NavyWife

For any issue that has previously been denied you need to find out what was the exact reason it was denied and then provide evidence to overcome that denial.

For example if it was denied due to "no diagnosis ", Then you would want to seek out a doctor on your own and get the diagnosis.

If it was denied due to "severity level is not high enough to meet a compensable rating ", Then you would want to have your own doctor write a letter stating what your severity level is.


Here are some good links you may want to check out.

http://www.benefits.va.gov/compensation/dbq_ListBySymptom.asp


http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38

As of right now I wouldn't do anything else.

First, Find out if your claim is an FDC or not.

Before we get too ahead of ourselves I see that the treatment for seizures was through the VA.

But did the seizures BEGIN while you were still in the military? If so then you need to find some medical records --from the military --showing symptoms, diagnosis or treatment. But if the seizures did not begin while you were in the military then that would not be a claim to file.

Your claim is very likely to run into an issue called pyramiding. It means that VA won't pay twice for the same symptoms. Ménière's and minor seizures have a lot of the same symptoms.

You really need to figure out which one you have so that you can make the best case for your claim. Also you want to figure out which one has the best medical records showing treatment and diagnosis to help prove your claim.

helman35,

Good advice from NavyWife. By the time I post this, she may have already responded but an FDC is a Fully Developed Claim. Go to the VA website for info on Fully Developed Claims.

I am not a medical professional but according to the info I have read, your symptoms and the abnormal ENG test seem to support a diagnosis of Meniere's Disease.

Have you been examined by a Otalaryngologist (ENT doctor) who specializes in Meniere's Disease? If not, you should consider doing so, preferably with a private specialist. The Meniere's Disease specialist will confirm or rule out Meniere's Disease. If the specialist confirms a diagnosis of Meniere's Disease, you should ask the doctor to provide you with an IMO (Independent Medical Opinion) to support your claim. See the IMO section on the Hadit website for info on an IMO format. If your symptoms are shown in your SMRs (Service Medical Records), you should take these records and your relevant VA medical records with you to the exam by the specialist. The specialist would then be in a better position to render a supporting opinion in the IMO that they have reviewed your SMRs and VA medical records and based on their review of the records and their test results, you have Meniere's Disease and there is a nexus between your Meniere's Disase and your military service.

Please keep in mind, your C & P exam will probably be performed by a nurse practitioner or physician's assistant. I would not depend on the C & P examiner to diagnosis your medical condition. They will probably base their opinion on the medical evidence provided to them at the exam as well as your responses to specific questions they will ask you from a checklist. JMO

Georgiapapa.

Lots of people give up with the VA because they make it excruciatingly difficult. You're not alone there!

A FDC is a fully developed claim. It means you have all the evidence and medical records to prove your claim and you submit them all at once.

A TBI is a traumatic brain injury. I see they have head injury listed in your list of claims.

No a diagnosis and treatment are not the same.

Do you have a copy of your service medical record or medical records from the treatment of these issues?



If this was filed as a normal claim, Since the claim was just opened last month it would be okay to add seizures now, if you want.

But if it was filed as a fully developed claim then you may want to wait, there are special rules for FDC claims.

Is the American legion or someone helping you with this claim now?

Below I have copied and pasted what the rating schedule says.

Here is the link.

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#sg38.1.4_180_64_184.sg2

6204 Peripheral vestibular disorders:
Dizziness and occasional staggering 30
Occasional dizziness 10


Note: Objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under this code. Hearing impairment or suppuration shall be separately rated and combined.


6205 Meniere's syndrome (endolymphatic hydrops):
Hearing impairment with attacks of vertigo and cerebellar gait occurring more than once weekly, with or without tinnitus 100
Hearing impairment with attacks of vertigo and cerebellar gait occurring from one to four times a month, with or without tinnitus 60
Hearing impairment with vertigo less than once a month, with or without tinnitus 30
Note: Evaluate Meniere's syndrome either under these criteria or by separately evaluating vertigo (as a peripheral vestibular disorder), hearing impairment, and tinnitus, whichever method results in a higher overall evaluation. But do not combine an evaluation for hearing impairment, tinnitus, or vertigo with an evaluation under diagnostic code 6205.

Seizures are extremely complex. Even the doctors and researchers do not fully understand them.


From what you have described, dizzy spells & loss of balance --that could be minor seizures. They have many names such as partial, complex, etc. Not everyone has major seizures--those involve convulsions and black outs.

But it could also be Meneire's.... There is usually a hearing loss that goes along with it.

What exactly have you been diagnosed with?? Seizures or Meneire's.

Did you have a head injury while in service? If it is documented, you may want to file for TBI at some point.

If you have been diagnosed with seizures, and it is currently bothering you, then at some point you may want to file a claim for that.

How long ago did you file this claim? Is it an FDC claim?

If you cant handle the stress of trying for an increase, then have someone do it for you. A spouse, a VSO, an attorney, or a friend..you choose. You can just give em the paperwork and dont check to see how its going.
This will give at least as good a result as doing nothing.
Ask your rep not to contact you until there is a decision. Or, dont even look for a decision, just do something else..get a hobby. Some people do well without "baby sitting" their claim constantly. Sometimes, a watched pot never boils.

The reason I ask if it is your first ever claim and fully developed claim is because VA is offering additional retro for those specific type of claims that meet those two conditions.

Here's the link.

http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2464

I guess check with your VSO what type of claim he filed for you.

Sorry to hear about these health issues you are having.

Yes definetely pursue these gwi claims and also pursue getting medical treatment for them.

I wasn't saying don't pursue them, just letting you know they can be very difficult to win. At the end of the day, it doesn't really matter whether your claim is approved for gwi issues or ptsd, just that it GETS APPROVED :)

I read about your ptsd claim and it sounds pretty solid to me. Just get that diagnosis from a VA Psychiatrist or VA PhD level Psychologist. These are the only 2 kinds of doctors VA will accept the diagnosis from.

I would focus on making a really strong claim for PTSD. If you can get rated at 70% and you aren't working then you could file for TDIU.


Gulf War illness claims can be incredibly difficult to win. A lot of the VAROs don't really understand the rules on how to process them regarding the diagnosed issues versus undiagnosed, then the presumptive regulations Versus needing a nexus statement. They're very complicated claims.

Good job being proactive and asking to see a different Healthcare provider. But a month seems like a really long time. If that is not acceptable to you then you need to keep asking for a sooner appointment with a psychologist or psychiatrist only.

It's unfortunate that the social worker is not recording in his notes accurately What you are telling him. But the good news is that he is not a psychologist or psychiatrist and certainly not a doctor. So it should be fairly easy to dispute anything he wrote-if it comes to that.

When you have your appointment with the psychologist say, "I would like to be evaluated for PTSD ". If they give you an official diagnosis that will dramatically help with your VA claim for ptsd.

With your CIB, and combat time, the stressor should be conceded (they accept it).

With the PTSD claim the three main parts are:
1. Get diagnosed by a VA psychologist or psychiatrist
2. Get the stressor approved-yours should be approved automatically
3. Get a proper rating based on how severe your symptoms are. You can do this at the C&P exam as well as in your appointments with the new psychologist. Many veterans will get approved for PTSD but start out with a lowball rating. You can help yourself by accurately describing your symptoms according to how you feel on your worst days, Not just the day you are there. You also want to make sure and point out how this issue is causing you to not be able to work full time.

Here is how the claims are rated.

General Rating Formula for Mental Disorders

Rating
Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 100

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 70

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 50

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 30

Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. 10

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. 0

PTSD Group Therapy, anyone? Things may have changed but I doubt it. Back in 2008, every time I saw my VA Primary Care Dr, she'd ask about PTSD symptoms and I said I really didn't want to talk to anyone. Jump ahead about a year or so. I'm discussing my Sleep Apnea with the VA Sleep Disorder PA. He's a retired USA Col. During our 3rd or 4th meeting he starts asking some very pointed questions. After which he directs me to go immediately down to my Prim Care Dr and tell her I want treatment for PTSD and if there are any questions, to call him. I did as he instructed, a PTSD Symptom sheet was completed and scored by the DR. I was refered to the Mental Health Dept where another PTSD screening was administered by a Nurse and scored again. After which she asked me to choose between seeing a Psych Dr or joining a PTSD Group Treatment program with a Mental Health Social Worker. About 6 mos later I had a PTSD C&P and about 4mos later was SC for PTSD. Attended group sessions on a weekly basis and once a month Individual meetings with the Social Worker for about 21/2 years. To the best of my knowledge, the PTSD Group Sessions are still part of the PTSD treatment options

As for the actual PTSD DX for compensation purposes, the C&P Psychiatrist or Psycologist PhD. determination as to what exact mental health issues are at play, will be the final determination. Other Drs opinions and possible DX will be looked at but under the VA's New PTSD Regs, the C&P Dr's DX is the one that counts. Check out the PTSD DBQ and study the New DSM V. How do your symtoms measure up? Be prepaired. Do the Lawyer thing, try to know the answer to the question before it's asked.

Good Luck

Semper Fi

Gastone

This is one of the VERY bad things wrong with VA. They dont have to adjuticate your claim, they can simply forget it until you die. This said, you dont have to take this treatment lying down.

Try these things:
1. Send an IRIS email asking your status on IHD claim.
2. Send a 21-4138 asking for your status, and reference your earlier claim date, sending a copy if necessary. Send the new one, to one of the 2 RO's where they scan em in. I beleive those are called data management centers.
3. Send an email to Robert McDonald, or Allison Hickey.
4. Call em.
5. Show up at your RO and ask why this 5 year old claim has not been adjuticated.
6. Resubmit the claim, if necessary, and reference and copy your initial claim for an eed.
7. You can also consider a Writ of Mandamus at CAVC requesting an adjutication.
8. If none of these things are productive, contact your congressman.

The CAVC has something called a "deemed denial" because what you indicate happens often enough that they even have a name for it. However, there have been more recent cases that "deemed denials" must indicate you got a decision and the decision led reasonably indicates a denial. You can appeal a case on a faulty "reasons and bases", that is, they denied it and did not give a reason. You could try appealing the deemed denial.

63sierra, always to the point. I kind of agree there has to be some accountability and changes in order for the VA's track record to change for the better. I believe the Honorable Secratary is doing the best he can, unfortunately the changes do not happen overnight. Cant change years of common practices overnight. I believe just as in a business if the employees and overseers forget what their purpose is, the customer, namely Veterans and their dependants, then the mission will become lost. JMO

Dear Mr. Mc Donald
I want to thank you for your service to Veterans. Many Veterans have indicated you are making a difference.
I have a simple suggestion on how to expand your "Ask Bob" emails. I love your ask Bob emails and many Vets like them also.
I do think he should be implementing this "email Bob" more nationally. In other words, we should email our VARO director, and that VARO director should solve the problem and divide his work load by 57 regional offices.
Maybe the complaints are "tracked", and there needs to be follow up...something like this:
(My suggestion for an email follows):

Dear Mary Smith (VARO director, St. Pete RO, a hypothetical name)
Im forwarding this email I got from a Veteran in St. Augustine Florida. Please check this out and report back to me in 30 days or less what the result was. Thank you
Robert McDonald

Then, these complaints should be tracked..and Mr. McDonald should respond, if nothing happens like this:

Dear Mary Smith, VARO Director:
A month ago, I forwarded you an email from Joe Veteran, in St. Augustive, and asked you to get back to me when you had checked it out. Since I have not heard anything, please call my office right away, and explain why you have not taken any action. If you were(are) gone on leave, please have your Assistant Director Call me and explain what happened.
Robert McDonald.
End suggested emails.

Notice that "follow up" is not recommended, its mandantory. This will keep the pressure on to do their job right.

Good luck on that, how about setting your bank account up to notify you via Txt & Email of all deposits and withdrawles. Vets usually have the Retr Deposit well in advance of receiving the actual award.

You indicated a SOC not a S-SOC, right. What exactly did it say? You may be able to get close by careful review of what the Rater put in the SOC.

If yours has been a long wait, don't run yourself into the ground, sounds like your going to have some sort of conclusion shortly. Phone calls will just drive you nuts going in circles. If you absolutely have to do something, take your SOC to the VRO's main office usually at your VARO. Call to make an appointment with the Head Guy/Women in charge. The VRO at VARO have greater access to your Appeal Info than the field offices not to mention more seasoned and experienced Reps. Sometimes the VSO can walk accross the hall to the VA Rating Dept and talk to someone they know.

Semper Fi

Gastone

If you went through a VSO they may know.

Wow, you had a goal and completed that goal.. This topic should be featured in what you can achieve with hadit and alot of hard work..

I agree Coffman was a little hard on the new VASEC. I do understand why, tho. We have seen a lot of VASECS and each one seems to make big promises and deliver a whole lot less, or even make things worse.
All that said, Robert McDonald seems to have gotten at least some things right. I like his idea about emailing him or Allison Hickey with problems. What I cant understand is why this did not happen earlier.
I am concerned, tho, that Mr. McDonald will "burn out" trying to help Veterans personally, especially when he was attacked like that.
I wish Mr. McDonald well.
I do think he should be implementing this "email Bob" more nationally. In other words, we should email our VARO director, and that VARO director should solve the problem and divide his work load by 57 regional offices.
Maybe the complaints are "tracked", and there needs to be follow up...something like this:
(My suggestion for an email follows):

Dear Mary Smith (VARO director, St. Pete RO, a hypothetical name)
Im forwarding this email I got from a Veteran in St. Augustine Florida. Please check this out and report back to me in 30 days or less what the result was. Thank you
Robert McDonald

Then, these complaints should be tracked..and Mr. McDonald should respond, if nothing happens like this:

Dear Mary Smith, VARO Director:
A month ago, I forwarded you an email from Joe Veteran, in St. Augustive, and asked you to get back to me when you had checked it out. Since I have not heard anything, please call my office right away, and explain why you have not taken any action. If you were(are) gone on leave, please have your Assistant Director Call me and explain what happened.
Robert McDonald.
End suggested emails.

Notice that "follow up" is not recommended, its mandantory. This will keep the pressure on to do their job right.

I like what the Sec McD said to Coffman '' offered Coffman his cell phone and said ''you can answer some of the calls and see if I am making a difference for veterans''
I believe the new sec will make a difference he just needs time!

JMO

HOORAH - Keep up the good work Allison! Sometimes all it takes is a simple response, a text, or IM. See, your response signifies that there is life at the end of the claim tunnel. We know the claims folks are busy, GOD knows we do, but I work at the VA and I can recall several times sending a very short email to my VSO asking for a status update and he would delete my email without reading it or read it and just never respond. That's where the frustration comes in.

So, kudos and Hoorah to you for sending this email. Its timely, its full of kindness and I truly THANK YOU for taking a moment to see us as people/Vets and not just another claim or SSN number.

About 20 minutes ago Ms. Hickey replied to me via email I was out shoveling snow and just saw her reply.

She is contacting the Director of the Buffalo VARO regarding my pending CUE issue.

My evidence is solid and if they apply basic VA case law (38 CFR 4.6) I will be happy.

38 CFR 4.6 is Not a Duty to assist regulation.

Thanks, the director of my VARO just emailed me and will contact me tomorrow regarding my issues.Probably by phone, I think..

WOW Congrats!!!!

P & T means the dependents are most surely eligible for both CHAMPVA and Chapter 35 DEA educational benefits.

I have both and have used both and they are wonderful benefits for a spouse and/or children of a P & T vet to get

Plus the property tax stuff if available in your locale.

I even get a break on my fishing license.

The Chapter 35 apps usually come enclosed with the award letter.

CHAMPVA is different but your spouse can apply on line at the CHAMPVA web site.

I have the medical care I want and still pay my 50 buck annual co pay but if I ever sign up for Meds by mail, no co pay on my meds.

A CHAMPVA booklet, if the wife signs up for this benefit, has a wealth of info in it.

When a CHAMPVA dependent spouse receives age 65 ,they must get Medicare Part A and Part B for continued CHAMPVA
eligibility.

NavyWife,

GREAT, GREAT, GREAT NEWS!!!! Can you remind me again, what his %s were and for what before the 100%? How long was he SC for? I am so happy for you guys, and so scared for me. As you know I have a lot of Chronic Health Issues and yet no Permanent. Now I find out that I have a ton of C&Ps over the next two weeks, to include a PTSD Review Exam next week. Take advantage of every benefit in Texas that you get. Remember also that if your hubby has School Loans that those can be forgiven, as I did this last year. God Bless You and your Husband for the Sacrifices you both have given for so long, and God Bless you for sticking with him thru it all. I am truly blessed that my Wife is there for me too.