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allan
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Posts posted by allan
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Hello abe,
Welcome to hadit.com
Heres some information that may also help to look over.
Allan
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Does VA provide any assistance for obtaining a motor vehicle for a disabled veteran?
VA does have an Automobile Grant that can be used for purchasing a motor vehicle. Veterans and servicemembers qualify for this benefit if they have service-connected loss of one or both hands or feet, or permanent loss of use, or permanent impairment of vision of both eyes. Veterans entitled to compensation for ankylosis (immobility) of one or both knees, or one or both hips, also qualify for adaptive equipment for an automobile. There is a one-time payment by VA of not more than $8,000 toward the purchase of an automobile or other conveyance. VA will pay for adaptive equipment, and for repair, replacement, or reinstallation required because of disability, and for the safe operation of a vehicle purchased with VA assistance. the application form is VA Form 21-4502 Application for Automobile or Other Conveyance and Adaptive Equipment, which can be dowloaded from http://www.vba.va.gov/pubs/candpforms.htm. For more information, please call 1-800-827-1000
https://iris.va.gov/scripts/iris.cfg/php.ex...php?p_faqid=536
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Inquiry Routing & Information System (IRIS)
https://iris.va.gov/scripts/iris.cfg/php.ex...php?p_faqid=975
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Section J. Compensation Under 38 CFR 4.28, 38 CFR 4.29, and 38 CFR 4.30
http://www.warms.vba.va.gov/admin21/m21_1/...2/ch02_secj.doc
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VA Special Fellowship Program in Multiple Sclerosis
http://www.va.gov/oaa/specialfellows/progr...lesclerosis.asp
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Section F. Compensation Based on Individual Unemployability (IU)
http://www.warms.vba.va.gov/admin21/m21_1/...2/ch02_secf.doc
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Section E. Other Due Process Concerns
Overview
In this Section This section contains the following topics:
Topic Topic Name See Page
16 Failure to Report for Examination Under 38 CFR 3.655 8-E-2
17 Severance of Service Connection 8-E-5
18 Reversal of Prior Determinations Related to Character of Discharge, Line of Duty, or Willful Misconduct. 8-E-9
16. Failure to Report for Examination Under 38 CFR 3.655
Introduction This topic contains information about handling a failure to
• report for examination
with good cause
without good cause
by a veteran receiving pension, and
• respond to a notice of proposed adverse action.
Change Date August 1, 2006
a. Handling Failure to Report to Examination With Good Cause A veteran may fail to report for a VA examination, or a scheduled hospitalization for observation and examination, in connection with a running compensation or pension award. If he/she furnishes a good reason for missing the examination, defer adverse action and reschedule the examination.
Examples: Good cause for not reporting to an examination includes, but is not limited to
• illness or hospitalization of the claimant, or
• death of an immediate family member
Authorization notifies the veteran that failure to report for the rescheduled examination is cause for immediate termination or reduction of payment.
Reference: For information on a veteran’s refusal to report for examination because he/she claims to have submitted medical evidence adequate for rating purposes, see
• M21-1MR, Part III, Subpart iv, 3.B.15.e, and
• Kowalski v. Nicholson, No. 02-1284, June 8, 2005.
Continued on next page
16. Failure to Report for Examination Under 38 CFR 3.655, Continued
b. Handling Failure to Report for Examination Without Good Cause If a veteran fails to report for an examination without good cause, refer the claims folder to the rating activity for a review of static disabilities.
On the rating decision
• if there are
no static disabilities, indicate in the Reasons for Decision “the veteran failed to report for a review examination and there are no static disabilities,” or
static disabilities, provide in the Reasons for Decision the proposed new or continuing evaluations for all disabilities considered and the proposed combined evaluation, and
• do not enter the effective date of the proposed reduction or termination.
Note: Static disabilities include disabilities
• protected under 38 CFR 3.951(b) and 38 CFR 3.952, and
• for which no examination was scheduled or will be scheduled.
Reference: For more information on a veteran’s failure to report for an examination, see M21-1MR, Part III, Subpart iv, 3.B.15.e.
Continued on next page
16. Failure to Report for Examination Under 38 CFR 3.655, Continued
c. Handling Failure to Report for Examination by a Veteran Receiving Pension Use the table below if a veteran is rated permanently and totally disabled for pension purposes and fails to report for a scheduled review examination.
If … Then prepare a …
the veteran does not continue to be permanently and totally disabled “failure to report” rating and notice of proposed adverse action as required by M21-1MR, Part III, Subpart iv, 8.E.16.b.
the veteran remains permanently and totally disabled rating showing the disabilities at the static level.
Note: If there is no response within 60 days, the case is sent to authorization for appropriate action.
d. Handling Failure to Respond to the Notice of Proposed Adverse Action If the veteran fails to respond to the notice of proposed adverse action provided under M21-1MR, Part IV, Subpart ii, 3.B, authorization discontinues or reduces the veteran’s benefits in accordance with 38 CFR 3.655©(2).
After the award has been processed and the veteran has been informed of the action taken in the decision, prepare a rating decision for those cases in which there are static disabilities.
On the decision
• code all disabilities with their new, continuing and/or combined evaluations
• include noncompensable service-connected (SC) disabilities
• consider a compensable rating under 38 CFR 3.324, if applicable, and
• use the effective date the award was reduced as the effective date of the new combined evaluation based on static and/or protected disabilities.
17. Severance of Service Connection
Introduction This topic contains information about severance of service connection, such as
• applying 38 CFR 3.105(a) and 38 CFR 3.105(d)
• severing service connection due to diagnosis change
• severing service connection for a psychosis
• handling severance of service connection
• handling multiple issues
• handling increases in compensation
• preparing the final rating decision, and
• severance after veteran’s death.
Change Date August 1, 2006
a. Applying 38 CFR 3.105(a) and 38 CFR 3.105(d) Do not take action to sever service connection pursuant to 38 CFR 3.105(a) and 38 CFR 3.105(d) unless all available relevant evidence, including complete service medical data and autopsy findings (if pertinent in death cases)
• is of record, and
• shows that establishment was clearly and unmistakably erroneous.
Reference: For more information on the ten-year protection even when service connection is erroneous, see M21-1MR, Part III, Subpart iv, 8.C.9.
b. Severing Service Connection Due to Diagnosis Change A change in diagnosis may be accepted as a basis for severance if there is certification that the diagnosis on which service connection was based was clearly erroneous under 38 CFR 3.105(d).
Continued on next page
17. Severance of Service Connection, Continued
c. Severing Service Connection for a Psychosis If service connection is severed for a psychosis, make a determination of entitlement under 38 U.S.C. 1702.
d. Handling Severance of Service Connection The table below describes how to handle severing service connection.
Stage Who is Responsible Description
1 RVSR Refers all ratings proposing severance of service connection to the Veterans Service Center Manager (VSCM) for approval or disapproval under 38 CFR 3.105(a).
2 VSCM Is the rating approved?
• If yes
signs the rating, and
forwards the rating to authorization.
• If no
clearly marks the rating disapproved
signs the rating, and
returns the rating to the rating activity.
3 RVSR • Revises the rating, if required, to reflect the current evaluation of all SC disabilities and disposing of all other matters at issue, and
• files the rating in the claims folder.
Note: Each regional office (RO) maintains a list of the names and claim numbers of all cases in which a monetary benefit or service connection is affected pursuant to 38 CFR 3.105(a).
Continued on next page
17. Severance of Service Connection, Continued
e. Handling Multiple Issues Prepare a single rating decision identifying both issues if a decision involves severance of service connection for one disability and a reduction of evaluation for another disability.
Notify the veteran concerning both the reduction and the proposed severance.
Reference: For more information on notifying the veteran of severance of service connection, see M21-1MR, Part IV, Subpart ii, 3.A.2.
f. Handling Increases in Compensation Award increased compensation if severance of service connection is proposed for one or more disabilities but one or more other disabilities have increased in severity.
Notify the veteran concerning
• the proposed severance action
• the increased evaluation, and
• any reduction that will result from the severance action.
g. Preparing the Final Rating Decision After the 60-day period of notice during which the claimant could have submitted additional evidence, the case is referred to the rating activity for preparation of the final rating severing service connection.
Include in the new combined SC evaluation only those evaluations for disabilities that remain SC.
Note: This will ensure that no retroactive increase or benefit attributable to the severed disability will be awarded after basic entitlement is terminated.
Refer the final rating severing service connection to the VSCM or VSCM-designee for approval only if new evidence has been received since the proposed decision was approved.
Reference: For more information on the effective date of the reduced evaluation after severance of service connection, see 38 CFR 3.500®.
Continued on next page
17. Severance of Service Connection, Continued
h. Severance After the Veteran’s Death Upon the veteran’s death
• discontinue all action on severance proposals not finalized, unless the severance would affect death benefits, or
• make a proposal to sever service connection only if such a proposal, if finalized, will result in entitlement to a lesser benefit or the complete disallowance of a claim for death benefits.
Notes:
• Proposals initiated but not finalized prior to notice of the veteran’s death, upon notice of the veteran’s death, will be reconsidered de novo taking into consideration all available new evidence, such as medical reports of last illness, death certificate, and autopsy report, if indicated.
• The claimant is notified of the severance proposal and given 60 days to submit further evidence, even though the veteran was given a prior 60-day notice.
18. Reversal of Prior Determinations Related to Character of Discharge, Line of Duty, or Willful Misconduct
Introduction This topic contains information about reversal of prior decisions, such as
• jurisdiction in clear and unmistakable error (CUE) cases that sever service connection
• preparing the rating decision, and
• handling cases of disagreement between authorization and rating.
Change Date August 1, 2006
a. Jurisdiction in CUE Cases That Sever Service Connection Prepare an administrative decision if the authorization activity, rather than the rating activity, has initial jurisdiction of a
• statutory bar to benefits and character-of-discharge determination under M21-1MR, Part III, Subpart v, 1.B
• line-of-duty determination under M21-1MR, Part III, Subpart v, 1.D.19, or
• willful misconduct determination under M21-1MR, Part III, Subpart v, 1.D
and finds that there is clear and unmistakable error (CUE) in a prior determination which will result in the severance of service connection.
Note: The decision must contain a summary of findings and a statement as to the specific CUE that was identified.
References: For more information on
• the preparation and approval of authorization determinations, see M21-1MR, Part III, Subpart v, 1.A.2, and
• CUE, see M21-1MR, Part IV, Subpart ii, 3.A.2.
b. Preparing the Rating Decision Refer the claims folder, if in order, to the rating activity for appropriate action including the preparation of a rating decision proposing the severance of service connection under 38 CFR 3.105© and 38 CFR 3.105(d) on the basis of the determination by the authorization activity.
Continued on next page
18. Reversal of Prior Determinations Related to Character of Discharge, Line of Duty, or Willful Misconduct, Continued
c. Handling Cases of Disagreement Refer the case by memorandum to the VSCM for resolution of an issue if the rating activity disagrees with the determination by the authorization activity as to character of discharge, line of duty, or willful misconduct.
################################################################
http://www.warms.vba.va.gov/admin21/m21_1/...8/ch08_sece.doc
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Veterans Benefits Administration M21-4, APPENDIX C
Department of Veterans Affairs Change 72
Washington, DC 20420 October 3, 2006
Veterans Benefits Administration Manual, M21-4, "Manpower Control and Utilization in Veterans Service Centers is changed as follows:
Remove pages App. C-1 through App. C-2: Substitute pages App C-1 through App C-2, attached.
Page C-1 is amended to specify that third-digit modifier 1, when used with EPs 110 and 010, may only be used for original BDD claims and not as a sequential EP to correct a processing error. The term “BDD processing centers” is also changed to BDD intake and rating activity sites.
Rescissions: M21-4, Change 71
By Direction of the Under Secretary for Benefits
Renée Szybala, Director
Compensation and Pension Service
Distribution:
FD:
LOCAL REPRODUCTION AUTHORIZED
October 3, 2006 M21-4
Change 72
APPENDIX C
SECTION I. END PRODUCTS - GENERAL PRINCIPLES
1. The end product system is the primary Service Center workload monitoring and management tool. Correct use of the end product system facilitates proper control of pending workloads, and appropriate work measurement credit. Correct work measurement is essential to substantiate proper staffing requirements and determine productive capacity. Received and completed end products are also used to formulate the annual budget submission to the Secretary, OMB, the President, and Congress.
2. Each claim should be promptly (within 7 days of receipt) placed under end product control. Except for the few exceptions specifically identified in this appendix, that end product should remain pending until all required actions on that claim have been completed. Unless specifically authorized, more than one end product should not be taken for any specific issue. Exceptions to this policy are noted in this appendix, or will be based on specific instructions from the Compensation and Pension Service. For example, when rating, award, and supplemental statement of the case are all required concurrently on an appeal issue, only EP 070 is warranted. However, if an entirely separate issue is raised which was not part of the original issue and which cannot be merged with the original appeal, a separate end product credit is warranted.
3. Third Digit Modifiers.
End products may be modified to identify specific issues, type of claim, or incremental multiple claims of the same end product category. For end products 010, 110, 020, 120, 130, 160, 170, 190, 180, 150, 310, 320, 330, 400, 500, 510, 600, 680, 690, 930, 960, and 140 the following modifiers should be used when applicable:
MODIFIER ISSUE
1 Benefits Delivery at Discharge (BDD) (EP 110, 010)
2 Radiation
3 POW Status
4 Post Traumatic Stress Disorder
5 Agent Orange Exposure
6 Foreign Case (Houston, Pittsburgh, White River Junction )
7 Pension Maintenance Centers & BDD Intake and Rating Activity Sites
8 Sexual Trauma
9 Gulf War
The Gulf War modifier 9 may be used with all end product codes. The Gulf War modifier of 9 has priority over all other third digit modifies and should be used regardless of what other modifier might also be applicable.
The modifier 6 should only be used by VAROs Houston, Pittsburgh, and White River Junction, and modifier 7 by the pension maintenance centers. BDD intake and rating activity sites may use modifier 7 only for EPs 020 and 290.
The modifier 1 for EPs 110 and 010 should be used only for original BDD claims and not as a sequential EP to correct a processing error.
App. C-1
M21-4 October 22, 2004
Change 67
APPENDIX C
SECTION II. END PRODUCTS-COMPENSATION AND PENSION OPERATIONS
End Product Codes Claims or Issues Applicable to End
Product Codes
010 1. General. EP 010 is limited to initial disability compensation
Initial Disability or concurrent initial disability compensation and pension claims
Compensation Claims containing eight issues or more. Each disability claimed or
- Eight Issues or More identified and rated for disability compensation entitlement will
be counted as an issue. A claim for pension entitlement will be counted as a single issue. Consideration of entitlement to Special Monthly Compensation will be considered a single issue. Specific determinations for ancillary benefits such as adaptive housing, Chapter 35 eligibility or automobile allowance will also be considered issues.
2. Unless otherwise noted, the EP will not be cleared until all issues raised by the claim have been resolved.
3. Final Disposition and Control in Total Waiver Case Where Compensation Exceeds Retired Pay. EP 010 will be cleared in the absence of certification of actual amounts of retired pay, but an EP 290 control must be maintained until certification is received and all remaining issues are resolved.
4. Exception
Claims from service members who are patients in VA medical centers awaiting discharge from active duty. (See EP 930)
020 1. General. EP 020 applies to reopened disability compensation or
Reopened Claims service-connected death claims. Unless otherwise noted, the EP will not be
- Compensation cleared until all issues raised by the claim have been resolved.
2. Disability Claims. Reopened claims related to service connection, line of duty or similar basic entitlement factors and claims for increase, are generally the disability claims applicable to EP 020.
3. Reopened DIC claims related to cause of death, and basic eligibility (line of duty, character of discharge or misconduct), subsequent to an initial claim (whether from the same or another claimant) adjudicated under EP 140, are generally the death claims applicable to EP 020.
4. Claims for special monthly dependency and indemnity compensation based on need for aid and attendance or being housebound; and death compensation or spouse's compensation based on need for aid and attendance. (See 38 CFR 3.351)
App. C-2
##############################################
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Hello ts snave,
you can go to this link: http://www.warms.vba.va.gov/TOCindex.htm
Type this in the search box:
(new evidence, reconsideration, DRO)
The sequence makes a difference sometimes.
http://www.warms.vba.va.gov/admin21/m21_1/...5/ch05_secc.doc
http://www.warms.vba.va.gov/admin21/m21_1/...2/ch02_secb.doc
Heres a couple I picked out of what came up.
Try it yourself. Theres a variety of results to pick from
Allan
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From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 7, 2003]
[Document not affected by Public Laws enacted between
January 7, 2003 and December 19, 2003]
[CITE: 38USC5905]
TITLE 38--VETERANS' BENEFITS
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
CHAPTER 59--AGENTS AND ATTORNEYS
Sec. 5905. Penalty for certain acts
Whoever (1) directly or indirectly solicits, contracts for, charges,
or receives, or attempts to solicit, contract for, charge, or receive,
any fee or compensation except as provided in sections 5904 or 1984 of
this title, or (2) wrongfully withholds from any claimant or beneficiary
any part of a benefit or claim allowed and due to the claimant or
beneficiary, shall be fined as provided in title 18, or imprisoned not
more than one year, or both.
(Pub. L. 85-857, Sept. 2, 1958, 72 Stat. 1239, Sec. 3405; Pub. L. 99-
576, title VII, Sec. 701(81), Oct. 28, 1986, 100 Stat. 3298; Pub. L.
100-687, div. A, title I, Sec. 104(b), Nov. 18, 1988, 102 Stat. 4109;
renumbered Sec. 5905 and amended Pub. L. 102-40, title IV,
Sec. 402(b)(1), (d)(1), May 7, 1991, 105 Stat. 238, 239; Pub. L. 102-83,
Sec. 5©(1), Aug. 6, 1991, 105 Stat. 406.)
Amendments
1991--Pub. L. 102-40 renumbered section 3405 of this title as this
section and substituted ``5904'' for ``3404''.
Pub. L. 102-83 substituted ``1984'' for ``784''.
1988--Pub. L. 100-687 substituted ``shall be fined as provided in
title 18, or imprisoned not more than one year, or both'' for ``shall be
fined not more than $500 or imprisoned at hard labor for not more than
two years, or both''.
1986--Pub. L. 99-576 substituted ``to the claimant or beneficiary''
for ``him''.
Effective Date of 1988 Amendment
Amendment by Pub. L. 100-687 effective Sept. 1, 1989, see section
401(a) of Pub. L. 100-687, set out as an Effective Date note under
section 7251 of this title.
http://frwebgate.access.gpo.gov/cgi-bin/ge...Cite:+38USC5905
-
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 7, 2003]
[Document not affected by Public Laws enacted between
January 7, 2003 and December 19, 2003]
[CITE: 38USC7107]
TITLE 38--VETERANS' BENEFITS
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
CHAPTER 71--BOARD OF VETERANS' APPEALS
Sec. 7107. Appeals: dockets; hearings
(a)(1) Except as provided in paragraphs (2) and (3) and in
subsection (f), each case received pursuant to application for review on
appeal shall be considered and decided in regular order according to its
place upon the docket.
(2) A case referred to in paragraph (1) may, for cause shown, be
advanced on motion for earlier consideration and determination. Any such
motion shall set forth succinctly the grounds upon which the motion is
based. Such a motion may be granted only--
(A) if the case involves interpretation of law of general
application affecting other claims;
(B) if the appellant is seriously ill or is under severe
financial hardship; or
© for other sufficient cause shown.
(3) A case referred to in paragraph (1) may be postponed for later
consideration and determination if such postponement is necessary to
afford the appellant a hearing.
(b) The Board shall decide any appeal only after affording the
appellant an opportunity for a hearing.
© A hearing docket shall be maintained and formal recorded
hearings shall be held by such member or members of the Board as the
Chairman may designate. Such member or members designated by the
Chairman to conduct the hearing shall, except in the case of a
reconsideration of a decision under section 7103 of this title,
participate in making the final determination of the claim.
(d)(1) An appellant may request that a hearing before the Board be
held at its principal location or at a facility of the Department
located within the area served by a regional office of the Department.
(2) A hearing to be held within an area served by a regional office
of the Department shall (except as provided in paragraph (3)) be
scheduled to be held in accordance with the place of the case on the
docket under subsection (a) relative to other cases on the docket for
which hearings are scheduled to be held within that area.
(3) A hearing to be held within an area served by a regional office
of the Department may, for cause shown, be advanced on motion for an
earlier hearing. Any such motion shall set forth succinctly the grounds
upon which the motion is based. Such a motion may be granted only--
(A) if the case involves interpretation of law of general
application affecting other claims;
(B) if the appellant is seriously ill or is under severe
financial hardship; or
© for other sufficient cause shown.
(e)(1) At the request of the Chairman, the Secretary may provide
suitable facilities and equipment to the Board or other components of
the Department to enable an appellant located at a facility within the
area served by a regional office to participate, through voice
transmission or through picture and voice transmission, by electronic or
other means, in a hearing with a Board member or members sitting at the
Board's principal location.
(2) When such facilities and equipment are available, the Chairman
may afford the appellant an opportunity to participate in a hearing
before the Board through the use of such facilities and equipment in
lieu of a hearing held by personally appearing before a Board member or
panel as provided in subsection (d). Any such hearing shall be conducted
in the same manner as, and shall be considered the equivalent of, a
personal hearing. If the appellant declines to participate in a hearing
through the use of such facilities and equipment, the opportunity of the
appellant to a hearing as provided in such subsection (d) shall not be
affected.
(f) Nothing in this section shall preclude the screening of cases
for purposes of--
(1) determining the adequacy of the record for decisional
purposes; or
(2) the development, or attempted development, of a record found
to be inadequate for decisional purposes.
(Pub. L. 85-857, Sept. 2, 1958, 72 Stat. 1242, Sec. 4006; renumbered
Sec. 4007, Pub. L. 87-666, Sec. 1, Sept. 19, 1962, 76 Stat. 553;
renumbered Sec. 7107, Pub. L. 102-40, title IV, Sec. 402(b)(1), May 7,
1991, 105 Stat. 238; Pub. L. 103-271, Sec. 7(a)(1), July 1, 1994, 108
Stat. 742; Pub. L. 103-446, title III, Sec. 303, Nov. 2, 1994, 108 Stat.
4658; Pub. L. 105-368, title X, Sec. 1003, Nov. 11, 1998, 112 Stat.
3363.)
Amendments
1998--Subsec. (a)(1). Pub. L. 105-368, Sec. 1003(a)(1), inserted
``in paragraphs (2) and (3) and'' after ``Except as provided''.
Subsec. (a)(2). Pub. L. 105-368, Sec. 1003(a)(2), added second and
third sentences and struck out former second sentence which read as
follows: ``Any such motion shall set forth succinctly the grounds upon
which it is based and may not be granted unless the case involves
interpretation of law of general application affecting other claims or
for other sufficient cause shown.''
Subsec. (a)(3). Pub. L. 105-368, Sec. 1003(a)(3), added par. (3).
Subsec. (d)(2). Pub. L. 105-368, Sec. 1003(b)(1), substituted ``in
accordance with the place of the case on the docket under subsection (a)
relative to other cases on the docket for which hearings are scheduled
to be held within that area.'' for ``in the order in which requests for
hearings within that area are received by the Department.''
Subsec. (d)(3). Pub. L. 105-368, Sec. 1003(b)(2), added par. (3) and
struck out former par. (3) which read as follows: ``In a case in which
the Secretary is aware that the appellant is seriously ill or is under
severe financial hardship, a hearing may be scheduled at a time earlier
than would be provided for under paragraph (2).''
1994--Pub. L. 103-446 substituted ``Except as provided in subsection
(f), each case'' for ``Each case'' in subsec. (a)(1) and added subsec.
(f).
Pub. L. 103-271 amended section generally. Prior to amendment, text
read as follows: ``All cases received pursuant to application for review
on appeal shall be considered and decided in regular order according to
their places upon the docket; however, for cause shown a case may be
advanced on motion for earlier consideration and determination. Every
such motion shall set forth succinctly the grounds upon which it is
based. No such motion shall be granted except in cases involving
interpretation of law of general application affecting other claims, or
for other sufficient cause shown.''
1991--Pub. L. 102-40 renumbered section 4007 of this title as this
section.
1962--Pub. L. 87-666 renumbered section 4006 of this title as this
section.
http://frwebgate.access.gpo.gov/cgi-bin/ge...Cite:+38USC7107
-
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 7, 2003]
[Document not affected by Public Laws enacted between
January 7, 2003 and December 19, 2003]
[CITE: 38USC7103]
TITLE 38--VETERANS' BENEFITS
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
CHAPTER 71--BOARD OF VETERANS' APPEALS
Sec. 7103. Reconsideration; correction of obvious errors
(a) The decision of the Board determining a matter under section
7102 of this title is final unless the Chairman orders reconsideration
of the decision in accordance with subsection (b). Such an order may be
made on the Chairman's initiative or upon motion of the claimant.
(b)(1) Upon the order of the Chairman for reconsideration of the
decision in a case, the case shall be referred--
(A) in the case of a matter originally heard by a single member
of the Board, to a panel of not less than three members of the
Board; or
(B) in the case of a matter originally heard by a panel of
members of the Board, to an enlarged panel of the Board.
(2) A panel referred to in paragraph (1) may not include the member,
or any member of the panel, that made the decision subject to
reconsideration.
(3) A panel reconsidering a case under this subsection shall render
its decision after reviewing the entire record before the Board. The
decision of the panel shall be made by a majority vote of the members of
the panel. The decision of the panel shall constitute the final decision
of the Board.
© The Board on its own motion may correct an obvious error in the
record, without regard to whether there has been a motion or order for
reconsideration.
(Pub. L. 85-857, Sept. 2, 1958, 72 Stat. 1241, Sec. 4003; Pub. L. 100-
687, div. A, title II, Sec. 202(a), Nov. 18, 1988, 102 Stat. 4110;
renumbered Sec. 7103, Pub. L. 102-40, title IV, Sec. 402(b)(1), May 7,
1991, 105 Stat. 238; Pub. L. 103-271, Sec. 6(a), July 1, 1994, 108 Stat.
741.)
Amendments
1994--Pub. L. 103-271 amended section generally. Prior to amendment,
text read as follows:
``(a) Decisions by a section of the Board shall be made by a
majority of the members of the section. The decision of the section is
final unless the Chairman orders reconsideration of the case.
``(b) If the Chairman orders reconsideration in a case, the case
shall upon reconsideration be heard by an expanded section of the Board.
When a case is heard by an expanded section of the Board after such a
motion for reconsideration, the decision of a majority of the members of
the expanded section shall constitute the final decision of the Board.
``© Notwithstanding subsections (a) and (b) of this section, the
Board on its own motion may correct an obvious error in the record.''
1991--Pub. L. 102-40 renumbered section 4003 of this title as this
section.
1988--Pub. L. 100-687, in amending section generally, added subsec.
(a), struck out former subsec. (a) which provided that determination of
section, when unanimous, be final determination of Board, added subsec.
(b), struck out former subsec. (b) which provided that when there is
disagreement among members of section, concurrence of Chairman with
majority of members of section shall constitute final determination of
Board, and added subsec. ©.
Effective Date of 1988 Amendment
Amendment by Pub. L. 100-687 effective Jan. 1, 1989, see section
401(d) of Pub. L. 100-687, set out as an Effective Date note under
section 7251 of this title.
Section Referred to in Other Sections
This section is referred to in section 7107 of this title.
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U.S. Department of Veterans Affairs
38 CFR Book C-Schedule for Rating Disabilities
-
2007 VA HEALTH, INCOME AND OTHER BENEFITS
http://www.law.duke.edu/aidsproject/400_01...VA_Benefits.doc
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Department of Memorandum
Veterans Affairs
Date: June 23, 2006 VAOPGCPREC 3-2006
From: General Counsel (022)
Subj: Multiple Ratings under Former 38 C.F.R. § 4.71a, Diagnostic Code 5285 (2003)
To: Chairman, Board of Veterans’ Appeals (01)
QUESTION PRESENTED:
Does former 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5285 (2003), authorize a single 10-percent additional disability rating based on demonstrable deformity of a vertebral body, or does DC 5285 permit multiple 10-percent additional ratings for multiple deformed vertebrae?
DISCUSSION:
1. Former 38 C.F.R. § 4.71a, DC 5285 (2003), provided the schedule of ratings for “Vertebra, fracture of, residuals.” Diagnostic Code 5285 prescribed a 100 percent rating for vertebral fracture residuals “[w]ith cord involvement, bedridden, or requiring long leg braces,” and a 60-percent rating for residuals “[w]ithout cord involvement; abnormal mobility requiring neck brace.” The schedule further stated, “n other cases[,] rate in accordance with definite limited motion or muscle spasm, adding 10 percent for demonstrable deformity of vertebral body.” In other words, a veteran who does not meet the schedular criteria for a 100- or 60-percent rating must be evaluated using the schedular criteria set forth under other diagnostic codes for evaluating limited motion or muscle spasm affecting the spine. An additional 10 percent may be added to that evaluation if the veteran also suffers “demonstrable deformity of vertebral body.” For ease of reference, we will call this last provision the “10-percent provision.”
2. This opinion was requested in connection with a veteran who suffered an in service injury to the spine and suffers limited spine mobility. There is no spinal cord involvement and the veteran is not required to wear a neck brace. Thus, the veteran does not meet the DC 5285 criteria for a 100- or 60-percent rating and has been rated in accordance with limited motion. At least two of the veteran’s lumbar vertebrae appear to be demonstrably deformed. The opinion request asks whether the rating assigned in accordance with definite limited motion may be increased by 10 percent for each demonstrably deformed vertebral body or is subject to only one 10-percent increase irrespective of the number of deformed vertebral bodies.
3. A “vertebral body” is “the main portion of a vertebra anterior to the vertebral canal, as distinct from the arches.” Stedman’s Medical Dictionary 221 (27th ed. 2000). Thus, a vertebral body is part of a single vertebra. Although DC 5285 does not refer to “demonstrable deformity of vertebral bodies,” it also does not otherwise modify “demonstrable deformity of vertebral body.” In other words, the regulation does not say that VA will add “10 percent for each demonstrable deformity of vertebral body.” Nor does the regulation say that the 10-percent addition applies “for every demonstrable deformity of vertebral body.” Herein lies the ambiguity in the 10-percent provision.
4. The 10-percent provision appeared in the 1945 Rating Schedule in essentially the same form that it appeared in 38 C.F.R. § 4.71a (2003). Therefore, the provision predates the Administrative Procedure Act, 5 U.S.C. § 553, and we are not aware of any contemporaneous documents explaining VA’s intent when it promulgated the 10-percent provision. However, a November 28, 1955, letter from the Deputy Administrator for Veterans Benefits, in response to an inquiry from the Office of the Judge Advocate General of the Navy, stated that, “under Diagnostic Code 5285 not more than one 10 percent (10%) will be allowed for each segment of the spine involved.” A September 23, 1959, letter from the Acting Assistant Deputy Administrator for Compensation and Pension to the Navy Physical Review Council similarly interpreted the rating schedule, stating that “an additional 10% may be allowed for demonstrable deformity or deformities in each of the segments involved but not more than 10% for each segment.” These letters reflect the view that, if VA assigns separate ratings under DC 5290 through 5292 for limitation of motion in more than one of the three spinal segments (cervical, dorsal, and lumbar), the rating for each segment may be increased by 10% if there is definite deformity of a vertebral body or bodies in that segment. However, under this view, no more than one 10-percent increase may be assigned for each segment. Further, a note to DC 5285 provided that, “under ankylosis and limited motion, ratings should not be assigned for more than one segment by reason of involvement of only the first or last vertebrae of an adjacent segment.” Based on this provision, the November 1955 letter indicated that only one 10-percent increase would apply in a case involving demonstrable deformity of the last vertebra of one spinal segment and the first vertebra of an adjacent segment.
5. Until December 13, 2005, the Veterans Benefits Administration (VBA) Adjudication Procedures Manual M21-1, Part VI, 11.06f, stated:
If there is any limitation of motion together with deformity (compensable or noncompensable), add 10 percent under hyphenated diagnostic code 5285-5290 (limited motion of the cervical spine), 5285-5291 (limited motion dorsal spine), or 5285-5292 (limited motion lumbar spine). Whenever there is muscle spasm together with deformity and the requirements for a compensable evaluation under diagnostic code 5295 are met, add 10 percent to the assigned evaluation under diagnostic code 5285-5295.
This provision is consistent with the view that a maximum increase of 10 percent for vertebral deformity may be added to the rating assigned to a spinal segment based on limited motion or muscle spasm. Although the Manual M21-1 does not contain substantive rules subject to public notice and comment, it provides institutional guidance to VBA’s adjudicators as to the interpretation and application of VA’s regulations. Indeed, in the veteran’s case discussed in the opinion request, the regional office applied the 10-percent provision only once, consistent with the interpretation discussed above.
6. VBA’s apparent historical interpretation of DC 5285 is reasonable and consistent with the language of that provision. It cannot be said that the plain language of the 10-percent provision compels the addition of more than 10 percent based on multiple deformed vertebral bodies located within the same segment of the spine. Moreover, multiple applications of the 10-percent provision to a single segment of the spine could create odd and seemingly unintended disparities in ratings under DC 5285. DC 5285 provides for 100 percent and 60-percent ratings that are not subject to the 10-percent provision. However, if the disability does not warrant those ratings, DC 5285 provides for ratings based on limitation of motion or muscle spasm, subject to the 10-percent provision. Under DCs 5290-5292 and 5295, those ratings range from 0 to 40 percent and are thus significantly lower than the 100- and 60-percent ratings. If VA were to apply the 10-percent provision multiple times in one case, a veteran could receive a higher rating for a spine fracture residual under the alternate criteria than a veteran whose spine fracture residual meets the schedular criteria established for the 60-percent rating, even if both veterans had an equal number of demonstrably deformed vertebral bodies. If VA had intended deformed vertebral bodies to be such a significant component of the disability rating, the DC 5285 schedular criteria likely would have specifically included deformed vertebral bodies as a primary rating criterion, rather than merely allowing the condition to be considered in connection with a limitation of motion disability and, moreover, likely would have made that criterion applicable to all veterans rated under DC 5285.
7. Multiple 10-percent increases also could be viewed as inconsistent with the statutory purpose of VA disability ratings, which “shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations.” 38 U.S.C. § 1155. If such multiple increases were assigned, a veteran with merely moderate or slight limitation of spinal motion could receive a significantly higher rating, based simply on the number of deformed vertebral bodies, than a veteran with severe limitation of spinal motion or a veteran with abnormal mobility who must wear a neck brace. VBA’s apparent historical interpretation of DC 5285 suggests the seemingly reasonable view that multiple deformities of vertebral bodies do not contribute to impairment of earning capacity to such an extent.
8. Because VA has in the past interpreted the 10-percent provision in DC 5285 in a reasonable manner that is consistent with the language of that provision and with the terms and purpose of the rating schedule as a whole, we believe that interpretation is valid and authoritative. Accordingly, we conclude that DC 5285 authorizes no more than one 10-percent increase for demonstrable deformity of a vertebral body or bodies in each spinal segment.
9. Although the issue is not specifically raised by the question and facts presented by the instant opinion request, we note that, under VBA’s apparent historical interpretation, the 10-percent provision could be applied more than once if the veteran suffers limited motion and vertebral deformity in more than one segment of his spine. The schedule provides separate ratings for the cervical, lumbar, and dorsal segments of the spine and contemplates multiple ratings for a limitation of motion disability if more than the first or last vertebra of an adjacent segment is affected. See DC 5285, Note (separate ratings based on limited motion “should not be assigned for more than one segment by reason of involvement of only the first or last vertebrae of an adjacent segment”). If there is but one rating provided for limitation on range of motion, DC 5285, as historically interpreted and applied by VA, authorizes but one 10-percent increase to that rating based on demonstrable deformity of vertebral body. However, if more than one segment of the spine is ratable under DCs 5290-5292, 10 percent may be added to the rating assigned to each segment that involves demonstrable deformity of vertebral body, subject to the limitation stated in the note to DC 5285. The application of DC 5285 in this manner would be reasonable because such application is consistent with the general rating policy reflected in the rating schedule of providing separate disability ratings for each segment of the spine.
HELD:
Where residuals of vertebral fracture are rated based on limited motion or muscle spasm, former 38 C.F.R.§ 4.71a, Diagnostic Code (DC) 5285 (2003), authorizes no more than a single 10-percent increase for demonstrable deformity of a vertebral body or vertebral bodies in the spinal segment (cervical, dorsal, or lumbar) that is the subject of the rating. Where spine fracture residuals cause limited motion to more than one spinal segment and DC 5285 permits separate ratings for each segment, DC 5285 authorizes a 10-percent increase to the rating assigned to each segment of the spine containing at least one demonstrably deformed vertebral body.
Tim S. McClain
###############################################################
SOURCE:
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Hello kris,
once you obtain favorable evidence, the Veterans Affairs Regional Office(VARO), may list it as an addendum, consult or comment in the SOC or SSOC, if its's favorable. They may try to add a comment like, the "only medical opinion of record" is not favorable.
If they do list it, they may alter the phrase until it has no meaning.
In my last denial processed by ST. Petes, a key peice of favorable evidence was altered. I say altered, because I have nothing else to discribe a repeated error by the claims officer, discribing a quoat from a private MD i've seen for many yrs.
My doctor stated, "on a more probable than not basis", he completely agreed with the VARO's C&P examiner, that all the issues I submited for SC, are service connected, as symptoms & complaints have been steady over the yrs.
This statement in the SSOC says, the doctor stated," on a probable and not bases".
In the SSOC, anytime this MD was quoted, he was qouted as stating," on a probable and not bases".
Having the evidence is one thing, getting it properly listed in the record as evidence that is favorable, is the hard part.
Allan
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Pain
http://www.nationalmssociety.org/Sourcebook-Pain.asp
From The MS Information Sourcebook, produced by the National MS Society.
Pain syndromes are not uncommon in MS. In one study, 55% of the people studied had what is called "clinically significant pain" at some time during the course of a lifetime with MS. Almost half (48%) were troubled by chronic pain. This study suggested that factors such as age at onset, length of time with MS, or degree of disability played no part in distinguishing the people with pain from the people who were pain free.
The study also indicated that twice as many women as men experienced pain as part of their MS.
Several Sources and Types of Pain in MS
Acute Pain
Trigeminal neuralgia is a stabbing pain in the face. It can occur as an initial symptom of MS. While it can be confused with dental pain, this pain is neurologic in origin. It can usually be treated successfully with medications such as carbamazepine (Tegretol®) or phenytoin (Dilantin®).
Lhermitte's sign is a brief, stabbing, electric-shock-like sensation that runs from the back of the head down the spine, brought on by bending the neck forward. Medications such as anticonvulsants may be used to prevent the pain, or a soft collar may be used to limit neck flexion.
Burning, Aching, or "Girdling" around the Body are all neurologic in origin. The technical name for them is dysesthesias. These pains are often treated with the anticonvulsant medication gabapentin (Neurontin®). Dysesthesias may also be treated with an antidepressant such as amitriptyline (Elavil®), which modifies how the central nervous system reacts to pain.
Other treatments include wearing a pressure stocking or glove, which can convert the sensation of pain to one of pressure; warm compresses to the skin, which may convert the sensation of pain to one of warmth; and over-the-counter acetaminophen (Tylenol® and others) which may be taken daily, under a physician's supervision.
Chronic Pain
Burning, Aching, Prickling, or "Pin and Needles" may be chronic rather than acute. The treatments are the same as for the acute dysesthesias described above.
Pain of Spasticity has its own subcategories. Muscle Spasms or Cramps, called flexor spasms, may occur. Treatments include medication with baclofen or tizanidine (Zanaflex®), ibuprofen, or other prescription strength anti-inflammatory agents. Treatment also includes regular stretching exercises and balancing water intake with adequate sodium and potassium, as shortages in either of these can cause muscle cramps. Tightness and Aching in Joints is another manifestation of spasticity, and generally responds well to the treatment described above.
Back and Other Musculoskeletal Pain in MS can have many causes, including spasticity. Pressure on the body caused by immobility, or incorrect use of mobility aids, or the struggle to compensate for gait and balance problems may all contribute. An evaluation to pinpoint the source of the pain is essential. Treatments may include heat, massage, ultrasound, physical therapy, and treatment for spasticity.
Pain and the Emotions
Most pain in MS can be treated. But not all pain a person with MS has is due to MS. Whatever the source, pain is a complex problem that should not be ignored. Many factors may contribute, including fear and worry. A multidisciplinary pain clinic may be indicated for chronic disabling pain, where medication in combination with alternative therapies, such as biofeedback, hypnosis, yoga, meditation, or acupuncture may be used. Self-help may play an important role in pain control, for people who stay active and maintain positive attitudes are often able to reduce the impact of pain on their quality of life.
Chapters of the National MS Society may be able to refer callers to area pain clinics or specialists.
Pain resources from NINDS
American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
ACPA@pacbell.net
www.theacpa.org
Tel: 916-632-0922, 800-533-3231
Fax: 916-632-3208
National Chronic Pain Outreach Association (NCPOA)
P.O. Box 274
Millboro, VA 24460
ncpoa@cfw.com
www.chronicpain.org
Tel: 540-862-9437
Fax: 540-862-9485
Mayday Fund [For Pain Research]
c/o SPG
136 West 21st Street, 6th Floor
New York, NY 10011
MaydyFnd@aol.com
www.painandhealth.org
Tel: 212-366-6970
Fax: 212-838-2896
American Pain Foundation
201 North Charles Street
Suite 710
Baltimore, MD 21201
info@painfoundation.org
www.painfoundation.org
Tel: 888-615-PAIN (7246), 410-783-7292
Fax: 410-385-1832
National Foundation for the Treatment of Pain
1330 Skyline Drive
#21
Monterey, CA 93940
markgordon@paincare.org
www.paincare.org
Tel: 831-655-8812
Fax: 831-655-2823
For information on other neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:
BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
www.ninds.nih.gov
See also...
Diagnosis
Headache
Spasticity
Symptoms
Last updated January 2004
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Gherardi, R. K. (2003). "[Lessons from macrophagic myofasciitis: towards definition of a vaccine adjuvant-related syndrome]." Rev Neurol (Paris) 159(2): 162-4.
Macrophagic myofasciitis is a condition first reported in 1998, which cause remained obscure until 2001. Over 200 definite cases have been identified in France, and isolated cases have been recorded in other countries. The condition manifests by diffuse myalgias and chronic fatigue, forming a syndrome that meets both Center for Disease Control and Oxford criteria for the so-called chronic fatigue syndrome in about half of patients. One third of patients develop an autoimmune disease, such as multiple sclerosis. Even in the absence of overt autoimmune disease they commonly show subtle signs of chronic immune stimulation, and most of them are of the HLADRB1*01 group, a phenotype at risk to develop polymyalgia rheumatica and rheumatoid arthritis. Macrophagic myofasciitis is characterized by a stereotyped and immunologically active lesion at deltoid muscle biopsy. Electron microscopy, microanalytical studies, experimental procedures, and an epidemiological study recently demonstrated that the lesion is due to persistence for years at site of injection of an aluminum adjuvant used in vaccines against hepatitis B virus, hepatitis A virus, and tetanus toxoid. Aluminum hydroxide is known to potently stimulate the immune system and to shift immune responses towards a Th-2 profile. It is plausible that persistent systemic immune activation that fails to switch off represents the pathophysiologic basis of chronic fatigue syndrome associated with macrophagic myofasciitis, similarly to what happens in patients with post-infectious chronic fatigue and possibly idiopathic chronic fatigue syndrome. Therefore, the WHO recommended an epidemiological survey, currently conducted by the French agency AFSSAPS, aimed at substantiating the possible link between the focal macrophagic myofasciitis lesion (or previous immunization with aluminium-containing vaccines) and systemic symptoms. Interestingly, special emphasis has been put on Th-2 biased immune responses as a possible explanation of chronic fatigue and associated manifestations known as the Gulf war syndrome. Results concerning macrophagic myofasciitis may well open new avenues for etiologic investigation of this syndrome. Indeed, both type and structure of symptoms are strikingly similar in Gulf war veterans and patients with macrophagic myofasciitis. Multiple vaccinations performed over a short period of time in the Persian gulf area have been recognized as the main risk factor for Gulf War syndrome. Moreover, the war vaccine against anthrax, which is administered in a 6-shot regimen and seems to be crucially involved, is adjuvanted by aluminium hydroxide and, possibly, squalene, another Th-2 adjuvant. If safety concerns about long-term effects of aluminium hydroxide are confirmed it will become mandatory to propose novel and alternative vaccine adjuvants to rescue vaccine-based strategies and the enormous benefit for public health they provide worldwide.
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Journal of Neurology Neurosurgery and Psychiatry 2005;76:362-367
© 2005 BMJ Publishing Group Ltd
--------------------------------------------------------------------------------
PAPER
White matter hyperintensities are related to physical disability and poor motor function
P S Sachdev1, W Wen1, H Christensen2 and A F Jorm2
1 School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
2 Centre for Mental Health Research, Australian National University, Canberra, 0200, Australia
Correspondence to:
Professor P Sachdev
NPI, Prince of Wales Hospital, Barker Street, Randwick NSW 2031, Australia; p.sachdev@unsw.edu.au
Objective: To determine the impact of white matter hyperintensities (WMHs) on physical health and cognitive function in 60–64 year old individuals residing in the community.
Methods: A subsample of 478 persons aged 60–64 from a larger community sample underwent brain magnetic resonance imaging (MRI) scans. WMHs on T2 weighted FLAIR (fluid attenuated inversion recovery) MRI scans were assessed using an automated procedure. Subjects were assessed for global cognitive function, episodic memory, working memory (digit span), information processing speed (Symbol Digit Modalities Test; SDMT), fine motor dexterity (Purdue Pegboard), and grip strength, and completed the Physical Component Summary of the Short Form Health Survey (SF-12). Regression analyses were used to examine the effect of WMHs on physical and cognitive function.
Results: Deep and periventricular WMHs were present in all subjects, with women having slightly more lesions than men. WMHs were significantly associated with poorer reported physical health on the SF-12 scale, after adjusting for depression, cognitive function, and brain atrophy. WMHs were also related to lower scores on the Purdue Pegboard test, grip strength, choice reaction time, and SDMT, but not on tests of episodic memory, working memory, general intellectual function, and global cognitive function. On regression analyses, the Purdue Pegboard test and grip strength were related to physical disability.
Conclusion: WMHs are common, albeit mild, in middle adult life. They are associated with physical disability, possibly through reduced speed, fine motor coordination, and muscular strength. They are also related to slowed information processing speed but not other cognitive functions.
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Abbreviations: CSF, cerebrospinal fluid; CVLT, California Verbal Learning Test; df, degrees of freedom; DWMH, deep white matter region; FLAIR, fluid attenuated inversion recovery; FOV, field of view; ICC, intraclass correlation; ICV, intracranial volume; MMSE, Mini Mental State Examination; MRI, magnetic resonance imaging; PVH, periventricular region; SDMT, Symbol Digits Modalities Test; SF-12, Physical Component Summary of the 12 Item Short Form Health Survey; TE, echo time; TR, repetition time; WMH, white matter hyperintensity
Keywords: white matter hyperintensities; physical health; motor speed; cognitive function; grip strength; magnetic resonance imaging
Source:
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Original Articles
Multiple sclerosis in US veterans of the Vietnam era and later military service: Race, sex, and geography
Mitchell T. Wallin, MD, MPH 1 *, William F. Page, PhD 2, John F. Kurtzke, MD 1
1Neuroepidemiology Section, Neurology Service, Department of Veterans Affairs Medical Center, and Department of Neurology, Georgetown University Medical School
2Medical Follow-up Agency, National Academy of Sciences, Washington, DC
email: Mitchell T. Wallin (mwallin@pol.net)
*Correspondence to Mitchell T. Wallin, Neurology Service, VAMC, So. Irving St. NW, Washington, DC 20422
The opinions and assertions contained herein are those of the authors and are not to be construed as reflecting the views or positions of the Department of Veterans Affairs, Georgetown University, the National Academy of Sciences, the Institute of Medicine, or the National Research Council.
This article is a US Government work and, as such, is in the public domain in the United States of America.
Conference: American Neurological Association, Boston, MA,
Conference: Congress of Epidemiology, Toronto,Canada,
Conference: American Epidemiology Society, New York,
Funded by:
Veterans Affairs Merit Review Grant; Grant Number: V688-1532, V688P-1997
Neuroepidemiology Research Program
Veterans Affairs Medical Center-Washington, DC
Abstract
We identified 5,345 cases of multiple sclerosis (MS) among US veterans who first entered military service between 1960 and 1994, and who were service-connected for MS by the Department of Veterans Affairs (VA). Two controls per case were matched on age, date of service entry, and branch of service. Available for service and VA files were demographic and military data for 4,951 cases and 9,378 controls. Versus white men, relative risk of MS was significantly higher for all women, at 2.99 for whites, 2.86 for blacks, and 3.51 for those of other races. This was a significant increase from our prior series of veterans of World War II and the Korean Conflict, where white women had a relative risk of 1.79. Risk for black men was higher now (0.67 vs 0.44), while other men remained low (0.30 vs 0.22). Residence at service entry in the northern tier of states had a relative risk of 2.02 versus the southern tier, which was significantly less than the 2.64 for the earlier series. Residence by individual state at birth and service entry for white men further supported this decreasing geographic differential. Such marked changes in geography, sex, and race in such a short interval strongly imply a primary environmental factor in the cause or precipitation of this disease.
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Received: 5 June 2003; Revised: 15 August 2003; Accepted: 19 August 2003
Digital Object Identifier (DOI)
10.1002/ana.10788 About DOI
Additional Material
Supplementary material to this article (Appendix Tables) can be viewed online at www.interscience.wiley.com/jpages/0364-5134/suppmat
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http://www.msa-sea.org/Medical/MedDir.htm#Symptoms
Multiple Sclerosis and Mood Swings
(Bipolar Disorder)
A person with Multiple Sclerosis has a fifteen times greater risk of
developing mood swings (bipolar disorder) than the general population
(Joffe, 1987). Many people who have MS are not getting the medication they
need to stabilize their mood because this symptom of Multiple Sclerosis
often goes undiagnosed. Like MS, bipolar disorder is a chronic illness
which requires medication to prevent progression of the disease, as well
as treatment for acute exacerbations. The primary goal is to avoid
relapses. Treatment improves the prospects for stable relationships and
productive work. Without treatment, most people eventually have
increasingly frequent episodes. There is evidence that the more mood
episodes a person has, the harder it is to treat each subsequent episode:
each episode worsens your chances of having a smooth long-term course. A
research study in Toronto found that 13-16% of their outpatients in an MS
Clinic experienced severe mood swings which included: elevated mood,
hyperirritability, and a feeling of being on top of the world alternating
with depression or feelings of worthlessness.
In the Toronto study 42% of the participants were diagnosed with unipolar
depression. This group is at risk because a person misdiagnosed as having
only unipolar depression may incorrectly receive antidepressants without
anti-manic medication. This can trigger manic episodes, set off more
frequent cycles and make the overall course of the illness worse.
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Sent: Friday, January 02, 2004 2:25 PM
Subject: MS and the Military
http://www.sonomacountyfreepress.com/react...oodsoldier.html
"If, as some believe, the causative agent is a
mycoplasma, vaccinations could conceivably be the mode of
transmission."
April 18, 2000
REACTIONS OF A KINDLY NATURE
by Ed Gherman egehrman@p...
A Good Soldier
Questions about VA Disability and Multiple Sclerosis
He fell suddenly, not a hundred feet from my moving car. It was a
solid,
bone breaking tumble and I was surprised when he got to his feet,
brushed
himself off and resumed walking hesitantly toward a car parked next
to the
curb from which he'd just fallen. I drove slowly alongside, then
braked and
asked if he were all right. He smiled when he saw me; I recognized
him as
one of my daughter's friends, Sam. I had known him for over ten
years. We'd
met just after his return from an enlistment with Army Rangers. It
had come
as a shock to all of us when we learned he had Multiple Sclerosis.
He'd
gone to a doctor because of numbness in his leg and blurred vision
and
after extended testing, was diagnosed with the disease.
Over the years I'd hear bits and pieces of Sam's progress from my
daughter.
After I witnessed his fall, I asked her for an update and she told
me that
he'd had some problems walking and that he was using a cane most of
the
time. I asked her what he was doing for money and she said that he
was
getting paid by the Army, full disability and all medical benefits.
I was
dumbfounded and told her that she must be wrong and would she check
as soon
as possible. She did and confirmed that he was indeed receiving full
benefits and that MS was considered a service connected disability.
I found this so hard to believe that I contacted Sam myself and he
agreed
to an interview. He confirmed that he was on disability. He said
that the
VA will grant disability status if the condition becomes apparent to
a
degree of ten percent or more within seven years from the date of a
veteran's separation from the service. Sam didn't realize he was
eligible
for these benefits until a friend, an ex-serviceman, told him, three
years
after his initial diagnosis. The VA confirmed Sam's disability and
service
connection.
I'm glad that Sam's needs are being met by the VA. He was a good
soldier.
But it's difficult, if not impossible to understand the VA's
reasoning and
justification for granting disability status and a service
connection for
MS. There is no know cause for MS. If the cause is unknown, how can a
connection be made between a person's stay in the service and MS? It
doesn't make sense. A service-connected disability can be granted
for any
condition which is incurred or aggravated by a veteran's military
service.
The big questions are: What is it in the service environment that
causes
folks to become susceptible to MS and how did the VA make a
connection
between this environmental factor, service in the armed forces, and
Multiple Sclerosis?
Multiple Sclerosis is an unpredictable disease of the central nervous
system. Myelin, which facilitates the high speed transmission of
electrochemical impulses between the brain and the spinal cord,
becomes
scarred and hardened into what are known as plaques. These multiple
plaques
damage the myelin and cause the neurological transmissions to be
slowed or
blocked completely which leads to diminished and, sometimes, lost
functioning. The symptoms, severity and duration of MS varies from
person
to person. Most patients experience muscle weakness and loss of
muscular
control, fatigue, vision problems and cognitive impairments such as
poor
memory and concentration. Other symptoms include pain, tremor,
vertigo,
bladder and bowel dysfunction, depression and euphoria.
There are 350,000 Americans who have MS and about two hundred new
cases are
diagnosed each week. Most folks experience their first symptoms
between the
age of twenty and forty, rarely before fifteen and seldom after
sixty.
Caucasians are more than twice as likely to contract MS than other
races;
MS is five times more prevalent in temperate climates than in
tropical.
There does seem to be a genetic relationship or connection between
those
who are susceptible to MS. In the population at large, a person has a
one-tenth of one percent chance of contracting MS but if one person
in a
family has MS then the other family members have a three percent
chance of
getting it also.
The cause for MS is not known. Some think it's an auto immune
disease that
launches an attack on its own tissues. While this is certainly a
clear
possibility, nothing conclusive has ever been established. One
plausible
theory is that the causative agent could be a unique microorganism
such as
a mycoplasma. These poorly understood organisms are able to alter
protein,
and then sensitize the host against itself. For example it was found
that
mycoplasmas can cause the formation of the rheumatoid factor. A
similar
mechanism could apply to Lupus and many other auto immune disorders.
Another interesting factor is that females, who are infected four
times
more frequently with mycoplasmas than males, are twice as likely to
contract MS.
But this is all only speculation because the truth is we simply
don't know
what causes MS. Then how did the VA decide that MS was connected to a
person's stay in the Armed Forces? I wrote the Department Of Defense,
through Barbara Boxer's office, and they refused to answer any
questions. I
also contacted the Veterans Administration. They did confirm that MS
was a
service connected disability and answered some of my inquiries. They
seemed
puzzled that I was skeptical of the MS disability designation and
informed
me that "congressional legislation would be required to change these
provisions of the law".
There are currently about eleven thousand veterans who have been
granted a
service connected disability for MS. The only condition is that the
disease
be confirmed within seven years of a veteran's separation from
service. As
any one familiar with the labyrinthian process of obtaining a service
related disability can attest, it isn't easy getting money from the
VA. The
problems surrounding "Gulf War Illness" is a certain reminder of
this fact
The VA and the Department Of Defense must possess information that
they're
not sharing with the rest of us and certainly not with the new
enlistees. I
know the Sergeant isn't telling new recruits that they should look
out for
MS, as they do with AIDS or syphilis. If there is a chance that MS
might be
contracted or complicated by their time in military service, then why
aren't enlistees told this? Would this complicate the recruitment
process?
Probably, but I have the sneaking suspicion that it would complicate
something far more important to the modern Armed Forces:
vaccinations. This
is the one factor, aside from the traditional haircut, that all
service
folks have in common. If, as some believe, the causative agent is a
mycoplasma, vaccinations could conceivably be the mode of
transmission.
What bothers me most is that I'm sure the VA and the DOD have
research that
justifies granting this disability to thousands of veterans. If they
have
information that connects MS to military service, then we should all
know
what that information is. Multiple Sclerosis is a serious and growing
disorder that afflicts millions of persons. To purposefully withhold
information that would better our understanding of this disease is
unjustified.******
-
Multiple Sclerosis References 2003; Authors: H-J
http://lansbury.bwh.harvard.edu/ms_referen...authors_h-j.htm
Haase, C. G., M. Tinnefeld, et al. (2003). "Depression and cognitive impairment in disability-free early multiple sclerosis." Behav Neurol 14(1-2): 39-45.
Cognitive and emotional capabilities were evaluated in 73 female patients with stable relapsing-remitting definite, and/or laboratory-supported multiple sclerosis (MS) and were compared with 32 matched healthy controls. Patients were categorized according to their score in the expanded disability status scale (EDSS) to either no (EDSS 0, n = 33) or few clinical signs (EDSS 1-2, n = 40) of MS without physical disability. Patients with EDSS > 0 were characterized by significantly (p < 0.001) higher scores on "von Zerssen's" depression scale, compared to controls. Patients with higher EDSS scores (1-2) showed significantly decreased performance with respect to the total score of Kimura's Recurring-Figures-Test (p < 0.001), in addition. Regarding visuo-constructive functioning, patients with EDSS=0 performed to a significantly lower level (p < 0.001), compared to controls. These results indicate that depression may present as an early sign in MS followed by cognitive impairment, in particular visuo-spatial short-term memory, before physical disability appears. Neuropsychological tests as mentioned here could serve as early diagnostic tools to detect subtle disease progression and to initiate and monitor disease modifying therapies.
-
Cortical/Subcortical Disease Burden and Cognitive Impairment in Patients with Multiple Sclerosis
Conclusions:
Our study shows that the presence and extent of MS disease in the cortical and subcortical regions significantly influence the cognitive functions of these patients. MT imaging findings suggest that both the macro- and microscopic disease burden play an important role, and indicate that MTR histographic analysis might be useful for monitoring the evolution of cognitive impairment in MS.
-
Bull Acad Natl Med. 2003;187(4):683-94; discussion 695-7. Related Articles, Links
[Psychological and neuropsychological problems in multiple sclerosis]
[Article in French]
Bequet D, Taillia H, Clervoy P, Renard JL, Flocard F.
Service de neurologie, HIA du Val de Grace, 74 Boulevard de Port Royal-75005 Paris.
Neuropsychological investigations have demonstrated that cognitive disorders are common (about 60%) in patients with multiple sclerosis. 22 patients and 22 controls participated in the study with a review of literature. The cognitive dysfunction may be termed a subcortical white matter dementia. The hallmarks are: forgetfulness, reduced speed of information processing, impaired attention and slowness of thought processes, impaired ability to manipulate acquired knowledge. Psychiatric disturbance have also high prevalence: emotional or personality changes, depression. Pathological laughing and crying are classical but not well understood. This intellectual and emotional changes in multiple sclerosis are studied by adapted psychometric psychiatric examination. Correlation of magnetic resonance imaging with neuropsychological testing is now demonstrated. Total lesion score is the best predictor of cognitive deficits, cerebral atrophy and lesions of the corpus collosium also. Neuropsychological rehabilitation techniques and symptomatic treatments must be applied to patients with multiple sclerosis.
Publication Types:
• Review
• Review, Tutorial
PMID: 14556476 [PubMed - indexed for MEDLINE]
Need Some Help
in VA Disability Claims Research
Posted
Abe,
do you use a cane, walker, crutches, etc?
What are your knee issues? Arthritis or injury?