Phury & Rhage

I'm just chiming in, but there are some obvious benefits to having a mental health diagnosis that ISN'T PTSD.  In order for PTSD to be service-connected, you have to have a stressor.  In a lot of cases, there are problems with verifying stressors.  There are some big exceptions to that.  If you were in any combat/exposed to enemy combatants, VA concedes that exposure as a stressor.  Then the hurdle becomes getting the examiner to link your current diagnosis to the conceded stressor.  If there are records of other stressors that could underlie a PTSD diagnosis (childhood/anything else when you weren't in the service) then it can be difficult to get the examiner to say that it was your service stressor that is responsible.  It can be easier to service-connect other mental health diagnoses because they can be linked to service without being the result of a specific stressor.  A common service-connection is for depression/other MH condition due to the effects of your other SC conditions.  Secondary connection is also easier for Veterans to obtain because it only requires a link to a current SC condition rather than trying to dig through service records for support.  This is also where your private opinion can carry a lot of weight.  VA examiners don't have a lock on determining whether your MH condition is related to your other SC conditions.  Private examiners are on a level playing field there.  If nothing else, having a private examiner link your MH condition to your SC conditions sets up a good appellate record.  
Good luck to you,
Phury

VBMS is the software used by the VA to manage Veteran claims.  If your VSO (organization) has an office at the regional office building, they usually have VBMS access.  If you live near a regional office, you can set up an appointment with the Public Contact Team at the regional office - some don't have walk-in hours yet because of COVID.  Specifically, you need to ask the VSO to look at the active claim and see if there are any "tracked items" pending.  These are used to track pending development.  For instance, IU claims require that forms are sent to previous employers.  You should have been sent a development letter requesting that you fill out the top portion with the employer information of the VA Form 21-4192.  I'm putting in a link to the M21-1 Manual that describes the required development for IU claims.  If you have questions, I might be able to answer them.  I can't look up your claim though - illegal for me to do that.  https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000177475/M21-1,-Part-VIII,-Subpart-iv,-Chapter-3,-Section-B---Individual-Unemployability-(IU)-Claims-Development
Phury

Your meds for s-c disability may cause ED. Check the adverse affects on the med sheet. If it can, ask your Doc if he thinks there could be a link. If yes, ask him to please put a note in your encounter notes to that effect. If not, get it from a urologist on the outside. The Favorable finding probably means that you have evidence of a diagnosis of ED; it's misleading. You still need a medical opinion of a link. 

I got retro back to 2020 check is in the bank.  ED as secondary to prostate cancer was denied. reason was, they did not find a link between my medical condition and military service But then they say there is a favorable finding . I have been diagnosed with a disability. Providence VAMC show a diagnosis of erectile disfunction in May 2018 .
This has continued being treated since. I assumed that the ED would be secondary to the PC. I have had elevated PSA for several years. And finally had a biopsy confirming the cancer in 2021. This year another positive biopsy . At least it is slow growing, so far. They are calling for watchful waiting after the TRU surgery this month.
My question is , should I apply for the ED secondary to my 70% PTSD.  I am going to wait and ask my psych Dr next week if he feels the ED would be secondary. We have been discussing the issue over the past several years,

Your VSO can check in VBMS and then look to see the next suspense date which will let you know what they are working on and when it will be addressed.  Your VSO can also call the VSO hotline to ask them to move it forward if it is stuck or file a 4138 stating it is not being worked on and for them to assign it to someone to address the reason for stagnation.

yes I was verified for herbicide exposure in letter from VA. Blue water 3 tours. I have managed to get my A1C numbers below threshold for diabetes. I am now at high level of pre diabetes so for now I will not pursue that claim
 I still have the neuropathy. That has not changed so I will file on that as the decision letter recommended. I do not want to do anything to lose the 100% at this time.

Today in the mail,
I recieved a letter from LHI stating that they recieved a request from the VA for a Medical Opinion(s).  This request was for a Medical Opinion(s) where an examiner performs and evaluation using your medical records and history.  At this time, no action is required on your part.
It will be done by a NP out of Tennessee. 
Service(s) requested, see attached.
 

Hi,
I don't have time to give a complete answer at this moment, but,  at a minimum, removal of a kidney gets a 30% rating (if service connected obviously).  However, active cancer gets a temp 100% when service connected.  I'm still at work 🙂 but I'll write more later...

Phury

In October 2020, after more than ten years of exclusion and being fenced out from participation in the program for pre 911 veterans, the Program of Comprehensive Assistance for Family caregivers (PCAFC) under the new eligibility regulations in accordance with the provisions, and as defined by the Mission act, was expanded to include Vietnam era veterans. I applied for caregivers benefits on October 7, 2002.
Due to the flood of new applications the decision took about six months. Although, according to the new regulations, my caregiver and I clearly met the eligibility requirements for level 2 benefits we were awarded level 1 benefits.  I immediately appealed. I was denied with no reason or basis given. I again appealed. I was then told that two appeals was the end of the line for me in the appeal process. I then asked for a chance for recertification, as it had been a year since my original application submission. My request for recertification was approved by VISN 9 but I was warned that recertification could bring about severance from the program for myself and my caregiver altogether.
The recertification process produced a continued award of level 1 benefits. I again immediately appealed and was once again denied. I immediately appealed again and was denied the very next day, in less than twenty four hours, by the CEAT team in VISN 8. After six wrongfully denied appeals for level 2 caregiver benefits before the Veterans Health Administration, (the VHA), I was still being denied with no reason or basis for the denial which was certainly not in accordance with the laws and regulations governing the CPAFC program. I spent many hours upon hours preparing for each appeal.
During the prosecution of my claim and as due to a Court of Veterans Appeals case, the law was changed to allow more than just two VHA appeals. Now we were not limited to just two VHA appeals, we could also appeal to the Veterans Benefits Administration. (VBA). Now we could ask for a higher level review or a supplemental claims appeal which are useless as they are both adjudicated by the same folks, the VHA, who have already shown their ineptness in rendering fair and impartial decisions. The Court rendered a decision that we could also ask for a review by the Board of Veterans Appeals, and even to the Court if need be.
In compliance with the order of the Court, I was notified by the VHA that I could ask for a higher level review, a supplemental claim, or ask the Board to review my case. At the same time, I was warned by the VHA, in what I took to be a threatening way, that if I chose a Board review and the Board denied my claim, that would be the final and the end of it for me.
I asked for the HLR, and my case was quickly closed, no decision, just closed. Immediately I asked for a review by the BVA, and that my case be advanced on the docket as due to my being a R-2 vet. The Board agreed to advance my case on the docket as the evidence of record supported the advancement of my case on the docket.. 
On June 22,2022, the Board granted my level 2 CPAFC benefits using the exact same evidence of record as was used by the VHA to deny me so many times. The BVA furnished a full explanation of reasons and basis for its decision to grant the benefit. I will be looking for my retro back to October 2020, which is well deserved by my faithful caregiver's free labor of many years.
Let me say this in closing and you can draw your own conclusions as to whether or not I should or should not have prevailed and what your own chances are if the system isn't fixed. My VA providers and my outside providers, do and have always supported my claim for level 2 benefits with letters and record entries. I have three 100% P&T awards and many, many lesser awards for both physical and mental disabilities. I have fourteen large painful service connected and rated scars. I run on a battery. My body has been completely reconstructed from my knees to above my navel as due to service connected circumstances. More than a few doctors and providers have stated in the record that I cannot sustain in my home or community without a caregiver. No veteran of any era or branch of service has ever been awarded a higher disability rating than I carry, and no veteran of any era or branch of service draws more monthly compensation than I do. VISN 8 CEAT team conceded in February 2021 that I needed help with five of the seven listed ADLs but they ruled that I still did not need assistance so as to require level 2 benefits. Considering all that has been said here, for what reason was was I and my caregiver put through so much grief and agony to the point of loosing what little self respect that we had left ????????????

Phury, you are right, the letter gave me a partial decision. PTSD will continue at 50%. But I think I mispoke about the rest. To be clear... Service Connection for cancer gave me 30%, which gave me the needed 70% for TDIU claim qualification. I am not looking for additional exam appointments, as I have already had C&P exams for those residuals. When I applied for TDIU, I made sure I only gave the two SC disabilities which I believe prevent employability. One is PTSD. The other is AO caused tongue cancer with residuals, one of which is fatigue, which is SC. The letter says, "The issue of whether or not you are entitled to Individual Unemployability is deferred for the following: pending VA examination." I could be wrong, but I think that means the VA will examine my case and the exams I had. Not that they will give me more exams.  Maybe that explains why they have not sent me to more exams. I've had them all.  But it doesn't explain why they're dragging their feet about a decision.  That letter was 08/09/2021. A subsequent letter dated 12/22/2021 says, "We are working on your claim."    Semper Fi

Cancer claims should -never- be at the bottom of any desk...

I have no idea why it would take so long. My recently submitted claims are being decided within two months. Now in my opinion this is not usually good.  I have had to appeal every decision. Recently I was awarded Service connection for ED. But they were in such a hurry they did not grant a K award.  Yesterday I actually received a decision based on my appeal, were I claimed cue and requested a K award. Ironically, I received the pay( in a separate deposit) for the K award on the first of the month.  What stage was your cancer at? IE: 1, 2 3 or 4. Today in the news was a new cancer drug that cured colon cancer completly without any other treatment. They claim it could cure all types of cancer. I wish you the best, I personally know having prostrate cancer can cause serious problems.  I had a surgery commonly refered to as "rotar ruter" ,   but its surgical name is  Turp surgery were they go in cut the prostrate so that you can urinate again, but after this surgery I have problems daily, with leaking, so i have to use a pad. Still that is better than having to use a cather.

Signcavah
Welcome to Hadit. I'm sorry you are having such a hard time getting the disability. I'd call the White House Hot Line 855-948-2311. It shouldn't take this long. Best of luck brother.

The examiner has rendered "an opinion", and opinions vary widely, even among doctors.  
Did you get a copy of this exam, as well as the rest of your medical records?
I agree with you, that there has been found a PTSD/sleep apnea link, but you need to demonstrate, with credible evidence there is a PTSD sleep apnea link IN YOUR CASE, not the participants in a study.  
My advice is, therefore:
Wait for a decision, and appeal if its unfavorable to the BVA.  It was a good idea to get a copy of the exam, half the battle is knowing what the problem is, and it sounds like you identified the problem:  Conflicting doctors disputing and confirming a nexus.  
The VA can still award, or deny OSA secondary to PTSD.  Are you using a cpap, and I assume you have had a sleep study, indicating you have OSA and use a cpap.  
If the applicable evidence warrants same, you may need an IMO/IME to win this, "if" VA denies it again.  
You see, the VA can favor one doc opinion over another, but they must give a reasons why they so stated.  For example, one doc may have done a more thorough exam, or may have known you for years, while another doc may have only seen you 5 minutes.  
Or, one doc may be a sleep specialist, with PTSD experience, and the other doc not so much.  
I think you should find out the c and p doc (the unfavorable exam), name, and experience.  Was he a sleep specialist, or has he zero experience in sleep medicine and or PTSD.  
VA sometimes sends you to an unqualified examiner..I was sent to a MD but with no sleep med experience.  
If your unfavorable examiner has no sleep medicine experience, you may want to challenge the competency of the examiner:
https://cck-law.com/blog/how-to-challenge-va-cp-exam/
IT MAY save you some time by filing CUE, "if" they based a denial on an examiner who was not qualified.  However, you may well need to appeal also.  
So, wait for the envelope, if denied, you can post the reasons and bases for denial, and we can help more then.  

Good morning,
I am not new to HadIt.com, but this seemed like the best category for this post.  There are a few things I wanted to say to you all - in no particular order:
I work for the VA I am a 100% disabled Vet I DO NOT speak for the VA my opinions are strictly my own I see and hear you - as a Vet and as a VA employee Working for the VA as a claims processor (more than one job title fits in that category) is my dream job.  Every single day, I make a difference in a Veteran's (claimant, family member, etc.) life.  I am very conscientious about the work I do.  I always remember that my work directly impacts a specific Veteran.  I am constantly learning new stuff that affects my job.  Changes in laws and regulations occur nearly on a constant basis and those changes impact Vets.  I work fast, smart, and hard.  I work with a lot of people who are similarly motivated...not all of them are Veterans.  I also run into folks who are "boxes of rocks", just like when I was in the military.  I have been a mentor in various positions to claims processors new to that particular workload. 
I pay attention, but I still miss stuff and I make mistakes.  The blame for that falls in a couple different places and I want to talk about that with you.  Sometimes the mistakes I make are all mine - I should have caught that; I missed a step; I interpreted something wrong.  Sometimes the blame is more difficult to assign.  Congress passes the laws that govern the work VA does.  Courts interpret those laws, but so does VA.  Interpretations change over time.  Laws get updated for lots of reasons and those changes can cause chaos in a system that struggles in a chaotic environment.  Training sometimes doesn't cover specific scenarios (lots and lots of them) and sometimes training is flat-out wrong.  Workload priorities change.  Emphasis on issues change.
One of the biggest challenges faced by claims processors (every single one of them) is that our job performance is primarily measured by two factors:  the number of "transactions" you complete; and the error rate of your reviewed claims.  Perhaps some of you are familiar with "production" environments where your pay and your ability to meet the required numbers ruled your work life.  This has been the first time for me.  By the way, I have earned awards and promotions for my production numbers (that and 6 bucks will get you a latte), so I'm not here whining about how I can't keep up.  Traditionally, I keep up.  I wouldn't do this work if I wasn't really good at it because it's important work that deserves your best.  That doesn't mean that it's not a rough environment.  Let me give you a hypothetical example:  let's say that a claims processor has been doing the work for over 24 months and holds a particular GS level.  The production requirements (numbers) vary depending on the work you are assigned to do.  If you are assigned to work claim "development", you might be the first person reviewing a claim for benefits - original or new or increases, etc.  You need to review everything in the file, order necessary federal records (service treatment records, social security records, personnel records, VA medical center records, etc.), verify and enter valid military service in the system, request appropriate private records, follow up on previous development requests, send information requests and letters to the Veteran/claimant, order exams, and review every response received to every request to make sure it meets minimum requirements.  That list isn't exhaustive.   This claims processor would be expected to produce 9.45 transactions in a day to be minimally successful (they did enough to keep their job).  You might think that each claim you work is worth 1 transaction credit...but you'd regularly be wrong.  You can only get credit for 1 transaction per claim, but the amount of that transaction credit varies. 
So lets say the Veteran submitted a request for service connection for a new condition - joint pain.  The first processor needs to reach out to the Veteran to clarify which joint since DBQs for joints go with each body part/system.  Knees, ankles, and hips all get different DBQs.  Once that is clarified, the processor gets to review service treatment records(STRs) for some event in service - a medical complaint, an accident, a physical profile, something.... They don't need to only mark one instance.  Certainly folks get denied because the examiner says it was an acute and transitory (A&T) condition that resolved without complications.  The more treatment/complaints identified and marked in the folder for examiner review, the less likely the examiner is to call it A&T.  Depending on the size of the STRs (number of pages/documents) and when the Veteran served (are the entries handwritten, bad photocopies, microfiche copies) that process can take a LONG time.  You know...if you do it right.  If the processor doesn't/can't find (or concede) an event in service, the Vet doesn't get an exam for that issue.  Not every claim requires an exam, but every claim requires an event in service (potentially proved in a number of different ways).  If the application says "joint pain" and nothing about how the Vet acquired the joint pain, the processor is left to scour the records to try to find something.  It is also common that the processor gets to review every other processors' actions on that claim to make sure the previous claim development was done properly and completely.  The processor who submitted your exam and medical opinion requests may very well not be the one who reviews it when the examiner uploads it.  If that original exam/opinion request wasn't done properly (didn't ask the right questions, didn't provide enough information for the examiner's review, etc.), the next claim processor is going to have to redo the request - if they catch the error.  In a perfect world, the work gets done properly the first time.  Less ideal is the next processor catches the error and fixes it with a minimal delay to the Vet/claim.  It gets worse the longer an error gets missed.  Your experiences will show the range of possibilities (horror stories).  For this example, let's say the processor has to review the STRs for complaints/events and then order the exams, if any.  The highest possible transaction credit for that new issue that the processor ordered an exam for is 1.309 credits.  If the processor finds the event in service in under 5 minutes (dang near never happens), it still takes time to mark it properly in the file.  Contract vendors can only download documents from the eFolder that have been properly marked...they can't even see the rest of it.  Then, the exam request has to list all of the relevant information and the location(s) in the document(s).  Doing the exam/medical opinion request (with all of it's required prep work) is gonna take at least 15 minutes to do properly - usually more.  How long did the processor spend reviewing all of the records?  That seriously depends.  What if the processor needs to send the Vet a letter or form?  Did the Vet ever get treatment for the condition at a VAMC?  All of those records (the system requires separate searches/downloads for each location) have to be uploaded and any relevant information marked for an examiner.  No extra transaction credit for any extra development requirements.  What if the only action the processor gets credit for is extending an exam suspense date (they look in the vendor's system and the exam report is still pending quality review)?  The processor gets .4 credits for extending that suspense date.  That seems pretty easy, but the processor also needs to review the entire life of the claim and all actions to make sure they were done correctly.  That review takes time.  Especially if the processor is trying to catch previous errors (one of my favorite things to do "how about we fix that error before you get denied").
Bottom line:  to do a thorough, excellent job on the Vet's claim takes time.  The system is built to deny the processor enough time to do it right.  The claim processing times reported by VA don't tell the whole story.
In the meantime, the clock is ticking.  That processor needs to meet production requirements.  You can't help a Vet if you can't keep your job.
Hypothetically.
One of the main reasons I wanted to do this work is that the process for my VA claims was tortuous and long.  I wanted to be part of the solution.  I have innate skills that are useful/necessary in this work.  I'm not bragging - the list of things I can't do well would fill reams of books.  I have learned A LOT since I started working for the VA.  I help friends, family, and total strangers online 😉 with their claims/the claims process.  I'm not an expert.  I have my own experiences as a Vet and a claims processor that I bring to the table, but that is obviously limited.  I can tell you the trends I've noticed when doing my job.  If you look closely at my posts, you'll see that I tell you what I recommend, experienced, advise, etc.  I always want you make a final judgement on the actions you take based on YOUR assessment, confidence, etc.  You have to live with your claim results and you are your strongest advocate (hopefully).
I have always been glad to be part of the HadIt.com community.  I hear your horror stories (I have some of my own) and I see how angry, depressed, and defeated that some Veterans get.  I know it seems like VA is this huge,  monstrous, impersonal, malevolent entity, but I wanted you to consider another small piece of evidence (you decide how much weight you give it).
In closing, "fight the fights that need fighting" and take care of yourselves and other Veterans.
Happy Independence Day 2022,
Phury  

Good morning,
I am not new to HadIt.com, but this seemed like the best category for this post.  There are a few things I wanted to say to you all - in no particular order:
I work for the VA I am a 100% disabled Vet I DO NOT speak for the VA my opinions are strictly my own I see and hear you - as a Vet and as a VA employee Working for the VA as a claims processor (more than one job title fits in that category) is my dream job.  Every single day, I make a difference in a Veteran's (claimant, family member, etc.) life.  I am very conscientious about the work I do.  I always remember that my work directly impacts a specific Veteran.  I am constantly learning new stuff that affects my job.  Changes in laws and regulations occur nearly on a constant basis and those changes impact Vets.  I work fast, smart, and hard.  I work with a lot of people who are similarly motivated...not all of them are Veterans.  I also run into folks who are "boxes of rocks", just like when I was in the military.  I have been a mentor in various positions to claims processors new to that particular workload. 
I pay attention, but I still miss stuff and I make mistakes.  The blame for that falls in a couple different places and I want to talk about that with you.  Sometimes the mistakes I make are all mine - I should have caught that; I missed a step; I interpreted something wrong.  Sometimes the blame is more difficult to assign.  Congress passes the laws that govern the work VA does.  Courts interpret those laws, but so does VA.  Interpretations change over time.  Laws get updated for lots of reasons and those changes can cause chaos in a system that struggles in a chaotic environment.  Training sometimes doesn't cover specific scenarios (lots and lots of them) and sometimes training is flat-out wrong.  Workload priorities change.  Emphasis on issues change.
One of the biggest challenges faced by claims processors (every single one of them) is that our job performance is primarily measured by two factors:  the number of "transactions" you complete; and the error rate of your reviewed claims.  Perhaps some of you are familiar with "production" environments where your pay and your ability to meet the required numbers ruled your work life.  This has been the first time for me.  By the way, I have earned awards and promotions for my production numbers (that and 6 bucks will get you a latte), so I'm not here whining about how I can't keep up.  Traditionally, I keep up.  I wouldn't do this work if I wasn't really good at it because it's important work that deserves your best.  That doesn't mean that it's not a rough environment.  Let me give you a hypothetical example:  let's say that a claims processor has been doing the work for over 24 months and holds a particular GS level.  The production requirements (numbers) vary depending on the work you are assigned to do.  If you are assigned to work claim "development", you might be the first person reviewing a claim for benefits - original or new or increases, etc.  You need to review everything in the file, order necessary federal records (service treatment records, social security records, personnel records, VA medical center records, etc.), verify and enter valid military service in the system, request appropriate private records, follow up on previous development requests, send information requests and letters to the Veteran/claimant, order exams, and review every response received to every request to make sure it meets minimum requirements.  That list isn't exhaustive.   This claims processor would be expected to produce 9.45 transactions in a day to be minimally successful (they did enough to keep their job).  You might think that each claim you work is worth 1 transaction credit...but you'd regularly be wrong.  You can only get credit for 1 transaction per claim, but the amount of that transaction credit varies. 
So lets say the Veteran submitted a request for service connection for a new condition - joint pain.  The first processor needs to reach out to the Veteran to clarify which joint since DBQs for joints go with each body part/system.  Knees, ankles, and hips all get different DBQs.  Once that is clarified, the processor gets to review service treatment records(STRs) for some event in service - a medical complaint, an accident, a physical profile, something.... They don't need to only mark one instance.  Certainly folks get denied because the examiner says it was an acute and transitory (A&T) condition that resolved without complications.  The more treatment/complaints identified and marked in the folder for examiner review, the less likely the examiner is to call it A&T.  Depending on the size of the STRs (number of pages/documents) and when the Veteran served (are the entries handwritten, bad photocopies, microfiche copies) that process can take a LONG time.  You know...if you do it right.  If the processor doesn't/can't find (or concede) an event in service, the Vet doesn't get an exam for that issue.  Not every claim requires an exam, but every claim requires an event in service (potentially proved in a number of different ways).  If the application says "joint pain" and nothing about how the Vet acquired the joint pain, the processor is left to scour the records to try to find something.  It is also common that the processor gets to review every other processors' actions on that claim to make sure the previous claim development was done properly and completely.  The processor who submitted your exam and medical opinion requests may very well not be the one who reviews it when the examiner uploads it.  If that original exam/opinion request wasn't done properly (didn't ask the right questions, didn't provide enough information for the examiner's review, etc.), the next claim processor is going to have to redo the request - if they catch the error.  In a perfect world, the work gets done properly the first time.  Less ideal is the next processor catches the error and fixes it with a minimal delay to the Vet/claim.  It gets worse the longer an error gets missed.  Your experiences will show the range of possibilities (horror stories).  For this example, let's say the processor has to review the STRs for complaints/events and then order the exams, if any.  The highest possible transaction credit for that new issue that the processor ordered an exam for is 1.309 credits.  If the processor finds the event in service in under 5 minutes (dang near never happens), it still takes time to mark it properly in the file.  Contract vendors can only download documents from the eFolder that have been properly marked...they can't even see the rest of it.  Then, the exam request has to list all of the relevant information and the location(s) in the document(s).  Doing the exam/medical opinion request (with all of it's required prep work) is gonna take at least 15 minutes to do properly - usually more.  How long did the processor spend reviewing all of the records?  That seriously depends.  What if the processor needs to send the Vet a letter or form?  Did the Vet ever get treatment for the condition at a VAMC?  All of those records (the system requires separate searches/downloads for each location) have to be uploaded and any relevant information marked for an examiner.  No extra transaction credit for any extra development requirements.  What if the only action the processor gets credit for is extending an exam suspense date (they look in the vendor's system and the exam report is still pending quality review)?  The processor gets .4 credits for extending that suspense date.  That seems pretty easy, but the processor also needs to review the entire life of the claim and all actions to make sure they were done correctly.  That review takes time.  Especially if the processor is trying to catch previous errors (one of my favorite things to do "how about we fix that error before you get denied").
Bottom line:  to do a thorough, excellent job on the Vet's claim takes time.  The system is built to deny the processor enough time to do it right.  The claim processing times reported by VA don't tell the whole story.
In the meantime, the clock is ticking.  That processor needs to meet production requirements.  You can't help a Vet if you can't keep your job.
Hypothetically.
One of the main reasons I wanted to do this work is that the process for my VA claims was tortuous and long.  I wanted to be part of the solution.  I have innate skills that are useful/necessary in this work.  I'm not bragging - the list of things I can't do well would fill reams of books.  I have learned A LOT since I started working for the VA.  I help friends, family, and total strangers online 😉 with their claims/the claims process.  I'm not an expert.  I have my own experiences as a Vet and a claims processor that I bring to the table, but that is obviously limited.  I can tell you the trends I've noticed when doing my job.  If you look closely at my posts, you'll see that I tell you what I recommend, experienced, advise, etc.  I always want you make a final judgement on the actions you take based on YOUR assessment, confidence, etc.  You have to live with your claim results and you are your strongest advocate (hopefully).
I have always been glad to be part of the HadIt.com community.  I hear your horror stories (I have some of my own) and I see how angry, depressed, and defeated that some Veterans get.  I know it seems like VA is this huge,  monstrous, impersonal, malevolent entity, but I wanted you to consider another small piece of evidence (you decide how much weight you give it).
In closing, "fight the fights that need fighting" and take care of yourselves and other Veterans.
Happy Independence Day 2022,
Phury  

I do not believe the VA sends out records anymore, I believe they give contractors limited access to veterans VARO, VAMC and Community Care Records. I had two separate contract examinations, the first examiner took and reviewed a copy of my medical evidence and wrote a favorable medical opinion with a good medical rationale. The second examiner refused to take my copy of evidence but listened to my statement then went into several VA systems and pulled out the medical documents that I referred to and then also wrote a favorable medical opinion with a good medical rationale
In other words, not saying what type of medical opinion you will get (favorable or not) at least is seems that the VES is trying to complete a proper examination and hopefully it should be a good one. Better than the examiner guessing and throwing their opinion up in the air.

I believe that I am going to have a "medical opinion" review here shortly.  Stopped by the County Lands Records and also visited the VA office there.  They showed me a letter being sent my way and also a request for a exam (opinion) regards my appeal.
I would definetly send them anything they ask for.  And I would highlight the portions that you feel are in your favor for a favorable, again, opinion.  Leave out anything that may go against you.  LOL.  Let them do the dirty work.
The examiner can only work with what he has.
How many times (before LHI and VES) did we go to a VA Hospital C&P exam only to find out the VA Doctor or NP did NOT have the pertinant records related to our claim(s)
Supposed too, and reality are polar opposites with the VA,
Carl
 

Good morning,
I am not new to HadIt.com, but this seemed like the best category for this post.  There are a few things I wanted to say to you all - in no particular order:
I work for the VA I am a 100% disabled Vet I DO NOT speak for the VA my opinions are strictly my own I see and hear you - as a Vet and as a VA employee Working for the VA as a claims processor (more than one job title fits in that category) is my dream job.  Every single day, I make a difference in a Veteran's (claimant, family member, etc.) life.  I am very conscientious about the work I do.  I always remember that my work directly impacts a specific Veteran.  I am constantly learning new stuff that affects my job.  Changes in laws and regulations occur nearly on a constant basis and those changes impact Vets.  I work fast, smart, and hard.  I work with a lot of people who are similarly motivated...not all of them are Veterans.  I also run into folks who are "boxes of rocks", just like when I was in the military.  I have been a mentor in various positions to claims processors new to that particular workload. 
I pay attention, but I still miss stuff and I make mistakes.  The blame for that falls in a couple different places and I want to talk about that with you.  Sometimes the mistakes I make are all mine - I should have caught that; I missed a step; I interpreted something wrong.  Sometimes the blame is more difficult to assign.  Congress passes the laws that govern the work VA does.  Courts interpret those laws, but so does VA.  Interpretations change over time.  Laws get updated for lots of reasons and those changes can cause chaos in a system that struggles in a chaotic environment.  Training sometimes doesn't cover specific scenarios (lots and lots of them) and sometimes training is flat-out wrong.  Workload priorities change.  Emphasis on issues change.
One of the biggest challenges faced by claims processors (every single one of them) is that our job performance is primarily measured by two factors:  the number of "transactions" you complete; and the error rate of your reviewed claims.  Perhaps some of you are familiar with "production" environments where your pay and your ability to meet the required numbers ruled your work life.  This has been the first time for me.  By the way, I have earned awards and promotions for my production numbers (that and 6 bucks will get you a latte), so I'm not here whining about how I can't keep up.  Traditionally, I keep up.  I wouldn't do this work if I wasn't really good at it because it's important work that deserves your best.  That doesn't mean that it's not a rough environment.  Let me give you a hypothetical example:  let's say that a claims processor has been doing the work for over 24 months and holds a particular GS level.  The production requirements (numbers) vary depending on the work you are assigned to do.  If you are assigned to work claim "development", you might be the first person reviewing a claim for benefits - original or new or increases, etc.  You need to review everything in the file, order necessary federal records (service treatment records, social security records, personnel records, VA medical center records, etc.), verify and enter valid military service in the system, request appropriate private records, follow up on previous development requests, send information requests and letters to the Veteran/claimant, order exams, and review every response received to every request to make sure it meets minimum requirements.  That list isn't exhaustive.   This claims processor would be expected to produce 9.45 transactions in a day to be minimally successful (they did enough to keep their job).  You might think that each claim you work is worth 1 transaction credit...but you'd regularly be wrong.  You can only get credit for 1 transaction per claim, but the amount of that transaction credit varies. 
So lets say the Veteran submitted a request for service connection for a new condition - joint pain.  The first processor needs to reach out to the Veteran to clarify which joint since DBQs for joints go with each body part/system.  Knees, ankles, and hips all get different DBQs.  Once that is clarified, the processor gets to review service treatment records(STRs) for some event in service - a medical complaint, an accident, a physical profile, something.... They don't need to only mark one instance.  Certainly folks get denied because the examiner says it was an acute and transitory (A&T) condition that resolved without complications.  The more treatment/complaints identified and marked in the folder for examiner review, the less likely the examiner is to call it A&T.  Depending on the size of the STRs (number of pages/documents) and when the Veteran served (are the entries handwritten, bad photocopies, microfiche copies) that process can take a LONG time.  You know...if you do it right.  If the processor doesn't/can't find (or concede) an event in service, the Vet doesn't get an exam for that issue.  Not every claim requires an exam, but every claim requires an event in service (potentially proved in a number of different ways).  If the application says "joint pain" and nothing about how the Vet acquired the joint pain, the processor is left to scour the records to try to find something.  It is also common that the processor gets to review every other processors' actions on that claim to make sure the previous claim development was done properly and completely.  The processor who submitted your exam and medical opinion requests may very well not be the one who reviews it when the examiner uploads it.  If that original exam/opinion request wasn't done properly (didn't ask the right questions, didn't provide enough information for the examiner's review, etc.), the next claim processor is going to have to redo the request - if they catch the error.  In a perfect world, the work gets done properly the first time.  Less ideal is the next processor catches the error and fixes it with a minimal delay to the Vet/claim.  It gets worse the longer an error gets missed.  Your experiences will show the range of possibilities (horror stories).  For this example, let's say the processor has to review the STRs for complaints/events and then order the exams, if any.  The highest possible transaction credit for that new issue that the processor ordered an exam for is 1.309 credits.  If the processor finds the event in service in under 5 minutes (dang near never happens), it still takes time to mark it properly in the file.  Contract vendors can only download documents from the eFolder that have been properly marked...they can't even see the rest of it.  Then, the exam request has to list all of the relevant information and the location(s) in the document(s).  Doing the exam/medical opinion request (with all of it's required prep work) is gonna take at least 15 minutes to do properly - usually more.  How long did the processor spend reviewing all of the records?  That seriously depends.  What if the processor needs to send the Vet a letter or form?  Did the Vet ever get treatment for the condition at a VAMC?  All of those records (the system requires separate searches/downloads for each location) have to be uploaded and any relevant information marked for an examiner.  No extra transaction credit for any extra development requirements.  What if the only action the processor gets credit for is extending an exam suspense date (they look in the vendor's system and the exam report is still pending quality review)?  The processor gets .4 credits for extending that suspense date.  That seems pretty easy, but the processor also needs to review the entire life of the claim and all actions to make sure they were done correctly.  That review takes time.  Especially if the processor is trying to catch previous errors (one of my favorite things to do "how about we fix that error before you get denied").
Bottom line:  to do a thorough, excellent job on the Vet's claim takes time.  The system is built to deny the processor enough time to do it right.  The claim processing times reported by VA don't tell the whole story.
In the meantime, the clock is ticking.  That processor needs to meet production requirements.  You can't help a Vet if you can't keep your job.
Hypothetically.
One of the main reasons I wanted to do this work is that the process for my VA claims was tortuous and long.  I wanted to be part of the solution.  I have innate skills that are useful/necessary in this work.  I'm not bragging - the list of things I can't do well would fill reams of books.  I have learned A LOT since I started working for the VA.  I help friends, family, and total strangers online 😉 with their claims/the claims process.  I'm not an expert.  I have my own experiences as a Vet and a claims processor that I bring to the table, but that is obviously limited.  I can tell you the trends I've noticed when doing my job.  If you look closely at my posts, you'll see that I tell you what I recommend, experienced, advise, etc.  I always want you make a final judgement on the actions you take based on YOUR assessment, confidence, etc.  You have to live with your claim results and you are your strongest advocate (hopefully).
I have always been glad to be part of the HadIt.com community.  I hear your horror stories (I have some of my own) and I see how angry, depressed, and defeated that some Veterans get.  I know it seems like VA is this huge,  monstrous, impersonal, malevolent entity, but I wanted you to consider another small piece of evidence (you decide how much weight you give it).
In closing, "fight the fights that need fighting" and take care of yourselves and other Veterans.
Happy Independence Day 2022,
Phury  

In addition to YOU filing directly, your representative with POA filing on your behalf, Inferred claims are a reality, but Vets often get mixed results with inferred claims.  
One example, is TDIU.  "If" you applied for benefits, prior to 2016, AND your doctor noted you are unemployed/unemployable, this is often an inferred claim for TDIU.  
Nowadays, you have to fill in a form for each claim, but that was not the case in the past.  
I actually got my tinitus claim awarded by contact with a VA employee ON THE PHONE, because it was a claim for increase, and, because the VA employee "documented" that I had applied by phone.  Remember, while claims do have to be applied "in writing", many Vets apply "online" digitally, and if you spoke to a VA employee telling them you want to apply for _________ this would suffice (prior to 2016) as long as the conversation was documented in your file.  The trouble is, we often dont know if it has been documented, until we review the file.  
Years ago, one VA employee told me "you could apply for benefits for increase  on a napkin and send it in".  Dont try that now, but, if your file did contain that napkin (applying for an increase of benefit "a").  and it was dated prior to 2016, you may get an earlier effective date.   The idea is, once you filed formally, you need not be redundant and tell the VA everything all over and over again such as name, dates of service, branch, exit service date, MOS, etc. etc, as many of these things just dont change.  
Also, no we dont always know the condition(s) claimed when VA calls us for a comp and pen exam.  We are required to attend the exam, however, or be denied.  Never miss a comp and pen exam.  The VA considers it like you have abandoned your claim and are no longer seeking benefits when you miss an exam.  "If" you have compelling reasons, you can reschedule the exam, such as if you were in the hospital, or otherwise could not attend the c and p exam, then you need to notify VA promptly, that you have to reschedule the c and p exam.  
I agree its frustrating to go to an exam, and not know what its about.  

Just like exposure claims, or Camp Lejeune, there are a few RO's that are tasked specifically with legacy appeals or Nehmer or MST. Their VSRs are divided up into groups within  each, so each smaller group is working specific claims. The bulk of ROs are still working general claims. The 'specialty' sites also work regular claims it's just a smaller group of the VSRs within that RO, the rest are dedicated specifically to whatever claim/claims special team they are on. For example, my RO works Nehmer claims that are part of being re-examined due to the the new presumptives for AO that were added last year, and MST (what I do). So, collectively, all MST and AO claims in the country are routed to those specific RO's. All ROs still have groups working regular claims, also. All claims are routed to whatever RO has the least workload that day, through the national work queue. 

One thing that changed is that during the last two years with the NPRC basically being closed or on a skeleton crew, and examiner sites- both vendor and VAMC-also having their own staffing issues, the ROs never went to a reduced posture. We just took our computers home, set up a secure subnetwork, and continued working. The difference was that with those other sites on a reduced posture exams and records requests were backed up in the hundreds of thousands (NPRC), plus the number of claims filed went UP over what an average for the same timeframe would be. So, reduced workload on two prongs of the three that work with claims, an increase in the number of claims filed.  We had the total number of legacy appeals almost completed a year or more ago but then the addition of the three presumptives meant going back through many of them again for the three new conditions. Plus, MST claims, both new, and re-examined claims (due to an OIG study a year and a half ago), have been going up instead of down no matter how many of them we work through and complete. That is due in part to an increased focus on awareness of those types of claims and an increase in the number of veterans feeling comfortable about filing them due to specific outreach to those populations. 

"Old School" was that there "was only one paper claim", and that file was transferred to VARO's outisde of the AOJ in some cases.  Nowadays, most all Vets files are electronic, which means "the next available" rating specialist would work your claim after you became first in the QUE. (The Que is an electronic waiting list for claims to be worked). 
Your old VSO sounds like he is old school.  With a VSO "with electronic VBMS access" (granted by VA),  My personal opinion is that if you have an old school VSO who refuses to jump through the hoops to get VBMS access, you should consider changing to one who has VBMS access.  Its a terrific disadvantage to not having access, and your is a great example.    The idea is you/your VSO (or attorney with VBMS access) can look through your file and see if its "stuck" (such as was mentioned, the claim was deleted and no longer being worked), or, in some other way being unnecessarily delayed.  
Another example, is the page or pages where your nexus is, could be missing from your vbms file (aka efile).  This would mean you either re submit your nexus letter, or get denied.  Key evidence which was missing, happens enough there is an entire regulation on "what to do if evidence is lost/missing and then found".  38 CFR 3.156.  
There fore , my advice is to call your VSO back again and inquire if he has VBMS access.  
If he has no access, then you will need to make a decision on the usefullness of your VSO, and decide on whether or not a change is warranted.  
Of course, there are instances where you are very happy with your VSO, and he is old school and does not have VBMS access, but DOES have a network of people he can talk to and get things done with your claim, when it gets stuck.  

Great point.  When a Veteran gets a leg amputated, and the applicable disability rating, they dont reduce his rating after fitting him with an artificial leg, suggesting,"well, we gave you your leg back, so what are you complaining about?" 
While it would not surprise me if VA tries something like that, it rarely happens and would be overturned on appeal.  
If your life would be improved, or you think it would, by having this procedure, go for it.  You never want to put your health above money.  Never.  We sacraficed life and limb while in the military, but we are out, now, and we dont want to sacrafice our health for money.  Tho, some of done this, most have regretted it.  
Personally, I have a replacement knee (Total knee replacement).  While my leg fracture DID occur in service, I no longer seek compensation for my replacement knee, because, its moot, as I think Im "maxed out" at 100 percent plus SMC S.  (Considering my level of disability).  
In other words, Im not gonna keep fighting VA any longer, as I feel I won and have nothing to gain by fighting.  
Your situation is likely different, so my advice is to get the surgery "but only" if you are convinced the potential for "lifes rewards" outweigh the risks.  I can see the life benefits if this works.  
Again, if you think the surgery life improvement, out weighs the risks, go for it.  Ask a lot of questions.  Get answers before you consent to the surgery.  But I dont suggest basing your surgery decision solely on money.  Health over money.  

I have not received any such type of emails.  However, some years ago, I used to receive "recruiting letters" from the national Guard.  
If you want to read brokensoldier's post, you can Un ignore.  
You can ignore posters again later, if you so choose.  
I rarely use "ignore"..Im capable of deciding whether or not I choose to engage a conversation, or not.    In other words, people sometimes ask me questions where "I dont want to go there".  
As far as I know, people are not arrested for not answering a question.  Indeed, sometimes the best answer is silence.  
I cant speak for Facebook, but on hadit, answering questions is strictly voluntary.  So, if you do want your question answered here, its a great idea to be cival, and polite.  We simply dont have to engage posters who have posted stuff we think is offensive, since there are a lot of different opinions on what is offensive.  
 

@Dustoff 11is right. For example, some ratings like asthma are based on medication use. If you use an inhaled bronhodilator like albuterol rescue inhaler, you get a higher rating than if you didn't. They also factor in breathing tests too, so there are multiple ways to qualify for ratings. However, they do cheat the veteran breathing tests because if you test bad before using the inhaler, they will take the better measurements from after you took the inhaler. That's an example of where they can use what is in the rating criteria to award a potentially lower rating. Jones v. Shiseki simply reminded the VA adjudicators to RTFM, but I feel that allowing medication usage in the rating criteria to justify a lower rating is a true disservice to vets because it does not compensate them justly for the severity of their SC disabilities.
For anyone who might opt out of taking their meds ahead of a C&P exam, consider doing that carefully. On one hand, you might get rated more accurately. However, on the other hand, for those like me who have critical health issues (prior heart attack), there are certain meds which I cannot go without. Consider talking with your doc and/or pharmacist to inquire about the safety of going without meds because some stay in your body longer than others.