jamescripps2

Are you already rated @ 100%? Generally you need a 100% P&T rating to be considered for A&A, although there are exceptions. See 38 CFR 3.351 (C) (3). Also see 38 CFR 3.350 and 3.352for SMC qualifications for each level.

I had that base covered as I had already called and filed an intent to file while i was still in recovery in ICU to establish the EED. There was no question about the start date as it is the day that I reported to the ER, barely alive, and the life saving emergency surgery was preformed. Remember, that was not my first rodeo amego!

Providing a nexus for a condition and being treated for a condition are two different things. If the claim is for a presumptive condition, no nexus letter is required.

Thirty five years after my discharge from the Army, I began as a non service connected veteran and submitted my first claim in 2005. Along the way, in my seventeen year battle with the VA to obtain my benefits I required many nexus letters. I always looked the doctor in the eye and asked ,straight out and up front, for what I needed in order to support my claim. I managed to go from 0% to R-2 on my own, as a pro se veteran. Then with the help pf an attorney, I went through the Court for earlier effective dates of those awards.

The following is my actual nexus letter as a direct result of my request. Upon submission of this letter I was granted SMC R-2. DEPARTMENT OF VETERANS AFFAIRS TENNESSEE VALLE Y HEALTHCAR E SYSTEM 1310 24th Avenue South 3400 Lebanon Pike Nashville, Tennessee 37212 5th October 2020 Re. James Cripps Date of birth Jan------ To whom it may concern, 1 am Dr. -----------, a cardiologist, and Director of the Advanced Heart Failure and Heart Transplant program at the Nashville VA Medical Center. I have been asked to provide a statement in support of the afore mentioned veteran's claim. I have personally reviewed his medical records in the Computerized Medical Records of the Nashville VA Medical Center. I have also reviewed and have noted the circumstances and events of his military service. Mr. Cripps has been under my care since June 2012. His diagnoses include an ischemic cardiomyopathy (heart failure with reduced ejection fraction and coronary artery disease), poorly controlled diabetes mellitus, chloracne and Fournier's gangrene. I am familiar with his history and have examined Mr. Cripps often while he has been under my care. Mr. Cripps has no other known risk factors that may have precipitated his current condition. After a review of the medical records it is my professional opinion that it is highly likely Mr. Cripps' Fournier's gangrene is a direct result of his diabetes mellitus, chloracne and empagliflozin prescribed to treat his heart failure and diabetes. In my personal experience and it is known from the medical literature that diabetes mellitus is a risk factor for Fournier's gangrene; he was also predisposed to Fournier's gangrene by chloracne and the use of empagliflozin (a sodium-glucose transport protein 2 inhibitor or SGLT2 inhibitor). Fournier's gangrene has been reported as a rare but serious side effect of SGLT2 inhibitor use (Bersoff-Matcha et al. Ann Intern Med 2019, 170(11);764-769. Signed, Dr. ------------- Director, Advanced Heart Failure and Heart Transplant Programs. VAMC Nashville Tn.

My actual request to my cardioligist. for a nexus letter. I enclosed the example of a nexus letter and the PDF explaining why I needed a nexus as posted above in this thread by Sgt Wilky. 10/02/2020 James M. Cripps, last four ---- Dr. ---------, I remember in SICU, a doctor, most probably Dr Patrick -----, told me that the Fournier’s Gangrene was caused by a perfect storm resultant of my Diabetes, Chloracne, and the medication, Jardiance, that was prescribed for my Diabetes and heart disease. I understand that when Jardiance was prescribed, risk vs benefit was most probably considered. In my case, as you know, it didn’t work out so well. I ended up with Fournier’s Gangrene, a well known side effect of Jardiance. As a result my life has changed and my abilities are now greatly diminished. I now find myself needing to ask for your help. I need to show the etiology of the Fournier’s Gangrene. When I file a claim with the VA for service connection for Fournier’s as secondary to Diabetes, Chloracne, heart disease, and the prescribed medication, Jardiance, I am required by the VA to support the claim with a medical opinion as to the etiology. I know that you are not a letter writer, but I am asking you to please consider writing this one, therefore enabling me to obtain my service connected benefits. Also, the entire time that I have been assigned to the advanced heart failure clinic you have been my doctor. Because I have memory problems, my wife and caretaker, Sandra, has always, and still does, until Covid 19 restrictions, attend all of my VA appointments to get face to face instruction of any medication and/or treatment changes that you might offer. If you could vouch that Sandra, as my caretaker, does attend my appointments for the purpose of communication and interaction with you, it would greatly help me with my VA claim. That statement may require a separate letter. Thank you for your consideration. James M. Cripps

It is reasonable to think that if you ask a busy doctor for a nexus letter that they would refuse due to time restraints. On the other hand, If you mention a nexus letter, and then hand the doctor that two page request with the explination as to why you need the nexus, it would be considered later on outside of the busy office setting.

Although my C&P was retrospective, I did have to appear and answer a few questions for clarification. I was not required to attend the retrospective exam preformed by my doctor. I would think that the favorable findings would remain in play, unless a revue of the record contradicted.

Yes, file on the foot drop. I would seek a medical opinion from a podiatrist, or your primary care. Permanent loss of the common perenial nerve causes foot drop. The AFOs are prescribed for the foot drop condition. At the very least ask your PCP or Podiatrist to enter into your medical record that you have permanent loss of your common perenial nerves. The following is an exerpt from 38 CFR 3.350. Google it, copy it, highlight the underlined portion at (b) and send it in with your loss of use of feet claim. (2) Foot and hand. (i) Loss of use of a hand or a foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function, whether the acts of grasping, manipulation, etc., in the case of the hand, or of balance, propulsion, etc., in the case of the foot, could be accomplished equally well by an amputation stump with prosthesis; for example: (a) Extremely unfavorable complete ankylosis of the knee, or complete ankylosis of two major joints of an extremity, or shortening of the lower extremity of 3 1/2 inches or more, will constitute loss of use of the hand or foot involved. (b) Complete paralysis of the external popliteal nerve (common peroneal) and consequent footdrop, accompanied by characteristic organic changes including trophic and circulatory disturbances and other concomitants confirmatory of complete paralysis of this nerve, will be taken as loss of use of the foot. Loss of use of two feet is an SMC "L" award in itself. There will also be a vehicle grant and a path to the $110,000.00 SAH grant. Go over to the SMC R-1 and R-2 forum thread here at hadit. Read and comprehend what is being discussed there. Learn from it. Pay extra special attention to the pyramiding rules, and then file for A&A due soley to the prostate cancer issues. Proceed cautiously with that A&A claim as there are pitfalls along the way that can cost you a lot of money. If you work it right and do not violate the pyramiding rules you could very well end up with a R-1 rating. The 2023 R-1 pay rate for the veteran alone is $9,036.89 per month. Pay for R-1 for veteran with spouse is $9,238.83. You got questions, just ask!

Pacman is correct. A retrospective C&P is a request from the rating authority for a medical professional to revue the medical record in search of the earliest effective date that the veteran would have been entitled to the claimed disability. The rater would look at the retrospective opinion and any other relative evidence of the record to arrive at the earliest effective date of the claim.

The VA prescribed Jardiance for my heart failure and diabetes. The side effect of the Jardiance caused me to have Fournier's Gangrene. As a result, my body had to be reconstructed from my knees to my navel. 4% survival rate to make it through all of the surgery and 12% to make it ninety days. That was in July 2020, and I survived!

Your VSO may have copied those for you but I actually wrote them and posted them on the United States Veterans Alliance site (USVA) web site in 2009. I wrote the two page examples in your first PDF attachment. I had nothing to do with the second PDF attachment and do not recognize it.I know that they were copied from our web site more than 5,000 times. I closed down the USVA website due to hackers in 2018 and transferred the Nexus letter documents to my web site where it can be found and copied today. [Removed Link per Forum Rules] I wrote those documents to be distributed far and wide in order for veterans to easily obtain their nexus letters. Thanks for helping in passing them along! It is indeed a small world!

In my EED case the VBA requested that a C&P retrospective medical opinion be obtained. Mine was a legacy 3.156c. The retrospective C&P opinion was obtained and was favorable to me. I also submitted a IMO from my private doctor. I did win the EED and ten years retro.

I am R-2 and I won the very first PCAFC caregiver's case to be heard at the BVA on June 22, 2022. The CEAT team conceeded that I needed help with at least five of the seven recognized CPAFC qualifying ADLs but still refused to relent and award level two caregiver benefits. The case was a shu in at the BVA. Do not rely soley upon your contention that you are rated at r-1 (100% major neuro cognitive disorder) and require daily assistance for your mental disorders. You need to expand on the ADL needs. The VBA and the VHA do not communicate. The social workers, medical professionals, and CEAT teams have no idea of what a R-1 veteran is, they probably never even heard of it. Yes indeed, fact that you qualify as a R-1 vet sort of dictates to any knowlegable and reasonable person that you require level 2 caregiver benefits. You need to point out to the BVA, and support with documentation, the ADLs that you need help with, each and every time the ADL is preformed. Ask the BVA to advance your case on the docket for the reason that you are a R-1 vet. It worked for me. You can go to the BVA search prior decisions site at https://search.usa.gov/search?affiliate=bvadecisions&_ga=2.77268117.1265507262.1648799257-1511624019.1640929699 Enter my case # in the search box and read about the claim and decision. My case number is A22011682 You can also read more of what I have to say about the CPAFC caregivers program on my prior post and threads here at hadit and at my web site at vatheredneckway.wordpress.com

You didn't mention anything about an award or denial of the claim for SMC "T".

Sounds simple to me. "L" award for loss of use of lower extremities. A second "L" award for A&A would satisfy the requirement of the maximum SMC "O", at which point the A&A becomes "R-1" at the least. Depending upon your situation, it could warrant a grant of "R-2". (see CFR 3.350 & CFR 3.352) Also see 38 CFR 351 (C) (3). Keep in mind that the need for A&A must be bessed upon a seperate and distinct disability in order to avoid the pyramiding rule at 38 CFR 3.352. Fail to do this and you will find yourself stuck forever at SMC "M 1/2". Refering to your original post in this thread, it is aparent to me that you need to file for loss of use of upper extremities which would provide for your seperate and distinct need of A&A should you be caught short. File the intent to file NOW. When you file the claim ask for A&A at SMC "L" Ask for loss of use of two feet at SMC "L" Obtain a VA form 21-2680 and have it filled out by your PCP in a way that states that your need of A&A is based upon soley upon the loss of use of two hands, disreguarding any other disabilities. File the claim along with the properly completed 2680. Instruct the VA that the loss of use of hands is to be used as the seperate and distinct disability that dictates the need of A&A. Ask that your claim be expedited. Sit back and watch the fireworks begin! By the way, you did not mention an automobile grant with adaptive equipment, or Independent Living Program, (ILP), benefits through VR&E, which you might want to ask for. How about an electric wheelchair and/or scooter? Have you applied for PCAFC caregiver benefits through your patient Advocate? Might want to do that, for shure!

Exactly whodat! So all that you need to do is to get the Pact Act presumtive hypertension claim filed, give it a little while, thirty days or so, and follow up with an intent to file. You will then have 1 year to get your IME, IMO or nexus letter, which ever you choose, and file the claim to seek service connection for the headaches and chronic sinusitis.

In reality, we never expected hypertention to be awarded at anything more than 0%, except in extreme cases where it might be awarded at 10%. The real benefit comes into play when the vet is awarded at 0% and later claims conditions as secondary to the hypertention. The posibilities are endless. Heart disease, stroke, vascular imparement etc.

I think the reason for the lack of information and/or training about the CPAFC caregiver program is its lack of consistancy of decisions over the different VISNs and even between medical centers. The VHA directs you to ask your unanswered questions to your nearest VSO, when the VSOs are not aware of the existance of the program, much less how to apply for the program or how to appeal. Lack of training is not the falt of the VSO. All they can do is to just kick the can a little further down the road!

By the answers that you are getting you can probablly tell that most people who deal with the VA, including VSOs, DVA employees, and even the moderators here at hadit do not have a clue as to what you are talking about. The PCAFC program is handled by the VHA, not the DVA. There are different rules and regulations. The DVA, if you hold theit fot to the fire, will eventually comply with regulations. On the other hand, the VHA is not in compliance with the rules and regulations and they are unreasonable people to deal with. It is hard to obtain justice when an agency refuses to comply with their own regulations. That is why we have to get those cases out of the hands of the VHA and to the Judges at the BVA. You did the right thing by appealing to the BVA. Bassed upon what you are saying, You will win the remand and recover your back pay. You can read more on what I have to say about the PCAFC at vatheredneckway.wordpress.com

# 1, Was your 10% HBP rating fully stabalized by being in effect for five years or better at the same rate? # 2, The C&P doctor did not /could not reduce you or assign a percentage. The rater made the decision, supposedly based upon all of the evidence contained in the record. Other than self satisfaction, going after the C&P doctor will get you nowhere, causing you to loose focus. I suggest that if you disagree, go for a Supplemental Claim and seek your own medical opinion and DBO. Being in the same situation once, I complained about the quality of the C&P exam and the credentials of the doctor. I was only offered another C&P preformed by the same doctor. Having no choice, I agreed and got the same old song and dance but the rater granted the claim despite the unfavorable C&P exam.

The VA don't recognize court appointed custody for chapter 35 benefits. Nothing can happen until the legal adoption is final. Once the adoption is final, you can apply for her dependent status which will be good as long as she stays in school or turns twenty six years old.

Pacman, I was pro se all of the way up to and including R-2. After I won the R-2 I filed for an EED for R-1 and took that all of the way up to the CAVC level pro se. At the Court I won a JMR with EAJA paying the Court $4700.00. Once I got the JMR from the CAVC I retained a legal team to get a new BVA decision which was remand back to the RO where it was again denied. Next it went for a HLR where it encountered a failure of duty to assist and was finally won in a supplemental claim whereupon I owed the 20% of retro which cost me $36,000.00 plus $500 for the cost of an IMO that was advanced by the law firm. So, the law firm made more than $40,000.00 because they represented me in filing for an EED. Gross retro was $183,000.00. Was it worth it? Do your own math while I go invest the money. Mr Cue, If you remain pro se at the Court, I have a lot of respect for you and I wish you luck.

Usually, anytime you win additional benefits the lawyer makes money. If you are 100% and win housebound S there is an increase with retro pay that the attorney collects his percentage. I have been 100% for more than 18 years but I just had to do a $36,000.00 wire transfer to my legal team at CCK because I won additional benefits.

I can't think of any circumstance where I would withdraw a claim rather than stand and fight for it. But, if withdrawal is someone else's strategy, I won't condem it either.