donna68

The new Evaluation Builder that is used to rate conditions places alot of weight on the GAF score, however a Rater can adjust the % generated by the program if they see its warranted. GAF SCORE SCALE 91 - 100 No symptoms. Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. 81 - 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members). 71 - 80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). 61 - 70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. 51 - 60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). 41 - 50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). 31 - 40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). 21 - 30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment, in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends) 11 - 20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute). 1 - 10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

ALS is now 100%! A Fast Letter came out in 2012, making ALS an automatic 100%. Sorry I dont have access to it online, if anyone can bring it up, I recall its is a FL 12-something...

http://www.benefits.va.gov/warms/bookc.asp#q The Spine Rating General Rating Formula for Diseases and Injuries of the Spine (For diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes): With or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease Unfavorable ankylosis of the entire spine................................................................... 100 Unfavorable ankylosis of the entire thoracolumbar spine............................................... 50 Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine................................................................................ 40 Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine........................................................................ 30 Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis................................................................................................. 20 Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height..................................................................................................................... 10 Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. 5235 Vertebral fracture or dislocation 5236 Sacroiliac injury and weakness 5237 Lumbosacral or cervical strain 5238 Spinal stenosis 5239 Spondylolisthesis or segmental instability 5240 Ankylosing spondylitis 5241 Spinal fusion 5242 Degenerative arthritis of the spine (see also diagnostic code 5003) 5243 Intervertebral disc syndrome Evaluate intervertebral disc syndrome (preoperatively or postoperatively) either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25. Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months................................................................................................................. 60 With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months.................................................................................... 40 With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months.................................................................................... 20 With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months.................................................................................... 10 Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Note (2): If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. General Rating Formula for Mental Disorders: Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name .......................... 100 Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships ........................................................................................... 70 Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships ........................ 50 Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) ........................................................... 30 Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication ..................................................................................... 10 A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication........................................................ 0

Irish-7 Pay-If you got severance pay when you retired the VA will hold your benefits until its recouped. Shoulder- A 20% for a shoulder is high as shoulders are rarely rated at 20%, because to rate at a 20% it means that you can only raise your shoulder or arm to parallel to the ground or 90 degrees. Lumbar or Back- As mentioned earlier, a veteran can have IVDS, DDD or DJD and rate at 0%, if there is no pain on motion or no decreased range of motion. If you were entitled to 60% for IVDS when you submitted your claim and they didn’t rate you with the IVDS Diagnostic Code, you have grounds to appeal. It will become a stepped rating, and decrease based on prescribed bed rest. So consider this, if they change the DC to IVDS and you currently rate at a 0% based on the IVDS DC, because you havent been prescribed bedrest, you will eventually be dropped from 60% to 0%. They may have rated you under a different code so that you are at risk of dropping to a 0% based on the IVDS DC. Mental disorders including PTSD and a mood disorder are rated together, so if you are already service connected for a mood disorder and you put in for PTSD, and they grant it, your rating % will not change just because there is a new diagnosis of PTSD. The rating is based on the mental health symptoms, whether PTSD, anxiety disorder, depressive disorder or a mood disorder. The % will change if your overall condition or symptoms have changed. Advice, since the new text generated system is rating veterans much higher than in the past, submitting a claim for an increase may be beneficial. Weigh the pros and cons. You are 100% IU now, if you appeal, you can risk getting decreased and no longer qualifying for IU. If you win the appeal, you will still end up receiving the same %. If an actual error (CUE-clear and unmistakable error) was made on your rating decision, you can point it out at any time and they will have to correct your rating back to when the error occurred. Hope this helps. Donna

wutxthedeal, Sorry to inform you, but it looks like the 50% was a CUE or ERROR. I didnt read the threads so I may be repeating stuff. The first thing is see is it looks like you were rated for ONE knee at 50%. The knee condition maxes out at 40% since an amputation at the knee is 40% when fitable with a prosthetic. So they arent supposed to give someone who still has their knee more than someone with an actual amputation of the knee. A 10% can be granted for limited flexion, extension, sbuluxation and instability (range of motion) and a 10% for the paiful scar, so if you have limitation of motion, subluxation, instability and a painful scar, that would be 10% for each. Its rare but happens! The reason why it seems like they arent reading your letters is because in this case, the VA ey give rates joints based on the VA exam based on the above limitations. Degenerative joint disease or arthritis without any of the above limitations is 0% unless there are two knees with degenerative arthritis and normal range of motion, then they can give 10% for both. Sorry that you are in so much pain, but no matter how much your knee hurts, no matter how many surgeries you have endured and no matter how arthritic your knee is, if it isnt limited in the above it rates at a 0%. The grant should have been a grant based on aggravation or an aggravated injury because there was an injury prior to service. The 10% subtraction may be VA math unless your entry exam shows decreased range of motion which would have been a baseline at 10% on entry. You are right degenerative means gets worse, but VA doesnt grant based on MRI results. There could be pins, bone to bone, arthritis, cartilage damage.....They grant based on the above.. VA sees things differently. You could have arthritis in every joint in your body with normal range of motion and only get 10%. If you got 20% they are definitely not saying you are healed, they are saying you are limited. It means that you only met the 10% criteria for 2 of the above or 20% for 1, probably flexion and extension. Most veterans get 10% and at times 20% for one knee unless its been amputated. Unfortunately, your mistake like many other veterans was asking for an increase, when there is no increase possble. If you get a replacement, you will rate higher, like 30% for replacement. I suggest that you look at the rating schedule for knees DC 5260, 5261.....so that you have a better understanding about what you may be entitled to. There is a link on this site. 38 USC.. Good luck with your case. Consider one kneecould have aggravated the other knee or your back, so you can submit a claim for asecondary condition. Donna

eganusn, Sorry you are having hard times. Im not sure why you are not getting instant results as it is my understanding that homeless veterans are a priority. It is true that a new claim can hold up an claim pending and its possible they sent your case back to the developemet stage if they feel they received a new claim. If you have access to a phone, call the VA again and send an IRIS inquiry via the internet pleading for an immediate repsonse. Hope things work out for you. donna

aggie, Not sure about Ebenefits, but I am sure that you are entitled to back pay to the day after discharge from active duty, and once they receive your marraige certificate, you will be entitled to the married rate back to the day after discharge or the day of marraige, whichever came second. Your SSD doesnt affect service connection so you can collect both! If they rate you at 90% and you arent or cant work, I would ask for a medical opinion stating that you cant work due to your disabilites so you can get IU at 100%. donna

Vets feel abandoned after secret drug experiments By David S. Martin, CNN updated 8:56 AM EST, Thu March 1, 2012 Tried to upload the website, but couldnt get it to paste. Access at CNN.com

Rose15534, NSAIDS are not like Nexium, they are non-steroid anti-inflamtory drugs, like Motrin or Ibuprofen and based on your SC conditions you have probably been taking them for years. So maybe you can submit a claim for esophagitis and hiatal hernia as secondary to gastritis and secondary to NSAIDS use. Defenitely get an opinion for the doctor who made the daignosis. Then I would also put in for an increase for your knees and back, as its been over 10 years and they have probably deteriorated since your C &P. Remember the C & P for your joints will be looking for decreased range of motion with pain to warrant a 10%. So if working out, jogging, biking....makes your knees and back hurt more, I suggest that you do all of the above in moderation the day before your C & P. I never recommend lying, but I do recommend you present at a level that is true and your worst. To submit your claim, you can upload a VA Form 21-4138 and fill in the blanks and just list your new claims note you are claiming them as secondary and list your increases based on the diagnosis listed on your award letter. If your address has changed since the award letter, note that on the 21-4138 too. Good luck and keep it simple!

roses15534, The VA doesnt usually SC "symptoms" like heart burn (so if you are actually service connected for a symptom you are very fortunate). They do service connect GERD or gastro esophageal reflux which causes heartburn and is an analogous to hiatal hernia. For VA purposes GERD and hiatal hernia are the same or use they use the same diagnostic code and a hiatal hernia causes GERD. Yes, the esophagitis can be secondary to GERD or heartburn, so if I were you, I would put in claim for Barretts esophagitis as secondary and put in for an increase for GERD or "heartburn" and hiatal hernia.

It iis true, the military has a long history of discharging veterans for personality disorders rather than giving them an Axis I diagnosis that is service connecatble. But, the good and possibly the bad thing for others about C & P exams is just because one is diagnosed with a personiality disorder in service, the VA examiner is not held to that diagnosis and if they diagnosis PTSD or a service connectable mental condition, a veteran can get SC. On the other hand, if one is diagnosed with PTSD in service and the VA examiner diagnosis a personality disorder and doesnt confirm the PTSD diagnosis the veteran will not be entitled to SC, but may be entitled to chapter 1702 or medical benefits.

Mil T, As far as tinnitus, the VA doesnt service connect symptoms, however they connect conditions or disabilites. Tinnitus, it IS ASSOCIATED with hearing loss, but to the VA it is not a symptom, otherwise it wouldnt be service connectable. Tinnitus must be diagnosed by an Audiology exam to be granted, so if a veteran only reports tinnitus, but it is never formally diagnosed, the VA doesnt generally grant it.

Buzz, One thing to keep in mind is that you could have degenerative disc disease, degenerative joint disease, spurs, the works, but if your range of motion is normal and you dont report pain during the C & P, you will warrant a 0% and the next guy can come in and have just a chronic neck strain (much less involved) and complain of pain and have decreased range of motion and warrant a 20%. Pain and decreased motion is what warrants a compensable grant.

It is my understanding that IU is 100% but you cant work an earn income gainfully, but if your actual ratings combine to 100% you can work and earn an unlimited amount, so if the C & P exams result in an increase in your rating to true 100%, you are in a better situation. Also, once you are 55, they arent supposed to do future re-evaluations.

Gomamtic, Based on these results, you have mild hearing loss based on VA regs in the left ear at 2000, 3000 and 4000 and in thr right ear at 3000 (40 or above or three at 26 or higher). So if it is granted you will get 0%. Now, you probably need a medical opinion that your hearing loss is related to military. Did the VA review your hearing tests from in service? Were any of your levels above 25 in service? Also, sometimes the pre and post delpoyment questionaires ask you if you have ringing in your ears, if you have copies, check them to see if you checked the box for ringing in your ears. Maybe the audiologist from 1978 and 2010 will write an opinion for you?? Left 500 25 db 1000 30 db 2000 40 db 3000 40 db 4000 45 db 100% descrimination Right 500 25db 1000 25db 2000 35db 3000 40db 4000 35 db 100% descrimination

vwoodsong, First of all you are in a good position, you were granted SC for a TBI and tinnitus separately. They could have included the tinnitus in with the TBI and given you a 10% for TBI, but they gave you the better scenerio. As far as your symptoms, if you have mood symptoms before the TBI and its in you treatment records, they cant be sure your currnent symptoms arent from that, but you can still put in for the mood disorder. As far as your congenital mental condition? Im not sure what you are referring to but mood disorders or mood conditions are not congenital to VA but mental retardation, ADHD and personality disorders are. So, if you had a mood disorder diagnosed in service, then you need to put in a claim for it, if it was a personality disorder, then it is not service connectable, unless you get amedical oinion your personality disorder was caused by your TBI in service. TBI can affect your mood and personality, so if you dont have a mood disorder and just a change in mood after the TBI, then VA will look at what are the residuals now, not then when the TBI occurred. Again if you have a diagnosed personality disorder, that makes things more complicated.

Gomatic, The answers to your questions depends on a few things. How long after discharge did you put in your claim (within a year or many years later)? Did you ever report tinnitus while in service? Yes, they can consider your job title rather than focus on the MOS, as many MOS's, and ASFC's have changed over the years. Did you have more than one hearing exam in service and f so,was there a shift in hearing? Hearing loss must be pretty bad to be granted a 0% and extremely severe to warrant a percentage of 10% or higher. They will also consider your civilian employment since the militaary and recreational acitvities if you didnt have hearing loss in service. If any of those can cause hearing loss, well, you can figure out what the results of the decision may be.

Tony P, The VA does not separate mental health conditions, so depression, PTSD, anxiety are all grouped together. They cannot pay a veteran for the same disability twice. Stress is a symptom not a medical condition or disability. VA does not service connect or pay for symptoms only conditions that are diagnosed. Like pain, I see veterans say they put in a claim for neck pain, but that is a symptom. If they have a diagnosis of a neck strain that causes pain they can get pay for the neck strain.

You can send in a 21-4138 stating somthing to the effect; Please note that I will be out of town from ( ) to ( ) attending to family matters, please contact me by phone prior to scheduling my C & P or please schedule my C & P between ( ) and ( ) or after ( ) upon my return. Thank you.

gooz87, Although your headaches are secondary to PTSD ro TBI, they can still break them out separately. If they are prostrating and cause you to lay down in a dark room twice a month you can get 30% if they are that bad and occur more often you can get 50%. The key word is prostarting. With the new SNL rating system veterans are getting higher grants for headaches and mental conditions. If I were you, I would put in a 21-4138 for an increase for both conditions.

Im not sure what link is below, it looks like it to the exam worksheets, but the worksheets are becoming extinct and DBQ's or disability benefits questionaires are the new exam worksheets.

manning01, Im not sure where to access public information about the new SNL ratings. Im sure veterans will be receiving them in the upcoming days and hoepfully they will provide feedback on this site. I know its also called Evaulation Builder. Try those key words.

Clarification on OT pay. Sorry for any mis-communication. It appears that the staff's LES lists an overtime rate which is the same hourly rate for GS 9, 10, 11 and 12's but the actual pay that they recieve is time and a half and not the hourly OT rate listed on their LES. This is very confusing and I wonder why the government lists one hourly wage for OT on the LES and pays a different hourly wage.

retiredat44, I understand your concern, however San Diego's current policy is a congressional case gets worked ASAP. They even have a congressional staff member that handles all of the congressional inquires. Which basically means he/she is the point of contact for any emails or calls from a congressman, and when he/she gets the call or email, he/she tracks down the case and flags it as a priority case and it gets worked that week or within a few days. Yes, Im sure some staff may be bias when they get a congressional if they dont think the case warrants being a priority, but in the end they have to work the case within a few days and whether they agree the case should be a priority or not, they still need to stick to the facts and evidence.

rdawg, Its sounds like you got good news. Congratulations.