TiredCoastie

Just did a round of visits to the VAMC. I did the "stupid veteran" trick: "Oh, I used the kiosk but is there anything else you need?" with the check in desk. It seemed to work, and I wasn't lost in the system...or more lost that the others sitting in the waiting room. The check in desk has to pay attention to the kiosk sending them a message that the patient is there and checked in. Not sure what the savings or benefit is to the VAMC.

With a NOD filed last year, you probably have years to wait for a decision on his stroke secondary to IHD. Meanwhile, the conditions that are being discovered secondary to DM II are pretty serious and the chronic renal disease is potentially life threatening. Personally, I'd file. The key to whether or not a particular condition is secondary to another is whether or not a doctor will make that determination and put it in writing. Not a doctor, but have heard that DM II can create kidney damage. Another factor to consider, having just gone through this with an elderly in-law, is how efficiently your dad's heart is working. You might want to have him checked for heart failure or congestive heart failure. If his efficiency is reduced, the blood flow throughout the body is reduced which means at some point his kidneys will stop working quite as well.

You have the right to submit new evidence even without a claim or an appeal so long as it's been less than a year from your claim decision date. Seeing a private doc does not limit your options. It only strengthens whatever option you choose. As you can tell, there are a lot of different ways to go about this. In terms of the PD vs PTSD, the suggestion to get an outside opinion is a very good one. Is the VA treating you for PTSD? One of your earlier posts seemed to indicate that. But if the VA is not believing its own doctors, getting one from the outside to evaluate and wrap this up for you in a neat package having reviewed your SMRs and treatment records post-service may be the ticket to getting this problem straightened out. We can only go on the diagnoses given by the treating physicians or find a different doctor to make a different diagnosis. If that diagnosis changes because it was found to be wrong, then that's completely understandable. However, for the VA to compensate for PTSD, the VA has to be actively treating you for PTSD. What did you file with the SSA to get SSD? That's got to also be a powerful piece of evidence in your favor if they agree it's PTSD and NOT a PD. What avenue to take to straighten this out? I still say NOD/appeal to protect your original claim date if it's still within a year of the claim denial. It will take longer than an FDC. But it will protect your original claim date which means more retro. If it's been beyond a year, then your options are more limited to either a claim like an FDC or potentially a CUE. Here's why, IMHO, the appeal process is the best way: * You get more retro if you win by standing on the original claim date and making the VA fix a wrong decision rather than give you a new one to cover up the old. * You have a better overall probably of success if you had a solid claim in the first place. The higher in the "food chain" you go, the better case review you'll get. Others have stated pretty bluntly on this forum that the BVA can read and that can be the difference between straightening this out and not. * Even if you submit new evidence with a claim, like an FDC, and you gain a higher rating or service connection, there's no telling what could be wrong with that new decision. Then you'll have to appeal anyway to make it right. Another option that I don't know much about is just submitting the new and material evidence on the old claim so long as that claim decision is less than a year old. I don't know how the VARO treats that action - as a new claim or as some sort of reopening of the decided claim? Someone else will have to chime in. There have been some posters who have simply submitted new evidence on top of new evidence to force a review of the claim decision time and again. My concern is that if the same people are not making a different decision, then there's that old adage about doing the same thing over and over and expecting something different to happen... So, in my mind, ultimately you'll wind up appealing anyway maybe years down the road. My brother, Navy04, has a different opinion on this as do most VSOs. If your focus is the higher monthly compensation check sooner rather than the lump sum later, and you're fairly confident that a second look within the VARO will result in service connection and a higher rating, then submitting new evidence without an appeal, either under a new claim or not, is a good decision for you. However, you're wrestling with service connection of a disorder that could result in you losing your life. If it were me, I'd fight the strongest with the highest probability of gaining service connection not just because of the compensation now but also to enable your spouse to obtain DIC later...for me, that's through the appeal process. I went down the "claim" road myself and wound up appealing both the original denial and the subsequent claim's decision...and am waiting to see both appeals combined now both to gain SC of a difficult condition and to protect the original claim date. I am also trying to obtain SC of a potentially life threatening condition. If it were to end my life, I know my wife would have little idea how to proceed to obtain DIC if I didn't already establish SC. So getting it "fixed right" is more important to me rather than getting it "better faster."

I would take an different approach as Navy04. I'd file a NOD, which is the beginning step of a formal appeal. A VSO will likely argue that you received a bad rater last time around and another one could turn around the decision more quickly than going the route of an appeal. However, that's assuming someone is going to do the right thing the second time. There's no guarantee AND you can be putting your original claim date at risk. While it does take longer, submit a NOD. If you can, file any new findings from your VA doc showing that the severity has increased, etc. You'll get a new look at your claim file and be queued up for your file and claim to go to the BVA if you don't agree with their review as published in the SOC. I took the route my Navy brother suggested last time around. I wound up appealing anyway after the FDC wasn't counted as one and the date of that decision was stretching beyond the one year point to file an appeal on the original claim. I should have just appealed up front and would be six months ahead right now trying to get all the decisions fixed....with now two NODs in the system waiting to be combined at some point.

I ask everyone to forgive me for my cynicism. Perhaps if more of us stood on principle like Asomdepot rather than expedience, then the system might be changed. However, few of us are willing to sacrifice ourselves and our families in the effort. I honestly need the disability payment each month. So, by giving in and doing as much of the VARO's job for them as possible, I took away some of their responsibility. And in doing so -- by partnering with them so to speak -- I gained a disability rating at least closer to the mark. May God bless those who chose to make a stand on principle, no matter if it's the VCAA or some aspect of 38 CFR!

And there lies the problem. It's a long term problem that obviously impacts so many but getting traction anywhere is difficult. I feel you're in a long, difficult battle to get a very large bureaucratic agency to do the right thing by you and follow through on the promises, laws, etc. I really wish the world would work that way. The government sure isn't. It hasn't ever, and it's not going to. I hear you about the expense, difficulty, etc. In the end, if you want it done right, you're going to have to do it yourself.

The only recourse to address an Executive Branch department or agency which fails to carry out the law in a situation like this is for Congress to hold the agency accountable. The other option is to find an attorney and file a civil lawsuit, but that's not a viable solution for us disabled veterans...we don't have millions of $$$ at our disposal. If you want to continue to use the VCAA, I recommend you engage your senior senator's staff and ask for help, unless either your congressman or junior senator actually sit on one of the VA oversight committees. You might also want to send a letter to the chairmen of the House and Senate oversight committees separately if they are not your elected representatives. I can't guarentee much, but those are the people who are supposed to do something about it.

There are good service officers out there, but they are hard to find and seemingly few and far between. Most appear to be overwhelmed by just trying to get stuff submitted. I think they can be of assistance in handling a claim but more often than not there's no value add or worse. It completely depends on who the service officer is. I fired my last VSO and have been through two. Each had their strengths and weaknesses. Ultimately, I had to write a letter to my last one and officially pull back the POA. Like the consensus above, read a lot and go it alone/with the community.

Like Asknod says, a nexus letter from your doctor tying TBI to your incident in 2005 is key. You can add whatever you want to a claim. The key to being successful is getting a medical opinion that makes your claimed condition the result of or exacerbated by military service. It seems like you have part of that already if your SMRs state that you passed out in the shower, etc. If a doctor today will consider what happened to you along with the symptoms you provided then along with the symptoms you have now, and will be willing to wrap it all up into a nice package, you're in great shape. Many will, especially on the outside. I'd personally recommend a little more than the DBQ form and getting the doctor to write a letter. I also recommend that you write a statement yourself and include it, describing the situation from when it first occurred up until today. Any medical records you have from then until now, including after you left the service, showing treatment for symptoms will also be very helpful to show continuity of the disability. Hope this helps!

So it seems as if the DAV was trying to dig out the hole in which they tried to bury you and was halfway successful. They screwed it all up in the first place, you sent them a NOD, and they decided to work a deal behind the scenes. At least in this case, the DAV did what we all expect our VSO to do...fix something to our benefit...and without a huge amount of time or effort on our parts. But your claim should have never needed heroics to save it. I don't think I'd immediately run out with a DBQ form and try to collect up new medical evidence at this point like Asknod said. But it still seems pretty odd that they'd find a service connection without any kind of rating decision. You might want to review the appropriate DBQ form but especially 38 CFR part 4 for the actual rating criteria to see what, if anything, was missed by either your doctors or the VARO. If the VARO has all the information needed to make a rating decision based on what you submitted, then the big question is what to do next. You can wait for a C&P. You could also appeal the non-rating decision they made and demand that they make a rating decision based on what they hold now. My gut says either the VARO screwed up or didn't believe your medical evidence and want to see for themselves. If you appeal, you'll likely wind up with a C&P anyway. Maybe the best thing to do is wait for the C&P? But I wouldn't be too patient...and if it drags on too long you may still need to appeal before the 12 months are up on your original PAD claim decision. Based on the notice of the claim date in your notification letter, it also seems as if the VARO is mindful of that date as the effective date...which is fine so long as they remember AND you agree. So it doesn't appear that there's a reason to appeal this portion at this time unless you think it needs fixing. The effective date of the rating you eventually receive will be the key piece. If it were me, I'd be on the phone to the AL in the morning asking how fast this C&P is going to happen. There does seem to be a difference in expectation and definition of certain terms like "at once". If that's not been scheduled yet, and the letter was signed on July 11, 2014, then I'd be jumping up and down that your expectation of "at once" isn't being met and make 'em at least define terms. You can probably see if anything is scheduled through eBenefits' "exam schedule" page...there's an exam requested link on that page too which shows when the VARO asked the VAMC to do the C&P. Lastly, was there a statement enclosed regarding whether or not you could appeal their decision? If there wasn't, that could be a problem for the VARO but I'm not smart enough to tell you how to leverage that. And...have you seen your C-file lately to ensure that missing doctor's statement actually got submitted and filed correctly? Hang in there, Hugh. We're praying and pulling for you.

OK...just found your new post!

I agree with Asknod. Be ready to fight for that "informal claim" date they mentioned in the decision letter unless you have evidence that they missed this sooner. Per my earlier post - just found your new post - the effective date of any rating increase for PAD is my biggest concern for you right now. Hopefully everything will work out OK. At least you got somewhere with the "reconsideration claim" you didn't ask for. You've been working on this for quite some time. Is PAD the only condition you needed to appeal back from your original claim?

That's really frustrating! At least you're SC now, but why couldn't they decide how bad your condition is by the records they hold now? Hey, many of us fight through the "low ball" rating problem but this is at a whole different level. How'd you find this out? What's going to be your effective date of the PAD rating, which seems like it's going to be different than the date of SC? The C&P exam to determine how bad it is? The original claim date? Some other date they pick out of the air?

Just be ready to appeal any decision of the effective date to the original claim date. I had to.

However, be ready to file a NOD if the effective date of any grant doesn't go back to the original claim date. I've done that in this exact same scenario. Watch the "reconsideration" claim closely. If they don't close it soon, I'd still file a NOD to preserve the original claim date. DON'T wait until the last day like I did, hoping against hope that the RO would come to a conclusion like my VSO promised me. You do have the option of cancelling the claim and hammering in a NOD now, or at any point, up until May 2015. However, if it's that close to completion, then you might as well let it ride. However, be prepared to appeal both decisions...May 2014 and whenever this one is done. JMHO.

The AL is going to have to straighten this out seeing as they've got the POA now. Claims can be cancelled. But as Stretch pointed out, maybe they'll reverse their decision through whatever the DAV submitted. Somehow, I doubt it. But, it could be that the DAV tried to work a deal with the RO on your behalf to give you part of what you wanted - some of that behind the scenes wheeling and dealing - if you didn't file a NOD and appeal. Your new NSO with the AL should be able to get in the middle of this quickly and hopefully get you an honest answer.

You're taking the right steps. When you get to see your new PCP, ask for a referral to an orthopedic back doctor. The neurologist who's doing the EMGs is all well and good, but buldging disks are usually ultimately addressed by a surgeon after physical therapy fails to assist. The EMGs are looking for nerve impacts secondary to the bulging disks. Why not look for the actual condition? Getting an outside doctor to actually provide care is important if you can't get the help you need from inside the VA system. Hopefully the state exchange will provide you access to that. Another option is charity care through a local hospital system. In our area, you could walk into an ER with severe back pain but bring some paperwork with you and you can apply for charity care on the spot. Getting into an MRI machine from the ER isn't something I've done even with health insurance, but it's worth a try especially if you're not paying out of pocket.

Good question. Can you file a new claim while appealing an old one? Yes. Should you? There are at least a couple of schools of thought. Some would say "no." Your claim has a high likelihood of getting entangled and caught up with your appeal, so that they are decided at the same time which could be years. Meanwhile, there is an approach that says to take on the big things first, then add the little things later. I don't know the rating schedule for asthma or how severe your asthma is, but you should check out 38 CFR part 4 and see based on what the doctor is telling you along with your experience with your disability. Some would say "yes." The sooner you establish an effective date, the more retro you'll get when the decision is eventually made. If your asthma is severe enough, and it could take your life, then I would think it would make sense to at least have the contention in the disability system somewhere so that if you do pass, your spouse will have an easier time with DIC, death benefits, etc. I've got a couple of appeals in right now and suspect that I'll want to apply for an increase to SC conditions myself at some point, perhaps before the appeals finalize. Looking forward to what the more experienced have to say...

I'll pray that it works out for you, Hugh. There are good SOs out there. Hopefully you just landed on one. As Navy04 related above, some of these folks make the nicest neighbors but sure wouldn't want to ask them for help. I had a similar experience with changing VSOs a couple of years ago. I got the big story about what he would do for me, and yes, 63Sierra, he promised me 100% in 60 to 90 days and was talking SSDI as well. Fast forward two years, I'm finally at 80%, have no VSO, and have two appeals in that may get me to 90% if anything...but gotta try and keep fighting. So ultimately, the proof is in the pudding, so to speak. Really hope that the help and good will go beyond the initial meeting for you. I've also heard that you cannot get these guys off your case after you sign a POA and the appeal process starts. AskNod is one of the guys to check with on that.

Saw this earlier in the week. Seems like there could be some stipulations. What does You have not been reimbursed by another government agency or some other source, such as the deceased Veteran's employer, mean? What about life insurance? If having life insurance means that this benefit does not apply, then the program seems like it's just a program to fill the gap of life insurance - having just done a funeral, looks like it's really just enough to cremate and bury a vet at a VA cemetary who dies of a service connected disability.

Even if you do see something happen that a politician claimed was supposed to happen, you might want to appeal to the instant replay just to be sure there wasn't slight of hand involved... Hey, I hear you. I've personally gotten pretty good care from the VA but, like you, have sought outside help for stuff that's vital or just isn't going right. For me, most of my care I'd consider to be vital.

I think you're right, John. It's like they're shoving the mess into the closet and hoping Mom doesn't open the door. The appeals backlog is one of the biggest the unspoken problems right now, IMO.

Latest statistics indicate that, at the present pace, the stacks of entitlement claims for disability compensation that are older than 125 days will be driven down to nothing by mid-summer next year. I don't believe they'll actually achieve no wait longer than 125 days, but there likely will be a great number of claims shifted around to be completed as fast as possible. With extra speed often comes extra errors. Like we've already seen, the stack in the entitlement inbox is being shifted to the stack in the appeals inbox. But the shifting around with the extra errors are going to make filing an appeal more challenging, because we're supposed to appeal to the RO which made the decision. For instance, I've got an appeal at our local RO as well as another one halfway across the country. The two appeals are related. I don't have any idea how they'll handle them other than combine them once they eventually arrive at BVA.

Filing a NOD is the first step to getting to the BVA. I'd do that. You might want to begin to gather new and material evidence showing again that you have those conditions and are still undergoing treatment for them. For the contentions that were denied outright for SC, you'll need to show evidence from your SMR that you sought treatment for them. Typically, if you are within a year of discharge and you're getting treated for them, you have the same strong argument (not sure how this works for reserves, though). If not, you'll need to develop a nexus that shows that the condition began on active duty or worstened considerably as a result of active duty. For your IBS, the VA too often "lowballs" a rating. At least you're SC. The increase ought to be simple enough as long as you've got a doctor who will vouch for your BMs. For PTSD, if you're not diagnosed and treated by the VA, you need to get onboard with the VA in order to have SC. For hearing loss, that can be difficult due to the high thresholds considered for a disability rating. If you have hearing tests from your MEPS exams and then afterward including when you separated, that will help quite a bit. Remember, tinnitis is another condition you can claim. Knees can be challanging unless your service records or service medical records show you were injuried or sought treatment while on active duty, drilling, etc. Is the VFW helping you with your claims? If so, I'd get with your NSO ASAP to discuss this. If they tell you that you need to file a "reconsideration claim" instead, it's time to figure this thing out on your own. I had a VSO tell me to file a reconsideration claim and it led me down the wrong road, almost costing me thousands $ in retro and definitely wasting about a year. Just file the NOD. It will result in a review of your file anway, like a reconsideration and especially if you provide new and material evidence, then will automatically queue you up for further action if they don't decide everything you appeal in your favor.

I don't understand why a security clearance would bump up a vet's C-file sensitivity unless the vet had classified or sensitive parts of his or her record. Personally, I would hope that everyone's record would be considered sensitive! Anyone know? How do you find out what your sensitivity rating is? Meanwhile, Motherof3, can you use the letters generated out of eBenefits? Or are those considered too unofficial for some reason and the letter must come directly from the VARO?