulations. Some of the decisions by some of these raters are so bad I wonder how they even got their jobs.
  31. 1 point
    After doing some research for you there is a possibility that you were rated incorrectly. You may need to appeal. I'm not trying to get your hopes up because this info requires it to be scrutinized by our more experienced members. I invite other members to please correct me if I'm wrong with any of the information provided. You are SC for prostate cancer. – Prostate cancer, code 7528 Were you ever treated for it at a VA facility/other facility? Did you receive a temporary 100% rating while you were being treated for prostate cancer? Is the prostate cancer still active? Is it inactive now? Code 7529: Benign tumors affecting the genitourinary system are rated based on how they affect the systems around them. For example, if the condition interferes with renal functioning, then it would be rated under the renal rating system. Code 7528: Malignant cancer is rated 100% while it is active. This 100% rating will continue for the first 6 months after the last treatment. The condition will then be reevaluated. If it is no longer active, then it is rated on any lasting symptoms like a benign condition. Notice the last sentence "If it is no longer active it is rated on any lasting symptoms like a benign condition". This is telling the rater to refer to code 7529. 7529 Benign neoplasms of the genitourinary system:Rate as voiding dysfunction or renal dysfunction, whichever is predominant. Code 7529 clearly states what you should have been rated as VOIDING DYSFUNCTION. Regardless, of what your urinary frequency symptoms are. Code 7529 clearly does not state to RATE AS URINARY DYSFUNCTION. It appears you were erroneously or deliberately rated to low-ball you. Why? This is the only rational explanation I could come up with below. If they rated you as Voiding Dysfunction ; and your symptoms were to become worse (which they may get worse over time) Urinary Frequency is capped at 40%. VOIDING DYSFUNCTION is capped at 60%. Urinary Frequency: A condition is rated under this system if it causes the body to urinate more often than normal. If you have to urinate 5 or more times during the night, or if you have to urinate more than every hour during the day, it is rated 40%. If you have to urinate 3 or 4 times during the night, or if you have to urinate every 1 to 2 hours during the day, it is rated 20%. If you have to urinate 2 times during the night, or if you have to urinate every 2 to 3 hours during the day, it is rated 10%. Voiding Dysfunction: All urinary conditions that cannot be rated as urinary frequency or obstructed voiding are rated by this system. If the condition requires the use of a catheter or other urinary assistive appliance to remove urine from the bladder, or if the condition requires the use of absorbent materials (like pads or Depends) that must be changed more than 4 times a day, then it is rated 60%. If it requires absorbent materials that must be changed 2 to 4 times a day, then it is rated 40%. If it requires absorbent materials that must be changed only once a day, then it is rated 20%.
  32. 1 point
    This is exactly how I feel about this, I live 24 miles from my local clinic, it takes more than 30 minutes to get there but if you google it drive time always says 29 minutes or something a bit less so they will use that or some crap similar to deny veterans like me the 30 minute rule for that one........I definitely will take advantage of the 60 minute one because I get sent 5-6 hour round trips for all of my specialty care. They wanted me to go to gait and balance once a week 3 hours away, I can't drive more than 30 minutes on a good day, can't take the van and as a pre 9/11 veteran my spouse sure as heck can't afford to be taking time off work every week to bring to to that many appointments so often I go without care. I also find it hysterical that MH is not a specialist??? Well played, well played. I sure as heck hope they start giving caregiver stipends to the first round of those they are supposed to roll into the program, I will be the last to be included but that is fine with me.........older veterans getting screwed over and over is absolutely beyond reproach. I was trying to work with adaptive sports, they referred me to all these organizations that receive grants from the VA, so I contacted the only one in Florida that helps with what I needed, guess what? They only help post 9/11 veterans. Seriously? So, the Va is giving them grants but not all veterans can get help??? This has to stop.
  33. 1 point
    The VA sometimes can be sticklers about things like this. They might want you to have had the final evaluation in-person, not just a potentially prior appointment. Keep in mind it might be worth it to get a letter from Dr El-Khatib stating you were seen in the office and his recommendation still stands. Submit the letter as a reconsideration and hopefully you might hear back soon. If you don't hear back within the 1 year appeal timer, convert it to a regular Notice Of Disagreement so you don't lose your effective date.
  34. 1 point
    I will explain what happen to me while on P&T TDIU. I applied for SSDI and had to go to the judge for a ruling. Before entering the court room, I asked lady working the desk if TDIU rating be used in a SSDI claim. I was told no because VA has a different system then them. I was ready to argue that my VA rating of P&T TDIU should be used as medical evidence to determine if my combined disabilities are sever enough to qualify me for SSDI. I also was going to argue that VA Doctors do not determine if you are too disabled to work because VA have a separate system to evaluate who is unemployable due to combined SC disability called TDIU. Having no lawyer, I went before the judge to argue my case. The judge starting asking about my medications so I explained what my life was like without them and what it was like with them. After the 2nd medication of 5 he stopped me saying he heard enough and ruled totally in favor of my SSDI claim. In his ruling he stated that no one disability qualifies me but my combined disabilities do qualify me. Just before leaving the court room. I explained how I believed that my P&T TDIU should be use to help qualify me for SSDI in my combined disability case. In his ruling he use it as supporting evidence to help justify my SSDI claim. This means that he agreed that VA has a separate system to determine if someone cannot work due to service connected disabilities and VA Doctors do not determine if someone cannot work because of said rating system. P&T TDIU can help with your SSDI claim if you have no doctor's letter saying you cannot work. I hope this information can help others get SSDI they paid for. Keep in mind every case is different and I am not a lawyer. Taking our case before an appellate court judge maybe worth it.
  35. 0 points
    Thank you vetquest. I do have 70% symptoms, but he only marked a few. Not all that I informed him. They are listed in the medical records and lay statements. Hard to get them all listed when he was looking at the clock for the next exam.
  36. 0 points
    I wouldn't question VA math, they do what they want anyway. Now, I want you to consider that all those zeros and 10% conditions; should they worsen, only require built up medical evidence to substantiate a request for increase.
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