GatorNavy

The polycythemia I don't know what to attach that to could have been caused by prolonged diving Could be caused by advanced kidney disease Could be caused by sleep apnea/breathing issues. A good hematologist should be able to pin the tail on the donkey there. Also do I ask the VA psych doctors for information? Your VA psychiatrist should have done a DSM workup which is a diagnosis and severity of symptoms. They should prescribe meds that won't mess with your kidneys. With all of the back/hip pain comes depression/anxiety and I would discuss that with them. The mental condition could be secondary to the DDD or hip injury. Holy smokes, diving doesn't cause "lesions" like that. Using your head for a racquet ball does though! I am not an MD but maybe I should save up the boxtops and send in for a "free" title. When you are 100% schedular then you can leave your wife and kids some VA benefits should anything happen to you. Just finding out that you are diagnosed with life threatening diseases can take a toll on you and your family. Hang in there and take care of your health. Thanks for the offer, but I can't drink any alcohol and I do miss a good beer. Hopefully I will stay on this side of the grass for a while so I won't need the flowers any time soon.

I think it's time to put all of the cards on the table and play your hand. I would get the kidney disease filed pronto. Also file for the TBI/PTSD or secondary mental condition. I'd play the music that is in your service med recs though. Without the right mental condition meds the stress could really put the hurt on your physical conditions. You are thinking correctly, pyramiding should be avoided, but the kidney disease is secondary to whatever condition the strictures are secondary. The same thing with the Polycythemia. If you require phlebotomy then that is rated at 40%. You will get to the 100% with what is going on. Also some SMCs in there as well. Some think it is good strategy to file the TDIU while trying to get to the 100% schedular. The VA will give you plenty of "wait" time. You want the earliest effective dates possible on those newly diagnosed conditions to get those retro bucks roiling.

Living in the outback, IMEs are near impossible to get.

The VARO will deep-six evidence only if it is positive toward the Veteran. If there is something wrong with an IMO/IME then they would gladly list it as evidence and flaunt it as the basis for a denial in a proverbial heartbeat. Notice how the timelines are always against the Veteran and the VA takes as long as they want too? IMHO if the VA doesn't start granting more claims sooner then they are finished as a Federal Agency. Non-adversarial means that we don't get a firing squad just for applying for benefits. The VA's "ex-parte" system amounts to a denial or low ball decision along with a take it or leave it attitude. Waiting 5-10 years for any semblance of justice on appeal is abominable, and has nothing to do with the US constitution. Their idea of justice is to let the appeals languish so long that many appeals will just fall to the wayside for one reason or another. Some Vets get just ratings sooner than later but most Vets don't win the VA lotto. In the mean time the VA continues their shell game.

This is an excellent thread. As Berta has already stated, sometimes an IMO is the only way to get Service connected Compensation. I flailed around for about a year trying to figure out what my VSO was missing. Asknod told me that I needed a NEXUS opinion to pass go and collect the 200 dollars: ------------------------------------------------------------------------------------------------------------- In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of the incurrence or aggravation of a disease or injury in service or during the presumptive period; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). Once the evidence is assembled, the Board is responsible for determining whether the preponderance of the evidence is against the claim. If so, the claim is denied; if the evidence is in support of the claim or is in equal balance, the claim is allowed. 38 U.S.C.A. § 5107 (West 2002); Ortiz v. Principi, No. 01-7006, slip op. at 7 (Fed. Cir. Dec. 17, 2001); 38 C.F.R. § 3.102 (as amended by 66 Fed. Reg. 45,620 (Aug. 29, 2001)). ---------------------------------------------------------------------------------------------- Of course the C&P exam (once I showed cause to have one) was a thumbs down, no surprise there as the benefit of the doubt at the RO is that no evidence equals negative evidence. . . I had an IMO/IME from the VA provider (An expert for 15 years in her field) that had been treating me for 2 years. The RO deep-sixed that one. I submitted a statement from my VA PCP who stated my service connected conditions and why I could not work and they deep-sixed that. Those opinions were never listed as evidence in the SOCs or SSOCs either so the VLJ would never even knew they existed to begin with. I guess I can say that this VARO is quite consistent about using POSITIVE evidence as toilet paper. Of course they lost my 10 years of active duty SMRs and then promptly rebuilt my C-file of over 25 years with nothing in it. My C-file is now as skinny as a toothless ferret. In two weeks I have my BVA hearing and it will be a trip down memory lane. All of the evidence will be re-submitted including a squeaky tight IMO that the VARO has never seen before.

Might want to listen to Paul Sullivan's radio show from the other day. Basically they are shutting down the appeals....That's all folks.

Congrats to you... They pay from the date when you became disabled, not the application date. They can go back up to a year before you filed, I believe.

Did you submit the evidence during the hearing? Where was your C-file?

Yes, that is the computer system they use at the VA Medical Center where he is treated. You can request paper copies at the records office. You can look at the records in MyHealthyVet blue button data: https://www.myhealth.va.gov/index.html

appeals_overview.pdf

So, NOD is notice of disagreement? Yes, correct...it stops the one year clock and preserves the appeal. Do you file that immediately, then file a reconsideration or appeal or something like that? Actually no such "reconsideration" exists in the VA claims process. Technically, it is a re-opening of the claim within the one year of the decision date. Filed with "New and Material" evidence like additional medical records that support the claim that have not yet been associated with the claim. The NOD can be submitted any time within the one year when you have all of your evidence and have good reasons for disagreeing with the denial. The sooner the better however it must be within one year of the decision date. Or is the NOD all you need? Do you just let them know that you disagree through a NOD and then get everything together or is the NOD the whole thing where you submit everything you have, all evidence? Yes, the NOD is all you need but all of the new evidence (IMO and such) should be with it so you can get the C&P exams scheduled. If you get a hold of evidence later on you can always submit that too. We actually have until one year from the denial date to submit the NOD? Yes, that is correct. If you miss that date everything is wiped out and you will have to start over. And you won't be able to use the evidence you already submitted on the issues. Also, the effective date will reset to the new file date. And, if we were to submit the NOD today, it should be about one year total from this point? If you filed the NOD today with all of the new evidence it could only take a few months or so. But realistically probably longer. Can't really put a timeline on these things there are just too many variables. My RO is quick and timely but they are very small and don't process very many claims. He doesn't actually have an IMO from a VA doctor. The VA mental health dept.did diagnose him and gave him some tests, including a combat stressor test. His PTSD was moderate to severe and the combat stressors were high. These are all in the VA notes. The mental health nurse specialist and sociologist said that is all he needs and they would refer to the notes along with a C&P. I get loose with term IMO or IME. For me I define "independent" as any opinion outside of a C&P exam. Sounds like he actually had a thorough medical examination for the PTSD. However it needs to be from a VA psychiatrist. If so he should be good to go to get a C&P exam for a rating. I would pull those Vista records and send copies along with the filing.

Only an IMO from a VA doctor can be used for PTSD as far as I know. Sounds like you already have one so you don't have to pay for that one. Pull that PTSD diagnosis out of the records and submit with the claim. Should be good enough to get the C&P for the PTSD. The payout for tinnitus is rather low so it may not be worth the IMO. Might be able to find something in the SMRs that is enough evidence for service connection. Has he had any C&Ps yet? The scheduling for a C&P for a mental condition was 4-6 months out. Was for me anyway. Add 3 months for the Kidney disease IMO and then 3 months to C&P exam and claim processing. That's puts the claim close to the magic one year since the denial date to appeal. The kidney disease you want to keep the effective date alive since that is a serious chronic condition. Like I mentioned I don't know if you would be able to keep the PTSD effective date from the original file date for the other mental conditions. If you can't, then you could file the PTSD as a new claim. You may be better off with a NOD on the other issues and submitting evidence with it. Then ask for a hearing. just some food for thought. Hope it helps....

The CAVC can and does: affirm, vacate, reverse, or remand its rulings. The Joint Motion for Remand or JMR is like the settlement phase that follows discovery in civil litigation. Opposing attorneys get together and negotiate a settlement for their clients in a JMR before it actually gets to "Court" for a judge to decide. You can get yur butt handed to ya' without an attorney in there fighting for the best JMR. The VA Secretary speaketh with forked tongue! Asknod eats, sleeps and breathes VA Law and he went into the CAVC with an attorney and got a big win from the JMR. No way would I attempt it without an attorney. If I have to go up to the CAVC; I am going to win. Losing is not an option. The CAVC does not write law, they interpret law. CAVC cases that lend precedence (do they need a panel decision?) are few and far between but they can be "cited" to lend credence to a particular claim at the RO or the BVA.

PTSD is a mental condition that encompasses anxiety, depression etc. and there can be only one rating for a mental condition. No secondaries there. You will need an IMO with a strong nexus for the kidney disease, another one for the tinnitus and yet another IMO with strong nexus to known stressors in military service for the PTSD as well. You need to get the IMOs moving. You can take the time to research what you are going to need to win and get your ducks in a row with what is left of the one year. When you are ready, file the NOD and all of the new evidence with it. A good VA claims attorney could tell you if it's possible to replace the anxiety, irritability issues with PTSD to keep the earlier effective date. Just my own opinion from doing my own claim as I am not a professional anything. Gator

There is no such thing as an administrative claim (for compensation purposes). Actually there is no such thing as different, separate claims either. There are different conditions that are rated and are part of one big happy compensation claim. There is only one C-File. An Administrative Review is when a claim is before a decision maker (DRO) that can change the ratings decision prior to entering into the appeals process....After entering the appeals process it is referred to as a DRO review. Vets do miss C&P exams for some very good reasons. The VAROs are infamous for denying a claim for a missed C&P exam when they never even scheduled one to begin with. Happened to me once and I caught them with their pants down! The VA was able to delay my claim for yet another 4 months because of it.

As I stated in a prior post, an Administrative Review is not a type of claim. In that post to you I also defined what it is. The reason they put it under "Claim type" is because the software lacks any other place to list it. Mine, everyone else that had a Request for Reconsideration had that as well. You have a year from the decision date (November 2013?) to file a Notice Of Disagreement (NOD) to preserve your further rights to appeal which includes the original effective date that you filed or when you first submitted your claim. Looks like things are moving along nicely with your claim and you can wait to see what shakes out of it now. If you don't like what comes out of your Reconsideration then the next step is to craft and file the NOD. We can help you along with your NOD as it appears that you have plenty of time left to file that. I know it becomes a tad bit overwhelming and down right nerve racking to start with, Soon you will get into the swing of things. Most of us here went through the same thing. I Hope this makes sense, a migraine is kicking my tail right now....

I opted for a video teleconference which might cut the time for a traveling board in about half. I don't know if you have an option to ask for one now or go back to the end of the line. I did want a hearing though simply because I believe the RO are a bunch of FNG polecats and would "lose" my new evidence before It got in my C-file because they've done it before....Took about six months to get on TV. My hearing is next month. Where is the backlog? Has anyone seen the backlog? Why there it is! right there in the appeals!! Sign up for an FDC today and get a free autographed picture of undersec Allison Hickey.

You need to file kidney damage as secondary to Urethral stricture and Bladder neck contracture/stricture. A kidney specialist needs to assess how much damage there is and what it is and then fill out a DBQ for it. In addition you will need a nexus letter from the kidney specialist or urologist stating that the kidney damage is more likely than not (or most likely) secondary. Look at your SMRs to see if they mention impaired kidney function. If so, you will need to copy those pages to submit with the filing. Then look at the schedule of disability ratings and see where the DBQ puts you and what your rating should be for the kidneys. Eventually it is going to get worse but later on you can file the increase if needed. The VA claim experts will come by and help you fit the pieces together. Just keep asking questions.

Final Rule - Secondary Service Connection for Diagnosable Illnesses Associated with Traumatic Brain Injury http://www.regulations.gov/#!documentDetail;D=VA-2012-VBA-0029-0212

The Administrative Review is a step in the process of the rating decision and is not a type of claim. It can be initiated by the Vet or the RO. Where I have seen it used is when a Request for Reconsideration (re-open of the claim within one year of the original decision date) is submitted. Then a senior member of the staff reviews the decision if a modification has been made or the rating decision does not need to be changed. ---------------------------------------------------------------------------------------------------------------- 3.05 Administrative Review a.Definition An administrative review is initiated after a formal decision is made. The review provides the resolution to uphold or overturn the formal decision. It focuses on questions regarding policy and procedures, application of the laws, regulatory guidelines or directives. b.Timeline for an Administrative Review An administrative review must be submitted within one year from the date of the written notification of decision to the Veteran. The Veteran must be informed of the decision for an administrative reviewconducted by the Director of VR&E Service or a VREO within 90 days of receipt of request. (38 CFR 21.98) c.Veteran Notification of the Administrative Review Outcome The RO notifies the Veteran in writing with the outcome of the administrative review conducted by VR&E Service or the RO.

Here is the adjudication rule in detail: Part 3 Adjudication 1. The authority citation for part 3, subpart A continues to read as follows: Authority: 38 U.S.C. 501(a), unless otherwise noted. 2. Amend § 3.310 by adding paragraph (d), to read as follows: § 3.310 Disabilities that are proximately due to, or aggravated by, service-connected disease or injury. * * * * * (d) Traumatic brain injury. (1) In a veteran who has a service-connected traumatic brain injury, the following shall be held to be the proximate result of the service-connected traumatic brain injury (TBI), in the absence of clear evidence to the contrary: (i) Parkinsonism, including Parkinson's disease, following moderate or severe TBI; (ii) Unprovoked seizures following moderate or severe TBI; (iii) Dementias of the following types: presenile dementia of the Alzheimer type, frontotemporal dementia, and dementia with Lewy bodies, if manifest within 15 years following moderate or severe TBI; (iv) Depression if manifest within 3 years of moderate or severe TBI, or within 12 months of mild TBI; or (v) Diseases of hormone deficiency that result from hypothalamo-pituitary changes if manifest within 12 months of moderate or severe TBI. (2) Neither the severity levels nor the time limits in paragraph (d)(1) of this section preclude a finding of service connection for conditions shown by evidence to be proximately due to service-connected TBI. If a claim does not meet the requirements of paragraph (d)(1) with respect to the time of manifestation or the severity of the TBI, or both, VA will develop and decide the claim under generally applicable principles of service connection without regard to paragraph (d)(1). (3)(i) For purposes of this section VA will use the following table for determining the severity of a TBI: Mild Moderate Severe Normal structural imaging Normal or abnormal structural imaging Normal or abnormal structural imaging. LOC = 0-30 min LOC > 30 min and < 24 hours LOC > 24 hrs. AOC = a moment up to 24 hrs AOC > 24 hours. Severity based on other criteria. PTA = 0-1 day PTA > 1 and < 7 days PTA > 7 days. GCS = 13-15 GCS = 9-12 GCS = 3-8. Note: The factors considered are: Structural imaging of the brain. LOC—Loss of consciousness. AOC—Alteration of consciousness/mental state. PTA—Post-traumatic amnesia. GCS—Glasgow Coma Scale. (For purposes of injury stratification, the Glasgow Coma Scale is measured at or after 24 hours.) (ii) The determination of the severity level under this paragraph is based on the TBI symptoms at the time of injury or shortly thereafter, rather than the current level of functioning. VA will not require that the TBI meet all the criteria listed under a certain severity level in order to classify the TBI at that severity level. If a TBI meets the criteria in more than one category of severity, then VA will rank the TBI at the highest level in which a criterion is met, except where the qualifying criterion is the same at both levels. http://www.regulations.gov/#!documentDetail;D=VA-2012-VBA-0029-0212 -------------------------------------------------------------------------------------------------------

The links I provided are relatively new. I didn't find out about them until this morning. Hopefully your VSO knows. The new criteria to meet is contained in the PDF at the Federal Registry but is now located: http://www.regulations.gov . The new adjudication rules for TBI went into effect around 16 January 2014: FOR IMMEDIATE RELEASE December 16, 2013 VA to Expand Benefits for Traumatic Brain Injury Adds Five Illnesses Related to Service-Connected TBI WASHINGTON – Some Veterans with traumatic brain injury (TBI) who are diagnosed with any of five other ailments will have an easier path to receive additional disability pay under new regulations developed by the Department of Veterans Affairs. The new regulation, which takes effect 30 days from today, impacts some Veterans living with TBI who also have Parkinson’s disease, certain types of dementia, depression, unprovoked seizures or certain diseases of the hypothalamus and pituitary glands. “We decide Veterans’ disability claims based on the best science available,” said Secretary of Veterans Affairs Eric K. Shinseki. “As scientific knowledge advances, VA will expand its programs to ensure Veterans receive the care and benefits they’ve earned and deserve.” This regulation stems from a report of the National Academy of Sciences, Institute of Medicine (IOM) regarding the association between TBI and the five diagnosable illnesses. The IOM report, Gulf War and Health, Volume 7: Long-Term Consequences of Traumatic Brain Injury, found “sufficient evidence” to link moderate or severe levels of TBI with the five ailments. The new regulations, printed in the Federal Register, say that if certain Veterans with service-connected TBI also have one of the five illnesses, then the second illness will also be considered as service connected for the calculation of VA disability compensation. Eligibility for expanded benefits will depend upon the severity of the TBI and the time between the injury causing the TBI and the onset of the second illness. However, Veterans can still file a claim to establish direct service-connection for these ailments even if they do not meet the time and severity standards in the new regulation. Veterans who have questions or who wish to file new disability claims may use the eBenefits website, available at www.eBenefits.va.gov/ebenefits. Servicemembers who are within 180 days of discharge may also file a pre-discharge claim for TBI online through the VA-DoD eBenefits portal at www.eBenefits.va.gov/ebenefits. The published final rule will be available Dec. 17 at http://www.regulations.gov. Information about VA and DoD programs for brain injury and related research is available at www.dvbic.org. Information about VA's programs for Gulf War Veterans is available at www.publichealth.va.gov/exposures/gulfwar/hazardous_exposures.asp.

https://www.federalregister.gov/articles/2013/12/17/2013-29911/secondary-service-connection-for-diagnosable-illnesses-associated-with-traumatic-brain-injury http://www.gpo.gov/fdsys/pkg/FR-2013-12-17/pdf/2013-29911.pdf

Phil Pardon me, trying to understand. Was your MDD diagnosed secondary to the TBI in your Service Medical Records? If so, it sounds like they ignored those records. Then maybe you should make a copy of the SMR pages that state such and talk to your VSO about sending that in (again?). If no such diagnoses in service exists, then you will need either a neurologist or a psychiatrist to give nexus with an opinion (IMO) that the MDD is secondary to the TBI. Berta, Carlie, Asknod can give you direction on what a good IMO should look like with the wording and legal jargon. Asknod has a very good chapter about it in his book or you can go to his website and look at his "Nexus Bible". It's frustrating when you are ill and don't know much about the process. You expect a VSO to pickup the point and then things go wrong. I think most of us have been there before, hence the existence of this forum. http://asknod.wordpress.com/6051-2/ edit: my keyboard died before I could finish. The 60,ooo dollar question seems to be is your progress notes (VA VISTA?) enough to prompt a C&P exam?

Way to go! Congratulations! That is nice of you to encourage others like that. Retro is rather quick. Look in ebenefits --- payments made.