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El Train
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Posts posted by El Train
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Your best advocate is you. A VSO is a good start, and good to answer some questions. Most are too busy to give your case the attention needed. It took a few denied claims for me to figure out what the VA is looking for. After that, I got all my ducks in a row. Got outside IME's to back up my medical evidence and then hammered the VA with that. When all the dust settled and I got to 100% P&T/SMC-S, my VSO was asking me for some advice. He was good for getting my C&P exams for me to study and file NOD's. Bout it.
This forum was a tremendous help, and I couldn't have did it without it. There are other forums out there that discourage vets from applying or shoot you down when asking questions. Just be leery of those. You are in the right spot here.
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4 hours ago, pwrslm said:
Dr Bash and Ellis are not so special. Lawyers have Doctors like them on retainer for accidents where they take the Insurance Companies to court to sue for clients injuries. That industry is huge! The specialists like Bash and Ellis literally show up in court and give testimony if it is necessary. The boiler plate reports are basic formats that cover specific terms and cover a legal necessity most of the time. They complete the opinion portions with acceptable medical treatise and specifics about your condition in these opinions. They probably have assistants that they pay to do research as well so they can provide a solid foundation for their opinions.
If it ain't broke, don't fix it. Bash and Ellis specialize in VA Claims.
Maybe true. I know Dr. Ellis has trained C&P examiners to do C&P exams (which use a boiler plate dbq form and give an opinion). His IME's blew away any of the VA/QTC examiners IME's. In fact one VA examiners said his IME's were impressive. But you best have the medical evidence and treatment records to back up you claims or he isn't taking your case. Instead of hiring a lawyer to drag it out, then collect 20 to 30%, I did it on my behalf. Got to 100% P&T, SMC-s in less than two years.
I got low balled and denied on a few issues due to lack of medical treatment records, natural progression, or no in service complaints. All which are VA lingo to deny. He specifically points out where and when the claimed incidents happened, what treatment was administered, then writes the all important VA lingo to help the VA out (they need help sometimes). I wish he didn't include what percentage the claim deserved. I had three claims get approved for way higher than his assessment (couldn't believe it).
After a few denials, I knew I needed a MD's opinion to help prove where the VA got it wrong. Some claims were new, like TBI. A very difficult claim since the VA doesn't really know as much as they should (at least at my clinic). Got 70% for that (they combined it with ptsd for 100%).
Last but not least; there is another forum out there that will tell you these DR's are on a blacklist of some sort. Fair enough, they probably are, but the VA has to take their assessments into consideration regardless. It is medical evidence. And if they did an in person exam, read all the evidence and state their curriculum vitae, they have to consider it. Hell, I hired one DR. to do a nexus and DBQ that had over 20,000 C&P's under their belt.
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You should throw in Dr. Ellis at the Ellis clinic (OKC). Very affordable. Worth a trip. Got me to 100% P&T.
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7 hours ago, broncovet said:
Congratulations! You cant really tell what the exam report will look like until you read it. Docs often have "poker faces", and will not reveal their "hand".
One C and p lady was super nice to me. She made it sound like, "Boom" ...100 percent. That is, until I got the report. It was just the opposite.
The reverse, also, happened. The doc was mmm..I dunno. This was the best exam report.
It almost scares me when the examiner is real nice. Bottom line: you have to read the book to know what is in it. The cover does not mean much.
Yep, happened to me too. I tell you what, you learn a lot from a C&P like this.
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4 hours ago, pwrslm said:
HADIT is unique. The closest thing to it is VBN, which was real political and a pain in the tush when I registered with them.
True. Seems like a lot of former or current raters at VBN lecturing us on why not to file or you're in for a denial. Then the bullying begins with some of their regular minions piling on. When I found this site, I went from 60% to 100% P&T/SMC-S. From time to time I'll post on that site my success and why some of the info. I got from them wasn't sound; only to get a rise out of the regular nay sayers. They must despise this site.
Now I'm here to help and it's appreciated.
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On 4/28/2016 at 8:38 AM, subic_marine said:
I agree with you Pete, that the VA should likely have a better handle on the gulf war presumptives, but the fact is that they don't ... at least the ones at Hines. They're still pushing graded exercise therapy and cognitive behavior therapy for chronic fatigue ... therapies that have simply not worked for me, and were sidelined years ago by most "real world" doctors in the field.
Maybe the VA has a doctor in their system that knows these symptoms (Fibro/CFS). Just not my VA. Nor do they have a grasp on TBI. Too complicated. If you have been getting treatment for these symptoms (taking meds, getting acupuncture, chiropractic procedures, etc.), then you can get the diagnosis for these by a MD. Doesn't necessarily need to be a specialist like a Rheumatologist. Although a Rheumatologist is preferred. I used Dr. Ellis in OKC, OK. He examined my medical/treatment records and did an in person examination. I then got diagnosed with Fibro/CFS. He is a forensic environmental MD. He teaches C&P examiners. He also helped me with a number of other diagnosis the VA had no clue about. The VA needs help with these items. I provided that help for them at my own cost. Totally worth it. Does the VA like it? No they don't. Not my problem.
I got approved at 40% Fibro and denied CFS due to PTSD and Fibro symptoms overlapping (pyramiding). You will not get both of these symptoms approved. If you do, it's likely a raters error. PM me if you have any other questions, or just ask away.
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Well the DBQ for Fibro covers a lot of the same things as CFS if you look at it (headaches, fatigue, joint pain, sleeplessness). They could lump all those symptoms into your Fibro and MDD rating and probably have. You got max for Fibro. If you were to trade your Fibro for CFS, do you think it would be higher than the 40%? I'll go out on a limb and say 'You will not get rated for both'. Especially being 100% for a mental condition. I know how bad you want the CFS. I did too. Especially with a diagnosis putting me at the 60% level, but it didn't happen. I got 100% for a mental condition with TBI & 40% for Fibro. I'm not putting that in jeopardy. I got 10% for headaches due to the TBI.
Think about what you could loose by trying to gain the CFS rating. Bottom line, you do you. Keep us updated.
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Regardless of what they call it, you're only going to get one mental health rating. GAD vs PTSD vs MDD, etc. I know we veterans get hung up on what they classify it as, but a rating is a rating. For example, my PTSD/MDD rating is classified as being 'Non Combat', when in fact it was combat related. I've seen this drive veterans absolutely bonkers even though it changes nothing. Sure, I don't like it, but I'm not going to go through the trouble to have it corrected. It changes nothing.
Do you think you stand a better chance of getting a rating if it is a PTSD C&P? Hell it might be the same DBQ as GAD by a Psyc. DR that does both.
You never know, they may rate you with PTSD/GAD. GAD is a part of it after all. So is MDD (major depression disorder). They all intermingle.
- broncovet and ShrekTheTank
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21 hours ago, Lavish said:
Wow, I didn't realize a 100% vet could get reimbursed for any treatment out of the county!
Ya, check it out. Even a 0% is a service connected disability that can be covered. I don't even think you need to be 100% to qualify.
https://www.va.gov/communitycare/programs/veterans/fmp/index.asp
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17 hours ago, Lavish said:
The difference is, from what I understand, is that IBS can be rated at 0%, but CFS starts at 10%. Maybe they meant to put in 100%...I doubt it. I should be rated at least 40% though -easily.
The claim isn't showing closed out yet, so maybe they are going to rate some of the other systems separately.
No, all GWI presumptive should be at least 10% disabling to get it. My decision letter actually states 'direct service', which it really isn't. I had no complaints or treatment in service to make it direct service. Maybe this is why I got the 0%. However, ebennies states 'Gulf war presumptive'. Ebennies is not always accurate however. Maybe I'll re-read the decision letter out of curiosity.
I can tell you this, my symptoms are at the very least 10%. I'm on constant medications for it and have developed diverticulitis because of it. Contesting it does me no good. I'm maxed out and I am rated for it even at 0%. This means I can use the FMP (foreign medical program) when I spend large amounts of time out of country and get reimbursed for any treatments.
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I think the 0% is a mistake, but you are rated for it. I got 0% presumptive for IBS which I think is a mistake, but I'm rated for it. You can contest it if you want, but it may not go your way. I got denied for CFS due to being rated for PTSD/MDD (100%) and Fibro at 40% causing the CFS symptoms. I had a diagnosis and a solid IME from an MD that put me in the 60% range. They took the VA's NP opinion over My MD who's credenza is two pages long. A small victory for the VA. Small since it doesn't matter for me. I have 100% P&T with smc-s.
I have heard of only one person who got rated for PTSD, Fibro, & CFS. My guess, he got away with it by a raters mistake since it is so rare. Just sayin.
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I wouldn't stress over it too much. You already have two favorable C&P's. They probably just want clarification on something. I did 5 C&P's for PTSD and TBI within 6 months. In the end I got 100% PTSD P&T with smc-s. They just wanted to make sure they weren't pyramiding and had the right diagnosis.
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2 hours ago, drago said:
I know it is dangerous to ascribe motive to looks and statements, but I think that format at the very least caught the evaluator off guard, and perhaps had a hint of "unethical" in the look and questions. Could be my own paranoia though.
No, I think this is good. Too many times an examiner skips questions and categories only to check the box as 'NO'. If they know that isn't going to work in this case, they are more likely to ask the question. If you answer 'YES', that's the box they should mark. Hell, I've walked in with the DBQ in hand. Guess what? The DBQ was asked and answered in full. Got 100% PTSD for that one. My initial TBI DBQ took 2 hours. Very thorough, and very good outcome. In fact this was used against a C&P examiner (an inept one at that) who spent all of 20 minutes and gave me an unfavorable opinion.
2 hours ago, drago said:Separate question then:
For higher rating purposes, would it be better to have them find a decision of no TBI, and then submit hypersomnia as a stand alone item?
Or maybe for conversation to say that TBI had originally been denied, and then submit hypersomnia as a stand alone?
Hope that makes sense...
Hell no. You have a mental rating already. Mental ratings (PTSD in your case) include insomnia/hypersomnia. It would be pyramiding. You can't file a stand alone on hypersomnia. If you think your mental rating should be increased to 100% (pretty high hurdle) due to increased hypersomnia, then go for it. I'd look for a Psyc. Dr. that can write you a DBQ and Nexus that put's you in the 100% range before doing that. Just wait for the outcome of your current claim. Who knows, you might get the 100% PTSD/TBI. PM me if you have any questions. I battled these two claims for over two years.
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My condolences Buck.
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1 hour ago, drago said:
So new question... how much weight does the MOCA carry in the process?
Hard to say. They will rate TBI based on how bad you did in any one category. In my case I was rated at 70% for TBI alone. I'm not a moderate to severe TBI but that's was based on the one category I did terrible on (memory section I believe). But who knows honestly. My guess, you stay at 70% PTSD/TBI. You're not gonna get any bonus for hypersomnia because it falls under your PTSD/mental rating. Just a guess on my part.
I got 100% based on PTSD alone. That was the higher rating of the two combined ratings for PTSD/TBI. I went from 50% ptsd to 100%.
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On 10/2/2021 at 7:02 AM, drago said:
I'm now scheduled for a neuropsych exam. I'm not sure what all that entails, and I can't seem to find much "meat" of what polytrauma is about, other than kind of marketing info that it's "good".
I'm guessing you are rated for TBI? If so, I'm sure you already did neuropsych testing. If not, look up MOCA testing. I did the MOCA test like four times with different C&P examiners. They were trying to separate PTSD with TBI symptoms. In the end I was rated 100% ptsd with tbi symptoms, P&T with smc-s.
I'm not sure what can be done about fixing TBI. The damage is done. In my case, I've lived with it for 30+ years.
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23 hours ago, creek chub said:
I guess claiming hearing loss at this point will be tough. I feel better about the tinnitus claim but may try for hearing loss too
I didn't even claim hearing loss. Because tinnitus cancels out certain frequency pitches, I think they just gave it to me. My hearing is not bad, but it could get worse. If so, I can get hearing aids at no cost. So 0% is worth something.
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15 hours ago, creek chub said:
Did you get your claim approved outright without an appeal?
Yes, first try. And hearing loss at 0%. The exam lady asked me when or how I thought it happened. My first experience was when some asshat NCO threw a flashbang in my fire hole in bootcamp. Being a 50 cal machine gunner didn't hurt my case either. Don't get cold feet. I think tinnitus is a given. Just let them know how it affects you. In my case I need a fan on in my room when I go to bed to ease the annoyance when it gets quiet, etc.
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Got out in 93. Got my tinnitus claim approved in 2017.
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2 minutes ago, drago said:
Good info, thanks brokensoldier244th.
Not "study" per se, because I think that could imply embellishment. But be prepared, so I called my VSO and asked for a few things. That way I can be prepared for when they ask a question, I can have examples and such ready as opposed to "oh, I don't know, let me think...". Because thinking in the moment like that is not my strong suit.
My advice (from experience) is find the DBQ, like Broken Soldier said, and know the questions prior to the exam. I've had C&P examiners go off script or not ask the questions from the DBQ at all; then fill in the answer that is favorable to a lower rating. If you have to contest a whack job DBQ, this will set you back years and more C&P exams.
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2 hours ago, pacmanx1 said:
It may be an off chance that you may have a nerve condition and or a spine condition due to your TBI and dropping things. I started this post not fully reading your entire post and prior to actually posting it I went back to make sure I tried to cover everything. I have a spinal cord injury, never thought of a TBI condition but I have problems holding things and there are times when my arms and hands feel like they are on fire or being stuck with really fine needles.
This is my case. I suffered nerve damage to spine and neck when my TBI occurred. Got TBI approved, but neck and spine issues denied. Had more than enough evidence. For some reason the VA was set on denying these conditions. Like it was a small solitude of gratifications to deny me on somethings. But hey, I did get max on Fibromyalgia, so in theory I did get rated for pain.
If I wasn't 100% P&T with smc-s, I would've appealed and won easily.
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I'll take QTC over VA any day of the week.
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I got a diagnosis with the VA for MDD/PTSD. Then I had my C&P who agreed with such diagnosis for 50%. Then I got an outside IME for the same claim putting me in the 70% range and included a diagnosis of TBI along with it. This triggered 5 additional VA C&P's. In the end I got 100% for PTSD/ with TBI, P&T.
I can tell you this, one of the VA C&P examiners was not happy with a paid Psyc. Doctors IME. Not amused at all. Her C&P reflected her dismay. So be careful. I had to file a complaint with the VARO to have her C&P dismissed and redone.
. I'm planning my next vacation right now.
So now the bva can say the benefit of doubt isn't applicable in veteran claims
in Appealing Your Veterans Compensation Disability Claims NOD, DRO, BVA, USCAVC
Posted
I got out in 93. Filed VA claims for the first time in 2017. Initially got 50% mental conditions. Got a two different psyc IME, filed an NOD with new evidence within the year. Once the dust settled, 100% PTSD/TBI P&T with SMC-S. The IME's I got helped me get there. And quick. No appealing for years on end. No attorneys, except to get back pay from 1993. I won 10% for that. Not a ton of money, but more than I would've had.
It's like a court case. The VA has there specialists on their side, I have my hired guns on my side. They gave my evidence the benefit of the doubt. Trust me, the VA tried to argue against my evidence. Fortunately, I had the means to get these IME's and they have been paid back in the first month of getting my 100%.
It's your fight to fight. Do it your way. I did it my way and it worked out very well for me. Just here to help now.