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First Class Petty Officer
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About acesup

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    E-5 Petty Officer 2nd Class

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  • Service Connected Disability
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    Air Force
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  1. acesup

    Rogue C&P Examiner?

    One C&P Nurse Practitioner's unfounded opinions can trump the opinions of several M.D. specialists, for sure. I filed for several issues in May 2007 and October 2009. The 2007 filing was apparently shredded, it was definitely lost. In 2010, I had a C&P exam by one of the most hateful, nasty people I have ever met in my life. I filed for OSA secondary to meds for my 40% SC thoracolumbar spine (DDD, arthritis, stenosis, etc.), had great opinion/nexus letters from two sleep specialist Pulmonary M.D.s. The C&P NP said I had one "enlarged concha bullosa" and that literature indicates that it is a possible contributing factor in OSA, therefore my OSA was not related to my SC disability. I had opinion/nexus letters and an IMO from two pulmonoligist M.D.s, one the head of pulmonary department and a professor at a major Texas med school stating that my DVT/PE (blood clots in legs, lungs) were likely caused by meds and lifestyle due to my injured spine. The C&P NP said I had had an appendectomy, therefore the condition couldn't be related to my SC spine, but was caused solely by the non-SC appendectomy. I had opinions from an M.D. and a chiropractor that my bilateral Sciatica was a result of my SC spine disabilty. The C&P NP said it was a result of age and/or other undetermined causes, and claimed that my initial SC injury was only a "soft tissue" injury (as if it was a minor issue that should have been cured by a couple of aspirin or something). It was not a soft tissue injury, the 1974 injuries showed damaged vertebrae. Back then, there was no such thing as MRI, so the severity of the damage was not evident. I claimed SC for my neck and upper extremity radiculopathy, which SMRs showed occurring at the same time as my lumbar injury. The VA had shot my neck down a couple of times over the years, but at the time I was advised not to appeal, so I had not done so. I submitted new evidence including some I had located recently in my service records and C-file, as well as opinion by a chiropractor. The NP claimed she had no idea how my neck got in the shape it is in, so it couldn't possibly be SC. Likewise for a couple other conditions, you get the gist of it. Anything I could claim as secondary or aggravated by my SC spine, all for which I submitted GREAT opinion/nexus letters by qualified professionals, that NP could find some alternate possible contributing factor, and then submit it as the reason that my claimed condition occurred. Her job, as she apparently saw it, was not to perform an unbiased examination, but simply to submit bases for denials of anything and everything I claimed. And the worst of it was, the Waco VARO accepted every one of her rebuttals as gospel, while apparently ignoring completely all of the information and evidence I had submitted with my claim. After appeals including DRO review, I had more C&P exams in 2011, and 2014. Different NPs, same results. Fast-forward to a couple months ago, August 7, 2018, when my appeal FINALLY was reviewed and decided by BVA. On all but two minor remanded issues, BVA granted every bit of my claim. In the "reasons and bases" explanation, it was said over and over that the C&P examiners and VARO decisions had failed to consider the secondary/aggravation prongs of SC, that their evidence was of "no probative value", and they offered "no competent evidence", etc. Each time, it was stated that MY evidence was the "only competent" evidence, etc. Will C&P NPs and VSRs at the VAROs learn anything from this? Not a chance! I'm not gloating, I'm just waiting for the BVA grants (including 100% TDIU and SMC (s), to be promulgated and the day I get that next BBE and a deposit. I hope it happens some time BEFORE I croak, that would be nice. 74 days and trying not to count, so far. LOL
  2. Not only would I call the White House Vets' Hotline, I would also be talking to someone at my Congressman's and Senator's offices. Meanwhile, have you tried to negotiate a smaller payment with VA? Not sure how they are nowadays, but way back when I was drawing my GI Bill (when dinosaurs still roamed the Earth), they overpaid me, then they allowed me to haggle with them until we reached a monthly amount that kept me from going broke. Best of luck, hope you get this resolved in your favor, and quickly!
  3. It's been 70 days since BVA granted 10 of my 12 issues, including TDIU and SMC (s), but hey, who's counting? LOL Two minor issues were remanded. No sign of movement on eBennies. I called Peggy a month ago, they wouldn't tell me who has my case now, VARO or AMC, just told me to wait. I figured by now they'd implement the monthly increase, but that's what I get for figuring. The retro will probably take awhile, it is 9+ years' worth. I'm fortunate, I have a good disability retirement income and a long-time 70% rating, and I owe no one, so there's no need for anxiety. Nevertheless, in this computer age, there's really no excuse for the constant foot-dragging of the VA. But, having a daughter that works for Uncle Sam, I understand why everything takes so long. It takes a minimum of 10 government employees to do the equivalent of the work of one civilian, and if all 10 choose to do nothing until 10 more employees are assigned to one menial task, that's okay too. I feel for those vets who are in need, and finally get a grant, only to have to wait forever for it to be promulgated. There should at least be some option for them to draw an advance from the U.S. Treasury once a claim has been granted, but that makes too much sense.
  4. Based on the reported Range of Motion, it sounds as if you're probably going to continue at 40%. I don't consider myself an expert, but I've had SC lower back ratings for 44 years now. Hopefully you'll find out the official results soon, so you don't have to wait and worry. Best of luck.
  5. acesup

    100% finally

    Congratulations, always glad to see a fellow vet stick it out and get a well-deserved grant!
  6. Congrats, you won a higher rating, and 100% TDIU. Don't expect the VA to rush in promulgating it, but eventually they'll get it done.
  7. Hamslice is correct. I have several secondary conditions that rate higher than my 20% (recently reduced from 40% after surgery) lumbar spine. The highest rating will be 60%, a couple of others are 50% each.
  8. As always, great advice here to address a tricky subject. The easy answer to which evidence is better would be the evidence that will best likely support your claim, but most claims aren't simple enough to say either DBQ or IMO/IME is better. IMHO, if a claim is for a common condition with commonly known and accepted logic that should get service connection, I'd think a DBQ is probably going to get the job done. Problem is, few claims are that cut and dried. In my own recently-granted (by BVA) claim, I had several issues that absolutely would have died with a plain DBQ. If a condition needs much in the way of a Nexus, or has some unusual circumstances to warrant SC, whether direct, secondary, or aggravation, an IMO/IME or Nexus letter with supporting evidence will get you there. For instance, before I filed my current claim in 2009, I was rated 50% overall: 40% for lumbar spine injuries, 10% for residuals of Hep B. (Both SC since I got out of the Air Force in 1974), I had several VSOs and "knowledgeable" vets, and even at least one career VA rater/DRO, tell me I would never get SC for the issues I was pursuing, including Major Depressive Order, Obstructive Sleep Apnea, residuals of DVT/PE (chronic thromboembolism), convulsive tic, C-spine injuries, upper extremity neuropathy, sciatica, migraines, and TDIU. I sought out specialists, none of whom are usually considered "IMO/IME doctors" like you'll find on these sites. I saw a sleep specialist Pulmonary M.D. and my civilian PCP to discuss connecting the dots between my SC back and meds and pain and lifestyle, etc. to OSA. I brought them my SMR and civilian medical records, evidence of meds' well-known side effects, anything I could find that supported any links, and after these visits, I went home and drafted Nexus letter with the key phraseology included, each letter having options for doctor to choose between "is due to", "more likely than not likely", "as likely as not likely", "not as likely as not likely", and "is not due to". When I came back for follow-up visits, I brought the draft letters in my hand. I would get the doc to discuss the talk we had the previous visit. I would then bring out the letter, and ask him if he agreed with the logic. I did the same with two experts on DVT/PE, with convulsive tic, with everything except the depression. Great thing is, the VA Psych who did my depression C&P told me that day that my depression had been present since 1973-1974 active duty, and I figured I didn't need any other opinion on that issue. (I didn't, either). I only had one doctor who refused to help, a weird Neurologist. (I was always kind of nervous around him anyhow, he looked/acted like he might strap on an exploding backpack at any moment) LOL In my experience, the best source of docs who would help with opinions are in the University med schools and hospitals. One of my experts was a head of Thoracic Surgery and a longtime top professor at such a school/hospital. Here's the challenge: being able to carry on an informed, intelligent conversation with a doctor, without making an ass of yourself OR him. And there probably is no competent doctor who would just blindly sign a paper saying "Mr. X's OSA is caused by his bad back." There HAS to be logical evidence to support a Nexus or any medical opinion. No doc is going to risk his reputation and face ridicule for a signing onto a preposterous, unsupported theory. Not to mention that the VSR at your VARO would add the letter to the office joke pool to pass around and give everyone a good laugh. It is YOUR job to amass that evidence, if it exists, then ask the doctor his opinion on your theory. And if you're wrong, you will possibly learn how and why you're wrong, and maybe even how you might go back and get it right. BTW, the recent BVA award I won was incredible. All but sciatica and migraines were granted, and they're remanded for fairly minor issues, I think when the dust clears I will get them granted too, even though they don't matter anymore. Best of luck in achieving the ratings you deserve!
  9. 63Charlie, Actually, no, the opinion/nexus letters were submitted with my claim before it got denied the first time. That's largely why I found it so hard to believe that I was shot down in flames, I had what I was certain was some awesome evidence. It seemed like the VSRs and DRO never even considered any of my evidence. Apparently the BVA Judge thought so, too. I would think you'd be better off to turn in everything you can from the get-go, just in case you get a reasonable and fair person handling your claim. I wonder if anyone at the VAROs ever reviews BVA rulings like mine with the staff. I'd like to think someone would get their noses rubbed in it when they screw up a claim so badly. I doubt it, but it is a nice thought. Best of luck with your claim, just hang in there and keep pounding them with the heavy artillery until THEY surrender!
  10. Warning: LOOOOONG story, 9 years + of it, ahead... But this one has a happy ending, (or at least I think it does)! First, a little background: I separated from USAF in Feb. 1974, and filed for a back injury that had occurred on duty in 1973. Three weeks after I got home to NC, I woke up sick and yellow one morning, apparently had gotten a parting gift from my processing-out physical or dental appointment, in the form of Hepatitis 'B'. During my three weeks in the VAMC hospital at Fayetteville, I joined DAV, and the DAV VSO filed for the residuals of Hep. Eventually, I got 10% ratings for lumbar spine strain and for the Hep, 20% combined. I filed for C-spine, lower extremity radiculopathies, and severe headaches; they were denied. I had also suffered some depression due to the injuries; the DAV guy put in a claim for "nervous condition". The VA said that "nervous condition" was not a compensable condition. During my career in the jet engine business over the next 25 years, my back and neck problems got progressively worse. In 1999, I could no longer do my job, and my company retired me, and hired a lawyer to get me onto SSDI (which was finally awarded retroactively in 2005). After leaving NC in 2000 and moving to East Texas, I talked to the DAV over the phone, and to a local county VSO, about filing for an increase in my VA Comp. Neither of them were very encouraging, to say the least. I went ahead and filed anyhow, for an increase in lumbar spine, re-opening of the headaches and neck issues, and TDIU. In 2002, they upped my L-spine rating to 40%, denied everything else, so I was at 50% overall. I didn't have a VSO, and didn't appeal. In 2007, my condition, especially the L-spine, had gotten worse over the years. I was taking a lot of meds for it including megadoses of Neurontin, lots of NSAIDs and opiod pain-killers, steroid injections, etc. I frequently couldn't exercise as much as I needed to. While just barely "obese" at times, I had developed a severe case of Obstructive Sleep Apnea, and had severe "Periodic Limb Movement Disorder" (convulsive tic, leg muscles going crazy all night long when I tried to sleep.) In four separate sleep studies over the years, I never would make it to REM sleep, so needless to say, it was a problem, and between the back pain, the depression, the drugs, and the lack of good sleep, I sometimes had long periods of "sedentary" lifestyle, even though I struggled to get adequate exercise. I filed a claim. We were living near Galveston, so I sent it to the Houston VARO. I never did hear anything about it, and didn't have a VSO. I later learned about "Shreddergate", so I'm pretty sure I know now what happened to it. One day in February 2009, I had to have an emergency appendectomy. After it was over, before leaving the hospital the next day, I coughed up a huge gob of blood. I told a nurse, and she said it must be from being anesthetized, that if I didn't do it anymore then not to worry about it. After I got home, I had a persistent mild little pain in my chest, but thought I would be okay. I had been told to get up and walk often, and I really did try, but between my physical and mental state, I sat/laid around way too much, I'm sure. Two days later, the chest still hurt. I had an appointment with my VA PCP, and told him about the chest pain. He sent me for X-rays, got the reports, and said I was okay. The next afternoon, I was standing in the kitchen beside my wife, who was cooking supper. I suddenly felt like someone reached inside my chest and was trying repeatedly to rip my lungs out. I could hardly breathe at all, and thought I was dying, my heart was pounding in my ears, it was bad. I started coughing up blood, lots of it. She took me to the ER about 10 minutes from here, and they quickly got me into a bed and did a preliminary diagnosis of bilateral Pulmonary Embolism (blood clots in lungs) and put me in Intensive Care. 8 days later, I got to come home. With nothing but time on my hands, I started to put together a claim. After talking some with my civilian PCP and my Pulmonary M..D. (also civilian), I turned in a claim for everything that could possibly be SC, direct or secondary: Major Depressive Disorder; residuals of Bilateral Deep Venous Thrombosis & Pulmonary Embolism; OSA; convulsive tic; C-spine; upper extremity radiculopathy; migraine/headaches; lower extremity neuropathies; and, TDIU. After reading so much on this and other online forums, and lots of research in general, I knew it might be a challenge to get favorable opinions, but I developed a strategy that eventually has paid off for my claims. I would make an appointment with a specialist. (State universities with medical schools/hospitals are probably the best source of specialists who are very intelligent and helpful). For instance, with OSA, I saw two "sleep specialist" Pulmonary M.D.s. Armed with my SMRs and civilian records, and as much research as I could find on how my condition could possibly be related to or aggravated by my SC disabilities, medications, etc. I would talk with the doctor about what I had put together, I would ask lots of questions and his opinions. We had some great, very informative discussions. I would make a follow-up appointment. I then went home and drafted a letter with the opinions and nexus statements that we had discussed. My "draft" letters were thorough, including the doctor's specialty and board certifications, the fact that he had reviewed all of my service and other medical records, and the research and logic that led him to opine how and why my present disability was connected to my my service or to my SC disabilities. Out of all of the doctors I approached, only one (a neurologist) refused to sign a written opinion. The others appreciated the trouble I had gone to and were really good about it, surprisingly. I submitted everything in October 2009. In 2010, I had C&P exams. Then, in 2011, I had C&P re-exams of most of it. The only item that I had no IMO or nexus letter for, Major Depressive Disorder, had a great direct SC opinion from the VA Psych that stated it had begun in service and I just knew I'd get granted for that. Later in 2011, I got a Decision Letter. EVERY SINGLE ITEM was denied. In listing the evidence considered, almost none of MY evidence was listed. I requested a DRO Review. In 2014, I was granted the Depression, and got 50% for it, which brought my overall to 70%. I got a lawyer and filed Form 9 for BVA appeal. Earlier this year, I got an invite for the RAMP route. I emailed my attorney, and she said she wasn't sure that would be the way to go. Early this summer, I was feeling discouraged, and told her I wondered if I shouldn't just drop the whole thing. I was tired of thinking about it. I was ready to surrender. She replied that I should just hang in there and see what happens. In July, I went on eBennies, and it said my case was with an ALJ since June 26. I couldn't believe it! However, I just figured I'd be left hanging for awhile, then eventually find out I'd been shot down again. I had already decided I did not want to pursue it to CAVC, I was done. The second week of August, I went on vets.gov, and it showed that a decision had been reached. It said something about issues "granted", two remanded. My heart almost jumped out of my mouth! I opened the next screen, and learned that everything but the sciatic nerve and migraines had been granted, and they are remanded. Here's what is incredible: they granted the TDIU solely on my lumbar spine condition, then because of the depression and other stuff, I also got SMC (s), all back to 2009. And even more incredible, the Decision letter states over and over how my doctors' opinions were the only "credible" evidence, and that the VA C&P examiners' opinions and evidence were of no "probative" value. It may be awhile before I see any money, but doggone it, it feels good to know that the BVA Judge considered ALL of the evidence, and saw through the deny-and-destroy strategy of the C&P examiners/ I WON! I'm attaching the redacted BVA Decision Letter. I've never seen anything like it. Sorry for the long post, but I warned you in advance!!! BVADecisionLtr2018Redacted.pdf
  11. Back to the original subject; "Does the VA have Cialis". I don't know what they have, but it works well. They need to share some of that powerful stuff with us!!! They had been screwing me since 1974, until they finally stopped last month for a cigarette, and the BVA actually gave me a kiss.
  12. I'm not nearly as experienced as many of the members here, but I think Buck52 hit the nail on the head. Anytime your ratings hit 70% or more with at least one rating of 40%, and could POSSIBLY qualify you for TDIU, it is my understanding that an "inferred" claim for TDIU exists whether you mention it or not. And with your particular disabilities, I'm not sure why the VARO wouldn't have granted TDIU, but then I think the process for granting or denying TDIU is arbitrary and sometimes grossly unfair. IMHO, CAVC cases like the aforementioned Bradley v. Peake and Buie v. Shinseki should be applied, and even the simple "benefit of doubt to the veteran" should have been used. Hopefully, if I'm mis-stating anything here, one of the resident whizzes will correct me for your benefit and my education. I'm considering trying to be an occasional part-time (unpaid) VSO, because I'm just reaching the happy ending of my 9-year war to get TDIU and service connect several issues. (Won all but two minor issues at BVA, they're remanded). This is what drives me nuts. They certainly COULD have granted in a manner that gave you TDIU and SMC(s), but simply didn't. If they decided the SSDI was primarily for your 20% C-spine and 20% L-spine, they actually COULD(should, IMHO) have considered granting "extra-schedular" TDIU for the spine conditions. That is exactly WHY the extra-schedular TDIU option was created. Let's be real, the spine AND the other condition are all Service Connected. I promise you there have been TDIU and SMC(s) granted that way, although realistically, probably only at the BVA or CAVC levels. I personally know of a TDIU granted by BVA for a 20% L-spine disability to a veteran with other SC issues, so that SMC(s) would also be granted, citing those cases above. (Even though the spine was recently reduced to 20%, it was and still is the primary reason for SSDI and even the C&P doctor that caused the rating reduction stated that the veteran would not be capable of doing any real job due to the spine condition and medications, etc.) And in that case, yes, the disabilities COULD have been totalled up to 97+ for a 100% combined rating without TDIU, so that SMC would have become moot. Now, here's where you might have a problem; those doctor's statements seemed a bit weak. Your case could be stronger if you can get the doctor to firmly opine that your SC spine disabilities absolutely preclude you from SGE (Significant Gainful Employment) due to pain, stiffness, clumsiness, inability to stay in any one position for any length of time, whether sitting, standing, etc., and so on. And/or get a FIRM, un-wimpy opinion that your 60% condition prevents you from being employable because of X and Y and Z. And with either of those conditions, you probably cannot be a dependable, punctual, satisfactorily-performing employee because each of these conditions interfere with normal sleep and rest/relaxation and your ADLs (activities of daily living), affect your moods, etc. IF the BVA hasn't yet decided your case, it is my understanding (or lack of) that you CAN call them and tell them you have more evidence to submit. It would likely delay the decision, but you'd have more ammunition. If they have made a decision to deny, I'd hope you'll talk to your VSO and/or a NOVA attorney. I'm not certain if or how you can get BVA to look at new evidence after a decision, I'm sure someone here can chime in on that. I hope you stick to your guns, it sounds to me like you should prevail. Best of luck yo you!
  13. If your husband isn't already service-connected for the PE, I'd suggest trying to get his cardiologist, pulmonologist, or other doctor (preferably a specialist) to opine/provide a nexus letter on the PE being a secondary condition. With SC for his CAD already, I would think they'd connect the dots. Also, diabetes is a risk factor for PEs, (as is Obstructive Sleep Apnea), so be sure to cover all the bases with medical opinions/nexus letters for possible secondary SC. Residuals of PE (usually thromboembolism) requiring daily warfarin is a 60% rating. Depending on the effects on his heart, he may warrant a 100% rating, especially if there is Pulmonary Hypertension. Besides Diabetes and CAD, is he SC for other issues, like the Sleep Apnea? I hope you have a good VSO, and are granted the TDIU. More than that, I hope your husband is feeling better. Hopefully some of the more knowledgeable members here will give you better info soon.

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