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El Train
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Posts posted by El Train
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17 hours ago, blahsaysme2u said:
i was just given SC for TBI last year but they merged it with my PTSD because "symptoms where too similar to separate". even though i meet the 3rd degree scale to warrant 70% for TBI. i didnt mind the 50% with PTSD but when they merged the two and gave me 0% TBI, i was pretty upset. my VSO said there wasnt much we could do with it it and at the time i believed him(have i mentioned how much i cant stand the VFW and DAV for their previous "help" with my claims)
http://www.militarydisabilitymadeeasy.com/tbi.html#system
anywho- with this- maybe i should file for increase? i dont have any "new evidence" other than their change mentioned by @awgv001 post here. think this would help? or should i file NOD for HLR(my letter is dated 8-30-2019)?
thoughts?
Same here. Except they bumped my PTSD to 100% from 50 and put me at 70% TBI. They combined them though for 100% P&T, which means I'm done. Also got SMC-s.
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5 hours ago, awgv001 said:
This is why I believe I have a situation of "VA failed Duty to Assist"
"In general, to obtain a C&P examination a claimant needs to show a current medical condition, some evidence of potential connection to service, and that available medical evidence is not sufficient to allow a decision on the claim. In other words, the claimant must first provide some reason for VA to believe that a medical examination would be helpful in resolving the claim. A claimant's own statement that his or her symptoms have continued since service or a previous medical examination report can be enough of a reason."
Prescriptions, treatment, evaluations, diagnosis, and lay statements other than my own... but no C&P.
Have you gotten with a VSO? They can help you file a claim. You won't get a C&P without filing for a specific condition.
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2 hours ago, JKWilliamsSr said:
It is the raters responsibility to review the outside doctors report and determine it's weight not the C&P Examiner. Where it can become tricky is if the rater decides to give the C&P examiner more weight than your examiner. Then the requirement is for the rater to state the specific medical reasons why. They cannot simply say they believe one over the other. On top of that most C&P examiners are either NP's or PA's. So it can be tricky for the VA to state why they gave their examiner more weight when most of us that use outside doctors use actual MD's. I have yet to have a C&P examination from an actual MD.
This happened to me. HLR still went with the VA C&P NP opinion over my outside MD well written nexus and diagnosis stating records review and the whole nine yards. I would win in an appeal, but why do I have to go this route? I'm 100% P&T so I won't. But I hate losing when it's a solid claim.
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They are taking it seriously. I put in a claim for TBI. It got started with diagnosis from outside MD and Psychologist. Otherwise the VA was ignoring my complaints of symptoms. Then the VA proceeded with three C&P's. The first one was positive. Then they sent me for two more. I haven't seen those yet. I did get my claim approved since then. They combined it with PTSD for 100% P&T. Also migraines were secondary at 10%. I can tell you TBI's are no joke. Not remembering siblings names, where you put away the dishes at, whether you took your medication, fed the dogs, took a shower, sucks.
If you are going to put in a claim, I recommend getting an outside IME first. Otherwise these are serious claims the VA will try to dodge. I guess that goes for all claims.
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Finally got my rating after battling only 3 years. 60% in 6 months, then 190 total after one year. Thanks to The Ellis Clinic and Dr. Valette, they were able to get the ball rolling on my initial TBI and increase for PTSD claims. They also helped in several other key areas and claims. 5 total C&P's (3 TBI & 2 PTSD) by the VA and it all worked out in my favor. Combined with an additional 92% on top of the 100% also qualified me for SMC. Wasn't expecting that. What a relief. I hope it's all over and no more C&P's. But I won't let my guard down. I will keep seeking treatment for my issues. It does help. I still do work part time as well.
I want to thank everyone in this forum for all the help. Such a positive forum. The other Veteran Benefit Network forum was a total drag down. Got into it so much with them stinkin thinkin fools, it just wasn't worth it. I may go rub their nose in it from time to time. I don't mind calling them out on their bs. I will continue helping here as much I can. I got my rating in short order as far as claim times go. So I do know a thing or two by now. I know I had a few people following me, so don't hesitate to contact me.
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They call it a C&P, but it really is just an examination and questionnaire for you. Same with burn pit registry exam. It will be in your VA record. If you have any of the Gulf War symptoms, then let them know. I have IBS and Fibromyalgia (catch all diagnosis for wide spread body pain). Hopefully you don't have to drive to far for this. But you do want it on record.
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Great info. My VA health care team wanted nothing to do with helping me get service connected. Down played all my symptoms. Blamed stress, old age, diet; the list went on. Shaking their head; 'it's all in your head, but don't go to mental health, they'll make thing's worse'.
Had to go outside the VA and get IMO's from pro's who know the VA lingo. That was the trick. They're still fighting me on some IMO contentions. You're damn right I paid for it. 100% now.
- Dustoff1970, Vync and GBArmy
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I've had VA rater deny my claims based on VA NP opinion vs. my outside MD's opinion. Got denied HLR too. The MD I used is very familiar with VA nexus letter and terminology (Dr. Ellis). So you know he know's the VA verbiage. The evidence was there, the in service incident was there, his diagnosis linking it to the in service incident was there. I told this info. to the HLR guy on the phone call. So I guess I'll go the appeal route if I need too. I'm 100%, so I may not pursue it at the moment. What a crock.
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2 hours ago, JKWilliamsSr said:
I understand the concept of taking the call and it does make sense. My problem is the trust factor and it is very difficult for me to get past that. Taking a phone call may give me more anxiety than it is worth and could cause issues with the call it self. If I did not provide full details on how I felt the rater did not follow the necessary laws I would have opted for the call. I gave enough details that if the senior rater actually read it a phone call would not be needed.
The 2 biggest concerns with my decision are:
1. Most of the medical evidence I submitted was ignored without explanation
2. All lay evidence was ignore as well without explanation.
This all boils down to a rater taking my claim and not looking at all the evidence. While I can't prove it I believe the rater saw that my IME was from Dr. Ellis and immediately decided to reject it. The rater only cited his IME in denials but in the end the rater made a critical mistake. The rater put this statement in my denial for diabetes. "So Although the statement of Dr. Ellis is credible given the medical credentials held, his statement is found to carry little weight as there is no medical document used in order to provide his opinion" By saying "The statement of Dr. Ellis is credible given the medical credentials held" the rater is stating that Dr. Ellis is credible and this credibility has to now apply throughout the entire IME report. I submitted Dr. Ellis Curriculum Vitae when I filed my claim and his credentials is clear. One of the credentials he holds is that of a "Diplomate, American Board of Disability Analysts" which means he is a board certified doctor in disability analysts. He is also board certified in Environmental Medicine and Family Medicine. Yet the rater gave more weight to a nurse practitioner.
Oh....and there was plenty of medical evidence to support the opinion by Dr. Ellis the rater just ignore it. On top of that. The claim for disability cannot be denied even if it was based on an opinion (Colburn v. Nicholson). The rater still has to provide a medical basis for denial.
Same boat as you. Rater took a VA NP's opinion over Dr. Ellis rock solid IME, backed up with medical records review, & stating in service incident that caused the issue. The denial letter stated 'no records of in service incident' (not true). Favorable evidence 'Veteran does have diagnosis of lumbarsacoral strain'.
I took the HLR phone call, and stated what was missed and Dr. Ellis strong IME. The gentleman was very nice. Asked when & where in service incident took place. So we shall see what happens. Probably stay denied.
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16 hours ago, Kuwaitin08 said:
If you requested it, they will call you to discuss your higher level review. It typically takes a month or so for that phone call. Make very sure you are 100% prepared for that phone call with your arguments and exact information that you believe was missed.
If they find any issues with your higher level review they will send you for more exams. I was sent for six different exams.
Just got the phone call last Friday. I pointed out the missed evidence by the VA C&P examiner and the solid IME I got from an MD linking everything together. Probably still get denied, but worth a shot.
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2 hours ago, Dustoff 11 said:
I did not read your whole post but if you have not then find an experienced accredited VSO such as DAV, VFW, Legion, etc located at nearest VA regional office and they can be big help to you in finding military and service medical records in addition to providing you additional advice and filing claims, etc. You do not have be a dues paying member for them to assist you by their own rules/laws, etc. They can also help you to upgrade your discharge if it is needed.
Interview them in person or by telephone and pick the one that seems motivated and most interested in your case. Avoid those with hostile or indifferent attitude or do a lot of sighing in your presence as if you are too much bother. You have to pick out the good apples from the bad in the barrell.
The other vets here have given you good advice also. Many of us know how just unfair military leadership was and still is. Just like civilian life the cream does not always rise to the top in the service.
There is another veterans benefit forum I refer to as VB* that spends a great deal of their daily post to vets bad mouthing lawyers and private doctors who provide medical opinions for a fee to assist vets with their claims. These former and present VA raters, and VSO lifer officers tell out right lies and falsely imply to new vets that the lawyers and IMO doctors are charlatans. Which is BS as I have read their many statements in BVA decisions winning benefits for vets.
This is fact. I've had a lot of them tell me I didn't have a claim or the VA C&P's examiners are not out to form craft their exams/opinions to get the lowest rating or flat out denial. Outside IMO's have got me from 50% lowball ratings to 100%. The VA is not looking out for you. They have hired guns working for them. We can hire our own guns just like them. I don't see the difference. Tell that to the other site and see what happens. Sometimes I wonder if the VA is running that site. But they do have some good info. and pitfalls to avoid. When their senior members (current raters, former raters) answer, view it like the VA is answering your question and do the opposite. They helped me out tremendously when you view it like this. Not sure they intended it to be like that, but it sure helped me out.
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Did they call you? Any follow up? C&P? Letters? I'm going through one now. Just started. I believe I have the evidence on my side.
Thanks.
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Most likely you will need a Dr's diagnosis linking it to you service in the Gulf. You are going to need a Dr. who knows what the VA verbiage is as well. Someone like Dr. Ellis. Or they most likely will continue to deny. Your going to need the diagnosis, therefor the law on your side. GW claims are not easy to get service connected. Presumptive doesn't make it easier.
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So I get a letter from VA stating they need additional info on a buddy statement. Wanting service entry and exit time frame. Pretty sure they have this info if they look up the individuals dd214. I had a hell of a time locating this person to even do it in the first place. It'll be the same the second go round. I'm not sure what will happen if I don't get this info to them by the due date. Which is a few weeks.
The buddy statement only solidifies my case. But probably not entirely needed since I have 4 different Dr's state 'At least as likely as not' caused by incident in the service and medically documented.
Any insight is helpful.
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I've used him. Very detailed in depth reporting. In my case, I had to separate TBI/PTSD. The VA isn't about to do that. It got the ball rolling for TBI C&P's (which were positive). I put in for PTSD increase based on his reporting and his recommendation I be at the higher rating. The VA Psyc C&P DR. was not impressed with his report (in fact quite dismayed). Her report reflected it. It was garbage and the VA knew it didn't match up with my medical history. I had to formally complain and got a redo on the PTSD C&P. They also re-did the TBI two more times. One C&P DR. was baffled why I was in there again. She found a couple more issues on top of my original TBI C&P. Had another C&P two days later for PTSD and TBI. Also was sent into a Migraine C&P after the initial TBI C&P. So a total of 2 PTSD and 3 TBI C&P's. Both these are deferred now. We'll see what the VA has to say about all this stuff.
If you go this route, be prepared for them to scrutinize. They hire their examiners for a 20 minute interview and that's ok. We hire ours that take months to examine all you medical records and they take issue with it. But if you have the medical evidence, you should be fine.
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It depends.
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3 hours ago, k5one said:
40 % is the max for Fibromyalgia, so you are good there. You may want to look into Chronic Fatigue Syndrome. There are a lot of similarities between FM and CFS, there are some key differences. I am rate 30% for IBS, 40% for FM and 60% for CFS, all connected to Gulf War. All you need is a diagnosis and DBQ from your provider. You don't have to prove service connection, it is presumed.
They can deny CFS for a number of reasons. In my case, it was PTSD/MDD/Anxiety that was used to deny my CFS (Sleep apnea probably would rule it out as well). I had a diagnosis from an MD for CFS. He was not Rheumatologist. He was an Environmental/Family/Forensic Dr. They used the VA's NP C&P opinion over my MD's opinion. Yes my MD used all the verbiage, rationale, and GW presumptive in his opinion; reviewed all my records, medications, and in person interview to back it up. He does this for a living. Could I fight it and win? Maybe. If I wasn't 100%, I would.
Too get all three is quite a feat, to say the least.
I did get the 40% Fibromyalgia. Still waiting on the IBS appeal in which I have 3 MD's diagnosis. Originally I didn't have the diagnosis for the first C&P.
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Does your C-File contain DBQ's or just results from DBQ's? I have gotten most of my DBQ's and am rated at 100%. I have never got a copy of my C-File.
Thank you.
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9 hours ago, Reese420 said:
Try to claim TBI with PTSD as a secondary. Also if you drink or smoke weed let then know your self medicating because thats also secondary to the PTSD.
Or in my case they can try to pin tbi issues due to alcohol and mj use. But this was only one examiners opinion. I have 3 other opinions that state otherwise. Yes, I have had 5 c&p's for ptsd and 3 for tbi in the last 2 years. That'll teach me to put in for an increase with outside ime/nexus/dbq.
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No. I had two dui. One in service and one out of service. Last one was over 10 years ago. The first one in service had nothing to do with the things that caused PTSD (and TBI in my case). I told them everything. I told them I binged drink back in my military days too; and occasionally when I got out. Same with MJ use. TBI was a different story. I did have a C&P examiner try to vaguely blame cognitive issues on alcohol and MJ. She will loose as I have 3 other opinions stating otherwise. But it is the VA. They may disregard the 3 nexus and dbq's and go with hers. They will loose.
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Have the same thing going on with me. PTSD increase C&P (which went terrible), then TBI C&P (which went great). Couple weeks later got called in for headaches and smell/taste alteration C&P by QTC. It is deferred for the time being. It is complicated and I'm sure they just want to make sure they get it all separated correctly.
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Here's my experience with handing the QTC examiner an outside DBQ and Nexus (PTSD increase). Pissed! And her exam reflected it. She wanted to know where I found the Dr. I didn't think it was relevant. More pissed! I wish I would have just went through the exam and not given her that. Now I get to file complaints with the VARO and hope the VA dismisses her ridiculous C&P. She needs to be fired.
Had a C&P 2 weeks after this terrible C&P (TBI mainly with PTSD secondary). Kept my mouth shut, it went in my favor big time. Refuting a lot of the bad C&P examiner claims about no TBI symptoms and not meeting PTSD standards. Yes, it will work out in my favor eventually, but I'm keeping my mouth shut about supplemental evidence from now on. The rater should have all the additional evidence hopefully.
Best way to inform about SW Asia theatre exposure in claim?
in VA Disability Claims Research
Posted
Yes, your diagnosis with SWA medal should do it. Here is a bad picture I took of my diagnosis. It directly links my symptoms to the Gulf. It would be hard for the VA to deny based on this solid wording and diagnosis. For IBS, you're going to need a colonoscopy. I waited until I was 50 to get this.
Got denied on CFS due to PTSD/TBI symptoms overlapping with it. Might be considered pyramiding. Hope this helps.
new doc 2020-02-03 12.22.40-20200203122323 (1).pdf