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Ricky

Master Chief Petty Officer
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Posts posted by Ricky

  1. Here is the catch...my employer has been paying me short-term since my sugery. The report I got today from my doctor now states that I was able to return to full duty back in March.

    A report you received in June retroactively clears you for work in March? First, normally, employers require doctors to clear an employee in writing, with an effective date, BEFORE returning to work after medical leave. This is normally a pre-requisite, otherwise, the employee does not return to work. This is proof that the employer performed due diligence in not interfering, for instance, with FMLA leave, or in the patient's recovery. It's to protect the employer against liability lawsuits, or accusations of violating FMLA regulations.

    The VA doc says he cleared you to return to work last March -- OK, then ask for a copy of the documentation he supposedly supplied to you or to your employer clearing you to return to work, or better yet, ask your previous employer to request it.

    Wherever the report you received today is eventually sent, you should include a copy of the doctor's prior report that contradicts it, as well. Discuss the circumstnaces behind the discrepancy (your having to get the patient advocate's office involved) and offer to undergo another physical at the insurer's expense. Then, follow through with your plans regarding getting another VA doctor assigned to you and to give you an IMO, as well as a non-VA IMO if you can possibly do that.

    My experience with long-term disability -- File the application as soon as the insurer will accept it (it's an implied LTD claim by the sound of your circumstances, that is, you're not expected to recover sufficiently to return to work). If they deny it, get an ERISA attorney to handle the appeal, do not -- repeat, do not -- try to handle an appeal on your own. Dealing with LTD insurers is like swimming with barricudas, very treacherous. The earlier an attorney gets involved in an appeal, the better the protection he/she can afford the client. The attorney does not have to be located in your state; ERISA is federal law, so any ERISA attorney can represent you. I can discuss this further with you if you like, but these cases usually end up denied, then appealed, then you get a lowball amount of money dangled in front of you to settle and then disappear (no future claims), the dickering goes back and forth, and then you either reach a figure both sides agree to, or it goes to Court (a judge decides these cases, not a jury).

    Also, file for TDIU and file for Social Security disability. You can do all of this at the same time. If you take any medications for depression, that's another reason why you can't work around machinery and your employer doesn't want you to return to your old job. Others disagree I'm sure, but here too, I believe in getting a lawyer right at the very beginning of the claim. We did it that way, and my husband was approved on the first try, no easy matter in this state. We used Binder and Binder.

    EXCELLENT ADVICE.

  2. Just read a post that makes me question where I am at. I applied for TDIU and am SC 80% total with PTSD at 50% and the rest Agent Orange stuff. I was denied last October and filed a NOD. My first DAV VSO had me go DRO, then I got more evidence (a letter from my VA Psychologist) and another DAV VSO changed it to a traditional appeal. I still haven't received a SOC, and the Reno VARO told me that it can take up to a year to receive.

    Should I leave it the way it is, or send in a form 9 and request DRO?

    My first question would be:

    Have you received an election letter from the VA as of this date? This is a letter that explains the DRO process and the traditional process. A vet will get this even if he/she asks for a DRO review in his/her NOD.

    What procedure did the second VSO use to "change" to the traditional process? And why did this idiot do such a thing. Run from him/her quickly...

    You only submit a form 9 AFTER receiving a SOC. This is why I question the action you described in dealing with the 2nd VSO. What you need to do at this point is prepare and send a statement in support claim explaining that although the 2nd VSO somehow ? requested a traditional appeal it is your desire to resolve the issue at the RO, therefore, you request a DRO review with a DRO hearing at the local RO. Wait about 30 days and then call/use IRIS to verify that you have a DRO review pending.

    Ricky

  3. If it is 4 years old it will not provide you any benefit on a recently submitted claim. Exams etc.......that are over 1 year old will have to be redone in order to provide a picture of the current level of the disability.

    Now if your claim is four years old it could provide a picture of the level of the disability at the time of the claim which could help with the level of rating and the effective of that rating.

  4. What you are running into is what a lot of vets face in an appeal.

    They are going to standfast on the fact that the 07 exam only equated to a 30 percent rating.

    If you look at your IMO I bet it speaks in the present tense... big mistake. If you were thinking of an 07 award date for the 70 percent the IMO should have attacked the 07 exam and opined that this doc's opinion was that the 07 examiner was wrong as to the level of disability and it is his opinion that your current level of disability was present during the 07 exam......

    An IMO of this type for a mental disability is kind of hard to get. However, for a physical disability it is kind of easy.

    So when you gave them the IMO and it said he examined you and you suffered from x and x and x etc..... he was saying that as of the date he examined you (08) your level of disability was x which they agreed with and awarded you the 70 percent. So in laymen's terms you gave them what they needed to screw you. KEEP IN MIND they are the ones who have the almighty power of providing weight to a piece of evidence and if they say the 07 exam only warranted a 30 percent rating then that is it UNLESS you can get a doc to say the 07 examiner was wrong.

    We need to keep in mind that when dealing with appeals (NODs) and we submit new evidence during the process IT needs to address your condition as of the day you submitted your original claim......... if not then you give them wiggle room and when that happens they take it and run smiling all the way.

    During my appeal process each of my new IMO's began with or had somewhere in the body the statement "since Jan 04 the patient suffered from.......".

    Now you can surely keep the appeal process going for the eed but I see no way to win especially if the argument hinges on the interpertation of medical evidence as your interpertation means nothing to the VA and theirs is the golden rule. As I said above the only way to get around it is to have a doc attack the 07 report.......and on a mental condition it will hard to do. The reason is that in the rating game medical evidence on mental issues is so subjective and based solely on what the doc saw that day during the exam..... there are no MRI's, xrays etc.... to back up (rationale) the current doc's opinion

    Just my opinion........ Good luck with your efforts.

  5. The only effect on your SS or SSDI will be that your military retirement is taxed (treated as income) - therefore, depending on your total household income (if wife works) it could make some of your SS taxable.

    Outside of that it has no effect on your SS or SSDI at all.

  6. this section seems to indicate that loss of use, indicates that the veteran can not ambulate or walk even a few steps. The section later goes on to interpret the term "preclude locomotion". however local rating officals seem to prefer section 4.63 as the correct interpretation------whats your opinion ???????? I am not sure how to handle this,help

    Not sure what you are asking but looks like you are only reading part of the CFR. Your "ambulate or walk even a few steps equals do you require crutches or braces to walk or are in the need of a wheel chair. to preclude locomotion equals to preclude locomotion (walk) without the use of crutches, cane, brace or wheel. So it really means the same thing.

    Bottom line is they truly look at the remaining function of the limb and the need for assistance to walk witn cane, crutch, brace or wheel chair is the same as amputation.

  7. Does anyone know much about this? My question is that we bought a new vehicle which went smooth (I think).

    However, since I have loss of use of a hand and foot I am authorized some adaptive equipment. Already approved is AC/PS/PB/AT. Was the dealer supposed to take off the costs of these items?

    I am also attempting to get approved a few more things such as power seat, power windows (can't roll them babies down with one hand) etc using VA Form 10-1394. So can I just include those already approved along with the ones I want approved and have the VA reimburse me?

    Thanks

  8. TAO - I am not a doc but normally things such as dislocated shoulders are the result of injuries to the brachial plexus - therefore, it would reason that the rating officer determined from your medical evidence that you suffered from some type of brachial plexus injury which resulted in your constant state of shoulder dislocation.

    Talk it over with your doc and see which comes first - and what is the cause of your dislocated shoulder - is it due to an injury to the brachial plexus (which nerve within the plexus) or is there other causes inwhich the should is actually causing damage to the plexus..

    I would bet a dollar to a dime that the rater determined that the brachial plexus was the cause of your shoulder dislocation which is why they say the brachial plexus problem was included in the shoulder rating.

    As hoppy said you gonna have to dig into this one if you persue it.

  9. Reconsideration is used only at the Board of Veteran Appeals.

    You need to appeal. Anyone that has done claims know this. Also, no one can tell you how long a claim at the BVA will take. If one person had it take four months, that was that person. Your could take years depending on the circumstance (such as having a person appearence before a judge).

    etihwr - anytime you have received a decision from an RO and you have new medical information that was not reviewed during that decision you can ask for a reconsideration. As long as one keeps in mind that while the reconsideration is pending his/her appeal time line continues to run {concurrently}

  10. Here's an off the wall question. What if you have already adapted your house without the VA, but could benefit from a pool? My civilian doc told me that it would help me a lot to wade/swim in a pool. I have severe back and hip problems. I just had 2 surgeries on my back 3 weeks apart. I'm waiting for an increase in rating right now. I may have to apply for TDIU. My employer said that they understand that I can no longer do my job to the fullest and are willing to keep me on the payroll until I get the TDIU. I thought that was cool of them. I told them it would be in upwards of 1 year and they were still OK with it. These are some great people.

    Just a thought...

    I told them it would be in upwards of 1 year

    It will much longer than that my friend if you are working. Much longer as in never!!!!!!

    VA will not award TDIU to a vet who is working as this shows the vet can establish and maintain gainful employment.

  11. It is general in nature as it was meant to be. This allows a rater to weigh and interpt your medical evidence.

    with more or less constant abdominal distress I would say this is meant to weigh out as - if you have abdominal distress four out of seven days you meet the requirement (abdominal distress would equal pain/and or cramping) Now a VA rater may look at it as you have to have abdominal distress at least 5 out of 7 days to meet the requirement. Then another one may......... see it simply goes on and really depends on the views of the rater in a situation such as this. If you are looking at a firm definition of what it means you will not find it my friend.

    The key to success during your DRO hearing is you argue your definition of more or less and convince them. If you are having constant pain/and or cramping 4 out of 7 days you should be able to do this.

    Forgot to add: I would argue that my IBS was severe due to:

    How it affects your personal life style and work environment. Use such things as - have you ever used your pants and become embarrased at work or in front of your family or friends?

    Can't leave the work site for lunch cause you can not make it back without having to go - which could lead to the above example..............That you do more or less have pain/and or cramping as it occurs 4-5 days out of the week and when it occurs it is constant - and that you consider the requirement of the reg met as more or less is simply a guess meant to impress to the listener the etc........ this was just meant to give you an idea of where you need to look......

    Good luck with your appeal.

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