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Greetings, I have been battling with the VA since early 2017 with my disability claim(s). In September 2021, I filed a supplemental claim due to the presumptive condition changes for OEF/OIF/OND and burn pits / particulate matter exposures. They followed through and rated me at 100%, but I then filed for a higher level review because they put effective dates in October (the date of my LHI exam, and not the effective date of change in law or date filed for disability). It is still on-going, and they did a partial grant. I didn't ask for a CUE claim, but they found several CUE claim issues upon that higher level review. So sleep apnea, IBS, hemorrhoids, and etc are being addressed because the VA failed in their duty to assist. They sent my records to an LHI contracted physician (one I saw back in October and she had favorable findings for me then). Presently, I have a combined disability of 100% P&T. And for now (I'm 39), I have gainful employment at a decent salary. Miraculously enough, PTSD and mental health are not among my medical conditions or concerns, even after 20 years in the USAF/ANG. As I go through life, I am finding it more difficult to do tasks independently. My wife cuts my toenails because it is hard for me to reach my toes and use clippers (right hand dominant), and I usually end up cutting too much and/or getting an ingrown nail. I also have one of those as seen on TV gizmos to help put on my socks. So, needless to say, managing my feet is rather difficult for me (and balancing on 1 foot in the shower to scrub them with soap is nearly impossible). The VA has provided me with special shoes and cork inserts to help with the flat feet. I wear collared shirts for work, and it is difficult to do the buttons on the collar as well as the cuffs. I almost always have to have my wife do those for me. I have about 20 medications that the VA has prescribed to me for all of my medical conditions and issues. And my wife is quite persistent about me keeping track of my medications. She bought me one of those medication holders that has a tube with 4 spaces (breakfast, lunch, dinner, bead) for each of 30 days. Just filling those sometimes is an awful pain in the ass with my hands and fingers. I have tried several times to get the VA to consider flare ups in the rating for my cervical spine and knees. Each time it has failed. So now, I have the DBQ's printed and on file with my PCP. The next time I have a flare up, the PCP will see me that day or next day and go through the DBQ's. Then I'll file for an increase, and I may try to file for an earlier effective date as I have not run out of appeals/reviews and I'm still within a year. And my flare ups When my neck gets tweaked, it is nearly impossible to turn my head left or right, my head is pretty much frozen at a slight rightward angle and limited ROM. This usually results in my right shoulder having a flare up as well. When my right shoulder goes wonky, I have severe pain and need to wear an immobilizing brace. And my my lower back will go out with shooting pain from lower back to my feet, unable to walk long distances, and if I pick up my son or dog, I will lose feeling and fall to the floor, so I don't do that when my back is flaring up. And sometimes lifting my younger son or dog will cause this problem. For my knees, these usually go out when I'm deep in the woods walking on uneven terrain, and braces/K-Tape don't seem to prevent the knees from becoming nearly impossible to use and they are in such pain that I can't flex them. It can take me several hours to walk/limp even 3 miles back to the truck when my knees go out. So now, I don't go as far out into the woods if it is an area that has zero cellular service. I also have problems with both wrists, and I have to sleep with braces on to keep them from curling my hands inward at night. So trying to manage a CPAP or even the buttons on my pajamas to take a piss gets very irritating and frustrating at night. I am to the point where I don't drink anything after 7pm so that I don't have to get out of the bed at night to relieve myself in the bathroom. To what degree is loss of use considered for extremities? And to what degree is A&A factored into basic tasks of hygiene and grooming and medication management? At least once per day, my wife does help me with something related to personal hygiene or dressing. If I'm not quite at the point for SMC type benefits, what should I be documenting and keeping track of, and where? Do I schedule more frequent appointments with my doctor? I have a community care provider as the local VA and CBOC's are well over an hour away from me. Also, is SMC paid in addition to, or in lieu of scheduler VA disability payments? I have an upcoming appointment with my doctor to discuss ED related matters, and it appears that several of my medications for service connected issues (arthritis medications, sinus medications) have ED listed as a potential side effect. So, I will be working on an SMC-K package for that. Lastly, I have tried and failed in regards to an earlier effective date for tinnitus, hearing loss, and rhinitis (all rated back in 2017 with an adjustment in 2018 for rhinitis). When I got off of OND/OIF orders in 2011, I went to the VA in 2012 for those issues. I was told that I should go see the VA and they'll take care of you. But nowhere did anyone offer any assistance or direct me towards a formal disability claim. Could it be seen or considered an informal claim (under those old rules) by having sought a VA diagnosis and/or treatment within 1 year of release from Active Duty? Should I try a formal CUE claim on this issue, or just accept defeat? Who knows, maybe 21-432 ARELLANO V. McDONOUGH might help with this if SCOTUS affirms for the petitioner. I do have a digital and electronic copy of my C-File from 2017-2018. I haven't requested an updated copy recently. But the last copy I got was over 1800 pages of documentation. I'm also looking forward to HR 3967, if that passes, the effective date for my sinusitis and migraine headaches could be back to my initial claim in May of 2017. But with that said, if it passes, and I file a supplemental claim for sinusitis, migraine headaches, and sleep apnea (if they grant it) will they review the present rating tables, or the rating tables at the time of the application? The VA published changes to the rating tables for ears, nose, throat, sinus, sleep apnea and etc on Feb 15th in the Federal Register. Thank you, Disability Rating Decision Related To Effective Date chronic strain right thumb (previously evaluated under DC 5224) 10% Service Connected 5/7/2017 shoulder condition, right 20% Service Connected 5/7/2017 radiculopathy of the right upper extremity 20% Service Connected 10/11/2018 radiculopathy of the left upper extremity 20% Service Connected 10/11/2018 internal derangement of the left knee 10% Service Connected 2/24/2020 internal derangement of the right knee 10% Service Connected 2/24/2020 radiculopathy, right lower extremity involving the sciatic nerve 10% Service Connected 10/12/2021 radiculopathy, left lower involving the sciatic nerve 0% Service Connected 11/10/2020 internal derangement of the right ankle (claimed as ankle condition, right) 10% Service Connected 5/7/2017 left ankle strain 10% Service Connected 10/30/2017 bilateral flat feet (pes planus) 30% Service Connected 9/12/2019 lumbosacral strain 10% Service Connected 11/10/2020 cervical strain with degenerative arthritis of the spine (previously rated as musculoskeletal - neck/upper back (cervical spine) (to include neck condition)) 10% Service Connected 10/7/2019 rhinitis with eustachian tube dysfunction 10% Service Connected 10/11/2018 sinusitis 50% Service Connected Gulf War Presumptive 3.320 8/5/2021 tinnitus 10% Service Connected 5/7/2017 bilateral hearing loss 0% Service Connected 5/7/2017 migraine headaches 0% Service Connected Burn Pit Exposure 8/9/2021

Greetings, Here's something that just wormed its way into my little pea brain. Does the VA's duty to assist apply to this scenario: I submitted a claim for several things a few years ago. I admit that I did not do my due diligence and was not aware of secondary connections, so I simply submitted the claim without mention of any secondary connections--all conditions I included in the claim claim were denied in a prompt and efficient manner--no direct service connection. I know know that the claim would have been better suited if I would have stated "as secondary to XXX", or whatever the phraseology is. I'm wondering if the person reviewing my claim should have asked if these issues were secondary to my service connected issue--would that not fall under "duty to assist", or when they talk about duty to assist, are they simply referring to scheduling C&P exams and the like? I know these people are extremely busy, and they certainly can't determine intent--they probably have to deal with what is presented to them. Just wondering! Thanks! Huggy

Bare with me as I have done all this work myself, so if I don't have a specific answer or know an abbreviation. All I ask is you give me some time to look it up cause I am not well versed in VA lingo. I completed a Higher level review (This apparently means sometimes you get a more experienced person, I explained to her all the issues I have been having and she basically said, I will send this back down so they can fix it and she said she has everything she needs to increase my Bell's Palsy which was at 0% and she changed it to 10% She told me she would have to issue me a couple more exams. They are specifically for IBS and Mental Health. The exam package from QTC for the Psychology exam does not mention a specific condition. (This would be my third mental health exam) The initial application was in 2019 and included depression and anxiety. I submitted a 2900-0659 as my stressor. The second exam from qtc came back and said "PTSD with ADHD" so my claim for "PTSD" was denied. On the latest Denial letter, I have the following line items. Depression,anxiety and sleep problems (listed as one condition) Post traumatic stress disorder with attention-deficit hyperactivity disorder, predominantly inattentive type. (VA Doctor thinks I must have seen a child psychologist cause he said and I quote "That's the most insane diagnosis I've ever heard of) The QTC package for IBS is with a nurse practitioner at a clinic in town. So is the duty to assist for all of my conditions based on the fact that the previous examiners did not do there job?

I have roughly one million questions but I'll try to keep it simple. This is the first time I am appealing a denied claim (though not my first denied claim - I currently have 50% combined). Almost exactly one year after my C&P exam I finally got a denial for both of my knees). I did a HLR informal conference and now my va.gov status says "The VBA is correcting an error". Here is the decision I received on Dec. 7th after the Higher Level Review (sorry I couldn't figure out how to add image) and below that are my questions. Decision: 1. A duty to assist error has been identified during the Higher Level Review of left knee pain. 2. A duty to assist error has been identified during the Higher Level Review of right knee pain. Evidence: Timeline from intent to file on 10/2/19 to HLR informal conference on 12/2/20 Reasons for Decision: 1. Higher Level Review for left knee pain The issue of left knee pain was returned for correction of a duty to assist error in the prior decision. We failed to get other records. We will develop for lay statements and if warranted additional opinions. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.159, 38 CFR 3.2502, 38 CFR 3.2601) Favorable findings identified in the decision: You have been diagnosed with a disability. The VA exam dated 11/7/19 showed a diagnosis of patellofemoral pain syndrome. 2. Higher Level Review for right knee pain The issue of right knee pain was returned for correction of a duty to assist error in the prior decision. We failed to get other records. We will develop for lay statements and if warranted additional opinions. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.159, 38 CFR 3.2502, 38 CFR 3.2601) Favorable findings identified in the decision: A nexus or link has been established between your claimed issue and an in-service event or injury. During VA exam dated 11/7/19 the VA examiner provided a positive medical opinion linking your right knee to service. You have been diagnosed with a disability. The VA exam dated 11/7/19 showed a diagnosis of right meniscal tear, right knee instability, and patellofemoral pain syndrome. MY QUESTIONS 1. Am I just out of luck because I didn't seek treatment during Active Duty? 2. Under "favorable findings" it states that "a nexus, or link, has been established between your claimed issue and an in-service event". Isn't that the literal definition of a service connected disability?! 3. What is the error? What have you all seen as timelines and outcomes for this? Thank you to everyone who takes the time to respond and post. Reading these questions/answers over the last year has been both educational and comforting.

Hi all. I need help understanding the application of Duty to Assist, Duty to Notify and Duty to Infer (an Issue in Scope) as it pertains to my claims. I will ask what I think is the easy one first. In 2012 I put in for PTSD, Tinnitus, and Hearing Loss. In 2013 Granted 70% PTSD, 10% Tinnitus, Denied Hearing Loss SC but that it does exist (no percent of loss given). The decision letter and the letter with all the reasoning's (which I think is properly called the SOC?) stated my full period of service. It listed all my enlistments (this is significant). VSO was dealing with advanced Pancreatic Cancer when my decision was made. no help there. I knew nothing about C-Files, NOD's or getting my DBQ;s. Just expected to trust VA (my bad, I know). In 2018 I got notice of a Review of PTSD claim C&P and it freaked me out, so before I had to go I started research and found Hadit. I ordered C-file and Got it. Had C&P and before results of C&P my c-file arrived and I found issues that the VA did not even tell me about or mention in my 2013 claim that they, VAMC, had uncovered and related to evidence in my Military STR;s. Found the Audiology DBQ from C&P. Dr. stated she had reviewed my full file then proceeded to state she only looked at my first 4 years in service. In that period she found NO OSHA STS for my hearing and did not mention that my job was associated with hearing loss (though for tinnitus she did). She stated that I did have hearing loss for VA rating but could not Service Connect. In 2018 I filed to reopen and included evidence from the C-file that she (the audiologist) said she had not reviewed. They rejected Reopening because the information was not "new and material." Another factor after that is I was deferred on a Vertigo claim (which was also not mentioned in the 2013 decision but I think should have been inferred as an Issue in Scope). When that claim came in the VA SC'd my Hearing Loss but only to the 2018 date. This claim rated me at 30%, yet the evidence developed by VA shows closer to 100%. Along with that Hearing loss and Tinnitus coupled to Vertigo should be rated as Meniere's disease according to the MR21-1. So what I need to know is : Under Duty to Assist the VA is supposed to help me with exams etc to develop my claim. If the C&P doctor ignores evidence (like dates and nexus) that demonstrates SC, are they violating Duty to Assist? Under Duty to Notify the VA is supposed to tell me what evidence is missing that would get me rated. In this case all the letters included my full service years. Yet under the Audiology section they DID NOT specify the dates she looked at. This leads the uniformed reader (me at that time) to assume she looked at everything. She gave all the numbers and readings and said I had a hearing loss for VA rating purposes but she could not SC based on not reading anything in my file (or at least the part she read) that was not noted as limiting in the decision letter. Did they Violate Duty to Notify? Under Duty to Infer an Issue in Scope. On the issue of Vertigo this came up by the VA doctors and is supported in my intake statement which service connected my PTSD. The VA sent me for a VNG to test for Nystagmus and an MRI that came up showing I have a partially empty sella, which controls the pituitary gland, hormones and is medically tied to issues with Vertigo, tinnitus, and hearing loss. The 2013 decisions are silent on these results. In the deferred 2018 decision where they SC'd hearing loss, they also rated me 30% for Vertigo. Did they violate Duty to Infer an Issue in Scope? Assist? Notify? If as I think they did violate any or all of those, what is my path? CUE? NOD? I know under AMA that I would have to file a supplemental claim to reopen with new and material (relevant?) evidence. Does this fit that standard? attached are the two sections denying hearing loss SCredacted 2013 decision denying SC..pdfredacted 2013 decision denying SC..pdfredacted 2013 decision denying SC..pdf redacted 2018 denial to reopen hearing loss.pdf

Folks: Although I filed a FDC Claim with all of my DOD, VA and Civilian Medical Records and all were provided to the Regional Office "hard-copy" , I was under the impression that VBA still automatically requests a Vets Service Medical Records (SMR's) from DOD as well as all of the VA Records to be loaded into the new VBMS System because of the "Duty to Assist" Requirements - even if it is duplicating the records that I've already sent in and they have? IS this True? Recently, "ebennefits" is saying that I need to load even more evidence? So, I called the 1800 number and was told that it's their (VBA's) requirement to get the evidence that is being referred to and that I should not worry about the ebennefits notification because it's very outdated? The VBA Rep said, that they were looking at the screen with my information right then and that everything in my c-file was in good shape for my claim with the exception of a couple more C&P exams that I'm scheduled for this week? But, I've been told many times before even if I had any new records and added them that my claim can be taken out of the FDC Program altogether? Finally, I'm having movment with my claim again, so I do not want to risk it? Has this happened to anyone before and what did you do?