31Bravo

Let's play VA math. 20 +20= 36. Do the bilateral gig for 3.6% and hold that (40%). 10 +10=19 so you get another 1.9% /// 40 + 20= 52; 52+10=57; 57 + 10= 61; 61+10 = 65% rounds up to 70%. You have it on paper but you have the "independently rateable" hurtle of three different diseases. You fall afoul of trying to count up different anatomical segments or bodily systems.

If you only take the highest (independent) ratings from each bodily system (anatomical segments), you have 20% (Left lower radiculopathy) +20% (lumbosacral strain)+ 10% (Chondromalacia) +10% (left shoulder condition)= 53%.

Before you count the chickens up, make sure the individual ratings are not related directly to or part of the 100% disability. VA considers it pyramiding and will not grant on that theorem. If you have a true 100% schedular for one disease, or TDIU to stand in its stead, all the added disabilities must be extraneous to it or be completely different disease entities/musculature injuries even if they are rated secondary. Here's 38 CFR § 3.350(i):

(i) Total plus 60 percent, or housebound; 38 U.S.C. 1114(s). The special monthly compensation provided by 38 U.S.C. 1114(s) is payable where the veteran has a single service-connected disability rated as 100 percent and,
(1) Has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) Is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. Always remember, too, that Special Monthly Compensation (SMC) at any rate is a separate, additional entitlement independent of your compensation rating. Thus you could be 40% for one thing and get SMC K for a lost hand or foot or loss of use of an eye-or both. You can actually have three Ks at the same time. But most importantly, SMC is awarded at the time you show the entitlement due. It technically does not require you to file to obtain it. It is paid retroactively to the date your medical records can show entitlement. VA's Sherlock raters are supposed to see this or the M21 computer is supposed to automatically point it out. If they overlook it, you merely have to tell them rather than file a tenuous CUE. I'd strongly suggest the IRIS method if the decision is rather new. This means the file and the claim are fresh in the rater's mind. I just whacked them for SMC S retro back to 1994. I did it the CUE path. I started in 2011 and won it in 2015 via an Extraordinary Writ when VA refused to honor their own C&P results. Remember, SMC is one of the least known, most complicated entitlement programs that VA has and consequently is one of the hardest nuts to crack if they want to be anal about it. VA's ability to reattach a prosthesis to the remains of an arm or leg can determine the difference between N or N 1/2. Or P. The reason you didn't just get it automatically indicates VA suspects or wrongfully assumes some of the additional 59% is related to your 100%(TDIU) rating. Best of Luck, sir.

Interesting, Berta. VLJ Hindin's little people had my 4138 NOD filed 12/2/94. It clearly stated "enclosed please find troop movement orders (AF Form 626 TDY) and Hepatitis records from civilian hospital. The 4138 and the new and material documents were date stamped 12/7/1994 by the RO yet Hindin's troops stated there was absolutely nothing in my files that could be ascertained as N&ME that had been filed during the pendency of the one year window to appeal. The January 5th, 1995 SOC clearly stated "We received your new evidence and will notify you when we make a decision soon." Somehow his staff attys. didn't dial in on that with a year to absorb it (April 2011-May 2012). I think you should qualify it such that any big dollar appeals will be denied if at all possible even if the evidence has to be overlooked to reach the incorrect decision. The OGC didn't have any problem figuring it out.

I personally think the quality of the staff attorneys, much like the quality of VSOs' reps, is variable ranging from brilliant to dim. I should shut up. I'm going to be an agent soon and someone will be saying it about me!

Knowledge is power! Which the VA is most afraid of, us Vets learning the truth, and learning how to fight and defeat them!

<<<<<<<<<< 38 CFR 3.350(f)(3) at the rate intermediate between subsection (l) and subsection (m) on account of schizophrenia, paranoid type with depression with additional disability, tardive dyskinesia, independently ratable at 50 percent or more from 12/06/2011.>>>>>>>>>>>
 
The answer is simple. If you are rated 50% over and above a 100% schedular (but notTDIU), 38 CFR 3.350 (f) (3) kicks in.:
(3) Additional independent 50 percent disabilities. In addition to the statutory rates payable under 38 U.S.C. 1114 (l) through (n) and the intermediate or next higher rate provisions outlined above, additional single permanent disability or combinations of permanent disabilities independently ratable at 50 percent or more will afford entitlement to the next higher intermediate rate or if already entitled to an intermediate rate to the next higher statutory rate under 38 U.S.C. 1114, but not above the (o) rate. In the application of this subparagraph the disability or disabilities independently ratable at 50 percent or more must be separate and distinct and involve different anatomical segments or bodily systems from the conditions establishing entitlement under 38 U.S.C. 1114 (l) through (n) or the intermediate rate provisions outlined above. The graduated ratings for arrested tuberculosis will not be utilized in this connection, but the permanent residuals of tuberculosis may be utilized.
 
Your ratings indicate you are 50% or more above 100% so they automatically go up 1/2 step from L to L 1/2. If you have two dissimilar ratings for 100% they would give you the full step from L to M. I'm in the process of doing this now at the BVA on appeal. I have one 100% schedular for HCV and fought a long CUE battle to get SMC S back to 94. When VA caved in at the CAVC after I filed my Extraordinary Writ in January, they granted 60% for the Agent Orange disease ( Porphyria). This entitled me to what you are talking about (3.350(f)(3) My 2008 C&P clearly said "totally disabled" due to Porphyria alone. If I prevail on it, then I qualify for the full bump from L to M (3.350(f)(4) after I get my driver's license for a wheelchair. Build it before you get there. If you even suspect you are entitled to a full schedular rating for any one of your diseases, do it now so the wifesan won't have to fight this when you are toast. Most VSO reps would not be aware of this. Hell, my VLJ at the travel board hearing had to look it up. It's not very well known. Funny how VA forgets to mention these things, huh?
 
 

Your VSO rep. incorrectly stated you have Diabetes Melitus or DMII. Above you cite that you have Diabetes I or Diabetes Insipitus. There's a big difference in the two when mistakes are made. Be sure you follow up and straighten that one out.

7909Diabetes insipidus

Polyuria with near-continuous thirst, and more than two documented episodes of dehydration requiring parenteral hydration in the past year 100

Polyuria with near-continuous thirst, and one or two documented episodes of dehydration requiring parenteral hydration in the past year 60

Polyuria with near-continuous thirst, and one or more episodes of dehydration in the past year not requiring parenteral hydration 40

Polyuria with near-continuous thirst 20



7913Diabetes mellitus Requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength
or complications that would be compensable if separately evaluated

100


Requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated

60 Requiring insulin, restricted diet, and regulation of activities

40 Requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet

20 Manageable by restricted diet only

10 Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913. Note (2): When diabetes mellitus has been conclusively diagnosed, do not request a glucose tolerance test solely for rating purposes. 7914Neoplasm, malignant, any specified part of the endocrine system 100 Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

You are not required to wait until 2018 for the last roundup C&P, sir. If you wish, you may go to your treating physician or specialist that provided the nexus letter and ask them to write one that says "Mr. DirtyD is very ill. His condition is not expected to improve but will indeed get worse over time. His prospects for a complete recovery from the Chronic Fatigue Syndrome are 0%."

I did this and was given P&T 90 days later (six months after 100% schedular). I also added in the argument that my son was in need of Chapter 35 bennies for college as well. VA fails to tell us there is no wait for this entitlement. Merely proving your condition is chronic and will only get worse is sufficient to trigger a decision in your favor. As for the SMC S, that has nothing to do with any P&T considerations and, if anything, simply adds more evidence to the argument for P&T.

Please do not subscribe to the old VA wive's tales of them taking things away(reduction of ratings) if they feel you're being "greedy". It's against the law and if they get caught doing it, we can now call "Bob" or Allison and get it all sorted out in a week or two.

Here's the gottcha. You need one rating at TDIU or 100% scheduler. The definition of 100% is... yep, a true 100% rating. From your list, the highest you listed is 60%. If that is the stand in for your TDIU, then yes, you have enough additional ratings to qualify for the SMC S. That will not affect the SMC K. If you are filthy rich and don't need an additional $346.84 each month, then don't bother, but an extra $4 K a year comes in handy for most. If VA indeed owes you this, they will have to pay it from the date you qualified, not the date you applied. It appears you qualified in 2009 from what you posted.

Thank you Phil Rogers, J, GP, everyone for your comments. GP how could I not contribute to Hadit the site was essential to my education and success. Bluevet don't worry, develop your medical and lay evidence, without evidence you will not win. You may win on your first attempt but if VA deny your claim. File NOD and ask the expert NOVA attorney to evaluate your claim, while waiting focus on your health, seek medical care for all SC contentions, educate yourself by helping other vets and enjoy lifetime hobbies.

.

I found it! It was in the Veterans Law Library. They are discussing whether zero percent ratings are legal.
http://www.veteranslawlibrary.com/files/Fed_Cir_Audio/2015/Wingard_2014-7017.mp3

You can access it at the Veterans Law Library, Feb 3, 2015.
http://www.veteranslawlibrary.com/

My neighbor calls me a "zero" from time to time.

Does that count??

Hamslice

CH3022 is correct. The language of 38 CFR §3.352(a) (which most associate with A&A 1, also known as SMC-L) does not mention your percentage of rating as a consideration for entitlement. What the regulation does say is far more important. §3.352(a) uses what we call the means test which is a far cry from using your rating percentage. By rights, if you are entitled to this Special Monthly Compensation (A&A 1), you should already be rated appropriately such that it would trigger this entitlement without having to file for it. Since VA is not exactly proactive, you sometimes have to give them a polite nudge. This became far easier March 25th with the new 526 EZ requirement if you believe VA.

Remember, you do not have to suffer or qualify for all of them. Each one is technically a stand alone qualifier. When the Saint Paul RO spokesman opined as to the need for a 100% schedular rating, he was partially correct inasmuch as it is presumed you are already at SMC S and merely transitioning into SMC L ($3,779.09)- which is the A&A 1 entitlement strapped onto a 100% plus SMC S ($3,415.74). That, for the record, is a $363.35 increase above the SMC-S rate. http://www.military.com/benefits/veteran-benefits/special-monthly-compensation-smc-tables.html

Here are the various means tests listed.

§ 3.352 Criteria for determining need for aid and attendance and “permanently bedridden.”
(a) Basic criteria for regular aid and attendance and permanently bedridden. The following will be accorded consideration in determining the need for regular aid and attendance (§ 3.351©(3): inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. “Bedridden” will be a proper basis for the determination. For the purpose of this paragraph “bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others. The underlined above in red is the salient consideration. To arrive at this stage and ask for A&A 1 does require that you be TDIU or 100% schedular. The Bradley v. Peake and Buie v. Shinseki line of legal reasoning distinguishes that TDIU is functionally equivalent as a stand alone to a true 100% schedular rating. Technically, you do not need to be receiving SMC S. It's conceivable that disability(s) requiring A&A 1 can arise instantly much like a car going from 0- 60 mph in a very short time. Most importantly remember, for the purposes of definition, VA defines schedular as a rating (singular) for a given diagnostic code (DC). Thus a 50% rating for PTSD would be considered by VA to be a 50% schedular rating for PTSD. Adding up all your ratings is a collective rating- not a schedular rating. The semantics are confusing so I thought I should clear that up. I see the term schedular tossed around and the significance of it is often lost in translation.

I’m praising God for my family’s first phase victory. When you find yourself in the position to help someone, be happy and feel blessed because God is answering that person’s prayer through you.

Three weeks ago RO offered me the prestigous”100% P&T Club Membership Card, without mileage plus, but they tossed in no future C&Ps, Chap 35, and retro to 2010 for SC musculoskeletal injuries. I’ve fought the first phase of my best fight, refused to abandon my appeal guard post, the AB letters are in E-benefits (Ratt-Now). I feel like Gomer Pyle rolled into Forrest Gump standing at “Parade Rest” rubbing my sleepy eyes, Shizzzaaammm!—It's Green Light Go Jump--the retro hit the account this AM, before arrival of the BBE.

Thanks Ms. T-Bird for the Hadit Scholarship, and my Professors Ms. Berta the Queen of CUE, Carlie, Chris Attig, Asknod, Jbasser, Bronco, all members that believe in “Leave No One Behind, Not On A Jungle Trail, Not On A Desert Trail, Not On A Paper Trail, you've made my partial victory possible. I’m going into R&R stealth mode before my next shock and awe assault at BVA. Humor is the best remedy I know for VA induced PTSD. Nada-Nada, Jose, I don’t mean getting squishy-soft-n-cuddly during denied or low-balled warfare! Fight, Fight, Fight on into Victory!

I answered your other post this AM on these issues.

Yes a private doctor can certainly prepare a valid IMO but they must follow the IMO criteria here at hadit:



In the reply I made today in the other thread I recommended Dr. BAsh, as he too is a former VA doctor and I developed this criteria from the 2 IMos I got for him for my AO DMII death claim.

I also searched for many months to find a Neuro who had treated my husband and had left VA for private practice.

He seemed to be the only doctor on my husband's treatment team who know what he was doing and a crossed out entry he had made in the med recs, I decifered as being DM conf dx). When I realized what this meant and still wasnt sure because it had been crossed out, I remembered suddenly something this doc had said and did to my husband that same day.

This doctor sent me a 2 sentence email reply and Dr Bash used it as co=oboration of his extensive medical opinion.BVA gave it a lot of weight.

2 IMos are better than one when they co -oborate each other with the medical expertise that each doctor has.

I will try to condense what proof VA needs if he pursues either FTCA or 1151, or both and add that as reply to your other thread here.

It might simplify the info on those forums here.

Good Evening Everyone,

I have been browsing this site for a few hours. I did not find answers to what I have questions for. So I am hoping someone can advise me.

My Father served in the Marine Corp In Vietnam from 7/1967 to 5/1970. It was determined that he was exposed to Agent Orange. Along with being on a registry for Camp Lejeune for water contamination.

My Father wears AFO leg braces for the Neuropathy. He was falling a lot and I had discussed with his Primary Care Dr a few years back that I felt my father had the beginning stages of Parkinson's. The Dr sent him to the Neurologist at the VA. Which they did a EMG, along with a MRI. They found that my dad had really bad Neuropathy. He could not even feel them shock him. He also had filed his claim for PTSD. Which initially they had denied, he appealed. He finally got it. But after seeing QTC Dr they tried to say my Dad was incompetent to manage his affairs. Which I had taken my Dad for 2 different evals to prove competence. So that did not go thru with the Fiduciary. My Father's conditions make it where he can not drive. He had an accident because he could not feel the brake pedal. My Dad has lived with me for the past 8 years. He manages all of his own money, medication refills, everything. He just needs help to get where he is going. Because of the physical limitations. Fast forward to 2015. After he got his claim for PTSD about 3 years ago my Dad was having chest pains. I took him to the Emergency Room where my father was found to have 2 major blockages in his heart. They did 2 Stents. There were still some more blockages they could not get to them because it was not reachable. I want to say they diagnosed him with CAD which I found VA referes to this as IHD. I believe he also has COPD I am waiting for his medical records. He has quite a few disc issues in the Cervical, Thorasic, and Lumbar areas. Along with the Siatic Nerve issues. My Dad was receiving VA transportation but since they say he no longer qualifies for this. With the new regulations. But he is unable to drive because of no feeling from the waist down.
We were in to see his Cardiologist a few months back and he asked me how my dad was. I had told him my concerns that he was falling a lot. That I cannot leave him at home alone. Because of the falls.We are with him 24/7 My dad has fallen and broken his ankle he was complete and total care for 3 months. He also fell before that and broke his toe and had a huge laceration. When I had addressed the issues a few years back with PCP, he said the Neurologist said all of this was from my Dad's Neuropathy.

I have addressed it multiple times with my Dad's PCP about the worsening of his symptoms with nothing being done. My Dad was finally diagnosed by outside Neuro with Parkinsons. The funny story is this Dr we did not know at the time had worked previously at the VA. I took my dads records into the office with me. He asked questions did the testing. He did another MRI to check for any issues that could cause this. He put my dad on some Trial medication with a follow up a few weeks later. My dad was falling at least 5- 6 times per week. Not small falls very hard ones. He had all the symptoms of Parkinsons. The medicine helped my dad in the past few months has only fallen 2 times which is a major improvement. So we cant chalk all of my dads issues up to the Degenerative Disc issue, Neuropathy. The medicine would not have worked. My dad had another EMG done with same Dr and his neuropathy is so severe. We follow up next week with him for results.

Sorry for the long winded history. I just thought it may be helpful. If they look at the new diagnosis will we have to go back for an appointment with QTC? Went to VA when we were into see PCP we told him of the new Diagnosis.. He said wow I know you had mentioned it a few times in the past. So with me mentioning that would they back date it? The Neuro said my dad has had the symptoms all along but the VA said it was the Neuropathy. Which is not fun either. The VA now sends my dad his meds for the parkinsons. On top of all of this my dad also had a Upper GI bleed, from the medications VA had him on. It tore his stomach up. My dad has an Abdominal Aortic Aneurysm as well. They have done nothing for it. Just watching it.

The outside Neuro has filled out the DBQ saying he does have Parkinsons. His Motor Manifestations are Stooped Posture Moderate. Balance Impairment Severe. Bradykinesia Moderate. Loss of Automatic Movements Mild, Speech Changes Moderate. Tremor Yes Right Upper Mild. Left Upper Mild, Right Lower Not affected, Left Lower Not Affected. Muscle Rigidity Yes R Upper Moderate, L Upper Moderate, R Lower Moderate. L Lower Moderate. Depression he marked Yes and wrote PTSD. Cognitive Impairment None. Loss of sense of smell None. Sleep Disturbance Moderate. Chewing None. Urinary Problems 2-4 is marked Constipation no. Sexual Dysfunction Yes Mild . Financial Responsibility he marked dad in his judgement is competent. Then does the veterans parkinsons impact his ability to work he put Yes. Unable to walk because of Postural Instability.

My questions are 1 with him already being at 90% SC, with Unemployability making it 100%. Does he have a claim to compensation for the following Diagnosis's

Parkinsons Diagnosis.

IHD or CAD ( I will check his records and see exactly what it says)

Sleep Apnea

Severe Peripheral Neuropathy ( it says on the report Length, Dependent, Predominatly axonal peripheral neuroapthy. 2 Sensorimotor median neuropathy across the right wrist consistent with carpal tunnel syndrome. Acute C8-T1 radialculpathy on the right. Chronic L2,3,4 and S1-S2 radialculpathy on the right. Acute on Chronic L4-5 radialculpathy on right. absent responses of the lower extremity sensory nerves. In short his Neuropathy has worsened.

Hypertension

Drop Foot

Abdominal Aortic Aneurysm

ED ( You guys will know what that is)

My dad gets a lot of swelling as well retention of water. Which he is taking meds for.

The person down at VA we had stopped in to get the clothing allowance form. We had asked a question. He said my fathers case when he pulled it up he had no clue why he wore the AFO's we told him the Neuro had ordered them a few years back. He said well if it was correctly put in there he would have seen why. He also said that if my dad wears those. Then he should be getting more compensation. ( He briefly explained how it all worked) We have an appointment to go and talk to a rep there about my dads case. We did submit the DBQ for his Parkinsons. The Dr will fill out a DBQ for the worsening of the Neuropathy. Should I take a DBQ to the cardiologist? My dad takes blood thinners for life with the heart issue. He also gets very short of breath. But is not on O2 yet. He gets also SMC (I)


My father had applied a while back for Aid and Attendance when he broke his ankle. The PCP at VA filled out the paperwork. To date we have heard nothing. I cannot even see the claim status on the ebenefits. Nor do I see the Parkinsons claim

My Dads conditions says below that this is all service connected to Agent Orange. Will we have to go and see numerous Dr's if he files for benefits for these since there is a trail already?

The guy we spoke to at Clothing Allowance said there are some grants that will modify or add onto a home for him to have accessibility. We own our home, but it is in our name. Will my Dad still qualify for these to make things accessible for him. or do an addition of a downstairs bedroom for him? Below are his ratings.

Disability Rating Decision Related To Effective Date diabetes mellitus, type II with diabetic nephropathy and tinea pedis 20% Service Connected Agent Orange
02/2004 early peripheral neuropathy, left lower extremity
10% Service Connected 02/2005 early peripheral neuropathy, right lower extremity
10% Service Connected 02/2005 hypertension
0% Service Connected 02/2004 peripheral vascular disease left lower extremity
20% Service Connected 12/2008 peripheral vascular disease right lower extremity
20% Service Connected 12/2008 posttraumatic stress disorder (PTSD)/major depressive disorder 70% Service Connected 10/2008 Thank You for all of your help. I will honestly say that it is an honor to take care of my Father. But it is also the hardest to see his decline with his physical abilities. My Dad has always been my best friend and Hero.

Thank You to each and everyone of you for your Service and Sacrifice for our Great Nation. Welcome Home!

Here's what my VSO rep provided.

The Nexus Letter To win an award of a disability benefit, you must meet 3 criteria: 1. You have to show eligibility of your military service. 2. You must have a current medical diagnosis of a condition or a disability. 3. You must be able to provide evidence that the medical diagnosed condition had its origin during the time of your military service, or if the condition was preexisting, that it was aggravated by your military service. In many cases, the connection of an event that happened while you were on active duty to a diagnosed condition today may be tenuous at best. For the purposes of this example, let's consider a back injury. You may have hurt your back in some fashion while serving your country. That was in 1970 and you went on sick call. Your sore back was diagnosed as a "pulled muscle" or something similar and you were given some IBU Profen and sent on your way to light duty for 3 days. The back was progressively more painful so you were back on sick call a week later. This time an x-ray was ordered and you were given some stronger pain pills and your light duty was increased to a restricted duty for a month with orders of no lifting, no PT and so on. The military culture demands that we don't complain of our "minor" aches and pains. The team depends on each member being ready to complete the mission and the mission is all that counts. From day one we're trained that complaints of pain will bring about scorn from superiors and fellow soldiers will know that they have to carry your load as well as their own. "Pain", we learn, "is weakness leaving your body." Your civilian career wasn't as physical as the military and during the years since your discharge you've had chronic, low back pain but it hasn't required much treatment...until now. In the last year you've had to seek more intensive medical care and finally you had an MRI. The MRI study shows numerous issues with discs and nerves and you realize that your old service injury is here to haunt you. You file for service connected disability compensation, you have a C & P exam and about a year later you have a denial letter. The VA tells you that although you had complaints during your service that your condition today is new and unrelated to those old problems. Now what? The nexus letter is the key to overturning the denial. Nexus is defined as "the means of connection between things linked in series." The task you face now is to seek an expert physician who will review your complete medical records and write a letter stating that it it his or her opinion that your injury (condition) today is related to the military service. The nexus letter should follow a similar format to all letters that you use to communicate to VA. It may be addressed directly to you or in a "To Whom It May Concern" style. If the physician is willing to provide you with a current curriculum vitae (a resume) that will support the physician's expertise. The nexus letter should follow the standard business format we always use when writing to the VA. This template below may be used as a beginning for your letter. Doctor's Letter Head Date: Subject: Medical history of Mr. Veteran Reference: C-File # and/or Social Security Number To the Department of Veterans Affairs: I am the primary care provider for Mr. Veteran. In my capacity as a primary care provider, I have cared for Mr. Veteran since 01/07/20xx. While I've provided care for Mr. Veteran, I've become familiar with his active duty medical history from 07/24/19xx to 08/07/19xx and from VA medical records from 19xx to present, past and present ailments and I've reviewed pertinent parts of his military record that document his injury, disease and clinical conditions related to the events that occurred. I am aware that Mr. Veteran was injured during his active duty military service on or about 1981 in Fort Army while (events description, time and place). A primary condition the veteran suffers is Lumbar Paravertebral Myositis (an Inflammatory Myopathy) and an L4-L5, disc desiccation and disc narrowing. MRI reports note sacralization of the L 5 representing a developmental abnormality and also that paraspinal muscle spasm is suggested. Further noted are mild thoracolumbar dextroscoliosis as well as mild spondylosis and degenerative endplate changes. Schmorl's nodes in the superior endplate of L3. L3-L4 and L4-5 degenerative disc disease are seen. There is an L4-5 small posterior disc bulge and small posterocentral disc herniation and L2-3 vertebral hemangiomas. Mr. Veteran has chronic pain due to his injuries. The veteran suffers radiculopathy with pain, muscle control difficulty, tingling, numbness and weakness in the legs, likely due the sacralization of L4-L5. Mr. Veteran suffers increased fatigability because of his chronic back pain. Standing for more than 15 minutes will make him become weak and exhausted. There are multiple other clinical conditions diagnosed that are more likely than not secondary to or aggravated by the primary back condition(s). The veteran takes numerous medications for both the primary condition as well as secondary conditions that are aggravated by said primary back condition. (Medicines and secondary conditions are listed separately.) The veteran is not a likely candidate to be rehabilitated. After examining Mr. Veteran, his chart and medical records it is my opinion that Mr. Veteran is totally and permanently disabled due to the above discussed back condition. The veteran can not hold gainful employment as a result of the injury he sustained while in the military. It is also my opinion that it is more likely than not the that the physical traumas suffered during the veteran's military service as noted in his record (description of events and dates) caused, contributed to and aggravated the totally disabling back condition(s). Respectfully, Dr. VA Physician, MD Diplomat of the American Board of Internal Medicine The language in the example above is specific. Any language less specific may not meet the standard that VA will require. Any physician who is qualified to write such a letter on your behalf may do so. While it is commonly believed that VA physicians aren't allowed to write such letters, that isn't true. VA physicians, as with many civilian physicians, simply don't like to write such letters as they are not skilled at the task, may not have the tools to write the letter at hand and they are often so busy caring for a heavy load of patients this is seen as work that isn't a priority. It is perfectly acceptable for the veteran to write the letter on behalf of the physician and then ask the physician to sign it. In any setting, whether VA or civilian, the veteran is advised that he or she should not ask a nurse or clerk to perform the task of obtaining a signature for them. These ancillary members of the care team often see themselves as "gatekeepers" to guard and protect the physician from tasks that will only take up more valuable time. They may believe that "rules" or "law" won't allow the physician to sign such a document and the veteran may be refused access to the doctor. It's best to make a routine appointment, wait until the veteran is face to face with the M.D. and ask that provider directly. Most physicians will sign such a letter if it is brief, to the point and factual. When writing a nexus letter great care must be given to recording only facts and the doctor's conclusions. There are physicians available who will perform records reviews and/or Independent Medical Examinations and provide opinions. Often these doctors do a very good job of providing a nexus letter if the veteran isn't otherwise able to obtain one. The charge for such a letter from an independent physician can vary depending on the extent of the services. The veteran must pay that fee in advance with no guarantee that any award will be won. The Independent Medical Examining doctor does not treat or prescribe medications but only provides services of review and report. The importance of the nexus letter can't be overstated. In many situations the nexus letter from an expert is the only evidence that will tip the scales in favor of the veteran. In the C & P Service Clinicians Guide instructions are given to the examiner as to the exact phrasing that should be used, as follows here; Q: How do I give an opinion for nexus(relationship to a military incident)? A: When asked to give an opinion as to whether a condition is related to a specific incident during military service, the opinion should be expressed as follows: 1. “is due to” (100% sure) 2. “more likely than not” (greater than 50%) 3. “at least as likely as not” (equal to or greater than 50%) 4. “not at least as likely as not” (less than 50%) 5. “is not due to” (0%) That key phrase of "more likely than not" is right where the DRO wanted it. The only thing missing from this letter is an often used statement to point out that there are no other known or apparent causes for the current condition. That might read like; "There is no known history of the veterans family having this condition..." or "The veteran has no other known history that would cause or contribute to this condition...". I only include that statement when the cause of the condition is less than apparent. I might use that to show that a cancer was more likely than not caused by exposure to Agent Orange and that the veteran had no family history or exposure to other carcinogenic chemicals that may be seen as a possible cause for the current condition. In this case there were 2 documented traumatic events that were the likely cause of the injury making any reference to other possible causes unnecessary. Remember, just because your Doctor writes a letter stating you have a medical condition that WILL NOT be enough to award you a disability benefit. Your Doctor must write the condition MUST BE (1) linked, (2) caused / contributed or (3) aggravated by your military service. If you have a letter without this information your claim WILL MOST LIKELY be denied. We cannot stress this enough. Also, just because you are going to the VA for treatment for your condition that does not automatically qualify you for compensation. You will still need the "Nexus" letter and file a claim for compensation.

If you are talking about presumptive AO conditions all you need to show is that your father has them. If he has PD then he is presumptive for AO. If you can match your father's illness with AO presumptive disease that is what you need for a claim. If he has CAD or has had a heart attack that is probably enough for a rating as AO presumptive. Now the degree of the illness and rating are things a IME can sure help you with and also if their is doubt about conditions.

Good advice. MAKE SURE your doc knows the wording it takes to win your claim. For example, some docs may write something like,

This patients condition could (or might) be caused by his event in military service.

This will almost always guarntee a denial. The Va calls that "speculative".

It has to say something close to:
This patients condition is at least as likely as not caused by the event in military service.
The doc will also need to say WHY he made that opinion..the medical rationale that VA often requires. Perhaps something like this:
"Medical records document a fracture to the left femur. While this fracture healed, the AMA Journal explains that
"Fractures of the Femur" result in arthritis and future pain 68 percent of the time".

This is why lots of Vets want to use a doc, such as Dr. Bash, who is very familiar with the VA and what it takes for a valid nexus. Not all docs have experience with VA.

Perhaps a more nuanced explanation is in order. Once you hit the magic 100% schedular in any one disease/injury, VA ceases to harass you with continued C&Ps. If, however, you have a pearl necklace of 50s, 40s 20s and 10%ers, they come after you unmercifully in an attempt to reduce you. It's what they do and they do it well. A lot of Vets don't fight it. Sometimes it's subtle. They say the reduction will not change your underlying rating. That may be true but they will be back some day soon if you do not throw down on them. I've seen Vets with a 60 or less get new C&Ps that endanger their TDIU. Vets will notice that they'll never see VA try to reduce a 0% rating...

For the record, I have never advocated cheating and I find anyone who tries it to be a scoundrel. We try to keep our heads held high in this business. One gomer makes us all look like Safeway Slip on the Floor Club members. My last CUE dustups were illegal and VA had to admit it. It took five years but now that I am cured of HCV, I have lots of time. There is no race to get everything in order for my wife before I reached room temp.

Navy 04's advice to have all the evidence in your favor is axiomatic. By rights, you shouldn't be in a predicament of having to defend a rating if it is legitimate and the IMO/nexus and medical science supports you. However, that will never stop VA from sticking their nose in under the tent. My strong advice is to always develop your most serious claim(s)-i.e. ones that will kill you- to its(their) optimum. Too many develop a long list of little ratings that serve no purpose for ratings unless or until you get over the 100%/TDIU hump and are in search of the SMC S. I have two 10% and one 0% but those are the product of using DAV and AmVets. They'd file for a hangnail even if it only netted 0%. My focus was always on the Hepatitis and AO and not just because they were big tickets. It was because they were killing me.

Keep that in mind when you begin your fight. Go for the gold. Don't be distracted by little things like hammertoe or excessive earwax buildup. If your injuries are going to put you in a wheelchair or wipe out your ability to earn $, go for it. Tinnitus is a 10% dead end but it's nice if you never get anything else. It'll sure pay the CATV bill. I do not try to instill hope. Hope and $5.32 will get you a mocha grande at Starbucks. This is far more serious. That's why I call it win or die. To try is often a preadmission of failure. Do... or do not do. Offense beasts defense every time.

Hello,

I just got approved for my SSDI. Thanks for your support.

Rock the boat? What a hoot. Read some of Berta's and my adventures in VAland. I'm 100% on Hep C alone, 40% for fibromyalgia and 10% for both tinnitus and an AO skin disease. I filed a CUE on the skin in 2010 after they zeroed it out and won it back-to 1994. I filed a CUE on not being given 100% for another AO disease. VA gave me first 40 and then 60% but not the 100% I asked for- again, back to 1994. I'm at the BVA with the judge for the full 100% now. In addition , I decided to appeal the 10% skin for 30% and got a private IMO. When they bitchslap you, get out the big stick and go after them. I have never subscribed to the idea of letting the sleeping dog lie. VA will be there eventually to see if they can reduce you anyway. It's programmed into VACOLS to do so and just a matter of time unless (or until) they declare P&T. Your spouse needs 10 years of P&T under his/her belt before they give out DIC. If you die of complications due to AO inside those ten years but were never rated for them, guess what? No DIC. Best to CYA.

As an aside, I've noticed most VSO reps shudder when you mention CUE or going after a EED. Most will say "Best not to upset the applecart, Jose. They may get mad and take it all away from you." I've been down that road. When they're wrong, they have to pay you. Sadly, no interest but what the hey. Always hold their feet to the fire. Never chieu hoi to the VA. Never. If you earned it and the medrecs support the rating, go for it. Once you start down the Casper Milquetoast road, VA knows they have you stampeded forever.

I've met Chris personally. He's good. Very astute and quick to pick up on a fact that doesn't fit properly. He taught a few classes on Sleep apnea filing at the NOVA conference in SF this April. I don't do them (SA claims) but I always like to learn the tricks of the trade.

Jbasser, thanks for posting those regulations.

I was always under the impression that fees could not be charged at all ,for claims help, unless it was from a retro payment and a lawyer was the POA.

I saw 2 local vets gets taken here in NY years ago by vet rep wannabees and one of them did get into trouble because he was actually a bonafide vet rep for the AL , but none of the vet orgs charge.

$500 up front?

and more?

"I did sign an agreement to pay him 10% of any retro pay received. However not sure if I qualify for any retro since no claim had been filed on my behalf."

I am shocked at that.

Your inservice sinus issues could have a bearing on the fact that you need a C Pap now. That will probably take a good C & P but more likely a strong IMO.

If you tell us more we can help.

Personally I feel you should contact this guy's boss (the head of the vet org) and tell them what happened and see if the claim was really filed.Possibly it was because:

"He did get me a psych eval".

What was the evaluation for, a MH claim? Do you have a copy of the results?

The advise at hadit is Free. The guests at our blog radio shows are here on their time, and their advise is free.

Title 38 and 38 CFR, and M21---these are the regulations that control our claims....are all freely accessible either here or elsewhere on the internet.

I think it is a disgrace what this rep did to you.I dont even consider him a rep, I consider him as a thief.

Rootbeer is right:
"Frankly, at the end of the day, you will be your best Advocate so you need to start on that journey right now....good luck."

And the hardcore claimants here know more about the claims process than many of the vet reps out there.

And more then the VA sometimes.

You folks hang around here too awful long, you'll all be teaching the others after we turn into feebs. Pay it forward always. Too many get the golden ring and we never see or hear from you again. You won because your brother and sister Vets have a "Leave no one behind" mentality. Never forget that. You belong to a very special brotherhood of less than six percent of the U.S. and carried the weight for the other 94%. Good work on winning. I salute you both. Use your new freedom wisely.

I would be a dollar to a donut that he has developed other blockages since 1997! I believe he should get an angiogram to make sure how all the coronary arteries are doing. The new method of determining whether or not more stents are needed is something called ffr where they measure inflow vs outflow. % of blockage isn't used much any more.

If you decide to go that way remember that you can ask how much experience the operator has. In fact, revealing operator experience is part of the standard of care. If they refuse to tell you, they are committing malpractice. My right radial arteries can never be used again because my last operator had only done 4 procedures before me. She rammed the catheter up my arm 5 times. Naturally, the artery started to spasm. On the left side, they did a through and through with the IV and all of the anesthetic, pain killers, and nitro collected in a pouch under the new fangled tape used to hold it in place. Believe me is was a real shitty day. The radial artery has now scarred shut.

Have your Vietnam vet contact me via PM. It all is on the up and up I will give him direct contact information. Having just gone throught this BS, everything is still very fresh in my mind and the supporting documentation is organized for use.