Chuck75

I recently questioned why two mileage payments were short. When all was said and done, the VAMC (in another city) is using the 5 digit zip code as input to some sort of computerized program, instead of mapquest or other "VA acceptable" mileage. Naturally the 5 digit zip code covers a large area, and typically results in much less than the actual mileage. I seem to remember that the mapquest mileage was considered acceptable by the VA. "http://www.va.gov/healtheligibility/Library/FAQs/BeneTravelFAQ.asp#currentmileage How do we determine mileage for reimbursement purposes? VA has not established use of a single reference. Mileage can be determined using authoritative guidance such as Rand McNally or MapQuest; or zip code to zip code as determined at the local VA health care facility, whichever gives the greater benefit to the veteran." Obviously a policy of shortchanging the veteran provides the "greater benefit to the veteran" in VA think! Comments?

You are quite correct, in that the difference is a percentage, rather than a fixed amount. Sort of an off the wall thought. If you take advantage of the higher contribution amounts in your later years to the IRA/401K plans, you can reduce not only taxable income, you reduce SSA "contributions" as well. This can impact the eventual SSA pension amount adversely .

First talk to the 'patient advocate".( which may go nowhere.) I'd then ask in writing via certified letter to the appropriate VAMC director, and if you don't get satisfaction, to the VA secretary and your congressional representatives. If they are refusing to provide proper treatment, there are also other options, particularly if failing to provide proper treatment cause your conditions to become more severe. Refusing to provide proper treatment to a 100% SC'd veteran can cause a lot of waves.

My experience with a sort of recent C&P that included HBP. My private PCP stated in writing that his opinion was that SC'd DMII was contributing to the HPB (At the time IHD was not presumptive, only DMII.) The VA C&P examiner (a NP) stated that it was "essential". My cardiologist flatly stated in writing, based upon twenty years of medical records, and treatment, that the HBP was directly related to my heart problems, which are now A/O presumptive SC'd. (And the cardiologist teaches and signs off on the area cardiologist's "refresher training" required by the state to stay in practice.) The Nehmer review board threw out the C&P examiners unfavorable opinions when they disagreed with the treating physician's opinions, which were based upon medical history as well as long standing treatment by the physicians. Pain from a back injury can also cause elevated BP.

Depending on a lot of variables, with SSDI dated 03, It's possible that you can (and likely should) appeal the VA's EDD. (as CUE if the appeal year is up) This is assuming that the SSDI is for the same conditions, or even part of them that are now SC'd by the VA. Seven or so years at 100% is a fair amount of change! Not to mention any co-pay that may have been charged) If the VA totally ignored the SSDI determination, it might reach CUE level. (Lawyer time?) SSDI can also be awarded retroactively (with a time limit). I applied for SSA & SSDI when I turned 62. The medical records showed that I had last worked when I was 60. When all was said and done, SSDI was awarded retroactively at the end of the year that I turned 60. In between SSA paid the 62 level pension, then paid me the retro and difference. (About $500 a month difference between the age 62 pension and the full age retirement amount, plus the full retro amount for the additional time.) Supposedly, SSA is easier to deal with if they have to pay, one way or another.

I agree with the not much getting done! As to the original poster's remarks. It's possible to shorten the process slightly if the existing evidence is known to be sufficient to "prove" the claim. Basically a certified letter can be sent to the VARO, stating that the veteran wants the claim decided on the existing evidence of record. This can more or less stop or abbreviate parts of the "development" process, and send the claim to the decision makers. Naturally, this, as many other things in dealing with the VA, can easily be a "two edged sword". There is always the possibility that the VA will try to minimize existing evidence, for a myriad of reasons, and deny, even when the evidence, by regulation and statute, sufficient. A classic example, is calling a single IMO speculation. This is more difficult when there are multiple IMO's that say the same thing.

As to not telling the VA about insurance. First, it's actually against the law. Next, the VA, if it goes to the trouble, can easily find out that you have insurance, be it medicare, group, or individual insurance. Medicare is particularly troublesome, in that it's almost automatic for older veterans. This means that the VA can and will weasel out of paying for outside emergency medial services as one example. And if the VA is really "on the hook", usually fight anyway.

I got into this fight as well. The VA was charging "co-pay" for drugs that they should not have been. I managed to avoid the visit "co-pay" issues by stating in writing that the VA was not my primary care provider. Thus, VA care was for an SC'd condition or things that were medically related to it. Even so it took some time and effort to fight with the VA and recoup the accumulated co-pay that was incorrectly charged. The VA has written statements and guides that said one thing, and the VAMCs were ignoring them and charging co-pay anyway. The runaround was unbelievable when I started to pursue recovery of almost a thousand in improperly charged co-pay. The hassle involved the VARO, the VAMC, and "financial". Each was pointing at the other. Things started to move when I requested (on advice) an "insurance audit" from the VAMC. Even after they started refunding the previously charged "co-pay", they were still charging co-pay and a "service fee" for non payment of the refunded co-pay. ??? That was refunded as well, eventually. Explaining what was still going on to multiple VA individuals was harder than getting the refund checks issued.

To me this can go different ways. You might be able to sue, but I'd think the chances of success are not great. Filing such a suit is one thing. Getting the result you hope for is another. The VA seems to be a major part of the problem, as the appeal seems to still be open. (The VA may try to say that the veteran abandoned the appeal when the open status is brought to their attention, and then show that status.) (Assuming that the VA may have asked for something, usually in very general terms, and the veteran did not follow through with a response.) Remember that ultimately you are responsible for your claim, and a VSO in fact is there to "help". Is there some sort of contract, written or implied, that obligated the VSO to do certain things? The advertizing by various service organizations implies that they can do various things for a veteran.

There is another possible source if a veteran's PCP is at a VA medical clinic. The C&P results, assuming that the clinic is under the VAMC that conducted the C&P exam, can be accessed electronically, (Once filed) and a veteran can usually obtain a printed copy by going to the clinic and requesting it. The clinic may require that the veteran sign a release/request for medical records form.

The situation is that you have a documented history of IHD. The VA requires current evidence of the severity of IHD, or most other conditions in order to rate. The next problem has to do with progression from then to now, and what period may be subject to retro pay, and at what level. Hopefully, the existing records can show some sort of either progression, or a stable condition. My experience with this was that I had open heart surgery a couple of decades ago, showing that there was a serious condition present. Since I used the same cardiologist and other doctors then and now, the continuity of medical records was better than usual. I did have a problem with the local hospital, in that they stored old records off site, then "lost them". Fortunately, regional hospitals in Atlanta and middle Georgia managed to find most of the older records. In the last decade, an additional heart attack, and several stints, along with the usual medical tests and evaluations showed that there was damage, and the extent of it. Still, the VA denied all but one of the claims, until the Nehmer Review came along, and reversed the majority of the denials.

It seems to me that "past anterior infarction" is by definition, evidence of probable IHD. EKGs can show damage. The prescriptions you mentioned also indicate treatment for a heart condition, and probable heart damage. These are not normally given to someone without at least a suspected heart condition. You should also be looked at for DMII at some level, possibly below that used for formal diagnosis. What is missing at this point is medical information that can be used by the VA to define and "rate" the severity. However, the "chronic diseases" reference makes me think that the RO may have been in the classic "deny anyway you can" thinking mode, and used the fact that there is no direct reference to IHD in your records to deny the claim. Your statement that you didn't think that you had heart disease was evidently used against you. Had you said that you thought you had heart disease, the VA would likely have totally discounted it, since you are not (as far as I know) a "medical professional". I believe even the mention of it might be considered somewhat prejudicial, but again, that's a lawyers call, not mine. If no C&P was made, or ordered, this can be used in your favor. You need to file an NOD, and, if you can get the necessary information in hand, use a "form 9" and send a copy of a cardiologist's showing that IHD exists, and the severity of it. The VA "likes" to use a definition (METS) that is not commonly used by cardiologists. However, a ventricle efficiency measurement (usually left), is also acceptable, and will allow a "schedular" percentage to be assigned by the VA. You can also ask for "reconsideration", based upon "new evidence". This might take less time. I think that the NOD and appeal route is preferable, unless you can somehow get the VA to "CUE" the decision, (doubtful) based upon the relationship between "infarction" and IHD. Others may have differing opinions, and I'd ask for legal advice as well before I made a decision as to which route to take. Just don't let your options expire. The no diagnosis bit is sort of a cop out, in that the medical records show that you likely have IHD at some level, and the VA should have at least called for a C&P to determine if IHD is present or not, and it's severity. I believe that the VA made some serious errors (nothing new!), and that a competent lawyer can capitalize on them.

What I would do - - talk to a non VA interventional cardiologist. The previous stress test should show some idea of your hearts damage. A heart cath should show the extent of sclerosis. The cardiologist's report will likely show that IHD exists. Past heart attacks cannot be ignored, even though the VA RO tried to do so. Remember that you have to appeal (NOD) within one year to maintain the original claim date. If you are a veteran that falls under Nehmer, you should also contact the NVLSP.

I believe this is a case that falls under Berta's area of expertise. Without knowing more, I'd suggest you and who ever represents you need to get a full copy of VA treatment records, as well as the VA "C" file. A claim, if made in 1984, precedes the 1985 Nehmer date. I don't know how pre 1985 evidence is dealt with. If your vet was treated by the VA, the medical records may show something that is significant to a lawyer. When did you file for "readjucation?

Generally, it's better to dress down a bit than dress up. Appearing in need of benefits can help. Remember that the VA often fails to properly follow the "evidence in equipoise"-- "to the veteran" legal requirements. Instead, the VA has been known to give more weight to a lack of complete evidence, and even try to negate positive evidence. It sounds like you will eventually win, although it may ultimately take an appeal. Evidence that the NG is "throwing you out" for PTSD documents the condition. The other evidence you mention should, if considered, show that there is enough of a relationship with your combat service to service connect PTSD.

My advice would be to contact NVLSP www.nvlsp.org Without knowing a heck of a lot more about your claims -- You may be a member of the Nehmer class action. If so, certain heart related conditions are presumptive. It very well may take an IMO from a cardiologist to connect your heart related conditions to the VA's presumptive heart conditions. Since DMII is already service connected, it's quite likely that you have previously satisfied the presumptive requirements for A/O related conditions. Usually the VA's language concerning from service to the present is a cut and paste phrase, and not necessarily germane, particularly with presumptive conditions. The sad part of the whole thing is that DMII can smolder away for at least a decade before it is formally diagnosed. Heart conditions can be caused or become more severe during this time, and, actually may be diagnosed prior to DMII. The blood glucose limits used by doctors to formally diagnose DMII are evidently higher than the levels that may cause or contribute to heart disease. Another facet of your dealings with the VA is related to a change in the VA's stance concerning the relationship between DMII and heart disease. Some time ago, in the same general timeframe that DMII was being considered for presumptive status, the VA changed (reworded and renumbered) a section in the M-21. Previous language acknowledged the relationship, and post change language omitted it. The VA/DOD treatment guides (last time I looked) do admit to the relationship. I believe the VA hopes that veteran's will make mistakes in appealing such claims, or not appeal at all, and thus loose the ability to successfully challenge denials.

Depending on what seem to be fairly random factors, calling the 800 1000 number may or may not provide useful and correct information. Evidently, the responders access level to the electronic files can vary. It may be dependent on the responder's qualifications. It seems that the more senior responders either have a higher access level, or more knowledge of the on line systems. Then, there is always the "get this veteran off the line", so that I can answer the next waiting call impetus. (Has to do with ratings, etc.) In short, I've had wildly varying results from calls to the 800 number over the last few years. Things did sort of improve in the last few months, in terms of information available, and it's accuracy. This may have been in part due to the VARO actually "getting with it", and updating the electronic records. Or it might have been due to changes in SC'd conditions (Nehmer review) that resulted in a much higher SC percentage. (The Nehmer review results show that the VARO did not do what they should have done in more than one specific area. E Benefits was still screwed up the last time I bothered to look. After some phone calls, it looks like data transfer to E-Benefits is part of the problem, and what data should be shown is another. Then, just to add another variable, the data may be such that it requires in context review to insure that it is placed properly in "form" boxes that become part of the VA letter generator output.

Unless a laptop or netbook is needed for portability, a good desktop is a much better price performance combination. I've used both since the Z80 days in the 80's. You can expect to pay almost double for a laptop vs. a desktop with more or less the same speed and capability. Replacing $100 dollar batteries periodically is also not my preference. The batteries on my last two laptops were recalled, and the netbook had a battery that started to fail while still under warranty. (Whew!) The previous laptop had NI-Cads, and they had to be replaced about every two or so years. The company my son works for recently bought a lot of laptops from a govt. surplus sale. Many had never been used. More than half had batteries that failed while the laptops were in storage (A bit over one year)

You might want to look at -- http://backandneck.a...ioxxhistory.htm The recall was in 2004, with concerns expressed in prior years. It looks like the doctor did the prudent thing. The drug maker may still be liable, but that's a matter for lawyers. Had it been me, I'd have questioned the reasoning behind the steroid shots. They have their own hazards. Chest pain is usually something that is of potential serious concern, and drives a need for further tests and investigation.

In short the RO screwed up with the No evidence statement. What a DRO will or will not do is open to question. I'd likely file an NOD and cite the RO's failure to consider positive evidence, despite the listing of it.. The other question has to do with the VA C&P examiner, and medical qualifications in relation to the doctors that gave favorable opinions. A VA C&P examiner may be only an NP, PA, or even a doctor without qualifications, or specialization in the appropriate fields. You can always file CUE, but have a limited time to file an NOD. As to requesting a DRO review, I once did so, several years ago, only to have the DRO "rubber stamp" the original denial. The turnaround was so fast that it was rather obvious as to what actually occurred. One would hope that things have recently improved, but there is no guarantee. A recent Nehmer review completely reversed the denial, and resulted in more retro than what would have been paid if the claim had been approved in the first place.

How long ago was the drug prescribed? It was recalled by the MFR some time ago, due to heart related concerns. http://arthritis.about.com/od/vioxx/a/vioxxrecall.htm

The rules are complicated when you are under 59-1/2. But, If you have a doctors brief signed statement of disability per the IRS Pubs, and you file it or have filed it in the past, The penalty is waived. But, the money from the IRA will be subject to tax. (unless it's a Roth IRA, which has the tax already paid. These days, one of my tax related tasks is to calculate how much I can withdraw from an IRA each year without hitting income limits that would increase the income subject to tax, or the rate. I'm still unhappy about the years that the VA delayed things, and I had to draw on capitol to survive. At least I was more fortunate than some.

A bonus for doing your job properly? Hah! That's why people get paid in the first place. These days, many workers in private industry are lucky to keep the job they have. In not a few instances, workers are being told that there pay will stay the same or even decrease, and the only alternative is to go find a job elsewhere. A bonus may be paid for accomplishments above and beyond the normal duties of a position, but not for competent performance in the position. The VA is in a similar position to a company that is going bankrup, or Krupp industries during WWII. Seems that Krupp's factories were bombed out, no production, etc. Yet the administrative headquarters was churning out paper as if the plants were in full production, and had a full to overflowing staff. There were serious repercussions when the German government (such as it was) found out. Something about the Eastern front needing more "cannon fodder". The VA is a bureaucrats wet dream. Horribly inefficient and redundant system. Years to do things that the SSA (as slow as it is) seems to be able to do in months, and a real error rate that is through the roof. Penalty for error? What penalty? A veteran cannot collect interest on long delayed payment, and is (if lucky) paid in depreciated dollars. Quotas are for quantity, not quality. It's easier (and faster) to deny a claim, and get credit, than it is to get credit for an approved claim.

Retro (back pay) is based upon the rates in effect during the time that the retro covers. (Minus any previous payments for the same periods.) IE This can occur when a rating increase is retroactive, or payment was made for a lower % condition that is separate from a retroactive 100% or TDIU rating. I.E. You were SC'd for DMII at the usual 20%. A retroactive award for another SC'd condition was granted, based upon a Nehmer review at 100%. The previously made payments for the 20% are deducted from the 100% retro due as a result of the Nehmer review's additional retroactive award. As to income credits, etc. The forms to claim this require that you disclose VA payments and other nontaxable income. I'm against this in principal, and every time I bothered to fill out/use the forms, The result was that I could not claim the credit. As to IRS rules http://www.irs.gov/i...=168606,00.html (Page leading to info, etc. for disabled taxpayers) In any event, a doctors statement that you are disabled, and so forth, is covered in IRS publications and instructions. (It would seem that you have several options to show the IRS that you are "P&T") I don't know anything about your VA disability rating. SSA uses different rules than the VA. As a result, it's possible to be disabled by the VA and not disabled by SSA. Or, SSA considers you to be totally disabled by the same conditions that the VA rates at lower percentages. This is where VA "TDIU" can come into play. SSA can lump together conditions that the VA rates as unrelated co-existing conditions.

Has anyone noticed that the call center responders have gotten more polite, and generally a little bit more helpful lately? Perhaps this is a clue as to why. http://www.va.gov/bu...PAR_Part_II.pdf (extract) Part II – Performance Summaries by Integrated Strategy New Policies, Procedures, or Process Improvements and Other Important Results VBA implemented call recording for the VBA National Call Centers (NCC) and 100 percent of inbound calls are recorded for standardized quality assurance reviews. 2011 Performance and Accountability Report / II - 23