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pawmbi
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Posts posted by pawmbi
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Thank you! This information is great. Your response hits on exactly what I am trying to figure out, which is to some degree a medical question or interpretation?? His exact medical records says -
"Assessment: GU: Malignant, neoplasm of the left kidney, except renal pelvis -C64.2"
A little further down it says...
" Notes 6/30/22 Doing well postoperatively. New diagnosis of renal cancer. In my opinion this cancer is as likely as not, caused by exposure to agent orange or contamination in Camp Lejeune water at the time. I am a retired Navy Urologist and served as program director for many years.
Proceed with MRI FUSION BIOPY OF THE PROSTATE FOR THE 3 PIRADS 4 LESIONS".
I am not asking you to determine if this is "active" but is sure sounds like it to me. and based on what you said in the statement forms you pointed to I will make that assertation. Because no were does it say "remission" which is what I think, medically, you would say if the cancer was not active? Anyway I'm not a doctor but it won't hurt to try this argument. Yes he has all his medical records I don't want to re-send his records but I will just to speed this process up and hopefully get him to temporary 100
Anyway, you gave me some really really good information to start this process and I sincerely appreciate it!
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21 minutes ago, Phury & Rhage said:
Hi,
I don't have time to give a complete answer at this moment, but, at a minimum, removal of a kidney gets a 30% rating (if service connected obviously). However, active cancer gets a temp 100% when service connected. I'm still at work
but I'll write more later...
Phury
Oh this is perfect...I didn't see this. Thanks I'll do some more research. I like to put in the statements what the rater should consider so that is why I am jumping through this hoop!
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Hello trying to get an understanding for filing a claim for my dad for renal cancer. He was at Camp Lejeune from 1968-1969. He is 90% and in the past six months a mass was found on his kidney, it was determined at the time the kidney was only performing at about 28% so they removed it. After testing it was was found to be Malignant neoplasm of left kidney, except renal pelvis (I am typing this directly from his medical records. Anyway, I'd like to file a FDC since this is considered one of the presumptive conditions. However, since the cancerous kidney was removed what percentage would he qualify for? I was reading through the rating for renal cancer and obviously if he didn't have surgery he would be 80% or 100% I think ( or we could at least argue that) but since they had to remove it does he fall to 0 or 10% if it is SC? Also his doctor, a retired Navy Urologist put in "more likely than not caused by exposure to agent orange and/or contamination in Camp Lejeune water" language in the bottom of his notes. Any advice suggestions would be very helpful.
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On 10/8/2021 at 10:11 PM, broncovet said:
Thank you Broncovet I am following your suggestions.
On 10/8/2021 at 11:38 PM, pwrslm said:Document the Gerd in your records showing that it was a ratable condition up to 1 year earlier. The VA can backdate the award 1 year, no more (that I have seen) before you submitted the claim in some situations. Citations from a recent VBA decision:
A Supplemental claim can be submitted up to 1 year from the date on your last HLR denial. Get the MD's letter if you can, but the GERD should have been documented somewhere in medical records that shows how long you have dealt with this issue.
In a higher level review, the more experienced rating official is not allowed to look at new evidence, but instead is "de novo" or a fresh pair of eyes looking at the same evidence. You can tell the same people trained the new and the experienced RO because the seem to all make the same errors. Seems like they would try to figure out what the less experienced RO missed, but I get the feeling that they just top sheet the claim and stamp "ditto" on the error so as not to embarrass anyone they work with.
Yep I think its down this tunnel so I am working with my doctor to come up with some evidence within the time frame I submitted the claim
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Hello fellow Vets
Sorry in advance for the long read. But I am at my wits end. Any advice on some next steps BESIDES filing an appeal? One thought I am flirting with is getting a doctor to write a letter saying my symptoms existed since "blank" date directly refuting the decision the rating official made February 2021. This would be considered new evidence and I could just do a supplemental? Anyway here is my story:
I don’t think it’s fair that I would have to get in the back of the line, again, when the error rested with the VA and how they adjudicated this claim…
On August 11, 2021, I filed a HLR for a decision on my claim for GERD made February 26, 2021. The HLR was for one thing: Early Effective Date (EED). Why my claim was granted, the date was for January 2021, I felt the date should've been earlier for August 2020. That is all I filed the HLR for. When you file a HLR online as I did, it does not give you an option to “check” your reason for the HLR as a paper copy does. With that concern, I called on or about August 16, 2021, and spoke to a VA Representative and explained what I was doing. She filled out a form “0820 Service Request” articulating I was seeking a EED with my HLR and the circumstances of my claim. Of course, in the original filing I requested to speak to a HLR Officer to discuss my claim.
Fast forward to September 29, 2021. In addition to my HLR claim, I had a separate claim for another condition pending. I called and spoke to a supervisor on September 21, 2021 and was informed earlier that an escalation ticket was put in because the claim was, as she put, just sitting there. She gave me a reference number for this second claim (210921000442) and said I should receive a call in 5 days regarding the second claim. So, on September 29, 2021, I called to just get an update on the second pending claim and to see if someone was going to call me. During routine conversation, the VA representative informed me that I missed my call for the HLR and wanted to be sure I wasn’t referencing that. I said “wait, I never got a call on the HLR” …He stated the HLR call was made 9/28/2021. I immediately looked at my phone and there on my phone is a “Restricted” notation at 08:30 am on 9/28/2021 (See Attachment 9.28).
First, my phone does not even ring if it’s a restricted number, so I never received a call. Second, why on earth is the HLR representative calling me from a “restricted” number?? I have had plenty of calls from the VA and all have come up with the VA 800 number. This past July I had a HLR call and she came through fine and we discussed my claim. In fact, During the call on September 29, 2021 the VA Representative thought he hung up on me and was nice enough to call me back and the call came through fine!
Why did the HLR representative reach out in a way that made it impossible for me to take his/her call? All the reps I spoke to said that should not have happened, but it did. Now, as I understand it, A failure of a “Duty to Assist” has been initiated by the HLR based on the fact that my condition GERD did not have a proper medical review and may need to be rated higher…..NONE OF WHICH IS WHAT I REQUESTED!!!
Here is how the VA lack of customer service not only impacts me, but other veterans, and VA workers as well by clogging up the VA pipeline with an unnecessary claim. Even if this Duty to Assist continues the HLR representative put through, this backlog creates more cases because now the HLR has dived down a rabbit hole with my claim that not only puts my original request, EED, out the door, but more veterans behind me will be waiting in the “que” for this process that was NEVER even asked for by me. Veterans are now waiting longer for their claim because a claim that was not even initiated is in the pipeline!
The HLR representative called from a restricted number that I know from experience does not normally happen, did not leave me any voicemail, and did not try and follow up so that I could take the call. Further, anticipating the bad faith the VA might try to do, I called shortly after filing the HLR to provide clarity for my claim. I was told this was submitted and SHOULD'VE been viewed by the HLR representative but apparently was not! The form was a 0820 Service Request that detailed my concerns about the EED and was submitted on or about August 16, 2021.
How else does this create more problems for the VA workers? If this Duty to Assist process initiated by the HLR representative runs its course my original request for the HLR, EED, is never answered, and guess what? I file another claim, and not only do I go to the back of the line waiting several months for another call, but I have just put another claim on the VA books that is helping create a backlog!!! Mind you, I can't be the only one that this has happened to nor have complained about it. But if nothing is done, this will continue to happen, the trust veterans have that the VA is helping them continues to dwindle, and the backlog, court cases, overturned cases will continue to grow if the VA is not held accountable for the little things like making calls so veterans can take the call and reading the entire file to adjudicate on the proper grounds!
I have attached not only the picture on my phone showing the restricted call at 8:30am on 9/28 but also screenshots showing calls from the VA on 9/29 that came in fine as I discussed this with various VA representatives that called me back fine.
Anybody have any recommendations on what I could do? So far I have emailed about 7 leaders here at my local VA Regional Office explaining the situation. One person did reply and said she was reaching out to the Seattle Office since they had "jurisdiction" over my HLR. I also reached out to my Congressman's office not sure if that will do any good. Any other suggestion or theories or am I just stuck like chuck and need to appeal or try a supplemental claim with new evidence if I can get it? Thanks in advance for any suggestions.
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Ok the facility is
Department of Veteran Affairs, VA Benefits. Here is how it looks on the VA website
Oklahoma City Outbased Public Contact
301 NW 6th St
Suite 113
Oklahoma City, OK 73102That address is just a main Federal Building that houses many govt. agencies (USDA, FDA, etc...)So I don't know hopefully you have something like this that could help you. -
I'm just jumping on this thread so forgive me if I respond to something you have done...
Just reading what you submitted from the VA...my response (keeping it simple and not 90 pages) would be:
1. Continued delay causes an undue hardship on the veteran (put in terms of your claim and getting the medical attention you need if you can)
2. The VA is holder of information. The Secretary seems to be trying to put the delay off on another mode of the VA but you just need to remind the court that they are all one big VA, and if the office cannot compel another to respond in a timely manner to not delay a case, then such is not the fault of the Veteran. Undue delays at the behest of the Agency in control of the information puts the Veteran in a position to remain and continue to be under the dominion and control of the responding agency....something like that. If that makes sense..
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On 8/17/2021 at 1:55 PM, GBArmy said:
Pqwmbi You are lucky; the official stance by the VA is you have to wait for 10 business days to request paperwork if you had not yet received it in the mail. It's nice that your RO is progressive like that but it isn't what usually happens.
OH wow I didn't know that. I thought this service would be available at any Veteran Affairs' office. I'm going to find out exactly what they are. I know its the Veteran Affairs department because its in the federal building with other federal agencies. But when I'm there getting my documents, they ask me if I want them to file a HLR or appeal. So they are some arm of the VA that are advocates is my sense but I'm find out as much as I can and I'll give that info because, this is not something that should be region specific. I agree that the VA has that 10 day rule but I'm not sure how that impacts when a Veteran goes down to pick his information up from these Veteran Affairs offices. This is interesting.
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Just curious...
In your geographical location do you have a VA Office? Here in Oklahoma City we have a VA office in the Federal building and when I get a decision I can go there the same day and they download the decision and any C&P exams done. I've never had a problem with getting this and it is a walk-in basis. I wonder if you have an office like that might you get your information faster?
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It is secondary. It is what doctors refer to as "bidirectional". Meaning the GERD can aggravate the OSA and OSA can aggravate the GERD. I have a IMO that states exactly that. I am SC for GERD and got my OSA SC through GERD. I got my GERD SC via the above mentioned medications the VA prescribed to me for pain for another SC condition. If you want to read a copy of the IMO...let me know I can redact and post.
- blahsaysme2u and Al329
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1 hour ago, Combat eng said:
You can log on to Benefits and go to letter generator. Pull up the one that says benefit summary and service verification letter. It will state if you're P&T there. The other letter are also important as far as commissary and taxes are concerned.
Thank you found it!
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On 7/29/2021 at 6:38 AM, broncovet said:
I agree with Scottish Knight, especially "the VA is clueless". Are you wearing hearing aid(s)?
In a nutshell you take the "Average". To determine the average, add up the numbers the audiologist wrote on "1000", 2000,3000,and 4000.
Then divide that total by 4 to determine average.
I will do it for your right, you do the left: (from your chart). 20 plus 50, plus 55, plus 65 equals 190. Divide by 4 is 47.5 (use 48).
So your average for right is 48.
You then use your speech discrimination percent on the bottom of the chart for each ear. Then you can plug into chart and get your disability percentage rating.
Im teaching you to do it rather than just do it all.
This is exactly what I want....to learn how to do it! Thank you sir for your answer I appreciate it
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First, I want to say thank you to every single person who has contributed to this forum. I have read or received great advice, success stories, encouragement and because of that I was able to pursue my claim. August 2, 2021 I was granted 100% !!!!!!!!!! I am beyond excited! But of course I have questions. So the rating official says in my rating decision..."An evaluation is assigned from August 19, 2020, the date of your supplemental claim since you have pursued the claim continuously since that time..." On page two of the packet it has 3 boxes Monthly etitlement Amount, Payment Start Date and Reason. In the Payment Start Date box it has Feb 1, 2021. So am I getting back pay to August 2020 like the rating official says or does the 100% rating start in February?? So confused.
Also where do I find that it is 100% P&T I didn't see that language anywhere.....
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Hello can anyone here read an audio test and possibly tell me where, or if, the Veteran's test should've' resulted in some type of hearing increase? Veteran is currently SC for Tinnitus (10%) and Bilateral Hearing Loss (0%). I had him do the VA approved test, and sent it in as a supplemental Claim. Claim was denied (still waiting on letter) and just wondered based on the test results if anyone could read them and give me a clue. I tried reading them but I simply couldn't understand it. Strangely, the VA did not have him come in and do a test through them, which I thought they would they just took these results and denied. Which leads me to believe the results do not meet any kind of threshold for an increase. Anyway, if someone can help I'd appreciate it and helping this Veteran make a decision on his next steps.
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13 hours ago, deedub75 said:
They tried to use the weight gain tactic against me when I filed claims for knees and back secondary to my already service connected pes planus and right ankle. The bad part is that when I originally filed the claims back in 2010 and had c&p exams in 2011, I was at my normal weight and not overweight at all. The claims were denied, went through the appeals process, and ultimately languished at the BVA and by the time the BVA remanded my claim back to the RO and I ended up getting new exams in 2017 or 2018 I had gained weight. The examiner blamed my age and weight on my knees and back issues. When I filed the claims I was 35 or 36 years old and at a healthy weight.
I ultimately ended up having the claims granted and received a huge backpay.
Well I attached the 2017 memo for you in case you need it. I used it as supplemental evidence when they tried that weight gain crap...and it ended their argument claim granted. You actually want them to go ahead and make the weight gain argument so once you present the memo they can't make something else up....unfortunately its a game to them
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Just remember that weight gain is not a ratable condition (generally but could be under certain circumstances). The VA often will use the argument that..."Well you gained weight so this new condition is a result of the weight gain and not your SC condition. This is false. weight can can be a "bridge" by the VA's own internal memo. So your argument will be something like this...Because of my SC condition i gained weight and that weight aggravates or caused the sleep apnea. Just be prepared for that especially if you bring up your weight gain...
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Hi I don't know where you live but for me in Oklahoma we have a VA Office in the Federal building downtown...soon as I get a decision I go there and ask for a copy of the decision and C&P exam. Takes me 5 minutes and I have both normally on the same day I get notice of a decision if its during business hours. If not, I go get it the next day.
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10 minutes ago, Johhny_Drama said:
Wow that was a thorough letter. Mine was one page. I am trying to get OSA and mentioning PTSD is aggravating my diagnosed OSA and hopefully this will work out. I may have to find a doc that specializes in nexus letters. My doctor specializes in ptsd but hasn’t written tons of letters.
I haven't seen your letter but the VA does have certain "phrases" if you will that NEED to be in a Nexus for them to even consider it. Also some BVA cases demonstrate what a VA Examiner is suppose to do when considering "secondary" conditions (is it caused by or "aggravated" by the SC condition) and these things HAVE to be in the letter. I do not know your situation or read the IMO but be sure it captures these elements or its just going to further frustrate you down the road. If you capable, I'd try and get a professional like Dr. Finnerty to write mine so it captures all those elements and puts you in a stronger position for success. Other things to consider: If you have OSA do you have a CPAP? if so, did VA issue CPAP? Sleep Study? make sure you include these things in your claim as well. If I am coming across as condescending like you don't know what you are doing, I apologize that is not my intent, I just want you to be successful the first shot out!
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6 minutes ago, Johhny_Drama said:
To Berta
this is for my OSA being aggravated by my service connected PTSD. My doctors both wrote nexus letters and my VSO looked over and said he thought they looked great. We will see how this goes. We are responding to the denial and new evidence is the nexus. So I’m going for secondary here and I know it’s a uphill challenge.
The other post you may have read was my c&p exams that I completed in June. I am battling this 30 percent flat feet issue. I have SC 30 percent plantar fasciitis bilateral and in 2016 or 2018 they denied me at increase stating I didn’t mention orthotics. I had my podiatrist make 2 pairs after reviewing everything and I gave it a shot for 2 years. They didn’t show improvement. I was issued a night splint due to my Achilles’ tendons being super tight. During the last 2 years I tore my calf muscle simply walking across the room in my house. And to top it off i now have heal spurs on both feet that feel pretty damn painful. These are the changes in the last 2-3 years since I applied for a increase.
I found out they kept my feet rating at 30. Even though the report stated the custom inserts didn’t work. I have pain full to the touch feet, tight flexing Achilles’ tendons, basically every single item in the box that warrants 50. They mentioned in order to get 50 you need to show these items ...I’m thinking who is looking at my claim because that’s everything that I’m going through. It’s beyond mind blowing. They said the new heel spurs I never had are already rated with the 30 percent rating. I thought they warranted their own rating. They are a separate issue. And no rating on my Achilles’ tendons even though they feel like they might snap. So I had 30 percent and I requested increase to 50. I requested heel spurs, torn muscles, and Achilles tendinitis as secondary. And after all this I got nothing as in nothing changed.
my VSO is reviewing and seeing what is going on before we move this to higher level. I can’t believe anyone of this. But I guess I should be use to it. So that’s the current situation.
I have a veteran I got a Nexus letter for OSA for his PTSD. It was all that was needed and perhaps one of the best Nexus letters written. Within a week the VA approved his claim. Search the forum for copy of it I posted on here or message me and I will send to you if you interested. The Nexus letter was 600 bucks and it took the Dr. about 3 weeks to get it to me.
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Hi just following this thread. I have a HLR for migraines as well secondary to OSA. I have a BVA case right on point (its also for Migraines secondary to OSA) but the rater just ignored the case. Also, they did not apply the reasonable doubt doctrine. When did you request your HLR? I requested mine 6/6/2021. Just wondering a general time frame to wait. Also did anybody request to speak to the decision maker and did you actually get to do that?
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1 hour ago, Berta said:
The new C & P exam- same doctor- but It could possibly go in your favor-this time.
That CAN happen.
I will go over this whole thread- to see if you attached the initial denial letter ( and Evidence list)
because with that, maybe we can help more.
Good for you for using the BVA citations,as I am sure they were case involving VA case law that should have been applied to your claim.
The BVA web site holds a wealth of info!
Thank you for using it!
The BVA decisions for a search are on the right side pf this page -for anyone who needs--
Thank you Berta!
I am attaching the decision and the BVA case that was right on point.....VBA 1Case 1640906.pdf
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So the VA accepted the BVA cases as new evidence...did not kick it back to me. But here is the rub: The are doing ANOTHER C&P Exam????
Granted this Exam is a "records only" and I do not have to report for an actual exam but is this giving the VA another bite at the apple because that is
exactly how I feel? In the NOD I pointed out how incomplete the examiner was from a single paragraph to missed checked boxes by the examiner. Now they
sent it back to the same doctor for him to correct those mistakes and make a stronger exam? I know I'm venting here but that makes no sense to me..how do
they get two bites at the apple to correct the C&P Exam just to continue the denial. Also, I am being speculative because I haven't been denied yet but I'm sure
its coming this week sometime....
Camp Lejeune Presumptive Condition
in VA Disability Claims Research
Posted
Hello just trying to get a better understanding of of the presumptive conditions. When I researched va.gov at https://www.va.gov/disability/eligibility/hazardous-materials-exposure/camp-lejeune-water-contamination/
It give a list of presumptive conditions and what must be filed. I filed the diagnosis for Renal Cancer (Kidney Cancer) and provided the dates of service April to September 1968. I've attached the letter received from the VA. It seems to me they are asking above and beyond what is required for a presumptive condition. The 61 pages of medical documents submitted from the urologist very clear diagnoses as Renal Cancer and the doctor even rights in his notes this exact statement "...In my opinion this cancer is as likely as not, caused by exposure to agent orange or contamination in Camp Lejeune..."
So I am asking how to respond to the VA's request for what seems like more medical and scientific proof as well as a Nexus letter when this is suppose to be presumptive and all that should be shown is records supporting his time at Camp Lejeune and the diagnosis for any of the eight presumptive conditions and in this case Renal Cancer. Any feedback would be appreciated.