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Found 731 results

  1. Need advice on a couple of areas. I am SC at 20% for the last 18 years. My SC comes from leg issues in the service. I recently went to the VA Hospital because my knee gave out and I fell and thought I broke my arm when I fell. The arm was not broken but during that visit the set me up with a primary care provider. I am severely overweight and have been fighting severely depression issues for the last three to four years to the point I have thought about ending it. I went to talk to my primary care doctor(not connected to VA) he first tried anti depressants which made thing worse because I did not care about anything when I was on them. He then put me on Testosterone replacement therapy. The reason I agreed t be seen by the primary care people at the VA is because my other doctor was moving to a practice were I could not follow. I am not sure what happened because I have always buried my feeling and just dealt with it. During the interview she kept picking at me till I just cracked. I had a mini melt down at the VA. She sent me to Mental Health and had them immediately see me to make sure I wasn't a danger to myself and mostly others. My labs were so bad she had me bring my wife back the following week to talk to us both. I don't sleep well and haven't for a long time. I have reaccuring nightmares about them making me go back to the service. I am diabete. I have gout. She told me and my wife that she thinks I have PTSD. I told her that I was never in combat and while my service was a nightmare after I got hurt I didn't understand how I could have PTSD. I blame the service for a lot of things. I have never been able to properly exercise after what they did to me. I think that has led to my weight gain and diabetes and most likely my sleep apnea. I looked up PTSD and I took the little on-line test. I read like a text book case. I was mental abused by my father for most my life. He would do this thing to us kids where he would yell at us for so long our bodies would shut down. It would start with a ringing in the ears. Then our vision would start to go on the outside edges. It was almost like the old time TVs where the channel would go off the air and be all staticy. The ringing would get louder and louder and our vision would get narrower and narrower. Once our vision was gone we passed out. If he stopped before we passed out it could take hours lying in our beds if we could make it that far for our vision and hearing to come back. It happenned to all of us boys. The called it seeing yellow. My freshman year in high school he beat the shit out of me one night because my locker partner left my locker unlocked and someone stole my winter coat and new wrestling shoes. I ran away that night. I went to live with my mother. I had some issues adjusting the first year but was fine after that. I was a B student and out going. I joined the service when I was 20 and actually turned 21 in basic. The abuse they inflict on you in basic training is quite a bit like the abuse my dad inflicted on me. I almost passed out on the mezzanine when all the drill sargeants were swarming around us yelling. I drill sargeant from another platoon harassed me and my life a living hell after I dislocated one of his kids knees in the pugal pits. I got through the same way I got through my childhood. I just somehow locked it away and told myself I could make it and the real army wasn't like this. I hurt my legs at my first and only duty station and they didn't believe I was hurt. The punished me verbally and physically till my legs were permanently damaged and I just could do it anymore. I had learned to survive living with my dad and I used those skills to survive in the military. But they had broke me and changed me. I finally escaped on a medical discharge because my BMI was not in line. I was not the same person getting out that I was going in. I would have panic attacks in places like walmart and the mall. I have had problems working for other people. It has affected my career path. I became self employed because I could hack working an office. The only time my wife is ever scared of me is when I am sleeping. I have had nightmares about them making me go back since I have been out. Those have recently increased since I have been dealing with the VA. I have not been effective at work for the last two weeks since I first visited them. My dad died this summer which I handled well. I had only spoke to him for a one month period in the 25 years. I never had nightmares about him coming to get me. I feel guilty even thinking that I might have PTSD because of all my brothers and sisters that have gone through the horror of combat. But the fact of the matter is I most likely do. I fit about 80-90% of the symptoms. I have struggled with my issues since the military and they now are threatening to overwhelm me and drag me under. I have been very close to checking out in the last few years. I have been hanging on for my wife of 26 years. The VA took away my rating once and I had to fight them for three years. I believe my PTSD started with my father but I think I was able to overcome it till the military got ahold of me. I believe they undid the progress I made after leaving my father and permanently scarred me. I did not even realize how bad they had changed me and why I was suffering. I know I need help if I am going to fufill my promise that I made to my wife a long time ago. I want to get better. I am of the opinion that the VA is not our friend when it comes to these issues. I plan on refiling my claims for all my medical issues and PTSD. However, I am scared they will blame it all on my father for at least the PTSD and not take responsiblity for their part. Also it will be 20 years next month since I got out. I am just now figuring this all out. I didn't go to the doctor in the military for this. I just survived and got away as quickly as I could. Can you even file a claim that is this old? Any helpful advice would be appreciated.
  2. I am rated 90% and tdiu p&t.and have been since 2002. I just learned that IHD is a presumed agent orange disease. I have IHD, and it is on a lot of my va docs notes and had a stress test showing mild ischemia. One of my ratings is for coronary artery disease tied to my diabetes because of agent orange exposure.Coronary artery disease can also cause IHD.I know their will be no benefit increase if im rated with IHD, but i would then have a schedular rating of 100% and possibly qualify for smc award. Or should i just let the sleeping dog ly? Thanks
  3. I was first service connected for hep c at 40 percent a while back. I was treated for the hepc with pegintron and ribavarin. I later developed kidney and adrenal gland cancer, that were removed, one side. I was service connected for the kidney cancer at 30 percent, because there is overwhelming medical study, that proves people with hep c are VERY likely to develop kidney cancer; HERE is my question, I have found out that the pegintron and ribavarin are know to destroy part of your cells,(ISLET CELL DESTRUCTION) the destroying of these cells can cause type 2 diabetes. I have been told im right on the diabetic fence, if I do go full blown diabetic, can I be service connected for it as secondary to hepc, just like the kidney cancer was? Or how does this work.
  4. Hello all I am new to Hadit i have been dealing with the VA onand off again since 2007 when i was medically discharged after 2 Knee surgeries i started out with a 70% combined rating and am not at 90% and my disabilities have gotten worse my Dr has told me flat out i kneed to quit working as i will never be able to walk normally again due to both ankles and now both knees being messed up due to over compensation for the left knee injury but so be it i have a claim in for increase on L knee and ankle and add service conection for right knee and ankle al with limited rom arthritis and pain also to have diabetes 2 service connected so we will see where that all goes claim has been in since July 2013 soits a bay case in va terms but i will wait and learn as i go thanks for reading and take care and a big THANK YOU FOR ALL YOUR SERVICE AND WELCOME HOME ALL
  5. This was part of my Gulf War Exam, and it doesn't look like it should be rated from the GW. But, the wrist injury received while I was in the Marines does have nerve issues. Would they continue the rating on it's own, or would I have to re-file again on a claim not under Gulf War? I'm currently rated for the wrist, but nothing to do with the nerve issues. Peripheral Nerves Conditions (not including Diabetic Sensory-Motor Peripheral Neuropathy) Disability Benefits Questionnaire Name of patient/Veteran: XXXX Indicate method used to obtain medical information to complete this document: [ ] Review of available records (without in-person or video telehealth examination) using the Acceptable Clinical Evidence (ACE) process because the existing medical evidence provided sufficient information on which to prepare the DBQ and such an examination will likely provide no additional relevant evidence. [ ] Review of available records in conjunction with a telephone interview with the Veteran (without in-person or telehealth examination) using the ACE process because the existing medical evidence supplemented with a telephone interview provided sufficient information on which to prepare the DBQ and such an examination would likely provide no additional relevant evidence. [ ] Examination via approved video telehealth [X] In-person examination Evidence review --------------- Was the Veteran's VA claims file reviewed? [X] Yes [ ] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: CPRS If no, check all records reviewed: [ ] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [ ] Department of Defense Form 214 Separation Documents [ ] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: 1. Diagnosis ------------ Does the Veteran have a peripheral nerve condition or peripheral neuropathy? [X] Yes [ ] No Diagnosis #1: lt ulnar neuropathy ICD code: (354.2) Date of diagnosis: 9/6/13 2. Medical history ------------------ a. Describe the history (including onset and course) of the Veteran's peripheral nerve condition (brief summary): He stated that he developed tingling in the left arm for a long time started while on active duty his left wrist was injured while on active duty no history of neck pain or surgery; no history of elbow injury or surgery. He takes Neurontin; he has mild weakness of the left hand with no history of diabetes mellitus. He has mild wasting of his left hand. b. Dominant hand [X] Right [ ] Left [ ] Ambidextrous 3. Symptoms ----------- a. Does the Veteran have any symptoms attributable to any peripheral nerve conditions? [X] Yes [ ] No Constant pain (may be excruciating at times) Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Intermittent pain (usually dull) Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Paresthesias and/or dysesthesias Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Numbness Right upper extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left upper extremity: [ ] None [X] Mild [ ] Moderate [ ] Severe Right lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe Left lower extremity: [X] None [ ] Mild [ ] Moderate [ ] Severe 4. Muscle strength testing -------------------------- a. Rate strength according to the following scale: 0/5 No muscle movement 1/5 Palpable or visible muscle contraction, but no joint movement 2/5 Active movement with gravity eliminated 3/5 Active movement against gravity 4/5 Active movement against some resistance 5/5 Normal strength Elbow flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Elbow extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Wrist extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Grip: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [ ] 5/5 [X] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Pinch (thumb to index finger): Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Knee extension: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle plantar flexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Ankle dorsiflexion: Right: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 Left: [X] 5/5 [ ] 4/5 [ ] 3/5 [ ] 2/5 [ ] 1/5 [ ] 0/5 b. Does the Veteran have muscle atrophy? [X] Yes [ ] No If muscle atrophy is present, indicate location: lt 1st dorsal interossei Normal side: not measured cm. Atrophied side: not measured cm. 5. Reflex exam -------------- Rate deep tendon reflexes (DTRs) according to the following scale: 0 Absent 1+ Hypoactive 2+ Normal 3+ Hyperactive without clonus 4+ Hyperactive with clonus Biceps: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Triceps: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Brachioradialis: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Knee: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Ankle: Right: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left: [ ] 0 [X] 1+ [ ] 2+ [ ] 3+ [ ] 4+ 6. Sensory exam --------------- Indicate results for sensation testing for light touch: Shoulder area (C5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Inner/outer forearm (C6/T1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Hand/fingers (C6-8): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Upper anterior thigh (L2): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Thigh/knee (L3/4): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Lower leg/ankle (L4/L5/S1): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent Foot/toes (L5): Right: [X] Normal [ ] Decreased [ ] Absent Left: [X] Normal [ ] Decreased [ ] Absent 7. Trophic changes ------------------ Does the Veteran have trophic changes (characterized by loss of extremity hair, smooth, shiny skin, etc.) attributable to peripheral neuropathy? [ ] Yes [X] No 8. Gait ------- Is the Veteran's gait normal? [X] Yes [ ] No 9. Special tests for median nerve --------------------------------- Were special tests indicated and performed for median nerve evaluation? [ ] Yes [X] No 10. Nerves Affected: Severity evaluation for upper extremity nerves and radicular groups ----------------------------------------------------------------------- a. Radial nerve (musculospiral nerve) Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis b. Median nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis c. Ulnar nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [ ] Normal [X] Incomplete paralysis [ ] Complete paralysis If Incomplete paralysis is checked, indicate severity: [ ] Mild [X] Moderate [ ] Severe d. Musculocutaneous nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis e. Circumflex nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis f. Long thoracic nerve Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis g. Upper radicular group (5th & 6th cervicals) Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis h. Middle radicular group Right [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis i. Lower radicular group Right: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis Left: [X] Normal [ ] Incomplete paralysis [ ] Complete paralysis 11. Nerves Affected: Severity evaluation for lower extremity nerves ------------------------------------------------------------------- Not applicable 12. Assistive devices --------------------- a. Does the Veteran use any assistive devices as a normal mode of locomotion, although occasional locomotion by other methods may be possible? [ ] Yes [X] No b. If the Veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: No response provided. 13. Remaining effective function of the extremities --------------------------------------------------- Due to peripheral nerve conditions, is there functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis? (Functions of the upper extremity include grasping, manipulation, etc., while functions for the lower extremity include balance and propulsion, etc.) [ ] Yes, functioning is so diminished that amputation with prosthesis would equally serve the Veteran. [X] No 14. Other pertinent physical findings, complications, conditions, signs and/or symptoms ----------------------------------------------------------------------- a. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis section above? [ ] Yes [X] No b. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms? [ ] Yes [X] No 15. Diagnostic testing ---------------------- a. Have EMG studies been performed? [X] Yes [ ] No Extremities tested: [X] Left upper extremity Results: [ ] Normal [X] Abnormal Date: 1/15/13 b. Are there any other significant diagnostic test findings and/or results? [X] Yes [ ] No If yes, provide type of test or procedure, date and results (brief summary): Findings: The left median sensory nerve conduction study (NCS) showed normal peak latency and amplitude. The left ulnar sensory NCS showed normal peak latency and amplitude. The left median motor NCS showed normal distal latency, amplitudes, and conduction velocity. The left ulnar motor NCS was ABNORMAL and showed normal distal latency, normal amplitudes, and DIMINISHED conduction velocities across the ELBOW. The right ulnar motor NCS showed normal distal latency, amplitudes, and conduction velocities. The left median-to-ulnar comparison mixed nerve study showed no significant difference in latencies. Electromyography (EMG) of selected muscles representing the ulnar innervations showed normal insertional activity, no spontaneous activity, and normal voluntary MUAP's. IMPRESSION: 1) Abnormal study. 2) Electrophysiological evidence of LEFT ulnar neuropathy across the elbow consistent with a focal demyelinating process. No evidence of axonal loss. 3) NO electrophysiological evidence of a left median neuropathy at the wrist. PLAN: 1) Prosthetics consult to issue a LEFT elbow brace to the patient 2) Advised patient to protect the elbows with gel pads or towels anytime they are on a hard surface and to limit sleeping with hands overhead 3) Please consider obtaining a LEFT elbow xray given hx of remote injury 4) Can consider hand surgery consult in the future for possible surgical interventions if above conservative measures fail. 5) Thank you the consult. /es/ AMAR G PATEL PM&R PGY 3 Signed: 04/18/2013 14:21 16. Functional impact --------------------- Does the Veteran's peripheral nerve condition and/or peripheral neuropathy impact his or her ability to work? [X] Yes [ ] No If yes, describe impact of each of the Veteran's peripheral nerve and/or peripheral neuropathy condition(s), providing one or more examples: Left ulnar neuropathy condition will limit repetitive moderately strenuous physical activity with his left hand. 17. Remarks, if any: -------------------- the veterans ulnar neuropathy is a disease with a clear and specific etiology and diagnosis. Medical opinion-it is less likely is not, less than 50% probability, that the above condition is related to any specific exposure event experienced by the veteran during service in Southeast Asia; rationale-current medical literature review does not correlate ulnar neuropathy with Gulf War exposure.
  6. So the VA sent the Proposal to Reduce my Diabetes Type 2 from 100% to 40%, theirs only 1 problem, I don't have Type 2 I have Type 1. I have been at 100% for the last 15.5 years and 60% before that. I used the VA healthcare for 22 years for my diabetes and then switched to my present private Dr. 17 years ago, I continued to use the VA till 2002 or 2003 for my eye checks. When I went to the C&P exam in Sept. 2012, I brought a DBQ for diabetes filled out by my Dr., a letter from my Dr. explaining my condition and present complications, and that in his opinion it was permanent and total (he is the head of Internal medicine for a big NY hospital) the only evidence that was reviewed was the Medical records going back to 2004 that I brought and the DBQ that I brought. I'm writing up the letter for the hearing, I'll bring it down Monday. I guess that battle begins now for real.
  7. Hi everyone, I have been a 100% disabled for the last 16 years with diabetes type 1 and it's various complications. I received a Proposal to Reduce on July 22, saying they were going to reduce to 40%, then I received another notice saying I was going down to 70%, I contacted my Congressmen aide back in May asking why things were taking so long to decide my case (never thinking they would want to reduce) the Notice came, I called him back in August, he called the VA in the middle of the month and all of the a sudden I see an Administrative Review on Ebenefits on 8/19, my hearing for the Reduction proposal is later this month, so I check Ebenefits today and my monthly went up to $3073 up from $2973. I find it very strange they would raise and then want to reduce, especially since the hearing is later in the month, anyone have any ideas.
  8. I am a 67 year old VN vet and was rated 50% for PTSD about 8 years ago. Then 6 years ago I asked for an increase which of course resulted in another C & P. At this time I was granted a rating of 100% tempory. A year later I was called in for another C & P for PTSD and remained at 100% tempory. Now five years later I am being called in for another C & P. What has me concerned is what I need to do if they reduce my rating. Would appreciate any advise. Thanks P.S. Not that it makes any difference but I am also rated for diabetes, HBP, sleep apnea, and Ischemic Heart disease. If I am reduced on the PTSD I should still be at least 70% and could possibly ask for TDIU. Is that something I could look at?
  9. As a Republic of Vietnam (1968) drafted combat veteran helicopter crew chief OH 6A, (33months active duty) I received my 100% disability rating. I received the rank of E-5 in 5 months. The VA insurance adjuster rater threw me a used bone. VA took a dead old WW II or Korean War Vets 100% and recycled it. (I would imagine that the raters have stats on that issue as well.) I have been with the VA since 1994, when I could not take it any longer. I wanted to check myself into a private mental ward in 1989 not thinking about the VA, but moved my life forward. I was homeless for 2 years, 1993-1994. I started out in 1994 with 30% PTS rating, drop the 'D'. I was at the Dallas VA Hospital. This was back in the day when no paper was on the exam table and docs wore the same gloves over and over. I was given a whole 20% for diabetes with insulin use in the early presumptive days and extra for Neuropathy which is a collection of disorders that occurs when nerves of the peripheral nervous system are damaged. Finally, this last month, I was given the electric test and the neuropathy is serious. So all said, this gave me a 70% rating. While all the above was going on in my life, I put myself through more schooling with my own money, effort, and struggled with work. Meanwhile, my background was a fortnight in a RVN field hospital with severe trauma. The field hospital records show no blood pressure readings and so forth. Present day, I have not been able to work for 2 years. I had no outside doctor nexus letters, using my own Veteran disabilities, and the VA own words, my PTS rating was given an increase to 50%, with an increase to 80% disability rating, and 20% unemployable. This gave me the 100%. I was denied secondary sleep apnea, missing right kidney with kidney disease, (by the way apparently missing since birth), and 4 other conditions that would go through with an outside nexus letter from a PhD or medical doctor. I was at a VA facility yesterday due to severe back pain, helicopter crashes. I was a walk in at the facility. I waited 5 hours. The nurse pulls me in and asks me, "What’s wrong?" I tell her as she writes this stuff down. The RN says, "Sorry, the Doctor cannot see you right now because his computer is down. Do you mind if he calls you tomorrow?" The doctor did call. God Bless the United States! The government is great; it's the idiots running the system. I have one daughter. She was born after RVN with birth defects. No history of known defects in my family.
  10. NO C-FILE 1. Diagnosis <X> Diabetes mellitus type II Date of Diagnosis: 2009 2. Medical History a. Treatment <X> Managed by restricted diet <X> Prescribed oral hypoglycemic agent(s) <X> Other (describe): Metformin 500 QD. On insulin while in hospital 2009 5. Diagnostic testing Current test results: Most recent A1C, if availabe: 5.7 Date: 6-12 Most recent fasting plasma glucose, if available: 112 Date 6-12 7. Remarks, if any: Type II DM
  11. 1. Diagnostic Summary Does the Veteran have a diagnosis of PTSD that conforms to DSM-IV criteria based on today's evaluation? YES 2. Current Diagnoses a. Diagnosis #1: PTSD Axis I Diagnosis #2: Alcohol Dependence in remission Axis I b. Axis III - medical diagnoses (to include TBI): Chronic pain, diabetes, hyperlipidemia, hypothyroidism, GERD, HTN, sleep apnea c. Axis IV - Psychosocial and Environmental Problems (describe, if any): Unemployment, recent death of dog d. Axis V - Current global assessment of functioning (GAF) score: 50 3. Differentiation of symptoms a. Does the Veteran have more than one mental disorder diagnosed? YES b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? YES If yes, list which symptoms are attributable to each diagnosis: The Veteran no longer drinks alcohol. 4. Occupational and Social Impairment a. <X> Occupational and social impairment with reduced reliability and productivity SECTION II: CLINICAL FINDINGS: 1. Evidence Review a. <X> Claims Folder (C-file) <X> YES <X> Other, please describe: Interview, CPRS and Vistaweb review b. Was pertinent information from collateral sources reviewed? NO 2. History a. Relevant Social/Marital/Family history (pre-military, military, and post-military): The Veteran reported a generally normal childhood and socialization although he had few friends growing up. He was married once for 6 years and had one daughter, but divorced after his wife cheated. He was married a second time for 4 years, but divorced after his wife cheated. He has been married for the past 3 years which is doing well. He spends his days shopping, cooking, watching TV, doing yardwork, going to church, and sometimes fishing. b. Relevant Occupational and Educational history (pre-military, military, and post-military): The Veteran completed the 12th grade. He completed 1.5 years of college with a 3.5 GPA in construction management, but left school when he was unemployed and unable to afford it. The Veteran worked in construction management at 2 different positions for 7 years total, leaving them for better positions, but at his 3rd position which he held for 4-5 years he was laid off as part of a downsizing maneuver. The Veteran did well and was being groomed for a VP position, but did have an argument with a client which he believes may have impacted the decision to let him go. He has been unable to find work and began collecting SSDI for PTSD in 2009. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): The Veteran first began psychiatric care in 2005 and psychotherapy last year. He currently attends group therapy and medications include prazosin and sertraline. He did participate in marital counseling during his second marriage. Family mental health history is positive for suicide and addiction. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): One suspension in school for fighting. One Article 15 in 1996 for having a foreign national in his barracks. e. Relevant Substance abuse history (pre-military, military, and post military): The Veteran does not smoke. He did smoke marijuana regularly from 2000-05. The Veteran began drinking heavily following Desert Storm until 2009 and would drink 24 beers or more until passing out. 3. Stressors a. Stressor #1: On 2/25/91 the Veteran was on guard duty at Khobar, Saudi Arabia when a SCUD landed and killed 28 soldiers and injured 250 others. The Veteran was later required to remove his protective mask to assess the possibility of chemical agents. Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? YES Is the stressor related to the Veteran's fear of hostile military or terrorist activity? YES 4. PTSD Diagnostic Criteria a. Criterion A: <X> The Veteran experienced, witnessed, or was confronted with an event that involved actual or threateded death or serious injury, or a threat to the physical integrity of self or others. <X> The Veteran's response involved intense fear, helplessness or horror. Criterion B: <X> Recurrent and distressing recollections of the event, including images, thoughts, or perceptions <X> Recurrent distressing dreams of the event Criterion C: <X> Efforts to avoid thoughts, feelings or conversations associated with the trauma <X> Efforts to avoid activities, places or people that arouse recollections of the trauma <X> Markedly diminished interest or participation in significant activities <X> Feeling of detachment or estrangement from others <X> Restricted range of affect (e.g., unable to have loving feelings) Criterion D: <X> Difficulty falling or staying asleep <X> Irritability or outbursts of anger <X> Difficulty concentrating <X> Hypervigilance Criterion E: <X> The duration fo the symptoms described above in Criteria B, C, and D is more than 1 month Criterion F: <X> The PTSD symptoms described above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning b. Which stressor(s) contributed to the Veterans PTSD diagnosis?: <X> Stressor #1 5. Symptoms <X> Anxiety <X> Chronic sleep impairment <X> Difficulty in establishing and maintaining effective work and social relationships <X> Difficulty in adapting to stressful circumstances, including work or a worklike setting 6. Other symptoms: NO 7. Competency Is Veteran capable of managing his or her financial affairs? YES 8. Remarks, if any The Veteran reported symptoms consistent with a diagnosis of PTSD. He reported a stressor wich would meet diagnostic Criterion A for PTSD and is consistent with the kinds of duties expected of a service member at that time and in those circumstances. There are no pre- or post-military traumas which would account for his symptoms and his entrance physicals on 5/31/88 and 7/7/88 do not show any indications of prior psychiatric history or treatment. It is at least as likely as not that the Veteran has PTSD that was caused by or resulted from military service. The Veteran reported only mild anergia and amotivation as current symptoms of depression. He did report prior depressive episodes beginning after service in Desert Storm, but these are more likely than not manifestations of PTSD rather than a separate medical entity. After the interview, the psychologist shook my had, thanked me for my service, and said "enjoy your retirement" Thoughts? Thanks in Advance!
  12. The show will be at 9am Eastern time. Please join Jerrel Cook, Mike Sasser and Jbasser as Dr Bash and John discuss the secondaries of Diabetes and heart disease. I guarantee you folks will learn something you may not have known, JBasser
  13. http://www.va.gov/vetapp12/Files4/1227528.txt Citation Nr: 1227528 Decision Date: 08/09/12 Archive Date: 08/14/12 DOCKET NO. 03-07 055 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an effective date earlier than October 4, 1996 for the award of service connection for posttraumatic stress disorder (PTSD). 2. Entitlement to an initial evaluation in excess of 10 percent for tinnitus. REPRESENTATION Appellant represented by: Kenneth L. LaVan, Attorney-at-Law WITNESS AT HEARING ON APPEAL Veteran and his spouse ATTORNEY FOR THE BOARD James G. Reinhart, Counsel INTRODUCTION The Veteran served on active duty from April 1972 to December 1993. This matter comes to the Board of Veterans' Appeals (Board) on appeal from August 2002 and November 2006 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In the August 2002 rating decision, the RO determined that there had not been clear and unmistakable error (CUE) in the rating decision that established an effective date of October 4, 1996 for grant of service connection for PTSD. In the November 2006 rating decision, the RO granted service connection for tinnitus and assigned an evaluation of 10 percent disabling. In October 2003, the Veteran testified at a personal hearing before a Veterans Law Judge. A copy of the hearing transcript is associated with the claims file. In March 2008 and in April 2008 the Veteran was notified that the Veterans Law Judge no longer was employed at the Board and that the Veteran had a right to another hearing before a Veterans Law Judge who would participate in any decision made on his appeal. In April 2008 he responded that he did not wish to appear at another hearing. In August 2010, the Veteran testified at a personal hearing before the undersigned Acting Veterans Law Judge. A transcript of that hearing is associated with the claims file. The issue of whether a June 1994 rating decision should be revised based on CUE in not granting service connection for tinnitus was raised by the Veteran's representative in July 2010 but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ, which is the RO in this case, for appropriate action. FINDINGS OF FACT 1. In an October 1998 rating decision, the RO granted service connection for PTSD and assigned an effective date based on a finding of October 4, 1996 as the date it received the Veteran's claim of entitlement to service connection for PTSD. 2. A claim of entitlement to service connection for PTSD was received by the RO on June 8, 1995. 3. There was no claim of entitlement to service connection for PTSD received by the RO prior to June 8, 1995. 4. Proper application of the law as it was understood at the time of the October 1998 rating decision would have resulted in an effective date of June 8, 1995 for the award of service connection for PTSD, based on a claim received by the RO on that date that had not been adjudicated until the October 1998 rating decision. 5. In a July 2010 written statement, prior to promulgation of a decision in the appeal, the Veteran, through his representative, indicated that he agreed with VA's determination that a 10 percent evaluation was the highest evaluation that can be awarded for disability due to tinnitus. CONCLUSIONS OF LAW 1. The October 14, 1998 rating decision contained clear and unmistakable error in establishing October 4, 1996 as the effective date of the award of service connection for PTSD. 38 U.S.C.A. § 5109A (West 2002); 38 C.F.R. § 3.105(a) (2011). 2. The criteria for an effective date of June 8, 1995, but no earlier, for the award of service connection for PTSD, have been met. 38 U.S.C.A. § 5110(a) (West 1998); 38 C.F.R. § 3.400 (2011). 3. The criteria for withdrawal of a Substantive Appeal by the Veteran for the issue of entitlement to an evaluation in excess of 10 percent for tinnitus have been met. 38 U.S.C.A. § 7105(b)(2), (d)(5) (West 2002); 38 C.F.R. §§ 20.202, 20.204 (2011). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Effective date of award of service connection for PTSD The Veteran contends that the proper effective date for grant of service connection for PTSD is June 1995 or earlier, rather than the date currently in place, October 4, 1996. Of note, in the instant document all referred to treatment records and examination reports are VA treatment records and examination reports unless specifically identified otherwise. A. Factual and Procedural Background On December 30, 1993, VA received a VA Form 21-526 listing the nature of the Veteran's disabilities as hearing loss, dislocated hip - contusion of left pelvis, and fungus infection. In a February 1994 report of a medical examination that was conducted in response to his December 30, 1993 claim, the examiner stated that, in his opinion, the Veteran had no significant physical problems but that a source of concern was the Veteran's report of suicidal ideation and feelings of violent hostility. The examiner stated that he had requested that a psychiatric examination be conducted as part of the compensation and pension (C&P) examination. A mental health clinic consultation was also requested on February 4, 1994 by the examiner who conducted the February 1994 medical examination. This examiner stated in the request that the Veteran had reported to him during the general medical examination that he was bothered by depression , did not like the way he felt, and had thoughts of suicide and hostile violence. A provisional diagnosis provided by that examiner was depression with suicidal / homicidal ideation. The mental health clinic professional who addressed this request on February 4, 1994, provided two diagnoses - adjustment disorder with depressed mood, and PTSD with nightmares of the war. Referral to a psychiatrist was planned. On March 23, 1994 the Veteran was again seen in the mental health clinic. Assessment included PTSD Recurrent. This note was signed by a physician. A C&P examination report dictated on February 4, 1994 and signed by a physician on March 3, 1994 refers to the Veteran's report that he had been suffering from insomnia and suicidal thoughts for the previous three years. He reported that he had taken over-the-counter medication for sleeping both during service and afterwards. He reported that most of the people that went to the Gulf War, as did he, had developed similar symptoms. He reported that he thought of suicide and felt depressed without knowing exactly why. He also reported that he was awakened by nightmares of people trying to kill him or of him trying to kill others. In response to a question from the examiner as to whether he had bad experiences during the Gulf War, he reported that he and other soldiers were told that it would be very important for each company to have at least 250 body bags just in case, and he complained that after they were in Iraq, the war stopped rather than giving them the opportunity to go all the way to where Saddam Hussein was and get rid of him. In the conclusion of the report, the examiner stated that there was no rhyme or reason for the Veteran's suicidal thoughts or for any connection between any experiences during the Gulf War and the ensuing symptomatology. The examiner's ultimate conclusion was as follows: "It appears that this man's history is not sufficient to enable us to make a diagnosis of post traumatic stress disorder." On May 23, 1994, the RO issued a rating decision in which it denied service connection for contusion of the left hip, fungus infection, and hearing loss in the left ear. It granted service connection for right ear hearing loss. Received by the RO in August 1994 was a response to a request for the Veteran's service medical records. This response states that the record was in transit to the recipient of the request and to resubmit the request in 120 days. In January 1995, a physician from VA's Medicine Service requested a Neurology Service consultation because of the Veteran's reports of headaches since his service in the Persian Gulf. The consultation report includes mention that the Veteran underwent a personality change following his return from the Persian Gulf and developed severe depression, suicidal ideas, became abusive towards his spouse, and had other symptoms. A March 1995 consultation request, from one department of Neurology Service to another department of Neurology Service, had to do with reports of headaches and sensory loss. A May 1, 1995 consultation report includes that neuropsychological testing was scheduled and there is a reference to memory problems. On May 23, 1995, a neuropsychological evaluation was conducted. Although there is a discussion of test results regarding both depression and PTSD, there is no definitive statement of whether he did or did not have PTSD. Mental health clinic notes from March 1, 1995 include an assessment of depression. On June 8, 1995, the RO received a VA Form 21-4138 "Statement in Support of Claim" in which the Veteran stated as follows: I the undersigned, here by request to re-open my S/C claim for an increase or to establish a new S/C disability, as indicated below. I am currently being treated at the Tampa, VA Medical Hospital and the Orlando, VA Medical Clinic for symptoms related to that of Gulf War Syndrome. Records of my treatment since returning from South West Asia may be found in my medical records located at the Orlando VA Clinic Tampa, VA Hospital, or St. Petersburg, VA Regional Center. Disabilities Include: Skin rashes, Headaches, Dizziness, Fatigue, Memory loss, Pain in the joints and Muscle, Numbness in arms and legs, Loss of range motion in right arm, Sleeping disorder. In a June 1996 decision the RO denied service connection for three "claims." Of interest is that statement listed in the Issue section of the document as "Service connection for headaches, dizziness, fatigue, memory loss, muscle pain, numbness of arms and legs, right arm condition with decreased rating of motion and sleep disorder due to undiagnosed illness." This statement is repeated in the Decision section of the document, adding the words "is denied." The Reasons and Bases section addressing this particular decision is, in its entirety, as follows: Service connection may be granted for a disability which began in military service or was caused by some event or experience in service. Service connection for headaches, dizziness, fatigue, memory loss, muscle pain, numbness of arms and legs, right arm condition with decreased range of motion and sleep disorder is denied since these conditions neither occurred in nor was (sic) caused by service. the (sic) service medical records contain no complaints of, treatment for or diagnosis of any of these conditions while the veteran was on active military duty. The medical evidence presently considered contains no complaints for or diagnosis of any of these conditions while the veteran was in the Persian Gulf Theater of Operations or within 2 years of leaving the Persian Gulf. Service connection may be established for disability resulting from undiagnosed illness which became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than two years after the date on which the veteran last performed service in Southwest Asia theater of operation during the Persian Gulf War. Service connection for headaches, dizziness, fatigue, memory loss, muscle pain, numbness of arms and legs, right arm condition with decreased range of motion and sleep disorder due to undiagnosed illness is denied since these conditions neither arose during service in the Persian Gulf theater, nor manifested to a compensable degree of 10 percent within two years after the last date of service in the Persian Gulf theater. Listed in an Evidence section of the June 1996 rating decision is "ervice medical records for the period 4/72 to 12/93." The next significant report is from a psychiatric C&P examination in September 1997. That report includes a diagnosis of PTSD. The rating decision in which the RO granted service connection for PTSD is dated October 14, 1998. It lists as evidence a copy of the Veteran's 201 personnel file received in December 1997. In the reasons and bases section of the decision the RO relied on receipt of the Bronze Star, showing in the 201 file, and the 1997 VA examination in determining that service connection for PTSD was warranted. In that decision, the RO also denied service connection for 14 other claimed disabilities and determined that the Veteran was ineligible for Chapter 35 Dependent's Educational Assistance. In a letter dated October 27, 1998, the RO informed the Veteran that a decision had been made on his claim and the decision document was attached. It informed the Veteran that if he thought the decision was wrong, he should write to the RO and tell the RO why. It also stated that the enclosed VA Form 4107 explained his right to appeal. This letter was also sent to the Veteran's representative at that time, the American Legion. Also associated with the claims file is a report of telephone contact dated October 20, 1998. This indicates that the person contacted was the Florida Department of Veterans Affairs. It states in its entirety as follows: Per Decision Review Officer, . . . , I contacted the above named veteran to ascertain if the veteran wished to pursue all issues under appeal. The veteran stated that he was very dissatisfied with the denials, that he is totally unemployable due too (sic) the injuries he received during service, and that he wishes to continue with his appeal. An October 1998 statement of the case is of record that lists 14 issues. These 14 issues address claims denied in the October 14, 1998 rating decision. In December 1998, the RO received a VA Form 21-4138 in which the Veteran stated that he wanted the RO to reopen his claim for service connection for PTSD. He stated that he was currently rated 50 percent for PTSD and had been hospitalized at the VA Medical Center (VAMC) for two weeks in August 1998. He also reported that he had seen physicians for PTSD treatment in December 1998 and asked that these records be obtained to support his claim of entitlement to an increased rating for PTSD. He stated that the medications that VA had prescribed had side effects that rendered him unemployable. He included a list of the medication and that list contains drugs prescribed for psychiatric symptoms. Date stamped as received by the RO in January 1999, is a hospital summary documenting the Veteran's inpatient treatment for psychiatric treatment from July 28, 1998 to August 3, 1998. Following the December 1998 letter, the Veteran provided argument in December 1998 regarding the rating assigned for PTSD and whether or not service connection was warranted for major depressive disorder. There is no mention of disagreement or dissatisfaction with the effective date assigned for award of service connection for PTSD. He referred to a May 1995 evaluation in the context of arguing that he had a clinical diagnosis of major depressive disorder at that time. There is no other document received within one year of the October 1998 rating decision with regard to PTSD and no document received within that time frame that refers to the date of award of service connection for PTSD. In a writing received on June 25, 2001, the Veteran stated that he had requested compensation benefits as early as January 28, 1994 and that he wanted retroactive pay from that date. The RO has referred to his request for an earlier effective date as dated on July 9, 2001. The only document date stamped with that date is a copy of his original VA Form 21-526. The RO accepted the June - July 2001 writing as an assertion that there was CUE in the 1998 rating decision. This is shown by the rating decision dated August 23, 2002 in which the RO listed one of the issues as whether the decision assigning effective dates to establish service connection for PTSD and other disabilities were clearly and unmistakably erroneous. The RO denied the Veteran's request for revision based on CUE. In October 2002, the RO received a notice of disagreement with that decision and it issued a statement of the case in December 2002. In January 2003, the RO received a VA Form 9 from the Veteran perfecting his appeal of the August 2002 decision. In June 2004, the Board denied an effective date earlier than October 4, 1996 for award of service connection for PTSD and in December 2004 denied a motion for reconsideration of that decision. The Veteran appealed that decision to the Court of Appeals for Veterans Claims (Veterans Court). In August 2007 the Veterans Court vacated the Board decision as to the effective date of award of service connection for PTSD and remanded that issue to the Board. The Veterans Court explained that the Board found the October 1996 statement was the first instance of the Veteran seeking benefits for PTSD but the Board did not account for the fact that some of the symptoms listed on the June 8, 1995 statement could correspond to a mental illness such as PTSD. Concluding that the Board had not provided a sufficient statement of reasons and bases to explain how the 1996 statement provided the earliest possible effective date, it remanded the issue to the Board. Another issue before the Veterans Court at that time was entitlement to an earlier effective date for award of service connection for low back strain. In a Background section of its decision, the Veterans Court first noted that in October 1996 the RO granted service connection for PTSD, effective October 4, 1996 and in November 1999 the RO granted entitlement to service connection for low back strain, effective June 8, 1995. The Veterans Court then stated "[t]he appellant perfected appeals of the effective dates assigned for both disabilities." In the August 2007 decision, the Veterans Court also determined that because there was no claim pending for entitlement to service connection for PTSD at the time of the May 1994 rating decision, the Veteran's argument that VA's failure to obtain all of his service treatment records before issuing the rating decision was without merit. The Veterans Court also determined that the Veteran's complaints to physicians of depression did not constitute a claim of entitlement to service connection for PTSD. In August 2008, the Board again denied entitlement to an effective date earlier than October 4, 1996 for award of service connection for PTSD. The Board found that if the June 8, 1995 statement included a claim of entitlement to service connection for PTSD, then the RO implicitly denied the claim in the June 1996 rating decision and the Veteran did not appeal that decision. The Board also determined that the Veteran had not appealed the October 1998 decision as to the effective date assigned for service connection for PTSD and that the October 1998 decision was final. The Veteran appealed the August 2008 Board decision and in December 2010 the Veterans Court vacated the decision as to the issue of the effective date assigned for award of service connection for PTSD and remanded it to the Board for further adjudication. In that decision, the Veterans Court indicated three points that the Board should address. First, the Veterans Court stated that it was not clear from the record before it whether this is a direct appeal from the October 1998 decision or if it is a CUE challenge to that decision. In that context, the Veterans Court noted "[t]he Court's decision in August 2007 indicated that the appellant properly appealed the effective date assigned to his PTSD claim, but the Board decision on appeal stated that the October 1998 rating decision was final." The Veterans Court stated that a remand would permit the Board to sort out the confusing procedural history in this case. Second, the Veterans Court addressed the government's argument that any error in the Board's decision was harmless because the Veteran was first diagnosed with PTSD in September 1997 and therefore was not entitled to service connection until September 1997. The Veterans Court stated that conflict exists as to the date of the initial PTSD diagnosis and the limited record before it did not allow the issue to be reviewed, indicating that the Board should provide the necessary discussion on remand. Third, the Veterans Court determined that the Board did not explain how the Veteran could have deduced that his claim was denied in June 1996 and that it was not readily apparent and therefore a remand was necessary. B. Analysis - Basis of the Appeal A direct appeal to the Board of an RO decision is initiated by the filing of a notice of disagreement with the decision. 38 U.S.C.A. § 7104(a); 38 C.F.R. § 20.200 (2011). A notice of disagreement is a statement, reduced to writing, that can reasonably be construed as expressing dissatisfaction with the RO's decision and a desire to contest the result. 38 U.S.C.A. § 7105(b); 38 C.F.R. § 20.201. If a notice of disagreement is not received within one year of mailing of notice of the decision to the claimant, the decision becomes final. 38 U.S.C.A. § 7105(b),©; 38 C.F.R. § 20.302(a). Once a decision becomes final it generally may not be reopened or allowed. 38 U.S.C.A. § 7105©. A decision that has become final may be collaterally attacked via an assertion that it contained CUE and if the decision is found to contain CUE it must be reversed or revised. 38 U.S.C.A. § 5109A (West 2002); 38 C.F.R. § 3.105(a) (2011); Fugo v. Brown, 6 Vet. App. 40, 44 (1993). A collateral attack of an RO decision may be made at any time after the decision is made. 38 U.S.C.A. § 5109A. Whether a decision is directly appealed or the subject of a collateral attack via an assertion of CUE is important because the collateral attack involves a more onerous evidentiary standard and limits the review to the facts as they were known at the time of the decision and the law as it was understood at the time of the decision. See Damrel v. Brown, 6 Vet. App. 242, 245 (1995). On its face, the October 20, 1998 report of contact is not a notice of disagreement with the rating or the effective date assigned for PTSD in the October 1998 decision. Service connection for PTSD was granted in the October 14, 1998 rating decision, fourteen other claims were denied. The October 20, 1998 report of contact expresses dissatisfaction with and a desire to contest those denials. Although the report includes that Veteran asserted unemployability due to his service injuries, a sympathetic reading of the report of contact could yield no more than a notice of disagreement with the rating assigned. There is nothing in this report of contact that indicates a dissatisfaction with the effective date assigned for service connection for PTSD. It did not initiate an appeal of that issue. The December 1998 submission is a notice of disagreement with the disability rating assigned for the Veteran's PTSD. Although the Veteran requested an increased rating, he submitted the documents dated prior to the date of the rating decision to demonstrate the increase in disability, thus effectively disagreeing with the initial rating assigned for PTSD. Regardless of the Veteran's choice of words, he was seeking a higher initial rating for his PTSD, whether that rating was staged or not. Moreover, given that at the time of the October 20, 1998 report of contact service connection had been established for only PTSD, right ear hearing loss, and tinea curis, and given that he argued that he was unemployable due to service related injuries, that document could have been construed as a notice of disagreement with the rating assigned in the October 14, 1998 rating decision. This makes little difference given the December 1998 submission. Even taking a sympathetic interpretation of these documents, the effective date of award of service connection for PTSD was not appealed. Both the October 20, 1998 report of contact and the December 1998 letter referred to the amount of compensation, not whether he was entitled to the award of service connection at an earlier date. Moreover, neither letter referred to dates earlier than the date that service connection had then been established for PTSD. While there is a blurring of effective dates and disability evaluations in claims for increased ratings, (i.e., where the claim indicates that there has been an increase in disability since the initial grant of service connection), that blurring is because the effective date of an increased evaluation can go back to one year prior to the claim for an increase. 38 U.S.C.A. § 5110(b)(2); Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). This is not the case where there is a dispute as to the rating assigned in the decision that awarded service connection. In such cases, if a higher evaluation is awarded it can be effective no earlier than the effective date of award of service connection. Cf. Moore v. Nicholson, 21 Vet. App. 211, 216-17 ("although Mr. Moore's claim also involves an initial rating and presents the possibility of staged ratings, those ratings would not extend past the undisputed date the claim was filed"). For these reasons, the Board finds that neither the October 20, 1998 report of contact nor the December 1998 letter constituted a notice of disagreement as to the effective date of service connection for PTSD. No other document was submitted within one year of the October 1998 rating decision. The earliest statement that could be construed as disagreeing with the effective date assigned service connection for PTSD is the statement received in June - July 2001. Regardless of whether the statement that initiated the RO's actions with regard to an earlier effective date was received in June 2001 or July 2001, it was received more than one year after the October 1998 rating decision. Hence, it was not a timely notice of disagreement as to the effective date assigned for service connection for PTSD. As such, the October 1998 decision became final as to that issue. The October 2002 notice of disagreement initiated an appeal of the August 23, 2002 decision denying the request for revision of the October 1998 rating decision as to the effective date assigned for award of service connection for PTSD. The January 2003 Form 9 perfected that appeal to the Board. There is no discrepancy between a finding that the October 1998 rating decision was final as to the issue of the effective date assigned for award of service connection for PTSD and the Veterans Court's statements in the 2007 decision that "n October 1998, the RO granted entitlement to service connection for PTSD, effective October 4, 1996 . . . In November 1999, the RO granted entitlement to service connection for low back strain, effective June 8, 1995. The appellant perfected appeals of the effective dates assigned for both disabilities." Although the effective date issue arose from a request for revision based on CUE, the issue was ultimately whether he was entitled to an earlier effective date for award of service connection for PTSD. That the avenue for seeking that result was a collateral attack rather than a direct appeal does not introduce any conflict between the statement in the 2007 Veterans Court decision and the finding that the October 1998 rating decision was final as to the issue of the effective date for service connection for PTSD. C. Analysis - The June 8, 1995 Claim The next question is whether the claim received by the RO on June 8, 1995 included a claim of entitlement to service connection for PTSD. As this issue comes to the Board via an allegation of CUE in the October 1998 decision, the Board's analysis considers the facts as they were known at the time and the law as it was understood at the time. Any communication or action from a claimant or his or her representative, indicating an intent to apply for one or more benefits under the laws administered by the Department of Veterans Affairs, may be considered an informal claim. 38 C.F.R. § 3.155(a) (1998). Such informal claim must identify the benefit sought. Id. Prior to 1998, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) had explained that VA is "to fully and sympathetically develop the veteran's claim to its optimum before deciding it on the merits." Hodge v. West, 155 F.3d 1356, 1362 (Fed. Cir. 1988) (quoting H.R. Rep. No. 100-963, at 13, reprinted in 1988 U.S.C.C.A.N. 5782, 5795.) If it was understood in 1988 that VA was to sympathetically develop a Veteran's claim to the optimum before deciding it on the merits, then it follows that VA was to sympathetically read the claim and, as such, would be the starting point of any development. The next question though is whether a sympathetic reading of the Veteran's claim was understood in 1998 to include reading a claim of service connection for PTSD given that service connection was requested for two symptoms of PTSD. When the RO granted service connection for PTSD in October 1998, 38 C.F.R. § 4.125 (1998) expressed that the diagnosis of a mental disorder must conform to the DSM-IV. At that time 38 C.F.R. § 4.130 (1998), stated that the nomenclature employed in the rating schedule for mental disorders was based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), American Psychiatric Association. It explained that to comply with the fundamental requirements for rating psychiatric conditions, it is imperative that rating personnel familiarize themselves thoroughly with this manual. Id. Prior to this, and in effect when the RO received the June 1995 statement, 38 C.F.R. § 4.125 (1994) addressed general considerations in determining the disability rating to be assigned for mental disorders. That regulation stated that the psychiatric nomenclature employed is based upon the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM III), American Psychiatric Association. It explained that to comply with the fundamental requirements for rating psychiatric conditions, it is imperative that rating personnel familiarize themselves thoroughly with this manual. Of note, in 1995, the Manual M21-1 directed adjudicators to the DSM-III-R. Cohen v. Brown, 10 Vet. App. 128, 139 (1997). The RO was required to employ the most favorable provision to the Veteran's claim. Id. Diagnostic criteria for PTSD under the DSM-IV included difficulty falling or staying asleep, as one of the listed symptoms under criterion D, and inability to recall an important aspect of the trauma as one of the symptoms under Criterion C. QUICK REFERENCE TO THE DIAGNOSTIC CRITERIA FROM DSM-IV 209-11 (1994). Diagnostic criteria for PTSD under the DSM-IIIR included these same symptoms. See QUICK REFERENCE TO THE DIAGNOSTIC CRITERIA FROM DSM-IIIR 146-48 (1987). The criteria found in the DSM-III listed both sleep disturbance and memory impairment under Criterion D. QUICK REFERENCE TO THE DIAGNOSTIC CRITERIA FROM DSM-III at 136-37 (1980). Even though the regulations just discussed are found in Chapter 4 of Title 38 of the C.F.R., an interpretation of those provisions as limited solely to rating a disability is inconsistent with the reference in the regulations to "diagnosis." An adjudicator thoroughly familiar with the DSM would recognize that memory loss and sleeping disorder are symptoms of PTSD and thus a sympathetic reading of the June 1995 statement would yield a claim of entitlement to service connection for PTSD. There was significant case law at the time of the October 1998 decision establishing that VA was to examine the entire record and infer claims for benefits without any requirement for specific mention of the claimed condition or claimed benefit. See Akles v. Derwinski, 1 Vet. App. 118, 121 (1991) (finding that the RO should have inferred a claim of entitlement to special monthly compensation from the claim for an increased rating even though he did not place eligibility for that benefit at issue); EF v. Derwinski, 1 Vet. App. 324 (1991) (providing that once a claim is received, VA must review the claim, supporting documents, and oral testimony in a liberal manner to identify and adjudicate all reasonably raised claims); Suttmann v. Brown, 5 Vet. App. 127, 132 (1993) (stating that when a particular claim has been raised, the Board must consider "all documents or oral testimony submitted prior to the BVA decision" and " 'review all issues which are reasonably raised from a liberal reading' " of such documents and oral testimony). Though the Veterans Court referred to the BVA in Suttmann, it cannot be said that the same reasoning does not apply to the RO, particularly given that it is the RO, not the Board, that views claims in the first instance. Here, the record included a clear diagnosis of PTSD from a physician at the VA mental health clinic in 1994, as well as numerous documents discussing whether or not the Veteran had PTSD. It is clear from Suttmann and EF, that the documents assembled in the claims file at the time of the 1998 decision had to be considered to determine the scope of any claim previously filed but not adjudicated. In summary, the writing received by the RO on June 8, 1995 included a claim of entitlement to service connection for PTSD. D. Analysis - First Diagnosis of PTSD As noted in the Background section of the instant decision, it was argued to the Veterans Court that service connection for PTSD could not be granted earlier than October 1996 because the Veteran was not diagnosed with PTSD until September 1997 and therefore entitlement to service connection for PTSD did not arise until September 1997. This argument arises from the language of 38 C.F.R. § 3.400 which implements 38 U.S.C.A. § 5110. Unless specifically provided otherwise in Chapter 51 of Title 38 the United States Code, the effective date of an award based on an original claim shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C.A. § 5110(a)(West 2002) (emphasis added). Except as otherwise provided, the effective date an evaluation and award of compensation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (West 1998 & West 2002) (emphasis added). In August 2011 the Veterans Court issued DeLisio v. Shinseki, 25 Vet. App. 45 (2011), a decision that renders without merit any argument that the effective date of award of service connection for the Veteran's PTSD can be limited by the date of diagnosis of PTSD. The Veterans Court corrected any understanding of the law that required a diagnosis of a condition prior to the establishment of service connection in its statement as follows: The Board found that the October 31, 1980, claim for benefits did not and could not include a claim for benefits for diabetes because "[t]he veteran could not claim a disorder that was not diagnosed." R. at 21. However, the Board misstated the law. See Brokowski, 23 Vet. App. at 90 ("[A] medical diagnosis is not necessary to initiate a claim."); see also Jandreau, 492 F.3d at 1377 (holding that a medical diagnosis is not required to substantiate a claim in certain circumstances). Specifically, entitlement to benefits for a disability or disease does not arise with a medical diagnosis of the condition, but with the manifestation of the condition and the filing of a claim for benefits for the condition. 38 U.S.C. § 5110(a); see McGrath, supra. Id. The Veterans Court explained that there are instances where the "facts found" or alternatively, "date entitlement arose" may be later than the date of claim. These included (1) date the disability first manifested and (2) the date entitlement to benefits was authorized by law and regulation; (it is noted that these two situations were not listed as the only two situations). Delisio, 25 Vet. App. at 52. Thus, even if the Veteran was first diagnosed with PTSD in September 1997, such fact could not limit establishment of service connection for PTSD to 1997 simply because of the date of such diagnosis. What is important is not when he was first diagnosed but when his condition first manifested. As to the second situation listed in DeLisio, it has no significance in the Veteran's case because service connection was available by statute and regulation long before the Veteran filed any claim for VA benefits. The Board finds no basis for a determination that the law was understood in 1998 to limit the effective date of award of service connection for a disability to the date of diagnosis of such disability. At the time of the 1998 decision, 38 C.F.R. § 3.304(f) (1998) required a clear medical diagnosis of PTSD. In Cohen v. Brown, 10 Vet. App. 128, 139 (1997) the Veterans Court stated that "a "clear diagnosis" should be an "unequivocal" one." The Veterans Court explained that an unequivocal diagnosis by a mental-health professional must be presumed (unless evidence shows to the contrary) to have been made in accordance with the applicable DSM criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor." Id. at 140. Even under this standard, the Board finds that the Veteran was first diagnosed with PTSD in 1994. The first mention of psychiatric symptoms found in the claims file is the February 1994 report of medical examination that was conducted in response to his claim of entitlement to service connection for a hip disability and led the examiner to request a C&P psychiatric examination and request a clinical consultation with the mental health clinic. The mental health clinic professional who addressed this request provided two diagnoses, adjustment disorder with depressed mood, and PTSD with nightmares of the war. On March 23, 1994 he was again seen in the mental health clinic and a physician diagnosed PTSD. Because the 1994 diagnosis was in a mental health clinic treatment note, signed by a medical doctor, and unequivocal, it was a clear medical diagnosis of PTSD. It is not ignored that the record also includes the C&P psychiatric examiner's conclusion on March 3, 1994 that the Veteran's history was insufficient to support a diagnosis of PTSD, the March 1, 1995 mental health clinic notes assessing depression, and the May 23, 1995 neuropsychological evaluation that included a discussion of depression and PTSD but provided no definitive statement as to whether he did or did not have PTSD. The word "unequivocal" is defined as "admitting to no doubt or misunderstanding." Webster's II New College Dictionary (2001) at 1203. Cohen and 38 C.F.R. § 3.304(f) (1998) refer to "a" clear diagnosis; there is thus no requirement that there must be agreement between medical professionals as to whether or not the claimant had PTSD; so long as there is at least one unequivocal diagnosis, the requirement is met. The March 1994 diagnosis was unequivocal. The Board thus finds that the Veteran was first diagnosed with PTSD on February 4, 1994. As noted above, it is not the date that PTSD was diagnosed that matters in determining the earliest allowable effective date for award of service connection. The VA mental health clinic treatment records, taking into consideration the later determination that he had PTSD, are evidence that PTSD manifested prior to when the RO received his claim on June 8,1995. E. Analysis - Whether Service Connection for PTSD was Implicitly Denied in the June 1996 Rating Decision. Having determined that the claim received on June 8, 1995 included a claim of entitlement to service connection for PTSD, the next question is whether the claim was still pending at the time of the October 1998 rating decision. The answer depends on whether the claim was implicitly denied in the June 1996 decision. This is important, because if the claim was denied in June 1996, then it could be argued that the October 4, 1996 submission was a claim to reopen the previously denied claim which could then lead to a finding that an effective date earlier than October 4, 1996 is not warranted. To answer this question and understand the legal theory of an implicit denial, there are significant cases that must be considered. In Deshotel v. Nicholson, 457 F.3d 1258, 1261 (Fed Cir 2006), the Federal Circuit held that Where the veteran files more than one claim with the RO at the same time, and the RO's decision acts (favorably or unfavorably) on one of the claims but fails to specifically address the other claim, the second claim is deemed denied, and the appeal period begins to run. It also held: We explicitly rejected the government's contention that the implied TDIU claim was pending and unadjudicated. Id. Relying on Roberson, 251 F.3d at 1383-84, we held that where an RO renders a decision on a veteran's claim for benefits but fails to address one of the claims, that decision is final as to all claims; the RO's failure to address the implied claim "is properly challenged through a CUE motion," not a direct appeal. Id. 1262. But in Ingram v. Nicholson, 21 Vet. App. 232, 239 (2007), the Veterans Court stated: In essence, we must determine whether the 1986 RO decision decided a section 1151 claim, which would now have to be the subject of a collateral attack, or whether the alleged section 1151 claim in 1986 was still pending at the time of the appellant's 1992 correspondence and, therefore, is part of the present claim stream including this direct review. If we determine that the 1986 RO decision decided a section 1151 claim, then we do not have jurisdiction to review any alleged error in that decision, as that decision is final and not part of the claim presently on direct appeal. . . . If we determine that any potential claim was still pending and part of the claim stream that resulted in the Board decision on appeal, then we would have jurisdiction to address the substance of the appellant's argument. This narrowing of Deshotel by Ingram is consistent with later cases issued by the Federal Circuit. Indeed, in Adams v. Shinseki, 568 F.3d 956 (Fed. Cir. 2009), the Federal Circuit discussed Deshotel and Ingram at length. It eventually summed up what is necessary to find that a decision implicitly denied a claim, stating "as the Veterans Court noted in Ingram, and in this case, the key question in the implicit denial inquiry is whether it would be clear to a reasonable person that the DVA's action that expressly refers to one claim is intended to dispose of others as well." Id. at 964. In Cogburn v. Shinseki, the Veterans Court discussed four factors that must be considered in determining if a claim was implicitly denied, as follows: (1) The specificity of the claims or the relatedness of the claims; (2) the specificity of the adjudication, i.e., does the adjudication allude to the pending claim in such a way that it could reasonably be inferred that the prior claim was denied; (3) the timing of the claims; (4) whether the claimant is represented. The third and fourth factors are not complicated in the case now before the Board. As to the timing of the claims, that factor operates in favor of finding that there was an implicit denial of service connection for PTSD in the June 1996 rating decision. The Veteran claimed entitlement to service connection for all of the symptoms listed in one document. As to representation, that factor operates in favor of finding that there was no denial of service connection for PTSD in the June 1996 rating decision because the Veteran did not have the assistance of an attorney to advise him on what was claimed and what was denied. The first Cogburn factor , the specificity or relatedness of the claims, is closer. Here, the claims were not specific, and there were not two or more specifically diagnosed disorders that were closely related. Rather he referred only to symptoms; the only mention in the 1995 claim of a theory of entitlement was Gulf War Syndrome. In Deshotel, this factor operated in favor of finding an implicit denial of the psychiatric condition because the psychiatric condition was claimed to have been due to a head injury and the claim of entitlement to service connection for a head injury was explicitly denied in the decision at issue in that case. In Ingram, the question was an 1151 claim versus a pension claim, which have different elements and are governed by different chapters of regulations and statutes. In the Veteran's case all of the claims in the June 1995 document were for service connection and therefore all were governed by essentially the same statutes and regulations and certainly by the same chapter of Title 38 of the U.S. Code. In that sense the case differs from Ingram and is more like Deshotel. However, in Deshotel the psychiatric condition was derivative of the claimed head injury so there was a close relatedness, while in the instant case there is no such stated derivative aspect. As such, this factor does not fall on one side or the other to the extent that it can be said to have much impact. This leaves the second factor discussed in Cogburn, the specificity of the adjudication. That is, does the adjudication allude to the pending claim in such a way that it could reasonably be inferred that the prior claim was denied. This is a reasonable person standard. See Adams, 568 F.3d at 963. As to the specificity of the adjudication, that is a closer matter. From the statement that the service medical records contain no complaints, treatment, or diagnosis of any of the conditions, the adjudication was general and one might say that a reasonable person would understand that any condition that involved these symptoms was denied since there was no complaints, treatment, or diagnosis of such conditions in service. However, the next paragraph in the Reasons and Bases section of the June 1996 decision deals solely with an undiagnosed illness and in that sense is specific and a reasonable person would not expect that a claim of entitlement to service connection for a diagnosed condition had been denied. The complete lack of mention of PTSD would also lead a reasonable person to conclude that no claim of entitlement to PTSD had even been considered, let alone denied. Moreover, the phrasing in the Issue and the Decision sections of the June 1996 decision would lead a reasonable person to conclude that what was considered by the RO and what was adjudicated in the decision was only service connection for an undiagnosed illness manifesting as such symptoms. In summary, the second Cogburn factor, specificity of the adjudication, falls in favor of finding that the June 1996 rating decision did not contain an implicit denial of service connection for PTSD. Taking a broader view and considering the statement in Adams, it is difficult to say that it would be clear to a reasonable person that the June 1996 decision intended to dispose of a claim of entitlement to service connection for PTSD. For the reasons just discussed, the Board finds that the June 1996 decision did not implicitly, or for that matter explicitly, deny service connection for PTSD. The claim received on June 8, 1995 therefore remained pending until the RO issued its decision in October 1998 granting service connection for PTSD. F. Analysis - CUE in the October 1998 Decision A prior RO decision must be revised or reversed when there is a finding of CUE in that decision. 38 C.F.R. § 3.105(a). CUE is established when certain conditions have been met. First, either the correct facts contained in, or constructively contained in, the record were not before the adjudicator, or the statutory or regulatory provisions extant at the time were incorrectly applied. See Damrel v. Brown, 6 Vet. App. 242, 245 (1995). Second, the alleged error must be "undebatable," not merely a "disagreement as to how the facts were weighed or evaluated." Russell v. Principi, 3 Vet. App. 310, 313-14 (1992) (en banc); and finally, the error must have "manifestly changed the outcome" of the prior decision. Id.; see Bustos v. West, 179 F .3d 1378, 1380-81 (Fed.Cir.1999) (expressly adopting the "manifestly changed the outcome" language in Russell ). The Board has already found that the law as it was understood at the time of the October 1998 decision included a duty on the part of the VA adjudicator to read submissions by claimants in a manner to recognize all claims reasonably raised by those submissions and the other documents of record at the time of the 1998 decision. The facts before the RO at the time of the 1998 decision included the identification of symptoms in the June 1995 statement that were listed in the DSM III, IIIR, and IV for PTSD. There were treatment records documenting that the Veteran had symptoms of PTSD and a diagnosis of PTSD as far back as 1994. Given the facts before the RO at the time of record, it was error to not have found the June 8, 1995 submission to include a claim of entitlement to service connection for PTSD. It was clear error in the sense that the adjudicator was required by regulation to be thoroughly familiar with those provisions. The error is undebatable. There is no mention of the June 1995 submission in the October 1998 rating decision. Nor is there any mention of 38 C.F.R. § 4.125 (1994 & 1998) or § 4.130 (1998). An adjudicator looking at the record documenting that the Veteran was diagnosed with PTSD as early as 1994, and seeking disability compensation for memory loss and a sleeping disorder, two symptoms of PTSD, and that adjudicator having determined that service connection for PTSD was warranted, would have, looking back through the record at the time of the October 1998 rating decision, recognized the June 1995 claim as a claim to include service connection for PTSD if the adjudicator had correctly applied 38 C.F.R. § 4.125 (1994 & 1998) or § 4.130 (1998) in light of Hodge v. West, 155 F.3d 1356, 1362 (Fed. Cir. 1988), EF v. Derwinski, 1 Vet. App. 324 (1991), and Suttmann v. Brown, 5 Vet. App. 127, 132 (1993). As to the outcome determinative aspect of CUE, the basis for establishing October 4, 1996 as the effective date of award of service connection for PTSD was that this was the date of claim. If the date of claim was June 8, 1995 then the outcome would be different; the date of award of service connection would be June 8, 1995. Reasonable minds could not differ if but for the error, the outcome would have been different. See Fugo v. Brown, 6 Vet. App. 40, 43-44 (1993) (To constitute CUE, the error must "compel[ ] the conclusion, to which reasonable minds could not differ, that the result would have been different but for the error" and "persuasive reasons must be given as to why the result would have been manifestly different"). The October 1998 decision must therefore be revised and an effective date of award of service connection of June 8, 1995 established. An effective date earlier than June 8, 1995 is not warranted. The December 1993 claim was the only earlier claim of entitlement to VA disability compensation submitted by or for the Veteran. That claim referred only to physical disabilities. A sympathetic reading of that claim could not yield a claim of entitlement to PTSD or any psychiatric condition. In other words, the December 1993 claim identified the benefits sought but did not identify entitlement to compensation benefits due to PTSD or any psychiatric condition and was therefore not a claim of any kind. See 38 C.F.R. § 3.155(a). The Veterans Court has already determined, in the August 2007 decision, that the reports of psychiatric symptoms by the Veteran to clinicians and during examination reports do not constitute a claim or claims of entitlement to service connection for PTSD. This is the law of the case and binding on the Board. See Browder v. Brown, 5 Vet. App. 268, 270 (1993) ("nder the 'law of the case,' questions settled on a former appeal of the same case are no longer open for review"). As to the receipt of the Veteran's 201 file after the initial request for service treatment records, such fact does not allow for an effective date for award of service connection for PTSD earlier than June 8, 1995 because the earliest possible effective date is the date of claim, which is June 8, 1995. See 38 U.S.C.A. § 5110(a); 38 C.F.R. § 3.400. Finally, the Veterans Claims Assistance Act of 2000 notice and assistance provisions are not applicable to this issue because the issue comes to the Board through appeal of the denied request for revision of the October 1998 decision based on CUE. See Juarez v. Principi, 16 Vet. App. 518, 520 (2002); Livesay v. Principi, 15 Vet. App. 165, 179 (2001). In summary, the October 1998 rating decision must be revised to assign an effective date of June 8, 1995 for award of service connection for PTSD. II. Disability Evaluation for Tinnitus In a November 2006 rating decision, the RO granted service connection for tinnitus and assigned a 10 percent disability rating. It established an effective date for service connection of November 14, 2005 based on its determination that this was the date that it received the Veteran's "reopen claim." In January 2007, the Veteran submitted a letter titled Notice of Disagreement. He contended that the RO was incorrect in stating that his tinnitus was caused by what he referred to as military specialty noises, described by the Veteran as noise from vehicles, and communication levels, but rather that the RO should have found that his tinnitus was caused by noise from ordnance, such as missiles and rockets. The RO interpreted this as a notice of disagreement with the evaluation of 10 percent assigned, and expressed the issue as "increased evaluation for tinnitus, currently evaluated as 10 percent disabling." The Veteran perfected this appeal in August 2007. In a July 2010 writing, the Veteran's representative stated as follows: The claim under consideration is for tinnitus. The veteran has been receiving 10 percent disability for tinnitus since 11/14/05. The VA considers that the veteran is claiming an increase in the rating for tinnitus; however, the veteran understands that 10% is the highest rating that can be awarded for this disability and is claiming an earlier onset date for the grant of disability from tinnitus, to the original application in 1994. After referring to the Veteran's service and providing an explanation of the history of his claim of entitlement to service connection for tinnitus, his representative stated that "[t]he veteran contends that the VA committed clear and Unmistakable Error in denying the 1994 claim for tinnitus." During the October 2010 hearing, the Veteran testified consistent with his earlier statements. That is, he testified as to the specific in-service cause of his tinnitus, asserting that it was caused by in-service exposure to acoustic trauma from ordnance as opposed to other sources of acoustic trauma during service. A necessary element of service connection for a disability is incurrence or aggravation of an in-service disease or injury. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303(a) (2011); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Once this in-service element was established and service connection awarded no change in the outcome could result from identifying the particular sources of in-service acoustic trauma. He also stated that he was not asking for a higher rating for disability due to tinnitus, acknowledging that the rating is limited to 10 percent. The only issue that was developed as an appeal from the 2005 grant of service connection for tinnitus was the issue of the disability rating assigned. The July 2010 letter and the Veteran's testimony establish that there is no question of law or fact in dispute as to the evaluation assigned. The July and August 2010 documents just described are effectively a withdrawal of his appeal with regard to the only issue before the Board as to his tinnitus claim - the disability rating assigned. Under 38 U.S.C.A. § 7105, the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. A Substantive Appeal may be withdrawn in writing at any time before the Board promulgates a decision. 38 C.F.R. § 20.202. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204(a). Here, the Veteran has withdrawn the appeal of the claim of entitlement to a disability rating in excess of 10 percent for tinnitus, has done so prior to the promulgation by the Board of a decision as to that issue, and there remain no allegations of errors of fact or law for appellate consideration as to this issue. Accordingly, the Board does not have jurisdiction to review the appeal of this issue, and it is dismissed. ORDER Entitlement to an effective date of June 8, 1995 for award of service connection for PTSD is granted. The appeal of the issue of entitlement to an evaluation in excess of 10 percent disabling for tinnitus is dismissed. ____________________________________________ TARA L. REYNOLDS Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs
  14. I was trying to get into to see a Endocrinologist at the VA, I am service connected for Fatty Infiltration of the liver (20+ years now) from day one that I got out of the military. Had Biopsy showing Fatty Liver with Fibrosis (Fibrosis is Scaring) Several years ago. and today the Endo refuses to see me with this statement: This is from Endo Doctor Dr. xyz as I will call him "As regards the NASH, he has no biochemical evidence of NASH at this time. His LFTs (liver function tests) are normal and they might have been high in the past given his GB disease. The relation between DM and NASH (which he does NOT have) is mainly thru weight gain and obesity." Therefore, vet does not need to see Dr xyz. Liver Function tests were High for 10 Years before I had any Gallbladder problems. From everything I have researched and read that NASH biochemical evidence can come and go (GB disease is Gallbladder) and DM is Diabetes I have called the local Endocrinologist and they don't see anyone without a referral. I don't currently have a private doctor but I guess I will need to find private doctor now to get a referral and fight them from what a now retired doctor from VA has told me for many years. So New Doctors and They do this DENIAL thing I am sorry to vent but had to get it off my chest. mike
  15. http://www.va.gov/vetapp13/Files2/1312585.txt Citation Nr: 1312585 Decision Date: 04/16/13 Archive Date: 05/02/13 DOCKET NO. 08-33 944 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Whether the RO's rating decision dated in March 1971 should be revised on the grounds of clear and unmistakable error (CUE). REPRESENTATION Appellant represented by: Kenneth M. Carpenter, Attorney ATTORNEY FOR THE BOARD Joseph P. Gervasio, Counsel INTRODUCTION The Veteran, who is the appellant, served on active duty from March 1965 to November 1968. This case comes to the Board of Veterans' Appeals (Board) on appeal of an April 2002 rating decision of the St. Louis, Missouri, Regional Office (RO) of the Department of Veterans Affairs (VA), which found that there was no CUE in a March 1971 rating decision that denied service connection for schizophrenia. By decision dated in August 2010, the Board likewise denied the appellant's claim, finding that there was no CUE in the March 1971 rating decision. The appellant appealed the Board's denial to the United States Court of Appeals for Veterans Claims (Court), and the Board's decision regarding the March 1971 rating decision was vacated pursuant to a July 2012 memorandum decision. The Court remanded the matter for readjudication consistent with its decision. FINDINGS OF FACT 1. In a March 1971 rating decision, the RO denied service connection for undifferentiated schizophrenia (previously diagnosed as nervous condition) as having pre-existed service and not being aggravated in service. The Veteran did not appeal this decision and it became final. 2. In a July 2012 Memorandum decision, the Court found that the presumption of soundness at entry into active duty had not been rebutted by clear and unmistakable evidence as to a psychosis by the medical evidence of record at the time of the March 1971 rating decision; the Board concludes that there is no basis to conclude that there was no increase in disability due to a nervous condition in service or that any inservice increase was due to natural progress. Therefore, the rating decision did not properly apply governing law; such failure was outcome determinative. 3. Schizophrenia was not manifested during service. 4. Schizophrenia was first manifested to a degree of 10 percent within one year of service separation. CONCLUSIONS OF LAW 1. The March 1971 rating decision which denied the Veteran service connection for schizophrenia involved clear and unmistakable error and requires revision. 38 U.S.C.A. §§ 5109A , 7105 (West 2002); 38 C.F.R. § 3.105 (2012). 2. Schizophrenia is presumed to have been incurred during active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist The provisions of the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 C.F.R. §§ 3.102 , 3.156(a), 3.159, 3.326(a), and as interpreted by the Court have been held to be inapplicable to CUE claims. Sorakubo v. Principi, 16 Vet. App. 120, 122 (2002), citing Livesay v. Principi, 15 Vet. App. 165 (2001) (en banc) (holding that the duties specified in the VCAA are not applicable to allegations of CUE in a prior Board decision). Consideration of CUE in the March 1971 Rating Decision Review of the Veteran's service treatment records (STRs) shows that on pre-enlistment medical examination in November 1964, the Veteran reported having or having had no history of trouble sleeping, frequent and terrifying nightmares, depression or excessive worry, loss of memory or amnesia, or nervous trouble of any sort. The Veteran did report having had difficulty with school, stating that he could not concentrate enough to pass. Psychiatric clinical evaluation was normal. The Veteran was examined in connection with his entry into active duty in March 1965. At that time a defect of "nervous trouble" was noted as a defect. The Veteran's physical profile was unchanged and the Veteran was found to be physically qualified for transfer to active duty. STRs show no complaint or manifestation of a psychiatric disorder until a reference in November 1967 when the Veteran complained of being extremely nervous. He stated that he had been experiencing personal problems and felt incompetent of standing duty. He was given reassurance and referred to a physician at which time he was found to have moderate anxiety reaction secondary to "girlfriend problems." He was prescribed Librium. There were no further references to any psychiatric disability in the STRs. On examination for separation from service in November 1968, psychiatric clinical evaluation was normal. VA outpatient treatment records show that in March 1969, the Veteran was seen for complaints of being very tense and nervous. The diagnosis was anxiety and the Veteran was again prescribed Librium. The Veteran was hospitalized at a VA facility (VAH) in May 1969. At that time, it was noted that the Veteran's history was given by the Veteran's father who was initially inconsistent and poor, but later presented information directly. It was reported that the Veteran's mother was currently being treated for diabetes and psychiatric problems. The Veteran's history included having played by himself as a child, done poorly in school with severe difficulty in high school and quitting to join the Marines at age 17. He had been unable to remain employed since his discharge from service. He had left his last employment with a chemical company either because of the acid fumes or because he had wanted to see a woman whom he loved. It was reported that the Veteran may have been treated during service for emotional illness. He had dated a woman several years younger and he became frustrated and angry when women with whom he had a relationship did not cooperate with him. It was reported that approximately one year earlier he had thrown a woman through a door, fracturing her ribs. Several weeks before this admission, he had become angry at a former boyfriend of a woman he was dating and became preoccupied with getting a gun to kill him, but later decided against this. It was reported that he had seen a psychiatrist while he was having difficulties in high school. At that time he was reported by his parents to have been diagnosed with schizophrenia. His current complaints were of nerves, an inability to control his temper, and of memory loss. Another incident with a girlfriend had precipitated this admission. On mental status examination, the Veteran appeared anxious and depressed with suicidal ideation. His speech had little spontaneity and blocking occurred, particularly in relation to recent events. The Veteran was ambivalent with looseness of associations. The Veteran was preoccupied with the difficulties he had had with women and with his tour of duty in the military. He had fair concentration, symbolized inappropriately and loosely, with poor judgment and insight. The initial impression on admission was anxiety, with an adult situational reaction. During the course of hospitalization, the Veteran was noted to be blocking at times, but was also very cooperative. He was also impulsive at times and threatened to leave. The Veteran eventually left against medical advice one week following his admission. The Veteran's father was notified and was urged to try to have the Veteran return to the hospital due to the Veteran's suicidal and homicidal impulses. Despite assurances, the father was unable to have the Veteran return. The diagnosis was undifferentiated schizophrenia. In December 1970, the Veteran's claims folder was sent for review by a board of two specialists in psychiatry to furnish a definitive diagnosis as to the neurosis or psychosis that currently existed, the etiology thereof, and any relationship with service, if any. It was noted that a May 1969 rating decision, made for the purpose of VA treatment, had denied service connection for a nervous condition on the basis that at the time of the Veteran's entry into service there was a notation of nervous trouble and that aggravation during service was not shown. The May 1969 diagnosis of acute undifferentiated schizophrenia was also reported. The rating board requested an opinion regarding whether there was a relationship between the schizophrenia and the previously denied nervous condition, as, if there was no relationship, service connection on a presumptive basis would be warranted. Therefore, it was requested that the medical evidence be reviewed and questions answered regarding: (1) whether the current diagnosis of a psychosis corrected an old and previous diagnosis of nervous condition; (2) whether the current diagnosis of a psychosis represented a mere change in nomenclature; (3) whether the current diagnosis of a psychosis reflected a new phase or later development of a condition formerly diagnosed differently as a nervous condition; or (4) whether the current diagnosis of a psychosis represented a new clinical entity not related to the earlier diagnostic entity described as a nervous condition. In a January 1971 memorandum, the Chief of the VAH psychiatry service responded with a subject headed "Clarification of diagnosis of nervous or mental condition." The physician stated that, after review of all attached records, including military hospitalization and hospitalization at the VAH, the diagnosis of undifferentiated psychosis established at the VAH in all probability represented an extension of the same process earlier noted in the military record as nervousness. This would be compatible with item 3, that the current diagnosis of psychosis reflected a new phase or later development of a condition formerly diagnosed differently as a nervous condition. In the March 1971 rating decision, the RO found that the January 1971 memorandum opinion was that the diagnosis of the undifferentiated psychosis represented in all probability an extension of the same process earlier noted in the military records as nervousness. It was noted that the Veteran's nervous condition had previously been determined for treatment purposes as having pre-existed service and was not incurred or aggravated in service. The medical opinion was interpreted as demonstrating that the subsequently diagnosed psychosis represented an extension of the same condition with was previously denied service connection. In May 1971, the Veteran was notified of the March 1971 rating decision. He did not submit a timely appeal and the rating decision became final. Accordingly, the decision may now be collaterally attacked and ultimately revised only on the basis of CUE. An unappealed rating decision is final, and may not be revised based on the evidence of record at the time of decision unless it is shown that the decision involved CUE. 38 U.S.C.A. § 7105. Where CUE is found in a prior RO decision, the prior decision will be reversed or revised. For the purpose of authorizing benefits, reversal or revision of the prior decision on the grounds of CUE has the same effect as if the correct decision had been made on the date of the prior decision. 38 U.S.C.A. § 5109A; 38 C.F.R. § 3.105(a). CUE is a very specific and rare kind of error; it is the kind of error, of fact or law, that when called to the attention of later reviewers compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error. To find CUE, the correct facts, as they were known at the time, must not have been before the adjudicator (a simple disagreement as to how the facts were weighed or evaluated will not suffice) or the law in effect at that time was incorrectly applied; the error must be undebatable and of a sort which, had it not been made, would have manifestly changed the outcome at the time it was made; and the determination of CUE must be based on the record and law that existed at the time of the prior adjudication. Allegations that previous adjudications have improperly weighed and evaluated the evidence can never rise to the stringent definition of CUE. See 38 U.S.C.A. § 5109A; 38 C.F.R. § 3.105(a); Pierce v. Principi, 240 F.3d 1348 (Fed. Cir. 2001); Damrel v. Brown, 6 Vet. App. 242 (1994); Fugo v. Brown, 6 Vet. App. 40 (1993). In the March 1971 rating decision the RO denied service connection for schizophrenia on the bases that the disability (a) clearly and unmistakably preexisted the Veteran's service, and (b) was not aggravated thereby. As noted in the July 2012 Court decision, VA law and regulations that were in effect at the time of the March 1971 rating decision are essentially unchanged from those in existence now, except for renumbering. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. § 310 (now renumbered as 38 U.S.C.A. § 1110); 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as a psychosis, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. See 38 U.S.C.A. §§ 301, 312, 313 (now renumbered as 38 U.S.C.A. §§ 1101, 1112, 1113, respectively); 38 C.F.R. §§ 3.307, 3.309. Under 38 U.S.C.A. § 311 (now renumbered as 38 U.S.C.A. § 1111) a veteran was considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such. The United States Court of Appeals for Federal Circuit(Federal Circuit) clarified in Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004), that the presumption of soundness under 38 U.S.C.A. § 1111 is rebutted only if there is both (1) clear and unmistakable evidence that the claimed condition existed prior to service and (2) clear and unmistakable evidence that any pre-existing conditions were not aggravated by service. The Court, has held, in essence, that the Federal Circuit's interpretation of 38 U.S.C.A. § 1111 had retroactive effect, and that the failure to consider both prongs of the § 1111 requirement for rebutting the presumption of soundness could serve as the basis for CUE. See Rivers v. Roadway Express, 511 U.S. 298, 311, 312 (1994). Thus, the law at the time of the March 1971 rating decision essentially provided that if there was clear and unmistakable evidence that a disability preexisted service, then VA was required to consider whether there was either clear and unmistakable evidence that the condition did not increase in severity in service, or clear and unmistakable evidence that any increase was due to the natural progress of the disease. Once a preexisting condition was shown to have increased in severity during service, the aggravation prong of the presumption of soundness could only be rebutted by a showing "by clear and unmistakable evidence" that any increase was "due to the natural progress of the disease." See Joyce v Nicholson, 19 Vet. App. 36 (2005). In the March 1971 rating decision, the RO did not specifically cite the presumptions of soundness or aggravation. However, it essentially addressed the first prong of the presumption of soundness by finding that the Veteran's psychosis clearly and unmistakably preexisted service as evidenced by (1) the notation at the Veteran's entry into service of nervousness; (2) the VAH report wherein the Veteran's father reported that the Veteran had been diagnosed with schizophrenia prior to service; and; (3) the medical opinion of the Chief of the VAH, that, in all probability the schizophrenia represented an extension of the same process earlier noted in the military record as nervousness and reflected a new phase or later development of the condition formerly diagnosed differently as a nervous condition. In the July 2012 Court memorandum decision, it was found that the presumption of soundness at entry into active duty had not been rebutted by clear and unmistakable evidence as to a psychosis by the medical evidence of record. In this regard, the Court found that the notation of "nervous trouble" is not a finding of a psychotic condition being noted at entry into service so that the presumption of soundness under 38 U.S.C.A. § 1111 was triggered. The Court further explained that the March 1971 rating decision focused its determination that a nervous condition was noted on entry into service, that the nervous condition had pre-existed service, and that the nervous condition was not aggravated in service. The RO then stated that the subsequently diagnosed psychosis represented an extension of the nervous condition. The evidence upon which the RO relied essentially was the notation of a "nervous condition" on examination at entry into service; the doctor's notes from the May 1969 VAH that recorded that the Veteran had been treated for schizophrenia in high school; and the January 1971 medical opinion that attempted to reconcile the nervous condition with the psychosis diagnosis. In the July 2012 memorandum decision the Court specifically found that the May 1969 doctor's notes indicating that the Veteran had been diagnosed and treated for schizophrenia in high school did not constitute clear and unmistakable evidence that the Veteran had suffered a psychosis prior to service. It was found that the source of the doctor's statement was the Veteran's father who was described as being inconsistent and a poor historian. No attempt to obtain the medical records from the doctor who had reportedly made this psychosis diagnosis prior to service was made by the RO. As the records were not obtained and the history of pre-service diagnosis of schizophrenia was from a lay statement made by someone who was reportedly inconsistent, the Court could not conclude that the evidence undebatably showed the Veteran's schizophrenia pre-existed service. The Court went on to state that, in addition, it could not conclude that the January 1971 medical opinion was "clear and unmistakable evidence" that, prior to service, the Veteran had suffered from a diagnosed psychosis. The January 1971 medical opinion concluded that the Veteran's psychosis was "an extension" of the Veteran's nervousness and was "a new phase or later development of a condition formerly diagnosed differently as a nervous condition." The Court stated that, as such, the medical opinion was not compatible with the other alternatives set forth in the opinion request, specifically that the psychosis was the same as the nervous condition noted at entry into service. Rather, the Court went on to state, the evidence showed that the psychosis was a "new phase" or "later development" of the nervous condition noted at entry. Because the psychosis was a later development, the psychosis developed after entry into service and, therefore, could not have pre-existed entry into service. The Court then reviewed whether, even assuming that there was clear and convincing evidence that the psychosis existed prior to service, lack of aggravation during service had not been shown. To do so, it must be established by clear and unmistakable evidence that there was no increase in disability during service or that any increase in disability was due to the natural progress of the preexisting condition. The Court stated that the evidence before the RO in 1971 consisted of the STRs showing that the Veteran was treated for moderate anxiety reaction secondary to "girlfriend problems" on one occasion in service and the 1971 medical opinion concluding that, in May 1969 that the Veteran's nervous condition had developed into a psychosis. The Court concluded that the RO's finding in 1971, that the nervous condition was not aggravated in service was not supported by "clear and unmistakable evidence" that there was no increase in disability during service. The Court reasoned that the January 1971 medical opinion must be interpreted as showing that the psychosis was a "new phase" or "later development" of the nervous condition noted at entry. There appeared to be no evidence as to why the nervous condition developed into a psychosis and no specific finding that the development was the result of the natural progression of the nervous condition. The Court then ordered the Board to make a determination regarding whether the Veteran's nervous condition may have been aggravated beyond the natural progression of the disease and, if not, address the question of presumptive service connection under the provisions of 38 U.S.C.A. § 1112. As noted, the evidence of record at the time of the March 1971 RO decision did not include findings regarding whether the aggravation of the nervous condition was the result of the natural progression of the disease. As such, the Board has no basis for making such a determination. Based on the posture of this case as outlined above, and in light of the Court's holdings in this case, the Veteran is considered sound on entrance, and the remaining question is whether service connection for schizophrenia would have been awarded had the rating board in March 1971 applied the legal criteria correctly. Essentially, with the correct application of the presumption of soundness, the Veteran's claim has been transformed from one of aggravation to one of service incurrence. In other words, the Court's finding that the evidence of record at the time of the March 1971 rating decision was not sufficient to rebut the presumption of soundness at entry into service, results in a finding that the Veteran entered service in sound condition as to a psychosis. This is not a determination that he is entitled to an award of service connection for his schizophrenia and this matter was remanded to the Board for such a determination. Given the Court's findings regarding the 1971 RO's incorrect application of the presumption of soundness, the Board must conclude that the outcome of the March 1971 decision would have been manifestly different as the question would become one of service incurrence rather than service aggravation. At that time, the evidence did not show schizophrenia while the Veteran was on active duty, but first showed a psychosis in May 1969, less than one year from the Veteran's discharge from active duty. The report of the VAH from May 1969 noted symptoms of suicidal and homicidal ideation, which would be considered to be productive of mild social and industrial impairment warranting a rating of 10 percent under the criteria for evaluation of schizophrenia in March 1971. See 38 C.F.R. § 4.132, Code 9204 (1971). As the evidence shows schizophrenia to a degree of 10 percent less than one year from the Veteran's discharge from active duty, the Board must conclude that the misapplication of the law regarding the presumption of soundness in 1971 would have manifestly changed the outcome of the case such that service connection based on presumptive service connection would undebatably have been awarded. As such, service connection for schizophrenia must be granted. ORDER The appeal to establish CUE in the March 1971 rating decision which denied the Veteran service connection for schizophrenia is granted; service connection for schizophrenia is granted. ____________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs
  16. I have been rated 90% with unemployability p&t since 2002. One of my ratings is for 60% IHD . I received this back then before IHD was presumptive ao exposure because I was able to tie this in with my presumptive diabetes and lung cancer. I think I can now ask this rating be increased to 100% on its own because I have a muga scan showing ejection fraction or 30% with ischemia and mets of 3. My current ratings are that 60%, plus lung ca for 30%, another for 30%, another for 20%, and the last for 10%.Would it be in my best interest to file for smc award as it stands now or do I need to try for the increase to100% rating for IHD on its own to help qualify for smc. Also if I do decide to file for increase, would it be fasttracked? Does it look like I qualify for smc and if so what kind and how to apply for it? Thanks Hadit
  17. I have been SC for the last 37 years with the VA, right out of the service at 40% with Diabetes Mellitus Type 1. I'm also have been Brittle (meaning my blood varies from low to high- in my case mainly low), for the last 37 years, I used the VA health care for 21 years, in 1996 I was bumped up to 60% because of Neuropathy in both feet, Proteinurea, and generally poor control due being unaware that sugar was going low (I passed out at work and lost my job in late 1996), I put in for 100% in 1997, Nov. 1997 I had my C&P. In Jan. 1998 I was granted 100%, my VA endocrinologist (who was my MD since the very beginning 21 years) retired from the VA, after 6 months of seeing Endo residents, I stopped using the VA system. I started the to see my private MD (I had been seeing him regularly for physicals and general medical for a year before my VA doctor retired. After being awarded the 100% the only time I heard from the VA was for COLA increase's, in 2012 I receive a letter from the VA saying they are setting me up for a physical because my Diabetes Mellitus in not considered Permanent. Sept. 2012 I see my private MD and have him fill out the DBQ for diabetes and peripheral neuropathy, he also includes letters from opthamologist showing I have Diabetic Retinopathy, he also writes a Nexus type letter (I know I'm SCed, but with the VA you have to hit the over the head) saying this disabilty and it's complications are permanent (My MD is not a general practioner, he is the head of internal medicine for a large prestigous hospital in NY), I have my C&P, I get a copy 3 weeks later, the C&P results are a carbon copy of my Dr.s DBQ and note. A brief overview, I take 7 shots a day, test my BS 12 times a day, my blood pressure is high (common in diabetics, 4 medications to control) the neuropathy is so bad I cannot stand or sit for more than 10 minutes, I sleep 3-4 hours a night and need 20 mgs of Ambien and a muscle relaxant to do that, my vision is poor, I urinate 40-50 times a day. My diet is strictly controlled, low protein due to protein urea, low fat due hyperchlosteroemia, and of course now I have Erectile Dysfucntion I called the 1-800 in Nov. and was told they reached a decision, actually nothing was decided, the farmed out part of my for an Admin Review, that was decided 3 weeks later. By 2013 no decisions, in March 2013 a new claim. a Rating Review, of course the compensation claim is still listed as Diabetes Mellitus (New). DAV who is my POA has been totally useless, when you do manage to get someone on the phone they give you the info, on March 15 I see my Comp claim go from Gathering to Preparation for Decision. To the present day on Friday July 19th, I decide to go down to DAV and ask whats going on (In Sept it will be 1 year since the C&P and the VA may declare it invalid), 9:00 in the A.M. DAV tells me to come back 2 hours later, I go to the RO across the hall (there in the same Building) and talk the VSO thats their, he's also a Diabetic and he's wondering why I'm not P&T, he calls up the Rater upstairs and she tells him that they are looking at each complication seperatley. So looking at Ebenefits and the unsolicited items I submitted ( under the things the VA solicited were just the C&P exam) the VA showed the Dr.s letters and DBQ and that was basically it. My question is if the VA looks at my Diabetes at the 60% rate and starts adding the peripheral neuropathy and others complications using VA math, it does not add up to 100% and I know that in 3.5 years I'm at my 20 year mark and theirs nothing they can do at that point, I just have a feeling they are going to try and lower it just to save money. Any input would be appreciated.
  18. Hi All, A vet that I am helping had an ED examination this morning. The BVA had granted him ED in February 2013 but he has yet to receive compensation. He filed his ED claim in 2007. The strange thing about this is the Doctor told him he was there for a ED rating; and that they wanted to know how much to rate his ED at and proceeded to ask him questions as to when it began and stop completely. Then the Doctor examined him and found it had bend. Has anyone ever gotten a different rating than 10% for ED. If so please let us know your rating and whether it was because of diabetes, mumps, etc. Thanks in advance for your answers!
  19. Hi All, One of the vets that I was helping died. His wife promised him that she would continue to fight for his claims. He was service connected for his diabetes under Agent Orange and the rest of his claims are under appeal. I know there is a way that a spouse can take over her husband's claims but I don't know if there is a form or letter that she would have to write stating so. Does anyone know, if so can you please post your answer. Thanks in advance for your answers!
  20. Hi, I Have question about my peripheral neuropathy C&P exam. I have a 20% AO DM II compensation. I had a C&P exam 2 weeks ago for peripheral neuropathy due to the DMII. I had a NP do the exam at a VA hospital. I just got a copy of the exam and the NP wrote that the peripheral neuropathy is not service connected but that I have peripheral neuropathy, and it does not prevent me from working. This is what I do not get, how is the PN not service connected when the Diabetes is and the PN is a result of the Diabetes. Will I get disability compensation? Anyone have the same situation? Thanks, Hugh
  21. FINALLY, AFTER FOREVER AND A DAY, I RECEIVED MY VA C-FILE. I HAD A VA EXAM IN 1989 AND AGAIN IN 1990. ON THE 1989 EXAM, THE DOCTOR WROTE THAT I HAD FOUR HIGH BLOOD PRESSURE READINGS WHILE SITTING (148/100, 148/100, 146/100, AND 147/96). HE ALSO WROTE THAT MY BLOOD GLUCOSE WAS HIGH. THESE HEALTH PROBLEMS WERE NOT A PART OF MY CLAIMS FILED WITH THE VA BECAUSE I DID NOT KNOW I HAD THESE MEDICAL PROBLEMS. A FEW YEARS AFTER MY MILITARY RETIREMENT, I WAS DIAGNOSED WITH HIGH BLOOD PRESSURE AND TYPE II DIABETES. MY QUESTION, IF ANY ONE CAN ANSWER IT IS: SHOULDN'T THE VA DOCTOR HAVE TOLD ME OF THESE MEDICAL PROBLEMS OR SHOULDN'T I HAVE BEEN NOTIFIED BY THE VA BY LETTER? WILL APPRECIATE YOUR THOUGHTS. THANKS
  22. I am presently service connected at 80% , with copd, asthma, do to asbestos . sleep apnea , and was just diagnosed with afib with arrhythmia with diabetes, I filed for increase do to the dr telling me my copd and sleep apnea are directly the cause of my afib possibly could be on and I was just sent to a whole new sleep study they are telling me my sleep apnea has gotten worse my pressure cpap pressure is at 13 . I also applied for iud what are my chances of actually qualifying for the iud with my conditions ??????? if I were to need assistance with my claim as far as having someone represent me likeka dav rep how wouldi go about getting that kind of assistance
  23. I am the wife of a VN Vet. Honorably discharged. My mind is spinning out of control! I just don't know what to do and although I know its not worth crying over, it sure makes me feel better. This may be lengthy; but this is how it has been. My husband was in VN and Thailand, during the conflict. He worked on the flight line, assembling bombs. *putting fins on the actual bombs, before they go to plane." They were brought in on 40' trailers and the guys would 'screw' the fins on the actual bombs. Occasionally, one of the fin components would "cross thread" and the person working on it, would have to pull it off and rethread it correctly. Some would get stuck and physical force was needed to remove it and attach correctly. My husband was standing on the flat bed truck; working on these fins, when one of them crossed. He attempted to pull the fin to realign it and fell off the back of the flatbed onto a pallet of already staged (finished) bombs. It (the fall) is in his records about falling off of the 40' flatbed trailer onto a pallet that had bombs staged for loading. He landed on the bomb fins. His hips landed on the pallet and the concrete floor under the pallet. He has three puncture marks in the thoracic area of his back. It is noted in his record of the event. The punctures oozed white liquid substance, but they put phisohex on them and sent him back out to his assigned duty. Within a few weeks he was stationed to MacDill AFB where he sought treatment at the hospital there. He states that there were 7 doctors that evaluated the wound and stated, "nothing too serious" return to duty. (We have requested record of those xrays and consult notes from Utapao and MacDill; they claim they were sent to St Louis) We have requested the records from the AFB in Thailand where he was stationed and again, no record, must have been sent to St Louis. Fast Forward to discharge: NO PHYSICAL DISCHARGE EXAM. One of the questions on the discharge papers that he had to fill out, was: Have you had or now experience "back pain" to which he replied YES. He gets out, comes back to Tx/Ar area. He was still having issues and went to a Chiropractor locally but the damage was too bad for him to continue to work on David Here is the trick: Doctors in the state of Tx, are NOT REQUIRED BY LAW, to keep medical records more than 7 yrs. (Pharmacies, not more than 2). I am going to copy a previous missive for the sake of expediency here: "So we filed in Waco, Tx. when we still lived in Tx. Bowie County Tx. is the only Tx county that is supposed to submit to Little Rock. In 2006 we moved here to SW Ar. and had requested a visiting board meeting. They, TX VARO transferred the records to Little Rock, AR, did not tell us, and then the visiting board meeting notification was sent to the old address in Tx, where the forwarding request had already expired. I called by happenstance one day and was told we had missed it.. There is more! He originally filed in 1998 and was denied. Didn't know he could appeal. We took it up again in 2002, when the right hip needed replacement...When we originally requested the records from St Louis they told us: burned. We filed anyway. Then requested copies of what they had, so we would know. *********While I was reviewing those, I found copies of two different 'service numbers'. Not social numbers that were originally used, and turned to SSN. but actual svc numbers and the other one had someone's name on it..***********We appealed several times and it went as far as the Court of Appeals for Veterans in Washington DC and they sent it back to Little Rock for further development, but did not deny it. Comp and pension for that: Doc said he observed the scars on his flank......there are NO scars on either flank for this injury. **********He did see a chiropractor, when he got back, but got too bad for him to work on David. Then we find out that VA does not recognize Chiro as an MD, which they say invalidates the doc visits. Meanwhile, he has had left hip replace 2 x (85/92) and needs to be done again. Rt hip replaced 6 months after we got married in 2002. Each time I bring this up with American Legion (our rep) they tell us to leave that alone. They tell us, that since the agent orange exposure was tied to Ischemic, that it would be easier to get the 100 % from that and let the back injury go.. He has peripheral neuropathy they keep trying to tie to diabetes, but.....there was no "official" diagnosis of diabetes until after the neuropathy diagnosis of a civilian physician.......I am so overwhelmed. I have 3 file cabinet drawers of all of my supporting documents......I am so lost. Sorry to burden you with all this, Don't want to hire an atty either, since they will get a portion. There is more: In Dec 2005 (before his ischemic award) a satellite clinic found "an aneurysm"; that turned out to be 3 aneurysms. 3 abdominal aortic aneurysms. Originally we were told it was one aneurysm, 5.5 x 5.8 cm. VA will not 'operate' on them, until one of the dimensions is 5.5, (as of 4/17/2013 the largest one measures 5.0 x 4.8 cm). The other two are not as large, but in the sciatic vessels. The VA does not consider aneurysms part of ischemic heart issues, because it is 'vascular' in nature. (HELLO, IT IS ALL CIRCULATORY). Presumptive Ischemic heart after his heart attack and bypass surgery that happened days after our notification about the aneuryms in 12/2005. Then 9 mos later, 2 failed graphs, resulting in a stent. They could not save the other graph. David is now rated at 90% unemployable, since Nov 2011. While awaiting a regular clinic appt., he had a blood clot in his rt leg, that broke loose and went to his rt lung, in the waiting room. I signaled the nurse at the desk and they got a wheel chair and took him back to his doctor; where it was determined his pulse was 28. I wheeled him all of the hospital for various tests, but they stopped short of calling it DVT, yes, that is in his records. Fast forward again: sleep apnea pressure raised , but he is always worn out, and short of breath. They cant figure it out, but upon further review we found out that he has 26 extra heart beats every 3/4 minutes, which they determined needed a heart ablation in Nov 2012. First surgery cancelled due to new machine failure, and rescheduled. We go to Little Rock for two days prior to the next scheduled ablation, and during the consult, the doc that was to do the ablation, tells us he is going thru the aorta, to do the procedure. We ask: Does that mean, you will go thru aneurysm? He was shocked, and surprised, to know about them (he didn't read the record). We asked, what about his hip going out, when he is relaxed? He wouldn't know until coming out of the anesthesia, if it was out of place. *this happens, whether sitting or laying down*. Meanwhile, appts in April 2013 in L/R we found out that the hip is an elective surgery! And they will not do it, until he quits smoking cigs! Today, we received a request from VA for more information regarding the Request for Reconsideration based on evidence in the file and his medical records. They are bringing up all this crap on things that we were told to 'let go' for now or had already been decided. They ordered a comp and pension exam, which he attended on the 22nd of Apr. That doc, thinks that David can have a desk job! Hell he cant even walk 30' without being winded and have to stop. Because of the hip and neuropathy issues, he looses feeling in his legs and fell over a year ago. Thinking it was a muscle pull, he didn't seek help. We recently found out that he has a severe 'torn rotator cuff' from one fall where he tried to 'catch himself'. I am in tears sitting here. My husband sleeps 10/14 hrs a day. I just cant handle the house and his health issues anymore, by myself. I am a heart patient as well, but he does not deserve this!!!!! Can anyone help us???????
  24. Hi All, I have a veteran who I am helping. He recently was awarded 20% for his diabetes under agent orange. Decision states: A higher evaluation of 40% is not warranted unless the evidence shows diabetes requiring insulin, restricted diet, and regulation of activities. Although it was noted that you are not specifically on a restricted diet, current medial treatises state that a primary objective in the treatment of diabetes is to maintain glucose levels through proper nutrition. Therefore, dietary restrictions are conceded as a widely accepted method of minimizing the disabling manifestations of diabetes.{Merck Manual, 18th ed. p. 1280}. He is currently taking 2 medications for his diabetes - Actos & Metformin. ? Does VA regulation state that in order to get 40% it requires your having to take insulin, be on a restricted diet, and regulation of activities? I'm a diabetic and I take both Actos & Metformin. I maintain my glucose levels by eating small portions of my everyday meals which are not restricted. ? Is it o.k. for the VA to use Merck Manual in their decision making to deny him in a higher rating?
  25. Hi All, I am trying to help a Vietnam veteran get service connected for the following listed issues listed below. He was service connected for diabetes mellitus type 2 at a rate of 20% under Agent Orange presumption. Is the following listed under Agent Orange presumption because he was denied service connection for them: 1. Hearing Loss - decision say: The evidence shows that you currently have hearing loss for VA purposes, but service connection cannot be granted without a medical link between your hearing and military Although you currently have a hearing loss for VA purposes, there is no medical link between your hearing loss and service. In the absence of such a link, service connection may not be granted. In addition, there is no evidence that disabling sensorineural hearing loss manifested itself to a compensable degree within a year of service . 2. Tinnitus - decision say: Service treatment records do not show evidence of hearing loss during military service. The October 2, 2012 VA examiner diagnosed tinnitus and linked this condition to your hearing loss. However hearing loss has not been linked to your military service. There is no evidence showing that your tinnitus condition is a result of military noise exposure.Therefore, service connection for tinnitus is denied since this condition neither occurred in nor was caused by service. Service connection is not established on a secondary basis because your hearing loss has not been linked to your military service. 3. Hyperparathyroidism, (claimed as thyroid condition) - decision say: The examiner did not diagnose or find any evidence of a thyroid condition during your military separation examination dated August 10, 1966. Although private medical evidence from Yale New Haven Hospital shows that you are diagnosed with hyperparathyroidism, there is no evidence linking this condition to your military service Therefore, service connection cannot be established. If these issues are presumption and b/c he was in Vietnam isn't that the link to military service? Is there a regulation for AO presumption, if so please cite? Thanks in advance for your replys.
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