Chuck75

I have to deal with them remotely. The issue has to do with treatment for "presumptive" SC'd treatment. I preciously posed VA documents showing that the VA "does not charge co-pay" for treatment of presumptive A.O. related conditions. The VARO has been dragging it's feet on the related claims for years. Further, the VARO has repeatedly awarded side issues at low values, deliberately to keep the VA total below 50%. The claim total if properly awarded by the VA schedule would equal ~ 150% or so before VA math is used. Since one A.O related presumptive has a schedular rating of 100%, and is fully documented by both medical evidence and SSDI (dating back for several years, and specifically for A.O. presumptive conditions only) It's just a matter of time.

Original claim 2005, subsequent claims 2006,2008,2009, 2010 Appeal in process. Somehow, the electronic records don't show that Nehmer applies. All involve A.O presumptive conditions, direct and indirect or secondary. One claim, not A.O. related, goes back to a denial in the late 1960's. This claim may involve CUE. The VARO made documentation in the "C" file relating to this old claim just disappear between 2006 and 2008. (They missed enough to substantiate the existence of a claim.) Funny thing, the missing documents were in a copy of the military records obtained from the records center prior to the VA getting their hands on the file.

Obviously, over 20 years of retroactive compensation is an amount not to be taken lightly. (Ask Berta!) I suspect that the VA hopes the appeals process takes long enough that they might get out of paying all of what is due, or the retro award occurs on somebody else's watch. If I were in your shoes, and given the seriousness of MS, along with the other problems, including mis-diagnosis, etc., I'd seriously think about filing an immediate NOD at the very least. It also may be that your case meets the requirements for an 1151 claim and federal tort. (Mal practice - lawyer time!) Sometimes just the fact that the VA knows a good and effective lawyer is involved helps them to make more favorable and fair decisions. Unfortunately, a lawyer does get a cut (at your expense) of the action. (Usually ~ 20% of any retro paid as a result of the lawyers representation. The VA charges the lawyer ~$100 as a fee for sending your money directly. Note that bona fide expenses can be billed directly to the veteran, and may be above the 20% set by law. Some lawyers include the expenses in the 20%. If you do elect to "hire a lawyer", make sure that the lawyer is registered and qualified to handle VA cases, and also practices in the federal district and appeals courts. A comment, due to your statements-- "i still never had a VA neuro diagnosis me", and "VA neuro's dismissed those reports" To me refusal to diagnose, and refusal to consider valid medical evidence is, of itself, evidence of refusal to treat and malpractice. Having the records to prove that such events occurred is a problem when it comes to legal action.

"fill out the proper form(s)" What forms are needed. So far, my VAMC claims they don't exist, etc. The only form admitted to is a waiver form for low income.

Yes, sort of ---- The Veteran's drug act outlines the process. Unfortunately, it is less effective than it should be. The VA originally supposedly was to just review the outside doctor's prescription, and issue if the prescription was appropriate, and on the VA's list. The first thing that happened was that the VA bean counters got involved, and the VA reviewing doctors (I assume by direction) started substituting less expensive drugs, where possible, even when the substitute was considered less effective than the original. Next, the VA saw this as an opportunity to enroll veteran's in the VA system, thus increasing the body count to get the number up. This allowed them to claim that there was a cost reduction (per veteran) in supplying veteran's services. (Bonus time) The original drug act law did not require that a veteran be "enrolled" in VA health care. A common mistake on the part of veterans was not to check with the originating doctor, or get the VA doctor to check with the prescribing doctor (usually a specialist), to insure that a substitute was desirable and appropriate. (This is the key to getting the exact drug needed when it's available, or a substitute that is appropriate.) A couple of years ago I got into a small battle over a drug that was on the VA list, yet (unstated, but due to cost and convenience) the VAMC in my area was only allowing to be prescribed for VA inpatients and VA resident veterans. Turned out that there was a process to obtain the drug, but the VA clinic doctors did not know what it was, and the process was a time waster from the doctor's viewpoint, when they finally were told how to go about using it to get the drug for an individual veteran. A bit later, the VA was allowed to revert to it's long standing practice of providing only drugs after a delay (up to 30 days) and, by default, the drugs used to treat "chronic" conditions. Then to add icing to the VA cake, "Co-Pay" was increased to a level that is more or less twice that of the total cost for drugs on the Wal-Mart and other pharmacy lists. Even the VA clinics will issue a prescription for use with a local pharmacy when the need is immediate. At one point, after the drug act was passed, the VAMC's would usually, (if available on the shelf, and needed) overnight ship the drug to a veteran. I think that the contract to do this was allowed to expire as a cost savings. Actually, in theory, the VA is not charging for the drugs, it is charging a "medical service", or "dispensing fee" to cover the operating costs of providing the drug. Having a fee higher than the Wal Mart four dollar price is just an illustration of either the high VA cost of running a pharmacy, or the VA's desire to make money. (Or both)

Remember that QTC gets paid for C&P exams. This can work in a veteran's favor, in that QTC (at least in theory) has more of an obligation to follow the law than the VA does. It's really hard to sue a government employee for actions that are considered part of the position. A private company and citizen under contract does not have the same level of protection. (I should know, after having worked under DOD technical contracts for decades.) The VA often follows the Ostrich model, and gets away with it, unless or until the appeals process catches the goof, and orders additional tests.

Here is one of the problems. A divorce judge has a lot of latitude in determining alimony and child support. The amount determined is paid by the (veteran in this case), even though the veteran's income may be mainly from disability payments. The judge can rule that the veteran is liable for the full amount. The key clause is "except to the extent specifically authorized by law". This statement is too general, and as a result, a judge can rule against a veteran.

Anything to delay a claim. Especially when they can say that they are waiting on the veteran. I have one "on appeal" for IHD, and other issues. Interestingly enough, the VA electronic file does not show "presumptive" status, even though the "C" file documents an already SC'd presumptive condition and "feet on ground". (Nehmer, what's that?) Another ??? is that the VA did not mark the "entrance exam" as A.O. exposure & registry, even though the evidence was there in front of the exam giver.

The Examiner did not want to spend the time or effort it seems, to do a complete back evaluation. Evidently, something caught some attention, though. The diagnosis of "Osteoarthritis of the Thoracic Spine" possibly leaves the door open if the VA made errors of certain kinds in the previous denial. It can be the result of a previous injury, or/and sometimes age. (Web References) A "General Exam" can cover just about anything the Examiner wants it to, along with whatever the current minimums are. Generally, specific complaints by the veteran can be/should be addressed.

The same problems that cause CAD and IHD can also cause strokes. The carotid arteries are susceptible to the same things that result in CAD. Some of the medicine used in the long term treatment of CAD (Aspirin for one) can cause the deposits (plaque) that are found in the coronaries to be more diffuse. This slows down the deposits in the coronaries and can increase deposits elsewhere, such as the carotids. Strokes are commonly caused by a clot that either forms in the brain, or migrates to it from the heart and the arteries, including the carotids. Although the VA has not recognized it, Diabetes and Heart disease combined tend to point to an endocrine and or an immune system disorder. Standard treatment when both exist together calls for careful cholesterol control, and watching for things that can more easily occur, such as Kidney problems (deposits, etc.) There is an obvious relationship between Diabetes and Heart disease that results in (on the average) an additional loss of about 5 years of life expectancy. In some cases, depending on other factors, such as present age, the life expectancy may be as short as five years, according to current literature.

A serious problem is that the VA has been known to loose records. (Lots of records, usually when the records are "inconvenient" to the VA in relation to claims processing.) It's virtually impossible to prove that the records were deliberately lost. If the records were in the VA's custody, there likely isn't a copy at NPRC. I guess it's too much trouble/cost to send a duplicate to the VA, and keep the originals. (Something I think should be standard practice.) It's worth $100 in this situation, if you have it to spend, and the researchers can come up with something worthwhile. The custodians (NPRC, Military, whatever) were recently complaining about the VA's loss of records.

With a claim going back to the 70's, a denial, and the VA's reiterated position that the injury did not occur, you are going to have quite a time. The possible retro alone is cause for major concern from your side, and the VA's. I believe the VA may continue to evade the issues. At this point, If I were in your situation, I'd collect all the pertinent records, index them, summarize your claim(s) and obtain a lawyer. Why? In the first place, the lawyer (assuming the lawyer is qualified), will notice things that you or I might not. Second, the VA tends to respond to written communications from a lawyer much faster than from a mere veteran. Third, It shows that you are serious. Cardiomegaly can occur for various reasons. IHD, also occurs from various causes. The thing to remember is that IHD is A.O. presumptive. A diagnosis of IHD is really needed in a VA claim. Conditions leading to it, and considered evidence of IHD include CAD and other related conditions. IHD is a result, not a cause. A possibly useful reference, just one of many. http://www.downloadheart.us/what-is-cardiomegaly.html

Skunk, your enthusiasm is remarkable! However "supercomputer" is a relative statement. For individual use, the first thing to consider is what is the computer going to be used for. (Use more or less determines the minimum and desired capabilities.) For instance Business applications are in general not too demanding. Exceptions exist when high resolution graphics and massive number crunching are involved. Software development is another demanding application. Gaming (Generally the most demanding of current consumer applications) Simple games are not very demanding. Animated high resolution first person shooter games (Crysis for example) demand high frames rates, detailed graphics and modern (read expensive) video cards. Storage: Currently, newer conventional hard drives have storage capacity that was unheard of, and the price is quite low. Solid State drives (SSD) are still about twice the price, and have less storage that the conventional drives. So, for storage, a solid state drive of at least 120Gb, with at least a 500Gb Hard drive is indicated on today's high end desktop systems. Processors: Intel currently has the speed advantage. AMD's processors have the dollar/performance advantage. Video cards: Most modern "high performance" video cards in today's market have Nvidia or AMD/ATI GPU chips. Prices range from "reasonable" to around $1000, with special purpose cards into the multi thousands. Memory: DDR3 is the most common on current motherboards. DDR2 is still commonly available, and often used on lower priced motherboards. ~4G of installed RAM is common, with 8G common on 64 bit windows 7 systems, Memory speed is a price/stability/use consideration. Display/Monitor size, color depth, speed, and of all things the capability to display "Blue Ray" and other encrypted video. I won't get into keyboards, mice/trackballs, etc. The newer design Motherboards have double the hard drive interface speed of the older ones, and higher speed USB ports as well. Some have video on board, but the on board video is usually not suitable for gaming and other demanding applications. (And so on) I'm retired now, thanks to A.O., and was a OEM/VAR, MS MVP & Consultant from 1989 to retirement. On occasion, I still build systems for personal/private use.

This is a difficult situation at best, and will likely require legal help. The VA, in some locations, has been less than proper when it comes to assigning a fiduciary. That said, you may/will need to refute the VA's contention that the veteran is not competent, or failing that, that the fiduciary has and is failing in the duties of a fiduciary. Dealing with the VA is usually a frustrating and time consuming process. It may be possible to get free legal help. What I would do first is get an opinion from treating doctors as to the veteran's competence. Next, with legal help, deal with the VA. The laws and practices concerning competency vary from one location to another. Generally, getting a competency hearing can be done, but it will not occur overnight. There are others in hadit that have had similar problems, and successfully dealt with them. One thing to remember is that the fiduciary does not really represent the veteran, instead, he or she represents the VA's interests, and is paid from a portion of the veteran's compensation. (A very sad state of affairs)

It's hard to say what your chances are. The problem is that there is no consistancy between RO's VAROs, C&P's and so forth. The only consistant thing seems to be the lack of consistancy. You do have several things working for you and against you. A major plus is combat operations, and if your records show that you were exposed to gunfire and explosions. Civilian Law enforcement should not count too much against you, since hearing protectors are normally worn when practicing, etc. What might really count against you is time and age. Normally, people (and dogs) suffer hearing loss due to age. In my case, at 65, I can no longer hear high frequency sound. In my younger days, I could faintly hear the ultra sonic emitters used in burgler alarms.

The problem is - - - How can you connect the Vietnam service with your present and past problems? A.O Presumptive, if any of the conditions are on the "list". (By far, the easiest way to go, since the heart of this method is a current diagnosis of conditions on the "list".) If not A.O. presumptive - - 1. Show some sort of treatment history going back to Vietnam service to current times. 2. A diagnosis of the problems/conditions now. 3. An "expert" medical opinion (IMO) relating your current problems/conditions somehow to Vietnam service and the problems you had during Vietnam service. You really want to obtain a copy of your complete service records, including all treatment and hospital records before the VA gets their grubby hands on them. The sooner your are able to file a claim with the VA, the better, in terms of time and money. Just make sure that you have the necessary documents, records, diagnosis, etc. You can submit copies with the claim. Sometimes it helps. If nothing else, you can usually start a claim by using the VA's new schemes on line. "High Temperature" is a symptom of something else. it's important to find out what, since the cause is what you will be filing a claim for.

Obviously, a lawyer specializing in VA claims is needed. I'd suggest that the lawyer must be authorized to practice in the VA system, as well as the federal district court as a minimum. Generally, a VA claims lawyer gets paid (by law) 20% of any retroactive payments. The 20% is deducted from the award by the VA, and sent to the lawyer. $100 is deducted by the VA from the lawyers payment as a handling fee. In addition, the lawyer can also be paid by the government, based upon an "equal justice" set of laws. The key is that the client has an income below a certain amount, (Much higher that you might think.) Besides all of this, A lawyer handling a VA claim is entitled to recover "reasonable expenses". The expenses may be billed to the veteran, and I'm sure that there are guides somewhere as to what is reasonable. The lawyer I deal with considers the expenses to be paid by part of the 20%, and any "equal justice" payments. Lawyers asking for more than the 20% exist, and the additional money is dubious as to the legalities. The internet can be used to find a list of VA lawyers in a given area. NOVA and other groups (Profit, Non Profit) specializing in VA claims are web searchable.

Maybe. If you can get a current diagnosis that agrees with the service diagnosis, and or an IMO from a specialist that links then and now. Did the VA conduct a C&P? And did a specialist do it?

Well, if you really want your "day in court", Look at the effective date, amount of retro, etc. It may be that you can, ask for an earlier effective date, and get it. You would need to read the SSA regs very closely as to how far back retro, etc. can go. Usually, SSA does not go as far back as the law actually permits them to. (I went through this a few years ago, and they awarded an additional retro amount and earlier date. This also did effect the date I was eligible for Medicare.

If I go by the statement you included, the answer would be no. There is no or between the two items. The use of a semicolon gets interesting- - - A partial Wikipedia quote - - - "using the semicolon mark to separate words of opposed meaning, and to indicate interdependent statements." Undoubtedly, the VA RO's will interpret the statement such that both 1. and 2. must be satisfied, unless a higher authority declares otherwise.

One of the "reasons" is that those using the new claims process are decided and awarded faster than the process in place as of October 09.

I'm also not sure exactly what you are asking---- You had a retroactive award award dated 9/9/08 ? You said the amount for Hep C is 1100 I assume that was as of 9/9/08, and that it's a monthly rate. The actual rate depends on disability % awarded, and any dependents. You appear to have rounded the amount, are at 60% and have dependents. 1100 and 1500 seem to be rounded amounts. based on the VA schedule. Then you said on 12/1/08 the amount was changed to 1500 ? If so, then it's likely that the new rate applied starting 12/01/08, and continued for 09. So, at least the 09 rate would be 1500x12. To figure retro, you would have to know the exact rate for each intervening year between then and now. For the exact amounts -- http://www.vba.va.gov/bln/21/rates/index.htm (The VA does not always get it correct on retro)

According to an un named person speaking about practices at the Atlanta VARO - - - Appeals (NOD's) filed after A.O. related HD claims are being given precedence. This allows the VARO to offload claims and delay IHD payments. What the VARO is ignoring is the Nehmer court order, requiring that A.O. related claims be given expeditious handling.

I guess the answer to your question would depend on where you want to live, and what VA services are available in that area. As to how to find out, I'd suggest you talk at least initially, to a patient advocate at your local VA currently providing care to you. I don't know of any master index of services and locations that would have the detail you need.. I do know that there can be a big difference from one location to another, even when they supposedly provide the same care/services.

It's not very likely that you can go back to the original claim date. You May be able, with a lot of help using IMO's to go back to a more recent date. If treatment records can be used as evidence of inadequate treatment, There are further options available. For instance did inappropriate treatment make your back problem worse, or did it get worse as a matter of "natural progression". Has pain been continuous or intermittent?