GBArmy

Shrek It may be worth a 30% rating See this case https://www.va.gov/vetapp14/Files2/1419164.txt Citation 1419164

An IMO, Independent Medical Opinion, is the same. You don't have to have in-service med records if you're claiming a secondary condition to an alreadys-c condition. But as Broken just said, your doc's letter has to have rationale with back up details why his opinion is correct. Search Hadit (and elsewhere) on what you need for a good IMO.,He has to be board certified for the most impact, provide his biography on work experience, education, published work, etc.and discuss medical studies, journals, technical stuff as back up. Just a letter from a GP on an IMO on a denial usually doesn't cut it. So you probably have to pay up front for the IMO.

Shrek If I understand your issue, you have to get an IMO from a specialist that will eval your conditions and say that it is difficult to determine how much pain is attributable to one verses the other but based on their rationale is is more likely than not that x (the higher rated condition) contributes pain more than the other. Not easy to get I would think but get a doc like Arnise or Ellis to consider your situation.

th175 Welcome to Hadit. The best advise I think you could get is to ask your doc what does he think has caused your back condition. I am not a doctor and am willing to bet you aren't one either. So the VA doesn't really care what we think about what caused your disability. Only thing that they care about is the medical opinion and reasoning of a doctor. It is called an IMO. They state the cause, "x' has caused the s-c condition. Why it happened and a statement that states that in their professional opinion, based on years of medical practice, study et. etc. it is at least as likely as not that it was caused by your service doing ...If your doc can't or won't provide such a statement, then you either can either get o new IMO from another doc or expect to lose appeal.

Ken Can't say this has happened to me but get on the horn immediately and call the QTC office where you went. They usually get those exams out quickly, like in a couple of days; that's how they get paid. Leave a detailed message with the examiner you had and ask for a call back. If that doesn't work, ask for the manager. You want that report to go to your RO right away. If they screwed up, maybe the examiner can piece a report together based on his memory? Tricky, maybe. If it isn't caught in some stupid hang up, you may need to get another one.

Understand. In your situation, the problem was that they "missed" documents/evidence in the first place. Like I said, some people need to do it. I can see trying for an EED could be one of those.

Deedub I am curious on what happened to you. Did this "informal conference" take place recently, and how did you request it? I didn't think they did informal conferences under the AMA? I had a "VA mad a recent decision ", but I couldn't get a straight answer out of them until I got the decision letter. (They made a mistake and had to further develop my evidence.) OK, now know what you mean. I usually don't request a an informal hearing. I heard from a couple of VA sources that I trust that it probably isn't worth it for most claims. Since it is a HLR, you can't submit any NEW evidence; all your evidence is already submitted. When you submit a HLR you are asking a "more qualified senior rater" to re-look at the evidence again. So if you had a good case and the evidence was complete, what do you have to gain by telling the new rater what is in the evidence? I was told by one that he has yet to get verbal argument that made a difference in the decision process. Everything is there. But it does delay the process, because they have to schedule a phone call with you so there is some queue time there. This is MHO; it may be important for some to do, but I doubt if I will ever use that option myself.

Deedub I am curious on what happened to you. Did this "informal conference" take place recently, and how did you request it? I didn't think they did informal conferences under the AMA? I had a "VA mad a recent decision ", but I couldn't get a straight answer out of them until I got the decision letter. (They made a mistake and had to further develop my evidence.)

Dee64 It may be that they have found enough evidence based on the sleep study info and nexus letter that they do not consider a C&P necessary. Maybe.The VA doesn't have to do a C&P for all claims. Log onto va.gov and go to benefits and check your status. It will take a few days but scroll down to the "letters" section and print out a copy of your benefits letter. It might show a change in your ratings prior to you receiving your decision letter. If you also have direct deposit for your benefits check, check there to see if you have a new deposit. It will take 7-10 days after you see that a decision has been made to receive your decision letter anyway. If it is unfavorable, which I hope not, be sure to get a copy of your C&P exam. Good Luck.

Thanks, Brokensoldier Thank you for sharing what goes on behind the scenes. Very informative.

Amazing!

Erhathaway I don't know if you can get to 100% combined. Doesn't sound like you would be able to get much on hearing loss if you THINK you may have hl. If you are hard of hearing, you would know it. One of the 3 principles of getting a disability is having a diagnosis. Perhaps you can get a free hearing eval from one of the hearing aid companies to see if you do have one. If you do, and it meets the criteria for hearing loss, it would have had to been performed using a specific method called the Maryland test. Either the VA or a certified audiologist has to do that. Then, if your MOS was on flight line, you may meet the second requirement, which is an event or injury while in the service. If you have been out a long time, you should also have a statement in support of the claim saying how the event started in the AF. That might get you a 0, 10, or 20% rating (I'm guessing), but using VA math, that's only going to get you an increase of 2 or 3 points on combined rating. If you have ring/buzzing in your ears,which is tinnitus, the max you could possibly get for that is 10%. So, that's about another 1 point or so on combined rating. So you see it is very hard to move the needle once your at 80% or higher. I don't know much about your other conditions. You need to provide a little more info.

Rambo123 This is my opinion, and there are others that will disagree, but I doubt seriously that you are getting another C&P by the VA just so they can decrease you rating. If you are looking for an increase to an existing rated disability, I agree with Buck. If your conditions haven't gotten worse, it is subjective. Another new examiner could say it is better. You then have to appeal that new decision. If your condition has gotten worse, then you should end up with at least the same, if not an increased rating. It is the chance we take when we go after an increase rating. You have to be honest with yourself about your current conditions when you consider going for an increase. If we are greedy, it could backfire on us. If you are honest about your condition symptoms, you shouldn't have anything to worry about (usually.)

It is easier to find in cfr 4.124a Headaches are under dc 8100; same as migraines. Here is a quick reference https://www.law.cornell.edu/cfr/text/38/4.124a Just to add to what Shrek said, I don't have the definition in M21-1 but prostrating+ simply you can't do anything, you have to lie down in a dark room for some time ex. 3-4 hours. Completely prostrating= same as prostrating, but much longer in duration, maybe vomiting, no noises, light bothers you, maybe over several days. Just more severe for a longer time. Severe economic inadaptability you can't go to work. You can't stay at work. You can't interact with co-workers, you simply can't function in the work environment, take too many days off, get laid off because of loss of work time, etc.

I agree with Pacmanx1 100%. Someone with all your history, including difficulty holding a job, should put in for depression/anxiety/ mental health disability. Like he says, most days he feels he can handle the situation, but that is what MH conditions are. Don't self diagnose; you don't know WHAT kind of MH condition you have due to your multiple s-c conditions and pain. Let the VA figure it out. Look up the diagnostic codes for MH conditions, and see if you honestly have any of those symptoms. If you do, be sure to submit a statement in support of claim form that talks to how one or two of them have an affect on your ability to work and/or interact socially with people.If you have a spouse or partner, have them do one also. You have a decent shot at getting a disability now. That could be very valuable if later on things get worse. Submit when you get your current claim decision letter. Good luck.

Rambo 123 Sorry that you have been getting the run a round but as you realize, it is confusing trying to deal with the VA. The short answer is that they feel that there is clarification to be had by having a review at a new C&P. It is further development. Maybe, it has something to do with the conflict between the diagnosis/effective dates? You didn't say when you are scheduled, but I assume it is fairly soon. You should know that it is important to be sure you attend; otherwise you could be denied. You could try to contact the director at the RO who schedules the C&P's and state your reasoning for it not being necessary, but short of that go to the exam and see how it falls out. If it is bad, you can always appeal.

Vet99 It sure looks good. Congrats!

Broken Speaking for myself, there is no need to apologize. We all have bad days, maybe more than our share I think. For sure it is great that you work at the VA and are able to give back to veterans that is very uncommon. We, too try to help our brothers and sister veterans in our own way, here and in other ways. But you provide insight and a first hand knowledge that Hadit really needs and is tremendously helpful to countless people. IMHO there isn't anyone using this site that's perfect, and that includes me for sure and probably you as well. Not to worry. Keep on helping out as well as you can, how ever you can. Like I said, no apologies needed brother.

blah Maybe you already heard this, but I would dispute it right away. HLR I assume. Have a cover letter/statement all the things you are calling out. If they don't give you another C&P exam, you do a CUE. (you don't put that in the appeal.) The DRO will see they did you wrong, I would hope. If not, higher level.

DL Rogers We certainly hope you do have good news but "wait for the letter" we say ALL the time. I have the same situation as you. HLR and decision made. When I got the decision letter, it said that they found an error, and have to do further developing. As Shrek and the others comment, wait for the letter. It will be in to you in about a week or so. After 10 days, you can call Peggy and they then will let you know what's in the decision letter and/or resend it to you.

Marine Corp 69/70 I don't know if this is it but one of the managers for VA Benefits has been doing a daily call-in type program in individual states an his name is Paul Lawrence. It sounds like that is what happened to you. Check Youtube under "VA" and you will see a bunch of these from different programs in different states. They seem to be added to Youtube the next day. I think that is what you experienced.

Thanks, Buck. I didn't realize that the veteran now has to start the process. If someone is interested in do it, Hill & Ponton has a good article on applying for TDIU https://www.hillandponton.com/va-individual-unemployability-tips-on-filling-out-a-va-form-21-8940-part-2/

Congrats to you! You're story will definitely encourage others not to quit. You don't lose until you quit trying! And thank you also LightofSolitude for giving back, not only sharing your success, but with a donation so Hadit can continue!

mb76 A veteran doesn't file a ITF for TDIU. You either request it, or, the VA does what it is supposed to do when a veteran's health indicates they no longer can have gainful employment. That is supposed to happen when a veteran reaches a combined disability rating of 70% or higher for example. They send you a form. In most instances, if you think you are ready for TDIU, you probably are. If you can gather evidence in the meantime, do that. They will contact your former employers and find out about your prior work, how you interacted with others, circumstances for leaving, etc. If you have a contact with your former employer, you might consider contacting and explaining that you don't want them to play down difficulties you had with others, but to discuss them accurately. If you don't have contacts, that's ok; that's the VA's job anyway. What your current rating is, what your disabilities are, how long you have had them rated, how old you are, are all considerations, but the big factors related to your employment history.

Tuesday call the 800-827-100 and ask them if they sent the decision letter, and when. You can ask what they said, but very unlikely Peggy will tell you anything.