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USMC_VET

Senior Chief Petty Officer
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USMC_VET last won the day on December 1 2015

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About USMC_VET

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    E-8 Senior Chief Petty Officer

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  • Service Connected Disability
    90%
  • Branch of Service
    USMC

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  1. I do this for every submission. I have a cover sheet that looks like this ----------------------------------------------------------------------------- Evidence List Note: You will see in the top left hand corner BATES NUMBERING (i.e. 000001, 000002, etc.) to denote page number. A total of XXX pages of evidence is to follow this cover page listing all the evidence to be considered. Contains names of files uploaded and how many pages per file and brief description of evidence contained. I REQUEST THAT THIS LETTER AND ALL EVIDENCE SUBMITTED BE INCLUDED IN MY C FILE. TOTAL INCLUDING THIS EVIDENCE LIST, PAGES OF EVIDENCE: (37) SWORN DECLARATION OF NAME: 2 Pages Stating current and past symptoms of X disability SWORN DECLARATION OF NAME PART: 2 Pages Statement by spouse/friend/coworker relating how my disability has effected my life, work performance and how the disability manifests in public IMO EVALUATION BY DR. JOHN SMITH: 32 PAGES Evaluation by Dr. John Smith from April 2020 indicating impairment form disability, symptomology, history, effect on life/work and how it relates to experiences occured in service. JANUARY 15, 2005 BAS Medical report: 1Page PA notes from BAS medical visit regarding first instance of Disability X manifesting in service. ---------------------------------------------------------------------------------------------------- After i compile all my evidence i not each individual report, statement, medical log, etc. down. i indicate how many pages that report, etc is, and a brief statement abotu what it says in relation to my claim. i then include a total pages list and then i convert it to PDF and use their "Bates numbering" function that stamps it with a page number for all pages in the compiled total evidence list. If you dont have adobe just do all the same thing then hand write it or hand type in the header. If you are uploading in ebenefits the whole thing wont upload all at once and will need to be broken up into separate sections to be uploaded. Personally i upload, fax & send certified mail w/ return receipt so theres no chance they can say they didnt receive it and didnt receive it by the required file date. its also helpful because maybe one person miss uploads it to your file but not 2-3 different people. After your claim is completed if its denied or not the outcome you wanted you need to request your CFile, personally i request the Cfile at the same time as the claim as they wont send it out until your cfile is updated with an existing claim. once you get that back (or go to the VARO to make copies) check to make sure that ALL of the evidence, every page submitted is shown. If it's not and especially if it was a critical piece of evidence you have a great case to be made on appeal that the VA didnt consider all the evidence submitted and with that you will include the cover sheet stating exactly how many pages of evidence was submitted, what was submitted in it and even the fact you wrote out in simple, plain english for them them what that evidence showed. So for example you are claiming sleep apnea as direct, you have a sleep study done in service and you were diagnosed. you are denied in the claim and see in the c file that pages 1-25 & 29-45 are in there but conveniently pages 26-28, the diagnosis, isnt in there and they claim no inservice event. well you can submit all the evidence you gave to them the first time show by certified mail and return receipt it was sent and received by the VA and that your cover sheet CLEARLY stated that it included a inservice diagnosis of the disability you are claiming. What ive learned about the VA is that all the things we talk about and tips we give about submitting a proper claim in NO WAY guarantees the right result, all of this does is gives you a better chance at getting that right result the first time, but where the advice really shines is on appeal.
  2. background. I submitted a new claim on April 14 I submitted a supplemental claim on April 24 Supplemental Claim granted on June 16 HLR requested June 18 (for eed) On July 16 a "authorization review claim" appeared on Va.gov as "closed" I dont know what this means or what it refers to as the HLR is not closed, my supplemental claim retro had already been paid (and was only around $280)
  3. I had a OSA diagnosis in 2015 from the VA and two VA sleep studies and was ordered a CPAP. My claim with all this evidence AND a OSA diagnosis did not get me a OSA Service Connection.The VA didnt dispute that i had PTSD or OSA, they acknowledged it but they did not consider them connected or that it was direct service connection. I had multiple buddy statements that i would snore loudly and stop breathing while in service but was still denied. It was eventually granted with the IMO because the connection via Medical opinion by Dr. Anaise that PTSD is comorbid with OSA and that my nightmares caused me to rip the mask off at night which aggravates my symptoms. I know i am Direct SC but I was willing to take an aggravation as a connection. I agree that maybe you should try to direct SC and then IMO in the appeal but everyones situation is different.
  4. After Denials for OSA both direct and secondary to PTSD, this spring I decided to spend the money on a IMO and do the claim right. I contacted Dr. Anaise and was told to send all my records, decision letters and $1500. After about a week I was emailed with a final IMO report that was around 40-50 pages. It was excellent & well researched. Within 6 weeks of submitting the IMO with a supplemental claim OSA secondary to PTSD was approved. Yes IMO's dont guarantee anything and they can be expensive but they are definitely worth it when you have been denied already and have nothing else to submit and someone like Dr. Anaise will always outweight the NP the VA usually has doing exams.
  5. You may be right. I haven't stayed up on the va guidance last couple of years. @broncovet @Berta was there any such ruling?
  6. Very likely a 5 year exam as others have pointed out. Go in and do it, the best advice ive heard is when you do these exams and answer questions is put yoruself in the mindset of the worst day you had recently in regards to symptoms and effects, dont talk about how you are feeling that minute especially if its a good day because the C&P is a snapshot that becomes how you have felt from your last exam to now, there is no nuance in it. No need to stress about it espeically before or after the exam. IF IF IF they try and reduce you go back start getting your VA & private (if applicable) medical records and anywhere you talk about that disability put those pages (or print them) aside. Prior to the 5 year mark you can be reduced WITHOUT showing improvement over time. Then get a IMO doc to look at your records. Look up the doc that did your C&P find out their bonafides and find a IMO doc that has more. Then when you get the report back from them send it in with all the medical evidence. I would also look at the specific C&P exam notes that led to the reduction and see what they wrote. Then in a sworn statement explain if the doctor misunderstood and answer, maybe you were nervous and rushed it to get it done, maybe he left things out and paint a picture of why those answers dont lead to the conclusions he drew. in 2015 i was freaked out by being put in a psych wing at the VA for a C&P PTSD exam. i rushed through said (fine, good, etc) to get out of there and they tried to reduce me. Obviously dont do that but my IMO along with explanation helped to get the VA to drop the reduction. All that being said dont assume the worst, a reduction is just a maybe, not a guarantee so go in for the C&P and explain how bad it is and how it affects you
  7. Without knowing the details its hard to give good advice. Attorneys can only collect a max of 20% of your backpay so to me its a no brainer once you have gone down the VSO/solo route and been denied on appeal, especially when your next step is the BVA or CACV. Now if you are at say 84% and the claim is for a disability that would be rated at 10% and your only talking a few hundred bucks extra month with 2 years backpay youre only talking about say $4500 total back pay with attorney fee being $900. This will affect whether a good attorney wants to work with you. If however, you have a significant increase and large backpay due if you win a good attorney will be more likely to want to take your case. its not about fair its about the fact they have to do alot of work and possibly hire docs for IMO's and if the payout is tiny you cant expect them to take your case. Personally if youve been denied 3 times (and its a initial, nod, supplemental) and youre looking at the BVA next then definitely hire a attorney. Start now to collect ALL the documentation and get your C-File. Dont miss your appeal date and start asking around different firms ( @broncovet had good suggestions above) There are good VSO's and bad VSO's the problem is unless youve worked with them before theres not rating/yelp system for them so you have NO idea if they will work your case or just do the minimum. I dont completely buy into the VA/VSO conspiracy but I do think theres something to the fact they are dependent on the VA for aspects of their job/position. Combined with the fact that VSO's get the same amount whether you win and get 100k backpay or lose and get 0, an attorney has a much bigger incentive to do more work and win your case. Yes you lose 20% of your backpay BUT the solo/VSO route has not only given you 100% of 0 but also wasted years of your life. I am more than happy to come home with 80% of X backpay than 100% of 0
  8. Absolutely. The VA can and in many cases will ignore evidence at the RO level no matter how compelling. IMO's done by legitimate specialists are REALLY hard for them to ignore especially at the appeal level. I will however say that not all IMO's are equal. The VA is very military in its approach to expert opinions, higher rank always wins. If you had a NP do your C&P exam for migraines and you get a IMO from a neurologist youll win. Conversely if you see a sleep specialists and VA psychologist and they say you ahve sleep apnea but its not caused by your PTSD and you get your local NP to write up a DBQ/opinion that states it is you will lose. The more experience, more degrees, more boards they belong to the better.
  9. Reductions are something every SC veteran worries about. Its often a fear that keeps vets from seeking increases in disabilities that have worsened or appealing bad decisions. I had my own scare a few years back when i filed for an increase, had a bad C&P on a disability and the VA sought to reduce me which freaked me out. I eventually beat them at their own game but i wanted to put out some information that are preventative measures to stop reductions from occuring or provide the evidence needed to fight them if the VA decides to push it. Unfortunately there is no silver bullet that makes a reduction ironclad, just as there is no ironclad approach to filing initial or increase claims that that VA cant argue with. Since rating is done by humans and humans are prone to fault and bias there is no guarantee with anything only higher or lower probabilities with getting claims granted and providing more armor for the appeals process. 1) Schedule regular checkups I know alot of vets here dont have access to secondary care outside the VA whether its location or money. If you do have the money/insurance outside the VA to see a outside primary care/specialist or can access the VA's choice program to see non VA medical professionals take advantage of that. I am lucky that I have access to this through my employer so outside of my annual checkups/specialists at the VA i go to private doctors at least annually to document the state of my current conditions. I am honest with my doctors and ask them to make detailed notes of each condition i talk to them about and its current symptoms, etc because i need to provide the VA with documentation of my disabilities. It doesnt matter if my condition hasnt worsened i still talk to them or a specialist about it so that i have the documentation. If you dont have access to this make sure that when you do your VA checkups you specifically talk to them about all your disabilities as well, how its impacts you, pain severity, how often it bothers you, etc. If your VA provider DOESNT address something in your medical record make sure you send a secure message through myhealthevet so that it is recorded that you spoke to them about it. 2) Start a Diary I would start a diary, preferrable on a word document or even better on the "activity journal" on myhealthevet and record symptoms, sick days, etc for ALL your disabilities and even things not SC that might in the future be something that is secondary to a SC condition. I prefer to keep these journals on a word doc, you dont have the write a novel just the big things like, "ran today, bad pain in shins after 10 minutes, 4/10 then 7/10 after i walked back home. took naproxen and stayed off for the rest of the day", "back pain after being at work for 2 hours, no relief with 800mg IBprufen and flexeril" This diary especially when its updated on myhealthevet in a timely manner say every month or a couple times a year is great for establishing what symptoms you have been experiencing regularly day by day, week by week or month by month in between doctors visits. The VA likes to take one or two visits where you are stressed, rushed or dont want to be there and answer "fine" to "how are you doing" or "how has _____ disability been " and use that as a justification that you are showing "material improvement" in your condition. The main takeaway is NEVER approach a C&P or ANY VA MEDICAL VISIT as routine. You dont need to stress but always describe how X disability is doing as how it feels on the WORST day not on the best or how you are felling at that moment. That being said meticulous diary entries can help bolster your case you have not experienced material improvement. Regularly updating you myhealthevet journal also timestamps it to show this has been done regularly over months, years or even decades so that a rater cant just say you made it up on the spot, and you can point to that you ahve regularly updated this journal to show over X number of months, years or decades to show what its like with your disabilities on a daily basis. 3) Dont let Medications Lapse Never let your medications with the VA lapse. If you need 3x daily naproxen and 1x daily muscle relaxant to deal with back pain and your med refills show a 6 month gap the VA can make the claim your condition has improved. The VA CANNOT reduce you if your symptoms improve with medication, but if you are not taking your medication it can be an indicator that you are getting better. I know i sometimes get private Rx's not throught he VA and have them lapsed so i document and keep records of those medications (the sheet they staple on the bag with the name, doseage, date, etc) so i can scan and upload as needed for C&P, claims, reductions, etc. the VA may not prescribe the Rx you want so i get why you would go elsewhere but send a message to your primary care stating that you have gotten a Rx through a private physician, ask to be prescribed it through the VA, if they refuse then keep screenshots of these discussions for reference as well so its documented. 4) IMO's are key I know when i got hit with a reduction attempt by the VA my IMO saved me. 100%. no doubt. I had a terrible C&P for PTSD increase, they took me to a deserted wing of this old hospital and scanned me into what i think was the psych wing with no lights, was put in a dimly lit room where a psychologists was on a telecon line. It freaked me out and i wanted to leave, so i rushed the exam to get done. This was my fault, but it resulted in him saying my symptoms had gotten better. I started looking for help and came to HADIT. the best piece of advice i got was about IMO's so i found a psychiatrist who did a full workup and submitted a fantastic IMO. It was hard coming up with the money but $500 vs losing $600 a month was a no brainer. You dont need to get preemptive IMO's thats a waste of money but I would make sure, if possible, that you take a little money out every month and have $1500 in savings for an IMO if this ever happens to you.
  10. I thought i would update this thread since the last post was pre AMA If you receive an unfavorable decision from your Regional Office (RO) then you have some different options to consider compared to pre 2019. NOD (Notice Of Disagreement): This is similair to the old appeal lane, however unlike the old NOD where you had to go through the RO first then the Board of Veterans Appeals (BVA) you can skip that step and go directly to the BVA. At the BVA you can choose from 3 dockets, direct, hearing & evidence. Direct docket is for vets who do not want to submit new evidence and do not want a hearing in front of Veterans Law Judge. Evidence Docket allows for Veterans to submit new and relevant evidence and do not want a hearing. Hearing Docket is to have a hearing before a Veterans Law Judge either via teleconference or in person in front of the Board in D.C. To use this lane you must appeal within 1 year of your denial by the RO. If you are denied before the BVA you have 120 days to file to be heard before the CAVC, if denied there you can start a supplemental claim or appeal to the federal circuit courts Supplemental Claim Lane: this allows you to submit new and relevant evidence for your claim. Supplemental claims can be made anytime after your denial however, If you go this route you can preserve your effective date if submitted within one year of denial, if after your effective date will be the date you submitted the supplemental claim. You can also use the supplemental claim after a denial at the BVA or Court of Appeals for Veterans Claims (CAVC). This route also is the only one that the VA maintains its "Duty to Assist" I.e. look for evidence outside what you have submitted in your claim (VA health record, Service Record, etc), however its never a good idea to hope the VA finds what you need, do your own research and work, dont leave anything up to hope. If you are denied you can request to have a HLR or file a NOD and go to the BVA, If you are denied before the BVA you have 120 days to file to be heard before the CAVC, if denied there you can start a supplemental claim or appeal to the federal circuit courts. Higher Lever Review (HLR): This allows for Veterans to request that the RO issue a new decision based on a "senior" rater reviewing your claim de novo (new look), basically they take a brand new look at your claim to see if anything was missed. The reviewer can overturn a previous decision based on evidene presented and CAN issue a Clear and Unmistakable Error (CUE) ruling. You CANNOT submit additional evidence with your request for a HLR of your denial compared with a NOD or Supplemental Claim. They will review the SAME evidence presented in your claim that the intial rater saw and issue a ruling on that. If you are denied you have one year to file a supplemental claim or a NOD and the BVA. If you are denied before the BVA you have 120 days to file to be heard before the CAVC, if denied there you can start a supplemental claim or appeal to the federal circuit courts Timeframes for decisions: Below are the goals the VA has set for each portion of appeals, these are not guaranteed timeframes and depend on current que and variables in your case. Supplemental Claims: VA’s goal for completing Supplemental Claim decisions is an average of 125 days. Higher-Level Review: VA’s stated goal for completing Higher-Level Reviews is an average of 125 days. Appeals to the Board of Veterans Appeals: VA lists varying adjudication timelines for each docket. Direct Docket: VA has set a goal to decide claims in this docket within 365 days. Evidence Docket: VA states that claims in this docket may take longer than 365 days. Hearing Docket: Appeals in this docket are projected to take the longest amount of time to adjudicate, with wait times that may exceed 365 days. Other Important Information: It's important to note that you can "switch lanes" at any point in the appeal process prior to a decision. Example: Your claim is denied and you opt for HLR 180 days after. 60 days after submitting the request with no decision being issued you decided to file a NOD and appeal to the BVA instead, OR you discover new & relevant evidence that supports your claim and you wish to submit a supplemental claim. You will need to submit a written request to the VA authority that has your appeal and request that it be changed along with the proper paperwork for the new lane submitted to the RO than issued the denial. Denials of your appeal also give you the opportunity to change your appeal. Example: Your claim is denied at the RO, you submit a supplemental claim and that is denied you can now choose to submit for a HLR or file a NOD to appeal to the BVA.
  11. Im a bit late into this thread but theres already great advice here so some of this may be repetitive. 1) check you MOS against the VA Fast letter for probability of noise exposure (https://vaclaimsinsider.com/duty-mos-noise-exposure-listing/) If your MOS is listed as high probability you shouldnt have much problem with a claim, if its listed as "low" then I would make sure you get sworn statements (template below) from yourself and as many buddies as possibly to swear to the noise level in your job, deployments, situations, etc include everything you or others can think of. I prefer Sworn statements over plain buddy statements because these statements have the penalty of perjury over a statement which has no legal implications, so it carries more weight. 2) I always include multiple statements from myself, the first is always me listing exactly what im claiming what i think it was from as well as other possible sources (however the VA has a duty to investigate and determine if its from something else in your record as you are not a MD). If there are previous decisions and studies that back up my claim i include that, i.e "Multiple studies (attached as evidence) have concluded that there are multiple links between PTSD and Obstructive sleep apnea...etc....etc" In the following statements i lay out my history in detail, for you i would list what your job was when you were exposed to loud noise, i.e. "As a Tactical Switchboard operator I would do X, Y, Z and for approximatley 4 hours per day when i was at my duty station I would be in an area where there was loud beeping the exact same noise level of a emergency broadcast signal, which would repeat every X seconds for the entire period." 3) If you can afford it i would consult an audiologist and have the do a audio test for your hearing, talk about your tinnitus and your noise exposure, in detail, that you experienced in the military. Let them know that you have been to the VA and couldnt get help and need detailed exam notes to resubmit to them so you can get rated for tinnitus and hearing loss so that you can get medical care for it through the VA SWORN DECLARATION OF **NAME** STATE OF **STATE** § COUNTY OF **COUNTY** § Pursuant to 28 U.S.C. 1746, I, **NAME**, declare under penalty of perjury that the foregoing statement is true and correct: 1. "My name is **NAME**. I am more than eighteen years of age, of sound mind, and fully competent to make this affidavit. I have personal knowledge of the matters set forth below.: 2. Executed on **NAME** Signed: ___________________________________________ **NAME**
  12. @broncovet I believe you are right i had already sent in my HLR request but sent in another letter requesting to drop the HLR for a BVA appeal. I cant find my denial letter in july only my denial of a DRO directly after so i requested copies of all letters from the VA in 2019 from my VARO so i can 100% be sure before i go to the BVA with this. Im worried that i misunderstood my denial letter in 2019 as not being a open claim then denied, 1 year to appeal but it may have been a "we arent even considering this a reopen claim" letter and no clock was started on the appeal. I need to see my letter to make sure.
  13. @broncovet I appreciate it. I had sent in my request for HLR yesterday but I think im going to send in another letter/fax revoking it and go to the BVA.
  14. @broncovet I think you misunderstood, i filed in 2016 was denied and never fought it but reopened the claim in July 2019 and was quickly denied and then asked for a DRO review directly after and the request was denied. So im not asking for because i dont think i am eligible for a EED/retro of 2016 but for my reopening date of 2019. The retro their would be only around $1800. The reason i want the EED of July is that i had a ITF for seperate claims filed at the same time and when those are approved it will bump me over 100% and a retro around 18k for that claim. The EED for the OSA appeal would establish 90% as of July and then the new claims would bump me to 100% backdated to July for that seperate set of new claims.
  15. Im seeking a HLR for a EED but was wondering if they can decide to not only deny the EED but reverse the raters decision to grant the claim? If i make my HLR request to be specifically about the Effective date can they decide to be vindictive and change the rating as well? Im guessing yes but wasnt 100% on it
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