12R3G

Whatever you do, don't let the time for filiing a NOD (1 year) get away from you. What did the RO say in the decision? Was his/her assumption that by mentioning Sleep Apnea in relation to your GERD request that constituted a claim for SA? Seems like a reach to me, but I guess it could depend on the wording of the request.

PF occurs when the long fibrous plantar fascia ligament along the bottom of the foot develops tears in the tissue resulting in pain, usually felt at the heel bone. PF can be the cause of heel spurs--calcium deposits on the bone itself. The heel spur can cause pain by pushing into the soft ligament/tissue that surrounds the heel bone. so while they are interconnected and related, they are two seperate issues--one dealing with bone, the other dealing with soft-tissue. File for PF -- pain and limited ROM. If your SMR shows PF, then the VA should directly connect, otherwise you'll have to go for a secondary to heel spurs connection which will probably mean an IME to connect the dots. Good luck chuck

...No. "Depression" is the common term. Major Depressive Disorder is the correct diagnois and is found in 38CFR (ratings schedule) under Diagnositis Code 9440.

CC "Could be QTC, which I don't have the exam results. But what do you do with a blatant untruth?" An IME to go along with the MRI/Neurology reports confirming pain in the legs would be a tremendous help. but, so would a statement from you attached to the reports that refutes the statement and accurately describes your symptoms. If you didn't already, you can ask for a new C&P.

Ditto... I went to my VA mental health intake the other day...when the psych came for me she asked "how are you", to which I replied "fine." I skipped a beat and then told her that "fine" is sorta the expected, automatic response. I was there so I wasn't really "fine". We had our intake inteview and I left after discussing treatment options, an appointment with a psychiatrist and a change in meds (depression). So much for being "fine" My point is that if you were really fine, you wouldn't be there. If you automatically answer "fine" or even "okay"--and if you are like me, that is invariably what how I respond--follow up with a "so much for the automatic social response...now, let me tell you how I really am..." but try not to say anything that indicates you are "fine" Good luck

Major depressive disorder (DC 9440) is the medical diagnosis for "depression".

The VA doesn't have any 4-year olds...or they never played connect the dots. Either way, you have to do it for them. My uneducated guess is that the rater connected flat feet, but gave a 0% rating as he/she could not determine what % to assign as prior to service, and thus the percent aggravated by service. You won't know until you get rating decision and read the Reasons for Decision section. If that is the case, you'll most likely need an indepentdant medical opinion providing that for the VA. Before "appealing", gather additional evidence, IMO, etc. and file a reconsideration request. Much faster. You can still NOD later--just don't go past the 1-year point. While you are getting your IMO (really should be an IME--exam), discuss secondary effects of flat feet. While hips/knees/achilles tendonitis/etc. are common, so are shin spints. I've read, and my PT agrees, that lower back pain can occur or be aggravated by flat feet--has to do with the additional strain and altered movement of muscles compensating for the flat feet and overpronation that goes along with it. If you can't get them SC directly, SC indirectly as secondary to a SC condition: flat feet. Good luck Chuck

According to my VSO, the VA won't accept the CD containing your MRI images...you can print them out and submit. I also carried an image of my cervical spine clearly showing the degeneration and a copy of the radiologist's report to the C&P. Good Luck

I think I had to file the 21-686c with my initial claim. I had to file it again a few months later--they weren't including my daugher who was still in school at the time. That was a one month turnaround and required a letter from the school. For initial, I would use the form and include the documentation it requires (birth certs, marriage licence, etc.). After they get this fixed, any changes can be requested with a letter or 21-4138 and appropriate documenation--say for over 18 still in school. should be fairly quick and should go back to original date of claim.

I suppose you could, but much simpler to either write a letter or use VA Form 21-4138 Statement in Support of Claim (download the fillable pdf). Attach a doctor's letter explaining what's happening and when. If you call the 800 number they will give you the fax number for the VARO, or you can mail. The VONAPP is designed for initial claims...pretty much overkill for what you are trying to do. the 21-4138 fills the bill, and can even be used to add new disablities (which sounds like a new claim to me) after the original claim. Total knee replacement and she is only rated 10%? What's up with that? good luck...

According to my physical therapist--yes...if you overpronate as most do with flat feet, something has to compensate, which causes something else to compensate. It just works its way up the line. Hip, knee, ankle and yes even shin splints are the most common complications/secondary conditions caused by flat feet.

Oh...and keep an eye out for further problems. Over the last year I've developed achilles tendinitis, knee pain, and bursitis on one side and a flare up of shin splints and lower back pain. Yes, all are likely connected to flat feet, the pronation irritates everything.

5276 Flatfoot, acquired: Pronounced; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances: Bilateral............................................................ 50 Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities: Bilateral....................................................... 30 Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral ............................. 10 I'm not sure if the CFR language really helps. I got 30% at my initial C&P, which seems fair. Your doc said moderate-severe (can they not just make up their minds?), so the outcome might depend on the rest of the C&P report. The limit on walking before pain is interesting and encouraging--I could walk longer than that (well, then...).

You don't need N&M evidence for a reconsideration of an active claim (that is, one that is not final and has to be "reopened"). A reconsideration could quite possibly go back to the same rater that denied or low-balled your claim in the first place. You can (and really should) submit additional evidence, ask the rater to reexamine the file, and request a new C&P. I filed a 21-4138 requesting reconsideration of my claim. I did submit an MRI and radiologist report to the VARO and had a new C&P which resulted in a staged award to 20% from 0%. The VARO did send the standard letter asking me to send any additional info for consideration, but did not require "new & material". To be fair, I didn't ask for a reconsideration of any denied conditions, everything was at least 0% SC...still, if you are filing within the first year, shouldn't need N&M since it's still an open claim. but to answer the original question--yes, a reconsideration can trigger a new C&P. Makes sense--you are essentially asking them to reevalute your open claim because they got it wrong the first time, and that could include the result of the C&P.

Glucose tabs work...but you're right, not very tasty; most likely on purpose B) Sweet Tarts work great--the smaller ones are 1 carb per piece, the larger (the ones in the rolls right next to the point of impulse purchase, AKA the cash register) ones are 3 carbs each. I have my wife carry them in her handbag when we are travelling togeather--always nearby, but not so near.

Neuropathy is rated seperately for each limb--so each limb will get a rating based on the diagnostic codes in the ratings table--it's the 8000 series of codes (check 8523 for right lower, and 8623 for left lower extremity?). DMII ratings are based soley on the DM: 20% is typical and covers most of us on oral meds, diet, exercise and even insulin. 40% adds a doctor ordered restriction of activies (you get too many lows and have to reduce your physical activities to compensate). DM is a Coronary / Artery (CAD) like disease, so yes, the heart could easily berelated to DMII.

Try the American Board of Independent Medical Examiners Search by state...

Since there is no timeline that the VA must follow when processing claims...the only answer is "it depends". Sounds like a rater has your file and will render a decision whenever he/she gets around to it, and that depends on case load which varies by VARO. Maybe fewer vets filing claims at your VARO (as compared to say, VA with a boatload of vets), but probably few ROs as well. But, to put it in perspective. I filed new claims and for reconsideration on a couple of issues in Nov 2008. The rating decision was dated 2 April 2009. Then in uncharacteristic speed, they took only 2 months to reprocess the reconsideration of one of the issues from the Nov claim--the VA had ordered a QTC C&P exam, but I was never notified. A new C&P was scheduled for 11 May (some of that delay was at my request) and the rating decision was dated 4 June. Hope that helps....

Well, decided to add the VAMC (Hampton) to health care lineup. Since several health issues are service connected and I really should have some specialists involved, it seemed like a good idea. Got an intake appointment fairly quickly--like 2 weeks--so that seemed okay. Made the appointment yesterday with interviews with Nurse, followed by Nurse Practitioner (long interview). At the end, she tells me its now taking 6 months to see a PCP and that's what she would put in my notes, but when the front desk would assign the PCP during checkout and they might schedule me as far out as 9 months!!!! I was a little stunned by this...so didn't even question her. Then the front desk couldn't figure out what to do, so I left with nothing but a phone number to call back. Called this morning, and spoke to someone at the front desk of the primary care clinic I visted yesterday. Now the story is that the N/P recommended a 6 month follow-up (huh?) with a PCP. Now I'm asking questions, but the runaround is that they are both saying the same thing, just using different language. Well gee...ya think? "6 month wait" is not the same as "schedule for followup in 6 months", at least not in english. Only the PCP can schedule specialty consults (except Mental Health, which the N/P did). I really need a couple of consults...but to wait 6 months? Is this right? should I call the other primary care clinic (where my PCP is assigned) to get an earlier appointment? Any suggestions?

One obvious thing we can all do is write to our Senators and Representatives. Tell them your story (just the facts ma-am--no emotional tirades) and provide a link (or the URL) to the House Veterans Affairs Committee hearings testimony by Mr. Strickland. Squeaky wheels do get grease, Congress does actually listen to their constituents (plural). Our contribution to politics does not end at the ballot box. 3(?) years ago, Rumsfeld wanted to double/triple TRICARE premiums for retirees virtually overnight. MOAA stapled pre-written/pre-addressed postcards to it's monthly magazine. The postcards went to MOAA members' congressional representatives of both houses and to relevant committee chairs. MOAA members were encourage to invest a stamp, sign, perhaps add a short personal comment, and mail. At committee hearings, DoD executives were faced with stacks (literally thousands) of post cards in front of the committee members table. Yes it had an impact, and despite 2 more annual attempts there is still no increase in TRICARE premiums. Gates didn't even try last year--he said 3 times getting hit by a 2 x 4 was enough! My point is that if we continue to raise these issues with our representatives they can't help but notice. Better, after describing the problem, outline a potential solution (which is exactly what Mr. Strickland has done). Don't just hope "...someone listened...", to Mr. Strickland, make the right people do listen: your representatives. After all, you hired them, and they write the rules that both we and the VA must adhere to.

Nothing is permanent with the VA If you are scheduled for a C&P, you have to go; otherwise the RO can use that as justification to reduce your award. Unless you have had your award for >20 years, it's not protected (lots of info on hadit regarding rating protection). I'm betting that if you check your original award, you'll find a statement in the decision that states your condition may improve and you are subject to reevaluation. Since you were on the TDRL precisely because your condition could improve, I doubt the VA would have considered your disability rating as P&T. It's all speculation...I'd call and ask "why?". Best prep is this site, and a through review of the clinicians guide, 38 CFR, M21-1--all are available on the VA's website.

I saw this topic in the "Member Needs" forum, but it's a pretty old thread and thought I'd post it here as well. The original question asked about carrying a CPAP on commercial airlines. I travel frequently and carry a CPAP. Under TSA guidelines (and mirrored by the airlines), CPAP is medical equipment and there is virtually no restriction to the medical equipment that can be carried aboard an aircraft. CPAPs and other medical equipment are in addition to the usual "1 carry-on & 1 personal item" limit. I've been asked all of twice about my "3rd bag" (the CPAP)--once by an airport employee at the entrance to the security line and once at the gate. "Medical equipment/CPAP" ended the discussion. Most gate agents have seen enough CPAPs that they recognize the bag and ignore it. TSA will screen for explosives (I don't get it either, but hey...its the same goverment that created the VA). You can greatly speed and simplify the process by removing your CPAP from the bag and placing it in bin (doesn't have to be in a seperate bin unlike laptops and now shoes [shoes?]). That way, the TSA will take the CPAP and test, leaving the bag and its contents (mask, hoses, humidifer) untouched. If you leave the CPAP in the bag, then the CPAP, the bag and it's entire contents will have to be screened for explosives. Believe me, MUCH easier to just put the CPAP in a bin and keeps TSA workers from touching your mask/hose, etc. Those gloved may protect them, but unless the screener puts on a fresh pair (and will if you ask), they don't protect you! http://www.tsa.gov/travelers/airtravel/spe...eeds/index.shtm

True...that's one major difference between VA and commerical loans. Commercial lenders and Realtors have a vested (financial) interest in the house you are buying passing inspection and appraising for at least the contracted purchase price. The lender chooses the appraiser, and one of the realtors/parties (whoever is paying chooses) picks the inspector. The lender wants an appraiser that will figure out a way to appraise the house so the loan will be approved; everyone "wants" the inspector to find no, or few, defects and most importantly, no major, show-stopping, problems. Appraisers who value homes below contract price too often, and inspectors that find too many problems too often don't get phone calls. I read a few articles pointing fingers at the appraisal system we use as being complicit in the housing meltdown by causing homes to be overvalued. The VA is a bit more involved in the appraisal and inspection process, and doesn't allow the seller (or buyer for that matter) as much leeway in determining what will or won't be repaired based on the inspector's report (which was probably more thorough if a VA inspection). With a commercial loan, what gets (or doesn't get) repaired is pretty much a seperate negotiation between buyer and seller once both have reviewed the inspection report. Concrete example: I purchased on house that, based on a roofing contractor's inspection, needed a new roof. Using 3 estimates of cost, I negotiated for the seller to pay me 1/2 the average cost of repair at closing. I never replaced the roof--as far as I know, it's still functioning just fine (I sold the house 4 years ago). The VA would most likely required the seller to repair the roof before approving the loan. I am certain my seller would have backed out of the deal at that point--he didn't want to put a dime into repairs.

9432 Bipolar disorder -- it's a "Mood Disorder" in the ratings tables. Bipolar disorder is also known as manic-depressive illness.

"mortgage insurance", ususally referred to as "PMI" (Private Mortgage Insurance) is an additional monthly payment if your FIRST mortagage if for more that 80% of the purchase price. $100k house, $80K First mortgage, no PMI...anything above will require you to pay PMI. This is the bank's insurance should you default on your loan. The VA home loan advantage is a no (or much lower) downpayment, no PMI and, in some areas, higher "conventional" loan limits (short answer, conventional = lower interest rate, jumbo = higher interest rate) than would be available with an FHA, or commercial loan. Disabled Vets--receiving compensation--are exempt from any VA funding fee (not to be confused with the lender's origination fee which, among other things, pays the loan officer's commission on the loan). In an odd loophole that only a banker could understand, you can borrow more than 80% of the purchase price of your home using a commerical loan and not have to pay PMI each month. If the lender will go for it (might be a little harder in today's market), you can obtain a first mortgage equal to 80% of the purchase price (no PMI), add a 10% cash downpayment, and borrow the remaining 10% using a second mortgage--closing both loans at the same time. Bankers refer to this as an "80-10-10" loan. While the second mortgage will have a higher interest rate than the first, you'll probably find the monthly payment for the second is less than what the PMI would cost. PMI is lost money to you and is not tax deductible--it only benefits the bank (and the insurer). Second mortgage payments pay down principal on the loan (increasing home equity) and the interest payments ARE tax deductible. Strange, but true--I've used this technique. Why go commercial vs VA? Interest rates (generally less), underwriting (my experience is that the VA is actually tougher on underwriting than commercial loans since the government is on the hook if you default). I've done VA (2 loans, and probably a 3rd when we move), FHA (2 ?), and commercial (8?) including purchases and refinances. Each has their slightly different standards and quirks. All of them are paperwork nightmares.