Objee

Cavamn, Here's some generics: Esomeprazole IPA (Nexium) is a proton pump inhibitor. (generic brand names for Nexium: Lucen; Esopral and Axagon) (I think Axagon is a foreign brand.) Ralph

Found this in researching for a vet claimant: BVA presumptive AO exposure on Okinawa in the 1970’s Citation NR: 9800877 Decision Date: 01/13/98 Archive Date: 01/21/98 DOCKET NO. 97-05 078 Now, thanks to the diligent Veteran in this case, AO exposure in an area other than Vietnam is ruled presumptive and service connected via proof of assignment, proof of AO in the area, and symptoms arising anytime in the claiming Veterans life! May open the door for you. Ralph

Special Medical Compensation (SMC) For an explanation of how the SMC category of compensation works, go to: www.warms.vba.va.gov/admin21/m21_1/mr/part4/subptii/ch02/ch02_sech.doc Note that virtually all the references for what is compensable and how/when to combine are based on standards listed in the Code of Federal Regulations or the United States Code. For an explanation of the additional 100% and 50% evaluations, see Item #41. The statutory requirements for Housebound (Schedule “S” – 60% Rule) are covered in Item #46. (Direct entitlement to Housebound is also covered in Item #46.) Although the reference contains a number of examples, it still leaves a huge number of disability combinations open for interpretation. A claimant will have to research the specifics of his/her situation very carefully. Following the logic of the examples given to interpret your unique case and finding the appropriate CFR/USC definitions will help you guide the RVSR into looking at your case the way you want done. There is general agreement that RVSRs and even DROs are confused by the SMC rating process, so there is ample room to guide their thinking along your lines IF you can provide logical documentation of CFR/USC permission. It’s still a crap shoot, but you at least get to shave the dice! :) Ralph

Suggestion on how to approach appeals..... You have the Decision Letter in hand and disagree with some or all of the decision. It's NOD time now. Check over the list of evidence in the Decision Letter. Compare that with the writeup (justification) for the decision the RO rendered. Is any important evidence ignored (not mentioned) in the writeup? If so, you'll need to bring it back into the NOD. I list it as "countering medical evidence" and go on to explain how it should have been included in the decision process. You may also want to strengthen ignored evidence with an IMO or other supplemental evidence. The point is: An appeal isn't a passive process. It can be driven by the claimant. Rememebr that a DRO review is de novo - it's a totally new look - see at the ENTIRE claim. The review effectively gives you a chance to refile the same claim you just had decided, strengthened with countering evidence that refutes the reasons for denial! Same with a Form 9 going to BVA. Hope this helps. Ralph

Army, this looks good to me. The other half of this method is to build a relationship with the physicians, NPs, whomever you need so that they are not only comfortable assisting you, but want to help you build your claim. This letter gives the authority and the relationship provides the desire. Ralph

Mark, my experience is the same as Cavman's. If I didn't have any receipt for my claims filing, I'd save the "processing letters" just to prove the VARO actually received my claim. Ralph

Windy, you're at 100%/50% thus: 100% - PTSD + 50% - FMS & foot. [40% + (100 - 40%)x10%. The (100 - 40%)x10% portion = 6%. 40% + 6% = 46%, Goes to 50%.] More VA Math: (44% would go back to 40%, 45% and up goes to 50%) The VA rates on "remaining well person" (RWP). e.g. - Say you're rated at 70% disabled. RWP would be 30%. More ratings would apply ONLY to the RWP. The basic 70% is the total rating foundation. Each additional rating builds on the RWP that's left until you hit 100% (if ever). Seems screwy, but there's a logic in there somewhere! :) Ralph

GOOD ADVICE!! Bear in mind that the BVA is staffed almost entirely with lawyers even though it isn't a formal court. The BVA is also your last chance to introduce new evidence for your claim into the system. The actual courts will only consider evidence already presented when they make their appellate decisions. At the BVA you are up against attorneys - professional law torquers. Don't go to a gunfight unarmed! Of course, the above only pertains if we keep the ability to employ lawyers after we get the Decision Letter!!!! Ralph

Windy - Be more specific. What SMC category are you asking about?? Ralph

Holli, if you're already at 100% TDIU or schedular it may not increase your $$$ right now. BUT if you've hit 100% you may then work toward 60% for different causes and gain an added SMC "S" rating (technically "housebound") and get another $295+/- monthly at some future time, so it isn't necessarily just an academic exercise. Ralph

John, I have no CHAMPVA experience, but their response sounds like a standard health insurer's response. I'm an old CLU (insurance) and a methodical program of pis-ing on them can ultimately work. I'd first ask how to obtain the codes THEY use and then get them. Back to the provider with the codes; provider rewrites the bill. Then, etc., etc., etc. Just like the VA. Never give up and make it plain that you aren't about to quit - you'll pursue this forever, until they pay. The squeaky wheel, and so forth. Ralph

Nathan, Looks good to me. The only other element he could have more stronglyaddressed is whether he thinks you would ever regain substiantial employabilty - the P&T issue. e.g. ". . .permanently and totally disabled . . . gainful employment, nor is he ever likely to regain employability . . . " Yeah, "permanent" means that, but the VBA needs a lot of reinforcement for any idea. Remember the old advice: "Tell them what you're going to tell them; then tell them; then tell them what you told them." Ralph

T-Bird, that's great work!! Terry, what you say is only reasonable. EVERYBODY - send me all your contributions to shrine building and I'll tell you when we have enough money to do Terry justice. I'll open an account with a resort in Fiji. :) Ralph

Betrayed, If the new evidence you submitted after you sent in the NOD pertained to the stuff you were protesting, it should have been considered by the DRO. If however, it expanded on your NOD complaint or actually introduced a new disability, what has happened in the past is that the new evidence either falls through the cracks or is treated as a new claim separate from the NOD. I can't find any direct guide to the DRO on how to treat this kind of situation, but clearly there is one somewhere. Ralph

The $10K is only free if you're totally disabled. If you're under age 65, premiums are then waived. If you qualify for that, you can then seek $20K more that you pay for. This is not "guaranteed issue" insurance, but actually subsidized for the actuarial rating you would get if you applied commercially. If you have serious NSC insurability problems, you could still be denied! Ralph (the old Chartered Life Underwriter)

VV, Chill out and welcome to Hadit! If you can give us more information about your situation, we may be able to give you much more direct advice. There's a lot of experience in this group and we're all "fambly", so pull up a chair and we'll shoot bulls until we get all the info needed to get you the max you're entitled to. Again, welcome fellow veteran! Ralph

Army, You don't have to simply passively accept the VBA approach to decisions. There is still a basic legal requirement (that the RO often likes to ignore in pursuit of their agenda.) You can call them to account simply by reintroducing stipulated evidence into your appeal or DRO review request and MAKING them acknowledge it exists and must be considered. If you detail the probative value and degree of probability with authority, you can change the results in the pre-appeal or appeal process! We're not simply spectators in the adjudication process unless we choose to be. We're PARTICIPANTS if we demand to be! In short, this ain't any spectator sport. We'd better be players in the whole process!! Ralph

M'lady, you're the best, but sometimes we get too involved in what we're doing and forget the basics. Forest for the trees. Even though the VBA rips the law and rapes due process, it can still be brought to a standstill with the proper approach. I'm learning more every day about how to "finess" the law through VA practices. I also don't intend to put up with their crap any more than you and the others here do! Hopefully, we're all MOUNT UP AND FOLLOW ME leaders! (And good followers, too!) Take care, keep 5, watch your 6 and God bless! Ralph

Mobie, The BVA is an intrinsic part of the VBA. It is a board, not a court. In between the Decision Letter and the Form 9 is the possibility of requesting a De Novo Review (a whole new "look-see" at your claim) from a DRO (Decision Review Officer) at your local VARO. Terry will say don't do it - go direct to BVA (with reason). Others will say use the DRO (also with reason). Your choice! Ralph

VV, First off, what is the status of your voice box cancer? In remission? Cured? You can claim for any condition, even if not listed, as long as you have a qualified medical opinion that it affects your ability to earn a meaningful living and is a secondary symptom of the primary SC ailment. Even though the Part IV may not list your specific problem, you can still submit it IF it makes medical sense as a symptom affecting your ability to gain and keep "meaningful employment." May or may not work, but worth doing; that's how new presumptive ailments get created!! Ralph

Berta, It's not just what is listed in the SOC but also what's listed in the evidence set forth in the original decision letter. I compare the two and bring any listed evidence I need that's omitted in the SOC back into the argument as "countering evidence". In my case, a favorable IMO was listed as evidence but ignored in the SOC writeup. I wrote it into the reconsideration request and the DRO bought the equipoise argument. Kept me from just getting an SSOC. Sometimes this may help swing the rating. Ralph

Tammy, it's also possible that VA wants to see whether SocSec classes your husband's back as a deformity or injury. If SS also calls the back a deformity, this would reinforce VA's evaluation. They could then play hardball with confidence. Ralph

Nathan, did they do a ROM before your last operation? If not, you can say that your ROM has decreased markedly. That should force a C&P to get a new ROM evaluation. Remember the clock's still running on your 1 year to file the BVA Form 9. A NOD tolls the BVA filing date but a reconsideration doesn't. Ralph

Berta, The analytical problem you're having is due to it being your and Rod's case. Were you to substitute "Joe" for Rod and "Gloria" for Berta, you'd have little problem structuring the process for this other vet's widow. Same reason a surgeon can't operate on a relative. Step back from the names involved and adjudicate this yourself as you would for any of the vets you regularly help. Hard to do, but necessary. You are, without question, the most capable member of this forum in accomplishing these types of tasks. The more directly a SC condition contributes to an 1151 death the stronger the probative element is. You have had success telling the RO & BVA what decisions they should render because you set your arguments forth in concrete. The important thing is that this enables you to define the argument. Were you to present your case in person, it'd be easier. But you're ex parte and have to do it in your briefs. Detach yourself emotionally (as much as you can) and do what you do so well. Best of luck!! Ralph

Never sign a blank authorization form! Ralph