awgv001

I want to include this here as well! TBI Symptoms Symptoms vary greatly depending on the severity of the head injury, but may include any of the following: Vomiting Lethargy Headache Confusion Paralysis Coma Loss of consciousness Dilated pupils Vision changes (blurred vision or seeing double, not able to tolerate bright light, loss of eye movement, blindness) Cerebrospinal fluid (CSF) (which may be clear or blood-tinged) coming out of the ears or nose Dizziness and balance problems Breathing problems Slow pulse Slow breathing rate, with an increase in blood pressure Ringing in the ears or changes in hearing Cognitive difficulties Inappropriate emotional responses Speech difficulties (slurred speech, inability to understand and/or articulate words) Difficulty swallowing Body numbness or tingling Droopy eyelid or facial weakness Loss of bowel control or bladder control Reference: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Traumatic-Brain-Injury

Somehow, since 2015 they never pressed the button to issue me a C&P for TBI. I don't know why to this day. Was referred to TBI clinic, they did a work up and questionnaire, I got a diagnosis, and they reviewed statements I had on hand at the time.

So, on my original claim (going back to MEB/PEB) I was checked out for vision changes via ophthalmologist - Nothing unusual was reported for my eyes, then, migraines - examined by an off-base neuro, and such, but it was never diagnosed as TBI until after service. The person evaluating my migraines recorded syncope, but didn't record a LOC, or that the syncope ended in the form of a fall. PEB found me unfit at 10% for nerve damage to my left arm. Migraines don't get a rating for DoD (BUT TBI'S DO) These were the only contentions on the original claim: VA SC'd for 40% for my left arm nerve damage, migraines, and tinnitus, (0% for each --- pes planus, left wrist strain, and a scar) Note -- My CO's report details that I missed 40 hours of work per week - He's not a doctor but shouldn't his input on this have like, a TON of weight in light of the circumstances? THIS WAS NOT EVIDENCE LISTED OR REVIEWED FOR MY RATING DECISION ^^^^ Symptoms present at the time of MEB/PEB Headache/Migraines Vision changes & Photophobia Tinnitus (LOC was not in here because it could only be verified by a witness to the incident - which I have, but only after separation.) You are not allowed to report your own LOC. I didn't even fill out the items being claimed on sheet myself, as I had no understanding of what I was looking at, or what I could potentially claim. They pointed out every line I had to sign. All of these filings that I have done and disagreed with (I'm now awaiting at the BVA level) and yet not a single one of them ever triggered a C&P exam, however I did get referred out to another neuro, and with all the other evidence in tow - hastily gave me both diagnosis and Nexus. The RO then kicked my claim back at me one more time after turning those in saying that it wasn't a "conclusive diagnosis" --- The treating Neuro post-service wrote this statement, that they had as evidence at the time they made this decision - Here it is verbatim "I AM TREATING HIM FOR SYMPTOMS RELATED TO A TBI RESULTING FROM TRAUMA THAT OCCURRED DURING HIS MILITARY SERVICE. THIS DIAGNOSIS AND MY TREATMENTS ARE IN EACH OF MY CLINICAL NOTES FOR YOUR REVIEW." This has now been followed up by yet another doctor as evidence to take with me up to BVA, who stands with the first doctor saying "HE HAS BEEN DIAGNOSED WITH TBI BY THE (city) VA TBI CLINIC" "I CONCUR WITH THE DIAGNOSIS CAUSED BY THE FALL....IT IS MY MEDICAL OPINION THAT IT IS MORE LIKELY THAN NOT THAT THE CURRENT SYMPTOMS OF TBI INCLUDING...(LIST OF 2ND'S)... ARE A DIRECT CONSEQUENCE OF THE INJURY HE SUSTAINED WHEN ON ACTIVE DUTY." --- I'm trying to do all that I can to strengthen my claim, you guys are all I have when it comes to battle here...Any help outside of here has been next to worthless. From the bottom of my heart, without you guys, I would most likely be homeless or dead. Thank you for everything!

CHANGE TO TBI RATING SUPPLEMENTARY INFORMATION: This document proposes to amend VA adjudication regulations (38 CFR Part 3) by revising 38 CFR 3.310 to add five diagnosable illnesses as secondary conditions which shall be held to be the proximate result of service-connected TBI. Scientific Bases for This Rulemaking In the National Academy of Science IOM Report, Gulf War and Health Volume 7: Long-Term Consequences of Traumatic Brain Injury, the IOM concluded there was “sufficient evidence of a causal relationship” (the IOM's highest evidentiary standard) between moderate or severe levels of TBI and diagnosed unprovoked seizures. The IOM found “sufficient evidence of an association” between moderate or severe levels of TBI and parkinsonism; dementias (which VA understands to include presenile dementia of the Alzheimer type and post-traumatic dementia); depression (which also was associated with mild TBI); and diseases of hormone deficiency that may result from hypothalamo-pituitary changes. The medical literature that IOM reviewed included two primary studies and one secondary study on TBI and parkinsonism. One primary study involved 196 Parkinson's patients living in Olmstead County, Minnesota, and the second involved 93 pairs of male twins who were veterans from World War II. The secondary study involved 140 civilian Parkinson's patients in Boston, Massachusetts, who had suffered a TBI severe enough to cause loss of consciousness, blurred or double vision, dizziness, seizures, or memory loss. These three studies support a link between moderate or severe TBI and parkinsonism. Medical literature supports a link between TBI and the two types of dementias listed above (presenile dementia of the Alzheimer type and post-traumatic dementia). Reported cases show that individuals with TBI often are diagnosed with dementia at ages younger than their early 50s and within 15 years of their injuries. As classic Alzheimer's disease strikes sufferers much later in life, the dementias suffered by TBI victims are unlikely to be classic Alzheimer's dementias. Classic Alzheimer's disease is the most common of many types of dementia that occur in older adults. It is difficult to conclude that Alzheimer's occurring at ages in the 60s or 70s is related to a distant TBI. The IOM reviewed 4 primary studies of civilians and of troops serving in World War II and the current conflict in Iraq and five secondary studies of mood disorders including major depression. The primary studies generally supported an association between mild, moderate, or severe TBI and major depression within the first twelve months after the injury. Current research does not provide significant evidence to support association more than 12 months following mild TBI. Moderate or severe TBI appears to cause an elevated risk for depression (up to 50% in some research) for at least the first 3 years. The IOM reviewed five studies on TBI and hypopituitarism, and five studies on TBI and growth hormone insufficiency. The studies generally showed increased risk of those conditions developing within months after a moderate or severe TBI and, although the effects in many cases were acute and eventually resolved, some long-term effects were observed. The medical literature reviewed by IOM supports a link between TBI and diseases of hormone deficiency resulting from hypothalamo-pituitary changes, when the disease manifests within 12 months of a moderate or severe TBI. The presence of other peripherally-mediated endocrinologic disorders (including, but not limited to diabetes mellitus) has no association with TBI. After careful review of the findings of the NAS Report, Gulf War and Health Volume 7, the Secretary of Veterans Affairs has determined that the scientific evidence present in the NAS Report, Gulf War and Health Volume 7 and other information available to the Secretary indicates that a revision to VA regulations to add the five diagnosable illnesses as secondary conditions is warranted. The five diagnosable illnesses to be added are the following: (1) Parkinsonism following moderate or severe TBI; (2) unprovoked seizures following moderate or severe TBI; (3) dementias (to include presenile dementia of the Alzheimer type and post-traumatic dementia) within 15 years of moderate or severe TBI; (4) depression, if manifest within 3 years of moderate or severe TBI or within 12 months of mild TBI; and (5) diseases of hormone deficiency that result from hypothalamo-pituitary changes manifest within 12 months of moderate or severe TBI. Section 501(a) of title 38, U.S. Code, establishes the Secretary of Veterans Affairs' general rulemaking authority to prescribe all rules and regulations which are necessary or appropriate to carry out the laws administered by VA. Based on VA's analysis of the scientific evidence discussed in the IOM report as well as the IOM's finding of sufficient evidence of relationships between specific levels of TBI and certain diagnosable illnesses, and all other information available to the Secretary, we propose to amend 38 CFR 3.310 in order to incorporate five diagnosable illnesses as secondary conditions that are the proximate result of service-connected TBI. The IOM also found associations between TBI and certain behavioral and social problems. These include diminished social relationships, aggressive behaviors, long-term unemployment, and premature death. Under 38 U.S.C. 1110, VA may only grant service connection “[f]or disability resulting from personal injury suffered or disease contracted in line of duty * * *”. Similarly, § 1310(a) states, “When any veteran dies * * * from a service-connected or compensable disability, the Secretary shall pay dependency and indemnity compensation to such veteran's surviving spouse, children, and parents.” VA does not believe it is necessary to establish new presumptions of service connection for these effects because they are not distinct physical or mental “disabilities” for VA compensation purposes. However, the behavioral, social, and occupational effects of TBI and related service-connected conditions may be considered in evaluating the severity of those conditions for compensation purposes as provided in provisions of VA's rating schedule. In relevant part, § 3.310(a) states: “[A] disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition.” We propose to revise § 3.310 by adding a new subsection (d)(1) that lists five diagnosable illnesses as secondary conditions that shall be held to be proximate results of service-connected TBI. VA recognizes that not all those who suffer a TBI during military service seek immediate medical assistance and receive a medical assessment of the severity of the TBI. Therefore, proposed paragraph (d)(2) will clarify that neither severity levels nor time limits for manifesting secondary conditions as proximate causes of service-connected TBI shall preclude a veteran from establishing direct service connection under the generally applicable principles of service connection in 38 CFR 3.303 and 3.304. Determination of the Severity of a TBI VA and the Department of Defense have established a joint set of factors and criteria for classifying a TBI as mild, moderate, or severe. The factors and criteria were created by a team of physicians from VA and the Department of Defense who are experts on diagnosing and treating TBI. The factors are structural imaging (such as functional magnetic resonance imaging, diffusion tensor imaging, positron emission tomography (PET) scanning), duration of alteration of consciousness/mental state, duration of loss of consciousness, duration of post-traumatic amnesia, and score on the Glasgow Coma Scale. See Memorandum by Asst. Secretary of Defense for Health Affairs, “Traumatic Brain Injury: Definition and Reporting,” October 1, 2007. See also Compensation & Pension Service Training Letter 09-01, January 21, 2009. We propose to include these severity criteria as a table in § 3.310(d)(3)(i). We also propose to explain in paragraph (d)(3)(ii) that the determination of the severity level is based on the TBI symptoms at the time of injury or shortly thereafter, rather than the current level of functioning. This provision is consistent with established medical principles for assessing the severity of TBI. See Memorandum by Asst. Secretary of Defense for Health Affairs, “Traumatic Brain Injury: Definition and Reporting,” October 1, 2007. See also Compensation & Pension Service Training Letter 09-01, January 21, 2009. Some veterans may not meet all of the criteria within a particular severity level or may not have been examined for all the factors. We believe the simplest, most efficient, and fairest way to rank such veterans is to apply two rules: (1) VA will not require that a TBI meet all the criteria listed under a certain severity level to classify the TBI under that severity level; and (2) If a TBI meets the criteria relating to loss of consciousness, post-traumatic amnesia, or Glasgow Coma Scale in more than one severity level, then VA will rank the TBI at the highest of those levels. We propose to include these rules in paragraph (d)(3)(ii). In some cases, it may not be clinically possible to determine the severity of a TBI (e.g., because of a lack of medical records contemporaneous with the injury or medical complications (e.g., medically induced coma)). In such cases, § 3.310(d) would not apply and the veteran's claim would be processed under § 3.310(a) which states that “disability which is proximately due to or the result of a service-connected disease or injury shall be service connected.”

Way to go @Vync!!!

While my claim was ultimately denied ( I went DRO route ) - they did have it in and done very quickly so that I could further appeal at the earliest opportunity. Kinda thankful it worked out this way tbh. It wasn't until VERY recent that I was able to retrieve more evidence and support, and strengthen my claim significantly. I understand your frustration to an extent - it's been 12 years since an incident occurred - this injury and symptoms were inaccurately diagnosed as something else, and I have been tasked to go back in time to make corrections and "line up" the correct information. I feel like I'm one of the lucky ones who were able to force my dots to connect - It took nearly 10 years just to get in contact and explain my situation with fellow battles, but it's working! 21 years is an unforgivably long time to wait, so I hope that they hold to their promise of having all legacy claims processed by 2022.

Wow! Great info and very descriptive. I especially like the part where they start discussing allostatic load, and its effects. I imagine the effect of gunning the accelerator to the floor and repeatedly pressing it over and over again. Eventually, wear, heat, and damage WILL occur, no matter how good the oil.

Thanks again @Vync - Yes, this right here may be the only recourse I have to get the EED pushed all the way back. My buddy statements shed light to my incident(s) and symptoms in service. Two Nexus connects the TBI - but in the past denial they threw out the first one because "the exam done in 2012 gave a more clear and concise picture of how you were at that time"-- something along those lines anyways. The (3rd) Nexus (by my pcp) is provided for the lower back and all things below as 2nd to TBI. Diagnosis (2015-2016) and treatments spanning continuous records since 2012. Suppose we just have to wait and see if CUE will be appropriate here. As for NVLSP - maybe I will send another contact inquiry, I have thoroughly checked my info, and there's nothing as of yet. I did mention to them in their general info submission that i'm awaiting a BVA hearing. Anyone have experience doing a discharge upgrade/review? specifically med sep up to med ret?

So, @Vync I exited service via PEB - %10 DoD w/sep (also wrong and being contested) - %40 VA (%30 of which was migraine, which is the right disability, but wrong diagnosis, it should have been migraine 2nd to TBI which is being contested currently, and an absolute guarantee once I get to BVA that TBI will be connected) I didn't fight the proposed rating right then and there because I hardly knew what I was looking at. I feel like I was done pretty dirty, but how was I to know all this stuff when they were rushing me out the gate? Anywho, I had a re-eval in 2015 that continued my rating for migraines at the %30 level, again, still citing the 2+ prostrating episodes p/m It's a colossal mess that no doubt is going to end up causing me to miss out on "X" amount of benefits. I have not appealed the initial ratings or the re-eval(outsourced exam) (both 2013 and 2015 respectively) There was something I read up about how a Secondary condition is NOT allowed to predate the "origin" SC'd injury/disease....so, maybe there's a chance that once TBI is connected, it'll just fall back to the date migraines we're SC'd (day after end of service)! Here's to still fighting and hopeful, now that it's been nearly a decade anyways LOL. Because that first neuro didn't record my fall, i've been having to try and go back and back again to overthrow that exam, and with the mountain of TBI specific evidence I have....I can only wait. I don't know if I'm strong enough to handle a CUE claim on my own. I tried getting someone from NVLSP, but no response yet there either. Seems that I'm mostly on my own, but with you guy's help I've been making my way down the road bit by bit!

I should have been rated higher since the beginning, if what I said below has any weight to it. - Well, then where would I stand? CO letter states i missed 40 hours a week, exit exam says 2+ prostrating attacks p/m, the re-eval I did 2-3 years after service only continues my claim at equal or worse levels... Not sure what to do...where do I go from here...plenty of evidence that met 50% - but without further explanation to what they need to warrant me higher than the generic "economic inadaptability" part...I felt like the CO's report pretty much nipped that one! Plus, it only complicates things that there's TBI (not sc yet but pre-dates the migraines)...

I'm in the same boat, claim filed 2015 - then reopened and denied (no c&p's for me though) - review (denied), ramp (Early 2018), ramp decision Jan 2019 (denied again) - appeal to bva in April 2019. April is my docket date --- still waiting for a hearing currently. So, now we should have our claims in order, and evidence "at the ready" If your POA is the DAV then yes, a DAV rep will be with you at the hearing, both you and the DAV rep get the hearing notice, so they should be getting in contact with you before the day of your hearing. I'd like to see an update of how this goes for you, and good luck!

@broncovet Taking a second glance at it, toward the bottom of RAMP REVIEW RIGHTS "If you are still within your one-year period at the conclusion of RAMP - you may seek review by filing under the new claims and appeals system" Yeah, I'd say its good, but at first glance I was like O_O ohhh nooo... Yes, my claim docket date is for APR 2019, appeal was timely filed, just gotta ride it out and catch some more fish.

^_^ Another job well done! Congratulations!

Following

I opted into ramp (2018), and my claims were processed quickly (2019), all denied - Would the appropriate form attached move my claim along via RAMP though it has been discontinued, but started off in this process?? Can the form 10182 be used, or does it HAVE to be the 21-4138 attached at the back of the decision....reason being is because I think we may have royally screwed up, and we filed a 10182 - but my claim is moved to AMA anyways or??? My current appeal is docketed - but.....I'm just scared that the wrong form being used not only is dragging my claim along, but may be struck down for using the wrong form!!! I'm wanting to go to my VSO tomorrow and correct this...I don't know what to do, and it sounds like my VSO doesn't either... So I plan on submitting the 21-4138, regardless of the other filing we did originally - even though ramp ended in February - there is still time for those who went RAMP to get in their last minute appeals and such right!?

Well, I also filed for a medical record amendment - and if that is granted, it will provide the medical evidence with the appropriate date of when I had that exam! This part is a work in progress still - but it is easier(exponentially faster) IMO to ensure that my records are more consistent. Plus they used the un-amended version both as negative evidence, and positive evidence, mainly because the doctor did not accurately reflect what I explained to him - so the whole time I was being evaluated by him, he remarked as if I had passed out, but that passing out alone didnt cause a head injury... (Guess what, my head hit the ground first, and thankfully (to much embarrassment) there were a ton of witnesses present.)

Well @Buck52 I have been SC'd for migraines since forever ago - it was diagnosed as such, and was never linked to TBI as being the cause, nor was TBI claimed upon my exit - so there's the issue. Also, I will continue to review more on TBI secondaries, and I have some other contentions that very well could be as a result of these injuries. My claim for TBI is currently sitting at the BVA, I have been actively fighting it since 2015, but my SC for migraines goes back to before EAS. I currently have an in service event(statements), two favorable Nexus/IMOs, and a formal diagnosis among other corroborative evidence in my possession that will be taken with me to my hearing. Two particular notes of which are N&M evidence.

Ok @Buck52 - The thing I didn't couldn't understand was the difference in a direct service connection and its appropriate EED. Like what you had said above, this would fall (I assume) under presumptive, and wether or not would be backdated to the day after the veteran left service. Or if it would end up being dated to the EED of when the claim was filed.

I think I may have found an answer.... Since migraines (can be) are secondary to TBI I wonder how this argument would work since the original claim didn't provide "causation" to the origin of the migraines...nor was a TBI diagnosed until years later. I bolded an important part because this may be a "loophole" to getting my SC TBI backdated properly....maybe? III.iv.5.C.3.g. Correlation Between Effective Date for Primary and Secondary SC Disabilities The effective date assigned for a secondary SC disability cannot be earlier than the effective date assigned for the causal or primary SC disability. When a claim for SC for a disability is pending and subsequent development of the claim reveals that the disability is caused by a disability that may be associated with service, the decision maker must investigate the possibility of SC for the unclaimed causal disability as well as SC on a secondary basis for the claimed disability. The duty to investigate SC for the causal disability as within scope of the claimed issue is prompted when the claimed disability is shown to be secondary to the unclaimed causal disability, and when the criteria under 38 CFR 3.159(c)(4) have been satisfied. If the causal or primary disability is, in fact, related to service, the pending claim reasonably encompasses a claim for benefits for the causal disability. The effective date of benefits for the causal disability is guided by the date of receipt of the claim for the secondary disability. Example: A Veteran claims SC for right leg pain and numbness. Development of the claim confirms a diagnosis of radiculopathy that is secondary to an unclaimed back injury. The back injury was sustained in service. Sufficient evidence to establish SC for the back disability is of record. Consider the unclaimed back disability within scope of the claimed radiculopathy and establish SC for both issues with an effective date assigned based on the date of receipt of the claim for SC for radiculopathy. References: For more information on determining whether an unclaimed issue is within scope of a claimed issue, see 38 CFR 3.155(d)(2), and M21-1, Part III, Subpart iv, 6.B.2.b the correlation between effective dates assigned for the causal and secondary disabilities, see Delisio v. Shinseki, 25 Vet.App. 45 (2011), and SC on a secondary basis, see M21-1, Part IV, Subpart ii, 2.B.5.

BTW ---- I found something on EED's that seems very well constructed to help out folks (myself included) on any confusion. Claims for compensation based on direct SC are governed by 38 CFR 3.400(b)(2)(i). There are two main provisions of this effective date rule. For claims received more than one year following discharge from active duty, the general rule applies. Thus, the effective date will be date of receipt of claim or date entitlement arose, whichever is later. For claims within one year of discharge from a period of active duty, the effective date may be as early as the day following discharge. Refer to the table below for more information on the application of this provision of 38 CFR 3.400(b)(2)(i). Step Action 1 Is the date of receipt of the claim within one year of discharge? If yes, go to Step 2. If no, then apply the general rule, unless another effective date rule applies. 2 Review the character of discharge (COD) for the most recent period of service. Refer to the table below to determine appropriate action to take based on the COD. If the separation from service was ... Then ... under conditions other than dishonorable go to Step 3. dishonorable and only a single period of service was performed refer to M21-1, Part III, Subpart v, 1.B. dishonorable but there were multiple periods of continuous service, and the prior period of service was under conditions other than dishonorable refer to M21-1, Part III, Subpart iv, 5.C.3.d. References: For more information on the necessity of a COD determination in claims involving dishonorable service, see M21-1, Part III, Subpart v, 1.B.1, and conditional discharge determinations following a period of dishonorable service, see M21-1, Part III, Subpart v, 1.B.5. 3 Determine when the disability was incurred or aggravated during the Veteran’s military service. Did active duty service continue without a break in service from the date the claimed disability was incurred or aggravated? If yes, go to Step 4. If no, then apply the general rule unless another effective date rule applies. 4 Were the entitling criteria for a grant of SC met as of the day following discharge? If yes, then grant SC effective the day following discharge. If no, then grant SC effective the date entitlement arose. Exception: If a claim is received to reinstate compensation following a return to active duty, apply 38 CFR 3.654(b) and follow the procedures in M21-1, Part III, Subpart v, 4.E.1.g. Note: A Veteran may seek entitlement to SC for new disabilities concurrently with a request to reinstate compensation following discharge from a period of active service. The effective date of SC for the newly-claimed disabilities is assigned in accordance with the steps in the table above. Reference: For more information on effective dates for the resumption of compensation following release from active duty, see M21-1, Part III, Subpart i, 2.C.3.c. ALSO --- The General Rule The general rule is that the effective date is assigned based on the date of receipt of claim or the date entitlement arose, whichever is later. Before applying the general rule, however, all information gathered during evidence review must be considered to determine whether a more specific effective date rule applies. Note: Date of claim and effective date are not synonymous. Although the effective date is often the date of receipt of the claim, the effective date is determined by a variety of factors and is frequently not the same date as the date on which the claim is received. References: For more information on the general effective date rule, see 38 CFR 3.400 determining the date of receipt of a claim, see M21-1, Part III, Subpart ii, 1.C.1 reviewing claims, see M21-1, Part III, Subpart ii, 2.B stating the effective date and explaining the reason for effective date in a rating decision, see M21-1, Part III, Subpart iv, 6.C.5.a effective date procedures associated with the rating codesheet, see M21-1, Part III, Subpart iv, 6.E, and the impact of a previously withdrawn claim on the assignment of effective date for a subsequent claim, see M21-1, Part III, Subpart ii, 2.G.1.e-g. III.iv.5.C.1.c. Definition: Date Entitlement Arose There is no regulatory definition of the phrase date entitlement arose. However, in Wright v. Gober, 10 Vet.App. 343 (1997), the phrase "date entitlement arose" was found to be similar to the phrase "facts found." This case, along with the regulatory context, strongly suggest that the date entitlement arose is the date on which the facts in the case demonstrate that the entitling criteria are first met. III.iv.5.C.1.d. Determining the Applicable Date of Claim for Effective Date Purposes When determining the date of claim and its relationship to the proper effective date for assignment, consider the date of receipt of a complete claim, as well as a related intent to file (ITF) or incomplete claim filed within a year prior to the date of receipt of the complete claim. Notes: Do not associate an ITF with a supplemental claim. If a claimant files both an ITF and an incomplete claim before the complete claim is filed, the complete claim will be considered filed as of the date of receipt of whichever was filed first, provided it is perfected within the necessary timeframe. References: For more information on determining the date of claim for claims establishment purposes, see 38 CFR 3.155(d), and M21-1, Part III, Subpart ii, 2.B.2.c effect of ITFs on effective dates, see M21-1, Part III, Subpart ii, 2.C.2.c handling incomplete claims, see M21-1, Part I, 1.B.1.g, and supplemental claims, see M21-1, Part III, Subpart ii, 2.D. III.iv.5.C.1.e. Determining Whether Date of Claim or Date Entitlement Arose is Later The determination as to whether the date of claim or date entitlement arose is later, as specified in the general rule, is dependent on the date when the entitling criteria for the benefit sought are met. The entitling criteria for a claim are frequently met on or before the date of claim based on the lay, medical, and other information presented during the entire process of claim development. When applying the general rule, the assignment of an effective date based on date entitlement arose being later than the date of receipt of the claim is only appropriate when the evidence clearly establishes that the entitling criteria were not met as of the date of receipt of the claim. Example 1: A Veteran claims SC for a knee condition with pain on March 21, 2015. There are no post-service treatment records submitted with the claim. Service treatment records (STRs) do show treatment for chronic knee pain and complaints of instability during service. The VA examination dated July 14, 2015, confirms a diagnosis of patellofemoral pain syndrome. Analysis: The entitling criteria are met on or before the date of the claim because the Veteran reported the presence of a chronic disability which was later confirmed on examination and linked to military service. There is no affirmative evidence indicating that the knee disability was not present on the date of receipt of the claim. In fact, the evidence indicates the presence of a chronic knee disability due to the in-service knee problems that predated the claim. Thus, the effective date may be assigned based on the date of receipt of the claim unless a different, specific effective date provision otherwise applies. Example 2: A Veteran claims SC for elevated blood sugar due to possible diabetes on October 8, 2014, associated with confirmed Vietnam service. Private treatment records are requested and received showing that his blood sugars were first slightly elevated in June 2013, and the records document continued monitoring thereafter. A VA examination dated January 3, 2015, indicates a diagnosis of type 2 diabetes mellitus, and the physician notes that the diagnostic criteria for diabetes were first met as shown in the private treatment records on November 13, 2014, when blood sugars and other testing met the American Diabetes Association criteria for a diabetes diagnosis, as the documented symptoms prior to that time were not sufficient for a diagnosis. Analysis: The entitling criteria were not met as of the date of the receipt of the claim because the symptoms were not sufficient for a diagnosis of the disability at that time. There is affirmative evidence showing that the entitling criteria (which require the presence of a chronic disability) were first met on November 13, 2014, which is later than the date of receipt of the claim. Thus, the effective date is assigned based on the date entitlement arose since it is later than the date of claim, unless a different, specific effective date provision otherwise applies.

I was confused on this - because then how is the effective date applied?? To the day after EAS? The claim? The diagnosis----??? because of the whole "date entitlement arose" nonsense.

Usually within 15 days. If not call Peggy.

The claim date you filed the secondary.

@Vync Hmmm, what you posted is a more specific look than what I had found in terms of "verbiage" - until I found and read my exit C&P which stated the same thing Code 8100: Migraine headaches are a type of headache caused by the swelling of the blood vessels in the brain. They are often more severe than other kinds of headaches (stress, sinus, etc.), and so interfere more with the individual’s ability to work and function in daily life. If another kind of headache interferes significantly with daily life, it can also be rated here. Two things are taken into account when rating migraines: frequency (how often they occur) and severity (how bad they are). To receive a proper rating, it is essential that the physician records these clearly along with how they affect the individual’s ability to work and function. The term “prostrating” means that the individual must stop all activity, take medication, and either seek medical attention or seclude himself for the rest of the day. The individual is unable to perform any occupational or daily activities either because of the migraine itself or because the migraine medication makes him too drowsy, etc. The ratings for migraines only go up to 50%. The Rating Authorities, however, can give a higher rating if the case is so severe that 50% doesn’t truly reflect the disability. It is completely up to the Rating Authorities, however, exactly what makes a condition severe enough to warrant a higher rating. Frequency Severity Rating 2 or more times per month Prostrating 50% Once a month Prostrating 30% Once every 2 months and prostrating 10% Once every 3 months or less Prostrating 0% If the condition does not make occupational activity impossible, then it cannot be rated more than 0%. Quoted from MDME ---In review of my C&P's it lists Number of visual episodes per month : 4-6 Number of headaches/visual episodes per month that are prostrating : 2 "SM has to take break s when he gets an attack. SM has difficulty working when he gets an attack" Here's the reason for 30% --- With characteristic prostrating attacks occuring on an average of once a month over last several months -----A higher eval of 50% is not warranted unless there are very frequent completely prostraing and prolonged attacks productive of sever economic inadaptability. This is from a C&P in 2012 - the condition remains the same, if not worse to this day, have since had re-eval that also continues the same details as the first exam. So, is the decision wrong because they simply said "average of ONCE a month"??? This detail is NOT found anywhere in my records of "ONCE" a month....in fact it consistently says "2 or more" across several records. Seems a bit silly to me, but yeah, because they said it this way, I feel that they deliberately underrated my symptoms.

So I noticed that per the CFR - migraines have a rating of 50% with 2 or more prostrating episodes per month... I have medical evidence dating waaaaay back to when I originally received my award (pre-sep) The historical medical evidence records that I had 2 or more episodes from before I left service....and I let them lowball me at 30% at the time because I had no idea what the criteria was. (smh) How shall I go about dealing with this, though I have a current appeal in for TBI/lower back issues??? Re-open? CUE? Or am I screwed and have to file for increase? I have had significant luck in the past with claims for increase....but this is different because, again, the evidence shows I should have been warranted for 50% from my EAS date.