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sixthscents

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Everything posted by sixthscents

  1. I have delt with this problem time and again in helping develop claims. The C&P examiner GAF's (Global Assessment of Functionality) the veteran at 70 or higher, but states they have PTSD, and then the VA slaps a 10% rating on it. What I do is ...immediately (within 7-10 days) file a NOD 2. Schedule an intake appointment with PACS, they will re GAF new patients, and their GAF is normally closer to realistic. (To ENSURE that PACS re-Gafs, go into emergency room, they have a psych doctor present at all times, and complain to him of your problems...anxiety, depression whatever they may be. Normally he looks up the C&P GAF and annotates that the veterans needs a NEW GAF upon intake to PACS.) 3. If you suffer from chronic pain, get a referral from your primary care to pain management....they also do a GAF on intake (people who suffer from depression have less beneficial effect from pain medications etc.) You can then use these 2 GAfs to counter the "arbitrary", and "lasse-fair" evalution you rceived from the oviousl "biased" and "uncommunicative" initial CP examiner. Further...dispute everythig the guy said in his C&P...thay often make Glaring mistakes and GLARING omissions that you can easily point out. Also, during you new gafs make sure you have your spouse/significant other or family member with you if possible to back you up and clairify your satements. This is really important. Further statements in support of claim from co-workers aout how you have chaned at work and how i has affectd your work haits are equally important. Remember the F in GAF is functionality. Statements which supporta decrease or marked change in functionalit directly affect the rating. *** sorry about the spelling...nw kyboar is driving me nuts ***
  2. My wife who had already completed her Bachelors, went thru Chap 35 for her Masters at the age of 36. I am unsure if there is a difference in requirements i.e. age of spouse vs. age of child. However, they paid for it, and they automatically selected the most advantageous date for her entitlement date. However, I am unsure if they will backpay for the member who asked about his childrens PAST bills. It would make sense if they did, but the VA seldom does. Hopefully though....
  3. Ricky, I guess an "I sympathize with you" isn't much huh? Yeah they should have rated you at least 90 days, probably the 180 days you mentioned, but 90 for sure. Yes, by what you state they also should be paying fairly significant residuals....and they absolutely should have provided a "statement of case" NOD the heck out of it...then NOD some more...I personally have had more success with the regional offices than the BVA, but that may be the route you want to take....personally I'd try to keep it at the regional out of spite and bury the RO in paper...demands for records...demands for c-file etc....supplement to NOD... I eventually got up to 170% (dont let anyone tell you there's nothing above 100%) schedular...thats after the body points etc., by doing just that, BUT I always provided a new objective test which further enhanced my claim, or anecdotal evidence, or something, so that they would have to pull my c-file again and thene go thru it again. I have been told not to file multiple claims (supposedly it "muddies the water")...Personally I think thats hogwash. You will end up filing, NODing, and appealing multiple claims in the end anyway, so I always filed when I felt I had sufficient objective evidence and a reasonable service-connection path. Just remember, look up what objective evidence is needed to prove you claim and know what the doctor is going to ask BEFORE the C&P...so first you can find the Clinicians Guide here: http://www.warms.vba.va.gov/21guides.html CFR 38 here: http://www.access.gpo.gov/cgi-bin/cfrassem...gi?title=199838 A decent guide to filing claims here: http://www.kfvn.com/ptsd/tablecontents.htm And a GREAT resource here: http://www.nvlsp.org/ You may already have all this, but I just bumped into the nvlsp site a couple of days ago. It was referenced in a guide, so I checked it out...it's phenomenal for advocacy and just good information. Hopefully at least SOME of this has been of help, you sound like you have done it all before so at this point you probably know most of what I said but it cant hurt huh? Also....stick it out, they are counting on you to quit. You quit, they win...it's really that simple. Dont give up, it took me years to get my rating to where it is...and I learned a lot along the way. Bob Smith
  4. OK, I've had time to consider your case, and I always tell the person I am advocating for what I would do in the same situation. Heck, I guess I kinda was...anyway here goes. I would file a NOD immediatly, Lets discuss the age issue first: Always reference CFR 38, 'k? And it says: TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS PART 4--SCHEDULE FOR RATING DISABILITIES--Table of Contents Subpart A--General Policy in Rating Sec. 4.19 Age in service-connected claims. Age may not be considered as a factor in evaluating service- connected disability; and unemployability, in service-connected claims, associated with advancing age or intercurrent disability, may not be used as a basis for a total disability rating. Age, as such, is a factor only in evaluations of disability not resulting from service, i.e., for the purposes of pension. [29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978] So..tell the Doc to get screwed...age is NOT a factor... Secondly about the temporary part: Again referncing CFR 38: TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS PART 4--SCHEDULE FOR RATING DISABILITIES--Table of Contents Subpart A--General Policy in Rating Sec. 4.13 Effect of change of diagnosis. The repercussion upon a current rating of service connection when change is made of a previously assigned diagnosis or etiology must be kept in mind. The aim should be the reconciliation and continuance of the diagnosis or etiology upon which service connection for the disability had been granted. The relevant principle enunciated in Sec. 4.125, entitled ``Diagnosis of mental disorders,'' should have careful attention in this connection. When any change in evaluation is to be made, the rating agency should assure itself that [[Page 337]] there has been an actual change in the conditions, for better or worse, and not merely a difference in thoroughness of the examination or in use of descriptive terms. This will not, of course, preclude the correction of erroneous ratings, nor will it preclude assignment of a rating in conformity with Sec. 4.7. [29 FR 6718, May 22, 1964, as amended at 61 FR 52700, Oct. 8, 1996] OK, so this says to ME that a rating can be applied and then changed if the condition improves or worsens...and this is backed up in several places...see total disability under CFR 38 again. SO...what does this all mean..well 1. File the NOD 2. Tell the psych Doc that age is NOT a factor, and that if she feels you have improved in 2 or 3 years..whatever...they can change the ruling...(they wont but they always can) 3. When the TDIU is approved NOD it for Total and Permanent..(hehe..that'll piss em off) ALSO:....just so you know..you do NOT have to meet the 40% for one disability 70% overall criteria...heres the skinny... TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS PART 4--SCHEDULE FOR RATING DISABILITIES--Table of Contents Subpart A--General Policy in Rating Sec. 4.16 Total disability ratings for compensation based on unemployability of the individual. (a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed [[Page 338]] the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. (Authority: 38 U.S.C. 501) (:( It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation and Pension Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service- connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue. [40 FR 42535, Sept. 15, 1975, as amended at 54 FR 4281, Jan. 30, 1989; 55 FR 31580, Aug. 3, 1990; 58 FR 39664, July 26, 1993; 61 FR 52700, Oct. 8, 1996] Now (:( is the important part....read it. So, you do not have to hit all the marks (though it'd be hard to get it pushed thru I'd bet it still could be done depending upon the case) Anyway there's my opinion based upon the VA's regs....anymore help and I'll be glad to provide it. Always NOD..make that your mantra...always NOD ...om mani padme ohm...always NOD etc etc etc... Bob Smith
  5. Oh, and the table and guidance for all rating calculations is here: http://frwebgate.access.gpo.gov/cgi-bin/ge...=1998&TYPE=TEXT Its a bit convoluted, but the table works both ways if you add the highest from the top to the side, or side to the top.... In your particular instance 40&+40% bilateral should be 84%, then with a 50% starting at the left side of the table at 84% and sliding across to 50% going down we see...92% and if we do the math ourselves...84% x 100 = 84 and 50% x 16 (the remaining health points) = 8 adding the point together is 84 + 8 which equals 92.... so it works. Bob
  6. Oh, to further clarify,... If a bilateral rating when combined and added was the largest rating then I would think that this ...(bilateral factor in this section will be treated as 1 disability for the purpose of arranging in order of severity and for all further combinations) So, if the bilateral factored injury is the most severe/largest, it is used first in the calculations for total percentage, then the next most severe etc etc.. Bob
  7. Subpart A--General Policy in Rating Sec. 4.26 Bilateral factor. When a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before proceeding with further combinations, or converting to degree of disability. The bilateral factor will be applied to such bilateral disabilities before other combinations are carried out and the rating for such disabilities including the bilateral factor in this section will be treated as 1 disability for the purpose of arranging in order of severity and for all further combinations. For example, with disabilities evaluated at 60 percent, 20 percent, 10 percent and 10 percent (the two 10's representing bilateral disabilities), the order of severity would be 60, 21 and 20. The 60 and 21 combine to 68 percent and the 68 and 20 to 74 percent, converted to 70 percent as the final degree of disability. (a) The use of the terms ``arms'' and ``legs'' is not intended to distinguish between the arm, forearm and hand, or the thigh, leg, and foot, but relates to the upper extremities and lower extremities as a whole. Thus with a compensable disability of the right thigh, for example, amputation, and one of the left foot, for example, pes planus, the bilateral factor applies, and similarly whenever there are compensable disabilities affecting use of paired extremities regardless of location or specified type of impairment. (:( The correct procedure when applying the bilateral factor to disabilities affecting both upper extremities and both lower extremities is to combine the ratings of the disabilities affecting the 4 extremities in the order of their individual severity and apply the bilateral factor by adding, not combining, 10 percent of the combined value thus attained. © The bilateral factor is not applicable unless there is partial disability of compensable degree in each of 2 paired extremities, or paired skeletal muscles. This comes stright from CFR 38 and can be found here... http://frwebgate.access.gpo.gov/cgi-bin/ge...=1998&TYPE=TEXT Also the index for this online version of CFR 38 can be found here: select book I or II, and it will take you to the index for that book http://www.access.gpo.gov/cgi-bin/cfrassem...gi?title=199838 Again..reference what we say.... So..as I understand it...a bilateral finding of 20% for each leg would result in a rating of 20%+20%, and then a 10% of this value combined. That being 10% of the bilateral value..or individual value...so this would amount to 42%..the important word being added, not combined so as to indicate only ONE of the two factors is multiplied by 10%, and then added to the combined rating. Now I have not had to deal with this factor...so if I am wrong PLEASE correct me, but this is how I interpret this....and of course there is the reference. Bob Smith
  8. 10thFO I got your message but when I tried to reply it wouldn't let me for some reason...who knows, but I'll research you question here and try to come up with some answers...as well as any others you have posted recently. Bob Smith
  9. OK, I actually read your whole post so I understand a bit better.....heres a couple of things that may apply (3) Additional independent 50 percent disabilities. In addition to the statutory rates payable under 38 U.S.C. 1114(l) through (n) and the intermediate or next higher rate provisions outlined above, additional single permanent disability or combinations of permanent disabilities independently ratable at 50 percent or more will afford entitlement to the next higher intermediate rate or if already entitled to an intermediate rate to the next higher statutory rate under 38 U.S.C. 1114, but not above the (o) rate. In the application of this subparagraph the disability or disabilities independently ratable at 50 percent or more must be separate and distinct and involve different anatomical segments or bodily systems from the conditions establishing entitlement under 38 U.S.C. 1114(l) through (n) or the intermediate rate provisions outlined above. The graduated ratings for arrested tuberculosis will not be utilized in this connection, but the permanent residuals of tuberculosis may be utilized. Also... (5) Three extremities. Anatomical loss or loss of use, or a combination of anatomical loss and loss of use, of three extremities shall entitle a veteran to the next higher rate without regard to whether that rate is a statutory rate or an intermediate rate. The maximum monthly payment under this provision may not exceed the amount stated in 38 U.S.C. 1114(p). Also... (i) Total plus 60 percent, or housebound; 38 U.S.C. 1114(s). The special monthly compensation provided by 38 U.S.C. 1114(s) is payable where the veteran has a single service-connected disability rated as 100 percent and: (1) Has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) Is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. Since you are seeking 60% I guess you already understand this...also If you are recieving SMC at say L and you have another injury that would qualify you for L or higher as well...you go to O...ok? It's a bit convoluted, but read thru it all and it kinda starts to make sense....from what I see you have if they determine that you have loss of use of that arm or hand then you should be entitled to the next higgher rate at least.... Bob Smith
  10. http://www.vba.va.gov/bln/21/Benefits/ Go here and click on the link under Aid and Attendance Allowance CFR 38 3.350. This outlines exactly what each SMC rating requires. You can have loss of use of both feet/lower limbs and still qualify for a higher rating than L depending upon your other disabilities. Also Housebound is a factor perhaps dependent upon your particular situation. The regulation is pretty clear so read it, and if you still have a question give a yell. Also, the loss of use of both feet/lower limbs is considered the same as amputation of both limbs at that level, and compensated accordingly. As stated, it is not 2 ratings of K, but a bump up to L. The compensation rate tables are located here: http://www.vba.va.gov/bln/21/Rates/comp02.htm So you can see what you are supposed to get based upon your level. Bob Smith
  11. Berta...HEY!!! HeHe...they gave me the higher rate SMC L...but this is supposedly the aid and attendance rate...like I said I need to check into this a bit more since it seems I should....should qualify for both but according to the VA 1-800 person, I am being paid at the Aid and attendance rate. I need to read up on this since it doesn't seem to jive somehow. I was awareded the SMC, but the rating decison made no mention of aid and attendance....go figure. Also, is this supposed to pay for someone to actually aid and attend...I mean it pays for a housecleaner 4 times a week and a guy to mow my lawn, but that's about it.... Like I siad I need to read up on it in CFR 38...something seems incorrect. I really think that Hadit is the best source for the idea of forming an advocacy volunteer...or, I could establish a new site with ties (a big bold link etc.) to Hadit..if permissable, and we could work from there. This is in the formative stages so any suggestions are welcome, as well as volunteers. Someone voiced the concern that it would take too much time, and they were very wise in stating that...BUT...each advocate would only handle as many cases as they think they could...period. We all have lives outside of this. Even someone just handleing 1 case per quarter, or even 1 per year would help 1 person more than is being helped now... This is NOT a solicitation for money, and I will not do so. If you need to send money, send it to Hadit....they deserve the support and the cost of running something as large at this are exponential.. I will fund this out of my money, since it is my idea. They should be modest, since we will be using the site just to communicate, shift cases etc. Anyway...chime in, if you would be willing and feel competent to help file a claim. (Honestly any help is better than none, and all you have to do is email one of us who has some experience...we can walk you thru the steps) However, this is a commitment to that claim and that person from beginning to end. Even one case can take a large amount of time, depending upon it's complexity. Please email me here sixthscents@hotmail.com if you think you would be willing to volunteer.... I need state of residence and an idea of how well versed you are in the claims process and different programs...again we can work with someone who is fairly new as long as they are willing to ask for help. Also...any suggestions (besides me using spell check...I do on all paperwork I assure you) Bob Smith
  12. Hey All, I just wanted to check in and say hey to all of you. I am still alive and still busy with volunteer claims, it seems that they keep coming out of the woodwork. I wanted to speak to you all about my claim form start to finish (briefly), and some ideas that I have had concerning volunteer advocacy. I started my claim actually prior to discharge in 2002. I didn't know Hadit existed at the time, so thru the magic of the internet I discovered CFR38. Yes it reads like programming your VCR, but I had nothing but time so read it I did. My initial rating from the VA was a wopping 40% (it may have been 20%, I cant really remember, but it was low). I NOD'd that immediately and began what has been a 4 year quest. By 2004 I was 100% TDIU P&T. As of 4 months ago I hit 170% schedular with a single rating of 100% for loss of use of lower legs/and feet. Then came the adaptive vehicle grant. Then came the vehicle adaptation(hand controls) and the additional payment for automatic transmission etc. Then the adaptive housing grant (now under remodel - we purchased a new single story home and had the VA guy come out...really nice person) Then came Voc Rehab - Independent Living Services and a whole bunch of stuff like a lifting recliner, a new computer, it just kinda goes on and on here. Then came Rehab thru the VA health, and their stuff. Then came HISA grant (also in construction on new house) Oh, and clothing allowance was in their early on. Let's see...oh Chapter 35 paid for wife's Master degree ChampVA came in with the 100% TDIU T&P - plus I pay for a supplemental plan Huh...did I miss anything? Oh state benefits.... No property taxes - in Tennessee No vehicle tag cost or wheel tax (Tennessee) Permanent Hunting/Trapping/Fishing killing pretty much anything permanent license for one time $10 fee. Oh, additional pay for loss of use of both legs....supposedly at the Aid and Attendance rate...but I'm going to delve a bit deeper into that. So...there I am so far...now I started this claim and got to 100%TDIU/70% schedular without the help of the great people here on Hadit....but almost ALL of the following was directly due to advice/reserch and information provided to me by others here on Hadit directing me WHERE to look in CFR 38, and what test were required, what had to be proved etc. So......THANK YOU. Thank you all so very much. I cannot express really how much I appreciate all the work that all of you here have done and continue to do. Yet while thanking you is appropriate, I owe somewhat more. I have an obligation to help others in the same way that you all helped me. Working with veterans in filing their claims, going thru the NOD's and appeals...filing for the seperate benefits. I owe that. So, I am doing that. Currently my case load has balloned to the point where its taking up a LARGE portion of my day, but honestly what else do I have to do? It's productive and lets me pay back the service done me. I discovered that the average veteran has no idea what they are entitled to, what they have been rated etc. I am currently workin with a Vitnam veteran (awarded two purple hearts, the broze star with v device) who lost half his foot to a mortar shell, and for 34 years NEVER filed for compensation and was NEVER paid any. He received medical care as catagory 5 - can you believe it? He was paying a co-pay on his drugs for his service connected injury...... I am handeling about 25 active claims and about 15 or so pop-tarts (people who appear and then disappear...we all know some vets are a bit flakey around the edges)...Thats about all I can do...but heres where I started thinking... Currently I am handling claims from Ohio, Illinois, Indiana, Kansas, Florida...all over the place plus local ones. I am working as a "veterans advocate"...I guess thats the legal term. Anyway heres kinda what I was thinking...why cant we form a network of people in each state who are willing to assist in the filing of these claims, but commited to see them thru to the end. Don't get me wrong, but it just makes sense that a veteran who is dealing with a regional office will have a better grasp on how they handle specific situations better than I would. Now we know its all supposed to be the same, but the reality is each regional office seems to have its own way of doing thing, or at least that is my impression. Plus, a local, or just regional advocate would be much more knowlagable about the specific state benefits and programs. So, I propose that like minded volunteers, using Hadit as their conduit for communication in asking each other for advice as pertaining to specific claims (ie.e I am VERY good at IVDS stuff since most of my claim hinged upon it). Of course we would NEVER post specific names, locations, or ANY personal information about the cases except the specifics which pertain to the claim. Such as John Doe served...Jane Doe was...etc. I request that if we can find a reasonable amount of people willing to participate in such a network that we request that Hadit B) form a seperate forum section just for the advocacy network, but it would still be a good source of information as veterans could actually see some of the claims progress, and we could identify the claims with a number such as IL-321, for Illinois claim 321, and submit notes about what was being done, and where the claim was, if it was of particular interest. Also, (I have mentioned this before)..since each states benefits differ perhaps a forum that discusses each seperate state, and their benefits might be a nice idea. OK...I know I just umped into the deep end here, but essentially many of you are already peforming as advocates here on Hadit, but it would allow for a more personal, and I believe effective way of assisting those in true need of help. Again, its already been done, for me, by people here over the past 3 odd years. It's just a more organized approach where we can focus our strengths (i.e. the differeng knowlege of certain types of cliams), and actually help people in our own community...at the same time using the Hadit community's vast repository of knowlege to help us do so in an organized manner. Again Hadit as a whole is jus a huge veteran advocate knowlege base...but this would actually entail helping people prepare NOD's, and helping them file appeals, and even filing their original claims correctly. Would we in fact be doing a job supposedly done by the VA, and state VA reps as well as Service Organizations....sure and at NO pay whatsoever. But consider that the DAV is the only Service Rep (VSO) that reuires even a minimum of understanding and training prior to putting these people into place filing claims, and the State reps are almost antagonistic in the manner (from my experience) and the VA is so very unhelpful in filing claims....well its honestly a needed service and one that I think the people on Hadit are more than qualified to perform...plus we already have an established knowlege base here if we dont know an answer. Most claims I deal with were filed either completely incorrectly from the start, and are a huge mess, or were never filed, or were filed by 5 different people at 5 different times for a myriad of things, etc etc etc. I just think that we can do it better....well I am certain that we can, but it will take an honest commitment so that if Bill in Texas gets a referral from a Veteran in Illinois, he could refer that vet to the advocate in Illinois, or the region of Illinois. Am I making any sense here? Maybe this is just a drem....but, I think that its what a great many people on Hadit are already doing behind the scenes. Thats it for now....email me at sixthscents@hotmail.com if you all have any ideas comments you want to keep private, otherwise tell me I am a fool here if you want, or make any suggestion you or idea you might have. Thanks...Bob Smith
  13. Berta, I and you go back a way, and I know your situation. The friggin VA has been malicious, criminally incompetent, and intentionally obtuse during the whole process. Stick with it girl...we are here, and a lot of us support you. Bob Smith
  14. First, before I start this whole thing I'd like to say that today in a decision dated 29 December 2006, in a claim started 15 Nov 2002, I finally received a 100% Permanent evaluation for my spinal chord injury. While I was previously had a combined rating 90% TDIU P&T, It gives me a great feeling of satisfaction to finally see a 100% rating for my initial injury. At this point with the one rating of 100%, I am over the magical 160%, so with some study I think that a claim for housebound might be appropriate. We’ll see, like I said I have to study CFR 38 and see what really is the criteria. In the past 4 years that’s one of the most important lessons I have learned. While a great many people on this board have a large amount of knowledge, I ALWAYS go back to the CFR 38 myself. Each time I discover something I didn’t know, but since the thing reads like an instruction sheet on how to program your VCR it can be a challenge. I've learned a great deal in the last few years about how the VA works and almost as importantly WHY they put a claimant thru some of the procedures they do. Specifically I have learned about back injuries and the VA rating/determination process. Now...we all know that the VA is going to lose your records numerous times (4 for me), and you will have to patiently explain the same disorder and symptoms each visit to the VA since they change doctors more often than I change toilet paper rolls, but...the claims process...if handled by a competent rater actually makes some sense, and the tests they require to establish injury are no different than that which a civilian Neurosurgeon would normally require prior to making a competent diagnosis. The First hallmark test for the VA in any back injury, or really even in any muscle/bone claim is a simple X-Ray. This may be done with flexion or extension of the joint to see how everything is lined up. In the case of a back, the doctor is looking for irregular spacing and either a twisting of the vertebra (like twisting a towel...the vertebra twist often in some patients) or a large curvature of the spine either inward or outward. Of course the curvature is Scoliosis, and the twisting is (forgive my spelling) Spondilothysis...sorry me and medical terms don’t spell well together. Ok so a simple X-Ray will show obvious problems like these...if they don’t and the patient still has symptology consistent with a back or spine injury the next Hallmark test is an MRI. Now, the thing about MRI's and back injuries is that they are not consistent. A person with what appears to be a completely normal MRI can have MAJOR problems/symptoms while someone with a terrible MRI complains of no problems whatsoever. Yet the VA insists on using this as THE hallmark examination to establish injury for several reasons. The alternative, a Myleogram is very invasive and costs quite a bit more. The civilian sector uses the MRI as ITS hallmark, most Orthopedic or Neurologists relying upon them to show whether there actually is some problems. My first treating Neurologist was a civilian (I was on Tricare-Remote), and that’s exactly the path he followed. Now, since I told him I wanted a conservative treatment plan, with surgery as a matter of last choice I entered into the whole physical therapy, steroid injection regime. I note this because in most cases that I have discussed with VA patients, that is normally the course the VA follows. It just makes money sense, as well as trying all the least invasive techniques first. Often, if the treatment still fails to provide relief the next thing a VA doctor or Civilian practitioner will do is order an EMG. Now this is a test which examines both the nerve function as well as the sensory aspects. Basically they first shock you…literally they stick a taser like deal against your skin and put a lead at another point and BAM, they jolt you. Then they insert a needle at the top of the nerve area (in different locations) and then place another a certain distance along the nerve path. Heres the deal…that kinda hurts, and if its testing both limbs it can go on for quit a bit. Its not as bad as a spinal steroid shot, but worse than a normal shot, and its repeated and the Doctors all seem to dig around quit a bit. The positive thing about an EMG is that its almost certain to show something if there is an impingement of the spinal chord, or even more serious things such as Multiple Sclerosis. It’s a definite “case maker”, if the test corroborates your symptoms and complaints, the VA claims raters can and will rate you based upon the symptoms shown and the results of an EMG. Nothing is perfect but a patient cannot “fake” an EMG. So it’s a very conclusive test for the VA for rating purposes. It is because of the nature an “objective” nature of the test, that almost anyone claiming Radiculapathy, or Neuropathy (shooting pain down a limb, or constant pain and numbness as well as possible tingling in the feet or hands, or partial or complete paralysis of a motor function) will get it ordered by the rater. A rater looks at both the subjective material, such as the patients statements i.e. descriptions of numbness or loss of feeling, loss of control or inability to move the feet or hand in a certain fashion. The doctors physical evaluation considering the range of motion with and without pain, as well as the other physical tests which can be open to interpretation. The rater then looks at the objective test, such as absent or diminished deep tendon reflex’s like ankle jerk or knee jerk etc. This is a significant symptom because it cannot be “faked”, either the doctor hits your knee and it kicks, or he pounds all day (I had one try for almost 4 minutes) and it doesn’t. Other “objective” tests which cannot be skewed are the EMG, and MRIs and Myleogram. The myleogram is probably the very last test the VA doctor will recommend, and the rating board wouldn’t normally require it because it is very invasive. They inject a small amount of dye into the spinal cavity. All I have to say is that I have had 5 of these and they hurt…a lot. They are VERY good a showing or comparing the function of different nerves. On a myleogram, the nerves actually glow and can be seen because of the dye. The left and right nerves mirror each other so if the nerves corresponding to your complaint and symptoms is darker than the one opposite it, well that pretty conclusive that something is going on. Again, a rater would normally NEVER ask for this test as its expensive, invasive, and still open to interpretation. By far, for the claims that I have dealt with, mine and others, the VA’s most ordered test for rating purposes is the EMG. It invasive but normally well tolerated. Its inexpensive when compared to an MRI or a Myleogram as well. Plus its very objective when compared to the other tests, and properly administered and evaluated. Even the best sometimes fail though, so if you’ve had an MRI and an EMG and have seen nothing to explain your pain, maybe a Myleogram is in order. A rater takes all this into consideration when rating a decision so some things you might want to do even prior to submitting the claim is to ask for an EMG test. Also you might want to consider going off some meds prior to taking it. There is a danger here and a person should at least read up on what might happen if they just suddenly stop taking a medication. Yet these very medications can often disguise the symptoms you are experiencing. I know, it’s a catch-22. I just know that I taper off my neurontin and my pain meds prior to taking any exam….please note I said taper. This does not include meds for other disorders like you heart etc. Jeez don’t go having a heart attack because I said this. JUST the meds that are for the illness or injury you are claiming. Even than consult a private physician or look up the drug an see what discontinuing it might cause. Now some people will say that by stating this I am telling people to lie, and that is simply NOT the case. However you are being rated upon your injury and if the medications you are taking “soften” the side-effects of your injury, it would seem obvious that you’d want the Doctor to be able to see the whole picture, as well as the rater. That’s only fair. Please again, be careful if you do decide to taper off a med prior to taking some test like the EMG. Going off a medication drastically can have some wicked and possibly life threatening consequences. Just make sure you can go off the med, then taper it off. Once the test is completed you can continue it again, slowly at first obviously for the same reasons as not quitting all at once. Again…I AM NOT TELLING ANYONE TO LIE. I just believe that if I am to be tested and rated for a condition, the VA and rater need to see how the condition affects my normal funcionality, without any pain meds etc. OK…that’s it for this installment. Next I am going to talk about filing for the adaptive vehicle grant and the adaptive housing grant. These are two little known programs that mean big money to a qualifying veteran. (I just had them pay $11K on my new vehicle) Bob Smith
  15. OK, I want to share a success story I suppose and also remind others about these programs. Starting with the adaptive vehicle grant. This is a grant for persons suffering from the loss of use of one foot or leg, and other stipulations. The most up-to-date info page I could find was here: http://www.vba.va.gov/ro/hartford/CandP/Autogrants /AutomotiveGrants.htm The basic entitlement amount has been increased to $11,000, and can be used to purchase any type of vehicle. Basically you file the form requesting the entitlement, and then the VA loses it for 2 months then you resubmit it and they take 90 days to process it, so its about a six month ordeal. However, they cut a $11K check toward my new Lincoln, so it was definatly worth the paperwork. This DOES NOT include the money required to adapt the vehicle for driving, just the purchase. The adaptation equipment is fully paid for by the VA, after you are evaluated to determine what equipment you need. Things like lifts, hand controls, etc. You can have 2 vehicles adapted, and there are further stipulations but its obviously worthwhile to a vet who has a disability including the foot or leg or legs. Also, the INDEPENDENT LIVING SERVICES people can help with more funds if necessary to purchase the proper vehicle. They are under Vocational Rehabilitation. Ok, so now we go to the Adaptive Housing Grants. The are several different types here, but I will only mention the three most common. First, again the Independent Living Services people can and do perform renovations to your home. I am unaware of any limit of expenses, however they come out and evaluate your home and decide what you need. This can be anything from side to side door refigerators (far easier for someone in a wheel chair to use) to front loading washers and driers as well as adaptations to bathrooms etc. Whatever they determine you need to live independent of any help. This in not all this program offers, but thats the housing stuff. Second there is the $50,000 adaptive housing grant. To qualify you must meet certain citeria which is detailed here: http://www.vba.va.gov/ro/manchester/lgymai...ptedhousing.htm This site also details the third adaptive housing program of $10,000 for blind veterans. Also, the physical therapy/amputee-orto people have some funds for small adaptations like ramps and such. I believe the limit is $2,400 for vets with a rating over %50, and $1,200 for pensioners. These numbers may be incorrect as I havent looked at the program in a long time. The significant thing here is that the 50K can go toward the PURCHASE of a new home as well as renovation of an exsisting one. Now thats a NICE down payment huh? I am unaware of any restrictions placed upon the adaptive grants i.e. what can be done, except that the renovations must be done by a licensed contractor and not your brother (unless hes a licensed contractor). For more information call: 1-888-768-2132 and aske to be transferred to Phil White. Again as an aside....I just received entitlement to the grant, and we are going to use it on a house we are closing on this week. I could have put it to purchase price, but then I would have had to finance the renovations so, it just made sense to do it this way. Anyway...these programs are out there, and the VA seems to never mention them, so YOU have to see if you fit the qualifying criteria and then file the appropriate forms. Expect the VA to lose them, deny you sent them, etc. but stick to it and in 4-6 months you WILL get approved if you qualify. Theres is a great deal of info on the VA's website about these grants but you have to search for it. Again, its almost like they dont want anyone to be aware they exist. Anyway, if you have any questions get back with me. Bob Smith
  16. Is there anything in ANY exam civilian,military or VA that would suggest Meniere's Syndrom? This is a rateable condition under CFR 38. Up to 30% in worse cases. I would certainly see if there was anything that indicated that. The VA is natorious for under-rating hearing loss, so I was not really suprised with the problem you face. I am sorry, but the rating tables mean you pretty much have to be deaf to get any real compensation. However, you may want to revisit the Tinnitus claim. Under the new change you can be rated 20% for bilateral tinnitus. That is, if you have ringing in BOTH ears, then you receive a rating for both. Perhaps somewhere you have compained about BOTH ears, and this under the new change is enough to request a reexaminati0on of the claim. You can also reopen the claim with just the statement that you are now experiencing ringing in both ears, if that is the case. Meniere's Syndrom causes the side effects you seem to be suffering from. You might want to visit a private audiologist, or physician and have them specifically test for this condition. Then, if it does exsist you can open a NEW claim, for it also filing for the secondary effects of the syndrom etc. The dizzyness and other symptoms could be reason for individual unemployability depending upon your situation etc. Check your records and get back, OK?
  17. Not to be obtuse but have you looked at your entrance and exit physical? If there is any loss of hearing, then a reasonable claim for service connected Tinnitus can be made. The VA will drag you through an audiology C&P exam, but they cannot really prove or disprove the existance of Tinnitus. IMPORTANT! If you plan on pursuing this claim, you MUST file a Notice of Disagreement within 60 days of receipt of rating decision. This should be very clear in that you disagree with the decision, and plan on submitting further material evidence in support of your claim in the following year. IF YOU DONT....the VA will close the claim and then it will take a formal appeal (2-5 years in some cases) to reopen and rexamine it without substantial NEW evidence. Perhaps you do not have you entrance and exit physicals? If not go to the NARA website and request them as well as record of service ect. These records can give you documents such as: AER's, awards, disciplineary action etc., which could give you names to follow up on. I will state from the get go that I am 100% behind you on this claim, but the Agent Orange link will be difficult. There are a LOT of Guam veterans who are suffering from exposure, and the VA is denying their claims with actual pictures of the defoliant storage area, and numerous statements, as well as extensive testing of ground water. It's a hige can of worms thatthey simply want to stay shut. When you file your NOD make sure you send it certified mail, so you can show that it was sent and the date. Sorry if some of this is basic and you already know it, but the steps to making a valid VA claim are pretty similar under Agent Orange, Tinnitus etc. Bob Smith
  18. I have had some difficulty with ChampVA billing thru labs....Somehow they always file it first under TriCare which gets denied, then thru ChampVa, but under (for my child) the mothers name as sponsor...again generating a rejection for "improper relationship"...third time was a charm though, and you can sign up to review your claims etc. at My ChapVa website.
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