JustGettingStarted

That information was in my military medical records at time of decision when I retired in 2009. But VA had my military medical records in their possession and it is all in my C-FILE. My 2009 decision letter even states I was taking the medication daily. St Pete chose to ignore all that when I submitted my claim for the increase until I got my own DBQ. The bogus denial based on a policy change didn't work so they are trying to find other ways to deny my earlier effective date. Since that failed, I guess their tactic is to prove I am committing fraud, either by not actually taking the meds or by taking them just to increase my rating. Since I started taking the meds 11 years before I retired from the military, and doctors since have said I need to be on the medication "chronically", the VA doesn't have a case. If they try to go that route, the first thing I will do is have my husband write a spouse letter and submit that as new evidence to reopen again. Maybe I need to remind the VARO they are supposed to be non-adversarial. (The Veterans Claims Assistance Act of 2000 (VCAA) reaffirmed that the VA benefits and disability claims process up to the Board of Veterans’ Appeals (BVA) process must be non-adversarial. See, 38 C.F.R. §§ 3.102, 3.103, 3.105, 20.700 (2007).)

I got clarification from my VSO on what the new C&P exam is really about. The VA wants an opinion from the examiner on whether I really need the medication constantly, or if I am taking it just to get a higher rating. Wow, they are looking for any excuse to deny my claim. At least they realized they cannot deny my claim based on a policy change. Now that I know this, I can focus my sights on the medical paperwork I need to show the examiner. The fact is that I was put on suppression therapy (constant use) in 1998, 11 years before I retired. It wasn't until 2002, 4 years later, that Code 7806 was changed. In 2002, skin conditions like eczema first became rated at 60% for constant use of systemic medication. My medical records and pharmacy records clearly show my constant use to the current date. Hopefully, my next examiner will be someone that listens and will get the DBQ/Medical Opinion correct for me. I will do my best to point them in the right direction. JustGettingStarted

Thanks SigBnSoldier, In the denial, VA actually wrote that I had all the proper conditions for a 60% rating in 2009, but the policy was different back then. They validated what I already knew - that this CUE is as clear as they get. I kept reopening and getting denied, but after about 5 tries, I finally got my skin condition increased from 0 to 60; however, the CUE was ignored in that decision. This is my second try at just the CUE. In the first try, it only took 9 days to get my decision back with the ridiculous explanation that there was a policy change in 2016 that allowed for giving me 60% now, but now back to 2009. The second sentence in the letter stated CUE has to be based on law and then they make a decision based on policy. Now it appears they are going to try and attack my 60% instead of attacking the CUE itself. It won't happen since I have tons of medical records that show I have been taking meds for suppression constantly since 1998. This was 11 years before I retired. It wasn't until 7 years after I retired that I learned I had been rated incorrectly, and all that time I was still on constant meds for suppression. The exam they are sending me to won't show anything because my skin condition is well controlled on the medications. The only way they can win this is to lie on the C&P exam (and I think they've done that before, which is why I got my own C&P exam and won). I don't think VA can order me to stop taking the medications, and I get them through my Tricare doctor, so they have no control over this situation. I also know my own body. I've tried going off the meds a handful of times, and ended up right back on them within a month. In Florida, it takes over 800 days to do RO Hearing - I do not want to wait that long for my back pay. I am 100% now, so I will be paid the same now or if I am paid in 8 years. And since the VA doesn't pay interest on all that money they withhold for years, I would prefer my money now. If they deny me again, I am determined to find more "new" evidence to invalidate any reason they give to say "no". JustGettingStarted

Thanks. Following up in eBennies is a good idea. I did email my VSO. That is how I found out I was dead.

Update, I filed to have my skin CUE reopened on Feb 2, 2018 with lots of legal precedence as evidence this time, since they tried to deny my claim on a Policy Change instead of the law current at the time when I filed before. My claim moved to Gathering of Evidence and VA has put in another C&P Exam request with a suspense date of 30 March. I called VA to let them know I was unavailable most of March because I am travelling and have purchased plane tickets. I talked to my VSO and he says the exam is to determine if my skin condition is rated correctly at 60%. The VA must be grasping at straws because condition code 7806 is very clear that a skin condition with constant use of systemic medication is 60%. Besides, what is current today has nothing to do with my CUE in 2009 since CUE is based on the law and record at that time. I can only assume the VA may try to say I only take the medication to get 60% versus a lower rating. They don't stand a chance because I retired in 2009. I have pharmacy records back to 2004 that show I have taken the medicine daily for at least 5 years before I retired, and continued to do so up to the time I was finally awarded 60% in 2017. I didn't even know I was supposed to be getting 60% for constant use of systemic medication until 2016. In all actuality, I have taken the medication almost continually since 1998. I have only stopped about 4 times to see if the condition would worsen without it, and it did, so I went back on it within a month each time. I take this as good news the St Pete VA knows they skrewed up when they tried to deny my CUE based on a Policy Change. They are grasping at other straws to deny it. :-) On top of all this good news, when I called VA to extend my exam window, the rep I talked to put it in VASRD as a First Report of Death (per my VSO). I had to spend another hour on the phone to get this correct so my benefits wouldn't be cut off entirely. The rumors of my death were greatly exaggerated.

I still haven't received my denial letter in the mail, so my wonderful VSO downloaded a copy and faxed it to me. Here is the bogus reason they denied my earlier effective date: "At the time of the August 2009 rating, MEDICATION, was not considered systemic therapy as it is an antiREDACTED drug but not an immunosuppressive drug, therefore a higher evaluation was not warranted.....Rating decision dated January 5, 2018 granted a increase evaluation to 60 percent disabling effective the date we received your claim for increase based on policy changes that took effect in 2016 that states the term "systemic therapy such as corticosteroids and other immunosuppressive drugs" that is contained in certain diagnostic codes under 38 CFR 4.118 refers to any oral or parenteral meidication(s) prescribed by a medical professional to treat the underlying skin disorder. Therefore, no clear and unmistakable error is shown." This retired chief knows this is wrong on so many levels. Since when is POLICY the LAW? The policy they quoted is from M21-1 Adjudication Procedures Manual. They don't even have the date correct because DC 7806 was changed on 15 Oct 2015, not in 2016. But I know that a manual is a set of instructions on how to implement law and not the law unto itself. I can also quote MR21-1. Under MR21-1 III.iv.2.B.4.a. Definition of CUE it states, “that a clear and unmistakable error (CUE) exists if all three of the following requirements are met… the statutory or regulatory provisions extant at the time were incorrectly applied, the error must be the sort which, had it not been made, would have manifestly changed the outcome at the time it was made, and the determination must be based on the record and the law that existed at the time of the prior adjudication in question.” Code 7806 in CFR 38 has not changed between 2002 and the present. The wording is exactly the same and that is the law. Also, I have a copy of the 2005 BVA decision where the judges reversed St Pete's incorrect interpretation of the law and instructed them on the correct interpretation. I quoted that one earlier. Finally, there was the 2016 US Court of Veteran Claims case on an anti-fungal medication that said under the 2002 revision to Title 38, any systemic drug, not just the two mentioned under DC 7806, are considered as systemic under the law. This was on a 2004 claim and did not change the law, they only clarified what the law is. That is in my previous post. I am going to slam St Pete with VA law. I will be fighting this again. I just hope they will allow me to reopen my CUE claim again versus having to file a NOD and wait 800+ days to see a DRO. At this point, I am not accumulating more back pay (I am now 100% P&T), so the VA is just sitting on my money interest free. I know I have seen that you only have one shot at CUE, so I hope St Pete doesn't use that against me to force me into filing NOD. JustGettingStarted

63Charlie, You made my day and you are certainly welcome. I hope this case can help a lot of vets because rating decisions have been all over the place on this subject. You can find the full text if you search "Warren, systemic" here: http://search.uscourts.cavc.gov/ If you've read through my post, you probably see that I finally won my skin claim for constant use of a systemic drug (60% under code 7806). I am not taking a corticosteroid or immunosuppresant drug. The key was asking my dermatologist to sign a DBQ that said I was on "constant systemic medication XXXX since 1998". During a routine visit, I handed the DBQ and the supporting evidence to his nurse with a short cover letter. Two days later, it was signed and I won my claim, just not the back pay yet. A Nexus letter probably would have done as well. I should have my denial letter on Monday and will try to reopen my claim right away. I do not want to do a NOD because a DRO hearing in Florida takes over 800 days now. This recent denial took less than two weeks. Once I show St Pete they did not follow the current law in 2009, I hopefully will get a favorable decision just as quick (a girl can dream, can't she?). What really steams me about waiting 3 years for a DRO hearing is the VA doesn't pay interest on all the back pay they are trying to get out of paying. JustGettingStarted

LOL Berta, I have already included the 2002 Title 38 in my new CUE I'm drafting. It is the entire reason they should have rated me at 60% in 2009! This is the law they are not following which constitutes CUE. 2002 was the last update to diagnostic code 7806 (there is a new proposal in the Federal Register now, but it doesn't affect my CUE). I believe St Pete has confused VA Manual M21-1MR with the law and I can't let that happen. I was in the military long enough to know there is a huge difference between manuals and regulations and that manuals cannot contradict the regulations that are law. Besides Title 38 and the 2005 St Pete BVA case quoted above, I will also hit them with two US Court of Appeals for Veterans Claims that came out of the 2002 revision to Title 38 Skin Conditions. "Below are quotes from the laws and regulations when Diagnostic Code 7806 changed in 2002, and during my claims in 2009 and 2017. Note that not a single word in the law has changed: 31 July 2002 38 CFR 4.118: “7806 Dermatitis or eczema. More than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period ........ 60” (Attachment 1). 1 July 2008 38 CFR 4.118: “7806 Dermatitis or eczema. More than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period .... 60” (Attachment 2). 1 July 2016 38 CFR 4.118: “7806 Dermatitis or eczema. More than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period .... 60 (Attachment 3)." I am quoting Mauerhan v Principi, 2002. This court case was instrumental in defining the words “such as” in Title 38. It states “By definition “such as” means “for example” or “like or similar to.”…The use of the term “such as” demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating.” And then the big one, which uses Mauerhan v Principi is Warren v McDonald in May 2016. This case did not change the law, but upheld that under Diagnostic Code 7806, systemic therapy includes any oral medication. The original claim was filed in 2004 (five years before my 2009 claim) for a toenail fungal infection treated with oral Lamisil, an anti-fungal medication. “VA has interpreted the phrase “systemic therapy such as corticosteroids or other immunosuppressive drugs” in that DC to mean “any oral or parenteral medication(s) prescribed by a medical professional to treat the underlying skin disorder…Given the evidence of record that establishes that Mr. Warren is receiving systemic therapy that is orally ingested…evidence that appears to satisfy VA’s own definition of the phrase “systemic therapy such as corticosteroids or other immunosuppressive drugs”—I agree with my colleagues that the Board provided inadequate reasons or bases for denying a disability evaluation for bilateral onychomycosis in excess of 10% under DC 7806.” I don't think I could be a lawyer. My life is consumed enough by my own fight with the VA. I wouldn't have a life if I took on cases of others, although I am happy to try and help other veterans with the knowledge gained from my negative experiences with the VA. I would just become totally frustrated with trying to cut through the ignorance. I can't wait to see the letter from VA so I can throw their own words back into their faces using real VA law! My VSO says he will print the letter up for me on Monday if I don't have it by then. I have a great VSO. He admits that I know more about my claims than he does, but he is always there when I need him to look into the VA system to see what they are up to. And he is good at reviewing my claims and telling me how to make them better. Still, JustGettingStarted

I just heard from my VSO that VA is denying my CUE again. They said my condition was not rated the same in 2009 as it is now and that medication wasn't considered "systemic" back then. As soon as I get the letter I am going to reopen the file again and hit them with a BVA decision from 2005 where St Pete was the Regional Office (My Regional Office is St Pete). Below is an excerpt from the BVA's favorable decision for the exact same skin condition and medication I use and claimed in 2009. Still, JustGettingStarted ___________________________________________ As of September 19, 2002, the evidence of record demonstrates that the veteran was prescribed MEDICATION. As indicated previously, a 30 percent rating is warranted under the post-August 2002 regulations, where systemic therapy, such as corticosteroids or other immunosuppressive drugs, is required for a total duration of six weeks or more, but not constantly, during the past 12-month period. While MEDICATION is not classified as either corticosteroids or immunosuppressive drugs, the Board observes that the language of Diagnostic Code 7806 (2005) indicates that such types of systemic therapy are only examples and are not intended to be an exhaustive list of possible systemic therapies. Specifically, Diagnostic Code 7806 provides for a 30 percent rating where systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks or more, but not constantly, during the past 12-month period (emphasis added). As such, evidence dated September 19, 2002, and in April 2003 shows that systemic therapy, specifically MEDICATION, was prescribed and, at the March 2005 VA examination it was noted that the veteran had been on MEDICATION for six months. Therefore, the Board finds that the veteran is entitled to an initial rating of 30 percent beginning September 19, 2002.

Thanks Gastone. And in a few years, I may revisit this one, and the back pay then will be just as sweet. :-)

I know, but I really don't want to take a chance on having VA schedule another C&P exam. It took me too long to get a rating for gyno problems and I am afraid that if I push this, they will find a way to reduce my recent rating and I will lose my new 100% T&P. I have had to many bad C&P exams to risk it. The 100% T&P pay and benefits aren't worth the risk to me. I do have another back pay issue for a skin issue that I do plan to pursue; there is no way they can reduce that rating and I claimed it in 2009. That one is worth about $46,000 in back pay and is very clear.

"Has your Private or VMC OB-GYN Specialist, recently or in the past, opined with Clinician Notes or a written statement in support of your pleadings regarding your "Loss of Use of creative organ?" I am still treated by an Air Force Base and see someone different every time I go in. I emailed my new PCM about doing it but he passed on it saying it would be best done by the doctor that did the procedure. I just heard from the office of the doctor that did the procedure this morning that he will not even sign a basic letter that says I was instructed not to get pregnant after the procedure, although all the patients are advised that. He personally feels that he would be frauding the VA since I had the procedure voluntarily. I think I am going to give up on the SMC-K and back pay for it at this time. The VA wants new medical evidence and the only way to get it is to do see a doctor that does Independent Medical Opinion. I am beginning to feel like it is not worth risking the 100% P&T I just got on the $105 a month for SMC-K and about $9,000+ in back pay. I am still going forward with the CUE for my skin condition - that's the big one. :-) JustGettingStarted

SMC-K was denied again. The VA is requesting more medical evidence. I have done up a medical opinion letter for the doctor that did my surgery and dropped it off at his office today. The receptionist was very nice and said she would give it to Medical Records to pull my file. I told her that may not be necessary because I had attached copies of everything including my operation report. She took one look at the file and commented that I was very organized and she really appreciated. She is supposed to call me when the letter is signed. I am also going to have my spouse do a letter that states we were told I was not to get pregnant once I had the surgery. If this doesn't work, I'll have to do a NOD I suppose. JustGettingStarted

The thing that tipped the scales this time was the DBQ I filled out for my dermatologist to sign, which says I have been on constant systemic medication since 1998. I needed this to overcome the bad VA contractor exam that left off my medications in 2017. The Congressional complaint I filed may have also been a factor. I was service connected for the skin condition when I retired in 2009. My decision letter says "the veteran says she is taking XXX daily". They had access to all my pharmacy and medical records that show I was put on the medication in 1998 and have been taking it ever since. I know it is still a CUE. I believe the rater did not know my medication was "systemic" since it isn't listed specifically in Title 38, or they rated me by area of skin coverage versus constant use of systemic medication. Either way, it was a big error. The letter I got today didn't mention my request for a back date at all, which I find odd. When VA denied the backdate for peripheral neuropathy that was awarded in 2017 by saying I didn't have a diagnosis in 2009. I may still fight that one because I requested a back date for cervical radiculopathy, which I did have a diagnosis for in 2009. CR is just rated the same as PN because the symptoms are almost identical. Hopefully since I finally got my increase for the skin condition, it will be easier to get a back date, but I really don't trust the St Pete VA after the hoops they put me through. Anyway, I've won a huge battle but haven't won the war yet. I guess I need to keep trying until I get that CUE. :-) Until I do, I really am not a cuerino yet. JustGettingStarted

"On the other hand, I contacted my dermatologist’s office to see if they had completed any of the forms I had requested at my appointment last week. ...I contacted VA again and asked if they had received the information. The person on the phone confirmed that they had received several documents from Dermatology Associates and PA Byron to include the Skin DBQ, a Nexus letter, and a statement." I have good news and bad news. I FINALLY was increased from 0 to 60% for my eczema condition, but it was only dated to the date I last reopened my claim, May 2017. Now I have to decide whether to fight for a back date to 2009. That is when I first claimed the eczema condition and the decision letter actually states I was taking the daily medication but I was rated at 0 service connection versus 60% for daily meds. If that was all there were to consider, I know I would fight it, but my claims have gotten really, really, FUBAR. The worst of it is that when I did the claim for SMC-K, the VA gave me 30% for female troubles. I don't deserve the 30% because the female troubles were all resolved when I had the endometrial ablation that was the subject of my SMC-K. But in giving me the 30% and then getting the 60%, it looks like the VA has given me 100% P&T schedular. It's awful tempting to just quit where I'm at and give up on the CUEs and such, although this CUE alone would be worth about $45,000 in back pay. But then, on the other hand, I never filed another claim that could be 30% because I couldn't find it in my medical records, prolapsed uterus. I finally found it in the operation report for the endometrial ablation. I don't want to file that unless I get a gyno exam that confirms it in writing. A couple of times, during my pelvic exam, the examiner has asked if anyone had ever told me I had a prolapsed uterus, but I guess none of them were ever confident enough to write it down. The operation report for my endometrial ablation says I have a "mild degree of uterine descensus". When I looked this up I learned it was uterine prolapse. Under Title 38, a partial uterine prolapse is 30%. So right now I have some serious decisions to make. The decision letter my VSO just sent me (he downloaded it on his system and I don't have the official copy yet) awarded my 60% for the eczema condition because of my constant use of systemic medications for the last 12 months. It references the DBQ my dermatologist did for me. However, the decision letter does not address my request for back date, and the DBQ clearly says I have been on constant oral systemic medication since 1998. Oddly, the decision letter denied my back date for peripheral neuropathy (which I got awarded in May 2016). What would anyone else do in my situation - shut up and keep the 100% P&T that you know you don't deserve, or go for the %45,000 in back pay that you know you deserve???? I live in Florida, and 100% P&T comes with a few bennies like 0 property taxes.

I've had similar C&P issues with LHI. They only have one contractor, at an office 1 1/2 hours away from my home. They called to schedule one exam and I was scheduled to be out of the country during most of their available window. Although I was never given an exam date, the VA said I missed a scheduled exam and they denied my claim. Later, they admitted the exam was never scheduled. For a different exam, LHI only had one opening the entire 30-day window they had to meet the VA's suspense. They said I would be a no-show if I didn't take that appointment. I had to cancel an appointment with my neurologist that day to go to the C&P exam. Not good.

Lemuel - I wish you better luck than I've had. When I originally filed this CUE, the VA sent me to an exam and they awarded bilateral Peripheral Neuropathy, but did not back date it as I requested. The decision letter said it wasn't back dated because I had no prior diagnosis of PN. I have to admit they were correct. My medical records say things like "radicular symptoms", "radiating pain", and "increased numbness in the hands"--all the same symptoms as when I received a PN rating in 2016. I have to admit they were correct that the records did not mention PN specifically. I have let my original CUE go, and have filed a new CUE for "Bilateral Upper Extremity Numbness, Pain, Tingling, and Paresthesia due to Cervical Spondylosis 2009 to 2016". That is what is in my military medical records, and if granted it is rated the same as Peripheral Neuropathy. In other words, I carefully read why I was denied and adjusted my claim to circumvent the reason for the denial. They cannot deny what is in my medical records, although I have a feeling they will still try to deny the CUE somehow. Tomorrow afternoon I have another PN exam. It seems entirely unnecessary for a claim for something that is in the past, but that is the way the St Pete office functions. The only thing they seem to consider is what the examiner puts in a DBQ - if it isn't there, it doesn't exist. They will not look at my active duty records or anything I've filed in eBenefits; I've learned that the hard way. So I hope I will get a good examiner tomorrow that will listen to me and paint the picture I need them to paint. I have organized everything and am ready to spoon feed the examiner make their job easy. :-) Something else I didn't do before was link my PN to an incident in the military. After going through my records again, I realized the PN symptoms began less than a year after a traumatic accident. The symptoms may have started right after the accident, but I had painful injuries I was dealing with (two broken elbows, a broken hand, and bruised ribs). I spent months on pain killers and going through occupational therapy, surgery, and more occupational therapy. Then I had my first medical record of PN symptoms. I also see my non-VA neurologist tomorrow morning and have a letter typed up for her to sign. I plan to hold onto it as "new evidence" in case the CUE claim doesn't go in my favor. I am not having her introduce new evidence - I am just having her review and confirm what is in my military records. I am not worried about my current rating getting reduced. In fact, with the flare-up rules recently coming to light, the chance of an increase would be more likely than a reduction. Good luck to you Lemuel! JustGettingStarted

Another SNAFU on the Skin Exam! I noticed a couple of weeks ago there was a claim in eBenefits that I did not initiate for “VERRUCAE VULGARIS, LEFT HAND (ALSO CLAIMED AS NEOPLASM BENIGN) (Increase)”. I did not initiate an exam for warts, and the only benign neoplasms I have claimed were colon polyps. I was concerned the skin exam I was scheduled for would focus on this instead of my claim for the eczema condition. Because of this, I sent an inquiry via IRIS with my concern. I received a response for inquiry that stated: “We are currently waiting for: The records indicate VA has requested examinations for skin diseases and scars disfigurement be conducted to support your claim.” When the exam began this morning, the examiner explained to me that she had only been authorized to do the exam for left hand warts and benign neoplasm. I explained to her that I was expecting a full skin exam and asked if there was anyone she could call. She left to make a phone call and I proceeded to call the VA at 1-800-827-1000. Neither call succeeded in getting the exam changed to a full skin exam. I do not blame the examiner in what happened. She was doing what she was told to do by the VA. I also contacted the VA rep at my Congressman's office. He said he will be discussing my case with a caseworker next week that specializes in these things, and she should be in touch with me soon. I hope I can finally get all this straightened out. ___________________________________________ On the other hand, I contacted my dermatologist’s office to see if they had completed any of the forms I had requested at my appointment last week. The nurse told me there was a note on the file that the information had been faxed to the VA, however she did not know if they had copies, and the person that had faxed the information was going to be gone for quite some time due to knee replacement surgery. I contacted VA again and asked if they had received the information. The person on the phone confirmed that they had received several documents from Dermatology Associates and PA Byron to include the Skin DBQ, a Nexus letter, and a statement. The person I talked to did not know if the information would eventually show up in eBenefits and said the only way for me to get a copy was to do a FOIA request. I've asked my VSO to review the files. Still, JustGettingStarted

I was looking for anything I missed on this claim, and found something I believe is significant. When looking through my C-File, I did not find any evidence of medical records from when I was treated by a neurosurgeon at Wilford Hall at Lackland AFB, TX. I provided the Dr's name and location and the dates I was treated when I filed my claim in 2009. The neurosurgeon talks about my radiating pain, numbness, tingling, and paresthesia, and says the clinical symptoms are supported by my MRIs. Since I think they have closed this claim and completely ignore the CUE, I guess I have two choices, either file a NOD or let it die and do a new CUE. I have decided to file a new CUE and base it much on the information in the neurosurgeon's diagnosis. This is information the VA had available but did not use and it is very supportive of my claim. I am also not using the words "peripheral neuropathy" in the new CUE since those exact words are not in my military medical records. My military medical records state I have radiating pain, numbness, tingling, and paresthesia in both arms and hands from the bulging discs. So this is the terminology I will use in my new CUE and then VA can rate it as equivalent to upper extremity PN. I haven't heard back from Chief Deatherage, of Neil Dunn's office, after he requested a copy of my decision letter. I don't know if he is doing anything to resolve these issues with St. Pete. I know he is a busy person, but that is very disappointing. 1-2008 03 30 Wilford Hall purged.pdf

I wanted to separate out the really weird part of my decision letter. In my decision letter they have raised my rating from 0% to 30% for "Early uterine fibroids status post hysteroscopy and uterine hydrothermal endometrial ablation." This is really weird because I didn't request it and the statements under the reasons for decision are totally out of sync with what I told the examiner, and gave her in writing. It says they have assigned 30-percent based on "Symptoms not controlled by continuous treatment. This is the highest schedular evaluation allowed under the law for disease, injury, or adhesions of female reproductive organs (uterus).....NOTE: The VA Examiner states that you experience "metrorrhagia and Menorrhagia Bleeding in between periods an [sic] prolonged periods." Since the continuous medication you take does not completely control the condition a 30 percent evaluation is assigned. The effective date of increase is the date we received your formal claim and your Intent to file a claim. Since both claims forms were received on the same day your date of increase is June 5, 2017." First of all, I was still in my original intent to file date of Oct 2016 so that should be the date of increase Vs Jun 2017, but that isn't the real issue. The real issue is that all these symptoms were from 2006 and led up to my endometrial ablation in 2007. After the ablation, I was fine. How do I tell the VA to keep the 30% I don't deserve and give me SMC-K that I do deserve? This is insanity. JustGettingStarted

This just gets weirder and weirder. I got a decision letter today basically denying everything except giving me a rating a did not request and am not warranted. However, since I won't get a copy of the C&P exam that was done by a contractor for 8 or 9 months, I don't know how to even go about fixing it. Under Entitlement to Special Monthly Compensation, loss of use of a creative organ benefits I was denied. "During your rmost recent VA Gynecological examination the VA examiner reported that you underwent a dilation and curettage procedure with hypothermal [sic] ablation after a hysteroscopy. This procedure did not result in the removal of your Vulva, Uterus, or cervix injury. The VA Examiner did note a history of friable cervix, but did not report this as current active condition. The VA Examiner stated upon examination that you have not had a hysterectomy, uterine prolapse, removal of fallopian tubes or ovaries. The VA Examiner reports that you underwent natural menopause without complications from a pregnancy or any gynecologic condition. The Examiner found no objective medical evidence of endometriosis, incontinence, constipation, leakage or rectofabginal fistula and no benign or malignant neoplasm or metastases was found on examination. Therefore, without a current diagnosis of a service-connected condition that would cause loss of use of a creative organ entitlement to Special Monthly Compensation, loss of use of a creative organ benefits is not met." They completely ignored the fact that endometrial ablation is a form of sterility whether or not the uterus is removed. There is precedence for this and I am going to keep fighting: Citation Nr: 9914661: The examiner remarked that the only chronic residual of the veteran's endometrial ablation was sterilization. A VA medical opinion in February 1998 stated that endometrial ablation usually resulted in sterility. However, if a patient did become pregnant following such a procedure, it was highly unlikely that she would have a normal pregnancy and delivery....However, the RO did grant special compensation for the loss of use of a creative organ....The Board further finds that the veteran has should be service connected for all the residuals of her surgery, not just for the loss of the creative organ, as well as the underlying disability that necessitated her surgery." Citation Nr: 1026353: Likewise, based on the objective medical evidence of record, the Board finds that the Veteran's disability is not for consideration under the rating criteria of Diagnostic Code 7618, as the evidence of record fails to show that her uterus has been removed. While the Veteran's ablation has rendered her sterile, she has been awarded special monthly compensation for the loss of use of a creative organ. The ablation, while destroying the endometrial lining of the uterus, has not caused the removal of the uterus, including its corpus as required for consideration under Code 7618. The VA is even considering a code for Female Sexual Arousal Disorder so women can receive SMC-K for it, and that does not involve the loss of any sexual organs. "In order to ensure gender parity, VA proposes the creation of a new diagnostic code 7632 “Female sexual arousal disorder (FSAD).” There is no diagnostic code in current § 4.116 which allows for analogous rating of female sexual arousal disorder, to include consideration of special monthly compensation. Under proposed diagnostic code 7632, female Veterans with service connected FSAD but without physical damage to female genitalia would be evaluated at 0 percent with a note directing rating personnel to consider eligibility for special monthly compensation (SMC-K)." https://www.federalregister.gov/documents/2015/02/27/2015-03851/schedule-for-rating-disabilities-gynecological-conditions-and-disorders-of-the-breast

After typing the above, I received a copy of my decision letter. It says: "Evaluation of [skin condition] currently evaluated at 0 percent disabling. We received your request for reconsideration of the evaluation for your service-connected [skin condition]. We scheduled you for a VA examination and a medical opinion regarding your current continuous treatment. However, we received notification that you were unavailable for your scheduled VA examination on September 8, 2017. The results from this scheduled exam may have allowed us to grant an increase in your service-connected disability compensation. If in the future you provide us with your good cause reason for missing your scheduled VA examination and you indicate a willingness to report for another VA examination we will reconsider your claim. We have continued our non-compensable evaluation for [skin disease]." I already contacted the VA and told them I was never notified of an exam for 8 September. When LHI had called to try and schedule an exam, I let them know I was out of town all but 3 days of the days they wanted me to schedule me. I never received an appointment packet and I called VA 3 times asking when the exam would be scheduled. When I found out a decision letter was being sent, I contacted VA, I was told an exam had never been scheduled and they would request a new one. Now I have a new skin exam next week, but I am a bit concerned it won't cover my eczema-like condition. The decision letter I just received says they have deferred a decision on "verrucae vulgaris, left hand (also claimed as neoplasm benign)". That does not make any sense at all. I am service connected for chronic warts (verrucae vulgaris) on my left hand, and have 10% for the basal cell I had on my left calf. This VA cannot get anything correct it seems. JustGettingStarted

I got the response below to an email I sent to a VA customer service rep. I have no idea where they got the idea I was using a topical medication: "I reviewed your current medical evidence as well as your exam from 2009. The 2009 exam did note the use of topical cream, which would meet the constant systemic medication portion of the criteria, but the examiner specifically stated that it was not a corticosteroid or an immunosuppressive treatment. Based on that, we did not grant the 60 percent evaluation. I reviewed your current medical records, but I didn’t find anything that would meet one of those requirements. I did see that you had a contract skin exam schedule; however, the exam was canceled by the contractor due to availability/scheduling issues." My response [redacted]: "I am requesting CUE because I have been on oral [medication} since 1998; not because of topical medication. My 2009 exam specifically says “[Medication] 500mg daily” on page 4. Page 22 of the 2009 exams states “4. [Skin disease] – Reports diagnosed in 1996. Taking [Medication] daily with good response”. This is a systemic oral medication. What is so hard to see this in my military records, the 2009 exam, and in my 2009 decision letter that says I am on daily [medication]? In addition, The US Court of Appeals for Veterans Claims, Warren Vs McDonald, No 13-3161 clarifies that any oral systemic drug, not just corticosteroid or an immunosuppressives, qualifies for higher ratings when used to treat a skin disease rated under diagnostic code 7806." I just can't believe how wrong the VA keeps getting this. I can't wait to see what they have to say concerning the oral versus topical medications. I have never used the topical version of this medication. Still, JustGettingStarted