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Everything posted by Vync

  1. You might still be able to get some other conditions SC as secondary, if you have them: You have a lumbar rating. If you have sciatica, pain, and/or numbness shooting down your legs, you can file for radiculopathy secondary to the lumbar. The VA gave me NSAIDs (i.e. ibuprofen, naproxen) for decades to treat my SC musculoskeletal injuries. It left me which chronic GERD/acid reflux, so I got that SC as secondary. Do your SC disabilities leave you feeling depressed or cause anxiety? Consider filing a mental health claim as secondary.
  2. Any increase is good, but it always helps to ensure they rated you correctly so you don't get low-balled.
  3. @shrekthetank1 Be sure to tell them you are a veteran. If you end up getting admitted, expect them to ask you if you are willing to transfer to the VA. Always say YES. If you say no, then the VA will not pay for the treatment. After you get released, definitely contact the VA hospital to let them know.
  4. I got the initial 10% and appealed because they completely overlooked the symptoms that qualified me for 30%, just like the veteran did in her BVA appeal. I'm at 30% now for the combo of GERD/IBS.
  5. No worries at all. I saw your approach and just wanted you to be aware of why they probably combined the two conditions. Because they are separate conditions (despite what the VA thinks), it still is a good idea to attack them separately to ensure both get SC eventually and prevent any confusion.
  6. That is strange. They might be having trouble with the number in your area. I just called 1-800-827-1000 and wait until the robot asks me to describe my reason for calling. I just say "claim status", then it prompts me to enter my info and routed me to an agent.
  7. Yes, it can tricky because of how things are broken out in their ruling. Here the BVA stated how they determine which evaluation % will be applied: Here's the linear timeline of when and what happened (extracted from the entire text): Initially rated at 10% at some point Sep 2004 filed for increase Jan 2005 VARO continued the 10%, she appealed Jan 2006 VARO continued the 10%, she appealed May 2007 DRO granted 30%, backdated to Sep 2004 when increase was requested, she appealed to BVA because her symptoms warranted a higher rating. This is a good example of the VA awarding an increase, but not necessarily the correct rating. Feb 2008 C&P showed she had symptoms in the 60% range. They probably sent her to a C&P to get a current assessment. May 2009 BVA ordered increase to 60% The BVA explains why she qualified for 60%:
  8. That is just bizarre. Well, you'll find out something soon.
  9. Whoa. When I got it, it was from the specialist doc at the VA allergy clinic. My primary care doc said they could not request it.
  10. Good deal. You still might be held up by the intake team, but it is worth a shot. At some point, you will get a diagnosis. They might start off with an adjustment disorder, but over time it may change into something else once they deem you have met the criteria. Regardless of the type or number mental health diagnoses, the VA will only grant a single MH rating. Your diagnosis may change over time. You don't need to have a currently diagnosed mental health condition. The VA will do a C&P exam and might make an initial diagnosis of some sort at that time. If they don't do it at that time, it still might not be bad. There is a concept called "relative equipoise" (a.k.a. benefit of the doubt). If evidence for and against SC is equal, the VA is supposed to find in favor of the veteran. A good example might be a situation where the C&P MH doc says they cannot opine without mere speculation, but you have the buddy letters from yourself and wife, plus whatever else could have been pulled from your service records. In that case, the VA may consider benefit of the doubt. I got my initial MH rating for depression secondary to pain from SC musculoskeletal disabilities SC'd in that manner. I did not have a history of MH visits at that time and the C&P doc did the "mere speculation" thing.
  11. I'm used to reading the BVA stereo instructions. Found the post here: https://www.va.gov/vetapp09/files2/0919318.txt Yup, you are right. That is the pyramiding rule at work (38 C.F.R. § 4.114). It prohibits granting separate ratings for GERD and IBS. They look at symptoms of both and grant a percentage based on the higher of the two. The lower of the two is still SC, but considered a non-compensable 0% rating and does not get factored into the overall combined rating calculation. That's exactly what they did to me, but I'm only at 30%.
  12. @Berta the link to the Hagel Memo did not show in your response. @usmcrm65 In addition to the good advice above, you can also visit a Vet Center if you would like to talk to someone face to face. Calling the crisis line is also very helpful, but you don't have to be in crisis. After my heart attack, I called them a couple of times to help deal with anxiety. They are also there 24 x 7. Having a claim in the hopper is a good idea. Just keep in mind that the status may bounce back and forth. Don't let that discourage you. At some point, you will get a phone call or a letter in the mail regarding an upcoming Compensation & Pension (C&P) appointment. I included a list of Disability Questionnaires (DBQ's) which the VA uses to perform these exams. This will give you an idea of what kind of questions will be asked during the exam. https://www.benefits.va.gov/compensation/dbq_listbydbqformname.asp If your mother happens to be available, you may consider asking her to write you a buddy letter to describe what she observed back then. More information about buddy letters can be found elsewhere here on hadit.com. If you have not done so already, get an online account for ebenefits and va.gov. Once you get the account validated, you should be able to check your claim status online.
  13. Many of the new meds are considered by the VA to be non-formulary, meaning they don't normally have or prescribe them. However, that doesn't mean they can't get or prescribe them. Back when Singulair (Montelukast Sodium) hit the market, it was touted as a breakthrough asthma/allergy drug, but the VA refused to prescribe it because it was deemed non-formulary and not available as a generic. My VA doctor, a specialist, got with the pharmacy and requested approval to prescribe as non-formulary. Of course, they had to ensure all the other standard of care options were tried and ineffective. Eventually, the request got approved and I started receiving it in the mail each month. After the med went generic, they started shipping me the generic instead.
  14. This could be accurate or just another case of ebenefits statuses being as accurate as the people who update them. While waiting on the IRIS response, you could always call 1-800-827-1000 and see if they can peek under the hood. They will not be able to tell you much, but it should be at least a little more than what you can see on the web site.
  15. Good plan on submitting the IRIS inquiry. I have heard of the VA changing a requested disability name to something more in line with the rating schedule, but not this. Did you ever give a POA to a VSO? That would give them rights to file on your behalf and without your knowledge. However, you should have at least received a decision letter at some point.
  16. Sounds interesting. I believe there is a reg that states that if you are SC for two different disabilities at 0%, they will grant a combined rating at the 10% level. Not sure about what you described, but I'm going to try and see what I can find.
  17. Yup! It's a simple case of "trust, but verify." The VA is well known for errors at all levels. Even though CUE reviews are supposed to be more experienced employees, they are as human as we are. I trust they are supposed to know the laws, but I had to comb through the Federal Register to sift out the exact regulations in effect at the time the errors were made on my claims. That was a lot of work. I decided to spell out the relevant laws exactly as they existed when they made the errors. I even added the year/date/FR reference #'s when necessary. Spoon feeding them can make their job easier, save time, and hopefully reduce or eliminate the chance that they will screw up again.
  18. I took a look at your documents. Looks like Dr. Bischoff was very abbreviated. Did you happen to serve in Southwest Asia? If you did, look up the Gulf War presumptive illnesses. If you meet the criteria for serving there, that considerably changes the standards they must use when exploring gastrointestinal issues and granting SC. 38 CFR 3.03(b) shows what the VA may have used to define chronic. I bet the VA examiner (rater) looked for the term "chronic" and didn't see it, but may not have understood how the VA defines chronicity and continuity. This might be a helpful addition to back up your CUE if you need it. Based on your STR exhibits, it looks like you have quite a history of diagnosis and treatment for GERD and IBS while in the service and afterwards. Even if you only had a couple of treatments in service, the last two sentences support cases where a condition is not deemed chronic, but continues after service. Even if you win SC, you should expect the VA to combine GERD and IBS together. That's due to this which is found here: §4.114 Schedule of ratings—digestive system. I won SC for both GERD and IBS and was awarded separately. Later, the VA called CUE and combined them due to that paragraph. They just give you a single rating, but it will be the higher of the two. That might take the air out of your complaint that they rolled them together, but still focus on each separately and see what they do. Some have written elsewhere that if you have to describe a CUE then you don't have a CUE. However, I don't believe that. One thing I did differently in my CUE was to describe how the specific legal requirements of 38 CFR (whatever) were not met. In the case of 38 CFR 3.303(b), you could reinforce it with the number of manifestations (times you sought treatment) of each condition during and after service (but before the date of the rating decision).
  19. It can vary depending on the level of staffing, kind of organization, and any health insurance requirements (if applicable). My first intake visit at the VA was with a psychologist, who referred me to an LCSW. However, when I went to a non-VA MH doc, my intake was with a psychologist and I stayed with them for follow up visits. After my heart attack, I was living in anxiety city. The VA let me see a psychologist and I have stayed with her for follow up visits too.
  20. @paulstrgn is correct and was probably done to keep the accounting as simple as possible. If I am not mistaken, here's how they determine when payments are made. The criteria appears to vary depending on some situations. 38 CFR § 3.31 - Commencement of the period of payment It's a shame the VA rips off veterans by not awarding partial month payments. I wonder if any law firms have ever sought to challenge this. If we are late paying our taxes, the IRS charges interest for each day late. When it comes to paying veterans, they can get away with not paying up to 30 days of payments. Could be a lot of money for veterans with higher ratings.
  21. @Foxhound6 That sounds correct: depression/anxiety as secondary and insomnia as new, but they could change it at some point after processing everything. The rating criteria for mental health disorders is here: §4.130 Schedule of ratings—Mental disorders. The VA will only assign a single mental health rating regardless of your diagnosis. They rate it based on symptoms indicated in the criteria. VES will have access to your STRs, everything you can access via MHV's blue button, plus your entire claims file. Some examiners may go through all that before your visit and others afterwards. Sometimes both. It never hurts to bring them along with your profile statements, but don't expect the examiner to go through them while you are in their office. They normally don't have time for that. They are there to fill out the DBQ and render an opinion. One more thing. If you happen to have any non-VA treatment records which are pertinent to your claim, be sure to provide a signed release of medical information authorization form. That way the examiner can look at copies you provide plus they can request them directly from the non-VA doc (for verification). If you don't provide the authorization form at the same time, they VA will have to mail the authorization form to you and wait for you to send it back before being able to request copies directly.
  22. Well, if you submitted it then you probably felt it was good to go. I didn't go over your final submission, but you appeared to be on the right track. With any claim, it is nice to get a fast win, but for CUE claims, it is important not to rush. Regardless of the outcome, when they complete the CUE, I recommend you do what I will do. In 2000, I made the mistake of blindly believing the VA was thorough in their decision and just accepted the awarded ratings that arrived in the mail. This time I am going to go through their response very carefully. Did they correct the errors? Did they award the proper ratings? If not, was their reasoning solid? It is possible they might be correct or they very well could have committed another CUE. If another CUE happened, I'll just file another one. My CUE submission was chewed on for quite a while. Having the help and guidance of other members here was greatly appreciated. Probably the toughest part I had was trimming out the unnecessary parts, focusing on each issue, and explaining the error clearly so a reasonable person would see which laws were never applied or were applied incorrectly. One other thing that I did was call the White House VA Hotline and file a complaint about the VA web site being unclear about CUE forms. The VA goes out of their way to tell veterans which specific form they need to use to file different types of claims. However, they completely fail to tell veterans which form should be used to file a CUE. The HLR form does have a section where you can indicate if you feel an error was made, but you have to dive into the actual form to get there. If they want us to use HLR or another form, then need to tell us. I'm still not certain that it was the correct form. I filed a complaint at the WH VA Hotline asking that the VA update the CUE pages with specific instructions on what to do and which forms are required (now that the VA is mandating certain claims be filed on certain forms). Now comes the wait that we all know too well. I'm just staying busy with other things and checking on it weekly just to keep my curiosity satisfied. Mine still shows estimated completion in March 2020, but who knows. Will find out eventually.
  23. You are doing the right thing by getting this ball rolling. The intent to file was the right thing to do. It gives you a year to formally open a new claim by filing a VA Form 21-526EZ and including a release of medical information authorization form. Just be honest and natural. Explain it just as you did in your post. It came across pretty clear to me. Give examples of the episodes. Consider writing down on paper each issue causing you problems so that you don't forget anything. The first visit is also referred to as an intake visit. They may take a bit longer than follow up exams because they are trying to get a good idea of what is going on. The doc will note things down from your perspective. They may not make an initial diagnosis (which is ok). Sometimes mental health conditions may take a while to accurately diagnose. As far as what the VA can use, I would not worry about that just yet. Get to know him and let him get to know you. After your first visit, come back and search Hadit for nexus statements, IME's, or IMO's. When it comes time to formally open your claim with the VA, they may send you to a separate C&P exam. That doc will have your records and independently verify. You can also ask your non-VA doc to fill out a disability questionnaire and write a nexus/IMO/IME. The VA DBQ's can be found here: https://www.benefits.va.gov/compensation/dbq_listbydbqformname.asp
  24. It is pretty common for the VA to merge some conditions together. Insomnia is a symptom that can be found on the mental health rating criteria. However, it is possible that it could be a sleep disorder that is found to be completely separate. Consider taking a look at the VA's Disability Questionnaires (DBQ's): https://www.benefits.va.gov/compensation/dbq_listbydbqformname.asp They contain the questions that the C&P examiners will ask. It is always a good idea to read through the questionnaires to get in idea of what to expect for each condition. The depression/anxiety DBQ's are here and separated accordingly: Mental Disorders (other than PTSD) Review Post Traumatic Stress Disorder (PTSD) If you have any non-VA treatment records, get copies and bring them with you. Never give them your only copy or originals. The C&P examiner may not always accept the records (wanted you to be aware of that). Don't be late. If you have a very legitimate reason you cannot make the appointment, contact them as soon as possible and request to be rescheduled. Look/search here on hadit.com for other C&P advice.
  25. Go through your medical records for the 12 months prior to when you requested the increase. Compare them to the rating criteria for the conditions which you requested to be increased. If you meet the criteria, ensure the VA gets those records. This is important for claims increases because the VA can adjust the EED of each specific rating back to when you met the criteria up to 12 months before you filed. Because it is tough to go from 90% to 100%, if you are successful it could back the effective date up a bit and mean a bit more retro money for you. Some additional information may be found on my blog entry:
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