harry59

Thank you for taking the time to answer my question. Nobody else did.

Question on S-DVI premium waiver... The site states that in order to be eligible to have premiums waived, one must meet these three requirements: You have a mental or physical disability which prevents you from performing substantially gainful employment. Your total disability must begin before your 65th birthday, and must continue for at least six consecutive months. Your total disability may not begin prior to the effective date of the policy. I've been 70% since 2001, and was recently (less than 1 year ago) awarded 100% on a new disability. Requirements 1 and 2 are no problem; but apparently I wouldn't qualify for the premium waiver because of the third requirement since I'm already at 100% before applying for S-DVI. Am I right, or am I missing something? Thanks for any and all replies!

Didn't know that. Thank you

Thank you for the advice. It's much appreciated.

I read your Nexus Letter and I have to say that I was a little confused. Your trying to connect your OSA to your PTSD, which is fine; but you also mentioned your back issue caused you to gain weight. Weight gain can also cause OSA. I would recommend referencing both PTSD and weight gain as a likely cause for your OSA. Let the judge sort it out. Of course you'll have to use weight as a "bridge" to your OSA. That is referenced in VAOPGCPREC 1-17. I would print that VA memo out as evidence. Good luck!

I went through a similar situation about 9 months ago. I did a lot of research prior to submitting my claims and referenced every BVA decision I could find that was similar to mine and put it in my Veteran Statements with my claims. Some decisions were nearly identical to mine. It did absolutely nothing for my claims. The raters completely ignored the references and denied every one of my claims. The claims I submitted were based on my weight due to my SC back issues, so I stated in my statements that I was using my weight, which was caused by my back, as "the bridge" to my claims. The VA decision letter didn't even mention that I used a bridge to my claim. Connecting a claim to an already SC condition is referenced in VAOPGCPREC 1-2017. Unfortunately, I found that memo after I received my decision. Probably wouldn't have helped anyway. In any case, referencing BVA decisions didn't help me at all in my claims.

Understood. I referenced several BVA cases identical to mine in my submitted veteran statements, as well as the VA directive outlining intermediate-step claims, but the rater still ignored it and denied. Not sure why, but any info is good info in my opinion.

Thank you. Just sent you a message.

I just don't see how VA raters can get away with ignoring The VA regulation regarding intermediate-step claims. Maybe I should appeal to the BVA and sidestep the HLR.

Thank you, brokensoldier244th. Those two claims were denied because the rater at the supplemental level totally ignored the "intermediate-step" that I made VERY clear in my veteran statement. No mention of the intermediate-step in my Decision Letter. I am unable to exercise because of my SC back issues, which of course caused my weight gain. I even had a Nexus from my Sleep Specialist linking my OSA to my weight.

broncovet, that is great information. I didn't know that about SMC-S. Thank you. And thank you to all who replied. Now I have to choose which route to take - HLR or BVA. Hmmmm

Fellow Veterans, A couple of days ago I found out that I was awarded 100% P&T. I was at 80%, but my mental health claim (that was finally decided on) pushed me over the line. I do not have my Decision Letter yet so I do not know any specifics. Now that I'm P&T, I'm really on the fence as to whether or not I should fight for my denied secondary claims of Hypertension and Obstructive Sleep Apnea (OSA). I'm not sure for a couple of reasons: 1. I'm not sure if, at my age (62), I will ever be reevaluated for mental health, which could possibly lead to a rating reduction in a future C&P exam. Is there an age limit where the VA will not reevaluate mental health claims? I know the M-21, Part IV, states that "with only rare exceptions, veterans over the age of 55 will not be recalled for reexamination." but I'm not sure if that pertains to mental health claims. 2. As you know, DIC can be awarded to a spouse if the veteran had been P&T for at least 10 years, or if the veteran dies from a service-connected illness or injury. DIC for my spouse is the primary reason I would fight for my denied secondaries as it is likely that hypertension and/or OSA could likely be a contributing factor in death. I know the VA is looking at changing the rating schedule for OSA, which will not benefit veterans. So, should I continue my fight??? Thank you to all repliers!

Thanks, I appreciate it.

I'm not 100% sure but I was told that a statement was ok as long as it didn't contain any new evidence. I will find out for sure before I file. Thank you for your reply.

Hello all. Hopefully an easy question as I can assume that there are a good number of people that have questioned this, and have gone either way, when appealing to a Higher Level Review (HLR). When I fill out my paperwork for a HLR, should I check the box and ask for an Informal Conference? Should I just submit a statement? Should I do both? I have heard good arguments for, and against, the informal conference. Some say it's better to speak to the rater to make your case and make sure that all the evidence was looked at. Others say that It's better to submit a statement making your case because the rater can't look at the claim until you're on the phone with them if you choose a conference, and that you may inadvertently say something that goes against you, and the HLR will take longer if you select the informal conference rather than submitting a statement. I'm not sure if all that is true or not. I'm leaning toward doing both, but am not sure as I don't want to delay my claim any longer than it needs to be. Any advice is much appreciated!

Greetings fellow vets, I'm getting ready to submit my "intermediate-step" secondary claims, that the VA has denied, to a Higher Level Review (HLR). Does anyone know if the senior claims raters at a HLR will consider an "intermediate-step" link in their decision? Or will they just deny the claim when they can't directly link it to service, like the initial claims raters do? I know the BVA will, and does, recognize the "intermediate-step" in secondary claims, but I can't seem to find any answers on the internet whether or not the HLR raters do. I'm just wondering if I'm spinning my wheels, or not. Hopefully someone has first-hand knowledge of this. Thank you for all replies.

Broncovet - thank you for your reply. I knew "why" my claim was denied, I just asked why the rater didn't follow the VA intermediate-step claim guidelines. Even though I made it VERY clear in my statements that my secondary claims were intermediate-step claims. There were several people in the office that I went to that specialized in different areas; eBenefits, claims, and so on... I saw a claims person and was just surprised at the lack of knowledge that they had. Even my VSO butchers what TDIU stands for half the time. Berta - Thank you! That is exactly my point, and one that I wanted to pass on to my fellow vets. Don't depend on getting good and correct information from VA "experts." You have to be your own advocate. Learn everything you can about the process, and then educate your spouse. Hadit.com is a great resource for vets.

I went to the VA Medical Center today to talk to the Veterans Benefits Adviser about my claims and to get a copy of two of my denied C&P exams. The first question I asked was why my secondary "intermediate-step" claims that I submitted were denied at the initial level. He looked at me an said "what's that?" After I explained to him what an intermediate-step claim was, he told me that he had never heard of that before. I asked if the raters at the Higher Level Review (HLR) would know. He said he had no idea. So, am I missing something here? They're supposed to be the experts. Last week I spoke to another advisor in the same office who told me that I wasn't eligible for TDIU because I didn't have the required percentage. He then (incorrectly) quoted me the requirements. I told him he was incorrect, but he was steadfast. I wonder how many veterans have been affected by their misinformation? Am I wrong in thinking that the VA purposely doesn't inform, or properly educate, their representatives about everything so that they don't pass the information on to veterans? Plausible deniability? MY OPINION: if a veteran is not self-educated about their claims, and relies solely on the "expertise" of VA representatives, they're screwed. In my humble opinion. Am I wrong? Has anyone else ever run across this?

Morning All, My Questions in this post are somewhat tied to my post of Feb 8th. I really appreciate all the input I received on that post. I've been really struggling on how I should proceed with two of my secondary claims (OSA and Hypertension) that were denied by the VA. Especially the OSA claim. And here's why... For my C&P exams for my Hypertension, Back Issues, Bilateral Radiculopathy, Abdominal Hernia, and OSA, the VA sent me to a Physicians Assistant (PA). The PA checked all of these claims in one appointment and hardly asked me anything about my OSA and Hypertension. My claim for Radiculopathy ended up being granted and I received an increased rating for my already service-connected (SC) back. However, the other claims were denied. Just to be clear, as I believe I noted in my Feb 8th post, I submitted the denied claims as secondary claims to my SC lower back using my obesity (caused by my SC back issues) as the "intermediate step" to these secondary claims. On a side note - I was given a C&P exam by a different PA, on a different day, on my knee. This was also a weight-related secondary claim that was denied. So, so far, the VA has denied all of my secondary weight-related claims. In any case, I have been seeing a Sleep Specialist for my OSA, who wrote a Nexus for me that I submitted with my claim. In fact, every claim I submitted I had a Nexus for (from Doctors - not a PA), as well as sufficient medical records. And yet, the VA chose to take the word of a PA over a Specialist. On a good note (at least I think) the VA did acknowledge in their decision letter that I did in fact have OSA and Hypertension. Is that a good thing for me? Even though I have four claims that have not been rated as of yet, that I sent in at the same time as the ones mentioned above, the VA sent me a decision letter for the ones that have been decided. The claims I'm still waiting on three claims that fall under the mental health category, and my TDIU claim. So I'm not sure if the VA already knows they will deny them, or if they realize it will take a long time to decide, so they went ahead and sent a decision letter. Doesn't make sense to me that they would send a decision letter when I still have undecided claims out. Thoughts on this?? Anyway, my main questions are: 1. For my OSA claim: should I get a DBQ from my Sleep Specialist and file for a Supplemental Claim, or no DBQ and just do a Higher Level Review (HLR)? This is the question that's had me tossing and turning the most. 2. Should I wait for all my claims to be decided before I file for a Supplemental or a HLR on my denied claims? 3. Should I file all denied claims at the same time, or stagger them? I'm mostly concerned about my OSA and Hypertension claims getting approved. If any of my conditions kill me, it will likely be one of those two - and I want to make sure my wife has a good chance at DIC if it does. Thanks again for any inputs and advice. It's much appreciated!

That's some good news.

On a Hill & Ponton live chat on YouTube, I just posed the question of "The VA denied my secondary claims for OSA and Hypertension using my weight as the "intermediate-step." Should the VA consider the Walsh vs Wilkie case in any of their decisions?" Their response was that the VA Regional Offices will not consider case law in their decisions. They suggested I file for a HLR appeal and if I'm not granted service connection there, appeal to the BVA. They said the BVA will consider case law in their decisions. Hopefully I won't have to appeal to the BVA, since that will take years, but I have to, I will. Hopefully this information will be useful to others going through similar issues.

In my Veteran Statement for my OSA, I referenced about five VetApp files (similar to what Berta posted), as well as the Walsh v Wilkie decision, a Nexus from my Sleep Specialist stating weight gain due to my SC back issues as the cause, statements from family members, and several credible online sources linking weight to Sleep Apnea. The VA completely disregarded all of that and made no mention in their letter of a connection between OSA and weight.

My Sleep Specialist did not have a copy of the VA doctor's examination of my OSA because my C&P was after my doctor appointment. I wonder if I should go back to my Sleep Specialist and have her do a DBQ. ???

Not sure of the medical terminology, but my lower back has bulging disc's, ruptured a disc a few years ago, DDD, disc narrowing, radiculopathy in both legs, and bone spurs. I've been told (in writing) by two doctors that I shouldn't be lifting more than 15 pounds. I'm also on SSDI because of my service-connected lower back and am currently waiting on my TDIU decision from the VA. My middle and upper back have about the same issues, but not as severe. Thank you for your replies. They've been very helpful.

Sounds good. That's how I'm leaning too. Thanks.