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Hoppy

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About Hoppy

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  1. Bronco and Buck Thanks for responding. The nuts and bolts of this benefit is what I am trying to understand. The nursing homes don't always speak the same language as the VA. Once I get it all translated it should be good insights for anyone who is 70% and getting old like me. I didn't see Fridays post. Re learning the site. SMC has not been a past consideration and is not currently. I am at risk for a stroke and I see stroke survivors every day here. I am trying to decided if I should keep my boat or not. If I run out of money or VA benefits. I will wind up in a state home for veterans. This place I am in is really nice. However, when you get to what they call "assisted living" it gets real expensive. A friend of mine told me his father was retired Marine Corp. and retired CA PERS and 60% service connected. He was told that he had used all available benefits from retirement plans and he would need to pay his continued hospice care out of pocket. They told him if he was 70% service connected the VA would pick up the hospice care. Unfortunately, he was only 60% and by the time he could process a claim for an upgrade he would be dead. Hearing this I decided to google “70% service connected in nursing home”. Point being, it appears there would be information available somewhere that specifically address’s what benefit is available to 70% service connected veterans that is different than aid and attendance since anyone is eligible for aid and attendance with a lower rating than 70% or no ratable service connected disability. Just yesterday I found the IRIS statement regarding 70% service connected being eligible for coverage fore "any condition" I will check out the info that Bronco posted and the asknod Buck posted. I want to get a table of payments the VA allows for specific services provided as defined by aid and attendance and up the later for skilled nursing and even hospice care then compare it to the actual costs MY FACILITY charges.
  2. T-bird—Thanks for your comments. Your mention of SMC gave me a new area to research. Before I was only searching “aid and attendance” The result I was getting involved the improved pension for veterans who did not have a service connected disability. I am still finding what appears to me to be conflicting eligibility requirements . This is what I found of significance. Shown below ---The VA iris site makes a reference to eligibility based on ANY CONDITION. However when I search BVA decisions for SMC the only decisions I find say DUE TO SERVICE CONNECTED DISABILITY. Any and all concerned-----If I am 70%+ for a service connected condition do I have benefits under SMC or is there something else. I doubt that I will need nursing home care for my service connected vascular disease. I am trying to plan future financial resources in the event I have a stroke. I am going to forward this post to my service org. on Monday. Unfortunately, the guy who got me 100% departed this earth many years ago. I just went over 20 years as 100% P&T. We will hear what they have to say in the future. From IRIS VA.GOV VA benefits provide for a range of long-term services which include, Nursing Home…….. a veteran must be in need of such care and seeking nursing home care for a service-connected (SC) disability, OR is rated 60% SC and unemployable, OR is rated 60% SC and permanently and totally disabled (P&T) OR for any condition if the veteran has a combined SC disability rating of 70% or more……. Veterans with a compensable service-connected disability are exempt from long term care co-payments. ……. From BVA decisions SMC at the "l" rate is payable when the Veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b).
  3. I have been away from hadit for quite some time. I was dealing with several health issues that made it hard for me to keep the intensity needed to deal with the insanity produced by the VBA. Recently, I decided to move into a retirement home. They have independent living, assisted living, skilled nursing, memory care, respite and hospice all in this facility. I am currently independent living. I am trying to plan my finances based on what benefits I can expect from the VA for nursing home care. Right now I have permanent balance and fatigue issues. I have been reading about aid and attendance and the fact that veterans with a 70%+ service connected rating have benefits. A lot is unclear to me. I am seeking information on whether or not additional benefits other than aid and attendance are available to me being 70%+ service connected and what medical issues are required before these benefits kick in. Any comments or direction to information would be helpful. I have talked to a lot of people including a VA social worker and still do not have anything concrete to use for decision making.
  4. Berta, The service officer I got for the veteran is really into this claim and has already started to push the TDIU issue. There are some potential CUE issues. However, it is very complex. I am really not up on CUE's. I have worked mostly on developing medical evidence and rebutting false objective standards of law. A term and set of circumstances I learned from a lawyer I worked with on Workman's comp. RO adjudicators are really good at inventing arguments to deny a claim that have no, legal foundation. The original denial in 2004 had no foundation in the law. The reasons they gave for impeaching the buddy letter were based on criteria that is a false objective standard of law. As a result of the impeachment of the buddy letter the claim was not developed and there was no C&P and no specific diagnosis of PTSD until 2008. Because of the 2004 denial the veteran gave up. He did not get a medical opinion linking his PTSD to service until 2008. This diagnosis came from a treating clinician. I did not get involved until 2011. I immediately research the doctor who wrote the report in 2008 and found out he was a department head and he performed C&P exams The notes he put in the treatment records were very detailed and covered all the bases, That is when we reopened the claim. The DRO hearing I am talking about was in 2014 after we reopened the claim. When the claim was awarded the claim date was the 2011 re-opening. Thus, any mistake the DRO made is mute because the veteran is getting retro back to 2011. The original denial by the DRO was based on false objective standards of law and the DRO rebutted a medical opinion with his own opinion. When he saw the letter I wrote in response to his denial he immediately trashed his own decision, scheduled a personal hearing and actually admitted to the SO I got for the veteran that he blew it. In 2014 I think we talked about a way to get a 930 review or some other way of getting another decision immediately. The DRO denial made absolutely no sense. The letter I wrote worked and we were back on track real quick. Then the VA went into slowmo. It took another 15 months to get a C&P and the award. I sure would like to get it CUED back to 2004. However, I think the lack of a diagnosis until 2008 is a roadblock. I have not seen the award letter. I am sure they figured out some way to blow smoke over the issue of the illegal impeachment of the buddy letter in 2004.
  5. broncovet, Keep pointing out their mistakes. That worked in the case of this veteran.
  6. I have been away from hadit due to my own physical problems and other priorities. However, I have continued to assist a friend of the family with a claim since 2011. He received a decision today. I wrote a brief history and posted it in Success Stories. I will not be spending much time on hadit during the next year. I have been pre-occupied with getting my life back together after being flat on my back for a year due to a medical condition. I deal with a lot of physical pain. However, I am in good spirits and I am optimistic about getting back on hadit when I get things worked out.
  7. Persistence combined with happenstance wins another claim. The veteran originally filed for PTSD in 2002. He had been “addicted” to psychotropic drugs since 1995 and was getting them from the VA. In 2002 he is seeing a marriage counselor with his wife (her idea). The counselor tells the veteran he has PTSD. He goes to the VA and they tell him he needs a “buddy letter”. He gets the letter and files a claim. The claim is denied because they say they could not corroborate the buddy letter with any other evidence in the file. They said the file was silent for any reference to an assault. There is no legal basis to impeach a buddy letter due to lack of corroboration. They need to show inconsistencies and other flaws to impeach a buddy letter. The veteran gives up on the claim. He is still ‘addicted” to psychotropic drugs and continues to get his drugs from the VA. He goes to an appointment to get this prescription refilled and the doctor wants to know what the problem is and why he takes these drugs. He tells the doctor his wife’s therapist told him he had PTSD. The doctor gets all the details as explained in the veteran’s buddy letter and says that the PTSD was “as likely as not” caused by the event described by the witness”. However, the veteran had already given up on the claim and does nothing. Three years later I am talking with him and he shows me the letter. By the way this is not a veteran who I had been helping with a claim. He was a friend of the family. At a party he told me about this denied claim. I told him to bring me a copy of the decision. This happens five years after the denial and three years after the doctor made the diagnosis of PTSD. I read the evidence and told him, “let's get this reopened”. The buddy letter was written by an officer in the USN. A DRO dismisses everything saying that the event in the buddy letter was not an assault. As it turns out the event described in the buddy letter could have gotten the perpetrator three years in Leavenworth. The argument is advanced that it is not a question of whether the DRO thinks it is an assault or not. It is a question as to whether or not the event is considered a PTSD stressor by a medical professional. I point out that it had already been determined by a medical professional and cite the existing doctors report. The DRO reads the response to his denial and realizes he screwed up. Maybe he did not read the doctors letter saying it was a PTSD stressor. He immediately reschedules another personal hearing. The officer who wrote the buddy letter is furious that they impeached his original statement and shows up at the DRO hearing. He had recently retired as a Commanding Officer of a unit about 80 miles from where the DRO hearing was being held. The DRO is now surrounded by evidence he can’t refute and awards the claim. The veteran calls me today and tells me he was service connected at 70% for PTSD. It took 13 years for the veteran to get a proper decision. During that 13 year period he was a dumpster diver living on $300.00 a month.
  8. After being gone for several years I expected there would be those who I knew here on hadit who had passed on. I remember carlie as being very concerned about people getting accurate information on the claims process. RIP carlie.
  9. Is IVDS an issue on your back claim. If so keep reading. Also see Citation Nr: 1536438 Decision Date: 08/26/15 Archive Date: 09/04/15 DOCKET NO. 09-19 478 The following information has been on my computer for many years. I think it still applies. From a VA training manual 1. How is IVDS rated? a. IVDS that is primarily disabling because of periods of acute symptoms that require bed rest according to the cumulative amount of time over the course of a year that the patient is incapacitated, i.e., requires bed rest and treatment by a physician, is evaluated at 60 percent if there are incapacitating episodes of at least six weeks total duration during the past 12 months; at 40 percent if there are incapacitating episodes of at least four but less than six weeks total duration during the past 12 months; at 20 percent if there are incapacitating episodes of at least two but less than four weeks total duration during the past 12 months; and at 10 percent if there are incapacitating episodes of at least one but less than two weeks total duration during the past 12 months. Many years ago I did a lot of research on the bed rest issue and found very little. I do all my research by reading BVA cases. WARMS will not tell you how the laws are interpreted. The BVA decisions include a summary of the medical evidence and the application of the laws. When doing my BVA research, I only found one claim that was awarded 60% using the bed rest criteria.. I found tons that were denied because there was no prescribed bed rest. The claim that was awarded was for a VA clinician (MD) who kept a log of days missed from work and he wrote a prescription for himself for bed rest to cover the days he missed work. A veteran who posted on hadit asked his VA primary care doctor for a prescription for bed rest and the doctor told him that the bed rest was not part of the treatment for a back condition. It would not surprise me if there are VA clinicians who make up excuses not to write bed rest prescriptions because they are anti compensation doctors. http://en.wikipedia.org/wiki/Bed_rest Bed rest is commonly prescribed in the following cases. For sufferers of acute pain in the spine or joints; for example, in the case of backache the unloading of the corresponding spinal segment decreases the intradiscal pressure, and it would bring relief in cases such as compression of spinal nerve. The prescribed duration of bed rest vary and opinions differ. ______________________________________________________________________________________________________________ There was another veteran on hadit who wrestled with the bed rest issue. He got letters from his doctor saying that he had been placed on bed rest in excess of six weeks during the last year. A DRO challenged the doctor’s assessment. The DRO wanted a more detailed explanation of the bed rest. The DRO told the veteran that he did not believe that he went an entire six-week period without getting out of bed. The DRO’s definition of bed rest was a requirement that you could not get out of bed at all. This DRO could be an idiot. The problem is that his decision to delay the claim or worse yet someone at the BVA might agree with them. I guess this DRO did not know the difference between bed rest and strict bed rest. Maybe the DRO just makes up requirements that are not beneficial to claims. Bed rest prescription should be made ongoing by the doctor and not based on a rehash of historical events. Getting the doctor to write letters showing that a history of bed rest was applicable has not worked. http://medical-dictionary.thefreedictionary.com/bed+rest bed rest restriction of a patient's activities, either partially or completely. A person on strict bed rest must remain in bed at all times. Many patients are placed on bed rest with bathroom privileges and are permitted to ambulate to a toilet in the bathroom. _________________________________________________________________________________________________________________ I have not seen anything in any VA case requiring that strict bed rest is necessary for rating under code 5243. By the way I have felt your pain. I have been incapacitated by disc disease pain which required bed rest every day for flares lasting one year in 2012 and two years in 1997 and 1998. However not service connected. Also the flares resolved to the point where I could return to playing golf and hit drives 300 yards.
  10. Vync You bring up an interesting point. I was talking to a lady who has a boat on my dock. She is a secretary for the director of the local RO. She said they were clearing out the new claims before they were working on appeals. The idea that there are two lanes one for new claims and one for appeals threw me. I thought there was just one lane called "claim date". Maybe it is the DRO's that go by claim date since all they do is appeals. I told the lady I thought it was unfair to put appeals behind new claims. Especially when the claim is being appealed based on misapplication of the law. When my claim went to the DRO way back when, it was awarded about six months after the C&P the DRO scheduled. It is going on 10 months for the veteran now. I will look into the 202 number
  11. For those who do not know me check my post in roll call and search “Hoppy”. There should still be some stuff in claims and research that will come up. Also people referenced my position papers in success stories. This is an update on a claim I talked about several years ago. It is quit long. If you make to the end there is an interesting set of circumstances causing a new DRO hearing and events at the hearing. The claim was originally filed in 2002. It was denied due to the VA’s impeachment of a buddy letter. The way the letter was impeached had no foundation in the law. I got involved in the claim in 2011 when the veteran showed me a medical report written by a department head at a VA hospital. The claim has been reopened and is continuing. Here are some of the gory details showing how far the VA will go to delay and deny. Update-the original unfounded impeachment of the buddy letter has been overturned. I got the veteran a really good VSO. She is very motivated. The veteran had been waiting a year and a half for a personal hearing. One day last November he got a decision letter saying that the hearing had been scheduled and that he was a no show. The veteran said he did not get a notice of the hearing. The claim was denied. The veteran filed the medical report as new and material evidence. A DRO determined that it was not material because it did not do anything to overturn the impeachment of the witness statement. The DRO went on to say that even if the buddy letter was verified the veteran still had no valid claim. The veteran’s service officer said she had not been notified of a hearing. The lack of notification was brought to the attention of the DRO with a letter written by me rebutting the continuance of impeachment of the buddy letter and explaining that the DRO,s determination that even if the buddy letter was verified the veteran still had no claim. As it turns out in my opinion the claim should have been awarded even though the veteran was a no show. The evidence of record justified an award of service connection. The service office told the veteran that my letter put the DRO on notice that he was dealing with people who were not messing around. The DRO rescheduled the hearing within two weeks of getting my letter. In the decision, the DRO claimed that the evidence of record showed that the incident the veteran was calling an assault was just a confrontation and not an assault. I notified the DRO that I was prepared to get a statement from a retired Judge a Advocate that the event described by the veteran and the witness was an assault while brandishing a weapon and the perb. Could have went to Leavenworth for three years. As such his (DRO) determination that even if the buddy letter was verified it would not result in a valid claim would need to be readdressed. I requested that he identify any adjudication law defining an assault that would justify his position. Otherwise his determination was a false objective standard of law. More importantly, the head of the department who wrote the medical evidence included a statement of the assault that was totally consistent with the statement from the witness. The clinician determined that the event was a PTSD stressor and that it was, as likely as not, the cause of the veterans current PTSD. Thus if the buddy letter was verified it is not a question as to the legal definition of an assault v. a confrontation. Rather the issue is whether or not the DRO rebutted a valid medical opinion with a false objective standard of law. In so doing the DRO was playing doctor. As I said earlier the validity of the witness statement had been established. Thus, the claim could be awarded. This is how the buddy letter was established as being valid. It was argued that the buddy letter was impeached without any legal foundation. Additionally since 2002 the M-21 has clarified procedures for impeaching buddy letters and that the m-21 actually gives reason to allow the letter. Additionally, the guy who wrote the buddy letter considered the veteran a lifelong friend who had a very positive influence on him while they were on active duty. At the time the buddy witnessed the assault he was an E3 in the USN. He wrote the buddy letter 10 years later. At the time he wrote the letter he was a LTJG. A month before the rescheduled hearing the veteran got a letter from his old friend telling him that his old friend was retiring from the USN as a Commander and the CO of a unit in California. He invited the veteran to his retirement. When the Commander found out that the VA impeached his letter he flipped out. He made it a point of driving 90 miles to show up at the DRO hearing and got in the face of the DRO for about one minute. The commander was pissed. After a minute the DRO said that the letter was in fact credible and that it is no longer an issue. A question arises why did the DRO not tell anyone about the hearing. Did he think that the veteran was out of gas and would just go away. In any event the DRO scheduled a new C&P and reopened the claim. Here’s the question. What’s going on with the VA. I will ask this again in a short post for those who do not read this far. The C&P was in January of 2015. The veteran has heard nothing. Are they really this backlogged or are they continuing with some game to delay and deny?
  12. A little serendipity occurred recently I was planning on posting on hadit for the first time in years in the next few days because I got a call from the one and only veteran I have been helping. I wanted to update the claims and research on some amazing developments in this claim. Also I know they now have the roll call page. And I wanted to let folks where I have been. I think about hadit every day. It was a big part of my life for so long. Then wouldn’t you know it I got an email from t-bird about the new forum. I will be posting here and a couple posts in claims and benefits. To let you know where I have been, this is what has been going on. It started about three years ago. I aggravated my lower back by obsessing over the computer to rebut a bogus environmental impact study published by the US Navy. Two weeks at the computer and the aggravation of the back lasted for a year. I could not sit for prolonged times and I could not even play golf. After a year the back pain went away. I was not motivated to get back to hadit because I had a habit of obsessing over claims. Sometimes I would work on the computer on a claim for hours at a time. I was afraid I would aggravate my back again. I also have been obsessing over drawing cartoons and comic strips. I guess I have had a desire to write humor for many years. Keep a look out for a couple posts in claims and research.
  13. Hoppy

    My Computer Crashed

    The computer is still a problem. However, I re-aggravated the back while fishing last week. It does not feel real serious maybe a couple weeks to recover.
  14. I should be back on line this weekend. It's not a virus. I have something running amok. I might need to reload everything.
  15. Free, You have put a lot of work and thought into this and I do not want to overwrite your comments. This is just the way I write things up. It is basically a regurgitation of much of what is already on this thread. I want to back up here a little bit and clarify. In a previous post I stated that the denial was not based on any congenital condition even though they mentioned one during their discussion of the evidence. The reason I thought the congenital condition was not in the mix is because they would have needed to show that the congenital condition was expected to produce the symptoms that he was experiencing. They did not address symptoms of any congenital condition. Rather the denial was based on the interpretation of the evidence that his condition was acute and involved a strain. After the denial 63 sierra says he has a diagnosis of spondylolisthesis both in the military and post service. I find medical literature that says this condition has complications including chronic lower back and leg pain. Time to get a nexus statement. The car accident is not the main issue at this time. I am not suggesting that the car accident etiology of the Spondylolisthesis be established to advance the claim. If anything rebutting the determination that the car accident was not the cause is a preemptive strike that would protect against further delays due to an adjudicator citing the congenital condition as yet another reason for a denial (see IMO statement below). The rater in my claim caused an additional 2 year of delay by refusing to schedule a C&P and citing irrelevant diagnoses noted in my medical records as the reason for denying my claim. The rater said there was evidence in the file that my angioedema was caused by post service employment. There was evidence of a condition not necessarily related to angioedema noted in association with post service employment. However, the condition was occurring while I was at work and at home. Additionally, the angioedema condition onset while I was in the military nine years prior to my working for that employer. The RO delayed my claim over 6 years by making decisions that were equated to meritless medical opinions and refusing to schedule a C&P. If they raise the issue of a congenital condition that rebuts the presumption of soundness then the argument can get very complex. My statements about interpretation of the bone scans and xray is getting into an area that may not even come into play. I just sometimes put stuff up to stay ahead of the VA’s game. I could even take the argument farther and get into the possibility of false negatives and whether or not the time frame between the accident and the tests would have impacted the reliability of the test, etc. Many diagnostic procedures are plagued by false results. I would think the presumption of soundness would need to be rebutted by reliable tests. All of which should be addressed by an expert in the field. Now back to what I think is the real issue in 63 sierra’s claim. A IMO which provides a link between the symptoms in the military and the diagnosis of spondylolisthesis needs to be in the evidence record. You could submit the literature showing the complications including chronic pain and the in service and post service diagnosis as new and material and maybe they will re-open and give you a C&P to address nexus. The complications of Spondylolisthesis resulting in chronic back and leg pain are well established in the medical literature. If you ask me the new evidence described above should result in a C&P. I just do not like to suggest that you rely on the VA. Or get a doctor involved and work out a statement your SO and the doctor can live with. Repetitive lifting trauma, unreported accidents or even the reported accident while in the military could easily have accumulated to explain the development of Spondylolisthesis and the reported ongoing symptoms of lower back and leg pain both in the military and present. The known complications of Spondylolisthesis including chronic lower back and leg pain clearly support a determination that it is more likely than not that the current symptoms of back and leg pain are related to the original diagnosis while serving in the armed forces. Have the doctor site some literature and or clinical experience in support of this statement. Just leave it at that Even though there appears to be some statements by military clinicians trying to say the condition was ongoing prior to the car accident this does not rebut the presumption of soundness. Most importantly, even though the decision refers to a congenital condition I do not recall seeing this clearly supported by any doctor’s opinions. Correct me if I am wrong. If you want to make preemptive statements that might keep the VA from dragging this out then do so. A preemptive statement may include an opinion that; the denial shows a diagnosis of a congenital condition. There is no supporting medical opinion specific to this case identifying the cause of the veteran’s symptoms as due to a congenital condition or other events predating service. There is no expectation that the unconfirmed congenital condition would exclusively explain the symptoms experienced in the military or present in their entirety. Have the doctor site some literature or clinical experience in support of this statement. I will be offline until Friday.
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