Snake Eyes

Spoke with him today. He recommended service way beyond a nexus letter -- $10,000 worth. Among other things, SSDI and a possible cue for an old claim. I may spring for a nexus letter from him and another doc, but looking unemployment for rest of the summer, 10K is a bit steep. Benefit is he's in our area for summer and he can do an actual exam , order tests, etc which make his letters more convincing :-) Anyway, he referred me to his list of wins -- cases not listed could not be pulled up as they're not public records. His win list is quite impressive. Wish there was a way to compare such lists with the total number of claims so we can compare records.

I haven't been able to find examples of wins for Dr. Bash other than on his site. He'll be in my area in the next few months and indicated he can do DBQs for my condition(s) as well as an IMO. I'll give him a call later today, but I wanted to know if anyone has had experience with him in terms of successful claims.

Congrats on the PCP support, Hugh. Neither my VA PCM nor my private PCP is willing to help in my case. I may use two or more of these Nexus Writing docs if they are inclined to approach my secondary condition with an open mind (I know they won't simply parrot our own lay theories as medical expert opinions :-) ). I wasn't surprised by the $1,500 for a nexus.... but when I saw his LEGAL fees and thought they were for a nexus letter, I admit I had the same reaction you did. I see four names regularly, Bash, Sniger, Anaise and Butler. Are these the only guys who publicize their work for vets or am I looking in the wrong place? I found two of their Websites through Jim Strickland. I'd like an IME with DBQs for diabetese and complications, but closest is a doctor in Oaklahoma. Anyone aware of a doc in California who does IMEs -- particularly endocrinology or diabetes?

My Private PCP will not do DBQs or IMOs. He did write an opinion letter for one of my conditions, but apparently when he moved to the hospital's jurisdiction he had a change of heart. Since the number of PCP docs in our area is limited, I may not drop him just yet. More on topic, does the IMO provide his opinion to the vet to submit with his claim? If so, do we have the option of only including the favorable ones with our claims? I'm not clear on how this aspect works -- and I don't want to file the claim until I know a doc is at least open minded to a given theory of etiology (whether he ultimately agrees with me or not, it doesn't matter if he disagrees outright before even seeing a patient).

I need an independent medical examiner or at least a doctor who can render an objective opinion. My primary care doc says he cannot write a letter about my condition(s) because he would be acting in the place of an "advocate" instead of an objective observer. I tried Googling "Independent Medical Observer" and got a lot of lawyer sites or "expert witness" type sites. Any suggestions from people who have had an IME or IMO done?

Thanks for the tip, John. I like the idea of doing investing, and I'm in the process of educating myself as this is productive work you can do regardless of frequent breaks, etc. I explained uptopic why I can't just quit work (committment to the school I do classes for). However, if it comes to the place where I can't work at all, or that I need to for rehab purposes in order to get healthy, I think they would be very understanding. I've heard volunteer work gives the VA a string to pull on -- if you can work at a homeless shelter, you can work..... That's probably a good thing in the long run since TDIU (and SSDI) is intended for people who cannot work at gainful employment -- whatever that is :-)

From my perspective, yes, I am reducing schedule because I can't get through a day without frequent breaks due to pain and fatigue. This has not been blessed by a doctor as of yet. My civilian doc does not want to enter the fray because he can't "prove" anything from medical history Essentially, I have to ask him question by question whether a given problem is likely to improve, and then ask him to document the conversation in my treatment record. Not the same as a IME, but at least he will be able to state his medical opinion with a clear conscience :-) As for the SSDI, my VSO said, "go for it" but then gave me some paperwork that implied I should go for TDIU or 100% schedular. And that's when he said, even earning $7K or $8K a year would get a denial for the TDIU. I've not heard anyone on here say they won a TDIU case while working, but I've heard many say it's not possible. The problem is I'm obligated to finish the summer session (which ends next week) and I'm committed to the reduced schedule next year (only 3 hours a week with specific time slots). I can manage that since I can manage my own schedule, take breaks when needed, etc. If it gets too hard after that, I may withdraw in 2015. Better news is that my VA doc is setting me up with "Physical Rehab" for the back issue. That could result in fixing the pain or at least getting a determination that it cannot be fixed. One makes TDIU unnecessary and the other makes it possible.

No intellectual curiosity from my VA PCM doc. I presented her with three BVA cases which ruled in favor of diagnoses showing diabetes secondary to sleep apnea.... and two papers citing a combined 70 independent studies also making the connection. Her answer, as VSOs and many on Hadit.com was that only Vietnam vets can get SC for diabetes.... Yes, she said that after I showed her thre actual cases where non-Vietnam vets were SC. This was fully expected, so I'm not particularly disappointed. It is merely the first of many steps I'll have to take to see this process through to award or appeal. Finding open minded doctors is a challnge as they do not listen to patients, much less research for which they did not get funding or had no part in publishing. That's the nature of the beast in many professions, so I'm not knocking doctors here :-) So where would I find doctors familiar with the research who are giving it serious thought? I contacted one of the guys who wrote the pape in American Journal of Medicine in December of 2009. Coincidentally, he is a VA doctor in Connecticut and one of his colleagues received a grant for the VA to do this research. I will post PDFs of two of the papers (the ones I showed my PCM) in a separate post.

Hi Lotzaspotz, I did not apply for TDIU based on any of my disabilities because my VSO said I cannot. I am still working (through the end of next week), and I have a reduced schedule (10 to 15 hours a week starting in the fall). He said you cannot get TDIU initially if you're working even below the poverty threshold. In other words (not sure I agree), he believes you can work some once you get TDIU, but not before. Our school has month long breaks between fall and spring semesters and between the shortened summer session and the fall semester -- two to three months with no income from work at all. The only reason for pursuing the 100% as opposed to TDIU is to get DIC protection for the diabetes which is not currently SC. If I get SC for the diabetes and related complication, I would "innocently" get to the 100%. And yes, I'd probably cut back on work regardless -- pain and fatigue are winning the battle for now.

MODERATORS: I just realized I posted this in the wrong forum by accident... Feel free to move it.

1. How do they evaluate a 100% schedular person for P&T -- do all of the vet's service connected issues have to be permanent? 2. In my case, I have a 70% mental health rating -- Does the VA ever regard a mental health rating at less than 100% as "permanent"? As I've posted elsewhere, I'm working on an FDC that if successful would take me from 90% to 100% schedular.

Stations is definitely another road to consider. I wouldn't be surprised to see a lot of vets with one or both conditions on stations since cholesterol and triglycerides are often right there in both cases.

Good catch on the "enjoy" wording. :-) Those who say DM II is only SC due to AO in Vietnam are probably thing in terms of presumptive SC. None of the BVA cases I found were Vietnam vets and AO was not a factor in those cases. I'm at more than 20 peer reviewed studies (most with links to other studies which show a causal, if not correlative link between the two. If the skeptics are right, at least we'll have good data on successful BVA appeals and studies we can abstract for our VA doctors. Thanks to all for the input.

Thanks, John.. I assume after my initial appointment with the VA PCM doc, I'll be scheduled for a shrink visit. That C&P will likely come up in the conversation as it is typical of what happens in a stressful situation. My workload will be cut in half in the fall semester.

Several people here have posted regarding diabetes II service-connection being only open to Vietnam vets. They're thinking of the presumptive connection Vietnam vets enjoy because of exposure to Agent Orange. It is possible to develop diabetes in-service, though unless you're in Twilight, you probably wold be medically discharged. In my case, un-treated sleep apnea in-service may have contributed to the development of diabetes post-service. I received a provisional diagnosis in-service for the sleep apnea before being deployed to Korea. After that, a brief tour to Hawaii and then retirement. The VA reopened the original claim and rated the sleep apnea recently. During the time I was researching for a possible appeal, I discovered that there have been several BVA cases where a vet's claim to diabetes II as a secondary to sleep apnea was approved based on the growing body of research supporting sleep apnea as a cause of diabetes -- or in one case, an aggrivating factor. The more well known association goes the other way around, but I have at least three BVA citations that show the diabetes II secondary to sleep apnea... but who wants to fight through the appeals process? Not me (though I may have to). :-) I'm sure there are vets who've won diabetes service connection as secondary to sleep apnea without going through the appeals process, but if there are, none have spoken up here. I'm creating this thread mainly to document my process of developing a FDC to get SC for diabetes secondary to sleep apnea, along with several other complaints that are caused by either sleep apnea or diabetes -- or both. The first step in this process, as advised by my VSO is to seek out doctors for IMO/Nexus letters. I've faxed all three treeting physicians during the period where the sleep apnea was confirmed with a sleep study, along with diabetes indicators over time. Weight fluctuated, and doesn't seem to track evenly with the development (and that's consistent with two of the cited studies in the BVA appeals. Remaining Steps: Get complete Diabetes DBQ workup from VA PCM doc Get EMP tests done Get DBQs for the complications (there are several from hypertension to glaucoma) Coordinate the IMO/Nexus letters for the treating docs who agree to do this (get SMR, VA Treatment and Claims File info for their review File FDC with two or more STRONG nexus letters with citations of research studies (and provide copies of the cited studies) as well as the medical opinions confirming that my case matches those study examples Wait. And then wait some more. On a separate but sort of related note: My VSO stated that if I submitted the claim -- even an FDC online -- it could take a year or more to complete, but if he submitted it, the claim could complete in as little as 125 days. Anyone know WHY the VA processes VSO submitted claims faster than vet claims? Or is the VSO giving me questionable info.

LOL about the US Senator part... I think you have a year after becoming eligible schedular to apply for TDIU (for back pay purposes). However, if I can meet my family's needs by working -- even at poverty level, that is preferred. No, I don't pay taxes each year because my earnings are significantly below poverty level. I downloaded my SSA report and they show income from employment (actually self-employment) well below poverty, so that would not be a problem. I agree with those who say the VA would see, "employed full time 40 to 50 hours a week" and not read the descriptions of the disabilities -- I think there's one there that's a medical euphemism for "Says stupid stuff without realizing the math won't add up" :-)

I think I was unclear in my original post... I actually only work about 20 to 24 hours a week compensated. Anything extra is reading, watching tutorials, etc. -- things I would be doing anyway just to keep from bing bored, but not in a way that would be practical in a "typical" job setting. I have dropped the idea of TDIU because my VSO said if you work AT ALL, the VA will just find a way to deny the claim. I agree, if you can work 40 to 50 hours a week, you don't need TDIU. 100% schedular is within the realm of possibility given claims I have been devloping but are as yet unsubmitted. If I got that, I"d probably retire :-)

I wouldn't want to "rehearse" for an MH C&P -- they can see a gamer when he's gaming, and for me it would be uncomfortable in the extreme. On the other hand, knowing the subjects covered could help me prepare and as you say, not get ambushed. The problem is they can't catch that a guy actually forgot the names of two out of four classes he teaches regularly probably can't remember how many hours he works either. Me trying to do math on my fingers in a panic should have been a clue that a follow-up question was in order :-)

Thanks for the Loui 14th era quote. True in poly ticks and the VA too. My VSO suggested having the VA shrink address this issue in treatment reports -- if indeed my circular thinking is the reason for the mistake. I'm wondering if in the back of my mind, I just didn't want to admit to someone I only worked a few hours a week for an online school. Nothing to be ashamed of, but certainly less than what I was raised to be :-)

The good news is they awarded the 70% for GAD even with the wierd comments. I agree, going back and trying to correct it at this point might be harmful -- just seeking confirmation (or comfort) from fellow veterans.

Hi Slowlane... Thanks for the input. I was talking about this with my VSO today.... I pointed out the obvious -- that in nothing else, saying stupid stuff under pressure kind of confirms the C&P doc's diagnosis :-) I haven't thought about quitting -- Although my workload will be cut in half in the fall (two classes a week instead of four). I'm not at the point where I feel "right" about quitting work just to get TDIU. My slowing down (and eventual retirement) is more about my ability to do a quality job consistently.

At my mental health C&P, the examiner asked about what I do and I explained I work part time as an independent contractor teaching online classes and I gave her info on the typical annual earnings. She asked how many hours I work and I said between 15 and 20 for the contract, but more unpaid (coming up with ideas for new classes in hopes of getting a bigger contract). When she asked how much I work total, I drew a blank and just said, "I don't know... maybe 40 or 50 hours". When I got home, I did the math and it is nowhere near that much, and certainly not done in one sitting like a 9 to 5 job. I included hours of thinking, reading trade books, articles and jotting down goals. Anyway... on my C&P exam it says I am employed full time at 40 to 50 hours weekly. Can this be corrected without raising concerns that I gave her bad info intentionally? Self-employed earning below poverty is not the same as employed full time. The kind of "work" I do and the sporadic nature of when I'm able to sit at a desk make the work about as non-traditional as I've every heard of :-) I'm scheduled for less than half the classes next year compared to this past year.

I received my C&P exams in the mail today -- about two weeks after requesting them by fax. I think the reason I can't "see" anything on the Blue Button yet is that my account is not premium. I have my first PCM appointment next week and I'll take the application with me. Thanks to all for your suggestions.

Thanks for the tip. Apparently the Blue Button does not always work. Last time I tried it, I only got the info I put in there myself. Could this be because I haven't had my first PC doc appointment yet?

Same here. The fax was a while back (when I originally posted). The psych one is needed as well... odd that they would not give that to the vet directly. This brings up another question in line with this thread: If you are seeking TDIU based on your most recent C&Ps and rating, do you need to submit additional info? Would they need another C&P if they just did one within six months?