NavyWife

Good advice broncovet! Sounds like a pretty good case for TDIU.

Thanks georgiapapa! Today hubby received his first full check including the dependency pay! That's sure nice to see in the bank account, but I do feel like I aged 5 years over the past 12 months of researching & being worried about his claim.

Green: If you haven't already done so, Start your VONAP claim to lock in your claim date. Once locked in, your good for 364 days to complete the actual filing. If you get all your medical evidence together, file an FDC. It recently took me (4) months to get a secondary SC'd. Do you really need a lawyer at this point, possibly not? As it stands right now, you don't have a secondary claim pending with a possible large Reto waiting, do you? If you haven't received a Claim Denial and there isn't a large retro payment in the offing, might be very difficult to get a VA Attorney for 20% of not very much. Give the VONAP & FDC a try, if it works, go for IU. When you get into IU claims, the Reto gets fairly large. You have to remember, most attorneys charge about $150.00 per hr normally. Hard for them to sign on at 20% of a low retro award that might take a large number of billable hrs.

As for some of your about to be Claimed Secondary Conditions being eligible for Back Pay (Retro), might be tuff. Generally the file date of the claim unless it qualifiys for the 12 month look back. It sounds that these different conditions all presented since your original claim was awarded. No mention of BVA Appeal with any of your secondary issues, right. I could be wrong but it appears that your original claim was awarded and became final after the 1 year appeal period. Then at some time post original award it was increased due to your request for an increase. That award also became final after the 1 year appeal period. If you never claimed these secondary conditions, I believe your award date will be your File Date of your NEW Secondary Issue 2014. The Award will be based on the Claim Filing Date 2014 not the DX date???? of the condition. I was DX'd CAD 2006, filed Claim 07/2008, denied then Nehmered 2011 back to original claim date of 2008. Get your claim filed, let the VA figure out the rest.

Semper Fi

Gastone

My discussions with the attorney were geared towards an independent view of my claim. I have not been denied and as such I do not have the ability to hire an attorney to represent me. So I've broken the process down to the following steps:

Gather all evidence of secondary conditions
Seek additional medical opinions outside the VA where the VA evidence is less than overwhelming
Put together and process an expedited claim
Wait for the decision

If they deny I will review and submit further evidence with the help of an attorney.

Berta, I have worked to this point but my issues are making it much more difficult. I'm eligible for retirement in about 3 years so I'm really trying to hit that date. If I can't, I'll file for unemployability due to disability (given my issues it would be a logical decision to approve, my thought anyway).

I'm hoping to submit all the paperwork by the beginning of the calendar year.

Green

Love the Google Search claims box- worked well on test search for PTSD and Apnea. I even modified to Apnea 2014 and it brought up posts including that.

Great idea having Ebenefits Questions and FAQs under VA Claims Forum. I also like the Tips for Veterans Applying for VA Benefits near the top.

You probably already give newbies info on posting but some tips I see which could help are:

1. Post a clear title like 'Need help preparing PTSD claim' or "VA med center won't schedule my surgery" instead of 'I have a question'.
Knowledgable people who don't have time to read all posts may skip yours if your need isn't clear in the title.
I don't read all posts every login and will gravitate towards those I have more info on.

2. Use paragraphs instead of one huge, rambling introduction or story.
Again - You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.
Leading to:

3. Post clear questions and then give background info on them.
Example is:
A. I was previously denied for apnea - Should I refile a claim?
I was diagnosed with apnea in service and recived a CPAP machine but claim was denied in 2008. Should I refile?

B. I may have PTSD- how can I be sure?
I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?

This gives members a starting point to ask clarifying questions like "Can you post the Reasons for Denial from your claim?" etc.

I'm not singling out any members here; these are common issues I see in many posts and have probably done myself.

Thanks, T!

I like the suggestions Kelly, I would like to have a discussion forum for vets that can just chat back forth and it actually helps how and what all they did to win their claim...I read interesting stories about claims, I don't get out much and hadit actually helps me kinda a theraphy for me just reading post and reading bout what other veterans has went through....I wish I could help out more.

Thanks Ms T For all your hard work, in my opinion out of all the web sites on the internet to help veterans with there claims and how to cut time down wining their claim Hadit is number One!

Its the new "shreddergate". Instead of your key evidence winding up in the shredder bin, they simply drop it in another claimants file, where it will be lost for a very long time if not forever.

Im thinking you need to write ask bob to fix this one. Its crazy to make the veteran wait four years or more for an appeal when its the va fault for shuffling yours and another vets file.

It's time for us to OWN these a%$klownz.

I think the worked 5 out of the last 10 years will work against you. That is that many quarters of insured work (as in insured with Social Security).
My husband applied in Spring 2006. He ran out of "insured status" December 2005. He retired from the military in 1998, and then went to school. He did some teaching after that, but that paid into SURS (State University Retirement) instead of SSA.

So at first they told him he wasn't eligible because he was no longer insured. We pointed out that he became disabled BEFORE December 2005 - and thus he was disabled while still under insured status.

So, yes - you can qualify if you can show you were disabled while you were still insured under SSD. But that is not very hopeful if you have to go 30 years back.

There might be other ways to qualify for benefits. If your spouse is retired, deceased, disabled - you could qualify for benefits on their record (i.e. on their insured status). But you would need to check on the Government Pension Offset -- http://retirement.federaltimes.com/2013/04/02/government-pension-offset-and-windfall-elimination-provision/

Even drawing your own benefits, you would want to check information on the Windfall Elimination provision. http://www.federalretirement.net/social_security.htm

Basically, as a Federal Retiree, SSD benefits you would draw on your own record would be reduced under the Windfall Elimination Provision. Benefits you would draw on someone else's record would be reduced under the Government Pension Offset.

The program for those who have not paid into the system, or who have not paid enough in to draw above poverty level SSDI is the SSI program. It is a needs based program that is pretty strict about the amount of money you can have coming in and the amount of assets you can have.

"Typically, if you are 31 or older, you must have worked at least 5 of the last 10 years to keep up your SSD coverage.

Even if you haven't worked for a long time, you might still be eligible for SSD benefits if your medical records show that your established onset date (EOD) of your disability precedes your DLI (date last insured). In other words, if you can prove that you became disabled before your federal disability insurance lapsed, you could still file for SSDI..."
http://www.disabilitysecrets.com/page11-4.html

The way VA has been ignoring C-file requests it may not affect your claim at all.

I wouldn't worry about it.

This link has an example

http://www.hadit.com/forums/index.php?app=core&module=attach&section=attach&attach_id=6544

And this link is to a topic regarding IMO IME

"do they reallly look at you like a person when they rate you? or do they look at the individual things separately? because any one of these by itself would be ok but when you combine the things i have already been rated for i can hardly even function let alone get and keep a job".

"I didn't apply for compensation on things that are wrong and things that i have military medical records and can prove because i was afraid if my va pcp didn't seem to be worried about them then nobody else at the VA would care either. do any of these things matter to the VA and should i file for them or try to get help with them?"

The VA compensation system does not really look at you as a whole. (Despite statements to the contrary.) The rating system is a divide and analyze methodology.
Thus, unless driven to do so, each detail or disability is looked at separately, decided, and assigned a percentage.
The rating scheme eventually uses "VA math" in such way that each succeeding lower rated disability is given less importance than the percentage would indicate.

There is a significant separation between the compensation system and the medical treatment system.
Your VA PCP should know some of the background that led to the problems that need medical treatment.
(But only that is necessary. The PCP has enough to do, given the current VA problems).

What you do or don't do concerning the compensation side should be determined more by what you can reasonably prove, rather than
any other concern. Treatment records are quite important, as are records that show a connection to military service.

It's certainly your choice as to what you do or don't feel that compensation is applicable.The VA has other ideas, and by default, thinks that
you are not due any compensation, unless you can "prove" otherwise.

Compensation and so forth are part of a contract that you and the government entered into when you joined the military and served.
Since you fulfilled your part, the government is obligated to fulfill their's. Obviously, the VA and the government would prefer to minimize that obligation
whenever possible.

Fighting for what you are entitled to is, regrettably, standard practice when the VA is involved.

As you age, many injuries that you received in the past come back to haunt, even some that seemed minor at the time.

Call Bob!

NavyWife,

I was impressed with the examples you provided from David Anaise. He has some great credentials and as a doctor and veteran's attorney his perspective when writing an IMO covers both the medical requirements of a good IMO and the legal considerations required to comply with VA policies, 38 cfr 4 and other applicable federal law. If I had the need for an IMO, I would definitely consider using David Anaise.

Thanks...

This link has an example

http://www.hadit.com/forums/index.php?app=core&module=attach&section=attach&attach_id=6544

And this link is to a topic regarding IMO IME

email from Bob Walsh:

"Appeals court holds VA secretary in contempt

Agency withheld care for critically ill patients disability claim

By Jim McElhatton - The Washington Times - Monday, December 1, 2014

A federal appeals court is holding the Veterans Affairs secretary in contempt after the department spent nearly two years ignoring a court order to process paperwork for a veteran's disability claim. The ruling last week by the U.S. Court of Appeals for Veterans Claims included some unusually blunt and colorful language criticizing the VA's excuse that put the blame on mail-processing delays and an "overburdened system."

"This inaction conjures a vision of a drowning man watched by a lifeguard in a nearby boat equipped with life preservers and rescue ropes who decides to do nothing even though the drowning man is blowing a whistle and firing flares to call attention to his plight," two judges on the three-judge panel wrote. A third judge dissented, saying the case didn't merit a contempt finding. The case comes as the giant VA bureaucracy faces a massive management overhaul in the wake of whistleblower reports of delays and doctoring of performance data at the department's health care network for veterans. The troubles cost former VA Secretary Eric K. Shinseki his post this spring, with President Obama appointing former corporate executive Robert McDonald to clean up the agency.

But even in the VA, where veterans are frustrated by an agency that "seemingly has acted with little urgency" on disability claim appeals, the case of veteran Gene Groves, of Texas, stands out, according to the judges. The ruling stemmed from an earlier decision in 2012, when the court remanded a case back to the VA's Board of Veteran Appeals for further proceedings. But the VA's internal computer tracking system showed the "remand" decision as an "affirmance" ruling that sided with the VA.

Mr. Grove sent the VA multiple letters pointing out the error, but nobody responded until earlier this year, when the agency's own appeals board ruled that a reduction in his post-traumatic stress disability rating was improper anyway.

Left unresolved, however, is why it took the VA so long to correct a data entry error in spite of numerous letters alerting the agency to the mistake passing through the hands of many employees. In court papers, the VA acknowledged getting at least four letters but blamed the mix-up on "problems VA had in handling the mail."

One VA official said that those problems have since been fixed and that VA shouldn't have an issue of "not being able to account for mail received," according to court records.
The judges, however, dismissed arguments that the delay was caused by an "overburdened system," saying the VA essentially put their court order in a "dead letter" box.
The situation affected more than one veteran, the judges added.

"The inattention the secretary afforded the court's remand order saps public confidence in the court and the fair adjudication of veterans benefits and impugns the court's dignity," the judges wrote. In the ruling, the panel ordered that the VA pay Mr. Groves' legal expenses and that copies of the ruling be sent to several top VA officials and the agency's Office of Inspector General."

This court got it right. I wonder if the VA will put this ruling in a dead letter box, too...

If you are 55yo (or older), or you've had your condition for five yrs or more, w/o improvement, the VA is supposed to consider you P&T, period.

pr

When you don't get P&T that means you are denied Chapter 35 benefits. I got TDIU and was specifically denied Chapter 35. I appealed it. It took a year for the appeal. I got an IME saying my condition was permanent, and the VA also looked back over the last year since I got TDIU and agreed I was entitled to Chapter 35. My P&T was retroactive to the day I got TDIU. Even that date was moved back about six months from the time I first filed for IU because I had been on SSDI. If I had not appealed the effective date I would not have gotten paid back for some dental work I had done while waiting for my TDIU. The VA moves so slowly I say appeal any denial of anything right away. If you got 100% the VA should have considered "housebound". If the VA did not mention housebound then I believe they did not consider it, so I would appeal that as well. I had P&T plus 80% and the VA never granted me "S" until I filed a claim/inquiry as to why? They called a CUE on themselves and granted it. What I am saying is that if you don't ask for something with the VA you often don't get it even if you are not supposed to HAVE to ask. I paid a very steep price for not appealing my first low ball rating in 1973. Since then I have appealed most of my VA decisions if it was worth it. I am in federal court right now trying to get that first low ball rating reconsidered since the rating was dripping with errors and omissions. The CUE hurdle is might high as AskNod can tell you.


John

Mike


If you are just trading for yourself and taking gains and loses I don't think that would be earned income. I think if you were on VA compensation, as in TDIU, and you were day trading that would be a good case for a sanity hearing. Because I hired a money manager who rather drastically reallocated some of my assets I had some big capital gains of the long term type this year. These are passive gains. I am just hoping I am still in the 15% actual tax bracket, so I don't have to pay the capital gains tax. Capitalism is a wonderful thing for those who have some money to invest. I am in a low actual tax bracket because I have only SSD, pitiful civil service pension and investment income (interest, dividends and capital gains). Last year I paid no tax on qualified dividends and long term capital gains being below the 15% tax bracket. If you had say 20,000 in what is considered regular taxable income the income you got from dividends and capital gains would not even be taxed. You could earn $100,000 in long term capital gains and not pay a penny in tax. Ah, to be part of the 1%. This is why Warren Buffet says he is in a lower tax bracket than his secretary who works for her money while he just takes capital gains and loses and dividends. He made probably a couple of billion bucks last year and paid zero tax. Well, maybe he paid tax on his SSA, but I doubt it. I, a disabled vet on SSDI, paid tax on my OPM disability pension and on my SSDI because I had made some interest income and short term capital gains and because my OPM disability pension is fully taxable. I paid more tax than the founder of Microsoft, Bill Gates, because he lives on capital gains. He has 60 billion dollars and the manager of the local grocery store pays more tax than he does. He could afford to be a day trader, but he gets his kicks giving away money. He can't give it away fast enough.


John

John

You can also get rated either TDIU or 100%, if your IBS interferes w/your ability to work. I've helped 2 vets get TDIU for IBS.

pr

Thank you NavyWife. I did send him an email and soon I received a call about granting part of my claim. The convalescence 100% for 6 months. But everything else on claim is deferred for medial opinion. Already had my c&p exams but they were not favorable and contained a lot of errors of what they said and did. Both exams i basically sat in a room while they typed on their computer. 6 months is good but after 6 months I will be in the same boat. And HUD-VASH did contact me but 1-2 months later still no word.

C&Ps are a game and you may have a positive outcome in spite of what you feel is a bad C&P.

That being said, my last C&P sucked and I got bad results now under appeal.

Good advice above; assume the worst and prepare countering evidence and present it all in a simple format on Form 21-4138 http://www.vba.va.gov/pubs/forms/VBA-21-4138-ARE.pdf

To clarify, At this appointment were you there for three separate issues?
1. Increase already Service-connected TBI
2. New claim for Ménière's or dizziness
3. New claim for migraines


You can appeal ANYTHING with the VA! As a wise member on here- john999- posted once, he would appeal it if VA made him King for the day! ha ha

Just remember when you're appealing or asking for a reconsideration with New and Material evidence, the goal is to specifically dispute the reasons they denied you. For example if they deny you because the doctor did not give you a diagnosis, then go to a doctor get a diagnosis and submit that. Or If they deny you because there's no Nexus statement a.k.a. a connection between your military service and your current diagnosis--Then go to your own doctor and get that Nexus statement where the doctor says your current diagnosis was most likely caused by the military.


Getting those DBQ's is a great idea! But if these issues are not service connected yet --you absolutely have to tell the doctor to write the Nexus statement on the DBQ in the Remarks section.