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[Federal Register: August 24, 2009 (Volume 74, Number 162)] [Proposed Rules] [Page 42617-42619] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr24au09-15] ----------------------------------------------------------------------- DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 3 RIN 2900-AN32 Stressor Determinations for Posttraumatic Stress Disorder AGENCY: Department of Veterans Affairs. ACTION: Proposed rule. ----------------------------------------------------------------------- SUMMARY: The Department of Veterans Affairs (VA) proposes to amend its adjudication regulations governing service connection for posttraumatic stress disorder (PTSD) by liberalizing in some cases the evidentiary standard for establishing the required in-service stressor. This amendment would eliminate the requirement for corroborating that the claimed in-service stressor occurred if a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD, provided that the claimed stressor is consistent with the places, types, and circumstances of the veteran's service and that the veteran's symptoms are related to the claimed stressor. This amendment takes into consideration the current scientific research studies relating PTSD to exposure to hostile military and terrorist actions. It is intended to acknowledge the inherently stressful nature of the places, types, and circumstances of service in which fear of hostile military or terrorist activities is ongoing. With this amendment, the evidentiary standard of establishing an in-service stressor would be reduced in these cases. This amendment is additionally intended to facilitate the timely VA processing of PTSD claims by simplifying the development and research procedures that apply to these claims. DATES: Comments must be received by VA on or before October 23, 2009. ADDRESSES: Written comments may be submitted through http:// www.Regulations.gov; by mail or hand-delivery to Director, Regulations Management (02REG), Department of Veterans Affairs, 810 Vermont Ave., NW., Room 1068, Washington, DC 20420; or by fax to (202) 273-9026 begin_of_the_skype_highlighting (202) 273-9026 end_of_the_skype_highlighting. (This is not a toll free number). Comments should indicate that they are submitted in response to ``RIN 2900-AN32--Stressor Determinations for Posttraumatic Stress Disorder.'' Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday (except holidays). Please call (202) 461-4902 begin_of_the_skype_highlighting (202) 461-4902 end_of_the_skype_highlighting for an appointment. (This is not a toll free number). In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at http://www.Regulations.gov. FOR FURTHER INFORMATION CONTACT: Thomas J. Kniffen, Chief, Regulations Staff (211D), Compensation and Pension Service, Veterans Benefits Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 461-9725 begin_of_the_skype_highlighting (202) 461-9725 end_of_the_skype_highlighting. (This is not a toll-free number.) SUPPLEMENTARY INFORMATION: The Secretary of Veterans Affairs has authority under 38 U.S.C. 501(a)(1) to prescribe regulations governing the nature and extent of proof and evidence required to establish entitlement to benefits. In addition, under 38 U.S.C. 1154(a), the Secretary is required to ``include in the regulations pertaining to service-connection of disabilities'' provisions requiring ``due consideration'' of the places, types, and circumstances of a veteran's service. These statutes provide authority for this proposed amendment of PTSD regulations. Current regulations governing service connection of PTSD are provided at 38 CFR 3.304(f). Under this provision, service connection for PTSD generally requires: (1) Medical evidence diagnosing PTSD; (2) medical evidence establishing a link between a veteran's current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. In some cases, the requirement to establish the occurrence of the claimed in-service stressor can be met based on the veteran's lay testimony alone, provided that there is an absence of clear and convincing evidence to the contrary and that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service. Such cases are those described under Sec. 3.304(f)(1), when the evidence establishes a diagnosis of PTSD during service and the claimed stressor is related to that service; under Sec. 3.304(f)(2), when the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat; and under current Sec. 3.304(f)(3), when the evidence establishes that the veteran was a prisoner-of-war and the claimed [[Page 42618]] stressor is related to that prisoner-of-war experience. Currently, in all other cases where service connection for PTSD is claimed, VA regulations require credible supporting evidence corroborating the occurrence of the claimed in-service stressor before service connection can be established. VA is proposing to amend Sec. 3.304(f) by redesignating current paragraphs (3) and (4) as paragraphs (4) and (5) and adding a new paragraph (3), stating that, if a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. VA proposes to limit the confirmation of a claimed stressor to an examination by a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, to ensure standardization and consistency of mental health evaluations and reporting of these evaluations, which will be based upon uniform VA examination protocols. Under 38 CFR 4.125(a), all mental disorder diagnoses must conform to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994) (DSM-IV). According to DSM-IV at 427-428, the first diagnostic criterion for PTSD is: The person has been exposed to a traumatic event in which both of the following have been present: (1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; (2) The person's response involved intense fear, helplessness, or horror. The evidentiary liberalization we propose in new Sec. 3.304(f)(3) is consistent with DSM-IV criteria for a PTSD diagnosis, which include experiencing or confronting ``a threat to the physical integrity of self or others'' and ``intense fear, helplessness, or horror'' in response. Also consistent with DSM-IV, the proposed new Sec. 3.304(f)(3) defines ``fear of hostile military or terrorist activity'' to mean that ``a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho- physiological state of fear, helplessness, or horror.'' A claimed stressor must be consistent with the places, types, and circumstances of the veteran's service. Additionally, the proposed regulation change is consistent with scientific studies related to PTSD and military troop deployment. In the recently published Gulf War and Health: Volume 6, Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress (2008), the National Academies' Institute of Medicine (IOM) reviewed studies on PTSD in veterans who served in Vietnam, the Gulf War, Operation Enduring Freedom (OEF), and Operation Iraqi Freedom (OIF). The IOM review analyzed the long-term mental and physical health effects of ``deployment to a war zone.'' The stressors associated with ``deployment to a war zone'' were not limited to combat because [A]s military conflicts have evolved to include more guerilla warfare and insurgent activities, restricting the definition of deployment-related stressors to combat may fail to acknowledge other potent stressors experienced by military personnel in a war zone or in the aftermath of combat. Those stressors include constant vigilance against unexpected attack, the absence of a defined front line, the difficulty of distinguishing enemy combatants from civilians, [and] the ubiquity of improvised explosive devices. * * * (Summary, p. 2) The IOM ``considered that military personnel deployed to a war zone, even if direct combat was not experienced, have the potential for exposure to deployment-related stressors that might elicit a stress response.'' (Introduction, p. 13) Based on these IOM findings, VA is proposing to reduce the burden of showing the occurrence of an in-service stressor if the claimed stressor is related to fear of hostile military or terrorist activity, and is consistent with the places, types, and circumstances of the veteran's service. The proposed amendment is intended to reduce the time devoted to VA claims development and research of the claimed stressor that is required to adjudicate claims for service connection for PTSD. VA will instead rely on a veteran's lay testimony alone to establish occurrence of a stressor related to fear of hostile military or terrorist activity, provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, if a VA mental health professional opines that the claimed stressor is adequate to support a diagnosis of PTSD and that the veteran's symptoms are related to the claimed stressor. The proposed amendment would benefit all veterans and would not be limited to veterans serving during the current OEF and OIF. Improved timeliness, consistent decision-making, and equitable resolution of PTSD claims are the intended results of the revised regulation. Paperwork Reduction Act This document contains no new collection of information under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3521). The Office of Management and Budget has approved the collection of information provisions that are related to this proposed rule under OMB control number 2900-0001 (VA Form 21-526, Veterans Application for Compensation and Pension) and under OMB control number 2900-0075 (VA Form 21-4138, Statement in Support of Claim). Regulatory Flexibility Act The Secretary hereby certifies that this proposed rule will not have a significant economic impact on a substantial number of small entities as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-612. This proposed rule would not affect any small entities. Only VA beneficiaries could be directly affected. Therefore, pursuant to 5 U.S.C. 605(:), this proposed rule is exempt from the initial and final regulatory flexibility analysis requirements of sections 603 and 604. Executive Order 12866 Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, when regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety, and other advantages; distributive impacts; and equity). The Executive Order classifies a ``significant regulatory action,'' requiring review by the Office of Management and Budget (OMB), as any regulatory action that is likely to result in a rule that may: (1) Have an annual effect on the economy of $100 million or more or adversely affect in a material way the economy, a [[Page 42619]] sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, or Tribal governments or communities; (2) create a serious inconsistency or otherwise interfere with an action taken or planned by another agency; (3) materially alter the budgetary impact of entitlements, grants, user fees, or loan programs or the rights and obligations of recipients thereof; or (4) raise novel legal or policy issues arising out of legal mandates, the President's priorities, or the principles set forth in the Executive Order. The economic, interagency, budgetary, legal, and policy implications of this proposed rule have been examined, and it has been determined to be a significant regulatory action under the Executive Order because it is likely to result in a rule that will raise novel legal or policy issues arising out of legal mandates, the President's priorities, or the principles set forth in the Executive Order. Unfunded Mandates The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C. 1532, that agencies prepare an assessment of anticipated costs and benefits before issuing any rule that may result in the expenditure by State, local, and Tribal governments, in the aggregate, or by the private sector, of $100 million or more (adjusted annually for inflation) in any year. This proposed rule would have no such effect on State, local, and Tribal governments, or on the private sector. Catalog of Federal Domestic Assistance Numbers and Titles The Catalog of Federal Domestic Assistance program numbers and titles for this rule are 64.109, Veterans Compensation for Service- Connected Disability and 64.110, Veterans Dependency and Indemnity Compensation for Service-Connected Death. List of Subjects in 38 CFR Part 3 Administrative practice and procedure, Claims, Disability benefits, Health care, Pensions, Radioactive materials, Veterans, Vietnam. Approved: June 29, 2009. John R. Gingrich, Chief of Staff, Department of Veterans Affairs. For the reasons set out in the preamble, VA proposes to amend 38 CFR part 3 as follows: PART 3--ADJUDICATION Subpart A--Pension, Compensation, and Dependency and Indemnity Compensation 1. The authority citation for part 3, subpart A continues to read as follows: Authority: 38 U.S.C. 501(a), unless otherwise noted. 2. Amend Sec. 3.304 as follows. a. Revise the introductory text of paragraph (f). b. Redesignate paragraphs (f)(3) and (4) as paragraphs (f)(4) and (5) respectively. c. Add new paragraph (f)(3). The revision and addition read as follows: Sec. 3.304 Direct service connection; wartime and peacetime. * * * * * (f) Posttraumatic stress disorder. Service connection for posttraumatic stress disorder requires medical evidence diagnosing the condition in accordance with Sec. 4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in- service stressor; and credible supporting evidence that the claimed in- service stressor occurred. The following provisions apply to claims for service connection of posttraumatic stress disorder diagnosed during service or based on the specified type of claimed stressor: * * * * * (3) If a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of posttraumatic stress disorder and that the veteran's symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. For purposes of this paragraph, ``fear of hostile military or terrorist activity'' means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, such as from an actual or potential improvised explosive device; vehicle-imbedded explosive device; incoming artillery, rocket, or mortar fire; grenade; small arms fire, including suspected sniper fire; or attack upon friendly military aircraft, and the veteran's response to the event or circumstance involved a psychological or psycho- physiological state of fear, helplessness, or horror. * * * * * [FR Doc. E9-20339 Filed 8-21-09; 8:45 am] BILLING CODE 8320-01-P
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And you'd know that , why ???
If it was hard you wouldn't need an exam.:)
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I doubt the exam will be hard, follow instructions the C&P person will be gentel
Anyone out there been through the C&P for ED? I'm sure they don't bring in a hooker :) so how do they Exam for ED?David
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The C&P people do in fact do as you reported......
Part of their little game to screw you......
Seems that the C&P no matter what your injury is is looking to back out and not pay-up
C&P exams are serious stuff should be treated as such, be polite arrive at least 30 minutes ahead of appointment.
Wear the clothes you mowed your lawn in and never be happy, in my case that is easy, never do anything once you arrive to be toooooooooo social, no matter what they play games... then once in they asked leading questions.....
Just sit there and wait for two they usually use.....
It is up to you to do what is right and inform them how you actually feel ALL the time.. like crap
One good day at the C&P can screw your claim up if you have a claim that depends on these things....
go see them be good.
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Social Security declared my husband's disability date as March 2004. With an ejection factor of 36, he had a defibrillator implant in May 2004. Does anyone have an AICD implant from IHD ? and I have read it is a 100% rating. His original claim was in 2006 for IHD and hearing loss
with the VA and was denied. 10% hearing loss is his current rating. This is the "kicker" his VCO said "we should know something by May or June". His claim was re-opened in April 2010. There is no way we think that working with the VA, but he said Oklahoma is rated number 1 as far as getting claims resolved and Oklahoma was sub-contracting for other states and has since quit doing that to devote themselves exclusivly to Oklahoma claims....could this be possible?
&&&&&&&&&&&&&&&&&&&&&&&&
Below is a File to answer all your ICD questions about ratings and all other rating the VA will use to assign a rating....
ICD information towards the end......
the button to get the file is below
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You need to have several tests done and send all of the medical records you have on IHD
Tests should be fairly recent indicating Ejection Fraction ( EF ) and your METS Score.
Tell your primary care you need what ever tests done now to show these scores.
Questions ?
had a heart attack, when, what happened
family history
They usually ask questions that are in your file, they are too lazy to read...
We you in RVN and where ( Like that matters, where)
usually they ask some questions that the medical records ought to provide, of specialized test to show your METS and or your EF.....
keep your cool.. your primary can order those tests ahead of time
You can tell the C&P guy if he needs that info (EF & METS score ) to correctly evaluate, then order these tests for you..
I opt the Primary care person you have order all these tests, then it saves allot of time... you in a hurry ?
good luck
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I think you are correct, as usual. SMC Q is the very lowest rate
I may have posed the question so that one may not have understood the question.. or the point of this thread.
I was asking and have been told by some folks that the LOWEST rate that would probably be awarded a vet with two
100% Schedulers and an additional 40% would most likely be a SMC of S .
I am sorry for any confusion, for you see this poster (Vet ) is not as sharp as those with all the knowledge I do not, and Never will have.
The lowest is actually the Q award but I didn't mention that as no one I know has ever gotten SMC Q-I stand by my post and the VA web site supports me-
SMC K is the lowest monetary award.
http://www.vba.va.gov/bln/21/Rates/comp02.htm
Tick tock you
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The Third ICD I have is a Medtronics, there are many different models and the uses vary.
The VA by regulation in CFR 38 is required to award 100% disability for a veteran thqat has a Implanted ICD, usually the ICD is there because you’d be dead without the ICD.
The VA actually knows this fact. Yes the VA requires proof you actually have an ICD… medical records, Dr. statements….. and a C&P by the VA
Unless the ICD is removed for good you will never have a C&P after your award because your reason for the ICD never goes away. Your heart disease will not heal..... you are terminal without the device..
11 years with these things and I am still doing what ever I do..
the VA knows this fact, so be happy
If you’re a Vietnam Vet this ICD with your Heart disease is going to be the Presumptive Agent ORQNGE AWARD…
I await the 100% award, all evidence and C&P done in Jan2010 filed 26Oct2009.
The Final awarding cannot take place till the
rules are published in Federal registry.
You can do a search here on this site to read all the posts that will answer all your questions
The Active duty fellow…… the VA will award you 100% SCHEDULAR
With all the benefits a 100% vet gets……
You may want to know what the VA offers compared to the MEB….
I have no knowledge as to what the MEB awards….. be sure it is equal to the VA awards…
There are folks here that are up to date on this…..
I just got a claim for 100% granted last week, and have gotten the CAC card, or as some call it the “ Tan card “ or the “ MWR “ card….. a real nice card with a lot of bennies, even some bennies that many do not know about……
I will let people do their own research……. Ask questions to the DEERS people they have answers, just ask the right questions….
That's good to here. I'm still on active duty and after the surgery I'll be facing a MEB. The good thing is that I'm already over 20 yrs in the AF. I'm going to sit back and see how things play out. Thanks...... -
So as I read that decision and the reg, as stated in the lower messages and from what Pete mentioned in his posting… the lowest should be SMC S
Tick tok we will soon know
Special Monthly Compensation is explained well in this BVA decision.I have a CUE claim pending for accrued SMC and happened to have this case at hand- it isnt specific to anyone here but contains the SMC regulations and explains them.
http://www4.va.gov/vetapp10/files1/1000066.txt
The SMC "K" award is the lowest monetary award- with higher levels that award well over the 100% rate.
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So as I read that decision and the reg, as stated in the lower messages and from what Pete mentioned in his posting… the lowest should be SMC S
Tick tok we will soon know
Special Monthly Compensation is explained well in this BVA decision.I have a CUE claim pending for accrued SMC and happened to have this case at hand- it isnt specific to anyone here but contains the SMC regulations and explains them.
http://www4.va.gov/vetapp10/files1/1000066.txt
The SMC "K" award is the lowest monetary award- with higher levels that award well over the 100% rate.
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V,
The regs are vague on this question, but you would qualify for SMC. I'm sure you already know that. It might depend more on the needs of the person related to the diagnosis and severity of the condition.
JMO,
Bergie
One maybe for cardiac claim and the other fro PTSD
Here is the link I was provided
http://ecfr.gpoaccess.gov/cgi/t/text/text-...144&idno=38
here is the regulation…
(4) Additional independent 100 percent ratings. In addition to the
statutory rates payable under 38 U.S.C. 1114 (l) through (n) and the
intermediate or next higher rate provisions outlined above additional
single permanent disability independently ratable at 100 percent apart
from any consideration of individual unemployability will afford
entitlement to the next higher statutory rate under 38 U.S.C. 1114 or
if already entitled to an intermediate rate to the next higher
intermediate rate, but in no event higher than the rate for (o). In
the application of this subparagraph the single permanent disability
independently ratable at 100 percent must be separate and distinct and
involve different anatomical segments or bodily systems from the
conditions establishing entitlement under 38 U.S.C. 1114 (l) through
(n) or the intermediate rate provisions outlined above.
(i) Where the multiple loss or loss of use entitlement to a statutory
or intermediate rate between 38 U.S.C. 1114 (l) and (o) is caused by
the same etiological disease or injury, that disease or injury may not
serve as the basis for the independent 50 percent or 100 percent
unless it is so rated without regard to the loss or loss of use.
(3) Amount of the allowance. The amount of the additional allowance
payable to a veteran in need of regular aid and attendance is
specified in 38 U.S.C. 1114®(1). The amount of the additional
allowance payable to a veteran in need of a higher level of care is
specified in 38 U.S.C. 1114®(2). The higher level aid and attendance
allowance authorized by 38 U.S.C. 1114®(2) is payable in lieu of the
regular aid and attendance allowance authorized by 38 U.S.C.
1114®(1).
(i) Total plus 60 percent, or housebound; 38 U.S.C. 1114 ( s ). The
special monthly compensation provided by 38 U.S.C. 1114(s) is payable
where the veteran has a single service-connected disability rated as
100 percent and,
(1) Has additional service-connected disability or disabilities
independently ratable at 60 percent, separate and distinct from the
100 percent service-connected disability and involving different
anatomical segments or bodily systems, or
(2) Is permanently housebound by reason of service-connected
disability or disabilities. This requirement is met when the veteran
is substantially confined as a direct result of service-connected
disabilities to his or her dwelling and the immediate premises or, if
institutionalized, to the ward or clinical areas, and it is reasonably
certain that the disability or disabilities and resultant confinement
will continue throughout his or her lifetime.
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Question:
If a vet has Two separate and different 100% Schedular Awards
One of the awards has been approved and all retro for the first
100% paid.
The second 100% Scheduler soon to be awarded (It is deferred)
Will make two different 100% schedulers….
What is the VA position on this ?
I was told by a very knowledgable person that the VA is required
To pay no higher SMC O, I have no real idea …. Even the regs seem
To be less than ….
So the question, is there a SMC to be awarded, any idea which SMC ?
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Unless the whole system has changed over these many years, and it has,,,,
Twelve credit hours are considered full time
I suspect any self respecting GI Bill would require
A student to go full time
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DC 7011, Ventricular Arrhythmias (Sustained)
A condition involving depolarization of the atria or ventricles, or both, that occurs before the next expected sinus beat. In other words this is a premature heartbeat. Most complain of a skipped beat, flutter or extra beats in the chest but usually disregard them until they become frequent. The cause must be found before treatment can be started. ECG is the most likely method of determining a cause.
The criteria are the same objective measurements that are used for arteriosclerotic heart disease and other heart diseases. However, there are specific provisions for a total evaluation while an Automatic Implantable Cardioverter-Defibrillator (AICD) is in place.
AICD - Automatic Implantable Cardioverter-Defibrillator - A pulse generator (smaller than a deck of cards) is implanted in the abdomen underneath the skin. Electrodes sense the rhythm of the heart and deliver a powerful shock when a life-threatening rhythm occurs (ventricular tachycardia or fibrillation). If necessary, it can give three to four additional shocks. The batteries are designed to last 4 to 5 years and deliver about 100 shocks. It originally required open-chest surgery for implantation. Now electrodes are inserted into the heart through veins. The pulse generator must be replaced (minor surgery) when batteries die. Firing may cause depression, anxiety, thoughts of dying, etc.
Uses of AICD:
- For people at high risk for sudden death.
- For episodes of ventricular tachycardia.
- For those who have survived ventricular fibrillation but have not had an acute heart attack; or those who are at high risk for another episode of ventricular fibrillation.
- For those with structural defects of the heart, like massive dilation or excessive thickening of the heart muscle.
After implantation, recovery of normal activity is expected in 4 to 6 weeks.
Rating Schedule:- For indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for indefinite period from date of hospital admission for ventricular aneurysmectomy, or; with an automatic implantable Cardioverter-Defibrillator (AICD) in place 100%
- Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100%
- More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60%
[*]Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30%
[*]Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10%
Note: A rating of 100 percent shall be assigned from the date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia or for ventricular aneurysmectomy. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. ง 3.105(e).
DC 7018, Implantable Cardiac Pacemakers
An electronic device that acts in the place of the heart's own pacemaker, the sinoatrial node, and is programmed to imitate the normal conduction sequence of the heart. They are usually surgically implanted under the skin of the chest and have wires running to the heart.
A two-month convalescence evaluation is provided. Following that, the condition is to be rated as supraventricular arrhythmias (DC 7010), ventricular arrhythmias (DC 7011) or atrioventricular block (DC 7015). The minimum evaluation under this code following pacemaker insertion is 10%.
A note following the rating criteria directs that Automatic Implantable Cardioverter-Defibrillators (AICDs) are to be rated under DC 7011 with an evaluation of 100%. An AICD is similar in many respects to an artificial pacemaker; however, pacemakers are usually chosen to correct a heart rhythm that is too slow (bradycardia) whereas AICDs are used to correct a heart rhythm that is too fast. AICDs are used to correct more serious heart irregularities than typical pacemakers, as described under DC 7011. People with AICDs need to be much more careful in certain situations. Because of the severity of the conditions that require an AICD, it is the only implantable pacemaker that supports the 100% evaluation.
http://74.125.155.132/search?q=cache:fscvp...=clnk&gl=us
Pretty sure Jim Strickland was right..... but we wait for VA decision.....
- For indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for indefinite period from date of hospital admission for ventricular aneurysmectomy, or; with an automatic implantable Cardioverter-Defibrillator (AICD) in place 100%
- For people at high risk for sudden death.
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DC 7011, Ventricular Arrhythmias (Sustained)
A condition involving depolarization of the atria or ventricles, or both, that occurs before the next expected sinus beat. In other words this is a premature heartbeat. Most complain of a skipped beat, flutter or extra beats in the chest but usually disregard them until they become frequent. The cause must be found before treatment can be started. ECG is the most likely method of determining a cause.
The criteria are the same objective measurements that are used for arteriosclerotic heart disease and other heart diseases. However, there are specific provisions for a total evaluation while an Automatic Implantable Cardioverter-Defibrillator (AICD) is in place.
AICD - Automatic Implantable Cardioverter-Defibrillator - A pulse generator (smaller than a deck of cards) is implanted in the abdomen underneath the skin. Electrodes sense the rhythm of the heart and deliver a powerful shock when a life-threatening rhythm occurs (ventricular tachycardia or fibrillation). If necessary, it can give three to four additional shocks. The batteries are designed to last 4 to 5 years and deliver about 100 shocks. It originally required open-chest surgery for implantation. Now electrodes are inserted into the heart through veins. The pulse generator must be replaced (minor surgery) when batteries die. Firing may cause depression, anxiety, thoughts of dying, etc.
Uses of AICD:
- For people at high risk for sudden death.
- For episodes of ventricular tachycardia.
- For those who have survived ventricular fibrillation but have not had an acute heart attack; or those who are at high risk for another episode of ventricular fibrillation.
- For those with structural defects of the heart, like massive dilation or excessive thickening of the heart muscle.
After implantation, recovery of normal activity is expected in 4 to 6 weeks.
Rating Schedule:- For indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for indefinite period from date of hospital admission for ventricular aneurysmectomy, or; with an automatic implantable Cardioverter-Defibrillator (AICD) in place 100%
- Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent 100%
- More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent 60%
[*]Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 30%
[*]Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required 10%
Note: A rating of 100 percent shall be assigned from the date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia or for ventricular aneurysmectomy. Six months following discharge, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. ง 3.105(e).
DC 7018, Implantable Cardiac Pacemakers
An electronic device that acts in the place of the heart's own pacemaker, the sinoatrial node, and is programmed to imitate the normal conduction sequence of the heart. They are usually surgically implanted under the skin of the chest and have wires running to the heart.
A two-month convalescence evaluation is provided. Following that, the condition is to be rated as supraventricular arrhythmias (DC 7010), ventricular arrhythmias (DC 7011) or atrioventricular block (DC 7015). The minimum evaluation under this code following pacemaker insertion is 10%.
A note following the rating criteria directs that Automatic Implantable Cardioverter-Defibrillators (AICDs) are to be rated under DC 7011 with an evaluation of 100%. An AICD is similar in many respects to an artificial pacemaker; however, pacemakers are usually chosen to correct a heart rhythm that is too slow (bradycardia) whereas AICDs are used to correct a heart rhythm that is too fast. AICDs are used to correct more serious heart irregularities than typical pacemakers, as described under DC 7011. People with AICDs need to be much more careful in certain situations. Because of the severity of the conditions that require an AICD, it is the only implantable pacemaker that supports the 100% evaluation.
http://74.125.155.132/search?q=cache:fscvp...=clnk&gl=us
Pretty sure Jim Strickland was right..... but we wait for VA decision.....
- For indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for indefinite period from date of hospital admission for ventricular aneurysmectomy, or; with an automatic implantable Cardioverter-Defibrillator (AICD) in place 100%
- For people at high risk for sudden death.
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I cannot know how you were treated, accepted at home, or the comments, attacks that you were subjected too...
The VA for all intents and purposes was not getting into the care of Vietnam era vets, no one knew or understood
what the benefits were for us vets just getting out......
We had no classes, or " debriefing time " on what we had gone through, or what services were available....
VA loan and VA money for college.... 191 bucks a month if I remember right.... no one mentioned
that us vets with Purple Hearts could get VA care..... no one mentioned, informed,,, nothing
Now, this whitewash ... by people that know nothing what happened ........
PC me....
Thanks for the info, Shamrock.Here's the statement and a bit of history for those that don't know. I don't believe Vietnam was termed a "war" when I returned home. Funny they term it that way now. It's good to hear that people thinking about us old guys!
I agree vperl...it should have been done 40 years ago!
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Today, U.S. Senator Richard Burr (R-NC), Ranking Member of the Senate Committee on Veterans’ Affairs, introduced a resolution in support of the establishment of “Welcome Home Vietnam Veterans Day.” Designating March 30, 2010, as “Welcome Home Vietnam Veterans Day” honors the return home of our armed service members after serving in Vietnam.
“There’s no question that our troops served our country bravely and faithfully during the Vietnam War, and these veterans deserve our recognition and gratitude,” Burr said. “Unfortunately, when these service members returned home, they were caught in the crossfire of public debate about our nation’s involvement in the Vietnam War. As a result, these brave men and women never received the welcome reception and recognition they deserved.”
“On March 30, 1973, our United States Armed Forces completed the withdrawal of combat troops from Vietnam,” Senator Inhofe said. “Our veterans who served in the U.S. Armed Forces in Vietnam deserve the greatest honor and respect - honor and respect they were denied when they arrived home. I am proud to join my colleagues in support of this resolution to establish a day in honor of the return of all troops from the Vietnam War.”
The United States became involved in Vietnam because policy-makers believed that if South Vietnam fell to a communist government, communism would spread throughout the rest of Southeast Asia. The US Armed Forces began serving in an advisory role to the South Vietnamese in 1961, and in 1965, ground combat troops were sent into Vietnam. After many years of combat, all US troops were withdrawn from Vietnam on March 30, 1973, under the terms of the Treaty of Paris. Therefore, March 30, 2010, is an appropriate day to establish “Welcome Home Vietnam Veterans Day.”
More than 58,000 members of the United States Armed Forces lost their lives and more than 300,000 were wounded in Vietnam. The establishment of a “Welcome Home Vietnam Veterans Day” would serve as a small way to honor these men and women who served our country in Vietnam throughout the war.
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Senate Passes Welcome Home Day
Week of March 29, 2010
A resolution introduced by U.S. Senator Richard Burr (R-NC), Ranking Member of the Senate Committee on Veterans' Affairs, encouraging communities across the nation to establish "Welcome Home Vietnam Veterans Day" was passed unanimously by the Senate. The resolution designates March 30, 2010, as "Welcome Home Vietnam Veterans Day," to honor the return home of our armed servicemembers after serving in Vietnam. For more information on the War in Vietnam, including educational materials, visit the U.S. Army in Vietnam, the Virtual Vietnam Archive, the Public Broadcasting Service's Battlefield Vietnam webpage, the Vietnam War Bibliography, and the Gravel Edition of The Pentagon Papers.
Find ways to support and honor U.S. military servicemembers and veterans who protect our security and freedom. Visit the Military.com Support our Troops
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BECAUSE THIS IS A pc BOARD, i WILL NOT TELL THEM AFTER MORE THAN 40 YEARS WERE THEY AND WHAT THEY CAN DO WITH THAT PAPER WORK
IMHO
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That report is worthless, I want better Exams, by actual Doctors, and actual specialists in fields the exam is for....
to use the proper instruments, tests, and the examiner should know the VA rules of what they are examining for.... and how to do the exam by Va RULES
Like they should know what test are to be taken and what tests are forbidden according to VA regulation because these test endanger the life of the Veteran...
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After about six months, I finaly going to get a C&P appointment. My file is thin on Gulf War Syndrome, I did not put as much thought in this claim as I have put in MY PTSD diagnosis. I have The rash on my body, swollen joints w/ pain, memory lost. Can't remember what else, no pun intended. What or How serious can this be. Exams or paper work or both. Can someone point me in the right direction?
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What has the VA done to help your PTSD stuff, and do you have a VSO helping you...you can find real good ones if you look...
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The "mailbox blues"... cruel and unusual treatment of the disabled vet. Though not intentional, I just wish the VA could find a better way to handle claims. My sympathies are with all those who have to endure the experience.
Hang there...
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Good news had mail
Bad news all bills
Think I will get chair and wait till tuesday
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Sounds to me like it will not be long at all.
Already made two trips to mail box today..... will face east and hope the mail is in there in an hour..
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Vet files claim for PTSD in FEB 2009 has PTSD C&P and is denied.
vet files appeal for the PTSD denial in January 2010 With IMO diagnosis of PTSD
and DEpression, tangental thoughts, and most of the usual listed systopms of PTSD
IMO. GAF 40
Vet gets C&P exam in March 2010 for PTSD the C&P examiner states to the vet
there is PTSD, depression, akward thinking, and most of the rest of the systoms
vet is told on way out of exam that the RO is requesting a second PTSD exam,
exam scheduled in April
Question why is the RO requesting second exam, no one seems to know or understand why.
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Any and all psychiatric disorders are taken as a whole, when being rated, and the psychiatric disorder that is most disabling is the one that your percentage of disability will be determined from.
In other words, if your anxiety disorder is now at 40% and you are diagnosed with MDD at (and it will be, most likely) either 50% r 70% (no 60%), then you will have a disability rating of either 50% or 70% in addition to whatever other disability that you may have (for you, it'd be the diabetes).
If you know what your GAF score is, I can tell you purty close to what your MDD will be rated.....................purty close!
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GAF scores ////// when I think of GAF scores I think of sugar and spice...
peolpe with a GAF of 55 I have seen get 70% people with a GAF of 40% I seen get 30% rating
GAF scores by us vets and the VARO are just a guideline with good results for those with a 55GAF that get rated at 70%
and bad news for the vet that has a 40 GAF and is rated at 30% potluck, DRAWN OUT OF A HAT... rating
but that is just me
3 Ao Presumptives Published ?
in Agent Orange
Posted
Someone needs to check this out...
Canton Daily Ledger Posted May 03, 2010 @ 05:56 PM LEWISTOWN — On Oct. 13, 2009, the secretary of the Department of Veterans Affairs (VA) announced his decision to establish presumption of service connection for three additional illnesses (Parkinson's disease, ischemic heart disease, and B cell leukemia) associated with Agent Orange/herbicide exposure in Vietnam.
On March 25, 2010, the VA published a proposed regulation in the Federal Register as part of the process to implement the decision to add those three diseases to the list of presumptive conditions related to Agent Orange/herbicide exposure.
The final regulation will affect a large number of Vietnam veterans, estimated to be at least 200,000 veterans.
"This is an important step forward in ensuring that Vietnam veterans are justly compensated for the adverse effects suffered by exposure to Agent Orange during their service to our country," said Andy Fyffe, superintendent of Fulton County Veterans Assistance Commission, in a press release.
Veteran service officers should file presumptive claims now for these conditions without waiting for the completion of the regulation process, the press release from Fyffe added. Filing these claims prior to the publication of the final regulation is important for effective purposes and it also allows VA to start the claims development process (conducting VA examinations, requesting supporting evidence, etc.) to allow for timely adjudication once the final regulation has been published.
Veterans Affairs and Rehabilitation (VA&R) staff are in the process of reviewing the proposed regulation for public comment. A more detailed VA&R Bulletin containing effective date and other information will be issued following the publication of the final regulation.
In the meantime, direct questions or concerns to Ian de Planque, assistant director for Claims Service, VA&R, at ideplanque@legion.org or (202) 263-5762 begin_of_the_skype_highlighting (202) 263-5762 end_of_the_skype_highlighting; or contact the Fulton County Veterans Assistance office at 309-547-7262 begin_of_the_skype_highlighting 309-547-7262 end_of_the_skype_highlighting for a copy of the official bulletin released by the VA.
Also, the Department of Veterans Affairs (VA) has issued a warning in American Legion Bulletin 16-10 to veterans not to disclose personal information over the phone to callers claiming to update, confirm, or verify VA-related information.
VA reports the fraudulent caller's mode of operation include asking for credit card numbers, bank routing number, and other personal and financial information. A recent fraudulent call reported by a veteran included the caller claiming to be a VA employee and stating that the veteran's medical card had expired. The caller would then ask the veteran to submit a check over the phone to renew the medical card.
VA warns to be leery of any call originating from (888) 555-1234 begin_of_the_skype_highlighting (888) 555-1234 end_of_the_skype_highlighting for it is the number identified in the case above.Veterans with questions about VA services should contact the Veterans Administration at (877) 222-8387 begin_of_the_skype_highlighting (877) 222-8387 end_of_the_skype_highlighting or their nearest VA medical center.
The Fulton County VAC office is located at 132 N. Adams St., Lewistown.
Copyright 2010 Canton Daily Ledger. Some rights reserved
http://www.cantondailyledger.com/news/x1540368784/VA-publishes-proposed-Agent-Orange-presumption-regulation-for-conditions-warns-veterans-about-fraudulent-callers