NavyWife

You can appeal that denial of Chapter 35 and I would do it if I were you. By the time they review your records for the appeal a year will have gone by with no improvement. That is basis for P&T. Also file for SSDI which will help get you P&T.

Unfortunately, that's what "free care" gets you. I use my Medicare and my Medicare supplement plan. I may have to pay a little out of pocket but at least I have a "choice." I find the VAMC's often reschedule appointments. This is their way of appearing to see the veteran in a timely manner but not really doing it. Just another way of juggling to books, so they get their bonuses.

jmo
pr

Sorry to hear of your troubles. I am having the same issues for a couple of conditions, that I have had multiple C&Ps for and the Docs either wont look at my Evidence or not even reading the DBQs. What I do so I don't get locked up for years in the Appeals process, I just reopen the denied condition on a New FDC Claim. Good luck and keep us posted

If you disagree the a C&P exam the best thing to do is to get your own opinion from a doctor you choose. By the time you get the C&P exam you are usually just a short step from a rating. I was examined by a NPRN for my heart as secondary to DMII. She did not do an exam. She just made wild guesses about my condition. I knew I was going to get screwed. I got some real testing done and appealed the 0% rating I got. On appeal I got 60% due to exams I got and testing I got. I went from 30% to 70% TDIU P&T based on a couple of IME's. I also appealed a rating based on biased C&P exam. It went to the BVA and three years later I got another inept exam from the VA, but that is when I got my own IME's.

I think you could get reimbursed once you prove via medical evidence that your eating disorder is the factor that made you pass out and bust your teeth. You need a medical doctor who treats you anorexia to say this I think. Have you had fainting spells before? Once you get the opinion from your doctor that it was the anorexia that caused you to fall then I think you can get the rest service connected and reimbursed. You know you have to connect all the dots yourself via the medical evidence. Example: You are SC for eating disorder. Due to eating disorder your blood pressure dropped and you fainted. Because you fainted due to anorexia you smacked your face. Your injuries are due, therefore, to your SC condition. If there is such a thing as "fainting disorder" you want to get that SC'ed because it is likely to happen again. Have you been to "Slip and Falls" clinic? I went because due to my feet and medications I take I have fallen in the past. They did some tests on me and found I had abnormal gait. Anyway, you just have to prove all the factors of your tooth damage are service connected as secondary to anorexia. I think I would put in a claim at Fee Base for the dental damage. I did it while waiting for TDIU. I spent money on my teeth. I got reimbursed. I used claim for unauthorized expense. This is what fee base told me to do.

John

I've waited months for appointments in Phoenx, Vegas and Portland only to have them call morning of and cancel - they then wrote it down as a "no-show" until I called and argued it.

They treat the ER as a day clinic and jaded ER staff are in no hurry to process the mountain quickly.

I came up with a saying for the awful San Francisco hospital: "Don't go to the VA unless you can STAY all DAY."

The VA is the epitome of a soulless, heartless, union-infested bureaucracy that should be shut down.

Just an update on my situation that might give a bit of encouragement to those veterans out there waiting. Emailed Mr. McDonald regarding a dependency situation and three days later it was resolved.

Robert.a.mcdonald@va.gov

I believe he really does want to help vets.

Vync,
That is totally redictlous I would email Robert ''Bob'' McDonald on that! This nonesense has to stop..if it keeps happening what the hell can us vets do? Most of us depend on VA Healthcare ... I can't afford to see a Private Dr.& the majority of veterans can't.

I don't think it matters what your rating is or what group your in its happeing to all of us no matter what.
you could be a General and still have to wait for the long appointments.
Makes me sick to see a disabled Vet that needs emergency care and has to sit in ER for 12 hours. grrrr

TBI ---examiner marked the box corresponding with 10%
Migraines. ---0%
Mental disorder ---10%

PTSD --examiner did not diagnose. Instead they diagnosed with ICD 9 code 310.1 personality change
http://www.icd9data.com/2012/Volume1/290-319/300-316/310/310.1.htm

For the mental disorder the examiner marked the box corresponding with 10%. But they might Only give one 10% rating that would cover both the TBI and the mental disorder because On question number three --differentiation of symptoms --they said they could not differentiate the symptoms of the TBI and the mental disorder.

Here's the rating schedule. TBI is under neurological
http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#sg38.1.4_1119.sg12

These are the opinions of the examiner and the rater now has to review this plus any other evidence in your file to determine your rating.

Just remember the way the TBI is rated it doesn't really matter the severity of the accident --what matters is the residuals or how it is affecting you now in your day-to-day life.

Try e-mailing VA Secretary McDonald. It has worked for others on this website.

Good luck.

Got the word today.. 50%, I really appreciate all of the feedback. This was an FDC claim so im not sure if it still has this status.. started in October 2013

On the knee issue--
I'm not sure if I'm understanding exactly, and please correct me. But it sounds like you're saying you had a diagnosis in-service of the knee issue however when you went to the VA C&P exam the examiner said that your range of motion was normal. If the C&P exam said the range of motion was normal then VA could not compensate for that. The exception would be if you had other evidence submitted showing that you had current knee issues due to the same diagnosis.

Did they give you anything in writing with the reasons they are continuing to deny?


It sounds to me like they are pushing you towards IU so they don't have to give you any backpay if you drop these other issues... However, I think IU is a great thing because it will allow you to be paid at the 100% rate. Granted you cannot work and receive that at the same time. But one option is you could pursue IU now to be paid at the higher rate, while continuing these appeals due to possible backpay. In my opinion you should file for IU if you're not working.

Can you list the diagnosis you have received from VA and who they were from.

The way I read your post was that Mille C. Astin had signed off on a diagnosis... Was it a diagnosis of PTSD? Or was it for something else.


If it was a diagnosis of ptsd, you are good to go. Because she is a PhD level Psychologist.

Since your stressor was combat related, it will be conceded ( automatically accepted).

When you apply you will need to write a short description of the incident. Make absolutely certain that you say it was "combat related". This will make it easier for your claim to move through the process.



At some point after you apply, you would be asked to go to a exam, where you would discuss the stressor incident again. Also, you would talk about what symptoms you have now.

Also, keep in mind, the way this is rated is based on HOW it affects you in your day to day life RIGHT NOW.
Here's the link to the percentages. http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#sg38.1.4_1124a.sg13


Usually the two highest percentages of 70% or 100% are for those who aren't able to work due to their disability.

Can you list the diagnosis you have received from VA and who they were from.

The way I read your post was that Mille C. Astin had signed off on a diagnosis... Was it a diagnosis of PTSD? Or was it for something else.


If it was a diagnosis of ptsd, you are good to go. Because she is a PhD level Psychologist.

Since your stressor was combat related, it will be conceded ( automatically accepted).

When you apply you will need to write a short description of the incident. Make absolutely certain that you say it was "combat related". This will make it easier for your claim to move through the process.



At some point after you apply, you would be asked to go to a exam, where you would discuss the stressor incident again. Also, you would talk about what symptoms you have now.

Also, keep in mind, the way this is rated is based on HOW it affects you in your day to day life RIGHT NOW.
Here's the link to the percentages. http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=38:1.0.1.1.5#sg38.1.4_1124a.sg13


Usually the two highest percentages of 70% or 100% are for those who aren't able to work due to their disability.

Take some time and read up on how ptsd claims are decided. They are pretty complicated. There's a ton of info here on hadit.

Getting the diagnosis signed off by a VA PhD level Psychologist is a great first step and really gives you a head start! VA requires the diagnosis be made or signed off on by a PhD level Psychologist OR a Psychiatrist.

Next step is knowing what "stressor" requirements you fall under.

Thanks for your input as well. This DRO is HUGE for me and I'm very anxious and nervous about the whole ordeal. I've spent hours and hours researching, gathering documents and writing my explanations, briefs, etc... I feel like I could be a frickin' attorney at this point in time and I haven't heard squat from the VFW.

kate7772,

It all comes down to money. Personally I believe if it is offered to one group it should be offered to all groups. I don't harbor any ill feelings toward post 9/11 vets but it angered me when I heard former VA Secretary Shinseki tell congress the VA did not need additional funding. Shinseki should have asked for additional funding for the Caregiver Program and any other programs which are not offered to all groups of veterans. What makes one group more entitled than another group? JMO

How about making the claims process, including DRO hearings, etc., actually pro-veteran instead of the adversarial bullshit that we have to fight on a constant basis.

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2790

Explanation of ace exams...




http://www.blogs.va.gov/VAntage/9048/ace-eliminates-need-for-some-in-person-disability-exams/

Here's the rating guidelines for migraines.

8100 Migraine:
With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability ---50
With characteristic prostrating attacks occurring on an average once a month over last several months ------30
With characteristic prostrating attacks averaging one in 2 months over last several months -----10
With less frequent attacks ---0

"Prostrating attacks" basically means a migraine so bad that you have to go lay down in a dark room.

Hey, I complained to the new Secretary and I got a call from my local VA. I complained about the fee base dentist they sent me to who made a mess out of a simple crown and tooth cleaning. I am going to change dentists with VA help. Maybe emailing this guy actually works. Get it while it lasts.


John

Those in receipt of DIC should get survivor benefits equal to SSA survivor benefits. A spouse should not get 30% of what her 100% housebound vet gets. Spouse should not be reduced to poverty when her/his vets dies. Tell McDonald to increase vet compensation by 50% minimum. The benefit has not kept up with true cost of living. Median household income in USA is over 50K. 100% vet gets less that 40k and wife often stays home to care for him/her. Everyone in family of disabled vets loses income either by taking early SSA or losing ability to give to IRA/401-K. My brother was able to continue working and built up 400K in his 401-K while I was not able to contribute.

Probably the number one thing is feedback. Microsoft uses it. McDonalds uses it. You drive up to McDonalds, and if you have to wait 15 minutes for a cold or dry burger, then you can call a toll free number and report it. THEN they take corrective action. They need a steady stream of customers and they recognize each complaint represents 999 more who did not complain.
Va needs to take a page out of the playbook of industry. Gee, I bet P and G had some sort of feedback, too, so they can constantly improve their product.
Henry Ford, in 1932 thought he had the "perfect" car, which needed no improvement. That was a big mistake and several other car companies produced "improved versions" and prospered..and even overtook Ford. Modern companies know that if you dont continually improve..your competitors will. There is no reason to eliminate this feedback with Va "just because" there are no "VA competitors", as there really are "competitors" to VA. Young people join the military in no small part due to benefits. If they hear the benefits are bad, they dont join. When I was in, we had a draft. Right now, the military gets away with a small, reduced military size due to technology improvements. But that only goes so far...and our country will become "weak" and be taken over by other countries...with a "weak" VA, and a "weak military". You cant "throw away" a "used up" Veteran like an empty beer can and expect a new generation of military age people to embrace the military. The economy was bad..so people joined the military because there was not a lot of choices. But, that wont last forever and VA needs to constantly improve. Our country depends on it. They need to take their "clients" (us) more seriously, and have even betrayed our trust. Employees need to really be held accountable to Vets..if a Vet complains, then that employee should be given corrective action, and, if it continues, that employee needs fired. Right now, there is no real accountability...employees get away with bad VARO decisions which are overturned. Why is this not tracked and decisions which are overturned on appeal show up on a report, when the numbers are excessive? Most companies understand they are ultimately paid by customers. No customers and they get laid off. With Social Security, getting that claim done in 120 days is NOT a goal. Its an ultimatum..get it done then or explain to your boss why not. SS employees are assigned a "case"..that they are responsible for. They get a printout, as does their boss, as to progress on each case. Even McDonalds tracks the time it takes to deliver food to the drive up...and you had better not be too slow, either. The VA has no tracking on claims...they just tell the public "VA is different than Social Security" and cant be compared. Hogwash. It is different...Vets deserve BETTER service than citizens because they served..not worse. If IRS can process a hundred million or so complex tax returns in a matter of weeks, then VA should NOT have VA claims which are 5 years or more old, like mine.

What about putting these "hidden under the rug" benefits? If it weren't for people like people on this site, people like my wife and I would just be another family who lost their job because of service connected disabilities, who loses their home and get divorced. My being 100% is only because of the kind hearted people here who have helped us with research and answers to questions that nobody else would explain,and being lucky enough to have a wife who didn't give up on me when any sane person would have.

My wife has had to "figure out" how the VA plays, and we aren't law school educated, so my "advice" to the secretary would be to make it easier to access the information needed to get the benefits people are eligible for. And to be able to read that information.

I've got a suggestion: How about "when someone emails the Secretary have someone who responds to the writer, that they've received the email and will follow up within X number of days."

pr