john999

I have been trying to get reimbursement from fee base office in Tampa for about a year. When I called recently they said they lost my claims. I have copies. I will email Allison. This is not the first time the Fee Base has lost claims. They are the most incompetent department in the VA system. When I send in my claims they don't even understand what I am talking about and send me paid bills from Fee Base providers that have nothing to do with me claim.

Can I tell you that if a doctor who might have suspected OSA prescribed Xanax or Clonazepam for OSA might have killed you right there. Those drugs slow down respiration. You were already having difficulty breathing at night and perhaps actually stopping breathing at times. I have OSA and I have not tried to get it SC'ed since I have been out of the service for 45 years. I had plenty sleep problems in service, but I just thought it was normal to wake up five times a night when Arty was blasting away.

Buck Do you have a CIB or PH or any other medal or badge that shows combat? If you have those you don't need to prove a stressor. What you have is all you need to file right now which is a VA diagnosis of PTSD. I would not wait for records or anything else. I would file today and wait for the records to show up. Did you ever fire your weapon in anger? That is enough since you have a DX from the VA for PTSD. Were you ever scared for your life in Vietnam. That is a stressor according to new rules. John

It sounds like the VA is calling CUE on itself. That means you should be SC for these conditions since 2007. That should mean backpay since 2007 for all those conditions if they increase your rating. The VA does need to examine you on all these conditions. Have you been getting treatment for these conditions since you left the military? Are you only getting 10% total currently? If you have evidence of treatment for these conditions you will want to gather it and submit it along with your claims.

You may have to do IME's before and after you file your claim and get a rating. I did IME's after my claim for an increase was denied. I did three IME's to go from 30% to P&T. I did two IME's to rebut the decision to deny me TDIU after the VA granted me 70%. I got TDIU but was then denied Chapter 35. I filed another IME to get me to P&T without waiting five years. The way the VA has rigged the PTSD claims process you have to be granted a rating for PTSD via the VA before doing an IME becomes meaningful. I know about IME's/IMO's for mental health conditions, but for most other physical conditions there are probably few doctors who will go out on a limb and say your physical disability is due to service unless they are willing to read your SMR's. I know there are doctors out there that will do it for a nice fat fee. For almost all claims I would just submit all the evidence I have and try and win at the local level and avoid the standard appeals process if possible. Berta used to say you just want to "surround them with evidence" as if you were surrounding an enemy nest of snipers. You want to cut off escape routes the VA can take to deny and prolong the process. They can latch onto one word in a claim and deny it and cost you an extra two years. For secondary conditions you need that IME or medical evidence to show the link between the primary and secondary condition. Even if it is obvious to the entire world that there is a link it won't be obvious to dumbasses at the VA. My very first claim I had an IME and the VA just ignored it. I was too dumb to file my appeal within the one year time frame. It cost me a lot of grief. I think I could have gotten 100% but ended up with just 10%. I was at fault for not filing my appeal and the VA was at fault for hiding my rights from me which they did do. John

What the VA usually does if they find you unemployable due to a SC disability is to bump you up to at least 70% for a single disability. I was rated 30% for a mental health condition. I got IME's to support an unemployability rating. I also got SSDI due to the SC condition. The VA eventually bumped me up to 70% and then granted TDIU. They did hem and haw about it and I had to get an extra IME to get P&T after I got the TDIU. I have never really heard of them lowering a rating to deny TDIU. Usually, it is due to the Vet going back to work or working just enough to alert the SSA and IRS that he owes. The VA compares notes with SSA and IRS from what I have read to smoke out vets who get TDIU while working some job. Also, your SSDI award should be evidence of being TDIU since it is solely for your SC condition. Did the VA consider your SSDI award when you got TDIU? If not that is new evidence as well. I know that after 5 years at a total rating or reaching the age of 55 it is much harder to reduce a totally disabled vet. I think they are trying to reduce him because he has not been TDIU for five years. Is he 55 years old? They know that in a few years he will be beyond their reach so they are trying this lame and treacherous tactic now. Once you get this done I sure would ask for P&T so they will leave your husband alone. John

Since you have a 100% scheduler rating from the VA I would go seek treatment at the VA for your SC conditions. Even if they just give you pills and skin creams I would accept them if you use them or not. You want to show that your conditions that are making your 100% are chronic and seeking treatment at the VA is a good way to do that. Be sure and complain about your aching back and your skin conditions. If you have AS then I bet your back hurts. If they ask you how bad it hurts always say on a scale of 1-10 you are at least at a 7 and a 10 without medications. What kind of pain meds do they give you? I have a problem with my cervical spine, lower lumbar and neuropathy in my feet. Any chance I get I complain about my pain and the VA will give you plenty of chances. I still think a potential rating for Chronic Pain disorder should be considered. This covers you for physical and mental/emotional disability. The VA cannot xray your mental health, so that is just another fall back position in case they get reduction happy in the future. John

I did call "Channel 8 On Your Side" which is a local TV station about a situation with the VA. They called me back and said when it comes to the VA medical system they just stonewall them quoting privacy laws and all that bunk. I tried to get help with how the pain clinic and my PCP were taking me over the hurdles because of my sleep apnea and pain meds. Perhaps I will call Ms. Hickey. I bet my claims are at the Fee Base Office because they did call me back and said they found one of them. What is Ms. Hickey's email? You know today the VA supplied me with very expensive Provent SR Sleep Apnea Nasal Devices. There is just no rational explanation as to how they allocate resources. My Fee Base claims have not been denied or accepted. That is another whole step if they are denied which I expect. They did not ever get that far in 10 months. They immediately lost my claims. I used an authorized VA form as well for my claim. There is a claim form called "Claim for Unauthorized Expense". I used it before and got some money. Let's say you get dental care while your TDIU claim is on appeal for five years. You can be reimbursed for that money spent on your teeth while you waited for the TDIU or 100%. That is what I did before. In this present case the VA just refused to do needed and customary dental care because they did not want to spend the money. They lied to me and told me I would never miss the teeth that I lost and that I did not need replacements in form of bridge or implant. This was malpractice and vindictive cheapness. If a dentist pulls a tooth and there is a tooth that opposes the pulled tooth then they should either do an implant or a bridge if possible. If not the unopposed tooth will start to grow longer and put your bite out of whack. A student dentist knows this. John John

Do you know what an IME/IMO means? You need to get one. You don't want to rely just on the VA to get an increase for your established PTSD claim. I was just 30% when I got a couple of IME's for an increase. It cost me maybe $300 bucks. I got TDIU P&T due to the IME I got from a psychiatrist that used to work for the VA in Tampa. These doctors exist in every larger city. They often work with SSDI lawyers who refer their clients to them to help win their claims. It is much harder these days to get private psychiatrists to treat you via medicare or insurance. The insurance industry has been allowed to not pay for out-patient mental health care. Despite new laws to bring equity between physical and mental/emotional treatment it is not happening. My private shrinks no longer take Blue Cross due to changes BC/BS made to create such a burden on the doctors that they will simply not accept the insurance. Medicare only pays for 50% of allowable charge for mental health treatment. Why are they allowed to get away with this? Fortunately, I have other ways of getting this treatment paid for even though I see a VA shrink. If I need a medical opinion I can get one from doctors who have treated me for years. Depending just on the VA for anything is a big mistake IMO. A one or two time visit to an IME doctor should not cost that much considering what you stand to get if you win your claim.

I made two claims for reimbursement in November 2014 and in February 2015 using the Claim for Unauthorized Expense form. I did this before when the VA owed me money for dental care they should have provided. It was the same situation this time. I have called numerous times to Fee Base, Congressman, and to the patient advocate to no avail. Finally, today the Fee Base office in Tampa responded to tell me they had no record of my claims. This really burned my azz since they had already acknowledged that they were processing the claims back in March of 2015. Now they can't find them. Thankfully, I have copies of the claims and the evidence I used. It has taken the Fee Base Office 9 months to tell me they lost my claims. Last time I made a claim like this the Fee Base Office just threw them away and admitted it to me when I complained about them taking 6 months to process my claim for reimbursement. I got paid on that one. I will probably have to gather more evidence on the recent reimbursement claims because they will probably lose the evidence, or not connect it to the right claim. They did not have my correct address at the fee base office even though I have been at the same address for 28 years. How come my credit card company never loses statements? When and if I owe the VA they never lose these records. IRS never loses records of debts. Nobody I owe money to ever loses the records of my debts. The VA loses everything. If you carry it, and put it right into their hands they lose it. This means I must always keep copies of everything I send them and expect them to lose it. I made a complaint to the IG. The only way to get things done right is to devote yourself to seeing a claim is done, and be willing to submit, and resubmit evidence and claim forms over and over again. I have to pay estimated tax to the IRS every quarter. They never lose my checks. They cash them within days of my sending them. Does he VA log in official claims at the Fee Base Office? Do they log in claims at the VARO? Is this incompetence or just a sinister way of cheating vets by delaying payment. The VA acts like a low life insurance company that wants to delay paying claims as long as possible until you hire a lawyer. I think the VA has lost every claim I ever sent them at least once. Vets and spouses who don't have that much experience with the VA system probably give up on trying to get their claims ever done right. When they screw up every single claim you send to them you have to wonder about a system that is supposed to be helping disabled veterans many of whom are elderly and without resources to fight for years. Enough is enough! What does it take to get the US government to treat us vets like human beings? John

If I were you I would probably at least get my SC disabilities treated at the VA even if it is just a few times a year. Every time you get treated for a SC condition at the VA they document it and this builds up a mound of evidence for continuity of symptoms. I got TDIU P&T in 2002-3. I got "S" in 2008. I got the extra 60% I needed due to using the VA since the VA discovered the condition that led to my increase above and beyond the TDIU. I actually have Total plus 80% that includes one 60% rating, one 20% and four 10% ratings. I think that is 80%. Like others I would file for the Housebound. John

When I used the Choice Program the VA sent me to a crooked dentist who billed them $1000 for stuff they did not actually do. I told them and they just yawned.

The VA should just surrender when they see Berta coming their way. As a DIC spouse she has just beaten the ^%$# out of the VARO over the years. If the VA had brains they would hire her and let her work on their behalf from home. John

And they hate to loose! Is your claim a CUE? I had a lawyer who stuck with me for about 7 years on a CUE I filed. We both thought it was a slam/dunk, but we learned just how tricky the CAVC can be. Lawyers are tricky about doing vet claims where there is a lot of work and a long wait to get paid. I have filed a number of lawsuits over the years and I think most lawyers won't file cases they don't think they will win. They do want to get paid. There are about a million SSDI lawyers and a much smaller number that do VA claims. The SSDI process is orderly while VA is just trying to catch smoke. John

IME/IMO=new evidence. If the evidence is in equipoise the vet is supposed to win. Tie goes to the runner. I say "supposed" but I would want much more evidence on my side. With a DRO Hearing you get good ones and bad ones, but evidence will win in the end.

The way to win the war on drugs is to just stop fighting it. What if the vet was using cocaine to ease his pain? Should he go to jail for 100 years if he had an ounce of coke? All these drugs were legal in 19th century.. They tried Prohibition of alcohol and we know that gave birth to organized crime in the USA. The War on Drugs has turned Mexico into a narco-terrorist nation and we supply the demand for dope and fill the demand for weapons in Mexico. Many of our politicians still believe in Reefer Madness. I just can't believe it since half of them are drunks and other sorts of degenerates.

A potential claim I would consider is Chronic Pain Disorder due to you knees, feet and back. Pain Disorder is considered an emotional disorder because it involves feelings of depression, anxiety, insomnia and everything else that comes along with living with constant pain. The VA likes to compartmentalize veteran's disabilities as if they just exist in the body and not in the emotions and mind. I have chronic pain but I got TDIU for another mental health disorder. I added chronic pain due to PN in all four limbs. This just increased my overall rating and helped me get HB.

If you just got a PTSD DX from the VA I sure would file on it. I was TDIU and due to AO presumptives I got to Total plus 60% and got HB. I would get every dime I could and since you already have Total if you can add 60% to that you get more money. Do you have any AO presumptives? It is hard not to considering how many AO presumptives and secondary conditions exist. I have 6 AO presumptives and secondary conditions which amounts to 80% on their own. Buck, I think that doctor was reaching out to you. They don't bring up making claims that often as you probably know. When I had the AO exam back in 2000 the doctor told me I had three AO presumptive disorders and made a point of it. I filed on them and got the grant. John

I am appealing a medical decision not to do necessary dental work involving dental implants which ended up costing me 15 grand. The VA said that in 2010 dental implants were not standard dental care, and they did not offer them at my hospital. They just pulled teeth and made dentures. Dental implants have been around for 20 years as an alternative to bridge work. I am appealing via Fee Base Unauthorized Claims. I won one of these before when I had work done while waiting for my TDIU on appeal. It has been six months since my claims. I bet they have lost them or just tossed them, but I have copies. You know there are dentists in my part of Tampa who have applied to be VA providers and the VA just ignores them. John

I I had a horrible C&P exam back in 1997. I appealed the rating decision based on the exam. I got a new exam. The new exam was biased because the new doctor was a pal of the old C&P doctor. The new exam was even worse. What saved me were multiple IME/IMO's I got. I was in treatment for years at the time and had two private doctors to go to bat for me. They also knew good IME doctors and referred me to them. I finally got an IME doctor who was a former VA employee who knew the VA. She wrote an IME/IMO that was so good the VA just incorporated it right into their decision. She knew all the buzz words and phrases plus she was respected at the VA hospital. The VA just SC'ed me for 4 new conditions based on her IME. John

Stay in treatment!!!! Being paranoid where the VA is concerned is not all that crazy. Did you get a medical discharge from the military? I got a DX of schizophrenia from the VA in 1971 and I only got 10%. I was too down and out to file my appeal on time. That probably cost me many thousands of dollars. I am glad you got yours. How are your symptoms these days? Do anti-psychotic meds keep you sane? John

If the VA can deny and delay claims by a certain number of years vets will die, loose motivation, move geographically, and get lost. This is the goal IMO. When you really start to get a much higher rating as in 70%-100% you find that you have a major burden of time and effort. It took me about three years to go from 30% to TDIU P&T. That is including three IME's. Three DRO appeals and two C&P exams. I had been SC since 1971 but I had never really gotten serious because I could still work and had a decent job. The VARO was adversarial all the way. They went over my IME's with a microscope to find anything they could use to deny my claims for TDIU. I was already on SSDI and OPM disability for the SC condition. When I see vets putting their whole faith in the hands of some VA C&P exam doctor I shudder. If not for IME exams I would still be at 30%. I used the IME's to dispute all the assumptions the VA made that my TDIU was due to non-sc conditions. I got a lot of help here at Hadit. To show continuity of symptoms you either need to really understand the system, or be so ill or injured to be in constant treatment. I just talked to a vet at the VA who hurt his back in a crash in the service. He was treated for it in the service, but it did not start to bother him again seriously for a number of years. Therefore he did not have continuity of symptoms or treatment that he could point at to show the VA that his original disability/injury was continually affecting him. You hurt your back when you are young and it usually comes back to haunt you when you are older due to arthritis and degeneration around the original injury. However, the VA makes you prove the connection between original injury and current injury/illness. I have at least 80% rating just due to presumptives due to AO. If not for presumptive rule I would still be P&T, but would not have HB. How many 22 year olds are thinking about how they will be doing 30 years later, and planning their VA strategy to get correct compensation? You need to plan your illnesses and injuries to fit into the VA framework. Nobody really does that except in the minds of VARO's. Half of my SMR's are missing and I never even got a copy or an exit exam back in the day. At least younger vets today usually get a copy of their SMR's and get an exit exam which givers them a chance to document their illnesses and injuries one last time. John

IME/IMO is the best way to fight these bogus C&P exams. The VARO is supposed to weigh the evidence both pro and con. You pile up more evidence you can win. IME is evidence. Your get the IME to refute each and every negative assertion by the C&P exam doctor.

The VA wants to perpetuate the current system because they want to keep their jobs regardless if it hurts their clients. USA has always treated their vets badly when the war is over. It is a national tradition. WWI vets lost their pensions during the Great Depression. Revolutionary soldiers did not even get paid. Civil war vets like my ancestors got $60 a month when they were determined to be Indigent.

$500 for a good IME is cheap. Does he take insurance? Some IME doctors will take insurance and you pay what is left. I had an IME here in Tampa and that was the case. I paid about $100 out of pocket. When you go for the IME be sure to take C-File and SMR's for his to review. Even if he just glances at them it is important.