Chuck75

It sounds like one of the reasons for the NOD is going to be that the VA failed to consider all available evidence. As others have said, I'd have to look at the denial, and also the evidence in favor. I have seen denied claims (including one of mine) that contained errors so obvious that the RO didn't know the regs/law, didn't take the time to read all the evidence, and may have been told up front to deny. In one claim the reason for denial wasn't even one that was imposed by law or reg, just a random RO generated "reason".

Around here, there are few interns. Many of the exams, be they the usual or a C&P exam, are actually given by an NP or PA, then "signed off" by a doctor that hasn't seen the veteran. Another problem at the remote outpatient clinics is turnover of the more qualified staff. The doctors seem to come and go more rapidly than I've ever seen before. Something about so much time to do an exam, and not enough time allowed to do a decent exam and write it up properly.

That's a very good question. Unfortunately for your friend, the DVA is likely to say that the presumptive requirements are not met. The DVA has still not formally recognized that ships can be contaminated for some time after presence in Vietnam inland rivers, etc. Australia, on the other hand, has recognized that Vietnam era ships systems did not have the capability to remove dioxin. It's somewhat interesting that the majority of ships used in Vietnam's inland waters were scrapped, or, in a very few cases, had fresh water systems completely replaced. One ship (a DD) that I briefly served on (reserve training, 70's) was sold to a south american country after it's freshwater systems were completely replaced. DD's usually were in inland waters such as rivers for short periods. If nothing else, DD's were generally powered by steam turbines, and had to use a heck of a lot of fresh water, even with water recovery systems. Unfiltered river water will clog the evaporators, causing serious problems. Most ships in Vietnam did not have filters that were effective in removing things like river water muck, let alone A/O related chemicals. (Dioxin) The Army did have some filters that sort of worked, but they were not large enough to provide the amount of clean fresh water required by steam turbine propulsion systems. The process we used on ships that were in rivers, etc for extended periods. Pump the river water into a "void", a large empty compartment used for ballast - water, air, whatever was needed to properly balance a ship. Let the muck settle to the bottom, and then pump cleaner water from the top. Pump the settled muck back into the river. Pump the cleaner water through an "Army osmosis filter", and then into a clean void. Finally, as needed, the clean water was sent through the ships evaporators, and stored in tanks used for fresh water suitable for drinking, food preparation, etc. The majority of these "up the river" ships were diesel powered, and used far less fresh water than a DD.

Not here!

Military members must "play by the rules" if they intend to stay in the military and eventually retire with full benefits. The problem is that there are many rules and practices that are based upon tradition, not law or regulation. Adapt or perish is one of the unwritten rules. Those who cannot do so, regardless of why or how, will be treated poorly, and a concerted effort may be made to "get rid" of them as a "problem". Commanders might say something to staff that prompts administrative action to transfer or discharge, for example. The medical side may be asked to assist. To the military, the "mission" is more important than any individual member, particularly those members in a "support" role. When you couple this with obvious efforts to eliminate future liability for pension, compensation, and other benefits, you end up with today's realities.

The treating VA doctor is obligated to document the conditions. The doctor is cautioned specifically to not state that the condition is/is not directly related to service. The doctor may say that the condition is a result of another condition that "happens" to be service connected. There are internal VA guidelines as to what the doctor should do when a veteran requests an "opinion". These seem to go beyond those publicly available, and may be "local" "informal" policies. Getting above board copies of these can be a problem. The VA has "total control" of the claim in any case, until a claim goes beyond the BVA. The Nehmer class action and others are examples. What might be the case these days is how an RO might complete the case as rapidly as possible, while following "CYA". If approval is the answer, so be it. If denial is faster (as it commonly was in the past) that's likely to be what happens.

The unstated problem is that the RO can (and often does) take the C&P examiners results as gospel, even when the C&P examiner is an NP or PA, and the IMO was made by a fully qualified board certified doctor in the appropriate specialty. As to denials and approvals. The VA's record is extremely poor in terms of accuracy when it comes to RO level decisions. Of those appealed, it's said that ~70% are reversed in the veteran's favor, or at the very least referred back to the RO's for additional development, etc. The majority of VA/OIG audit efforts or efforts similar to them concentrate on claims that were awarded in error, in that more benefits were awarded than the case seems to justify. Very little effort seems to go into claims that were denied or "lo-balled". The VA prefers to deny claims. The actual Laws require the VA to award them when at all possible, even when the evidence is not complete. To the VA no evidence is negative evidence, and given negative weight. Every possible attempt is made by the VA to counter or degrade the value of positive evidence, so that the ratio of positive to negative evidence can be altered. In some cases this includes C&P shopping to try and get a less favorable C&P. C&P examiners often seem to be informally "graded" by C&P results that aid rather than hinder the denial process. I might go on, but the actual situation is quite clear.

Hydial Hernia, Barret's, GERD and heartburn can be medically interrelated in terms of cause and effect. It looks like one of the effects is SC'd, not the cause. This is perhaps one of the fundamental problems with the VA's C&P system. The first thing to do is to get a medical opinion that the VA will accept for claims. The VA, at the RO level, may or may not accept the opinion of a VA PCP. On receipt of such an opinion, or diagnosis, the VA does whatever the RO decides. (Usually the RO calls for a C&P) An independent workup and opinion acceptable to the BVA may not be given any weight by an RO. In any case, the most common RO actions are to request a C&P, or just summarily deny. Very occasionally, an RO may approve such a claim. The denial forces the veteran into the appeals process via an NOD. The C&P process will cause another delay. The C&P gives the C&P examiner (often not even a doctor specialized in the appropriate field) an opportunity to minimize the severity or say that it's not likely that the issue is service connected. An independent diagnosis and opinion (IMO) when done properly, will usually be more definitive, and at a review level, or the BVA, may overcome a poor, incomplete, or biased C&P. If such an opinion and diagnosis exists, and the C&P examiner actually reads it, the examiner may or may not agree, and may or may not produce a more favorable report. The cause effect situation is often not dealt with properly by the VA. You would think that getting the cause of an already SC'd condition also SC'd would be a logically forgone result. Not so with the VA. They might deny the cause, then try to sever the effect for compensation. Since the SC'd condition is at 0%, there is no compensation for the condition, so severing it would be of little gain, other than to make it harder to get the cause SC'd. Treatment is another issue. Some VA doctors will consider the cause to be related to the SC'd condition, and check the appropriate boxes that result in no co-pay for treatment. Others will not, and force the veteran to go through the adjudication (claim) process. In other words, you takes your "best shot", and eventually find out the results.

"The standards for what is considering your ability to adjust to other work changes with age. " That they do! The real problem is that they cause a "mind set" against younger claimants. The rules and practices are very subjective in this area. In some cases, it's better if you are older (62+) to apply for early SS, and simultaneously also apply for SSDI. This basically shows SSA that you will no longer be working, and the reason is related to/contained in the SSDI claim. Without this option, a younger person is at a disadvantage in that the system tends to work against them. Even if you are older, when you were working at an "unskilled job", SSA might deny, and say that you can still preform other "similar" jobs. The advice I was given was to look at the SSA requirements in detail, especially those addressed in the questionnaire, and how they might best be answered. It was actually somewhat amusing when I answered the questionnaire, because the positions I filled involved multi-discipline highly skilled technical fields, along with physical agility. One of the questions had to do with climbing ladders and stairs. The answer was yes, and that the ones of most concern involved large military aircraft.

To "Papa" The problem may be in the details. Your case "should" be looked at by the Nehmer class action lawers. You claimed DMII, and the VA denied it. The reasons for the first denial are what can be critical. If they denied the claim saying you did not have proof of DMII, then it's possible that they denied "due process" and so forth, since they did not schedule a C&P or other action to determine that you did or did not have it. On the other hand, using the year after service period, which they often mention as a boiler plate insertion in a denial, is misleading, and usually incorrect when it comes to Nehmer cases. There is another go around concerning DMII and IHD, in that IHD related conditions often occur before DMII reaches diagnotic levels. The VA's own documents admit this, yet the RO's often try to downplay and ignore the facts. I'd suggest that you should contact the Nehmer class action lawyers. It's possible that the VA did not include you in the list that the court required the VA to furnish to the lawyers. (I wasn't on it, even though I already had an award (presumptive, A/O). part of my A/O related claims were previously denied, deferred, and stuck in VA limbo. When the class action lawyers contacted the VA concerning the problems with the "list", things started moving again.)

My take--right or wrong-- Ratings go in order from highest to lowest. IHD 60% 60% DMII 20% 20% of 40% = 8 % , if this were all, round up to 70% Then the 10% 'ers get figured with the bi laterals. This is how the VA would get to ~80% They might (should?) have not rounded the 8%, and left it in the calculation instead of the 10%, until the others are figured as individual items, then rounded at the end. (I never deciphered this exact combination of things, let alone adding in the bi laterals.) Lets say that you were originally rated for just the IHD and DMII. (70%) Then the other 10%'ers were awarded. Would the VA go back and re-rate the whole thing, or just use the 70% as the base to work from? This is why things can get confusing, to say the least!

The Atlanta VARO managed to be gracious enough to call about two weeks before my C&P's were scheduled. No C&P appointment letter, etc. I did manage to get one canceled. Seems that they scheduled it at a location and time of year that made the trip hazardous (secondary roads, snow, ice, etc.) and having to stay overnight for one or two nights, depending on what times were involved.

"Women's Hips" That's a new on on me! Men's hips have as much variation as women's do. Perhaps the biggest obvious difference is related to child birth and the way wider hips better meet the needs. As to bone mass in general, there can be a great variation from one individual to another, even when they have similar geographic backgrounds. Most of my ancestors were of German decent, yet tall and skinny, with "light frames", and short and wide, with "heavy frames" are still quite common in my modern relatives and descendants.

Some of the Atlanta VARO past denials show a difference in detail between an approval and denial. Unless the approval is a simple "slam dunk" the approval writeup is in more detail, and contains more justification than a denial. When a denial was based upon a faulty C&P, the C&P was listed, yet the inadequacy was not addressed. When the C&P is part of an approval, frequently the inadequacies of the C&P are mentioned, yet it is still sufficient, although it may result in an incomplete or lesser award. Don't get it right the first time seems to be a working goal. Just look at the appeal statistics, and remember that they just show part of the problem. I have no doubt that things have improved under the current secretary, and that there is a long way to go. One of the major problems is generic with almost all institutions, in that they expect people to adapt to them, rather than the institution adapting to the "real world".

You have no choice to treat the disappearance as a denial if you don't like the results and want to appeal. Remember that the VA hopes you will forget, and allow the appeal time limit to expire.

Although the "strength" should be the same, such things as exactly how a drug metabolizes, and residual effects may differ. Actually, this can also happen with the non generic drug as well. I still remember one drug the VA dispensed several years ago. It had a "fishy" taste. Investigation showed a Canadian drug number, an American packager/distributor, and an Indian source that was a satellite facility of an American drug company. If memory serves, the drug was for DMII.

I'd file, so that it is a matter of record for EDD determination. Who knows what else might happen in the future.

That's a difficult question! It's all in the regs! That aside - - two different PTSD examiners may give quite different opinions. Perhaps more of concern is what can happen when a 100% PTSD rating is awarded. The VA usually "proposes" that the Veteran is incompetent to manage affairs. This can result in withholding benefits, transferring a veterans bank account to a fiduciary's control, and so forth. Generally, the veteran can have a difficult time, unless the ruling is promptly challenged with a formal notice of disagreement. The available information on Hadit and VAwatchdog.com goes into far more detail than I did.

If the ED is SC'd, SMC "K" would apply. The rest depends on what is awarded, and at what percentage. Basically, the simplest "combined rating" to look at would be a single 100% rating, then other ratings not contained in the 100% that add with "normal math" to 60% or more. "Lo-Ball" ratings for conditions are not uncommon. The vet may end up getting or needing to apply for "TDIU", if the VA's ratings are lower than 100%.

If you read carefully, the award documents will contain a phrase no future exams scheduled, assuming that you are P&T. It will also say 100%, and usually contain other forms for insurance, CHAMPUS (for dependents), Life insurance, etc. The brown envelope should also contain instructions and a form used to apply for a DOD ID card. For other purposes, your state veterans affairs representative may need to look at the VA paper work, and then generate letters for homestead tax exemptions, vehicle tax elimination, free tags, and a free driver's and fishing/hunting license. The benefits and requirements differ from one state to another, so you will need to look up your state's benefits, and how to obtain them. I ended up (in Georgia) Getting a letter from the state VSO Going to the nearest military base with all kinds of records and the VA documents. Visiting the county Tax assessor's office twice. Going to the Drivers license office. The results were Military ID cards for my self and wife A real estate tax reduction of $1,000 a year Free vehicle tags and no PPT for one vehicle. Free Driver's license. I have not yet bothered to get the hunting and fishing license, as the stores that sell/issue them don't deal with the free license. The free license is issued directly by the state.

Unless things have recently changed, I believe that the VA cannot bill Medicare. They can bill "private" insurance. In not a few cases, the VA's co-pay or deductible is less than private insurance. In theory, payment by an insurance company to the VA is deducted from your co-pay.

From what I can see- Wait until the problem with question 21 is resolved by the various political and security people. At this time 21 would be answered yes in this case, since there is a government agency record of mental health consultation/treatment. Withholding information, unless it is exempted, is of itself a reason to deny clearance, and creates a faint possibility of prosecution. A statement from any entity that information is withheld under public law is enough to create interest on the part of the security people. As to the PTSD relationship to question 21. I believe any "combat veteran" is very likely to have some level of PTSD. I'm saying this as a Vietnam Navy veteran with three combat related awards, "feet on ground" (and in the rivers) Vietnam service. Answering yes to question 21 causes immediate problems. It will likely result in administrative suspension and even revocation of a government security clearance. The person involved then must get "evidence" - reference letters, etc. stating that the mental condition(s) that were/are under treatment do not pose a significant risk. Although I have not ever sought counseling that might qualify as counseling under the rules, I have discussed certain things with medical doctors in the past. This does not count under the existing and past rules! Anyway, I did hold an active security clearance from the 1960s until I retired six years or so ago, due to A/O related medical problems. After 9/11, the government (DOD) did tighten up a bit, with more frequent and more detailed background checks.

I still firmly believe that denials should result in fewer points than an approval. Has to do with the difference in the way an approval gets through the system. The law requires the VA to be an advocate of the veteran, not a devil's advocate. Unfortunately, many veterans find the opposite to be true. In past years, there was some relation between the fiscal year and claim approval rates. I don't know if this is currently the case, as new presumptives, laws, etc. have changed things.

Appeal is possible for one year after the decision is made and mailed. When a claim has deferred portions, it's possible that the VA will assign an incorrect limit to the time to appeal the deferred items. If errors reach the level of "CUE" in the decision, the year is not the limit. When an award is made, and does not include the maximum that a veteran applied for, or that might be inferred, an appeal is usually needed to try to get the maximum. The VA usually regards a 100% "schedular" P&T award as TDIU, although there is a technical difference. A major distinction is that most P&T awards allow a veteran to work, (100% PTSD seems to be the exception) and TDIU requires reoccurring "proof" via an annual VA form that a veteran is not working.

My concern is that long term overtime and pressure generally cause or contribute to a myriad of problems. Tired workers are not as accurate or efficient, and usually eventually end up taking more sick days. What we don't need are more cases that were incorrectly processed and "adjudicated". The BVA is already totally buried in appeals. What veterans need and deserve are fundamental changes in the VA's approach to claims. Currently, and for over a very long time, the VA is still taking the devil's advocate position, rather than following the stated intent of congress (in law) It should be harder to deny a claim than approve it if the intent of congress is taken at face value. I also think that a claim denial should result in minimal credit, and an approved claim should generate full credit. This is based upon the amount and "quality" of work needed to get an approved claim through the system. If nothing else it, would discourage the widespread institutional bias towards claim denial. I also think that a veteran should receive some sort of additional compensation that is based upon the delay in processing an original claim and the time it takes to appeal an unjustly denied claim.