USMC5811

I'm really beginning to believe, as far as completion dates on ebenefits goes, that Peggy has taken over inputting data (dates) into ebenefits just to screw with us. I'm figuring sooner or later somebody will look to see their completion date and it will read the truth = we'll get to it..... when we can get to it - when you see the envelope in your mailbox you'll know your claim is complete. For those that are not familiar with Peggy: http://youtu.be/GRLwKw9up3s

I would give it a few days to sort itself out concerning ebenefits. One thing we all need to remember (to include myself) is that any computer program or site can only be considered reliable and accurate IF the person putting the data in is reliable and accurate and knowledgable - the accuracy of ebenefits have proven time and time again (specifically where dates are concerned) not to be accurate. Congrats on the anticipated increase!

It took me this long to read all the C&P results - but I did go through them numerous times before comparing them to the past/current medical records that I have. As stated before he is already Sc'd for Basal Cell Carcinoma 0%. I don't think that will change because thankfully his doctors are being proactive by destroying all the pre-cancerous lesions etc. I do however feel that the scars that he has from previous and current treatments could render a ratable (above 0%) decision - perhaps 10%. His C&P examination for Skin Disease consisted of the Dr (QTC - no speciality in Dermatology) getting up..glancing at his head for 2 seconds and that's it. He had an appointment a few days ago with his private Dermatologist and I suggested that he bring the DBQ for for Skin Diseases (21-0960F-2) and Scars/Disfugurement DBQ (21-0960F-1) and see if his Dr. would be willing to fill it out. I was specifically interested in if the Dermatogist, who actually does spend time examining, would write something different concerning Scars - his scalp looks horrible from all the treatment. The C&P doctor did state there was a scar and some hypopigmented areas and scabbing from liqued nitrogen treatment. The dermatogist (who is a Naval Academy Grad, did his Dermatology Residency at the National Naval Medical Center and was Chairman of the Dept of Dermatology at a Naval Hospital) was a bit more detailed actually measuring the scar (from an incision to remove BCC while active duty) and described the scar: surface contour depressed on palpation and abnormal texture along with hypopigmentation. I typed up a cover letter that pointed out his private doctors background and training, advised them of his recent treatment by his doctor = another biopsy (which thankfully came back negative for cancer) and having to destroy 15+ pre MLG Lessions again using liquid nitrogen (he's had this done 3 times in the last year and several times in previous years ) and specifically pointed out the discrepincies/difference in both doctors examination and answers to the question concerning scars. I listed the attachments on the cover letter and enclosed them (DBQ's from his private Dr.) and his most recent treatment report. I left the decision to send the above in to my better half - and he is leaning towards submitting it now. Hopefully it won't set him back to far in obtaining a decision. Any opinons from those more knowledgeable is appreciated - wait for a decision on this one, then file a NOD or send it in now? Forgot to add......Thanks in advance for any and all opinions.

As I'm fairly new to the process...just going by what I've researched on hadit.com....here's my two cents, if nothing else it'll bump your post up so that maybe other more experienced vets will give their opinion: What I would personally do is: If they did not give you a copy of both C&P results yet, I would get/request a copy of them. My understanding is if the C&P was done at a VAMC then all you would have to do is go in and sign a privacy act request and they usually give you one right there. IF QTC or the new/other contracting agency with VA did the C&P then you could either 1. Ask at the Contracting place if they will give you a copy - some have had luck obtaining one...others not 2. wait until the VA receives the C&P report (usually shows when the receive it on ebenefits) then request a copy directly from VA. I would then compare what they have on the C&P results with the results of your private cardiologist. If they have the same information on both - I personally would not submit them. If there is pertinent information on the private cardiollogist report that is missing from the C&P report that is in your favor OR the private cardiologist somehow has shown a nexus to your service connection that the C&P doctor did not (if it is needed ) OR the private doctors report would possibly (according the the rating tables) increase your percentage....then yes I would send the private one in. My reasoning being that when you do send in additional information it could set your claim back in the process. If you were lucky and somehow your C&P was done at a VAMC....then maybe you can take a copy of THAT report and show it to your private cardiologist and see what he thinks. I hope someone else with more experience will give you their insight. Praying that things work out for you this time around...... Just wanted to add that there is a DBQ form for Ischemic Heart Disease perhaps you could bring with you to your next Private Cardio appt and maybe the Cardiologist would be willing to fill it out for you and send that in to VA - if you do intend to send additional info in. Tried to add the direct link but it is just not working for me - just type in DBQ in the search box on hadit.com and the Forms page will come up

Not sure if I'm understanding the question correctly but ........As far as claims go....the agency that sends you to have a C&P done is the Department of Veterans Affairs. Looking at my own paperwork that was sent to me for a C&P there is no specific person listed ...just the Department of Veterans Affairs. If you no longer have the paperwork that they originally sent you to have a C&P - if you have a Designated Power of Attorney on file with the VA ie., VFW, DAV etc - you could check with them as they might just have a copy of it in their file. I noticed on the bottom of my C&P Appointment notification letter they have "cc: VFW". So I'm assuming that they sent a copy to the VFW rep who I have designated.

Congrats! Take it all in and enjoy - you earned and deserve it!

I also was confused about this....because I saw the same thing on ebenefits. I was told (via IRIS request) that mine was due to them "recognizing" the VFW was my designated/authorized power of attorney (mind you that mine apeared almost one year after the claim and the designation form was submitted). Has the exact same thing as yours = Claim Type = Authorization Review Date opened and closed were the same date (mine was of course a different date then yours) and Appeal is Possible. Odd how some things appear late and others are fast but then that's the VA way - I requested a copy of C&P's and that appeared also in Closed Claims less then 5 days after I submitted the request: Claim Type: FOIA/Privacy Act Request - both opened and closed dates were the same and Appeal is Possible.

Also, anybody out there ever attend an audiology or infectious diseases C&P? What do I need to do to be prepared for the interview/examinations? Many do or should use DBQ's (Disability Questionaire Form). You can look up what is on these forms here: http://benefits.va.gov/TRANSFORMATION/dbqs/ListBySymptom.asp

Noticed no one has responded to your question yet, so I'll give my opinion. I'm guessing the reason why the entrance exam was asked for so many times is because it is not in your C-File that they might have. Because of the VA's "duty to assist" 38 USC 5103 VA must make every possible effort to obtain relevant records held by any Federal department or agency, unless and until it is reasonably certain that the records do not exist (I doubt very much anyone could say that a Service entrance exam never existed) or that continuing efforts to obtain them would be futile. This will generally require a statement from the custodian that the records no longer exist, or that they have been transferred elsewhere. So I'm guessing, as you probably already have, that the Service Entrance Exam might be lost. Heck with all the threads I've read here, with people stating that they are finding other vet's records in their C-File - it's not surprising at all. Eventually, for better or worse as far as the vet's claim goes, the VA does move on they have to cover their butts though (38 USC 5103).

If you actually click on Pending Decision Approval tab while in ebenefits it will reveal that they define Pending Decision Approval as: The recommended decision is reviewed, and a final award approval is made. If it is determined that more evidence or information is required, the claim will be sent back in the process for more information or evidence. I highlighted the second part of the info because sometimes it does get sent back in the process..... Not sure about your question (as in exactly what your looking for) but I'll give it a go - What on ebenefits can I see to let me know about the claim? Once on ebenefits if you go to you Compensation & Pension Claims Page - you can see the date that you filed the claim - claim status - action - needed by you and/or received by VA If you click on the date that you filed (which is underlined) you will be taken to another page that has: Details of your claim such as - date filed, claim type, estimated completion date, your contentions (what your claiming) as well as: Additional Details: Your designated power of attorney, Regional Office of Jurisdiction and the address to send documentation to. and the MOST IMPORTANT on this page: What the VA needs and what they have received from you, doctors, c&p examiners etc. Sometimes people are able to check to see if an actual decision has been made by clicking on the Download VA Letters Tab and looking to see if there has been a change to the AB8 Form (Benefit Verification Form)

Congrats! I can't imagine the feeling....after waiting 2 years and then being there to watch as the ebenefits site updated - definitely a day you won't soon forget.

I would think that because they have never scheduled you for a C&P before = "this is the first C&P that the VA has ordered since the very beginning".....that hopefuly it is a good sign and I pray it is for you. With that said, I don't think just because a C&P is scheduled....does it necessarily mean that a Service Connection is inferred by the VA and a compensation will follow for anyone but perhaps this might be a reason that they might finally concede if your are a Vietnam War Veteran. I believe it was just recently, in 2011 (need to edit the date it was actually 08/31/2010), that they added Ischimic Heart Disease to the presumptives of exposure to herbicides in Vietnam. e) Disease associated with exposure to certain herbicide agents. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of §3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of §3.307(d) are also satisfied. Ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina) 38 CFR 3.307(e)(2011) I apologize in advance if this does not specifically apply to you = not a Vietnam Vet.

I think your referring to this: 5.9.1 Protections against Reductions after Ten and Twenty Years of Continuous Benefits or Rating at a Particular Level If a rating level or benefit has been continuously in effect for a certain length of time, it may be protected by law from reduction or severance. For example, after ten years of the veterans continuous receipt of service-connected disability or death benefits, the VA cannot sever the benefits (that is, terminate service-connected status) unless there was fraud involved in obtaining the rating or the VA discovers that the veteran did not have the required length or character of service.429 Similarly, if a disability has been continuously rated at or above a particular rating level for twenty or more years, the VA cannot reduce the rating below that level unless it discovers that the rating was based on fraud.430 For example, if a veteran is granted compensation based upon an original rating of 30 percent and for the next twenty years the rating varies between 30 percent and 100 percent, the rating cannot thereafter be reduced below 30 percent in the absence of fraud. The twenty-year protection rule applies even to rating levels that are assigned retroactively because a previous final decision is revised based on a finding of clear and unmistakable error (CUE). That is, if a rating is "retroactively increased [based on a finding of CUE] and the effective date of such increase is more than twenty years in the past, the revised disability percentage is protected" by the twenty-year protection rule.431 (The concept of clear and unmistakable error is discussed in Section 14.4 of the Manual.) I am currently trying to read a few cases a day of the US Court of Veteran Appeals - it seems when there is a reduction involved, many of the claimaints/reps/attorneys refer to Brown vs Brown 92-325..... In Brown v. Brown, 5 Vet. App. 413 (1993), the Court of Appeals for Veterans Claims (Court) identified general regulatory requirements which are applicable to all rating reductions, including those which have been in effect for less than five years. Id. at 417. Pursuant to 38 C.F.R. § 4.1, it is essential, both in the examination and in the evaluation of the disability, that each disability be viewed in relation to its history. Id. at 420. Similarly, 38 C.F.R. § 4.2, establishes that "t is the responsibility of the rating specialist to interpret reports of examination in light of the whole record history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of the disability present." Id. The Court has held that these provisions "impose a clear requirement" that rating reductions be based on the entire history of the veteran's disability. Id. Furthermore, 38 C.F.R. § 4.13 provides that the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms. Additionally, in any rating reduction case, not only must it be determined that an improvement in a disability has actually occurred, but that such improvement reflects improvement in ability to function under ordinary conditions of life and work. See Brown v. Brown, 5 Vet. App. at 420-421; see also 38 C.F.R. §§ 4.2, 4.10. A claim as to whether a rating reduction was proper must be resolved in the Veteran's favor unless VA concludes that a fair preponderance of evidence weighs against the claim. Brown, 5 Vet. App. at 421.

Your very welcome SSGmajik. I'm really new to all this but I have been reading numerous BVA decisions to gain knowledge, mainly for my own claim and my husbands claim but....... There are several cases where failure to use a goniometer during C&P exams were mentioned in the arguements. EXAMPLE taken from a case: At his August 2011 Board hearing, the Veteran testified that the VA examinations with which he was provided were inadequate because they did not properly test for certain clinical findings, the basis of which his disabilities are rated; for example, he indicated that in testing his knees, a goniometer was not used to test range of motion. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that it is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In most of these cases a new C&P was ordered for the Vet - and the decision was deferred UNTIL then. You can find such cases by going here: http://www.index.va.gov/search/va/bva.html . In the search box at this site: just type in something like "failure to use goniometer" and you'll see numerous cases that come up or you could try researching your specific conditon and see if there are any similiar cases like yours.

Thanks GeorgiaPapa.....He is already service connected and rated (the max) of 10% for tinnitus and 0% for hearing loss. I'm guessing that they did not provide the C&P doctor with his previous documented hearing exams because he was already service connected. Odd though that on the C&P results for Tinnitus, the same doctor stated that the tinnitus was due to service - even with no records.

38 C.F.R.4.46 - § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect to landmarks, should be insisted on. The use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department of Veterans Affairs. Muscle atrophy must also be accurately measured and reported. On DBQ's (VA FORM 21-0960M-14) it states the following for Measuring Range of Motions: NOTE: Measure ROM with a goniometer, rounding each measurement to the nearest 5 degrees. During the measurements, document the point at which painful motion begins, evidenced by visible behavior such as facial expression, wincing, etc. Report initial measurements below. Following the initial assessment of ROM, perform repetitive use testing. For VA purposes, repetitive use testing must be included in all joint exams. The VA has determined that 3 repetitions of ROM (at a minimum) can serve as a representative test of the effect of repetitive use. After the initial measurement, reassess ROM after 3 repetitions. Report post-test measurements in Section 5. C&P Service Clinicians Guide.htm 17. Musculoskeletal: a. For all joint or muscle disorders, state each muscle and joint affected. b. Separately examine and describe in detail each affected joint. Measure active and passive range of motion in degrees using a goniometer. In addition, provide an assessment of the effect on range of motion and joint function of pain, weakness, fatigue, or incoordination following repetitive use or during flare-ups. (See the appropriate musculoskeletal worksheet for more detail.) NOTE: The diagnosis of degenerative or traumatic arthritis of any joint requires X-ray confirmation, but once confirmed by X-ray, either in service or after service, no further X-rays of that joint are required for disability evaluation purposes.

Thanks for verifying that for me jv.......well, at least he's getting hearing aides for free.

I'm going over the hearing test results of C & P exam and believe I have the % figured out using the tables but was wondering if someone could help me verify the results - already SC'd for hearing loss at 0% and I'm thinking no increase will happen with the following results but those tables are confusing for me. Results: Right Ear Avg Hz(B-E) 51.25 Left Ear Avg Hz(B-E) 50 Speech Discrimation Score: 92% Diagnosis: (for both ears) Sensorineural hearing loss in frequency range of 500-40000 Sensorineural hearing loss in frequency range of 6000 Hx Was the Veteran's VA claims file reviewed? No Etiology Cannot provide medical opinion regarding the etiology of the Veteran's hearing loss without resorting to speculation - no medical records or baseline hearing tests. Configuration of hearing loss is like that usually seen with noise as the etiolgoy. I'm assuming that because he was already SC'd they did not give the examiner his records as there are about 8 hearing tests in Active Duty Service Health Record? I would also assume that of the 18 yrs (of 22 years) that was spent as 0811- Artillery...that the 198 Howitzer just might cause a little noise as well as the incoming rounds during combat <----------my attempt at being sarcastic. Thanks in advance for response.

Just a guess on my part (very very new to all this) specifically because of the Occupational and Social Impairment with reduced reliability and productivity.....being checked .....seems to fall into the 50% range rating forumula, although there are some symptoms listed in the 30%- 70% range as well. I'm wondering if when this occurs (different symptoms in different precentages of the General Rating Formula for Mental Disorders) does the GAF score (that the C&P examiner records) come into the decision somewhere, even though the GAF is/can be fluid (can changes like ones blood pressure). Hope VA does right by you - I'm sure someone with alot more knowledge will be along shortly........ General Rating Formula for Mental Disorders: 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 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 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

Using the hadit.com search engine - I found the following for a sample of a NOD: www.hadit.com/vaclaimslibary/law/nodsample.gif For some reason having problems posting the link to the NOD sample but if you just type: Sample of Notice of Disagreement in the search box of hadit.com (located just above the title of this thread) you will be able to click on the link it provides. Hope this helps a little.....sorry about the troubles they are causing you. There is also some good information - scroll down to Carlie's post here:

Thank you very much for your replies John and Berta. Thank you also Berta for your insight and understanding, no doubt you of all people understand the pain, sadness etc of watching a wonderful man fight the demons of war that haunt him - its such a helpless feeling for a spouse. His current therapist did reach out to me in regards to a wife (of veterans with PTSD) support group, providing me with a phone number to call, but I have not yet called. Maybe someday I will....... I am a veteran also and am dealing with my own demons. We are muddling through all this..... Believe it or not...he is still working. He had to give up his business a few years back because of not being able to deal with people or be around people without the rage rearing its ugly head and other symptoms of his illness. Something that had to be done and I'm glad for his sake and others around him (their safety), that he reluctantly gave in. He now works delivering small packages...he's by himself 97% of the work day, but that 3% is what has me worried everyday. I think him working...is something he needs but to be honest we also need to survive financially...even though it takes him upwards of 2 hours to get ready for work and get out there - he says it gives him a purpose in life.:( Other then work and dr appointments...he would not leave the house..stopped fishing or doing anything that he usta enjoy:( I got him a German Shepherd puppy a couple of years ago which has been the BEST thing for him...he takes her for short walks and spends alot of time with her on our property, they are both very bonded....has helped his moods just having her by his side. Sometimes I'm actually jealous of her and his attention to her:) Thanks again for the responses...sorry I rambled...

Berta, I just contacted them via email to ask where I could locate the 2012 Decisions because on their website http://www.index.va....bva.html hope this is correct) the prompt of 2012 is not yet available. Not sure if I am looking at the same page as you Berta because I cannot see any of the 2012 cases - let alone try to click on them. IF your are able to see the individual decisions for 2012 yet the link is not connected (dead link or unclickable)- it is an easy fix....takes less then a minute to fix each link IF the corresponding information (page they are linking to = individual cases) is/are completed. I'd do it for them for free...if they let me = fat chance of that happening:) Maybe if enough people send emails or phone - they might get the ball moving a little faster?

How much weight does a C&P exam/report have in the overall rating by VA? - I do realize that is is not the only thing they consider. The reason I ask this is because the local VA mental health doctor/therapist that has been treating my husband did diagnose him with PTSD that conforms to DSM-IV criteria but not to the extreme (both in GAF Score and when it comes to Occupational and Social Impairment) that the C&P examiner did. Please understand I'm not complaining about the C&P report as I feel it is a more accurate representation of my husbands current (to this day)problems, having been married to him for over 20 years I knew him very well before and after combat. Diagnostic Summary Does the veteran have a diagnosis of PTSD that conforms to DSM-IV criteria based on today's evaluation? Yes Current Diagnoses Diagnosis #1: Post Traumatic Stree Disorder/Chronic, Moderate to Severe Axis 1 Diagnosis#2 Panic Disorder with Agoraphobia - Axis 1 Diagnosis#3 Depressive Disorder Not Otherwise Specified - Axis 1 GAF score: 35 Comments: Major impairment in several areas Does the veteran have more then one Mental disorder diagnosed? Yes Occupational and social impairment Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking and/or mood. (Is checked) Is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? PTSD: 70%, Panic Disorder with Agorophobia 10% and Depressive Disorder NOS: 20% In the section for Stressors: Does this (there are several stressors listed - all combat related that I would rather not post the details ) meet Criterion A - Yes Are the stressors related to the Vet's fear of hostile military or terrorist activity? Yes Which stressor contributed t othe Veterans PTSD diagnosis? All the stressors are checked. Symptoms (the following are checked): Depressed mood, anxiety , suspiciousness, panic attacks more then once a week, chronic sleep impairment, difficulty in understanding complex commands, disturbances of motivation and mood, Difficulty in establishing and maintaining effective work and social relationships, Difficulty in adapting to stressful circumstances, including work or worklike setting, impaired impulse control, such as unprovoked irritability with periods of violence, disorientation to time and place, intermittent inability to perform activies of daily living. Other Symptoms: Other symptoms are listed for each listed Disorder but I believe they are a bit personal. Is the Vet capable of managing his or her financial affairs? Yes. Remarks: A diagnosis of PTSD is made. It has been determined that the veteran's claimed stressors are related to the veterans fear of in-service hostile military or terrorist activity. Rationale: His stressors/traumas are eligible for PTSD definition of traumas and he further met all of the other criteria of DSMIV for PTSD. He had gone to a Civilian Psych (via Tri-Care as he's retired 22 years) over a year ago - that Dr was the first to diagnos him with PTSD - had to threaten him with leaving (which I would NEVER do....no matter how bad it gets but at the time he did not need to know this) to get him to go . He's been seeing a VA therapist since that time who also diagnozed him with PTSD - her initial exam of him is much like the above....but her recents comments have just been things like: has much less anger, clear speach, calm, coherent, Pt aware of person, place, time and situation. Casually dressed and adequately groomed, in fair mood with congruent effect. Complexity of Illness/Level of Impairment: moderate and stable at this time. YET they increased the doseage amount of medication that had been perscribed. To be honest....I personally have not seen much change for the better since he has been going to therapy....the medication has helped with his anger/outbursts a little but other things have remained the same or gotten worse:( Looking at the VA's rating table for MH problems - I would think he would get a 70% rating if all they considered was the C&P........but with some of the things his current therapist is stating I think it might be lower. To be perfectly honest though.....I just wish I could have my husband back to his former self. Thanks in advance for any thoughts or answers to my questions.

Received the copies of the recent C&P results today - The actual claim process/decision has been slow but I gotta give props to the Winston-Salem RO for the fast service for getting the copies to me. Thank you Berta for suggesting I request them....it's gonna be a long read.

Great News for you - Congrats!