DSIG

john999, not going down TDIU route quite yet. May do it by claiming protected work environment with the PTSD but I don't want to spend my time and energy on that now and I also know that's going to be difficult. I'm going to see how these other little claims turn out. VA math is like the casino slot machines basically. The claims system math is rigged in a way that reaching 100% is close to impossible...unless you have a litany of little claims. Look, I really didn't think I had hearing loss and was surprised with my hearing test results but I'm being realistic and know I will probably get 0%. Its good to put in for it in case it gets worst. So, I really don't know what to expect with the sleep study either. I honestly would rather have excellent health than compensation all my life.

John999 I’m 70%. I’m expecting 0% for hearing loss and 10% for tinnitus. TMJ 10 or 20% and not sure how they will rate bruxism and dentin sensitivity. Cranial neuropathy comes with 4 years of symptoms. Monday going for a sleep study. I’m sure I’ll move the needle a little, not sure if it will get to 100.

Thanks GBArmy. The oral surgeon is also helping me with a bruxism and TMJ claim that I’m filling as secondary to PTSD. He took a panoramic X-ray for the TMJ. What VA examiner will do that? I know he will include this in his remarks. As for the form being filled out completely I have a question about this for another claim. I went to an audiologist about my tinnitus which I thought for sure was from the TMJ. Turns out I have slight bilateral hearing loss. The audiologist used to work for the VA years ago so she wrote a nexus letter for me and included her CV and also filled out a DBQ for ear condition. Hearing loss and tinnitus has its own DBQ but the VA hasn’t made that available for public release and the one I found online says for internal va use only. On the ear condition DBQ she competed she wrote that she reviewed private dental records but did not give the dates of the records. Since she basically did all this for free I don’t want to go back and ask her to include the date because I’ll be including the dental letter about the TMJ which has a date. Does it matter that she did not include the date range of the dental records she reviewed? Or should I not include the DBQ since the hearing loss and tinnitus DBQ also needs to be completed? I’m filing the bilateral hearing loss as a new claim with tinnitus as secondary but I will also include the tinnitus with the TMJ claim and see where it sticks. I don’t know if the nexus letter, cv, DBQ snd hearing tests are overkill for a new claim.

I’m preparing a claim for an increase to SC cranial neuropathy that happened from wisdom teeth extractions. Since my symptoms are neuropathic but they are oral I’d be interested to see if the VA is going to send me to an oral surgeon specialist or neurologist for the C&P exam. I read a BVA appeal decision that involved similar symptoms and diagnosis I have and the VA sent the evidence not the veteran to some director of oral maxillofacial department in some college to conclude there is no way a tongue biopsy procedure at the VAMC caused the pain. I agree with VA that the veteran had those oral neuropathic symptoms before the biopsy. The point is that the VA used an oral surgeon for a claim involving a neurological condition. I’ve had this condition for 4 years with documented visits to specialists and failed treatments. I went back to the oral surgeon who originally saw me for this and he said he will fill out the DBQ for me. He is also a family friend so I am very fortunate. Let’s see where the VA sends me.

Buck52, I’ve never had to deal with meds through community care but my guess is that since the meds are related to the dental referral you would get reimbursed through community care. Call the community care office and ask them how to do this. They have often helped me with with referrals where I receive bills because these doctors don’t know how to bill optumcare, but I haven’t had to deal with meds. By the way, geez, what pain meds cost so much?

When I filed for the increase I didn't know its actually a monumental leap and nearly impossible to get it approved for mental health and TDIU would've been a better option. I read a BVA decision about a veteran who was teleworking for the government and was approved for TDIU but she didn't have a mental health condition. It really depends on the Veteran's circumstances. Since I filed the claim I've learned so much on hadit that I wish I knew before I filed. I haven't filed any new claims for 9 years but now I'm going to be filing some additional claims. I probably left a lot of money on the table, not from the botched PTSD increase claim that I filed but for other conditions. The TDIU isn't off the table but at this time I am going to focus on developing and gathering all the evidence for the future claims. Thank you john999 and broncovet. As always, I appreciate your feedback.

pacmanx1 please no need to apologize, we are on hadit to help each other and I will not be offended if I receive advise based on facts. Thanks for clarifying the OCD. I recall reading a decision where the BVA decided for OCD as secondary but I may have misread it. Berta, thank you also again for your thorough responses. My intent with documenting the telework was to demonstrate that was it not for this work arrangement I would not be able to work in person somewhere and the social impairment is tied to this. I did not submit as evidence my telework agreement or my relocation package paperwork which I declined back in 2010. The relocation would have offered more substantial work opportunities vs the teleworking. I don’t know if it’s worth making this case or just letting it go. I don’t want to piss off the VA and have them hold up decisions for other claims I plan on filing soon. Lastly on the OCD, should I ask the VA to add it to the PTSD with the MDD? Shouldn’t these mental health disorders be added or removed if they are in remission?

Berta, this claim was for an increase. I didn't file a separate claim for OCD secondary to PTSD since the DBQ reflected this. I expected the VA would capture this in their decision or award OCD as secondary. Should I file it that way now using this IMO? I just don't want to go back for another C&P exam. The C&P examiner didn't list OCD but she mentioned it in her remarks. I've enclosed a redacted copy of the IMO that I submitted. I don't want to be misunderstood about the advise I received on hadit. Nobody here said don't appeal. They said that since my doctor didn't check the block for total impairment that I would stay at 70%. I concluded that an appeal would be fruitless. Your interpretation that this isn't a denial makes sense. I just need to know how do I proceed from here and admit that I don't know the process like most of the varsity members on hadit. Broncovet and I have exchanged a few messages and he has been very helpful. If I should file a NOD then I'll work with Broncovet on how to word it...thanks or connecting him with me.

Berta thanks for that blog link and the decision -- I read through both. I submitted a DQB and narrative from my private doctor. He's done hundreds of these as he only treats veterans. He and I had a session yesterday and discussed the decision letter and DBQ. We think that it was convenient for the VA to just ignore his DBQ because it may have resulted in a higher rating and/or addition of the secondary OCD claim. So, a lot of these law firms do an intake and don't even ask for a Decision Letter unless you pass through initial screening. Two national firms I spoke to are only taking TDIU claims. One firm finally asked me to send the Decision Letter. Hopefully they can see its not a decision at all. If they don't take the case I'm going to try on my own for a high-level review. Thanks for explaining what a CUE is; I don't know all these process violations but I'm learning fast. If the VA used my doctor's DBQ also as evidence, shouldn't they have suggested that there are favorable findings with the OCD diagnosis?

Fat and Berta, thank you. This amounts to a denial of due process. I don’t recall receiving anything on TDIU. I went to the regional office this week and picked up the C&P DBQ. This exam was rushed and the DBQ shows it was a rush job. The examiner misrepresented a lot of things I said. Also, she doesn’t list OCD as a diagnostic code but talks about this behavior in her remarks. My private doctor’s DBQ lists OCD as a diagnostic code. This should’ve been either considered as secondary condition or added to the PTSD along with the MDD. The DBQ was digitally signed 20 minutes before the exam was finished. The exam actually concluded at 9:06. I know when I left her office but even if this can’t be used as evidence I have evidence of how long everything took. I took pictures of my complete questionnaires I was given to fill out before the exam. My phone time stamped the last photo at 8:23 which is when the examiner also met me at the lobby to see if I was done filling out the forms. Her DBQ was digitally signed at 8:47. Are 24 minutes enough time to score the questionnaires, examine the veteran and complete the DBQ? The other thing I noticed with the DBQ is that the first page has a different form version than the rest of the pages, which is a different version from the DBQ that the VA just publicly released on their site. As for the decision letter, there is no basis for the decision. Shouldn’t it indicate what criteria I did not meet? I’m in the process of replacing my VSO. I asked them to get the DBQ for me and all I heard was crickets. I’ve done a couple intake interviews with law firms but this is in the early stages. I don’t know if I can find one to take my case. I’m not going to file anything on my own in case I screw it up. This would be my first time challenging a decision. I have some future claims I’ll be filing and don’t want those screwed with because I’m appealing.

Berta, I don’t think there is a problem with your pdf reader. The decision was a lousy 3 pages. There were some admin pages listing my dependents and actual payment but I didn’t include that here. My C&P exam is favorable inasmuch as it maintained my current rating at 70%. My 70% is solely for PTSD. I have another SC disability at 0% I will be claiming for an increase in the near future. I am trying to obtain the C&P exam DBQ because I may need it for a future secondary claim. I may have to go to the regional office and request it in person. DSIG

As I indicated I won't appeal the decision but I uploaded it because I have a question (see enclosed). The decision restates the applicable CFR criteria. Is this typical or should the decision specify the deficiencies for which evidence was not presented out of those listed for a 70% or higher rating? Decision.pdf

The VA would pay for the medications if they were prescribed through a community care referral regardless of if the veteran has a rating or not. There will be a copay based on the veterans priority group; no copay if over 50% SC. You can't go get treatment outside the VA without a community care referral and then come back and ask 'where should I send the bill'. A community care referral is required and will cover these expenses. I'm preparing to file a claim for an increase to a SC disability where I spent a lot of money out of pocket to determine any idiopathic causes to include failed treatments. If the VA awards the increase I don't think I can come back and say 'I spent thousands of dollars out of pocket to figure out what was wrong with me, where do I send the bill?". As cumbersome as it is, it is more cost effective to use the VA to cover some if not all of your healthcare.

I was recommending that Berta contact the community care office because ultimately they would be responsible for interfacing with Optum Care about the emergency care hospitalization bills.

Berta, This is a good find and consistent with what I posted but its vague on who at the VA you should contact. As large as the VA is, finding the right POC at the VA is like finding a needle in a haystack. Can you get in to the veterans myhealthvet and send a secure message notification to the community care office? This is a start. Those messages have read receipts. Next is to call the community care office and keep calling till you talk to someone in person. Or you ask to speak to the person on staff duty at the VA hospital. All the hospitals have a staff duty officer. You need to ultimately find someone of authority and document all this. DSIG

Berta, The VA is silent about using emergency care through community care because the Mission Act is new and even though the VA is still unpacking it they still do not completely understand all the components. I received a briefing on the Mission Act that was given at a VA stakeholder meeting that I usually attend. The VA rep explained that’s how to proceed with emergency care. It’s not an established process like urgent care is but it should cover the veteran till the VA healthcare can take over. Let us know how it goes.

Berta, Here is the procedure for urgent care; the video is helpful https://www.va.gov/COMMUNITYCARE/providers/info_UrgentCare.asp And here is the link for the network of providers https://provider.vacommunitycare.com/tpa-ap-web/?navDeepDive=VACCN publicProviderHomeDefaultContent For emergency care notify the VA regional community care office immediately that the veteran was hospitalized and ask what is the procedure to have his expenses covered through community care. If the veteran has myhealthvet they can send a secure message to the community care office but you would need to follow up with a call. The VA understands there will be emergencies where a veteran can’t get to a VA facility. With proper communication the VA will understand and will work with the veteran.

**sister (I'm a )

Thanks Shrek, Berta and GBArmy.... I don't have the ability to attach documents to my posts so I cannot enclose the decision letter. I had this ability for two previous posts where I attached documents but this option is not available to me and I also reviewed the YouTube tutorial which confirmed that the option isn't available to me. That having been said, I do not intend to appeal this decision based on feedback I received in another forum and from Alex Graham about meeting the criteria for a PTSD increase to 100%. I understand now that it is a very high bar to clear and I don't meet the requirements. I thought that the evidence that my doctor provided of my telework arrangement would demonstrate work impairment and this is one of the reasons I filed for an increase, but I realize now that the better approach would've been to submit a TDIU. The only good thing that came of this claim submission, even though the C&P exam was emotionally draining, is that my rating of 9 year did not change so I don't have to be concerned about the VA requesting an Administrative evaluation anytime soon to see if my condition improved. This will help me as I prepare to file some secondary claims to PTSD. Even though I will not appeal the decision I find it problematic that the VA did not consider the evidence from my treating physician of 11 years (since it was not listed in the decision) and went with a DBQ from an examiner who saw me less than 40 minutes. This is indicative of how they actually decide claims denying a veteran due process.

If the services you are receiving meet the criteria for being covered through Community Care it will cost less out of pocket and would be limited to the VA deductible. You will need to submit a consult request with your primary care doctor at the VA and then the VA community care office will authorize a referral which will be used to bill the VA. The only issue with community care is it cannot be used indefinitely. It has a beginning and end defined as an episode of care, which varies for whatever healthcare service you are authorized to receive.

The following evidence was listed in my decision letter: -VAForm21-526EZVeteran'sFullyDevelopedClaim,received January8,2021 -ReviewPostTraumaticStressDisorderDisabilityBenefitsQuestionnaire,received February 16,2021 -Section(§)5103NoticeResponse,received January25,2021 I can't tell if my private doctor's report and DBQ were considered as evidence. I submitted the report/DBQ as part of the Fully Developed Claim, uploaded it in as evidence and it shows as evidence online. Was it not considered because it's not listed? OR was it considered and is actually part of the "VAForm21-526EZVeteran'sFullyDevelopedClaim,received January8,2021"?

Bronco and Buck thanks. I’m not anywhere near TDIU. The VSO and my private doctor who is very familiar with VA claims and only treats vets said that my employment may be a show stopper. I’m hoping that the worsening social impairment, new secondary diagnosis and evidence of 11 years of therapy tips the scale.

jfrei, are you sure this trick works? My claim closed last week. I opened an application for a new claim to increase a current rating and I'm still rated the same. Is it possible I didn't move the needle? How do I delete the application I opened? There is no option in va.gov.

broncovet, do you think 10 years of teleworking may fit the definition? I don’t know if I could sustain a ‘go to the office job’ if I didn’t have this telework arrangement. I got lucky with the BRAC I was able to keep my office job as a teleworker while my organization moved to another base.

El Train, thanks, that is helpful. I've been teleworking for 10 years as a DoD contractor. My doctor's DBQ mentions the teleworking but not the duration of it. When asked about work during the C&P exam I explained that I telework and that its from 2010 so hopefully the VA noted this and factored it in their decision.