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Thanks to people who responded. It is helpful. Looks like the route is through my Primary.

I am 100% s/c and currently being treated for Hepatocellular Carcinoma (HCC - liver cancer). I am on the transplant list and hoping to have transplant surgery within the next few months. The transplant hospital is not a VA facility. My primary VA physician is very supportive and been a huge help throughout. The recovery from the surgery is pretty invvolved and requires a 'support person' 24/7 for the first two weeks after release from the hospital. My ex-wife is a nurse and has agreed to take time off from work and cover that period (lucky me). But over the next few weeks I will continue to need supportive care at home. There will be dressing changes, medication adjustments, physical therapy sessions, etc. So I will need help for a few weeks until I am more mobile and able to drive, etc. I know the VA provides certain kinds of Home Healthcare Services, but that's about all I know about it. How do I find out more? What is involved in applying? Is there a waiting time for approval? If so, how long is the waiting time (a year waiting time won't be of any help because I hope to have had the surgery well before then). Has anyone had experience using VA home healthcare services and, if so, how did it go? Any help in this are would be greatly appreciated. Thanks John

Thanks for your response. I have not applied for service-connected Cirrhosis. There didn't seem to be any point as I was at 100% with the TDIU. I do have a letter that ties my alcoholism to PTSD. Moreover, my rating letter cites "Service connection for post traumatic stress disorder with secondary depression, anxiety, and alcohol dependence" The Cirrhosis has been diagnosed as Alcoholic Cirrhosis, so I think the chain is there. I do not have a letter that ties the CA to the Cirrhosis, but can get one fairly easily, I think. Thanks for the info on benefits, I will follow up. At this stage, the CA is treatable with Trans-catheter Arterial Chemo-embolization which is a localized chemo that should kill or shrink the relatively small lesions that I have. The plan is that this treatment will be a 'bridge to transplant'. Thanks again for your help.

After a long stint with Cirrhosis (Alcoholic), I have been diagnosed with Primary Hepatocellular Carcinoma (HCC). Detection was through a regular screen and is quite early. I have four questions. 1. Does anyone have familiarity with this problem and know of veterans or non-veterans support groups that can help me navigate the whole business of treatment, transplants, etc.? This group was invaluable when I was working with the VA to get disability benefits and I'm wondering if there isn't something like this for my current situation... 2. I am currently 100% disabled via TDIU with an underlying rating of 80% due to PTSD with alcoholism (in remission), Depression and Anxiety, Diabetes II (Agent Orange presumptive), and a few other more minor problems (e.g. hearing loss). Does it make sense for me to file a claim to add the HCC to the list and perhaps move 100% on basic rating? Are there some benefits I would get that I'm not currently getting? (Including survivor benefits) 3. I know the VA healthcare system does do transplants. Does anyone have familiarity with this process? What transplant criteria do they use? 4. Is anyone aware of any research studies or clinical trials underway that look at the effect of Agent Orange on the onset of liver cancer? I'm just looking for information and anything would be helpful. Thanks

I finally got my case clear of appeals and receiving benefits. It has been a long haul and I want to thank the people who contribute to this forum for help in answering the many questions that I had during this process. Your answers and support made a big difference to me and I"m very grateful to have had it. Happy Thanksgiving to all.

Thanks, Carlie. Hope its a few weeks instead of a few months....

I have received word from a person inside the VARO that my appeal has been rated and is headed next for promulgation. I have a private attorney. Any estimates as to how long this process might take? Is there anything I'm supposed to be doing? (Already have direct deposit set up).

Berta: I am not advocating slowing down those claims. I'm just wondering what's going on because it affects me. I don't think that's unreasonable. Also I understand that anyone can say anything. That's why I posted here to see what's up. One of my sources works in the RO and told me that ALL raters had been pulled to work only on those claims until the review is complete. There may be a separate group created to do that, but that is not what he told me. Of course, he could be shining me on..... Thanks to folks that responded. I know a little more than I did before and that's good, right?

I have heard from two independent sources that all rating of claims/appeals has been put on hold while so-called Nehmer claims are processed. The edict from Washington is to complete these cases by the end of December. I have an appeal that was handed off to the rater nearly two months ago and has not moved a milimeter since. I'm told that all raters are working on the 'special Agent Orange cases'... Is there any truth to this? Has anyone else been told this? There is not much available via Google and when I call my local representative's veterans affairs person, they knew nothing about it. What's going on?

Absolutely right. The problem starts with Congress and ends in the Executive. Congress just doesn't care about veterans. Look who is on the Veteran's Affairs committees. We have seen that the only thing Congressmen (and women) care about is getting re-elected. Period. Then the same is true in the Executive. The Department of Veteran's Affairs is so poorly managed that it is a national embarrassment. I have been pursuing claim and appeal now for over two years and the number of mistakes, omissions and errors is staggering. Before you blame "federal bureaucracy' I have also been dealing with Social Security Administration since 1998 and have had two IRS audits over the years (one random, the other because I filed the wrong form). Both those agencies had problems, but nothing at all like the VA. Social Seucrity (which handles many more claims) is not nearly as screwed up as the VA.

Come to find out, someone at the VA authorized the Prudential (and other) insurance companies holding of death benefits funds in their corporate accounts drawing interest on dependents' money. Check it out at: http://www.nytimes.c...ml?ref=business Several states are conducting fraud investigations of Prudential and other insurers. They were required to make lump sum payments of survivor benefits on demand and were prohibited from profiting from the interest on retained funds. That interest should have gone into the account of survivors. The American Insurance industry does it again and this time knowingly taking financial advantage of dead service members survivors. Utterly shameless. But anyone who expects anything else from the Insurance Industry is either hopelessly naive or has been living on another planet for the past few decades.

Carlie: Yes I am aware that the VA will not use GAF alone to set a rating (nor should they), but I have three GAF scores about in the same range and that does provide evidence. Together with the twice assessed unemployability I would think it shows impairment beyond the 30% level. I also know that SSA disability criteria and VBA criteria are different and they have a different process. But my medical problems (for which I am receiving the SS) are complicated and the VA claim is straightforward. That is the point I was trying to make. Anyway I have asked the lawyer to try to find out if the review has been scheduled and, if so, for when. I'm sure I, like thousands of other vets, are very frustrated with not only not having a fairly clear date for the rating, but also no published statistic (I spent a lot of last night looking for processing estimates) giving a ballpark estimate of how long they will have to wait. Of course, that leaves room for the rumor mill and reporting of best case and worst case scenarios. I did find grave site forecasts for the national cemetaries so believe me when I say, I looked.

I'm beginning to find out that even simple stories become 'long stories' when dealing with the VA. I processed a Social Security disabiity claim from start to finish in less than a year and it was much more complicated than this. There is no question whatsoever about the validity of my case, nor is there any real question about the degree of impairment. Social Security Disabiity requires 100% disability (they don't have partial disability) and I've been receiving it for years, plus both VA examiners have given me GAF indicative of a higher rating and an examination by a VA psychologist (which is part of my C-File) gave an even lower GAF rating indicating worse impairment.

Thanks, I'll have my attorney call and see what they can find out. Hope you have a favorable outcome on the 20th.

Commander Bob: Thanks for good wishes. How did you find out that your review was scheduled for July 20th? All I know is that the review officer has been assigned, but nothing about a date. I'd love to know (save trips to the mailbox!) Thanks

Hi Carlie, Thanks. I have seen these before, but they give aggregate data (unless I'm missing something). They tell you how many claims they are processing, but don't tell on average how long a claim takes. Actually what is needed is both the average and some measure of spread. I'm starting look a little more now.

Drive me nuts? That's not a drive, that's a putt. I waived the hearing and am on De Novo status. The original claim did take about a year. I had a favorable C & P exam at the time that said (explicitly and unequivocally) that I am unemployable. I am on SS disabiity (further proof). As a part of the appeal another C & P was requested. The report of this one agreed completely with the eariler one saying several times that I am unemployable. It is so frustrating to wonder what will happen when it is so clear what should happen. It's like dealing with an insurance company and their policy of deny, deny, delay, delay. In fact, the VA is worse because the insurnce company gives you their no answer much faster.

Thanks to all for replies. I think I will go looking for some resource where the VA publishes estimates of processing time. They can easily calculate an average for each step of the way, publish it and that would give people a sense of how they are performing. This administration has been better than others at sharing information...we'll see. If I find anything I'll post it here.

As of June 4th, my attorney spoke with a person who claimed to be the DRO assigned to my case. They went over the file contents to be sure he had all the relevant material and the lawyers brief and addendum. He did. So from that point on we wait for him to go through his backlog, get to the file and make a determination. Then that probably goes through a process of review and the final report, disbursement orders (if needed), etc. are prepared. It's been over a month and I'm wondering what a reasonable waiting time might. To get to this point with the appeal has taken months and had to have a review C & P exam (which I had and have seen the report) and so all requested exams have been done, the lawyers brief are in his hands, so all that wating time has gone by. But once he gets the case, what can be expected? Any ideas? This is the Oakland VRO (I know times vary from RO to RO quite a bit). Any info would be helpful. I know everyone says just forget about it, when it comes it comes. But that's easier said than done. Thanks, John

As of June 4th, my attorney spoke with a person who claimed to be the DRO assigned to my case. They went over the file contents to be sure he had all the relevant material and the lawyers brief and addendum. He did. So from that point on we wait for him to go through his backlog, get to the file and make a determination. Then that probably goes through a process of review and the final report, disbursement orders (if needed), etc. are prepared. It's been over a month and I'm wondering what a reasonable waiting time might. To get to this point with the appeal has taken months and had to have a review C & P exam (which I had and have seen the report) and so all requested exams have been done, the lawyers brief are in his hands, so all that wating time has gone by. But once he gets the case, what can be expected? Any ideas? This is the Oakland VRO (I know times vary from RO to RO quite a bit). Any info would be helpful. I know everyone says just forget about it, when it comes it comes. But that's easier said than done. Thanks, John

As of June 4th, my attorney spoke with a person who claimed to be the DRO assigned to my case. They went over the file contents to be sure he had all the relevant material and the lawyers brief and addendum. He did. So from that point on we wait for him to go through his backlog, get to the file and make a determination. Then that probably goes through a process of review and the final report, disbursement orders (if needed), etc. are prepared. It's been over a month and I'm wondering what a reasonable waiting time might. To get to this point with the appeal has taken months and had to have a review C & P exam (which I had and have seen the report) and so all requested exams have been done, the lawyers brief are in his hands, so all that wating time has gone by. But once he gets the case, what can be expected? Any ideas? This is the Oakland VRO (I know times vary from RO to RO quite a bit). Any info would be helpful. I know everyone says just forget about it, when it comes it comes. But that's easier said than done. Thanks, John

Just went through the same thing. The C & P department can tell you why the exam was ordered (mine was for appeal for an increase in rating). This particular one was for BH (Behavioral Health) and was a review exam (I had the first exam a little over a year ago). The instructions to the examiner are different for a review exam than for an initial exam. You will have to decide if you have had a initial exam to assess what has been ordered this time (i.e. did you have one of these before?). The instructions can be found at: http://www.vba.va.go...exams/index.htm Good luck.

The lawyer filed a brief which puts forth the reasons for the appeal. I realize that IU must be linked to SC conditions which is why the examiner's statement is so important. Also I didn't quote the entire report. The linkage between family disruption, mood disorder and social isolation is linked in the report. The basic history is that before Vietnam I was basically a normal person with no issues of distress and that changed after RVN. I have a wife-support letter (not mentioned by the rater) that traces that chronology and makes that exact point. My 'buddy' letter was not mentioned nor is the letter from my ex-wife. What can a person do about that?

Carlie, Thanks for your help. The following is directly quoted from the exam report: "Axis V - Global Assessment of Functioning Score: Posttraumatic stress disorder with secondary depression, anxiety, and alcohol dependence ( in sustained full rernission) - 45." "The extent of Mr, xxxxs social and occupational impairment is reflected in his Global Assessment of Functioning score above. From a practical standpoint, it is felt highly unlikely that Mr. xxxx will be employed again. His lack of return to competitive employment appears related to the combination of his nedical and mental health problems; however, for the purposes of this ewaluation, his posttraumatic stress disorder with secondary depression, anxiety, and alcohol dependence is considered sufficienl grounds for his unemployability." /s MD (the exam was conducted by an MD, but not a psychiatrist) Also in the record is a report from a VA psychologist assigning a GAF of 32. If one looks at the GAF rating for level 45 and level 32, the descriptions are much more in line with 70% than they are with 30%. For example I don't have "occasional decrease in work efficiency, ...etc", the level of 30% as spelled out in 38 CFR §4.130. I have been unemployed since 1996 and on SSD since 1998. That is a "major occupational impairment" as required by 70% criteria in 4.130. There are several other instances such as mood disorder, social isolation, family disruption, etc. All are called out in the C & P exam report and essentially ignored in the rating decision (the rater didn't mention employment status at all). I am also rated: 20% SC for DMII (A/O presumptive) 10% SC for Neuropathy (secondary to the DMII) 10% SC for Tinnitis 0% SC for hearing loss I have retained an attorney. He filed a power of atty, a copy of our agreement and a cover letter waiving a hearing. I had already filed an NOD before retaining him. I received a notice of a scheduled hearing (anyway) and it lists the CA dept. of Veterans Affairs as my rep. It's like they have never received anything from him, but they have and have acknowledged that and corresponded with him...I'm guessing the new C & P exam is connected to the hearing, but, of course, I can't take any risks and will attend the exam. What I have to report is that not much has changed. I tried SSRIs and couldn't tolerate the side-effects that resulted from my liver disease. I take sleep meds, but since I've been addicted to alcohol, I use them only when I am really sleep deprived. Everything else has stayed pretty much as it was when I was examined a year ago. Any thoughts about how best to proceed?

Thanks for the encouragement. I get your point. Be more complete and describing the problems I've been having. We'll see how it goes. It's just like I feel like I"m playing the lottery (something I don't do) and I don't think the process is supposed to be like that.