john999

My experience with the choice program for dental and vision is that is it really poor. The dentist and doctor I saw were just worried about getting paid. The dentist wanted to crown every tooth in my head and the eye doctor would not prescribe new glasses because he thought the VA would not pay him. If I have any serious sorts of medical issues I use Medicare and my insurance. I would not have a VA choice doctor do back surgery on me. What about your follow-up and any PT you might need? Is the VA going to run your over the hurdles for every little issue you have every time you have one with your back. I am pursuing the VA Fee Base program now for dental bills for treatment the VA should have done. I got $940 out of them so far. I want $14,000 more. They just wanted to pull my teeth and then tell me I did not need them anyway. The Tampa VAMC is in chaos due to very heavy turnover among PCP doctors. I have had three in the last year. One quit, one got pregnant and one I never met yet. John

I suppose you could have CIB, PH, Silver Star, Bronze Star with V and the VA exam doctor could say you don't have PTSD based on his one exam and you loose. The big thing used to be the stressor and now it is just the VA exam doctor's word. A good friend of mine I served with in Nam got SC'ed for PTSD recently. He did not get wounded or have direct combat with the enemy. I think he got badly scared one time when he lost his bag of dope. He was pretty depressed at the time he filed his claim. I don't know how that claim became a successful claim for PTSD. I encouraged him to file for everything and I am glad he got it. I have to call him and find out if he is 100% yet. I be he is since he got SC'ed about 3 years ago for an AO thing and the PTSD. John

I was TDIU P&T in 2007 when the VA did a CT scan of my left leg. It indicated advanced calcification in some of my arteries. I filed for this then as a condition secondary to DMII and AO exposure. The reason I filed was because problems of this kind in my legs would likely be in my heart and brain as well. The VA doctor agreed with me. This was at a time when your PCP would write you a medical opinion. I ended up using this claim to get SMC "S". It also alerted me to possible heart and stroke problems down the line. Now I have a cardiologist but not via the VA. If you have any sort of claim that might result in your death or future real disability file on it. I have been rocking the boat since 2001. I just recently filed for reimbursement for a medical expense. I was told there was no way I would get paid. I got about $1000 bucks just the other day. The VA's game is to tell you as little as possible about any rights you might have under their system as a disabled vet. Then they and VSO's try and discourage you from filing. What you don't know does not cost them a dime. For Vietnam vets many conditions that were originally NSC are now SC due to AO. The VA had to pay big bucks to vets who filed for things like heart disease and Parkinson's even before they were SC. New regs. included these things as connected to AO exposure. What is NSC today may be SC next week. File when in doubt. When I began to have to take oral meds for DMII I filed for an increase. No money but I want it documented that my DMII is not just a minor blip in my AIC. I would bet that when the big bulge goes down the VA python's gut the VA may start looking around for ways to cut disability payments. There are many politicians that consider us as about one step ahead of Welfare Mothers. That would include many doctor's and administrators at your local VA. File that claim for your own protection.

It is not a new claim. It is a claim for an increase. Claim it just like any other claim. Actually, you are not supposed to have to claim it. However, in the real world you need to claim it and have evidence that you are housebouned due to medical reasons. I got it for statutory reasons and I had to claim it. I got it via the CUE avenue. Just having TDIU is not enough to get "S" unless you can show that you are substantially confined to your home. For instance, you have agoraphobia. That is a basis for "S". Any physical disability that keeps you at home is also good. The VA will want to examine you I think. If it is not statutory it gets medically complicated. There is a VA medical exam for HB. John

100%, but watch out they don't designate a fiduciary for you to handle your money.

Buck Do you have CIB or any award, badge or medal for combat duty? If you do all you need is the DX for PTSD from the VA because your stressor is conceded. If you have any basis for the PTSD disability the VA will get around to sending you for C&P for PTSD. Only the VA can make the initial DX of PTSD. They have that rigged. Once you get SC'ed for PTSD then a private shrink can help when you ask for increase. For you this should not be too hard just time consuming getting ducks in a row. All you need is a good percentage of the PTSD symptoms. John

Just be sure you don't get VA claims mixed up with non VA disability claims like Worker's Compensation or SSDI. Are all your disabilities related to service connected military claims? I will give you a for instance: I had a VA disability that was aggravated by my work for Postal Service and I also had non VA injuries that were job related only. You want to keep these things straight and don't let there be overlap. What will happen is the VA will end up saying the reason you can't work is due to work-related injury and worker's compensation will say your inability to work is due to just you VA disabilities. With SSDI it does not matter why you can't work, but VA will often want a copy of your SSDI decision and paperwork. If you are trying to get TDIU or 100% from the VA it must be solely due to SC reasons. You don't want to give VA ammunition to shoot down your SC claim for increase. During my attempts to get all the disability I was entitled to get I applied for disability retirement, worker's compensation, SSDI and to my private disability insurance policy. I got all these things but some impact your ability to collect from all at the same time. Workers compensation is usually the worst because if you were to get WC and TDIU for the same injury or illness you would not be able to collect both at the same time. Also, with my disability retirement from federal government I could not collect WC and disability pension at the same time for total disability. Just try and keep things distinct and don't let them overlap or it usually causes problems down the line.

If I did get TDIU or 100% for your claim I would check to see if you were granted or denied Chapter 35 which means P&T. If there is a statement saying "No future exams" that is also indication of P&T. It does sound to me like TDIU or 100% and more likely 100% scheduler. Can I ask how old you are? If you are 55 or older I think you should get P&T. How long have you had 40% for MDD? If you are granted any sort of Total rating then the VA is supposed to consider Housebound. If they do not consider that then that is grounds for appeal on the HB front. Also if the VA does not grant P&T I would appeal that and not wait 5 years for the VA to get around to granting P&T. If you want something from the VA you have to ask for it. John

I would really shoot for the P&T if I were you. When did you get 100%? If it has been less than a year you can appeal the denial of Chapter 35. If it has been more than a year then request P&T as if it were a claim for an increase. Get evidence from a doctor or vocational counselor to document that you are stable and unlikely to ever improve significantly as in being able to work. I don't believe in waiting for years to get P&T. I appealed my denial of Chapter 35 and it took the VA about a year to review my records and determine that there had been no improvement. I got P&T and it was well worth the effort. P&T has many benefits to you and your family. Better than getting a higher level of SMC in most cases.

I drill my wife on the fact that no matter what the VA may tell her she is entitled to DIC based on one or more factors: First, I have been P&T for over ten years: Second, I will most likely die from SC condition. She is also entitled to extra money because we were married at least 8 years before my death if it happens. I can surely imagine some VA idiot telling my wife she is not entitled to DIC because I was not KIA or some such nonsense.

I agree with Asknod. The burden is on the VA since the decision to grant you TDIU P&T was made final. I tried to climb that hill from a different direction and I can tell you that is should be as hard for them as it was for me. File the NOD on the official NOD form and ask for a personal hearing on this proposed reduction. I think I would also get a VA lawyer ASAP. You do say that you combined rating was 70%. Were any of your ratings at least 40%? That might be a reason they are calling CUE, but that rule is only part of the rule for being eligible for TDIU. The regulation says that if you are unable to work solely due to your SC disabilities then you qualify for TDIU. The part about being at least 70% with one disability rated at least 40% is an add-on just to make it harder. The rules about having at least 70% combined with one disability at least 40% is an after thought to the spirit of the regulation. The only reason they can validly reduce you is if you are currently working, or there was some problem with your character of service, or if you did not keep them informed about your continuing eligibility for TDIU. The employability eligibility form we send in every year is no joke. You must send it and have proof you sent it even if they don't send you one to fill out. I download a copy every year and send it certified mail/return receipt every year for the last ten years.

If you can qualify for TDIU I say take it because it may be harder to get in the future. Even as the VA and current administration talk about honoring vets they are busy thinking of ways to make it harder for unemployable vets to get 100% compensation. Unless you have fantastic life expectations I would take the TDIU because you will have that for life and it beats most pensions these days since there are none but what you can save in an IRA or 401-K. To get the equivalent of TDIU you would need to save about 1,000,000 bucks and get 4% interest on the entire amount for the rest of your days.

When the doctor touched you knees you should have screamed in pain and when you stood up you should have moaned and shown that standing up from prone position was very painful for you. Do you have a cane or walker. You should use it before, during and after the exam if possible. You should have lost your balance and crashed into the table and grabbed the doctor on the way down. This reminds me of many half ass exams I have had in the past. The VA did a heart exam by just looking at me and asking me if I could walk two blocks. After that exam I went out and got many tests at VA expense to show that the C&P exam was totally inadequate and incompetent. You need outside documentation on your knees. You should go to IME doctor and get a report if you want to appeal and win something on your knees. Did they do MRI, CT scan or even x-ray?

GP So Inspire is working for you? I am glad to hear it. I know that since Inspire I don't snore when it is in use. It did reduce my OSA from "Profound/Severe" to "Moderate" which is a big deal in my case since I just could not tolerate the CPAP.

Since I got P&T in 2002 I have filed at least 7 claims for other AO conditions and a couple of CUE,s. Since the VA is still years behind on just doing first time claims for much younger and more recent vets I am not too worried about them reducing me just because I file for an increase. If you have been 100% for five years and are 55 or older I don't think they will mess with you unless you give them good reason. However, it is always good to be prepared. If you have good evidence for the 30% to 50% increase I would fly with it. VSO's always tell you not to risk what you have and this can be good advice, or it can be really bad advice. If there is money to be gained by filing they I say file. If you are just adding another 10% to your rating then I would not do it. I did file for an increase in my DMII rating when I started taking oral meds for it. I would file for things that could be fatal or make money. I would file for any cancer that is AO related. I am waiting for them to make skin cancer presumptive. I am pretty light skinned and my forearms took a beating from tropical sunlight. Now I see the damage on my face, ears, and arms where I get some pre-cancerous lesions. When I filed for my CUE to get a much EED the VA did bring up exams I had in the late 1980's that challenged my service connection, but it was all bluff since I had been SC'ed for 15 years by then. The VA can get down and dirty and really show that they are jerks who care nothing about vets. If I have a good claim I will go forward with it. The best defense is a good offense with these guys. Look at Berta. She has raked them over the coals so often I think they are taking up a collection to send her to China as our secret weapon.

That is some bill that a politician has proposed. It is not a law. Taking all that money from the Choice Program to treat Hep C is a hell of a trade off. The VA screws one group of vets to help another deserving group of vets. How diabolical can you get?

VA lawyers are really good at making legal arguments. If you do all the work of gathering the evidence, getting IMO's, and doing all the appeal work then I think if all you get from a lawyer is for him to show up at your hearing and if you win collect 20% of your retro that is a sorry deal. However, if the lawyer devises an action plan and sends you to an IME and puts together a strategy to win your claim then I think they are worth the money. My lawyer showed up for every hearing at both the DRO and BVA. He argued my case at the CAVC and at federal court. He traveled from New Jersey to Florida to be at my hearings and went to D.C. for court hearings. Unfortunately, we did not win but he tried and I tried. All my other claims I have just done them myself as in gathering evidence and filing appeals. I had American Legion show up with me once to talk to a DRO. I won the claim, but I had the evidence. I also won a DRO appeal for a 0% rating for CAD as secondary to AO DMII. I did this completely on my own with help from guys at Hadit, and got the 0% raised to 60%. What I did between the time I got 0% and 60% was to get more evidence since the VARO had based my 0% rating on an awful C&P exam that involved no testing at all. What I am saying is that 90% of claims can be done by the vet just getting some information from Hadit and guys like AskNod, Berta , Jbasser, Flip or any number of other posters here. Here is a SOP type of claim process: The vet has in his SMR's an injury or illness. He/she files a claim. The VA schedules a C&P exam. The exam either denies that the vet's current problems are related to his in-service injury/illness or opines that the vet has minimal disability. The VARO just runs with this 10 minute exam conclusion, and you get denied or low balled. The next step is that the vet files a NOD and asks for either a DRO or BVA hearing/review. In the meantime the vet must get more evidence via an IME, testing, or finding new medical records from SMR's. If the vet gets more evidence that shows that his/her current condition is at least as likely as not a result of in-service events then he/she gets a rating. If the vet has asked for an increase in existing SC rating then he gathers evidence to show that the current condition is worse than the current VA rating. Sometimes the vet can show the VA made legal errors and make an argument has violated its own rules. Usually, piling up evidence on the vets behalf is what wins the claim. This is why I like the DRO process since in my experience my DRO hearings have taken less than a year and I got new evidence in that time period and presented it at the hearing. If you go to the BVA directly you start off having a two year wait just to get your hearing. Often the VARO screws around for almost a year just getting your claim to the BVA where it gets in line with the hundreds of other appeals. You finally get your hearing and the BVA says the VARO made a mistake and you should have been SC'ed or given the increase. Now it takes 6 months or longer for the VARO translate the BVA decision into a rating. So four years have gone by and that is all very well if you win. If you lose you must either appeal to CAVC or go back and start over gathering new evidence etc. If you hire a good lawyer he/she should probably send you for an IMO and he/she will want to win the claim at the lowest possible level because they know that if they go to the BVA they will be waiting years for payment and they will have to travel multiple times no doubt on their dime. Your lawyer will request a complete copy of your C-File. This can take months and you get to the hearing and find that the VA only sent your lawyer half of your C-File. I guess I am saying if your claim is based mostly on legal issues or the process has confused or scarred you so badly that you feel that you are drowning then hire the lawyer. If you can't state your claim in one double spaced typed letter then you probable need a lawyer. The lawyer should not just tell you to get your evidence together and meet him one hour before the appeal hearing. He should present a brief at your hearing using VA precedents to show why you are entitled to SC or an increase. He should be organized and know your claim in detail. I still think using the DRO process is like having another bite at the apple before you go off to the BVA. Claims often take years to go from a 10% disability to 100%. You build your claim for higher ratings one rating at a time. My first rating was 10%. I was low balled. Some years later I got raised to 30%. When my condition got worse with time I got 70% with an IME. When I lost my job I filed for TDIU. I was denied and had to appeal as usual. I got TDIU with yet another IME, but was denied Chapter 35. I appealed this and got another IME to show that my condition was P&T. So this whole process took me 30 years because I did not know what I was doing and depended on pathetic VSO's who never even told me to get IME/IMO and had no plan for me to win an increase. The VSO's discouraged me from filing for increases and appeals even when I had SSDI. If you file a claim and get any sort of rating your foot is in the door and you can eventually get 100% or TDIU when and if your condition gets worse. Most vets get worse with time. I don't know any who started off get 30% and five years later they walk away from treatment with no symptoms or scars from their experience. They may never get worse but they never get to 0% from 30% or 50% or even 100% . There are always residuals and secondary conditions. John

Read your contract with the lawyer very carefully. You and the attorney are bound by what is in the four corners of the written contract. Whatever else is said outside of the written contract has no weight if you and your attorney come to blows over something done or not done. The lawyer may tell you this or that but the written contract is what will hold up at any legal hearing if you and the lawyer part ways. Even the best VA lawyers cannot turn a pig's ear into a silk purse. You still need the evidence. If you are going to hire a lawyer he will probably want to have a hearing with the VA at the local level if he is local lawyer. I had a lawyer for my DRO Hearing, BVA Hearing, CAVC and Federal Court Hearing. I did not win the claim, but if I had a claim again that I knew was going to be disputed I would sure pick the lawyer over a VSO. Many of the VSO's have little training and are so fearful of the vet ending up with a reduction that they settle for the least rating and least amount of retro. If someone works for me I think they should get paid by me. You get what you pay for and if you hire a lawyer who can refer you to IME's etc. then that is a good lawyer. If the lawyer wants you to do all this on your own and he just show up to collect a check forget him/her. Evidence is what wins claims and the lawyer should help you get that evidence otherwise what good are they?

Last time I saw a complete copy of my C-File at a BVA Hearing it was in such a mess the judge apologized. If they converted that mess to electronic format it will be full of repetitions, double copies of the same claims, and all sorts of crap in no time frame. It looked like somebody just threw everything into my folders in haphazard manner and not according to date. I was at BVA about five years ago. Can I assume it has been converted to electronic format. My father's entire C-file and all his personnel and medical records went up in smoke according to the St. Louis office. I do have his discharge papers and his letters. I have a copy of my file as of about five years ago and not much has happened since except losing at CAVC.

File all your claims via Certified Mail/Return Receipt before the end of the month. Why have you waited so long to file? If you file within one year of discharge there are many chronic disabilities that will be considered as service connected without having to prove the nexus.

Were you in combat or in combat zone when the headaches started? This could be physical symptom of PTSD. They used to call physical symptoms of combat stress other names I can't think of right now. People in combat zones in WWII had all sorts of physical disorders from stress.

Keep asking. As long as you got the NOD in before the deadline your appeal should be alive. Can you visit your VARO and ask to see your C-File. You NOD should be in that file. If the VA says they don't have it you have a copy and you have your certified mail receipt. I would call your VARO and ask the status of your claim. The VA is great at losing claims and stuffing a c-file and then forgetting to proceed. John

You have an official PTSD DX from the VA in your records I assume? Your therapist is not expert on VA benefits that's for sure. I would file a claim for PTSD. Any rating you get will open the door for possible HB. Let's say you get 30% the first time. Then you hire yourself an IME and maybe you get 70%. Now you have HB. Buck, you are an RVN vet, so let's assume you will probably get some presumptive rating for an AO condition. That would also help you get to the 60% level for HB. I was rated P&T TDIU in 2002. I claimed DMII presumptive for AO a couple of years later. Then I claimed PN in all four limbs as secondary to DMII. Then in 2008 I think I claimed CAD as secondary to DMII. I got 60% for that. Then I heard about Bradley v Peake and requested housebound. The VA called a CUE on themselves and granted the HB with 2 years retro. I would claim every compensable condition I had because it may pay off in the end. Mine did for me. At our age they are not likely to revisit your TDIU claim nor any of your other claims you being p&t and over 55. I think unless we get hit by a beer truck most of us Nam vets will die from an AO condition eventually. Even if the AO condition just contributes to our demise it counts towards DIC.

CUE is for final unappealed decisions. Have you gotten an independent medical opinion on your feet? If you are still in appeals an IME/IMO is the best weapon. There are many posts at hadit on how to use an IME to win a claim. Your IME comes under the category of "New Evidence". Without IME's/IMO's I would never have won my major claims with the VA.