jet187

Hi, hoping I can grab some knowledge and wisdom from the forum. I was awarded IU P&T no future exams in January 2019. VA bumped up 2 disabilities and also awarded the IU P&T but denied 2 other issues(IBS/Rt Hip Joint pain) and didn't process 2 other claims(E.D. SMC-K & Scars),never called for C&P exams. The claims were all packaged and submitted together in August 2018, and award letter came in January 2019 The appeal deadline is fast approaching and not sure what to do. Now that I am IU P&T, should I go ahead and still appeal the Higher Level Review for the IBS & Rt Hip Joint pain and also for the ED SMC-K & Scars? IBS is winnable as I had all the evidence and also presumptive illness Regs, ED is secondary to VA meds I am on, Scars would rate 0%, Rt Hip pain is a little involved. Will the VA go back and review all my disabilities with C&Ps again, and try and reduce my benefits? Or will they just review the IBS & Rt Hip pain, ED SMC-K & Scars issues? Should I not appeal and just let all 4 issues die? Not sure what to do. Any input is appreciated.

Stick Slinger, thanks for the feedback. I'm leaning toward claiming bruxism/TMJ secondary to the PTSD. I have a Dental appt. on the 18th and having a mold made for a night guard, and then talk to the oral surgeon on staff about the TMJ with the idea that I may need surgery. Did you have your VA primary Dr. fill out the DBQs stating its more than likely due to the PTSD? or the VA Dental doc? I am not sure who needs to fill out the DBQs. I have obstructive Sleep Apnea also and use a CPAP to. I plan on claiming it as secondary to PTSD also. You mention you are on the 3rd mouth guard because you chewed thru the first 2. Do you get them thru the VA? Just asking to see what I have ahead of me, if I chew thru mouth guards. Thanks again for any feedback. Semper FI Brother!

Hello everybody, Sorry its been awhile since I last posted and see the format has changed. currently rated at 70% for PTSD and currently in Voc Rehab. The past few weeks my wife has been complaining to me that I have been keeping her up most nights with me grinding my teeth during the night. I have been doing this for many years but it flares up bad intermittently every year. This time I think I really hurt my jaw bad and might have TMJ. The right side is painful and it hurts to talk, yawn and eat. My upper/lower teeth on the right side are sensitive and bleed when I brush, I guess this is due to all the pressure I put on them when sleeping. The grinding started after I came back from the Middle East. In 1989 I fell and hit my face on concrete in GITMO busting open my chin which required many stitches and have the scar today. I have the Medical report also. I know that bruxism and TMJ can be related to PTSD as secondary conditions. And I have been grinding for over 25 years so I know I have done some damage. I contacted my Voc Rehab counselor to refer me to dental to address both issues, I need to get a mouth guard and need to see about the TMJ. I have a dental appointment this coming Monday. My question is: 1 )should I try and connect the bruxism/grinding secondary to PTSD? 2) Separately, should I try and connect the TMJ to the fall I had in 1989? Its documented and I feel this facial injury may have contributed to me developing TMJ over the years, even knowing my grinding has probably helped the TMJ get worse? 3) Or should I put both the bruxism/TMJ together as secondary conditions to PTSD? Not sure how to proceed on this one. Any feedback is much appreciated, Thanks!

Georgiapapa, Thanks so much for the info. I do have the Schedule of Ratings for Asbestosis and he meets 1 criteria, the pulmonary hypertension rated at 100%. I have to look up the VA Circular "Asbestos related diseases in 1988" And I agree with your assessment, he needs a strong nexus between his medical condition and service. The VSO my dad is working with wants to submit his claim as Fully Developed Claim(FDC) because it would be quicker, I guess due to his age. My dad's SMR don't reflect any diagnosis of Asbestosis in service, he was diagnosed last year. The VA doc said exposure to asbestos could take a long time to show up, 25-50 yrs later. He's had CT & PET scans done with nodules in both lower lungs that confirm prior asbestos exposure & noted in his VA records. He was on 2 Heavy Cruisers in 58-61 with his job as Boatswain Mate, which I read is one of the primary MOS exposed to asbestos in the Navy. His jobs after the Navy did not expose him to Asbestos, so his likely exposure was on the ships. Some of his shipmates were diagnosed also. He has no post discharge continuity of treatment for his medical condition until the past 2 years when he started having symptoms. Since the VA Pulmonary doc was the only doc treating him for asbestosis I was hoping he would at least make a strong IMO argument that it was "as likely as not" related to his military service. He said late last year that he thinks its most likely from the Navy but had to wait for all the tests(PFT/CT/PET) to be done to make a decision. But he flipped and now appears to not want to do anything to help or assist my dad, and give my dad bad info like taking the DBQ to the VSO to fill out. I believe he doesn't fall under any "Presumptive Disease" because he was in 57-61, not a war time period. He was in Beirut in 58 for Op. Blue Bat during the Lebanon crisis. I am seeing this might be an uphill battle but I have to try. I just need a doc to connect the dots. My dad said he was going to call the Pulmonary doc on Monday and ask him why he told him to take the DBQ to the VSO when a Dr. needs to fill it out, and then ask him again to please fill it out as its his duty to assist. If he refuses again, I guess my next step is to file a complaint with the Patient Advocate, contact the VAMC Director and like you said send an email to Hickey or McDonald. Then get a new Pulmonary doc, probably outside the VA. And the VA saga continues, Delay Delay Delay & hope you go away! Does anybody think I have a good plan to address this correctly?

I feel that the doc looked at my dad at 75 yrs old and rolled the dice that my dad would go away if he blew smoke up his butt, knowing my dad would probably just go with what he said.

georgiapapa just saw your reply, thanks for the help.

Thanks for the quick replies, much appreciated. Somebody at the VAMC gave my dad the DBQ and he asked me about it, but I know nothing about them. So I looked the form up and I read all 7 pages and the sections that are relevant to his claim and guessed he had to take it with him to his follow up appt. yesterday and have the Pulmonary doc fill it out then submit it with his claim. I guess that is not how DBQs work from what I am reading. Just so I am clear, DBQs are used for C&P exams only? Not for your treating VA physicians to fill out?

Thanks Navy04! Would the VA accept a DBQ form filled out by a civilian doc? My dad would have to get a Civilian Pulmonary doc on the outside first.

Hello all, Can anyone tell me what's the deal with VA doctors that refuses fill out DBQ forms? My dad primarily uses the VA for his treatment. He had a follow up appt. yesterday and his VA Pulmonary doc told him he doesn't fill out the DBQ form for Respiratory conditions, he said the VSO does. Really? The DBQ form has to be filled out by a physician and signed by one. It contains medical questions related to his medical condition that only a doctor can fill out. Its very obvious a VSO is not a doctor or could fill out the DBQ form!! I am trying to help my dad with his asbestosis claim and he has all the tests/scans/evidence done and ready to submit a claim, but I live in another state and can't be with him at his visits and he is 75 and doesn't know what to say or ask, he just tells me what the doc says. The VA Pulmonary doc is his only treating physician for his asbestosis. The doc says yes he has asbestosis, my dad asked him if he could make a note in his record if he would state in his medical opinion if it was more than likely a result of his military service in the Navy, he said no he wouldn't do that because the raters at the Regional would make that determination. Really? Its obvious the doctor punted him or kicked the can down the road. What can I do? Is there a directive for VA docs on filling it out? Are VA doctors permitted to fill out DBQs if they are the only treating physician the patient has? Or is the DBQs only for civilian doctors to fill out? What's the point of these DBQs if the docs refuse to fill them out or give their patients bad info? What should I do? Any feedback is appreciated.

Thanks very much for the feedback. I will put in for the Travel claims and see what happens.

Hi everyone, question? I was referred by my VA provider for Non-VA Care(Fee Basis)recently. Can you receive Travel pay for Non-VA Care? I get it when I go to VA but this is the first time outside the VA. Any feedback is appreciated. Jet187

Thanks for the feedback Todd & Berta, much appreciated. The question still remains what exactly is Enhanced Eligibility and how it applies to Veterans listed under the Enhanced Eligibility criteria? Specifically how it applies to Veterans who served in the Persian Gulf from Aug.2 1990 to November 11 1998. Todd's post of the VA's Combat Veteran Eligibility Enhanced Eligibility only mentions eligibility for health care for Veterans who served in a theater of combat operations AFTER November 11 1998, and they have 5 yrs. from discharge to apply for healthcare. I am talking about BEFORE November 11 1998, and Gulf War Veterans who have been out since the war's end, I was discharged in 1992. If I go on the VA site now it is clearly stated on the VA site Veterans Eligibility, under Enhanced Eligibility when applying for Healthcare. The Combat Veteran Eligibility memo does mention if a veteran who does not enroll during their Enhanced Authority Period, eligibility to enroll and subsequent care is based on other factors such as: it gives a laundry list of factors but it did say the Veteran's financial circumstances. I guess this might be the part that some of my guys in my unit & other Gulf War vets get tripped up on? And perhaps why VA employees in the Eligibility office across the country are focused maybe on the Vets from OIF/OEF/OND and confuse the interpretation of the memo? I think that is where the disconnect is. I think they run Vets prior to OIF-OND thru the VA system for enrollment and if a guy makes above the Financial assessment part they get kicked out of the system & denied. This is what happened to my buddy, but he finally won on the 3rd time when he asked to speak to the supervisor and then they found out he had the Southwest Asia Medal and POOF! He became eligible!! This directive was not in effect until Jan.28 2008 and states a veteran had to be discharged ON or AFTER Jan. 28 2003 with a 5 yr window from discharge. Am I wrong in saying this does not apply to Gulf War veterans? We were 1990-1991, that is a long stretch to 2003. This is what makes me question what does Enhanced Eligiblity mean and how does it effect enrolling for VA care for the Vets listed under the criteria? The way I read & understand it is any Gulf War veteran can walk in off the street to the local VA and say they want to apply for healthcare with the VA under the Enhanced Eligiblity rule because they served in the Persian Gulf between the dates listed. Am I wrong? If I am not reading it correctly I apologize in advance. Just looking for the straight scoop. Thanks

Does anyone know what Enhanced Eligibility with the VA is for and what it does for Veterans? I have been trying to help some guys in my unit enroll in the VA but the VA keeps telling some of them they are not eligible because they make to much money, and a few guys had no problem getting enrolled. They all have fairly decent jobs but in no ways a millionaire or making over 100K. They just want to get enrolled in the VA and get some things looked at. I went to my Eligibility Office in East Orange and spoke with a woman, told her the situation that they make to much money, etc. and she said that to tell my guys to tell their Eligibility office that they are Gulf War veterans and that should fix the problem with the Financial part. She said that under the Enhanced Eligibility the Financial part is waived. Is that true? When my guys go back and say that they are Gulf vets and they want to enroll under Enhanced Eligibility they are told otherwise & denied. A buddy of mine finally just got enrolled in the Houston VA system but not after a couple of trips & told he wasn't eligible due to making to much money. The 3rd time he called me, while he was at the VA with the eligibility rep and was having a hard time again, I told him to tell the guy to call his supervisor. I even went on the VA website took a picture of the Enhanced Eligiblity with my phone and sent it to my buddy and told him to show it to the Eligibility rep. While on the phone I hear the guy talking and then tells my buddy that yes he is eligible because he was awarded the Southwest Asia Medal. He texted me today that he received his VA package in the mail this past week and has his first appt. in July. He did mention the VA Eligibility rep. was nice enough but he got the vibe the guy didn't know or was aware of the policy until he called the supervisor. Its like some VAs don't even know about the Enhanced Eligiblity criteria policy and tell Veterans they aren't eligible for enrollment when they are. It's very aggravating & frustrating!! Under the VA's Enhanced Eligibility criteria it states: Certain Veterans may be afforded enhanced eligibility status when applying and enrolling in the VA health care system. Veterans who: Are a Former POW receipt Purple Heart receipt of Medal of Honor have a compensable VA awarded service connected disability of 10% or more receipt of a VA Pension were discharged from the military because of a disability, early out, or hardship Served in a Theater of Operations for 5 years post discharge Served in the Republic of Vietnam from 1962-1975 Served in the Persian Gulf from Aug.2 1990-November 11, 1998. Does anyone know what Enhanced Eligiblity is, what it means or what it does for Veterans listed in the above criteria? Any feedback is much appreciated.

Philip & Cooter, I was originally 50%. Then went into the PTSD program for 2 months in April-June. I was advised by the VA docs to put in for 100% when I got out which I did in June. Had my Increase C&P in July. They shot me down for 100% in the Reasons for Decision as stated: "A higher evaluation of 100 % is not warranted unless there is a total occupational and social impairment, due to such symptoms as: Gross impairment in thought process or communications 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. I think I have at least 3 of the symptoms listed above now. They said my GAF was 45. A range of 41-50 indicates serious symptoms, or any serious impairment in social,occupational, or school functioning. The also said" The overall evidentiary record shows that the severity of your disability most closely approximates the criteria for a 70 % disability evaluation." I did go back to work shortly after being discharged from the program,because of family financial issues but I work 2 days a week now. Maybe they denied me the 100% because I am still working I guess. I want to talk to my VA Pysch Doc when I see him in a few weeks & see what he has to say. He has been supportive in the past, wrote me a support letter when I put in for the increase. The Decision letter does not say anything about 70% & applying for TDIU. Notorious Kelly, sorry I don't know how to post this in the Success Stories forum. Apologize if I posted in the wrong forum. What should I do? Thanks for any advice given.

Hey all, thanks to all the great advice & people on this forum, I received the big white envelope from the Regional yesterday saying I was given temp. 100% SC for 2 months March 30 to June 3 due to hospitalization over 21 days. An evaluation of 70% is assigned from June 2011 going forward. I put my claim for increase for 100% P&T immediately after I was discharged from the PTSD program in Lyons in June 2011. Had my Increase C&P in July, then waited until yesterday. My next step is to decide if I should NOD the decision or just go ahead and apply for TDIU. Couldn't have done it without the support & advice I have read on this amazing site. Thanks Brothers & Sisters!