Chuck75

Unfortunately, such things often happen when the VAMC in my area has no one available to authorize fee based services. In fact, during the normal business day, it's even difficult to impossible to get approval before the fact. Standard answer seems to be something along the lines of "we'll think about it", get done what needs to be done. Don't forget to contact us as soon as the "emergency" is mitigated, etc. Indeed, the famous don't come here with an emergency message is the first thing you will hear from the VA number, even during normal working hours, and in spite of the same VAMC supposedly having an emergency room. (Evidently emergency room yes, emergency room staff, No?) Since the VAMC is about two hours away ~64 miles down the interstate, only the local community hospital (~5 miles), or the area regional hospital (~15 miles away) is appropriate for true emergency care. The regional hospital is an open heart surgery hospital, as well as a transplant facility. The community hospital can and does provide good emergency care for heart related problems, but is limited to using techniques appropriate to a hospital that cannot do open heart surgery. Use of "The Clot Buster" (TCB) is a common emergency treatment.

Why do you need "new evidence"? Was a claim denied? Or, did you make a claim, and the VA sent you a letter saying that there was no evidence, etc.? (I had gotten such a form letter, when my file was over 800 pages, an SSA determination of total disability was in my file, and medical records proved that I have a disability that is to be rated at 100%.)

The data is interesting, and a bit confusing here and there. That aside, I noticed that the expected output for 2011 is not significantly more than 2010. (And, the BVA complained that they lost a week, due to problems. Then, I'd take exception to the methods used to compute the case cost of ~$1,500. I believe this number is a gross understatement, and does not include the total VA administrative time expended to get the case to the BVA decision point. Nor, does it obviously include costs that occur after the BVA makes a decision. A case has a cost per day, even when it's "just sitting" at the VA.

"I believe some Vietnam veterans might definitely well have non coded disabilities that are now AO presumptives" Or, in the case of IHD, coded as some other problem that is included in the definition of IHD, or related to it. Looking at my own difficulties in getting the VA to properly look at my heart disease, I ran into several problems. LVEF was and is such that METS testing is not advisable, or required. My records have "the golden standard" test results. The VARO kept trying to schedule treadmill tests anyway. The last one was with a local contracted Cardiologist. Instead of consenting to a treadmill or stress test, I gave him a copy of pertinent medical records and cath test results. I also mentioned that in my doctors written opinion (copy to him as well) that such stress tests were not only pointless, they were hazardous, and especially so in my case. Emergency surgery (heart/lung machine and all that) is not available locally. Based upon my treating doctors written statement, and the VA guidelines, had he conducted the VA ordered tests, and anything untoward happened, an expensive malpractice suit by me or my survivors would have been cut and dried. The VA contractual relationship did not prevent a direct suit against him (under state law), and further action against the VA (1151, Tort, etc). He declined to do the tests. I have no idea exactly what he sent back to the VA. However, this paperwork information was made a part of an earlier VA conducted C&P for DMII. In essence, the VA DMII examiner stated that the records showed that I was, in fact, presumptive for IHD, and the equivalent METS would be well within the 100% rating requirements. More interesting was a statement that further testing was not required or desired. ( the examiner made the statement at least in part as a result of my comment that the VARO had repeatedly tried to schedule treadmills.) That C&P statement looks like a basis for P&T to me. Even more interesting was that I ended up having to get the NVLSP to add my name to the list of Nehmer veterans that the VA had not bothered to tell them about. This seemed to produce a response from the VARO, who recently transferred my claim to one of the processing centers for IHD, etc. Nehmer cases, upon receipt of a records request from NVLSP. Delays, delays, delays. The SSA determination of total disability, based solely upon SC presumptive conditions, has been in my records since the first VA claim was filed, years ago.

Finally! A refund check from the VA for improper co-pay charges! (High hundreds) I had complained for quite some time, and the VA ignored the complaints. The runarounds were not to be believed. (VAMC. VARO, VA Clinic, VAFinancial, and around the mill again and again!) The VA has written documents stating that they do not charge co-pay for A.O. presumptive treatment. However, Once a Veteran has co-pay in the records, (for non service connected treatment, etc.) the situation is difficult to remedy.

Unless there are law changes that I'm not current on, yes, there is an offset. From a tax standpoint, you are usually better off taking the full VA compensation, and having the retirement payment reduced.

Well, the numbers are always suspect. I'd guess that the larger numbers are closer to the truth.

Any A.O. presumptive that was denied before it became presumptive (with certain time constraints) falls under Nehmer, including DMII. The VA did do something that was odd concerning DMII approved & SC'd cases. They were known to put the veteran with DMII in "Class 2". Fine, but, removing the veteran from "Class 6" meant that the VA did not fully acknowledge that the veteran was a member or potential member of the Nehmer suite, and likely did not put the veteran on the list the VA is required to send to the class action consul. Being in class two instead of or and class six can contribute to the VA wrongly charging co-pay for drugs associated with the treatment of A.O. presumptive conditions. If you happen to be a Vietnam Veteran, and believe that you may be a class member, you should contact the class action consul. The reason is that if and when they obtain enough evidence that the VA is not in compliance with the court order, they can go back to court, and ask that the VA be compelled to comply, and it's even remotely possible to have the court find the VA in contempt.

The C&P examiner is likely to be an RN or PA, at least for "usual claims". An audiologist or a med tech may be the person that gives you an auditory test. I prefer to take my wife with me, simply because that tends to make a C&P examiner a bit more formal and above board. I believe a wife's presence in certain kinds of claims, such as ED, or back injury, can help.

My general experience was that the VAROs don't like veterans in the various office areas. That's not saying that a veteran cannot or should not represent themselves. I choose not to do so, because of the 100 mile away VARO location, as well as my age and medical conditions. My experience with VSOs was mixed. They are generally OK for providing basic help in making initial uncomplicated claims, and seem to be "at sea" about the rest. My initial experience with this VA escort business was also an illustration of how dumb (or lax) the VA can be at times. Basically, the VA had hung up payments and authorization for flight schooling. I had a small family at the time, and could not afford to carry the costs by my self. Thus, the VA delays put a serious crimp in things. At the time, I worked for a bona fide defense plant, and was part of the B1 bomber engineering team. As a result of the job, I had a picture ID card that was very impressive looking. It even carried the government security classification that I was cleared for. That, along with a very conservative suit and tie, including the usual B1 aircraft tie tack, and the flag lapel pin, evidently made me look exactly like one of the major vet org VSOs, or a "wheel" of some import. Basically, the VA gave me free run of the Chicago VARO, unescorted. I was able to get a hand written and signed certificate of entitlement, and a written form showing the amounts due and past due me from the VA. Normally, such a computer generated entitlement form covered only the next step in the training process. The hand written one authorized training to include the ATR (Airline Transport Rating)

The way to deal with automatic approval is complex, but it might be done without major changes to multiple existing laws. For instance, the at least as likely as not can be applied correctly, (as it should be, and is not) Combat veterans can be actually given the leeway that the laws allow and the VA ignores. Differences between valid IMOs and C&P results can be automatically resolved in the veteran's favor, as the appeal process often does. The automatic approval can be based upon existing law when applied in the veteran's favor, something that the VA routinely does not do. If really doubtful, interim benefits can still be paid. After all, doubtful cases or obvious fraud can be dealt with as it is now, but without repayment, unless fraud is proven in a civil court. Lets face it, the VA's present process is more concerned with expending the government's money, and less about providing veterans with the benefits earned and prescribed by the law. As an organization, the VA and perhaps individually, the VA bureaucrats, (I believe) should be held in contempt of congress, until it's ways are changed. (I don't believe this will ever happen, because I think that congress and past administrations gave the VA instructions under the table to minimize benefits paid to veterans any way possible.)

I'd agree that the VA system is broken, and has been so for decades. How to fix it is the big question. Bureaucrats will just stumble along in the same old ways, until something major forces change. In other-words, the system needs radical change/replacement. The problem is that no one can agree as to how the system should be changed or replaced. Different factions that might drive change do not see eye to eye. There are factions that, if any major change is made, that the change must reduce the costs to the government at the expense of veterans. Others insist that any changes not disturb the present system, or benefits. Some think, (As I do) that SSA (Who is far from the ideal) might be able to better process veterans claims as an alternate, and perhaps a replacement for the VA claims system. (Obviously, this gets back to factions not agreeing, etc.) Another possible cost saving has to do with Medicare, and the limited availability of "local" VA medical services. Again, in my opinion, the VA is poorly setup to provide Urgent and Emergency medical care. Such care needs to be available to veterans in a time frame that is often less than hours, and within a reasonable distance of much less than an hours travel. Critical Care often needs to start and be effective within "Golden Time" frames. This may be within minutes, or as long as three hours. A short time frame example might be a Stroke, and a longer time frame certain kinds of heart attacks. In both cases, the potential damage and chance of death increases with time before treatment. It would be more efficient and less expensive to use the medicare system to provide such care, and have the VA pay the Medicare deductibles and monthly "B" plan costs. For the "average" veteran, the conventional medical care system has many advantages- - usually such things as local facilities and capabilities, private doctors who generally know the patient, and take the time to review the patients history, and so forth. I believe the VA has several areas that it might and should concentrate on, instead of trying to provide for all. Most of these areas deal with things that are very unique to disabled veterans. Currently the VA's practices/proceedures related to coverage for emergency treatment are utterly insane, and actually are intended to drastically limit the VA's costs, rather than benefit a veteran needing immediate care. In the case of a veteran that is entitled to no cost care from the VA, the VA should pay all costs when they cannot provide the needed care in a timely manner.

One Year? Is that all? I ended up resubmitting a specific IHD claim well over a year ago, (Before the regs were even final.) The claim was previously denied, and several years of retro are due, going back to the first A.O. presumptive claim and award. I know that the VA is trying to figure out how to reduce the retro by applying a sliding scale. If they do that, (Quite Likely) I can go back, and say you forgot about the temporary 100% interim ratings called for by the compensation schedule. (And then the fight begins. Again!)

It's my understanding that they should. However, the VA's record for doing the things they should when they should is rather poor. In the not too distant past, the VA was known for ignoring implied TDIU, even when it was glaringly obvious. I.E. Veteran is totally disabled by SSA for the same conditions in the VA claim, and the VA has the SSA records.

You can argue that the TDIU claim was "inferred" and the law required that the VA consider it based upon the claim date that was used for your percentage ratings. An SSA determination that was earlier than that date, if in your records at the time of the percentage determinations, helps support the "inferred" contention.

Some of the "quick process" A.O. related claim forms, when filled out properly by a treating physician, do result in claim processing without a C&P. Currently, the law & regs are such that if the claim is denied without a C&P, and the other conditions are met, a veteran can claim lack of "due process". The real problem is that the RO's don't like to make a decision without a C&P. I don't know if this is because the RO wants someone else to help bear the responsibility for a resulting decision, hope that the C&P might help deny a claim, or just delay it, and take the pressure of the RO for the moment.

Your previous C&Ps may have been too favorable to suit the RO, or they may have not been complete by current standards. In any event, If you have written opinions by qualified and board certified doctors, it may be to your advantage to ask the C&P examiner to look at them. Mentioning to the examiner that the VA has repeatedly sent you to C&P exams for the same problems can also work to your advantage. (It resulted in a "no further C&P exams are required/appropriate" in my case, since the conditions that the C&Ps were repeatedly ordered for are presumptive.)

Conversely, when a Veteran is rated a totally disabled by SSA solely for things that are VA A.O. presumptive conditions, the VA may rate them at low levels, forcing the Veteran to reapply for TDIU benefits. Supposedly, the SSA determination is to be considered by the VA, and TDIU as well. The VA's record in this area is not very good. By law, the SSA "Bar" is higher than the VA's. In practice, the opposite may be true in an individual case.

From what I could find out - - "Normal" SSA & VA pension, SSDI, VA compensation, etc checks "should be on time". Other checks may get delayed. BUT, the short interim funding (just passed?) supposedly results in no delays, so the issue may be moot.

On the surface, it sounds like the VA is playing fast and loose. I'd say that with just the information given, a rapid response disagreeing with the fiduciary appointment, etc. is needed. Further, If there is any way to involve one of the better Pro Bono Veteran lawyers, I'd do so. You don't have much time. Also, you need to do something concerning any existing funds in bank accounts before they may become subject to VA fiduciary control, and you no longer have access. One of the problems can be that the notification letter was dated in the VA files well before the VA got around to actually mailing it. (Keep the envelope with the actual date of mailing postage) This VA mailing delay can effectively shorten the time you have to respond with a disagreement notice. Five to ten days out of thirty is significant! I'd at least contact a veterans VA lawyer before the sun sets! One National Pro Bono is: NVLSP PO Box65762 Washington, DC 20035 202-265-8305 Fax 202-328-0063 info@nvlsp.org

The key seems to be related to the size of the aortic aneurysm and a bunch of other factors, such as blood pressure control, surgical risks associated with heart conditions, etc. There is a % of increase over normal that is judged as cause for immediate surgery. Basically, a mesh tube (It's an ugly looking thing!) is placed/ sewn over the aortic aneurysm if the aneurysm cannot be removed. It's quite true that a "blowout" is often fatal, even when emergency surgery is attempted. Time is a very critical factor. Immediate availability of an open heart class surgical support team, surgeon, and the associated equipment may be needed. Although the VA has so far refused to SC high blood pressure as A. O. presumptive, various studies, starting with "Ranch Hand", and including the one used to to justify the IHD presumption decision show the same statistical association that IHD has. Far more Veterans of the Vietnam Era have HBP than IHD, (even if it's "just age related"), and undiagnosed/untreated HPB can eventually lead to IHD.

The reasoning behind the way things were written is simple the way I see it. COST! Originally, the idea was to try and cover more of the veterans. What was passed was obviously what got agreed to politically. Throw 'em a bone, but make sure that most of the meat was boiled away! Ah, Well, perhaps I'm a bit too cynical these days.

Actually, I'd have to wait and see what a VA decision actually said. I believe that they are in fact related. But IHD as the VA sees it includes coronary arteries, and as I recall, an aortic aneurysm is not included. If they rate it and compensate as if it is included, that gets into the argument about rating it distinct from an IHD rating for increased compensation vs. the VA reversing themselves as to SC'ing it.

The VA "should". However, you will need to get a VA doctor to go along with the deal, and your private physician to originate the necessary prescriptions, etc. for you to take to the VA doctor. I hope that there is a VA clinic or VAMC that is reasonably easy for you to get to.

The 30% should be paid in ADDITION to the schedular amounts when the VA has delayed a claim for an unreasonable amount of time, say over one year. Or, the VA made an improper denial or other ruling that was overturned by the courts. The only way to force the VA to act in a reasonable and timely manner is to eliminate any financial advantage that is gained by delay or improper denial. An additional 30% paid retroactively for the delay time to the end of the current year would certainly provide the impetus needed! A source of the funds? How about the Bonus funds?