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brokensoldier244th
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Posts posted by brokensoldier244th
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No, you log in as normal. Nothing has changed other than moving most everything to VA.gov. If you have no updated status of your appeal its because no one else does either. Every thing is taking longer, evidence gathering for federal records is taking weeks and months instead of days because one or more of the NPRC facilities are either on skeleton crew or locked down. They are not VA facilities, we have to wait for things just like the rest of you.
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Ebenefits has been in sunset mode for the last year or more, and is being decommissioned. Most everything on it has been moved to VA.gov and the only reason Ebenefits is still up is because there are a few things left to convert, and for informational purposes for veterans that already started claims there.
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No, because I’m not a clinician or a contractor.
Generally a statement would be on an exam within 1yr RAD- SC opinions aren’t needed for general medical exams, though a Gulf War opinion is requested for MUCMI issues on Gulf War gen meds. They are their own thing and look for specific things.
Outside 1yr any claimed contention needs an SC opinion, unless it’s for an increase.
The opinion is a separate DBQ with rationale and answers to specific questions regarding the condition and whether it’sSC or not. The clinical dbq is just measurements and findings.
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27 minutes ago, broncovet said:
Here is the deal. In order to determine etiology (whether your condition is related to service), the doc renders an opinion. He was not there, so he can not establish a fact, but he can make an educated guess as to the likeliness of whether or not your condition is related to military service. This is called a nexus.
There are actually 3:
1. Independent Medical exam. This is the doc recording the facts of what he sees. Your temperature, your blood pressure, lab results such as cholesterol levels, are not opinions, they are facts measured by a doctor.
2. Independent medical opinion. An IMO need not examine the patient. Instead, he reads the other doctors medical exams (the patients history), listens to the patient, and renders an opinion. You see the patient IS competent to tell the doc things like: (example)
"Yea, I fell out of a tree and broke my arm in service". So, if the doc sees an xray of your arm, with a fracture consistent with falling out of a tree (x) years ago, he can render his opinion that its at least as likely as not your (event in service) fall out of a tree, caused your fracture which led to your current diagnosis of arthritis. The doctor makes a "statement" in your medical records that he thinks its likely your tree fall caused your arthritis. His statement is an opinion, but its based on other doctors statements and diagnosis. A previous doctor, such as a military doc, makes a statment such as: "I viewed the Xray, and it shows a fracture of the right posterior humerous about 1 cm from the elbow. "
3. Independent medical evaluation. This is a combination of the two above. The doctor examines you, does tests he feel are appropriate such as blood pressure, cholesterol, etc. He then reads your history. He also speaks to you, establishes your age, medical history etc. For example, he may ask you if you have asthma. (Some things are not included in medical records, so they simply ask you). The doctor will likely ask you other questions, such as do you have a history of alcohol or substance abuse.
Based on your medical history, doctors statements, your statements, what he observed on your medical tests as well as previous medical tests, and his vast medical experience, he makes an evalution of what he thinks is your medical history, and often makes a prediction of the outcome, such as you are likely to have arthritis in your arm due to the previous fracture.
All 3 of these, above have medical statements.
I will explain it this way. A medical statement is like a motor. You cant drive the motor, but your car is rather useless without one. The motor is one part of many to your complete car.
The site he’s pointing at is not for private providers, it is (or was) for training c&p clinicians)
the course links he’s pointing at are from 2015. (EVERONE) VA doesn’t go around sanitizing the internet of things except it’s own sites. Just because something is found out there about VA rules or exams is not ‘official’ or up to date information unless it’s in our site. Including NVSLP, Hill and Pontin, CCK, etc. and especially not links on any hired guns sites that promise to do medical exams or help you for a few.
I know that this site is not using current training because I went through some of the Gulf War training set on this site this morning, and parts of it are based in FLASH, which has not been supported in current browsers to varying degrees for a few years, and was completely discontinued on 31DEC2020.
I’ll look at the rest and try to post later. Time for work , and it’s been a bit stressful lately.
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Thats not true- we've had more than 10 claims this month with between 100,000 and 400,000, with 1 being 762,000 in backpay just in my RO that is a Nehmer and MST specific site. That's not great that it took this long (Nehmer/new contentions for AO) but once the claims were worked and sent to rating it was only a few weeks for them to get signed and promulgated to finance. They get signed like anything else. The appropriations from where the disability awards come from is not the same as the operational budget that we have to wheedle for every year before Congress. Its just signing another piece of paper/PDF. How much is paid out is not any part of our review or performance as employees.
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Decisions aren't just a click and a percentage. They still can take time to finalize, and there are more than just 1-2 people involved. After the deciding there is double checking it, then the promulgation people (figuring up the award if there is one), then signatures- there higher the amount the more people it has to go through and they aren't all local at there RO.
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Fyi, too, depending on your term of service and when it falls 3.317CFR covers general sleep disturbances as presumed as a result of Gulf War exposure, so, maybe you don't have apnea, per se', but you DO have sleep issues, circadian rhythm problems, other respiratory issues that might contribute to sleep issues (sinusitis, asthma, or rhinitis chronically- ALSO on the list as a presumed condition as of August)
This discusses (click here) the particulate matter announcement specifically, but scroll down further and it also discusses Gulf War Mucmi's (Medically Unexplained Chronic Multi symptom Illnesses)
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An examiner can't diagnose sleep apnea. Much easier to have it diagnosed. It is not a catch-all term for sleep issues either, it's a specific condition. If you don't have it and you claim it specifically it is usually a denial.
Either claim sleep disturbances, or apnea, but you can't just self diagnose apnea or get a CPAP, even privately, unless you actually have it, from a provider. You could buy a used one but without knowing how to set it up it would do you little good, plus you still wouldnt have the diagnosis.
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We continually get information sent by veterans right up until we're send it for decision to a rater.
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You can request them from nprc just like we do and wait three to 6 months or more... Just like we do.
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The rater goes off whatever is in the record. If you want it in there, send it.
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They will get a direct or secondary opinion on all of it and rate it. There isn't a single 'GWS' rating, so they will take all of them and rate them is usually what I see, whether they are primary or secondary to something else.
Also, for our listeners out there, the 31DEC2021 deadline for filing GWS has been extended to I think 2026.
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5 minutes ago, pacmanx1 said:
Unfortunately, here is another issue TDIU veterans have to be aware of. I am not nor have I ever been TDIU, I was rated 100% scheduler and dealing with other veterans and people in general, it is none of their business. I would tell other veterans that I retired being rated 100%, I knew I was not going back to work so to me it is not a lie, but some veterans think that if you/I did it they can do it, or you/I could help them. I quickly explained/explain to them that it is really what is in your/their medical records. The VA is just not going to grant you/them 100% or TDIU if there is no medical reason.
I have been called a liar and a cheat because after trying to help other veterans and informing them that I did not think I could help them that they would turn on me. I really don’t care, and no VA doctor is going to lie just to help a veteran out. Either your medical evidence proves or disprove that you have a legitimate disability or not, it is what it is. I even had a VA doctor lie on my C & P exam and had to file a statement in support that proved that the C & P exam was inadequate for rating purposes because the examiner failed to address my remanded issues. After given a new C & P exam my disability was corrected and increased. People/VA do some crazy things and you the veteran have to do what ever you have to do and to be honest because if you ever lie, it will catch up with you. IMHO (IN MY HUMBLE OPINION).
Great points, all.
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Mucmi consists of the conditions listed in the CFR. 3.317, depending on where you served and when it manifested.
Not every injury,ever, is an inferred claim. That hangnail you got at Victory Forge that got infected does not usually rise to the level of claimable, at least for inferring. An inferred claim needed to be an injury or illness with chronicity in and post service- it's still subject to Caluza.
As a vsr I can't infer a claim because it involves creating a decision and that is outside my lane. I document things like " I sprained my ankle in basic...." Or I hit my head on X...". Usually it's acute injuries that have no continuing symptoms but I document then as I come across them, because while they may not rise to the level of inferred claim because they are acute with the records on hand that doesn't mean that you can't claim it down the road or that a RVSR won't kick it back to me and say that there IS enough for an exam. They have more systemic medical terminology knowledge than we get at my level, though I read a lot on my own.
https://helpdesk.newmobility.com/index.php?pg=kb.page&id=1779
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Just now, pwrslm said:
But say you are 35. What do you do if you are bored out of your mind with TDIU?
Introduction to Marginal Employment and Protected or Sheltered Work Environments
In order to gain approval for TDIU claims, a veteran is required to demonstrate that they are unable to secure or follow a substantially gainful occupation as a result of their service-connected disabilities.
Substantially Gainful Employment is defined as SGA, Substantial Gainful Activity, an amount of earnings that is at or above the federal poverty threshold for one person. Anything less than this is known as Marginal Employment.
...
Self & Family Employment Does Not Bar Vets From Individual Unemployability Benefits
Self-employment and family employment are other examples of protected or sheltered work environments.
https://www.woodslawyers.com/marginal-employment-sheltered-work-environments/
A small family run business can be very profitable and not violate TDIU requirements. Husband/wife teams can become very successful.
Always consult with a lawyer when thinking about this. One mistake could cost your TDIU award.
Im not 35 but I feel you. I was rated 100% about 6 yrs ago, so I was 39. It took a few years to wrap my head around. I was a stay at home dad/uncle for a few of them and I could tell you more about Paw Patrol and Fancy Nancy than I could about Game of Thrones or BS Gallacta. That said, I started volunteering at the local library for a few hours a week in the stacks, and eventually started working part time doing the same. It certainly wasn't SGA, but over the next two years I figured out what my tolerances were for situations when working and volunteering, and how to mitigate or temporarily step around them when possible. I work full time for the VA now, and they are fully aware of my limitations- but, im not I/U either.
One thing to be careful of with the sheltered environment is that the Dept of Labor waffles back and forth on what they consider to be sheltered employment, and for family employment you have to be really well documented to justify it should there be any doubt down the road.
Honestly, having been I/U for 6 months prior to a pending decision, I wrestled with this and spent my time being home dad, catching up on my hobbies, and trying to make myself the (reasonably) best person I could be. I volunteered a bit at the VA clinic, too, wearing one of those blue jackets and giving people coffee or whatever, too. The going back to work part still happened a few years after being rated P&T, partly because I couldn't believe it and felt that I had to 'justify' to other people that I was disabled by not working or engaging in much outside the house because part of my stuff is mental, and part of it is physical- but none of it is 'obvious'. Im not missing limbs, or blind or anything like that. I avoided people just because I didnt want to have to explain all the time why I wasn't 'working' during the days when everyone else was. Eventually I just told them that I was self employed and that seemed to shake most people off.
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We just had a meeting over this today, and among other things veteran anxiety was brought up several times, as was how to define 'sustained improvement', usually in the context of cancers and other malignancies. That is still being addressed, but the short of this is that there is a National push for creating fewer RFE's, due mainly to statistical analysis that shows they are often unnecessary. I get one, I look at it, I document or obtain all the current medical from the last action on a condition, then send it to an RVSR that then looks it over to determine if an exam is truly warranted, etc etc. The dates for these things are set like 90% by computer based on previous regulations and estimations of medical conditions that are gotten from I have no idea where. No, really, im not kidding. I don't know what went into programming the dates for all the various conditions into the system for assigning RFE dates.
It takes up a lot of time for me (us, VSRs) and Rvsrs to evaluate these only to have them not even be needed, meanwhile you have gotten a letter about it and are stewing and worrying about it. Well, this says that we (VA) are changing the policy effective date of this letter (7 OCT) forward. RFEs scheduled prior to are being weeded out and evaluated like normal.
QuoteAll VBA Regional Offices and Centers Policy Letter 21-01
Subject: Updated Guidance on Routine Future Examination Requests
Purpose
This letter provides instruction to regional office claims processors regarding scheduling of routine future examinations (RFEs). Based on a data-driven analysis of outcomes of RFEs over a three-year period, RFEs will not be established or required absent an exception outlined in this policy letter.
Background
Generally, reexaminations will be required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or that the current rating may be incorrect. This principle and other requirements for RFEs is contained in 38 CFR § 3.327. An Office of Inspector General (OIG) report, released July 17, 2018, indicated that further guidance may be needed in this area to ensure consistency in policies pertaining to reexaminations, including more clear direction as to when they are necessary. This OIG report estimated that approximately 37% of RFE requests from March to August 2017 were unnecessary or should not have been requested based on the regulations.
Analysis and Conclusion
Compensation Service analyzed data on all Veterans who had an RFE conducted in fiscal years 2018, 2019, and 2020. The analysis revealed that the majority (77%) of conditions reviewed were confirmed and continued. Only about 10% of conditions were reduced, and the remaining 13% of conditions were increased.
Furthermore, the data revealed that mental disorder conditions accounted for approximately 40% of all conditions reviewed by RFEs without a VA examination being required under the VA Schedule for Rating Disabilities (VASRD). While accounting for a large volume of RFEs, only 5% of mental disorder conditions were reduced. The majority (75%) were confirmed and continued, and the remaining 20% were increased.
These trends indicate that RFEs are being requested in circumstances other than when they are required. Unnecessary RFEs are not a demonstration of good stewardship of resources entrusted to VA. Apart from the time and costs to the agency of conducting unnecessary RFEs, there is impact to efficiency and timeliness of claims processing as VA examinations are often an important piece of evidence in claims for original service connection, claims for increase and for new conditions. Equally as important, there are costs to Veterans, including their time to travel and attend. Some Veterans have reported anxiety and fears when receiving RFE notifications. RFEs can involve invasive medical examinations or cause Veterans to re-experience traumatic events associated with their mental health. Therefore, VA must improve consistency and focus on the intended purpose of RFEs.
Guidance
The policy guidance in this letter applies to all regional office claims and appeals processing personnel within the Veterans Service Centers and Decision Review Operations Centers.
Effective immediately, routine future examinations shall only be requested when
- Mandated by a provision found in 38 CFR Part 4 (e.g., 38 CFR §§ 4.28, 4.128, 4.129, and in evaluation criteria found in diagnostics codes like 7528 Malignant neoplasms of the genitourinary system), or
- Necessary to reduce an evaluation in accordance with 38 CFR § 3.344.
Duty to Assist
This policy letter does not alter VA’s duty to assist, including the provisions for providing medical examinations or obtaining medical opinions when necessary to decide a claim. See 38 CFR § 3.159(c)(4) and 38 USC 5103A(d). Additionally, VA will continue to accept, without further examination, any hospital report or any examination report from any government or private institution, provided that it is otherwise adequate for rating purposes. See 38 CFR § 3.326.
Failure to Report for Examination
This letter also does not alter the provisions, found in 38 CFR § 3.655(c), concerning reexamining a claimant after failing to report for an examination. If an examination has been ordered to assess continuing entitlement when there is a running award and the claimant fails to report but indicates willingness to report for reexamination before payment has been discontinued or reduced, a reexamination shall be rescheduled.
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Out damn standing. Now, breath. Then, depending on the retro, have a plan but do have some fun, too.
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Excerpts from an email I got yesterday after I had logged off, but read this AM. I don't pretend to understand point C.- I don't work on court appeals stuff.
We are apparently having meetings next week about all of this.
A. Intent to File (ITF) Framework Applies to all Supplemental Claims
The Court invalidated a portion of the introductory language to 38 C.F.R. § 3.155, which
excluded supplemental claims from the ITF process. VA must now accept an ITF for a
supplemental claim. Claim processors must consider whether an ITF of record is
applicable to a subsequently received supplemental claim under § 3.155. This includes
all supplemental claims, whether filed within one year of a decision or after the
continuous pursuit period has ended. An ITF filed within one year of a VA decision may,
therefore, operate to maintain continuous pursuit if the ITF is applicable to a
supplemental claim filed after expiration of the one-year period following notice of a
decision.B. Claimants can file supplemental claims while a claim for the same issue is pending at
the Court.
The Court also invalidated 38 C.F.R. § 3.2500(b), which prohibited the filing of a
supplemental claim when adjudication of the same issue was pending before a federal
court.
Note: The Board of Veterans Appeals (BVA) does NOT fall under this definition of a
federal court. The existing guidance in M21-1, II.i.2.A.3.a-c. still applies when
determining if a claimed issue is duplicative of a legacy or BVA appeal.
To allow timely consideration of new and relevant evidence, effective immediately, claim
processors must accept a supplemental claim filed on or after July 30, 2021, when the
same issue has been appealed and is pending before a federal court when the
supplemental claim is filed. This includes cases before the U.S. District Courts, the U.S.
Courts of Appeals for Veterans Claims, and the U.S. Supreme Court.C. Revision of Attorney Fee Eligibility Due to Invalidated Regulation.
The Court invalidated 38 C.F.R. § 14.636(c)(1)(i), which treated decisions on various
types of claims as initial decisions in the case thereby making attorneys and agents
ineligible for fees based on those decisions. The Court disagreed and explained that, for
example, clear and unmistakable error claims and supplemental claims filed after the
one-year continuous pursuit period are, for fee purposes, part of the same case as
earlier proceedings adjudicating compensation for the same disability.
VA may no longer apply the regulation, 38 C.F.R. § 14.636(c)(1)(i). Under the Court’s
ruling and the relevant statute, 38 U.S.C. § 5904(c)(1) and (4), agents and attorneys
may charge claimants or appellants for representation provided after an agency of
original jurisdiction has issued notice of an initial decision on the claim or claims if the
notice of the initial decision was issued on or after the effective date of the modernized
review system as provided in 38 C.F.R. § 19.2(a), and the agent or attorney has
complied with the power of attorney requirements in 38 C.F.R. § 14.631 and the fee
agreement requirements in paragraph 38 C.F.R. § 14.636(g).
Under this ruling, once VA has initially adjudicated an issue, fees may be charged for
work on later claims involving that issue without the requirement of a new initial
decision. Attorney fee eligibility now applies to all supplemental claims. This applies to
fee decisions on underlying claims processed under AMA required on or after July 30,
2021. -
He said up above his dmii is already sc for exposure.
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YES- OSA can kill you slowly. Over time it strains your heart, it strains your brain/cognitive function, it can directly impact daily activities to the point of causing physical harm, and untreated your 02 sats drop slowly in your sleep and you can eventually just not wake up.
OSA is no joke. I was Dx'd about 10 yrs ago, and it was a partial driver for some of my MH issues, though more it just made them worse, plus I was falling asleep at work and while driving, and just while sitting in the living room with the wife and kids *poof...* missing 15 minutes all the time. I couldn't remember routine things I did the day before, and sometimes in the same day- sometimes meds. It was a running joke for a few years leading up to my diagnosis, but it sucked hard because I couldn't help drive on long trips, for example (my wife's family is about 6 hours away), and it caused some marital strife there until we knew what was going on and why.
CPAPS are expensive, a thousand or more. Masks and tubing every 4-6 months, there is another hundred or so. Its much better to get it covered by VA. This means through VHA (unless you are already being treated- if so, thats great! ). They'll provide the stuff for you regardless of SC, especially since you are already 100% (IU).
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The employment aspect of this is a great point that Pac makes. I was briefly iu about 6 yrs ago,(for about 4 months) and then was converted to 100% schedular by a subsequent rating that was pending. During that period of IU before the other rating hit I had to go through this decision.
A large chunk of my rating is MH related due to chronic pain and residuals of some days feeling really worthless as an individual because of its physical limitations. I have fewer of those days now, but still do. It still took me 4 of the last 6 years to work gradually back up to full employment after I was allowed to. Prior to my 100% rating I had been 70% total, and was working in IT as an engineer. I lost that job of years due to mh, migraine, and physical travel limitations. It had been my job(s) and my college degree path ( voc rehab paid for that so I felt obligated) for over 15 years. I had to come to terms with that at 100% and take a real hard look at what I could and couldn’t do. IT was my identity, and I lost it. Sure I moonlighted on the side, still, but it wasn’t the same feeling of worth.
I was later (few years later) lucky to find the one job for me that allows me to work full time, now, with my 100% rating, due to accommodations, and Covid (being allowed to remote work). Otherwise I’d probably still be part time at 9.00 an hour at the library, in the stacks and away from people, for the 15 or so physical hours a week that I could handle there, or not working at all.
It’s really hard to work at the higher percentages, much less full time, and an almost perfect storm of events has to happen to make it possible. Think about that strongly.
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Safe as in what? If you’ve gotten better, you might get a reduction in something. If you haven’t the likelihood is greater that you don’t. If you don’t file you get nothing. So it comes down to are you going to file or not, because the only way you ate going to get what you want is by filling. All P&t means is that we can’t call you in for a reexamination on a schedule. If you are p&t for IU it means you already got a rating for whatever that made you unemployable and p&t IUs aren’t just handed out.
We don’t just go looking for ways to reduce people. If we come across an error in a rating during a review for another claim we are legally and fiscally required to act on it- that’s money that could be going to another veteran. We also can’t cherry-pick conditions out of your file, it’s not cross indexed with table of contents. We have to look through everything to find whatever you are claiming. Your doctors, civilian or otherwise, don’t neatly separate your records into conditions with name tags
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That’s what we’ve been doing for months . We have specific teams at the ROs that have done nothing but this since May.
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If you are talking about DEA, she has to apply for it and it goes to her, not you. It’s not your benefit to claim. You can leave her on yours but then she can’t use DEA. it’s double dipping if she does and you don’t remove her from your va award, and va auditing WILL eventually find it and take it back from you. You can still claim her on your taxes, though.
Higher level review
in VA Disability Claims Research
Posted
?? What are you asking? Those records have been at the NPRC for years. We have whatever was requested at different times for your claims, but the originals that are unscanned are at NPRC same as always. You can file a request under FOIA for your C file from VA or you can request your records directly from NPRC- but those are only medical and personnel. Your VA files have never been there.