Chuck75

Actually, drug refunds, interest, etc. can come into play when a Vietnam veteran has any Nehmer related claim granted, or even in some cases, in the "mill". Once the veteran is determined to be a "group 6" veteran, any medications for presumptive conditions, or for treatment secondary to those conditions is eligible for no co-pay, and refund. (Adjudicated or not!) What gets interesting is that an "adjudicated" A.O. related condition can also result in the Veteran being placed in "group 2", Theoretically a higher group for treatment priority than group 6. The rub is that the group 2 classification entitles the veteran to no co-pay for the SC'd conditions only, in contrast to group 6, which covers all A.O. and other presumptive conditions. An interesting question arises in a Nehmer case. Perhaps the veteran has a condition that has required drug treatment, and obtained drugs from the VA under the Veterans Drug act prior to making a claim for the condition. Remember that the time limits under Nehmer are different, and so forth. There seem to be at least two different takes. The VA will certainly take the stance that refunds are due only from the time of the claim. Yet, if the group 6 classification is retroactive as well, it would actually go back to the first treatment or drug prescription date, since it's claim date independent.

10% for IHD is an obvious "low ball". (Or the medical tests needed to actually show the amount of damage were not done, or the results were not considered.) IHD is damage caused by restricted blood flow to the heart. It also encompasses Cardiovascular disease, (CHD), and Coronary Artery Disease (CAD) among others. "METS", as used by the VA, is not a very accurate measurement of heart damage or "efficiency". Remember that the average healthy individual does not really fully stress the heart during "normal" activity. A few years back, the USAF was kicking athletic enlisted men out because their heart was not reacting sufficiently to the USAF's retention stress tests. "Gold Standard" tests are such things as a heart cath, or a chemical stress test with dye, imaging, and combined with electrocardiograph results. When a chemical stress test is done properly, heart failure is easily seen. Real time imaging actually shows when the heart starts to fail, and how it's failing. The real time image changes often occur before or co-incident with changes in the electrocardiograph traces (also real time). Normally, the patient feels a stronger heartbeat during the test, may or may not have some discomfort (usually due to a mild reaction to the dye used), and possibly sort of an undefined uneasy feeling. A precautionary drug sometimes called for is Prednisone. It is usually prescribed for up to several days preceding the stress test. Basically, it helps reduce or eliminate a possible reaction to the imaging dye. (Yes, I've been through these tests as a patient, more than once.) The stressor chemical's effects can be reversed within a very short time.

In short, yes they can refuse to give you the records. The simplest thing to do is to have them sent to a private doctor of your choice. You also might want to get the doctor to write a short letter citing "medical necessity". A lawyer representing you should also be able to obtain a copy.

Congratulations. I don't know the details, but 100% schedular is a significant win. It's beginning to look like the VA C&P section was repeatedly kicked in the posterior until they started getting things done right! Evidently, some RO groups are still doing things the same old way, and others have gotten on the train. It's going to get interesting when the approval and denial statistics are collected and analyses made.

You can request a waver and NOD part of the decision. They made the error. Just do so as soon as possible.

If you were able to get the three doctors to put their opinions in writing, that would surely help. I had a VA doctor give me such an opinion in writing. The VA RO's ignored it, until the claim (after partial denial) went to appeals, and a C&P was ordered. The C&P examiner was an RN, and was not about to try and rebut or disagree with the VA doctor's written opinion. Another part of the claim was intentionally "minimized" by the C&P examiner. The examiners opinion was rebutted by statements and diagnoses from board certified specialists contained in my medical records. I used an "in house" VA form that has since quietly disappeared from the VA's forms lists. A form is not really necessary, but a written statement is.

You are going to visit the local SSA office. They may or may not be correct in what they tell you. But, I'd check with more than one "official" source before you are comfortable with the answers. Logically, you are correct, since your SSA credits have nothing to do with the CSRS or federal employment. On a practical basis, there may be a "quirk" in the system that jumps out and gets you.

Generally, the VA sends out a letter acknowledging a claim. This letter may ask for the world as far as service records, medical records, etc.. What I do know is that your Navy service records were kept at the St. Louis records center. When the VA receives a claim, they normally request those records. The records center has been known to occasionally say that they don't have records when they actually do have them. IMPORTANT! If you have a service connected disability, or claim in progress, the VA likely has the master copy of your records. It seems that the National Records center sends the ORIGINAL to the VA, not a copy. The Original may eventually be returned by the VA to the records center after a period of inactivity. (No further claims, no VA actions needed, etc.) Just to add to the problems, service record custodians have repeatedly claimed that the VA is returning incomplete files, showing that the VA "lost' key records. It also seems that the type of records often "lost" are those that might be favorable to a claim. If the VA has somehow "lost" the original copy, completely reconstructing the records is a chancy thing. "Buddy" Statements may be the only option. This gets difficult after forty or so years have elapsed. Since you mentioned "brown water" service, you may have been part of what is called the "River Rats". If so there is a web site run by the MRFA that may have some useful information. http://www.mrfa.org When I was separated from the Navy in 1969, I was given a copy of the records in my "jacket". These were not complete, and several problems resulted. I had to do research to determine the number and type of awards that I was entitled to that were not on the original DD214. This eventually resulted in the issuance of a DD215. All of the records involved were at St. Louis. I was also able to obtain a copy of my records from ST. Louis before the VA got their grubbys on them. This included some hospital records that were key to proving "feet on ground" well before the VA finally acknowledged "Brown Water" service was presumptive for A.O. exposure. Funny thing, records of a potentially "CUE"able claim going back to 1969-70 are no longer in the Original file currently held by the VA. (I'm still digging to see if I have a readable copy of the VA denial somewhere in a closet full of records.) Just to complicate matters, my parents passed away some years ago, and we are still sorting those records as well. So far, we have disposed of uncountable bags of shredded records that are un-needed. After a dozen or so bags, we loose patience, and have to quit for a week or two.

I don't resent the fact that lawyers get paid. Under the "old rules" they had to work "Pro Bono" as the law required a payment that was a 'pittance". 10 or 20 dollars? On the other hand, I deeply resent that the veteran in essence has to pay to correct the VA's mistakes. The time required is totally ridiculous, and from that alone, the VA should be paying reasonable costs, not the veteran. The anger is such that if the VA had done what it should have done, and complied with the law, I would likely have quit at this point. But, since they forced me to fight, I will not consider the fight over until all reasonable "issues" are resolved in my favor. Collectively, they result in about a 10% difference in the monthly payment.

The fat "white envelope" showed up today (Good Friday, yet!) With the gory details of a Nehmer award. Check was in hand yesterday. There is a six day difference between the stamped date on the envelope and the date on the award letter. Only two days from the envelope date to "in hand", and the award letter actually was sent from Florida, not my area VARO. The VA actually did get the EDD correct (Shock!). The married rate was applied. The correct current monthly payment was calculated properly. There was some question as to what date they would try to use, since the correct date was dependent upon a claim application (A.O. Presumptive condition) that did not specifically mention IHD or heart disease. Later the VA specifically denied heart disease when a specific claim was made. They also awarded hypertension as secondary to IHD, which was also previously denied. A C&P examiner tried to claim essential hypertension, and the treating doctors records and statements refuted the C&P examiner's opinion. (Board certified specialist vs. RN examiner) This means that so far, the individual SC'd condition totals add up to 150%, 10%-20% short of what things actually should be, wonder why? <G>. Now that the major hurdle has been overcome, it's time to concentrate on the rest. Scars were SC'd at 0%, and an SMC duty related condition previously denied was not mentioned. The VA did include the information form 21-8760 concerning P&T, but not the "certification of total disability" and DD 1172. (Always something) Phone call to the infamous 1000 number actually went through first try, and the VA rep supposedly generated the needed certification, etc. while I spoke. Supposedly, I should see stuff early next week. Hadit was a great help and provided encouragement during the persuit of this claim. I wish I could say the same thing about the state veterans affairs reps, and the other service organizations. (DAV, VFW, etc.) Their ineptness caused or contributed to denials and the need to eventually get a lawyer. Someone once said that the VA starts actually doing what they should have done when lawyers get involved. I found that to be the case. The VA actually did respond within the 21 day Nehmer limit after receipt of the last letter from the lawyer, which basically said that you have everything needed, quit screwing around. Actually, a case can be made that everything was in place over a year ago, and The VA was technically in contempt.

The Eagle roosted on my mailbox today. Just long enough to deposit a six figure retro check. Paperwork was supposedly generated at the VARO last week, and has yet to catch up. The post office must have fired the pigeons, because it's less than one hundred miles as the "crow flies" to the VARO. In the past, I've had VA letters from the RO that were dated up to five days before the postage machine stamp on the envelope. Without the details - - They may or may not have used the correct rate (married) The effective date may be off a bit.

I fully understand your frustration and anger at the situation! You obviously will need to do something concerning outside medical care. Unfortunately, the VA is very unlikely to be willing to pay for such care. I don't know anything about possible alternatives, such as Medicare, etc. that might be available to you. What I would consider - - Prepare a single page "Form" in letter format Usual headers etc. The form basically says that you asked for medical care for ________ on ________ at VA facility _________. _________ (Name, Title, an employee, member of medical staff, etc. of the facility informed you that medical care was not available. Reason Care was not available if known______________ VA representative or "Gate Keeper"refuses to initial, acknowledge, or properly identify position and authority Yes/No VA Facility Date Stamp (If available) Using such a form generally causes polarization, and may not win any friends, to say the least. On the other hand, it does generate something that can be used in an effort to get the VA to pay for outside medical services.

The original claim was filed (and approved) for presumptive DMII. The VA failed to do several things. 1. The VA entrance exam (several years ago) was fairly decent, except that the Examiner failed to check a box relating to A.O. Vietnam, etc. 2. Due to a peculiarity in the Veteran group assignments, the DMII approved claim placed me in group 2. 3. The VA failed to notify the Nehmer class action lawyers. 4. My VA and service records show evidence of IHD, and other records as well. They had denied a previous claim. The claim was refiled between the time the decision was announced, and before it was effective. 5. Within the last month, my lawyer wrote a letter to the VARO, reminding them of certain time limits in the court order, of which the shortest was 21 days. The VAMC, VARO, and the VA clinic failed to correct things for several years. (Veterans don't know anything, don't-cha know!) Some months ago, I ended up contacting the Nehmer class lawyers, and they sent a request to the VA for records. That sort of triggered several things. A C&P (last year) also had Nehmer related statements from the examiner. I also requested an "insurance audit" from the VAMC. Since I currently have only one Nehmer claim up for decision, I was able to give the phone rep enough info that she could say a little bit more than usual, without getting into trouble. Also, being nice and polite sometimes works wonders. The claim was recently transferred from my "normal" VARO to BayPines for decision, etc. as a Nehmer claim. I can't say more-- Other than, like you, to me, cash in hand is the real determination.

If the VSO doesn't care what the law is, there is a problem. I'd also have to agree that the RO's may not read far enough to get to (2), and seem to forget the last word "or" in (1). The M-21, now that I think about it, may also skip or alter the plain language meaning of (2). (I honestly don't remember, and haven't read the current version.)

The other day, the VA sent an insurance brochure and application form. Reading the details, if a veteran is over 65, the amount drops to $500 from a minimum of $10k. Since I fall into the over 65 category, and have a significant currently not service connected condition, I was scratching my head as to why the VA even bothered. Thinking back, past copies were sent to me when a service connection decision was made. Then it slowly dawned on me that some event might have driven the "automatic issue" of the letter. After considering the hassle, etc involved in using the 800 number, I decided curiosity was getting the better of me, and called. The effort, naturally, involved the usual we're to busy to answer, call again at a later time, etc. replies, and required multiple tries (4) to finally get to speak to a real person. I found out that a "Nehmer" award had been made, and "I should be quite pleased". The VAMC supposedly sent a letter out dated late last week. Unknowns are when the letter was actually mailed, and how long it takes the letter to travel about 100 pigeon miles by "Snail Mail". The "Nehmer" claim involves a 100% condition and several years retro, as well as 20% of retro to the lawyer. Things that may be left to fight about - - "staged ratings", secondary issues, effective dates, etc. The VA was blatantly not compliant with the Nehmer court order, and what happens as a result of that is still unknown. The equal access to justice act bit, due to the current budgetary squabbles, is also up in the air. If eventually paid, this may eventually result in a refund to me. Unfortunately, this is just one part of several claims, that were denied. Other claims still need to go through the appeals process, so "it's not over" yet!

Since you were hospitalized and in the VA's care, this along with the other paperwork, may help your case. The VA is very likely to take the position that you did not follow through, and try to force you to file a new claim with the resulting effective date of the new claim. If you were to do so, and obtain an award, you still have the option of of NOD'ing the effective date. I'd say that you will likely have a bit of a fight ahead over the 2000 date. Also, there are some peculiarities, since IHD, CAD, etc. are covered by Nehmer, if you met the various conditions. This can change some of the award date considerations/entitlements.

Congratulations in the partial win. The VA seldom does what should be right and fair. I believe that the VA tries to "low ball" in many cases, and it looks like your case is no exception. If you feel justified in continuing the fight, I'd encourage you to do so. Since the C&P examination didn't properly address (according to your remarks) all the issues properly, this is one more opening to consider using. I'd likely file NOD's concerning ratings and non service connection if I were in your shoes.

BigCountryVet: You quit working in June 2010. Have you applied for SSDI? You applied for TDIU in October 2010. Normally, that will be the effective date for a VA claim. Since the VA had you at less than 100%, it's likely that no earlier date would be considered. Waco is handling your claim. Successful PTSD claims resulting in 100% at Waco have been known to result in the VA appointing a fiduciary, which is something to avoid if at all possible. Should you have any indication that the VA is going down the fiduciary path, contact a qualified veteran's lawyer without delay. The last thing you want is a VA fiduciary in control of your money.

"Can they do that?" They did. A DRO review can cause an award to be generated. Or, you may end up going to the "Board" with the claim. Since the VA is treating this as an appeal, it may be to your advantage to find a qualified lawyer.

Additional compensation for "the ankles" is dependent on how your ankle problem fits in the VA compensation schedule. There also may be "secondary effects or conditions that might or might not be ratable. It's possible that a more favorable rating and "code" for your problem might be applied. (The devil is in the details.) SSDI is total disability. How the VA deals with it and PTSD can get complicated, since your SSDI determination includes non service connected problems. The VA will likely say that the primary cause of your disablement is due to the non service connected or connectable problems, in order to avoid an award. The SSDI payment may preclude eligibility/award of a VA pension, if the SSDI payment is substantial. You should also be aware that the VA recently has used SC'd PTSD (usually 100%) as an excuse to appoint a Fiduciary. This, if it starts to occur, will require rapid action to combat. The last thing you want is to get involved with the VA's fiduciary program. They might use the SSDI determination of "Schizophrenic/PTSD" as the justification, along with C&P exam results. All it takes is a "not competent to manage own affairs" statement to start the fiduciary ball rolling. How the VA can claim a veteran is not totally disabled, when SSA has awarded SSDI is beyond me. A favorable SSDI determination is usually admissible evidence of total disability in any court. As to VA mental health treatment, the quality seems to vary from one facility to another. A veteran is, generally, entitled to treatment (co-pay may apply). VA treatment may help with the compensation process. You should also be aware that the current law gives the VA C&P process the sole authority to diagnose and rate PTSD for compensation. What happens when an outside IMO or SSDI determination of PTSD exists, and the C&P examiner claims some other condition, or "lo balls' a PTSD condition is currently less than clear.

Yes it looks like you will be due retro. If you have at least one 60% and one 100% SMC should also be considered automatically (something that the VA tries not to do), and usually awarded. Note that the VA may use a more restrictive method to determine SMC than the law allows/provides for. You have what is called "staged ratings". This complicates award calculations tremendously. You will need to check the award amounts and how they were figured. There should be a case for retro award of SMC as well. This depends on how and when the various percentage became effective. Nehmer should help with SMC retroactive entitlement. (Something else to look at, and there is a possibility that the VA (again) may not figure things correctly.)

IHD, CHF & "41% LVEF and 8.6 mets" Off the cuff - - - Obviously, all are related. Given the VA's wierd and obsolete way of looking at things, I'd look at the VA compensation rate schedule, and see if CHD is evaluated any more favorably towards your situation than IHD or other applicable conditions. When you do this, take note of the "codes". "Pyramiding" is generally not allowed, so making sure that the most favorable applicable code is applied is to your advantage. Another one that may apply is "congestive heart failure", which also can be related to the causes of IHD. an 8.6 mets rating, if accurate, is not too severe. Your 1997 claim for CAD should be the date used to figure the effective date of claim, and any retro to be awarded. Expect to see "staged" compensation rates and periods. If you were hospitalized in the interim for heart related problems or treatment, you might also find that you may be entitled to periods of higher than otherwise compensation.

Using the "poverty" criteria, a Wal-Mart Greeter at minimum wage would likely not be eligible, and the VA might jump on the idea. Fie on thee for bringing such things up! <G> We know that the VA tries to reduce veterans benefits any way they can think of, and does so quite well without outside help! It makes no difference that this income level (10-11k) is not a "living wage" by any means. This is quite different that something I ran across in the late 70's. At that time, it was possible for a USAF junior officer, such as a short time captain, with two or more kids to be eligible for food stamps. His or her school age kids in DOD schools were also potentially entitled to free or subsidized meals. (Bitburg USAFB, West Germany (Closed ~1995) with base housing and schools)

"VBA’s Systematic Technical Accuracy Review (STAR). This accuracy standard was established to ensure the appropriate processing of fiduciary activities, such as accounting and field examinations, and the protection of the interests of incompetent VBA recipients." If this is where your claim really is - - It's possible that PTSD is involved, and the proposed rating is high. Recently, the VA , in some cases, seems to have developed a practice of pre-emptive strikes that involve competency. The system can be rather arbitrary, and difficult to deal with. I believe that it is in your best interest to talk to a qualified veteran's lawyer as soon as possible. Were there any C&P's that addressed your ability to handle your affairs?

Without getting into details, just talking to the appropriate people can really help.