Rivet62

I never ever discussed family issues for fear they would call it that. Whenever any health provider asked questions in that direction I never replied or kept my comments generalized and minimal.

Right. It doesn't pass the smell test.

Congressman Jim Costa (D-CA) has raised concerns over what appears to be a spike in the reductions of veterans disability benefits and has made an inquiry to the VA. Included in the concerns raised is the VA proposed changes for how VA rates tinnitus, sleep apnea, and mental health. In addition, Costa is responding to concerns that veterans have that cause them to avoid medical care for fear of reductions. https://costa.house.gov/media-center/press-releases/costa-raises-concern-us-dept-veterans-affairs-over-unexplained I know that my personal experience with VA healthcare or VA paid care (Community Care program) is the sense that I am seeing claims adjusters. I don't think I am imagining it. I have spoken to other vets who feel the same. I often experience a line of questioning or statements made in such a way as to frame things as less than they actually are. This is why I keep a close eye on my VA medical records so that everyone's on the same page, so to speak. Where I see narratives veering off-course I'll request referrals to others.

I'm convinced that successful practitioners are too busy in their successful practices to do C&P exams. That leaves the unsuccessful to do C&P exams. Is it any wonder... Anyway, you might have been better off just claiming headaches rather than specifically stating migraines?

Ok on the STRS... We'll have to just wait.

I was thinking the same thing. At least get him to submit an intent to file a claim. So then it becomes part of the C-file? And if so, then it can be seen in VBMS? I was thinking if he filed claims for all existing conditions, generally stated (back issues, mental health issues, etc), then he can wait on the veteran service records himself, and as you say the VA will request and get his records faster.

In 2014, when I made the request for the personnel record, they were sending out the basic information that most everyone would want. They did this to speed up requests. If you wanted a complete record then you would make a request for the complete record after receiving the one-size-fits-all response. They may not be doing that now, but that's the way they responded to requests in 2014. I have all the correspondence relating to the requests back then. If you're interested then I can post it here. Yeah, that's the way the request form was back in 2014 too. You can check all the boxes, but their policy at the time, to handle backlog, was to send the basic file first. This is good to know. But the record migration into VBMS...does this depend on it already being in DPRIS? The gulf war (army) veteran discharged before 2002. Ok.

"The department is also proposing a broader change for its evaluation of mental health conditions, basing the ratings decisions on a “more robust and holistic approach,” the department said. The agency will assess how the condition affects a veteran’s cognition, interpersonal relationships, ability to complete tasks, life activities and self-care." It sounds to me like "robust" means more scrutinizing. Robust = synonyms: strong · vigorous · sturdy · tough · powerful (of a process, system, organization, etc.) able to withstand or overcome adverse conditions. They are raising the bar, imho. Holistic: relating to or concerned with wholes or with complete systems rather than with the analysis of, treatment of, or dissection into parts. holistic medicine attempts to treat both the mind and the body. In my thinking, this holistic approach takes into account other factors that cause a current MH diagnosis, not isolated by just an in-service event. In other words, all things considered, did these factors occur in service? In my thinking, it flies in the face of equipoise and reasonable doubt, or at least presents a strong framework of contentions. I searched for something that can illustrate the point I'm making about this. I found this on the other forum. III.iv.5.A.9.f. Example: Evidence in Equipoise Evidence supportive of the claim includes the July 1991 opinion of Dr. T., who treated the Veteran for several years prior to his death, that posttraumatic stress disorder (PTSD) had been the major factor in the Veteran’s suicide. Evidence against the claim includes the January 1992 opinion of the VA physician that the evidence did not point to PTSD as the actual cause of suicide and that the Veteran’s suicide had occurred in the setting of alcohol dependence, family breakdown, and depression. An award of SC for PTSD is warranted based upon the facts of this case as the evidentiary balance is in equipoise. Take away the equipoise and what have you got? They are not attempting to change the legal rulings of equipoise, as that would take eons. No. It's much simpler to have medical evidence to the contrary in the form of a widely accepted "holistic" framework that better defines the diagnoses. Quoting the quote on the article on Stars and Stripes: “We’re in the process of modernizing the schedule to account for today’s understanding of diseases and treatments to ensure that veterans getting the ratings, and therefore the care and benefits, deserved,” he said. I read this as saying, we're further defining what is deserved, based on today's understanding. Today's understanding looks at everything and the benefits will be defined based on everything. Soon, it will not be enough to point to in-service event(s) and a current diagnosis of the same, because today's understanding was not yesterday's understanding.

I'm just curious if anyone has managed to get their in-service records within a reasonable time frame? What I consider reasonable is the time frame I experienced in 2014. I got the basic records in maybe 2.5 weeks, and the extensive records in about 6 weeks. I'm helping a gulf war veteran begin the claim process by first acquiring his in-service records (personnel file and medical and health records), and now we're going on 4 months still waiting for the basic record. Covid, covid, and more covid. The Archives website has no timeframe stated, but they do provide a number to call to check on the status of the request. https://www.archives.gov/veterans/military-service-records

You can make it easier for SSA and you by adhering to the SSA evidentiary rules which apply to the blue book listing of conditions and having your Residual Functional Capacity (RFC) already completed. It's what SSA reviewers go by. Hopefully then you won't have to have a hearing following a denial. The only time things are straight forward is if your condition is in the Compassionate Allowances Conditions https://www.ssa.gov/compassionateallowances/conditions.htm Some advice concerning the blue book list: To prove you are completely disabled, you will need to meet the Blue Book listing for the condition you are experiencing...Proving your complete disability, however, is often not so easy or straight forward. It’s best to review the Blue Book with your doctor to make sure you have met the needed criteria. Your doctor can help orchestrate any tests that are needed to qualify. Keep in mind that this is just for qualifying and doesn't mean you will actually prove you are too disabled to work. You can prove the medical part of it, but the next consideration is the functional part of it. https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm You should look over the evidentiary requirements, to hit this out of the park. https://www.ssa.gov/disability/professionals/bluebook/evidentiary.htm The functional part: Residual Functional Capacity (RFC) The Social Security Administration uses residual functional capacity guidelines to define an individual’s work capability in the following categories: sedentary, light, medium and heavy work. A residential functional capacity form is often completed by a claimant's doctor and is reviewed by the SSA to determine if an individual qualifies for disability benefits. https://www.disabilitybenefitscenter.org/glossary/residual-functional-capacity-RFC The Social Security Administration (SSA) evaluates your residual functional capacity (RFC) when determining if you are disabled enough to qualify for Social Security Disability benefits. A residential functional capacity form is often completed by a claimants doctor and is reviewed by the SSA to determine if an individual qualifies for disability benefits. Let this be your guide for physical disability determination: https://secure.ssa.gov/apps10/poms/images/SSA4/G-SSA-4734-U8-1.pdf When you apply to Social Security for a mental health condition, a claims examiner who works at Social Security will fill out a mental residual functional capacity (RFC) form. This form says what types of tasks you can and cannot do. If you can have your own doctor fill out a similar form and submit it to Social Security, the claims examiner needs to use it in developing your RFC Mental Residual Functional Capacity Assessments: DI 24510.060 Mental Residual Functional Capacity Assessment https://secure.ssa.gov/poms.nsf/lnx/0424510060#:~:text=Because of the complexity of mental disorder evaluation%2C,despite his %2Fher impairment. 2. Medical Consultant Completion An older official form: https://www.ssdfacts.com/forms/SSA-4734-F4-SUP.pdf A worksheet: https://www.disabilitysecrets.com/sites/default/files/MENTAL_RFC.pdf What SSA goes by: Program Operations Manual System (POMS) DI 24510.000 Residual Functional Capacity (RFC) https://secure.ssa.gov/poms.nsf/lnx/0424510000 Code Of Federal Regulations § 416.945. Your residual functional capacity https://www.ssa.gov/OP_Home/cfr20/416/416-0945.htm It's important to realize the process: "Most Social Security disability claims are initially processed through a network of local Social Security Administration (SSA) field offices and State agencies (usually called Disability Determination Services or DDSs). Subsequent appeals of unfavorable determinations may be decided in a DDS or by an administrative law judge in SSA's Office of Disability Adjudication and Review," source: https://www.ssa.gov/disability/determination.htm Disability Determination Services (DDS) functions much like a VARO does to vets disability claims. If your social security disability claim does not check off all the boxes according to POMS or the regulations, then you will get a denial because... and you will have to appeal it at a SSA hearing with a SSA Administrative Law Judge (ALJ) and you will likely have a SSA vocational expert there at the hearing, and you, and your attorney, and the vocational expert, and the ALJ will hammer out how you qualify. They may resort to the SSA grid rules, which lower the threshold based on age, past work history, and education. https://secure.ssa.gov/apps10/poms.NSF/lnx/0425025035 That's where the vocational expert comes into the conversation. If you can make your SSA claim complete by seeing to it that your claim checks all the boxes that DDS considers then your claim should be approved with no need for a hearing. To make your claim complete, get your doctors to review what tests you need to solidly place your conditions in the blue book list (by the evidentiary requirements), and get your doctors to fill out the RFC forms, or something similar, that serves the functional part that SSA and DDS's look for. You can slam dunk this if you can get a vocational expert opinion, too.

SSA administrative law judge and my SSDI attorney moved my effective date up, and called my working a 'work attempt,' becasue my work attempt didn't exceed a certain time frame (I can't recall what that limit is), so my work didn't disqualify me for SSDI, otherwise my working would have disqualified me for SSDI. I got less backpay as a result, but for me that was ok.

Each VAMC has their own numbers of enrollment. If a VAMC has room at a lower priority then they will take you. Once enrolled, always enrolled. Also, it's important to apply by paper application. Don't take anyone's word for it. Reapply to a VAMC or VA CBOC nearest you. Just apply to one within the same VISN.

And do it quickly. That's exactly what he needs to do. I'll tell you why. I was getting C&P exams scheduled by MSLA ( I think they're out of the business of vets exams, now). For same whacky reason, MSLA had my old address and contact info... like... they had gotten that info from an old database file that was forwarded to them. Every time I tried to update my contact info the changes wouldn't stick. My information was current with VA all across the VBA and VHA and had been for a year. I first learned of the problem when a local psychologist called me at work at 4:30pm and he said, did you know you had a C&P exam with me at 3:00 today? I said no sir I did not. He asked me if I could be there soon. I said yes with traffic I should get there by maybe 5:20 - 30... HE WAITED. So that's how I learned that I wasn't getting notified of C&P exams. I called MSLA WEEKLY to find out whether or not I had C&P exams ahead. I had to stop outside during lunch to do so because I had no cell phone signal inside the VAMC where I worked. That's my advice to anyone wondering why they may not be getting a C&P exam, when the expectations are that they should. Meanwhile, VA will close the claim for a missed C&P (meaning denial), and you're left to argue it later.

That's like a one-size-fits-all status. Here's my experience after seeing that. I had a BVA hearing. VA.gov showed Claim closed. Separately it said, A decision has been made, we sent you a decision letter. I thought...sweet. Here it comes... My attorney said he was 100% sure I won my TDIU at the BVA hearing, along with an effective date for back pay. So then, what I'm seeing on VA.gov must mean that I can keep checking my bank account. Surely the money will be there soon. A deposit did not occur, nor my rating increased. The decision letter, which came 4 months after my BVA hearing, was that the BVA hearing and all its decisions were DISMISSED, because of a docketing error. This occurred because the attorney AND the VA made a mistake by proceeding with my hearing under the new AMA system of appeals when I should have stayed in the legacy system or opting in PROPERLY in the AMA system. Fun huh? I waited 2.5 years from the date of my NOD to the final decision of a BVA hearing, only to be told it was a waste of time. I ended up filing as though it were the first filing ever, and I'll have to argue back pay at another BVA hearing. I'm sure. I would be suspicious when it says Claim closed. In my case, the claim was closed and another opened in the right way when VA realized its own errors in docketing my hearing. Still, a lot of time lost, and arguing an effective date adds even more time. The 800 number couldn't see enough of what was happening with BVA to be able to tell me what Claim closed meant. They told me I would have to wait for the letter. It used to be that you could call the BVA. Not anymore.

This sounds like the rationale behind extraschedular, in a way. If extraschedular is possible for TDIU at an RO director's discretion, then why is the bar so high for SMCs?? All your conditions is why you are seeking appropriate SMCs. Instead, they are saying that you must have a strict high rating of 60% for one condition over the 100% TDIU that you're currently rated for? Makes no sense what they're doing. You are seeking appropriate SMCs because all your conditions make you substantially confined to the home, in the same way that TDIU is granted when the schedular requirements are not met. I can't believe you have to fight so hard for what amounts to simple help.

Ah ha that's what just happened to me. Just yesterday. I had a C&P exam for thoracolumbar DDD and the bilateral radiculopathy. He asked me something, and I said well it's in the record, and he said he hasn't gone through 3,000 pages (well my record isn't even 1,500) so I suppose this is the way he does it. Examines, then looks at the records. I had uploaded my most recent radiology reports to VES (which is Veterans Evaluation Services...so he could at least see these right away) and I asked him if he had those. No. So, my positive C&P experience may turn out to be a dud after he combs through records to find the least little thing to undermine my back issues claims. And maybe the VBA has this in mind when lo and behold my examiner trained as a cardio thoracic specialist, but ended up practicing his career as a general physician. I can only think of the arguments ahead, when lo and behold my new VA primary care doctor has breathed new life into old cardio diagnoses that had since not warranted any follow up. It's as if she has made a comment sticky, or pinned to the top of everything else. Well here's what's going to happen. I've got a psych C&P exam coming up this coming week. I am making no special effort to look my best. I'm going to roll out of here like I rolled out of bed, because that's how I look everyday anyway. This doctor at the back issues C&P exam just happened to comment that my face looked cyanotic when I went to lay down. Geez I can smell the arguments coming. I'm not cyanotic when I lay down because if I were then why not a single doctor has ever noticed?

Maybe he sees it in ways that are only reasonably attainable? Or he sees it in a totally different way? Maybe he sees it as having a different theoretical foundation of law? Who knows. There have been times in my life where I thought I had a slam dunk case (not VA related) but was set straight by attorneys who saw otherwise. I was never one to win millions of dollars because hot coffee spilled in my lap. Remember that famous lawsuit against McDonalds? Things that have occurred in my life where there was real serious injury (happened to a family member) were just brushed off by attorneys, and not because it lacked money if we were to win...just different thinking. Who knows..sigh.

If you're in quicksand then you need to get out of the quicksand while you can comfortably. Don't wait, like me, and let it swallow you until there's no getting out because then you're just going down, and you'll experience first-hand that the bottom that you think is bottom is not quite the bottom. You can't hope for luck because there is none. The bottom for me was couch surfing without the couch, and no wheels on top of not being able to walk. The bottom was hoping to make $5 a day and maybe getting that twice a week. BTW folks, I was never an addict or substance abuser... just disabled and it caught up with me. Moving this topic to private messaging.

We can only pray, but Mr. Cue's journey will definitely have a lot of attention.

Exactly. So, you do understand where I'm coming from on this issue of vets not being allowed their own access to VBMS where it concerns them. Right. The information silo and the delays made on purpose to acquire that information is what bogs down the system, causing incredible unjustified costs to the taxpayers in veterans having to re-attempt their claims and appeals and so many mistakes are made by both the veterans and the VA that have to be redressed. Things linger for decades. .... I'll get to experience that next, for the first time. When I first started with my first claim for vets disability I had no idea I was embarking on the engagement of so much. I feel like I'm active duty again, with the tangle.

One really should ask why that is. Is it something vets should fight to change? Should the fight start with me? Maybe... It's sort of like sitting in a realtor's office, and they're thumbing through all the opportunities in the current MLS and they only let you see a few of what they think you should be interested in. You just want to reach over and yank the book from their hand, when the book is 3 inches thick. Or you're making an application for a loan, and the loan officer sees what's most important to you (the version of the credit report they see), but they're not turning that computer screen so you can see it. Yeah, I know their version is proprietary...just grumbling. I'm grumbling...only because I've never been a good backseat passenger watching what flies past me while others have the wheel. Maybe because I've been in too many wrecks, figuratively. But overall, I do think that vets could benefit greatly with more transparency, and/or timely or unfettered access to VBMS. I shouldn't have to make an appointment. Time matters. When time is gone it's gone. If had had access to the VBMS, and if my attorney didn't keep it from me, then I might have saved my TDIU situation and had the back pay to have paid off my house already. I didn't know my attorney was playing games with my TDIU. The VBMS might have revealed that, had I had the access in that circumstance. I'm not grumbling at you... do know that I'm not grumbling at you. I'm a newbie. I just think the VBMS should be made available to vets, and access to information shouldn't have so many steps and time delays.

My ex lives in a very relaxed state and gets seeds from the state, and says it's darned good...like the best gold. Me? The only thing that is legal in my state is if the weed has been ground down into an approved capsule from an approved vendor I suppose. The VA will pay tons of money for less beneficial prescriptions and tons of money to yack about it, but the yacking is nothing more than note taking that can be used to either decrease or deny. I suspect that with every encounter that doctors are claims adjusters. Fortunately for me, the situation is so serious that they can't pretend it's all ok.

Mr. Cue, I think you're in the wild west with this...slinging it out. It's not like fighting for service-connect or service-connect increases. What you're going through truly is madness making. I saw the Hill & Ponton video below where the attorneys are calling the fight for SMCs outlandish, and that VA is abusing this somewhat uncertain area of regulations and law. Making it super hard. I thought of you when I saw this video. They start talking about it at 1:10:52. So, fast forward the video to that time. https://www.youtube.com/watch?v=79R1YBR-KVA&t=4365s

I think a lot of people here know what that's like...they know what it is to lose a home and lose your things...or dodging cops because your registration is expired...your home on wheels...lol. Survival becomes that. It becomes keeping the only thing that's good that you've got left, to be free of tickets. Anyway, I spent some several months waiting on a BVA decision that I was sure would have me paying off my house, only to be dismissed on a technicality. Even sure things are not so sure. What you want you've got to fight for. Fortunately, the fight gets easier in some ways. It's much easier to fight when you have a roof over your head and can pay the basic requirements to stay on the good side of the law. In other ways it's harder to keep fighting, because you just want to enjoy your time left on earth. Keep fighting...it's all you can do, because this inflation on fixed income is not getting any easier. Fight today, to make it easier in the coming few years.

Others are telling me that, too. Yeah, and then trying to replace that with 'mindfulness programs'... or some psych-driven pain management to cope with pain, that doesn't really work. Basically telling you to distract your thoughts from the pain...and the VA pays these people GOOD money for the people who work in those bla bla bla programs...more time yakking and less time really treating it.