[Secondary To Asymptomatic Or 0% Rated Disease]

I served on the ground in Vietnam in 1967 & 1968. I currently have asymptomatic/smoldering Multiple Myeloma. Multiple Myeloma is one of the diseases listed on the agent orange presumptive list. In reviewing the VA Rating Schedule it appears that anyone with a service connected disease considered to be asymptomatic is rated at 0% service connected. I have been having problems with neuropathy in my extremities for several years which is gradually progressing. My local orthopaedic spine specialist recently conducted several diagnostic tests and concluded that my neuropathy was not caused by spinal stenosis or other orthopaedic problems. I was referred to my local neurologist who also conducted various tests and concluded that my neuropathy was secondary to my smoldering multiple myeloma.

At tne end of my appointment with the neurologist I asked him to write me a independent medical opinion. The first letter he provided was not detailed enough to pass muster with the VA so I prepared a proposed letter and included the necessary details required by VA and asked him to sign it if he agreed with the content. His medical assistant typed the letter on the doctor's letterhead and the doctor signed it without making any changes to my proposed letter. In the letter the doctor states "severe symmetrical distal polyneuropathy in his lower extremities that is primarily sensory" and he also stated "Considering every possible sound medical etiology/principle, to at least the 50% level of probability, I am of the opinion that the patient's neuropathy of his lower extremities is more likely than not secondary to his currently diagnosed smoldering multiple myeloma." My neuropathy is chronic not acute or sub-acute as listed on the agent orange presumptive list.

QUESTION: Will the VA give a rating for a secondary condition when the service connected primary condition is rated at 0% and considered asymptomatic or should I wait until my Multiple Myeloma becomes active before filing the neuropathy claim? Although I have some of the symptoms of active Multiple Myeloma (e.g- recurrent infections/pneumonia twice in past five years, low back pain, pain in legs, neuropathy, etc.) it appears Multiple Myeloma is not considered active until you have actual tumors or lesions in your bones, kidney problems, anemia and over 30% plasma cells in your bone marrow. According to the VA disability rating schedule, severe neuropathy would be rated at 20% for each leg or maximum total of 30% for both legs.

Suggestions and comments would be appreciated. Thanks... Georgiapapa

[Correct Imo Letter Or Leave It As It Is?]

Hi,

I currently have smoldering multiple myeloma. I am a "boots on the ground" Vietnam veteran so I know my multiple myeloma is one of the presumtive diseases caused by agent orange. This message is in regards to a condition which I wish to claim as secondary to multiple myeloma. I also have neuropathy in my lower extremities and my right upper extremity which has increased. As a result, I went to an orthopaedic doctor who conducted MRIs, x-rays, EMG studies, and a CT myelogram of my spine. My EMG study revealed I had "severe , axonal and demyelinating, tibial neuropathy in my right and left lower extremities." The EMG study also revealed I had "moderate, demyelinating, right ulnar neuropathy across the elbow (cubital tunnel syndrome) and moderate, demyelinating, right median neuropathy at the wrist (carpal tunnel syndrome affecting the motor and sensory components."

My orthopaedic doctor at first thought I had spinal stenosis but after reviewing the results of the CT meylogram and the other diagnostic tests stated he could not find an orthopaedic cause for my pain and neuropathy and when I asked what is causing it, he said "it is probably your myeloma but we need for you to see a neurologist to make sure."

I recently went to a neurologist who conducted a neurological evaluation and reviewed all of my tests. After conducting his evaluation and reviewing my tests, the doctor advised me that I have " a symmetrical distal polyneuropathy that is primarily sensory, slight proprioception problems and a positive Romberg which is effecting my gait. He advised me that he believed my myeloma was the cause of my pain and neuropathy. I asked if he would write me an IMO letter and I provided the sample info for him in the letter. He said he believed his report basically followed the same format but with additional info and that should be all I need. He did not act like he wanted to do anything other than his normal report. I reminded him of using the correct terms such as "more likely than not" or " as likely as not" and he indicated he would.

I just received a copy of his report which was thorough but it had what I perceived to be some problems. It was on letterhead but was a copy not an original. It also had the notation "electronically signed" instead of an original signature. In the most important part of the letter where he states the cause of my neuropathy the doctor stated "His neuropathy is most likely secondary to his dysproteinemia/smoldering multiple myeloma." He did not use the language I suggested for the letter.

QUESTION: Should I ask him to change the letter and use the term "more likely than not" or is the term "most likely" an acceptable term for the VA?

QUESTION: Should I ask for an original of the report or would a copy with an original signature suffice? NOTE: I will definitely advise him that it must have an original signature, electronically signed will not work.

Any suggestions would be appreciated. Thanks... Georgiapapa

[Scars Rating Cue Or Request For Review]

I was in a jeep accident in Vietnam in 1968 which resulted in the transverse fracture through the anatomical neck of the humerous of my left shoulder. I underwent surgery in a field hospital in Vietnam which left a large ugly ragged deep tissue scar on my left shoulder. Shortly after my discharge from the Marine Corps in 1970, I filed a claim for disability with the VA. The VA service connected my shoulder injury at 0% and I appealed their decision and provided the VA with a photograph of the scar on my shoulder. After I appealed, the VA awarded me 10% disability for residuals of fracture of left shoulder. I appealed the 10% award and underwent an exam by the VA in 1971. During the 1971 VA exam, the examining doctor stated the following in his report:

"On examination, there was a 10 and 3/4 inch slighly ragged nonlineal scar running down the anterior left shoulder and into the anterior axilla. The scar was old and well healed and not symptomatic. The veteran could go through all motions with the left shoulder, but it seemed to be somewhat stiff. He complained of pain and tenderness just posterior to the acromioclavicular joint on the left shoulder. X-ray films showed possible minimal cortical irregularity involving the metaphysial region of the left humerus, more apparent in external rotation, compatible with old, healed, remote fracture. The final diagnosis was old fracture, left upper humerus, moderate."

My scar runs from under my arm pit and goes completely over the top of my shoulder. Looking at my shoulder from the front it appears that my arm had been ripped off at the shoulder and sewed back on. The scar's width varies in width from about 3/4 inch to over an inch. Because of my scar's ugly appearance I do not go out in public without a shirt on. Even when I go swimming I always wear a t-shirt to cover the scar. I would estimate my scar covers between eight to ten square inches.

In the Statement of the Case I received from the VA in 1971, it made the following reference concerning their denial of a rating for my scar: "For a compensable rating to he assigned for scars of the shoulder, there must be poor nourishment with repeated ulceration, tenderness and pain on objective demonstration, or limitation of function of the part affected. (Codes 7803, 7804, 7805)." NOTE: Based on this statement by the VA I felt further appeal for a rating for the scar would be futile.

In the Decision paragraph of my final letter from the VA it states the following: "Entitlement to an increased rating for left shoulder disability or to an earlier effective date of the compensable rating for left shoulder disability is not established. Accordingly, thte appeal is denied."

In doing some recent research about the scars rating criteria used by the VA, I discovered the VA has changed their scars rating criteria one or more times since my claim in 1970. The most recent rating criteria I could find (Diagnostic code 7801) Burn scar(s) or scar(s) due to other causes, not of the head, face or neck, that are deep and nonlinear and cover at least 6 square inches but less than 12 square inches is entitled to a 10% rating for the scar. Based on this recent criteria, it appears that I would be rated at 10% if rated by the VA under the current criteria. NOTE: Nothing in the VA decision letter from 1971 referenced Diagnostic Code 7801. It appears the VA indicated in their decision letter that my shoulder scar did not meet any VA criteria for them to even consider a compensable rating for my shoulder.

QUESTION: Does anyone know if Diagnostic Code 7801 contained the same criteria in 1970 as it does today?

QUESTION: If Diagnostic Code 7801 did contain the same criteria in 1970, would I have a basis for a CUE since it appears Diagnostic Code 7801 was not considered in my decision?

QUESTION: If the VA used the correct Diagnostic codes and rated my scar appropriately in 1971, would I be successful in asking the VA for a review and reconsideration to now allow a compensable rating for my scar under the current Diagnostic Code 7801 criteria?

QUESTION: Should the VA have service connected my shoulder scar and at least awarded a 0% rating so the rating could be increased if the criteria changed in the future?

I really feel like I was low balled by the VA when they made the decision about my shoulder but that is water over the dam. I have had other problems with my left shoulder over the years (bursitis, arthritis, torn rotator cuff, etc.) and if I am entitled to any additional compensation for my shoulder I defintely want to file a claim for the additional compensation. Any input or suggestions hadit members can provide would be appreciated.

Georgia Papa

[Va Fl 10-35]

The attachment refers to 10-39 not 10-35 and doesn't appear to have anything to do with hearing loss and tinnitus. The link with the duty mos noise exposure listing also does not work. I have tried it several times. Do you have another way for me to get an actual copy of the VA duty mos noise exposure listing?

Thanks...Georgiapapa

NOTE:

DEPARTMENT OF VETERANS AFFAIRS

Veterans Benefits Administration

Washington, D.C. 20420

September 2, 2010

Director (00/21)

All VA Regional Offices

In Reply Refer To: 211B

Fast Letter 10-35

SUBJECT: Modifying the Development Process in Claims for Hearing Loss and/or Tinnitus

Purpose

This letter introduces the Duty MOS Noise Exposure Listing, a rating job aid for determinations regarding service connection of hearing loss and/or tinnitus. The Duty MOS Noise Exposure Listing is a compilation of Department of Defense-verified lists of military occupational specialties (MOSs) and the corresponding probability of hazardous noise exposure. Use of a single listing of duty position and probability of exposure to hazardous noise will help to standardize processing of these claims.

Background

Each branch of the Armed Services has reviewed and endorsed lists of military occupational specialties and the corresponding probability of hazardous noise exposure related to an individual's occupational specialty. The Duty MOS Noise Exposure Listing is available at http://vbaw.vba.va.g...utymosnoise.xls.

Direct service connection may not be granted without medical evidence of a current disability; medical or, in certain circumstances, lay evidence of in-service incurrence oraggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

A Veteran is competent to report symptoms of hearing loss and/or tinnitus as a disability because symptoms of hearing loss and tinnitus are capable of lay observation. SeeCharles v. Principi, 16 Vet. App. 370 (2002); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Consequently, a Veteran's testimony regarding hearing loss and/or tinnitus is sufficient to serve as evidence that the disability(ies) currently exists.

[Use Of Fehb & Va Benefits For Scn]

John,

How do you respond when you receive the questionaires from BC/BS asking if you have other health insurance? Wouldn't you have to tell them anything about your VA health care?

Believe me I really do not want to put off applying but at this time I do not think I would receive much of a rating for my disease because I am not to the point where I have a lot of disabling symptoms. I am retired but will not be eligible for Medicare for about 3 more years. I did contact Medicare and they sent me something in writing stating that once I was eligible for Medicare I could use both the VA system and private providers for SCN disease and Medicare would not have a problem with it.

I also don't think I would qualify for SSD since I am not totally disabled according to their definitinon.

I do appreciate your input but I am still going to try to get something in writing before I apply for the VA benefits at this time.

Thanks again... Georgia Papa

I have BC/BS via FEHB and I have received treatment for SC conditions at the VA and via private doctors. I have never even been asked that question by private insurance. The only ones who want to know are the VA so they can try and bill my insurance. I think you are unwise not to immediately apply for service connection. It takes time to get benefits even for presumptive conditions. You don't want to leave this for your spouse to do while you are very sick

Have you applied for SSD? Are you still working? I don't have a document in front of me, but I think you are scaring yourself over nothing. If you seek treatment outside the VA that is fine with them.

[Use Of Fehb & Va Benefits For Scn]

I am a Vietnam vet (67-68) who served with USMC 1966-1970. I was diagnosed with Multiple Myeloma (Smoldering) this year and am currently receiving care at the Myeloma Institute of Research & Therapy at the University of Arkansas in Little Rock. I live in Geoergia and drive to Little Rock every 3 months for follow up tests and staging updates. My disease is Agent Orange presumptive disease and I know I am eligible for VA benefits for the disease. However, I can not apply for benefits until I know positively sure that upon receipt of VA benefits my current FEHB insurance will not stop providing me with benefits for my treatment in Little Rock.

I know some folks wonder why I don't go ahead and apply for VA benefits and use the VA for treatment of my disease. Multiple Myeloma is a rare incurable cancer and very few cancer centers specialize in the treatment of this disease. The Myeloma Institute in Little Rock is reputed by some to be the best place in the world for treatment of my disease. Nothing personal against the VA doctors but I believe I would live longer if I continue to go to Little Rock.

I already posted a message on this forum and other forums regarding my situation but I have received so many different opinions from so many different people that I do not know what to do. It is hard for me to believe this situation has not arisen before. I know there is someone out there who can help. Someone with reliable documentation to back up their opinion. I have communicted with OPM and was told this was between my FEHB plan and the VA. I communicated with my FEHB plan and my question was sent to their claims office which provided a response which did not address my question.

I need input from veterans who currently have FEHB plan coverage and also have health care coverage through the VA due to their service connected disability and get their treatment for their service connected disability (disease or injury) at both their FEHB private providers and the VA.

NOTE: I am not talking about receiving treatment at the VA for service connected problems and treatment at FEHB providers for non-service connected problems. I am also not talking about receiving treatment at the VA for non-service connected problems and billing your FEHB plans. I am talking about receiving treatment for service connected disabilities(disease or injury) at both VA and FEHB private providers where the FEHB has no problems with paying benefits for a service connected disability.

Some folks on this forum have told me they received benefits from their FEHB plan for treatment of their service connected disabilities but it was not clear if there FEHB plan was aware they were receiving VA health care benefits for their SCN. I do not want to just take a chance and hope the FEHB doesn't find out about my VA benefits because it not only could cost me a great deal financially but it could jeopardize my longevity if my FEHB stops paying benefits for my Multiple Myeloma treatment in Little Rock.

Is there a SCN veteran out there who has used both FEHB and VA benefits for treatment of their SCN at both the VA and FEHB private providers and whom has something in writing from their FEHB plan or the OPM stating the FEHB plan can pay benefits for a scn disability at a FEHB private provider?

Also, if you have something in writing stating the FEHB plan will not pay the benefits, I also need to know. In this situation, my plan B would be to wait until I only have a few months left and then apply for VA benefits so my wife can receive DIC and CHAMPVA benefits after my death. I would have to carefully time this event.

There should be a directive or something addressing this question. However, so far I have not found it. Even Google could not answer this question.

Sorry for the length of this post and for being repetitive but I did not know how to make it any shorter without leaving something out and I wanted to be as clear as possible about what I am seeking.

Thanks...Georgia Papa

[Claim For Hearing Loss & Tinnitus]

Carlie,

I just sent in my informal notice to the VA for bilateral hearing loss and tinnitus from my exposure to artillery in Vietnam. I had previously been told by a friend that I could get hearing aids from the VA if I had a service connected disability (for any reason) rated 10% or higher. However, last year I went to my local VA outpatient center and asked about hearing aids and was told I could not get them unless my disability was for hearing loss. I am wondering if I was given bad info at the VA outpatient center. My current scn disability is for a shoulder injury I received in Vietnam in 1968. Would I be eligible for an audiological exam and hearing aids prior to my claim being rated for my hearing loss and tinnitus?

Thanks...Georgia Papa

packrat,

Being that you receive VA disability compensation at 10 % you are fully eligible for

VAMC audiology services to include hearing aid/s.

[Claim For Hearing Loss & Tinnitus]

I just sent off a request yesterday to the National Personnel Records Center asking for copies of all of my service records including my medical records. Do I need to send another request somewhere else requesting my medical records? If so, please give me the info on how to request the medical records.

Thanks for your input.

Semper Fi.

If you have not sent off for copies of your service medical records you should do so. I did not remember my seperation phy. that I took in 69. My hearing has been terrible for years. My records showed 45-50 in the 4,000 and 6'000 db range in both ears. This is a moderate close to severe loss. At 22 I should not of had this type of damage as I joined the Marines fresh out of high school. I was not aware that you had to make a seperate request for you medical records until my son told me.

Semper Fi

[Claim For Hearing Loss & Tinnitus]

Hi Navy Doc,

Thanks for the input and thank you for your service. When I was discharged, the Marine Corps was discharging a large number of Vietnam veterans due to downsizing and our exit physical exams were short and quick. We were released a few months prior to our scheduled discharge date. In your reply you mentioned MEPS. What is MEPS?

Thanks... Georgia Papa

Thank you for your service. Others will chime in if I'm wrong, but here is my two cents. I think you can prove exposure to noise in service especially since you have combat exposure; the VA may concede that. They did with me for my tinnitis since I could prove I was in combat (Somalia). Tinnitis is rated 10% whether one ear or both. It will be difficult proving hearing loss since with the VA you have to be almost deaf to get it. You said you didn't have a hearing test when you separated; how about when you entered through MEPS, do you have a copy of that? If you can get a copy of that, it may be possible to draw a nexus with the help from your audiologist/doctor now. Hope this helps. Good luck.

/doc

[Claim For Hearing Loss & Tinnitus]

Hi,

I served with a U.S. Marine Corps artillery unit in Viet Nam in 1967 and 1968 and was exposed to the daily firing of 105 and 155 howitzers. We were not provided with hearing protection when firing the howitzers. I was also exposed to the noise of exploding mortars when we received incoming fire. During my stateside tour of duty with the Marine Corps from 1966 to 1970, I was exposed to all types of weapons firing as are most Marines. When I was discharged from the Marine Corps, I was not given a hearing test as part of my exit physical. I knew shortly after my discharge from the Marine Corps that I had tinnitus and a hearing loss but I did not file a claim with the VA at that time because I was trying to get a job in law enforcement and I was worried this could keep me from getting the job.

I was employed with the U.S. Marshals Service from 1978 until my retirement in 2004. Fortunately when I was hired by the Marshals Service, I never received any type of stringent hearing tests. During my career with the U.S. Marshals, I never fired my weapon in the line of duty. However, we did qualify with our weapons once or twice a year. We always wore hearing protection during weapons qualifying.

In June 1981 I went to a local hearing doctor and had my hearing tested because my hearing was getting worse and tinnitus was driving me crazy. The doctor tested my hearing which showed I had a bilateral high frequency hearing loss which he said was noise induced. In his report, he noted my exposure to artillery fire in the Marine Corps. He also diagnosed me with tinnitus. The doctor suggested I use a white noise device to mask the tinnitus noise when sleeping. I purchased the device and have been using it ever since. The doctor I went to in 1981 has since died but I have a copy of his report and the audiologist who performed the hearing test is now a doctor and has started her own practice. My hearing has gotten worse over the years so I plan to make an appointment with the same audiologist to get a current report of my hearing. Since she will be aware of my earlier hearing test, I am hoping she will give me an IMO report stating my hearing loss and tinnitus were more than likely caused by my exposure to artillery and mortar fire in Vietnam.

Since so much time has passed and since I was employed with a law enforcement agency for a long period of time, I am concerned the VA will claim my hearing problems were caused by my age or my exposure to gun fire with the U.S. Marshals.

I have a photo of me firing a 105 howitzer in Vietnam. In the photo I was not wearing hearing protection. I also have a receipt from 1983 showing the purchase of one of my white noise devices used for masking tinnitus. My DD-214 and my other military records show my service in Vietnam and my assignment to an artillery unit and my MOS as a Field Artillery Batteryman.

I would like any input from other hadit members as to whether they think I would be successful in filing a claim for hearing loss and tinnitus at this late date and and with the knowledge I had worked for over 25 years in civilian law enforcement. I am currently receiving 10% VA disability for a shoulder injury I received in Vietnam in 1968 and I am in the process of filing a claim for Multiple Myeloma due to exposure to Agent Orange. Any input or suggestions would be appreciated.

Thanks...

[Option To Use Va And/or Private Providers For Sc Disease]

John,

Thanks for the info. Do you use your BC/BS for any of your SCN problems or do you use the VA for all of your SCN problems and your BC/BS for your non SCN problems? When I eventually go to the VA for my initial exam, I am sure they will probably run some of the same diagnostic tests as my private doctors. Do you think I might encounter any problems with BC/BS paying my private doctors stating I am receiving duplicate tests from the VA? I am 62 years old so I am not eligible for Medicare yet. I will get Medicare when I turn 65. Again, thank you for your advice.

Georgia Papa

Everything you have been told is untrue. You can get file with the VA and get all your treatment via your insurance if you want. Do you have medicare? You can use the VA and use your medical insurance for private doctors. File the claim! I am retired federal worker. I have 100% SC for some AO stuff as well. I use my insurance and the VA. I have BC/BS and medicare and I use the VA as well. Your insurance is yours and you can use it for anything you want that is covered. Go where you get the best treatment. I can't believe the bad information you have gotten.

[Option To Use Va And/or Private Providers For Sc Disease]

Hello,

I am a retired CSRS employee and have the same health insurance as active federal employees. I also served in the USMC from 1966 to 1970 including 1967 and 1968 on the ground in Vietnam. I have recently been diagnosed with Multiple Myeloma (Smoldering). Multiple Myeloma is an incurable blood cancer. I now go to my local oncologist for monthly blood tests and I also go for extensive diagnostic tests at the Myeloma Institute for Research & Therapy in Little Rock, Arkansas every three months.

After seeking advice from others, including some in these forums, I was preparing to file a claim with the VA for my Multiple Myeloma since this is one of the diseases presumed to have been caused by exposure to Agent Orange herbicide. After talking with different people at the Myeloma Institute, I am reluctant to file for VA benefits at this time. Some told me my federal health insurance will not pay any benefits for injuries or illnesses sustained during active military duty. I know this is usually true of private insurance plans but I am not sure if this is true of federal health insurance. Others told me if I was approved for VA benefits, I would have the option of using either the VA system or my private health care providers without incurring any problems with my current federal health insurance. Some told me my federal health insurance may require me to file for VA benefits so they would not have to pay any benefits for medical services related to my Multiple Myeloma. I do not know what to believe at this time. I do not want to contact my current health insurance company because they may decide to suspend any benefits for my Multiple Myeloma until they determine if they should pay for the benefits or the VA should pay. This could take months for them to make a decision.

I know the VA has some great doctors and treatment facilities but if possible I would prefer to keep using my current doctors and myeloma treatment center with the option of using the VA for my medications. I am looking for responses from anyone who could address my concerns, especially civilian federal retirees or active federal employees who are in a similar situation or know of someone else who could answer my questions. I would like to apply for VA Disability Compensation to help pay for my out of pocket expenses (medical, medications, travel & hotel expenses to Arkansas), etc. I also feel I need to file a VA claim at some point in time so my wife will be able to file a claim for DIC & CHAMPVA benefits after my death.

Any thoughts or suggestions would be appreciated.

Georgia Papa