El Train

Ya, and they won't take the case unless they feel they can win. You should be good.

Ya, the VA will use that gap to deny you. Even though ongoing treatment isn't required for your claim to get approved. In my case, I sought continuous treatment from the time I got out to the present. The gap in treatment resulted from Dr's retiring or records destroyed after a certain period of time (like 7 years). Didn't plan on filing a claim. I had buddy, spouse statements, Dr's nexus, etc. Denied. Now get this, I got TBI approved from the accident in which my neck and back were injured. The rappelling accident knocked me out. TBI approved combined with PTSD for 100%. Never sought treatment for either until I filed a claim (24 years after I got out). Unless you count weed and beer as treatment. That's what I told them.

How long have you been out? Have you been getting treatment for these injuries? These are tough claims to win without ongoing treatment, even with an in-service event and a diagnosis. I know, because I have in service incident, diagnosis for both spine issues, and got denied. But I filed 20 years after getting out. I didn't keep treatment records even though I've been treated for spine issues since getting out. This was their reason for denial.

I noticed most of the people saying you don't need an outside medical opinion have been fighting their claims for decades. Stuck in appeals at all levels (won some, lost some, some still in litigation). The decades of experience makes their opinion valid. Maybe so, and I respect that. Then one person says file the claim, if it gets denied, then get an outside IME. I went this route and got denied 2 out of three claims (both GW presumptive). That is when I came to this forum and learned about getting outside medical nexus/dbq's. A year and a half later I got the other 2 claims approved and a hand full of others approved or increased (100% P&T SMC). I don't enjoy fighting with the VA. Some people do. I get it. There are people who insist on filing more claims after 100% P&T with SMC's. I even have the itch to file claims I know I can win in appeal. Not going to wake that sleeping bear up. There are a lot of things in my SMR's that are vague and lack detail by an E-3 Corpsman. An MD's IME can clarify this for a VA nurse C&P examiner. Otherwise probably 'DENIED'! Going into a C&P exam with an IME already done, keeps the VA a lil more honest.

100% P&T SMC-S in a year and a half. Couldn't have done it without IMO's. So yeah, enough said. I'm not stuck in the never ending appeal wheel or an extended battle with the VA. You do it whatever way you want. I did it my way. A year and a half and done. I don't play around. I play to win.

If you don't have a VSO, I would get one. Have them do an intent to file. Or something like this. They can help you get your claim together. Hopefully you get a decent one. My VSO was ok. I learned the system on my own. My VSO filed claims for me, got copies of C&P's, and answered some questions. I got to 100% P&T within a year and a half doing the rest of the work (gathering evidence). He was asking me for advice when it all settled. If you do an intent to file, I think you have a year to gather and submit your evidence. Someone will correct me if I'm wrong. If you get claims approved or increased, it goes back to the date you filed.

File for an increase and any new or secondary issues. If you have additional new, additional or relevant evidence, then submit it. Sounds like you should be rated at 100% easily. You're worse off than me and I'm 100% P&T with SMC-S. I got there with an abundance of evidence that I got outside the VA. In other words I paid for outside DR's medical opinions. You may not need to go this route. IDK. The VA most likely will not help you with medical opinions when it comes to claims.

You're only going to get one Mental health condition. No telling what your overall rating will be. If they haven't combine your TBI with your mental health, they probably will do that. They can separate any TBI conditions such as vertigo, headaches, vision problems, incontinence, etc. In my case, I had 100% for ptsd. I had TBI rated at 70%. They combined them at 100% ptsd/tbi since my ptsd was the higher of the two. They will not overlap symptoms to avoid pyramiding. PTSD and TBI share a lot of the same symptoms. I did get some tbi issues separated, like headaches.

Yep, they tried this with me. Fortunately I knew where they were going so I didn't fall for it. I like the proposal of being allowed to work while being 100% mental condition. It gives me peace of mind not worrying about a reduction since I'm working while being rated at 100% ptsd/tbi. Even though I'm P&T, I'm sure a rater who ever reviewed my records could use this as an excuse to reduce.

Insomnia is part of my mental health condition (100%). You may want to approach it in this manner. It may be easier to get it approved. I mean pain obviously causes mental health and insomnia issues after all. I also was awarded 40% for Fibromyalgia when they couldn't figure our what was causing my neck and back pain. MRI's and Cat scans couldn't reveal what was causing my pain. It causes mental health issues for sure. MDD (major depression), insomnia, etc. Of course treatment and a diagnosis from the VA would substantiate a mental health claim.

I got mine automatically. You should too. You are close having other ratings total 70%. Are you sure they all add up to that? If so, have your VSO contact the VBA to make sure they didn't miss something. You can recheck you ratings again using this link. Obviously don't use your 100% rating. https://www.hillandponton.com/va-disability-calculator/

I didn't have barbae, I had cystic acne. I had a no shave from medical. During field training (Marines) we had an inspection where I failed the shave part. NCO made me shave with a dull disposable razor without shave cream. It was a very dirty environment. Dirt, camo paint, bug spray, etc. Bled and got infected. Scared the F outta my face and neck. Had a Navy Corpsman lady about cry when I told her what had happened and the damage done. They should of wrote that NCO up. I got 80% for the extensive scarring on face, neck, cheeks, back, and chest. Painful scarring with underlying damage. The cystic acne persisted for another year until treated with Accutane. Three regiments to get it under control. Lucky my liver is still in good shape. Pretty sure this would happen whether it was acne or barbae. I claimed it when I got out - denied. 20 years later, pursued it again - 10%. Got an outside IME filed an NOD - 80%. If you have scarring from the incident, I'd pursue that.

I work damn near 40 hours a week. I'm 100% ptsd/tbi P&T with SMC-S. It's pretty rare, but doable. It helps that I have sheltered employment. I've told every C&P examiner this info. This won't fly with SSDI, but maybe it will when I'm done working in a couple of years. I can't take the stress much longer.

I had a lower back C&P during a flare up. It's debilitating. Her opinion, questioned my effort during the exam. Guess she's never dealt with back spasms and not being able to tie your own shoes for weeks at a time. I got denied.

Well hot damn. I got a prolapsing heart valve. From what I've been told, it's a fairly common issue. I can't see how one would link it back to vaccinations. Pretty sure mine is hereditary and I drink like a fish. So it could be that. I do run 3.5 miles per week. Not fast, but I just did a best of 8:45 per mile this week. A little of my best in the military of 6:25 per mile.

Sure do. Had to go to OKC for the exam. If you go this route, follow their application guidelines or they might not see you. I put together a three ring binder separated by tabs for each condition I was claiming. It was well organized with pertinent info. only. Not a lot of extra non sense. Past C&P exams and treatment records, etc. I even sent a nice written letter on why I am a good candidate to be seen. A cover letter so to speak. Well worth it.

https://ellisclinic.com/va.html

My experience is a lil different. Initially approved for 50% PTSD, 10% tinnitus, 0% hearing loss, & 10% skin scarring. 60% overall. All of this was done initially with my VA records alone. Got outside IMO's from an MD (nine total for $800) and a separate one from a Psyc. Dr. for $2K). So $2800 and maybe $1200 for a mini vacation for two to see the Dr's in person. I'm lucky enough to have the means to afford this, so this may be a factor. When the dust settled (drum roll), 100% PTSD/TBI, 80% skin scarring, 0% IBS/gerd, 10% migraines, & 40% fibromyalgia. All P&T with SMC-S. I had some conditions denied (which I surely could win in appeals with the evidence), but I was maxed out. Roughly $4K cost vs $3700 in monthly benefits. Do thing's your way. Get caught up in years of appeals and fighting. I took a short cut, with evidence and help from experts connecting the dots. No appeals. Granted if you don't have the evidence to back up your claims, then yes, perhaps money down the drain. So I hear you on that. Not my opinion, just my experience.

Good chance they'll just rubber stamp a HLR. Couldn't hurt to try I guess. Submitting peer reviews or other vets court cases most likely will get you nowhere since everyone's case is different. At least that will be there excuse. Most likely won't even read them. I personally would get a MD's IME (independent medical opinion) and file a NOD (notice of disagreement) and submit that evidence. Have your VSO do it. I've got to 100% P&T/SMC-S, in short order going this route. There are Dr's out there who are familiar with VA lingo that can help you connect the dots with secondary's.

That is correct.

It took mine about a year to get (pre-covid). I can only imagine it taking a lot longer nowadays with the covid crap going on.

File for an increase for the TBI and PTSD. TBI exams are different nowadays. I doubt you had the MOCA test by someone certified to administer it (neuropsychologist). I had three TBI C&P exams and two PTSD exams when I filed for increases. A lot of these two exams are very similar except the MOCA test. https://www.mocatest.org/ They want to separate the PTSD symptoms from the TBI symptoms (headaches, visions, vertigo, etc.). I scored a level three on one of the MOCA test categories. That put me in the 70% rating. They combined it with PTSD for 100%. They will separate tbi conditions that don't overlap. I had a bad PTSD C&P psyc Dr. state I didn't have TBI. She got destroyed by the other four C&P exams. I did file a complaint about it. They ruled in my favor big time.

I wouldn't use any of these third parties as others have suggested. I wouldn't even hire a lawyer to do the things that you can do on your own. You'll get results quicker and won't have to pay them. Your best path, as others have suggested is to file for an increase on your PTSD and TBI. I've gotten to 100% PTSD with TBI symptoms on my own using these people: https://veteranspsychevaluations.com/ https://ellisclinic.com/va.html They will take a look at your old C&P's, and medical evidence and get you the proper assessment. This is what lawyers are going to do anyway. The VA probably lowballed you on these two things. Hopefully you have been in constant treatment for these. If you have any questions about my experience, PM me. I've been there, done that. With great success and no lawyers dragging it on for a decade and no appeals process. Just straight up used VA law and procedures to get my claims approved.

Totally agree on the in person exam. I had a VA C&P examiner ask me if I saw the Dr. in person who assessed my IME. 'Why yes I did. It was a four hour medical examination'. Which is 3.5 hours longer than you're going to spend with me.

Sounds like they're hoping you go away. I'd hammer them with a Voc Rehab specialist IME like Bronc mentioned. Don't go the appeals route. Could get tied up for years. Have your VSO file a NOD with additional evidence after you get it. You have a year from the denial to file a NOD. You can look into an outfit like this. https://www.cliffordvocationalservices.com/ Can you walk in that form to you former employer and have them fill it out in front of you? Doesn't hurt to try.