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Vync
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Posts posted by Vync
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I'm not an expert on SMC-S, but did have it for a few months and will try to describe my interpretation of it.
Think of service connection (SC) as direct or secondary. Direct SC means it is not related to any other disability. Secondary is as a result of another disability or the side effects of treatment of another disability.
Separate and distinct means the two percentages cannot be related to each other or one being secondary to another.
Example 1:
Vet has 100% for PTSD.
Vet also has a separate 60% rating for something completely unrelated to their PTSD.These are separate and distinct.
Example 2:
Vet has 100% for PTSD, but secondary to that they have a 60% rating due a disability secondary to PTSD.
These ARE NOT separate and distinct because the 60% is secondary to the 100% for PTSD.
I hope this is helpful. I expect other members to comment, too.
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Thank you for sharing this information. It's ok if you don't know all the terminology or jargon.
Was yours a legacy claim, Higher Level Review, or formal appeal to the Board of Veterans Affairs?
I don't want you to worry, but some of us (including myself) have been told they are siding in our favor, but when the decision letter arrives we find that we were denied to some extent. We all have our fingers crossed that they really will find in your favor. If you have a VSO who has access to the VA system (VBMS), they can look up decision letters and tell you what was decided before it arrives in the mail. In the end, it is a case where you really don't know for certain until the decision letter arrives. Additionally, even if they find in your favor, double-check everything. The VA is supposed to maximize benefits, but often misses things or low balls ratings. Trust, but verify.
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@Freedom101 I just received an email from the VA giving the usual status update:
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On 3/13/2024 at 8:52 AM, Freedom101 said:
Any update on yours? 10/02/2020 was my file date and 02/26/2024 it was finally assigned to a judge so hopefully anytime now.
I have not checked it for a bit, but as of this morning no change from the "waiting to be assigned to a judge" status.
It is promising to learn that your appeal, which is about 3 months older than mine, actually did get assigned to a judge. Did you have a hearing already or did you waive that option?
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Welcome to Hadit!
This information might be helpful, but this only mentions apportionment to spouse, children, or dependent parents based upon need, however siblings are not mentioned. Call 1-800-8727-1000 or an accredited VSO to learn more. I hope this helps!
https://www.benefits.va.gov/persona/veteran-incarcerated.asp
QuoteApportionment to Spouse or Children
All or part of the compensation not paid to an incarcerated Veteran may be apportioned to the Veteran's spouse, child or children, and dependent parents on the basis of individual need. In determining individual need, consideration shall be given to such factors as the claimant's income and living expenses, the amount of compensation available to be apportioned, the needs and living expenses of other claimants as well as any special needs, if any, of all claimants.
Additional Information:
- VA will inform a Veteran whose benefits are subject to reduction of the right of the Veteran's dependents to an apportionment while the Veteran is incarcerated, and the conditions under which payments to the Veteran may be resumed upon release from incarceration.
- VA will also notify the dependents of their right to an apportionment if the VA is aware of their existence and can obtain their addresses.
- No apportionment may be made to or on behalf of any person who is incarcerated in a Federal, State, or local penal institution for conviction of a felony.
- An apportionment of an incarcerated Veteran's VA benefits is not granted automatically to the Veteran's dependents. The dependent(s) must file a claim for an apportionment.
This is a link to M21-1 which is the VA's internal processes. It goes much deeper into it.
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I do not know if this is rolled out everywhere, but wanted to share my experience. I had a pre-scheduled appointment at my VAMC. Of course, I was bombarded by letters and text messages reminding me about the appointment. However, when I was driving to the hospital, I received a different text asking me to check in remotely. Once I got on the premises, I used the feature to check in. It was pretty simple. What surprised me was it asked if I wanted to file a travel claim for this specific appointment. I decided to give it a shot. It appears to have worked. I checked the travel web site and found the claim showing as "claim submitted". I kind of doubt this would work for community care, but have not tried it yet.
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@Lemuel No worries. Each party has their own set of pros and cons.
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Welcome to Hadit!
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Right now, everything is pretty much backed up unless you have a reason to expedite processing. The front of the line is now generally for hardship, terminally ill, over 75, legacy, and PACT Act (which opened the doors to a ton of new claims). The VA keeps hiring, but they have always seemed to be perpetually understaffed.
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On 2/20/2024 at 12:40 PM, Lemuel said:
As I said. They are obviously cutting entitlements the way Reagan did in the 1980s. And they are going beyond U S Code as they did then. Do not understand why under a Biden Administration. Would understand under GOP. But then the Military Industrial Complex lobbies local directors. Maybe some bribes there because of the competition for Budget dollars.
I understand what you mean. I did not want to stride into the political realms per the site policy (unless it has recently changed). I believe everyone is entitled to their opinion. I remember when Reagan gave active duty the largest pay raise in decades. Also remember the Graham-Ruddman and Clinton consolidation/draw-downs. Kind of sad to see Army bases where I grew up getting turned over to host countries simply to be demolished. But that is another story (to quote Paul Harvey).
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@Lemuel I submitted a couple late last month via the online system. I would have had a third submitted, but the system would freeze and I had to call they helpdesk. They are being processed at my local VAMC. They approved one and are still working on the other (which makes no sense).
Per the original post's topic:
I also submitted a few more this morning. One of them was for imaging tests and the other was for an ER visit. In both cases, my primary care either had me scheduled solely for that visit as an appt or asked be specifically to go to the ER and get more imaging done after hours. For those two, I chose round trip based reimbursement. It's stupid that someone snuck in one-way payments... -
On 1/30/2024 at 8:35 AM, tazntaylr said:
26,290
Appeals ahead of you
Just curious, but how did you get that number?
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Best of luck! Please let everyone know how it turns out!
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@mayertucker Like the others who have responded, I strongly first finding a reputable lawyer like NOVA or others. The SF-95 seems like a simple form, but knowing what you need to put in every field is a bit.
I filed an FTCA on my own and won a settlement. Despite almost dying, it took about two years to complete (during COVID).
Look up @Berta and FTCA or 1151 here. She is no longer on Hadit though, but had filed a number of them. Keep in mind that FTCA wins or settlements means they pay you money, but 1151 means service connection just like any of your other service connected disabilities. In some cases, an "offset" might apply, but you'll have to research that on your own. 1151's can be filed at any time.
They said my case was presented to three VA doctors for review, but only one was against my claim. If offered a settlement, you can present and justify a counter offer. When the settlement is accepted, you have to sign a release not to hold the VA legally liable for the injury. However, they would not provide copies of the VA doctor's findings or how the settlement was calculated.
My care providers over a 5 year period prior to the injury were doctors, student doctors, contractors, and lesser staff like nurses, nurse practitioners, and physicians assistants. Some were direct VA employees while others were not.
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@Legiboka Welcome to Hadit!
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@Atlcocky Glad to hear they finally got it all sorted out!
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@Atlcocky How did you end up getting the corrected EED? I have a similar situation where several initial issues were filed in 1995 and ultimately denied in 2000. About 10 years later I filed again and got them SC, but the VA did not assign an EED back to 1995.
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14 hours ago, jamescripps2 said:
she would qualify for $16,012.74 per month at the 2024 DIC pay rate
@jamescripps2 I think that amount is just a bit off... Per https://www.va.gov/disability/survivor-dic-rates, the 2024 base DIC rate is $1624.75.
@LESASSIER The video provided by @jamescripps2 is really helpful. There are other calculations that can factor in depending on your circumstances at https://www.va.gov/disability/survivor-dic-rates.
Keep in mind I do not know much about DIC, but hope the information is helpful.
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Just now, shrekthetank1 said:
I will update once it moves forward.
As will I. Personally, I hope everyone's appeals get handled tomorrow, thoroughly, and accurately. I realize that is wishful thinking though...
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@shrekthetank1, @pacmanx1, and @rentalguy1, thank you for your updates! It seems to be the same thing which I dealt with back in the 90s. Hasty analysis and inability to follow the laws/regs...
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Just curious where everyone else is sitting with their BVA appeals.
This month, my BVA AMA appeal turns 3 years old. It was an appeal of a CUE denial I submitted in 2019. The BVA received my appeal in January 2021 and the video hearing happened in December 2022. VA.gov still says it is waiting to be assigned to a judge to make a decision. I realize there are a ton appeals ahead of me as I am not terminally ill, not over 75 years old, not having a financial hardship, not having a legacy appeal, and not a PACT Act/Toxic Exposure appeal.
Not only did I receive one copy of this email today from the VA, but they were nice enough to send me a second copy of it! Bonus!
QuoteDear Vync,
Your appeal, docket number 2101##-######, at the Board of Veterans’ Appeals continues to be in Appeal Docketed status. We must work cases in the order in which your VA Form 9 substantive appeal (for Legacy) or VA Form 10182 (for AMA) was received and we will update you with any progress.
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@Dustoff1970 Yep. The old worksheets did offer greater flexibility to the examiners because they could use as much or little space as needed. They did have template files which they used to fill them out so if they needed more lines to answer questions, they were not constrained. But that second screenshot I posted, it's like either you have painful motion or you don't. Of course, the examiner took lots of handwritten notes which contained more favorable and easier to understand comments than made it into the report.
The newer DBQs do have checkboxes to make things easier, but if I were to take the heart exam to a civilian doc, they would be a bit lost. It is almost like the VA made them so "busy" as to require a special training course just to understand how fill them out.
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@rentalguy1 That guide from 2002 does look familiar. Back then before they used DBQs, the VA used to use "C&P examination worksheets" which told the examiner what to check and then they would document the findings separately.
Here is an actual redacted copy of the dental exam worksheet that was in effect around late 1997:
The examiners would type up their findings using letters and numbers which contained the findings for each question. At the time, the VARO staff had a copy of that guide and could look up what was being asked so they could compare it against the laws, regs, and rating criteria. However, after filing a CUE on one of my exams from the late 90s, the VA denied and said they did not know what questions were being asked for each letter/number. Apparently, they were not able to locate the guide you posted. It's almost as bad as digging through old copies of the Federal Register to see how laws/regs read at certain points in time, except I could never locate this clinicians guide (thanks for linking to it).
With the advent of the modern DBQs, that changed a lot of things. I don't know which or any sections of the old clinicians guide may still be relevant. In general, based on my experience, the VARO's probably do not know either!
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The rating criteria for asthma is under 38 CFR 4.97: https://www.law.cornell.edu/cfr/text/38/4.97
Quote6602 Asthma, bronchial:
FEV–1 less than 40-percent predicted, or; FEV–1/FVC less than 40 percent, or; more than one attack per week with episodes of respiratory failure, or; requires daily use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications 100
FEV–1 of 40- to 55-percent predicted, or; FEV–1/FVC of 40 to 55 percent, or; at least monthly visits to a physician for required care of exacerbations, or; intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids 60
FEV–1 of 56- to 70-percent predicted, or; FEV–1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti-inflammatory medication 30
FEV–1 of 71- to 80-percent predicted, or; FEV–1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy 10
Note: In the absence of clinical findings of asthma at time of examination, a verified history of asthmatic attacks must be of record.Taking the PACT Act approach, as long as you meet those qualifications and have a current asthma diagnosis, you should likely get SC presumptively for asthma.
As far as ratings go, I made the 30% criteria bold for emphasis. The presence of the word "or" means you can qualify for 30% if you meet any of those criteria, not all or multiple. Hypothetically, use of inhaled steroids alone would equate to a 30% rating.
Be sure to read the higher percentage criteria for 60% or 100%. Your PFT results could qualify you for either of those. Again, keep an eye on the presence of the word "or" for other possible ways to get a higher rating. Regarding steroids, the term "systemic" means administered by swallowing, injecting, or via IV. For the "intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids", if you get to that point the VA may grant the higher rating, but only as a temporary rating to be reviewed later because they expect you to improve.
Good luck!
VA ER fails to address severe pain. Advised to take Tylenol
in VA Disability Claims Research
Posted
@FloridaNative I can definitely sympathize with your situation.
Around 2011 was a big push to get marijuana legalized. The FDA suddenly changed their guidelines for prescribing opiates. Almost overnight, the VA docs began refusing to issue or renew opiate prescriptions without a lot of headache and outright refusals.
The VA medical centers had a "VA patients bill of rights" posted all over their facilities. With it was a right to have your pain treated. That section seemed to disappear for a while. However, it is back as of checking this morning at https://www.va.gov/health/rights/patientrights.asp
That sounds promising, but it has became increasingly more difficult to get effective pain treatment lately. And what works for one vet might not work for another.