Persistant

To further clarify, our connection to the attorney was during the last 9 months of my late husband's life and was a time of evaluation of his C file to advise us of what he qualified for in making a claim for his kidney failure (which occurred 4-5 years prior). When he passed away there was no longer a client relationship with the attorney. He did advise me to file for DIC AND accrued benefits which I did within the 1 year time limit....it was another year later (just before the time limit for filing a NOD that I gave the NOD to the DAV to file for me which I had prepared. The rep received it and said it would be filed immediately as the date limit was only a couple days away. I found out about it not being filed almost another year later when I called the DAV to see why the VA didn't have it as ever been received. To clarify the other question about qualifying for SMC...that should have happened when he was declared 100% disabled P&T Service Related...but we didn't know about it's existance at that time and it's written in his claim decision that they didn't consider it for him because he was gainfully employed. HE WASN'T and hadn't been since before his first disability claim. We included in his claim information that he was on SS Disability and was unable to work in any capacity he had training for or could be trained for. That was referred to in later claims as well in trying to get the SS decision paperwork added to the C file. It seemed to me after his death, when I understood SMC and what had been mistakenly written in his earlier claim decision that an error like that could be fought...however submitting all the pertaining paperwork to several VA attys (including NVLSD) every one of them said if he was still alive it would be an open and shut case - easy...but because no claim was started before he died they didn't see it having any chance.

I am a surviving spouse of a VietNam veteran receiving DIC. In the request for DIC I also requested any back payment due my late husband and because there wasn't a formal claim made by him prior to his death it was denied. The DIC was approved. There were additional facts about his health that we tried to add to his rated conditions, but were told by VSOs from 2 different organizations that he couldn't go above 100% and they wouldn't help us file a claim for it. We also asked the VA doctors he saw and were told they didn't know how. He was rated for ischemic heart disease, diabetes and neuropathy....equaling 100%. Then he went into kidney failure and was on daily dialysis at home for 5 years before passing of his heart condition. He would have at least qualified for housebound and aid and attendance in addition to loss of use of his kidneys. I don't know what else. After the first 2 years of treatment, VA wrote saying they would be paying for it going forward. We hadn't applied for their help. Of course, VA had records of paying for it and it was many times referenced in his 6 month checkups with the VA doctor as well. But as I said, no one could tell us how to add it to his rated conditions. Several months before he passed we found out about SMC online. We engaged a lawyer's help to determine what to claim for in the SMC tier and by the time they got the C file and reviewed it to advise us, my husband passed. They advised me to apply for additional $ owed along with my DIC form. But beyond that they weren't involved. After the denial, I began putting together claim information by myself. I filed a NOD with a DAV rep, in person, at the local VA hospital to give me more time to finish. Many months later I found out it was never filed due to a direct instruction NOT to. The person giving that directive was in an authoritative position so it was obeyed. No one ever told me until I called to see why VA didn't have it. And on the phone was told what had happened. Of course that ended my opportunity to show reason for back pay. Also during that time there was a change in the VA procedure that they could no longer use material evidence of a condition, such as their records I referenced above, to prove they knew about the dialysis, but never put anything in the C file about it. So then my records couldn't be honored anyway.

Michigan also grants the property tax waiver to the vet or surviving spouse...however, as others have said, there are fees that are not exempted. I pay $109 for a drainage fee over the next several years. It is billed on the tax bill once a year and is paid out of my mortgage escrow. You might be able to increase your escrow withholding to pay it if you would prefer that. My mortgage company said no I couldn't do that..but when the "tax bill" went to them, they paid it and have incorporated it into the amount of my payment for taxes and insurance. Most of us already have escrow being collected out of our payment for insurance so it doesn't need to be set up from scratch.

There is another reason you should file claims for any new developments in s.c. rated conditions or new secondary conditions stemming from the s.c. rated ones - it establishes a record (or a rating) in the event of your death for the new condition or updated status of currently rated conditions...without that, all the proof in the world (including proof in VA's possession meaning various records in the system) will not allow any back compensation for the condition. This is, of course, to allow a surviving spouse or qualified other family member to pursue and complete the claim for retroactive pay under a new rating for it. Additionally, if your death is recorded as one of the rated conditions, your surviving spouse can apply for DIC which entitles her to receive a reduced monthly amount of your disability compensation as well as many of the same benefits you now have as 100% p&t...

I just saw your comment added a couple minutes ago Berta - thank you for clarification on substitution. And for the attorney you think is most likely to help. I also saw your other answer under my PN posting...I respect your decision on personal contact information and am so grateful for all the time you devote helping me and so many others...I so wish I had known about this forum a few years ago - invaluable information here!

Thank you Berta and Broncovet for your comments and help!

Berta you had asked to see the decision for the PN claim. I'm attaching it here. I may be wrong but I think there are some CUEs in this one... Under Reasons for Decision: There are 9 conditions being considered. All of them were tested against whether or not they developed during service or a prior condition worsened in service or was it caused by diabetes. In regard to the stroke occuring during open heart surgery, their statements conflict with each other seems to me. And they lumped stroke with post pump syndrome which does not compute in my mind...they are not both strokes I don't think. In the beginning it says sc could be granted ....but is denied because it didn't occur during service or caused to worsen by service. Then it says there's no evidence of residuals from it. WOW - wrong! They then talk about sc on a presumptive basis if manifested to a compensable degree 38CFR 3.309(a) and 3.307 and then say the evidence shows that it is currently disabling to a compensable degree but evidence shows it didn't happen within one year of discharge so must be denied. Does that all sound right? Then the IHD narrative...my underlined sentences are in conflict with one another and the higher rating it referrs to is proven and met, but not granted. Also, what about this...IHD became presumptive a few years later but they never made the IHD a primary condition - it remained a secondary condition. Doesn't that make it impossible to rate the stroke and post pump syndrome as caused by the IHD? So not changing it to primary caused 2 conditions that were denied to stay denied? Weren't they supposed to go back to all claimants of IHD and update the status? Maybe I have misunderstood, I'm not sure. Under PN they say no nail abnormalities in either foot which isn't true and we submitted the records from his foot doctor to show the history of nail fungus from VietNam. It eventually caused the removal of both big toenails and some of the secondary toenails were as thick as they were long from the cuticle to the tip and couldn't be cut except in the doctor's office. I don't think I saw those records in the C-File but we submitted them and I have them. Now the question would be does that change the rating any...I would guess not. I haven't seen a listing of conditions after the 100% yet (in my paperwork) to know about the PN combination you suspected. I will look tonight in the C-File Scan0026.pdf

I uploaded (last week) some of the decisions my late husband had gotten and Berta spotted a couple CUEs and gave me some help in drafting them. Berta if you are able to help with a few more questions Please? I have only 2 more days till my year is up from the DIC/Accrued benefits claim where DIC was awarded and Accrued denied saying there aren't any. At that time also, I intended Substitution but the VA form got separated (my fault) and didn't get submitted. I, however, wrote it into the 21-534EZ form and checked it. I also included a cover letter that said explicitly I was substituting for any and all accrued benefits... They didn't address substitution in their decision. Now with the CUEs which aren't an accrued yet, do I need to address those 2 forms immediately before the deadline? Here are some questions I still have if you could clarify these for me please: A. Is a NOD for accrued benefits claimed with DIC a year ago needed – to appeal their conclusion that there are no accrued benefits? Would any backpay from these CUEs be considered accrued benefits that I would have to NOD the decision now for? B. Is Substitution needed to do CUE claims or to receive any backpay on them? C. What happens when future presumptions of ao are added to the list going forward (as a surviving spouse) does it affect anything I can act on? 1. Conditions claimed before – either rated or denied sc 2. Would conditions listed in the C-File but never claimed come into play ever as a presumptive? D. If CUE is successful: 1. then qualifying for housebound or A&A will need to be judged and evidence has never been presented before… a. does the judgement come only from the C-File? And if so, should I include printouts from C-File to bring attention to issues pertaining to them? b. Can any evidence be added (from that date and before) since it was never considered before? And if so, do I include it with the CUE claim? E. IHD was first decided as 30% and went back to one year prior to our first claim – effective 2004…the bump up to 60% was effective . But the 100% was effective 2006…Should any of those effective dates be different because: 1. SSDI was in place for IHD qualification date of 12/2000 2. TDIU decision being effective 2006 (but he was unemployable per SSDI in 2000?) 3. 100% decision? 4. 100% effective date adjusted back due to Nehmer 2010 addition listing it as a presumptive 5. Combination of all the above? F. Many of the evidence documents we submitted are not in the C-File and none of the forms we submitted are there to prove what we submitted or said. Is that normal? G. Also, the only SS docs in the C-File are the ones where I outline his conditions and behaviors in answer to the many questions on the intake paperwork for that SS claim. There’s 4 pages of handwritten (including along margins due to space shortage) that I doubt anyone is going to wade through but it’s filled with problems he was having. Should I type it all out and attach it to the handwritten forms? H. We submitted the whole SS file but can’t prove it. We even wrote a letter to our Congressman to help us get a particular letter sent to us by SS along with their decision listing a myriad of restrictions to employment they concluded for him. I couldn’t find it and neither could SS but the Congressman did try for us. I have those communications too, but don’t want to drown them in paperwork with this claim. Any thoughts? Again, thank you Berta. I did try the other people you suggested without success. And thank you to everyone here who has helped me or does going forward!

You're welcome treysnonna...I recognize the insulins your husband is on and my husband was also on Lantus (64 units) U100 (not sure about it being Solar Star or not) and Apidra 14 units + the correction insulin based on the carbs in his meal (2 units for every mg/dL greater than 120). I haven't any idea how Humalog compares to Apidra though. His A1C back then was a super good 6.3 after several years of medication balancing. At that time the notes indicate the doctor was titrating 2 of his meds up to meet lab goals. This was the dosage in Jan 2007 which was 3 years before he started to use the pump. If I run across an office visit summary closer in time I'll let you know if you'd like me to as that level did change and so did the A1C. Oh and another reason the doctor put him on the pump was because the U500 was going to be too difficult to measure injections precisely enough, as finite differences could be very important. Also all of the settings for each day were done by the professional overseeing the pump and insulin at each 3 month checkup. We took care of filling it every few days, inputting the carbs for each meal/significant snack and making sure after that to confirm the pump delivered (the readout says that). We made small changes under her direction, when he was going low too often in one or another part of his day. Then she'd lower the amount of the drip for that part of the day.That's a great thing about the pump - it is so customizable. You will find that a specialist has many avenues of change to help your husband that the GP probably doesn't know about. At least that was our experience. Do you have family or friends who are supportive to you both? Or someone who has also walked through some of these conditions with their spouse or family member? As I mentioned before, a support group is also helpful...you both have walked through a lot with the conditions he has and may be able to help others as well as they being able to help you. Sometimes just attention to all the requirements for his conditions takes up so much time & tension that it keeps you separated from others, but purpose to stay connected to others, whether on the phone, email, a quick coke together or whatever.... It helps. Have a great rest of your day and evening!

Hi Treysnonna, Yes the insulin pump did help with several things. He was put on the pump because he needed so much insulin in a day's time that the doctor had put him on 2 kinds and at high amounts...and finally decided he needed something more. So the pump allowed a continual drip between meals which helped to even out his ups and downs. Having a more even blood sugar will affect the A1C. Also the doctor put him on U500 strength insulin. Now that is something that must be managed expertly so if there isn't someone who specializes in managing it in the pump, don't consider it. It's very dangerously potent. And because it is, tiny tiny adjustments in the delivery (the drip or the mealtime doses) can make huge differences. Because of that, it takes a very long time to get it just right around the clock. The pump can be adjusted for different times of the day on the drip and the mealtime doses can also be adjusted as to the strength delivered for each carb you enter for the meal. You need access to the professional helping to manage it for months by phone as problems do come up, but it is doable and it did really help my husband. He struggled at first learning about it (I learned with him so I could help him) but got pretty good at it over many months. His A1C was high but I don't recall now how high before the pump. I do know he managed to get it down to 7.2 though and I think he started in the 8's range. The pump can be used with normal strength insulin too if your husband doesn't need large amounts daily. It's still challenging, but worth the effort. I don't know if he sees a diabetic specialist, but hopefully he does. He really needs that expert supervision with the problems he has to deal with. We switched from our GP to a specialist when we saw that the GP wasn't able to intervene in every situation and it was a most excellent decision. The specialist has someone on staff who specialized in the pump management and the U500. Yes he did have lows both before the pump and with the pump. I'm sure your husband probably does too. And you probably have learned how much juice he needs to come back up. My husband needed way more than the doctor said to use, but everyone's different. We always kept a few bottles of grape juice in the car and of course a lot of it at home where we usually were. I'm sure your doctor has talked to you both about that though. It sounds like you and your husband are on top of the claims and reading this forum, you have access to information we never knew about. So stay connected here and take note of TDIU and SMC topics because they will relate to your husband's ratings if they don't already. You don't mention if his heart is rated for anything yet, but the aortic valve replacement surgery can be rated in addition to the IHD (together). I am not familiar with stenosis, sorry. Another thought is SS disability if he is unable to work. Just thoughts. I hope this has been helpful and I'm always happy to share any knowledge or experience that can help you. Is he on dialysis for the kidney failure yet? That's a whole other subject so feel free to connect with me anytime. A support group is maybe a helpful thought too. Thank you for your sympathy and good wishes!

The only appeal we ever did was the one you've already seen the DRO decision on. We simply did what our VSO suggested always...now I see so many issues...one of the big ones was denial of PTSD being service related and there appears to me to be some suspicious stuff surrounding that one involving 2 VA psychiatrists at our local level. So I'm going to leave that one alone due to one of them having seen him monthly the last 4 years of his life and recorded his PTSD as childhood predominantly so I'd never win that one but it is definitely an error at time of decision based on qualified evidence considered and even quoted in the decision. Oh well. Sorry, I'm venting on that one because I lived daily with the issues from PTSD and it was hard. The other denials included the Post Pump Syndrome and the TIA on the surgery table both of which I judge to be because he was getting operated on for the quadruple bypass in the first place and should be related to that which is rated. But the decision linked it back to diabetes (which the heart was secondary to) and said they didn't relate. No the appeal was for the accrued benefits the original attorney told me I should appeal after a denial and it seemed he would represent me in it but he decided not to I guess. He never said why or how he was going to justify filing after death just that were many loopholes that could be possibly used. The other 2 Nehmer conditions in the 2010 decision I assume don't apply to his conditions or you would have said. So I will do what you've said about the CUE's and the SMC rating. I called VVA again and talked to the benefits person and she said I needed to talk to a local VVA rep. I got voicemail for the closest one to me and left a message. Will I be able to add any evidence to this for the years following the decision to include all the A&A during the dialysis years? They have records of payment for 2 1/2 years of dialysis to our private provider in their Treasury records and medical records evidence but not the C-File. Regarding the 160% for the SMC referral - what can substantiate the "adding" as opposed to "combining" to make the argument that they should have done it? Thank you for the CUE instructions!!! And for everything you've done for me!!

Berta you mentioned housebound and there is a myriad of information that actually reaches the higher level of Aid and Attendance since he would have had to have round the clock attendance without me to get through every day safely. I took care of the needs surrounding his dialysis (5x per 24 hour periods) that he couldn't do alone; I was trained extensively to do it and operated under the umbrella of the dialysis clinic nurses and doctors which we saw (always together) 2x a month for almost 5 years. That's just one aspect of the whole picture. And of course, as I've said before, his renal failure was never rated at all. So I'm not sure how all this needs to be presented to VA now. I have collected written, signed statements both lay and doctors and head nurse from the clinic stating what each observed that he needed me to help him with. Doctor statements that the renal failure was due to diabetes. Etc. I went to every doctor appt and test because he couldn't get the information straight either to them or from them; I had to understand what every med was and what it was prescribed to do (not always what they were know for doing), when to reorder so he didn't run out (21 medications), helped him put shoes and socks and pants on, dress his dialysis port, get juice and open it when his sugar went low, then check again 15 min later and give him food to keep it up, watched his dietary needs which were different for renal issues and heart issues and again for diabetic issues and on and on the list goes. But when he was in a doctor's visit, he was the picture of having much together and it wasn't obvious to them...he didn't want to appear deficient as a man. So he sometimes lied to them too especially in C&P exams when I wasn't allowed to accompany some interviews. So information in the C-file is inaccurate in many places too. Well you get the picture. The head RN at the clinic wrote a great letter about what is involved in Peritonial Dialysis at home and my lay letters are outstanding as well. It's overwhelming to me to read them now and realize all that went on day after day back then.

forgot to add the scans - sorry

forgot to add the scans - sorry Scan0020.pdf Scan0021.pdf

I am attaching the 100% decision reprinted directly from the C-file...I scanned the pages in and had 2 left when we had a storm and I lost internet and it stopped the scan. So the last 2 pages are in a separate scan - both attached - 0020 & 0021. The 100% decision does not address referring for consideration of SMC. As you know, the 60% one mentions it but nixed the idea because they didn't consider the evidence for SS. Well the 100% one does consider that evidence and does list the C-file in the list too. But they didn't even think about the referral I guess. Also, the documents from SS in the C-file are really only the application that I filled with details on his problems so at least they could have read it...don't think so as it should have impacted them. Dates...there are so many different ones in each document that it confuses me. I'll see if the SS app in the C-file shows a date received stamp. There is a lot of docs missing on this CD and I wonder if they just didn't include them on the CD but they're in the file actually? I don't know. But the letters noting the documents enclosed seem to be there and in many cases indicate new medical records of 20 pages or something and then you don't see them in there. Some of the evidence cited isn't in there either that I can tell. I know there is a one page doc that tells about SS's award and is notifying us of it. I read it in the last few days but now don't see it. I'll keep looking though. Berta, the VA told us the same thing - that SS couldn't find the letter laying out all the restrictions he had in a work environment and how there just wasn't that kind of opportunity to use his skills, stay within the restrictions and not exert too much pressure on the heart. I couldn't find it and so we had asked them to get it. It looks like they didn't get anything from SS because we submitted the application notes. I'll do my best and quickest to find what you said I need. I think I do understand your reasoning...but what is CAD? It's probably something I know or should know but I can't figure it out. :) Even so, I get your meaning overall. If you answered about filing the substitution form right away, I didn't see it. Should I?