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  1. Moderator, you might want to Pin this somewhere, as this seems to be a recurring trend. I have given out this information to others, but I will post it here so that others can find it rather than searching through the forum. First and foremost, claiming and getting sleep apnea secondary to PTSD or Mental disorder is not easy. I have personally seen more lost than won, however, it can be obtained and I myself have personally received it. If you had sleep apnea diagnosed while in active duty, it is usually a slam dunk........for the rest of those trying to get it, it could require a lot of work. I suggest trying to get it both direct and secondary service connected. It is easier to get sleep apnea as a direct service connection obviously, however, most Veterans do not get it diagnosed while in service. Best way to get that resolved is through buddy statements. I suggest getting 3-4 (I personally had 7-8) or more. Do not have them only say that they saw you snoring.......that is great and all, but that is not a symptom of sleep apnea.......it is incidental. They would need to say that they saw you gasping for air, choking, etc. Preferably roommates. If you were deployed, it would be easy to have many people saying that they saw/heard this as you would have more than likely been in an open bay setting at some point in time. You can also have your spouse write up a statement. This all needs to be during active duty periods of times and dates need to be included. M21-1 reference III.iii.2.E.2.b "Types of Evidence VA May Use To Supplement or as a Substitute for STRs" allows for buddy statements to act as STRs for medical evidence.........if they are certified "buddy" statements or affidavits.............having them written on VA Form 21-4138 solves this issue as it has the appropriate verbiage written near the bottom. Under M21-1 reference III.iii.1.B.7.a and 38 CFR 3.200, it meets the certification criteria..........problem solved. From my experience, getting all of the buddy statements needed can take longer than you originally anticipate....plan ahead. Now, for secondary criteria. Have you ever been diagnosed with alcohol abuse (it is frequently written as "ETOH")? If so, has it been attributed to your mental disorder or did it exist prior to that and is it considered willful? If you have been diagnosed with alcohol abuse, and it is attributable to your mental disorder, guess what, alcohol consumption is attributable to sleep apnea. would suggest that you start doing your own academic research. You might be able to locate peer-reviewed academic journal articles (those are the types of articles that you want to submit) through https://www.researchgate.net/. If not, another alternative is using a college database to search academic journals through. Ah, but you need to be a college student to use the database to search academic journals through. One might make an argument that you could register for classes at a local community college (you can even register online nowadays without even stepping foot on campus) and even register for "late start" classes, and have access to the aforementioned database immediately (hint hint, look in the academic journal Chest); one could easily find within a 60 minute search at least 5 appropriate and recent journal articles clearly establishing a link between specific mental disorders and sleep apnea; there is a clear link between PTSD, anxiety disorders, depression, and especially schizophrenia. One might make an argument that you could simply then disenroll from the classes that you enrolled in by the date specified in order to get a full refund, thereby being charged nothing. Save the academic journal articles as pdf files, and create a work cited page (bibliography) for them in APA format (google is your friend.) You now have a choice........... Submit your claim with the buddy statements, mental health notes from a private provider, and evidence that you have and go with either a VA exam or vendor exam (whichever is given) or you can get an IME and IMO from private providers. If go the latter route, I would schedule one with a sleep specialist, why, because sleep apnea is their specialty. Pulmonologists also fall within this scope as well, though I suspect that you will have better luck finding a sleep specialist believing there to be a link between mental disorders and sleep apnea. You will get a Sleep Apnea DBQ and an IMO. Make sure that you have your C - File first as an examiner is required to have access to it and state that they have seen it on the DBQ for it to acceptable proof to the VA. I would also get one from your psychologists/psychiatrist (Make sure that they are a psychiatrist or a psychologist.....if a psychologist, they need to be PsyD or Ph.D., or under the observation of a Ph.D.). Make sure before you solicit those medical opinions, that you acquire "buddy statements" from 3-4 (or even more) people with whom you served. Roommates would be best, or people who slept in close proximity to you.........again, this is only if you believe that sleep apnea developed while you were in Active Duty service. Make sure that they are written on VA Form 21-4138. Make sure they say that they witnessed clear symptoms of sleep apnea i.e. gasping for air, choking sounds, moments where they visibly or auditorily could determine that you ceased breathing etc. Remember, you will want the sleep specialist and the psych professional to have your academic journal articles and buddy statements. Once you have all of them, solicit your medical opinions from the two aforementioned providers. Ideally, you would love for the IMOs to say that they believe that you could be both direct service connected for sleep apnea or secondary due to mental disorder, possibly even say that the mental disorder and sleep apnea aggravate one another (which there is medical evidence to support.) If you opt to go the route of getting the private IMO and IME, you will obviously submit those with your claim, and all medical records from private providers pertinent to sleep apnea and your mental health treatment, buddy statements, academic journal articles, and a nicely written statement written by yourself on a VA Form 21-4138 talking about the issue at hand and summarizing everything concisely. Mention everything that you are providing that you wont to be considered for the claim, and when the issue first manifested.
  2. A little background first on this specific claim to provide greater context for the readers. I had no idea that i had OSA until i got married and through the years my wife has told me about how i would snore really loud, stop breathing at night, choke, etc. pretty standard stuff for anyone that has it. I had buddies in the Marine Corps who told me the same thing after our first deployment, but i had always chocked it up to my dad snored so i snored, the stopping breathing thing was weird but i was 18/19 so your health isnt a primary concern and BAS is only for bones sticking out. I got out in 2006 and didnt make a claim for OSA until 2016. First i talked to my primary care then was referred to a VA pulmonologist. He ordered a sleep study and the VA fumbled it sending me to a private facility and did a in home test. When the results came back i saw in my VA health record the Pulmonologist was terse with his message saying he wanting a in facility sleep study so a month later i did mine at the VA overnight. I was diagnosed with Mild OSA and given a CPAP. When the CPAP arrived i spent a month trying to get it to work but every morning it would show only 45-60 minutes of time. I have nightmares at night, some i remember some i dont but would rip off the mask or when i woke up would be so worked up i didnt put it back on. I do cycles of trying it for awhile and stopping for awhile, giving it a chance because my wife is worried about the OSA and its health effects. My claim history was this, as i stated i made my first claim in 2016 and was denied. I reopened the claim (when that was still an option in 2018) and was denied again. What i submitted was bascially the VA medical record showing that i had it, that i was ordered a CPAP and sworn statements by myself, my wife and buddies in the Corps that stated they saw symptoms in 2003-2006. I had NO nexus or medical proof that it began in service I made a mistake in 2019 when it was denied again and NEVER filed a NOD as i kindof gave up when that and other new claims for increases were denied, but I DID make a intent to file back in July 2019. I was out of the VA regulation changes loop and didnt know that they had gotten rid of reopening and moved to the Supplemental evidence route so in February through April i decided to really focus on making a quality claim since my 2016/2018 claims were more shot in the dark hoping that the VA would just grant it. I went to specialists in the field for the claims i was making and got updated diagnosis of symptoms and effects, got my sworn statements (which in my opinion has more 'umph' than a buddy statement) more detailed in terms of observed symptoms, timelines and effects upon my life as well as i went out and got two IMO's. The first IMO was for PTSD from Dr. Elaine Tripi in Michigan whos IMO got the VA to drop their attempt to reduce my rating in 2015/2016 (and i suspect it was because her IMO made a case for an increased rating). In that IMO she detailed my history, current symptoms, etc as well as opined on how my PTSD affected my OSA symptoms and how it interfered with its treatment. I also got a IMO from Dr. Anaise who wrote a lengthy (near 50 pages) on how my OSA is aggravated by Tinnitus and PTSD and interferes with my ability to go to sleep, stay asleep and interferes with my treatment. When i submitted the claim (reopen was still available as an option on ebenfits) my new claims, increase and "reopen" were all lumped together as one big claim and sent off in April. As a sidenote whenever i send my claim i do so through ebenefits as well as fax AND send CERTIFIED MAIL WITH RETURN RECEIPT. i keep a copy of the USPS receipt with tracking, Cert Mail receipt and the return receipt and staple that together with my hard copy claim evidence in a folder for each claim ive ever made. The VA has a way of "losing" evidence and if you ONLY submit via ebenefits, regular mail and/or fax you cant prove they received it per say. This DOESNT mean they wont pretend they didnt get it but what it does is allows you to prove upon appeal that YES you did send it in the time window necessary for your claim AND that they did receive it because the return receipt shows Jim VArep did in fact get it on such and such day. So if you get denied its really important to look at your cfile after to see what evidence the rater actually looked at and if they dont have ALL the evidence in that file you can appeal on those grounds in conjunction with more evidence if necessary that X doctors exam or IMO proves your case, wasnt considered AND the VA had received it. So a few weeks after i submitted it, the VA sent me the normal letter stating they had received my claim for X,Y,Z New & increased claims but i didnt see anythign about OSA which was weird. a week later i got a letter from the VA saying that my claims for OSA were not new, had been denied previously and were not on appeal and gave me a list of options. I chose Supplemental Evidence since the IMO's were "new evidence" to be considered and met the criteria and it had been over a year since my denial so i couldnt submit a NOD and get the backdated effective date. This was my fault. One i gave up in 2019 and didnt file a NOD to hold my place and Two i didnt keep up to date with new VA regs regarding reopened claims, etc. Since that supplemental claim was received on 4/24/20 (todays date is 6/18/20) I have had two psych exams and two records reviews through QTC (private company the VA contracts to do DBQ/exams). The first pysch exam was related to my request for an increase for PTSD back in April and in May i had a NP contact me who was reviewing my med records for OSA and had follow up questions regarding my condition both current and past. In that conversation i talked about how i never went to go get checked because i never knew what OSA was at that time, thought it was normal to snore, etc., how BAS is frowned upon in the Marines for things like that, my history with it since i got out up to now and how my nightmares make me rip off the CPAP at night. I did ask her if she had seen my imo, other evidence and she said no JUST my medical record. I know examiners arent raters and all but I find it weird that VA will deny IMO's as valid if they dont "review veterans entire file" but will accept something from a examiner if its negative when only their VA med file is shared. Its great advice to always bring your evidence with you to a exam but given the current COVID situation ALL of my exams thus far have been telephone or video. I asked her what the exam was specifically for or what they asked her to examine and she said it was basically whether or not my OSA was service connected and occured in service. I do believe it was but i was making the claim as SECONDARY to PTSD and/or Tinnitus as an aggravation which she was unaware of. I fired off some angry messages via the IRIS system to the VA regarding this (no idea if they got included in my record or reached a rater since the only response i got was "thank you for contact us heres how to make a new claim"). Within the last 3 weeks i had a 3rd & 4th "exam". The third was a MD who was reviewing my records as well and asked alot of the same questions, she was also unaware this was a secondary claim for aggravation and had seen no evidence submitted or my entire file so i went through it with her again. The 4th exam was another psych interview which i was told was to examine my secondary claims to OSA, but knowing the VA i knew it was basically another review of my ENTIRE PTSD claim ive had as well. Vets should be aware that even if a exam is about something specific any evidence or statements made that can negatively effect an existing general disability & will be held against you. This was quite clear when he just asked about current PTSD symptoms and never ONCE asked about my OSA, etc. So i had to bring that up myself. VA.gov check claims hasnt been updated since a week after my claim submission. my OSA claim has said "we dont know your status" even now and my other new/increased claim stopped after "request for more information" (i.e. requesting new QTC exams). So ever few days i check that as well as ebenefits to see if any of the DBQ's show up in my blue button (none have but im guessing because QTC doesnt have to update the way in house VA does). Finally today i see on my disabilities list that OSA was granted secondary to PTSD for 50% bringing me to 90% with an effective date of 4/24/20. I know that this ISNT the same as a letter from the VA but i know someone who is a VA rater who has been giving me updates on my record so im 99% certain this ebenfits update is accurate. The takeaways are this. 1) Do the damn research and work the claim yourself, no VSO or rep is going to care as much as you do. You care about your case, they have 15,50,100 other vets whos cases they are working and even if they are a great VSO/rep they cant possibly give a crap as much as you do. dont hope the VA just "gives" you the rating you deserve make it so they cant NOT give it to you with the proper evidence. 2)IMO's are golden. I know not everybody can afford them, i couldnt per say and had to sell some things to come up with the $500 for Dr. Tripi and $1500 for Dr. Anaise, but they were well worth it, without them i definitely wouldnt have gotten my OSA approved. I think have both a MD stating both the phyiscal and mental nexus and a Psychologist stating the pure mental side gave it a one two punch. 3) Along with the IMO go to doctors/specialists in your area and get documented evidence of you issue, ask them to be detailed in the exam notes. I even emailed a couple time asking the doc (this wasnt for OSA but a different claim, but good general advice) asking them to update the notes to specifically include certain symptoms and effects upon quality of life. Having this helps alot, combined with IMO's its very difficult for a random NP to override their findings with one exam or phone interview. Remember the VA is military based in that the ranking officer rules. So if you only have a NP (nothing against NP's this is just how the VA works) from a urgent care saying you have OSA caused by PTSD or that your shin splints are 8/10 pain and they have a pulmonologist, MD or specialist say its only 1/0 and doesnt effect guess who wins. If you have two psychologists but yours has great bonafides and background and theirs has only been practicing for 5 years solely at the VA yours wins. Im not saying dont go to a primary care to document because youll only see a NP all evidence helps but be aware if they pull out a MD who counters that exams findings youre likely to lose. Because they will always want to lean to denial and if their person has more experience or is a specialist that will win over what you submit. Dont give them an option, and even if they do decide to rule against you, you can make a great appeal based on the fact they sided with their NP over a specialist in the field your making a claim for who knows more. 4) Never let claims die. Dont make a new claim until your ready to with great evidence (file a intent to file first though to preserve backpay/effective date) If denied make sure you keep a reminder about the NOD date and when you do file a NOD make sure that is certified mail with return receipt to prove you mailed it/VA received it before the deadline, because if you dont and they can make a case it was received 24 hours after the NOD deadline you lost you backpay date and possibly years of backpay. Now there are situations where claims die but if theres a opportunity to still make it on appeals hire a GOOD (there are alot of crappy ones) appeals attorney and move forward. I know they take 20%+ of your backpay but if you aent comfortable enough to navigate the appeals process its well worth it. 5) stay up to date on new VA regs, Hadit is a great source for this you dont want to be like me thinking that certain avenues are still open and they arent. If I had stayed up to date i wouldve been able to file earlier for the OSA and preserve YEARS AND YEARS of backpay now im only going to get 2 months. 6) I didnt do this for this claim although i should've and kept a diary of when i was using the CPAP, roughly when i ripped it off, data on how long i wore it, frustrations over not being able to wear it, info on my nightmares causing me to rip it off etc. years of diary entries wouldve been a help. I didnt need it in the end but if you cant afford a IMO things like this can help because theres NO SUCH THING AS TOO MUCH EVIDENCE. A diary is one of the key things that helped me win my migraines case. for months prior I kept a diary of my headaches and effects, then transcribed them into ebenefits health diary. I am not perfect at it but i now write as much as i can as often a i can in this diary about ANY service connected or possibly service connected illness (especially things that could be considered aggravated by a service/possible service connected disability). That way when you are making a claim or fighting a reduction you can pull out timestamped entries for months/years relating to it and it makes it harder for a rater to think you pulled this out your but last month to make a claim. A big thanks to everyone on HADIT. i did alot of research here through the years to help make my claims better and it worked Another big thanks to Dr. Anaise and Dr. Tripi for their outstanding IMO's that helped me win this.
  3. Hello everyone. I've been searching this website and yukon website for my answers and I guess I just want to ask this question again because the answers I'm seeing are from 2011 or so and I want to make sure it's still valid for 2017. I got out of the service on medical discharge for fibromyalgia, MDD, and GAD in 2008. I was unable to tell anyone about my MST that happened prior to me developing Fibro (which I found out is usually connected to PTSD). Anyrate, since then I have talked to the VA Psychs for help and tried to "fix" myself and finally I opened up and told them about my MST and received a diagnosis of PTSD in 2013. Then in 2016 my VA Primary Care told me to reapply for benefits because she said they need to service connect me for my PTSD. I submitted my application, was honest and straight forward and very forthcoming even though I cried through my Comp and Pen exam. I have used Voc Rehab to change careers from Nuclear Electronics Technician to an Ultrasound Tech, and have worked as a tech from 2012-2014. After 2014 I quit working when my daughter was born, but also my fibromyalgia was flaring up so bad that it made it impossible to work anymore. I haven't worked since. Voc Rehab screwed up my award and didn't close out my case so I still have benefits left over and I was approved with a severe work handicap to use my benefits to go back to school after the birth of my second child. So here I was waiting for my disability decision and studying for the GRE to apply to a Nurse Practitioner Program helping women only because I have PTSD attacks with men. I was hoping that wouldn't be as hard on me as my Ultrasound position was. Then I get the decision stating that I am 100% P&T for PTSD, and 60% combined for fibromyalgia and hearing issues from the Navy, all service connected, and I'm getting SMC for Homebound criteria being met. I called the VA directly to find out if that meant that I wasn't allowed to work anymore. (I didn't plan on going to school until 2019, and not trying to work again until 2022.) The VA rep said that I WAS allowed to work and they may evaluated me in the future for my PTSD, and 'could' lower my rating, but that the rating wouldn't be lowered if I still met the criteria for 100% PTSD, it wouldn't have anything to do with whether or not I was working. The American Legion rep said I was allowed to work as well. But then when I read these forums it says I'm not allowed to work. I know already that Voc Rehab wouldn't pay for me to do the Nurse Practitioner schooling anymore because I was having difficulties trying to get them to approve it when I had a 50% rating, and now that I'm higher I know without a doubt they wouldn't allow it, so I understand I'm not going to be a Nurse Practitioner for Women's Health anymore. So I guess what I'm so upset about is accepting the fact that I can't work. I will have two children that I don't want to lose the education benefits for whatsoever, and everything else that's included with the 100% rating. No way in heck I want to lose that! It will sit easier with me if I get approved for SSDI. But that terrifies me too! I'm waiting for an appointment to apply in person because I'm scared I'll mess it up doing it online. So, confirmation: I cannot work if I don't want to risk losing any benefits, correct? And what are the do's and don'ts as far as what I should do in order to keep this disability rating for the next 19 years? I think that terrifies the most, screwing up and having my rating decreased. I know we are all stressed about this, please forgive me for this long post. And thank you all for your service and your advice. Peace and Love.
  4. If you are working but need special breaks to deal with PTSD can you still get 100% rating?
  5. Hello All! So, I was initially 50% for PTSD and during my appeal I applied to VR&E as my therapist convinced me I should persue it and thought I would be a great candidate. I told her I wanted to become a therapist and she thought I would be great at it. She has worked with me for 2 years in both individual and group counseling and feels I have alot of wisdom and insight in trauma. Anyway, I saw VRE counselor last summer he said I definitely qualified as I had a severe work handicap and he said they would in no way pay for me to work in the psychology field due to my mental health history. I attempted to convince him, but he said it was a no go. Instead, he approved me for working with plants in horticulture. So I was approved to begin courses for this spring. While I do enjoy gardening and being outside, pragmatically, I really don't see this as some great employment outcome. After doing research, it seems that even with a degree in the field essentially, you will be making just above minimum wage....at best, 12 bucks an hour. So just last week, I received a call from my lawyer that my appeal was complete and the DRO called her personally to report that I was granted 100% P and T for PTSD. My current dilemma is this. I am not very passionate about the horticulture pursuit as a career path. I only wanted to go to school if there was an actual economic benefit that made sense and for something I was really interested in. I don't know what to do. I am also scared if I pursue this that my rating could one day be jeopardized. I have been homeless 2 out of the last 3 years so the money is a big deal. I dont want to go through that again. Any thoughts or suggestions?
  6. I am only providing the information that show that a veteran with SC (Rated and Service Connected) PTSD could be eligible for the new Caregiver program that just started in May 2011. Others may be eligible and there is a lot more info out there! Hope this helps, I wanted to figure this out before applying with the wife. Here's the link to where I found the info: VA-2011-VHA-0012-0001.pdf (EDIT-since I posted this, the VA has moved the information that was attached to this link, and I have yet to find it elsewhere) Before I go further, I must say this. Although I am thankful for this benefit...I do find it backwards and unfortunate to not take care of the previous generations of veterans first. Thanks to YOU for MY freedom. Draggin' ___________________________________________________________________________________________________________ A veteran or servicemember is eligible for a Primary or Secondary Family Caregiver under this part if she or he meets all of the following requirements: a) The individual is a veteran b) The individual has a serious injury, including traumatic brain injury, psychological trauma, or other mental disorder, incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001. (PTSD). c) Such serious injury renders the individual in need of personal care services for a minimum of 6 continuous months (based on a clinical determination), based on any ONE of the following 4 clinical criteria: (Only showing #2 of the 4) 2. Need for supervision, assistance or protection based on symptoms or residuals of neurological or other impairment or injury is the 2nd alternative basis for a determination that an individual is in need of personal care services. Also stated as: Need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury means requiring supervision or assistance for any of the following reasons (p.26): (1) Seizures (blackouts or lapses in mental awareness, etc.); (2) Difficulty with planning and organizing (such as the ability to adhere to medication regimen); (3) Safety risks (wandering outside the home, danger of falling, using electrical appliances, etc.); (4) Difficulty with sleep regulation; (5) Delusions or hallucinations; (6) Difficulty with recent memory;and (7) Self regulation (being able to moderate moods, agitation or aggression, etc.). d) A clinical determination has been made that it is in the best interest of the individual to participate in the program. e) Personal care services that would be provided by the Family Caregiver will not be simultaneously and regularly provided by or through another individual or entity. f) The individual agrees to receive care at home after VA designates a Family Caregiver. g) The individual agrees to receive ongoing care from a primary care team after VA designates a Family Caregiver.
  7. First off, hello and thank you in advance for any help that can be provided. Also, I apologize if something is not clear, trying my best to keep things concise. On Friday, May 15, I received letter from the VA, dated May 11, proposing a rating reduction from 100% to 70% for PTSD. The only evidence for the change listed is Rating Decision - Narrative(17SEP18) and DBQ PSYCH PTSD Review(06MAY20), whereas on my initial decision letter there was an abundance of evidence used. The major takeaway appears that my medical records(both prior to and after the initial rating, also from VA facilities) were not considered in this proposal. Is this normal? I have yet to obtain the most recent C&P as I just received the proposal letter, but intend to attempt on Monday, May 18. Looking at the proposal letter though it seems that examiner didn't check a few specific boxes that were checked on my previous C&P. Other than that the differences appear to be minor. The two lists are as follows: Original C&P Gross impairment in communication Suspiciousness Depressed mood Suicidal ideation Near-continuous depression affecting the ability to function independently, appropriately, and effectively Disturbances of motivation and mood Chronic sleep impairment Near-continuous panic affecting the ability to function independently, appropriately, and effectively Difficulty in understanding complex commands Total occupational and social impairment Panic attacks (weekly) Difficulty in adapting to stressful circumstances Neglect of personal appearance and hygiene Difficulty in adapting to work Inability to establish and maintain effective relationships Flattened effect Panic attacks (less than weekly) Intermittent inability to perform maintenance of minimal personal hygiene Difficulty in adapting to a worklike setting Anxiety Difficulty in establishing and maintaining effective work and social relationships Intermittent inability to perform activities of daily living Gross impairment in thought processes New C&P Forgetting names Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and mood Depressed mood Suicidal Ideation Near-continuous depression affecting the ability to function independently, appropriately, and effectively Disturbances of motivation and mood Mild memory loss Forgetting recent events Chronic sleep impairment Near-continuous panic affecting the ability to function independently, appropriately, and effectively Difficulty in understanding complex commands Panic attacks more than once a week Difficulty in adapting to stressful circumstances Neglect of personal appearance and hygiene Difficulty in adapting to work Inability to establish and maintain effective relationships Impairment of short- and long-term memory Flattened effect Difficulty in adapting to a worklike setting Anxiety Difficulty in establishing and maintaining effective work and social relationships Forgetting directions I bolded the important items not that were not checked on the new c&p which led to the reduction proposal. It seems strange to me that new symptoms were added, however the very specific ones that would've caused the rating to remain the same all disappeared in just 1.5 years even though there is no noted improvement in my actual medical records. What exactly is my next step? I have written a few statements of disagreement contesting the proposed reduction and pulled my VA medical records and will be getting a copy of the new C&P shortly. I have no idea were send the items as it is unclear in the packet. It says I have 30 days for one option and 60 days for the other. I don't think I need a notice of disagreement or start the appeal process as the final decision hasn't been made(this is a poorly worded question)? Can I also request that they consider TDIU if the rating reduction is finalized or will I have to start a new claim for that? Should i send TDIU forms with my statements of disagreement and records? I have been avoiding poking the bear and not filing claims for other conditions, some of which are caused by the various medications they have me taking, should I start filing claims for those as well? And finally, if I do have to file for TDIU separately, should I start the claim now so that the date is saved? Do I submit the claim before or after I receive the final decision on the proposal? Sorry for the long post. I'm lost as to what to do next. It took me over 5 years of being denied before they would actually service connect anything and now this. Thanks again for any help, it is appreciated.
  8. The most common hormonal deficiencies associated with TBI include: Pituitary deficiencies (TSH/FSH/GH/IGF-1) Gonadotropin deficiencies (LH/FSH/testosterone/estradiol) Adrenocorticotropic hormone, thyroid deficiency and prolactin deficiencies are also seen among patients with neuroendocrine involvement following TBI Hypogonadotropic hypogonadism (acquired): pituitary-hypothalamic injury from trauma. These men have low testosterone serum concentrations but have gonadotropins in the normal or low range. Suggest Neuroendocrine Dysfunction Screening ( NED ) for FSH, See links at: http://www.ncbi.nlm.nih.gov/pubmed/15879352 http://www.brainline.org/content/2011/07/hypopituitarism-after-brain-injury.html http://www.ncbi.nlm.nih.gov/pubmed/18780593 http://cdn.intechopen.com/pdfs/30501/InTech-The_case_of_hypopituitarism_in_traumatic_brain_injury.pdf http://www.ncbi.nlm.nih.gov/pubmed/20731261 http://www.noticeandcomment.com/An89-Proposed-Rule-Secondary-Service-Connection-for-Diagnosable-Illnesses-Associated-With-Traumatic-Brain-fn-3325.aspx https://www.federalregister.gov/articles/2012/12/10/2012-29709/secondary-service-connection-for-diagnosable-illnesses-associated-with-traumatic-brain-injury https://priorservice.wordpress.com/2013/04/30/ptsd-or-hypopituitarism-nearly-half-of-veterans-found-with-blast-concussions-might-have-hormone-deficiencies/ http://www.va.gov/vetapp09/files2/0910774.txt http://www.va.gov/vetapp07/files3/0726237.txt http://www.dcoe.mil/content/Navigation/Documents/DCoE_TBI_NED_Training_Slides.pdf http://www.dtic.mil/dtic/tr/fulltext/u2/a568011.pdf http://neuro.psychiatryonline.org/article.aspx?articleID=103172 A good read: Gulf War and Health: Volume 7: Long-Term Consequences of Traumatic Brain Injury By Committee on Gulf War and Health: Brain Injury in Veterans and Long-Term Health Outcomes, Board on Population Health and Public Health Practice, Institute of Medicine
  9. I have a current claim for several injuries to include PTSD. I did some research and found out the best way of getting a rating for migraines is to have a diary through the VA of the migraines. For my PTSD which I got diagnosed through the VA in February, I'm taking Doxazosin (Nightmares), Hydroxyzine (Anxiety), and Sertraline (Mental Health). All of the medication causes headaches. However, the Sertraline only causes headaches within the first 2 weeks. I was going to wait until the claim was complete before filing for Migraines because I wanted to already have the rating for PTSD first so I can claim the migraines as secondary. But is there a way to still file for it now to still say it's because of the medication for the PTSD? Which route should I go or is there a better one? And should I talk to my VA counselor/medication doctor to get him to state that my migraines are caused by my PTSD and medications? I heard every time you file for a new claim, then everything gets re evaluated so it would be ideal if there was a way to get everything done now. Also, I did get diagnosed through the VA for Sleep Apnea back in February,. So, can I say that the migraines was also caused by the Sleep Apnea?
  10. Due to some good advice and help on here, I decided to put in a claim last week for an Increase to my current PTSD 70% and SMC L. My wife is paid to be my Caregiver thru the VA Post 9/11 VA Caregiver Program. I had my Yearly Reassessment recently and the VA decided to continue my at the highest Tier, and listed me as not being able to Bath, or do activities of daily living without the help of my wife. My PTSD has been very bad for a few years, but I was scared to put in for an increase, as I did not want to rock the boat. As most of you know the VA has done alot to mess with me to include my recently being Reviewed, Even though I am 100% P&T. The VA actually reduced my Scars from 30 to 10% even though the Review Exam was for Urology issues. So I printed out the DBQ and Aid and Attendance forms. I will give those to my VA Docs over the next month or so. I uploaded all the VA Caregiver Assessments which go back to Feb 2014, stating that I need a caregiver full time with activities of Daily Living. Also my wife typed up a 6 page Spouse Support Letter which I uploaded, and my best friend of 30 years is going to write a letter in support as well. It looks like I might have a few surgeries and procedures by the end of the year. I will tackle those with the VA afterwards. I am a nervous wreck and scared to death. This is the first time, that I feel that I am going head first at the VA. Just so tired of them Reviewing this, or doing that every other month. What is the point of being P&T, if I still have to look over my shoulder and sleep with one eye open. I have had more then one good Vet on here tell me to put in for this, and I hope now is the right time. I am going to Upload my SSDI letter that states that I am Permanent for PTSD and found unable to handle finances and daily living activities. I am well documented in the VA system since 2013 with all of my health issues. I really hope this works out, and need you guys to Pray for me. I chose the traditional claim, instead of filing as a FDC due to still needing the DBQ and A&A paper work filled out. You know how long that stuff takes, if I can even get them to fill the paper work out. Thanks again to all on here for the Support, and God Bless!!!
  11. So today I found my claim was approved today for Sleep Apnea secondary for PTSD for 50%. As promised I have attached all the documents I sent in with my claim. This claim took less than a month from when I sent it into approval. I have also included a copy of the nexus my doctor wrote. With the proper research and a good nexus you can win this. I hope my research willhelp other win their claims. High Risk.pdf How PTSD relates to obstructive sleep apnea & cpap therapy.pdf My Statement.pdf Obstructive Sleep Apnea and Posttraumatic Stress Disorder.pdf PTSD and Sleep.pdf PTSD Severity Linked to Higher Risk of Sleep Apnea in Veterans.pdf PTSD symptoms go beyond psychological.pdf Sleeo Study.pdf Sleep and PTSD.pdf Sleep apnea found in 57%.pdf Sleep Disordered Breathing in patients with Post-traumatic Stress Disorder.pdf The National Veteren Sleep Disorder Study.pdf The PTSD and Sleep-Apnea Connection.pdf The PTSD-OSA Paradox.pdf VA sleep study Publication.pdf Nexus.docx
  12. I found your website. I have never posted anything asking anyone about this but I'm finally doing something about it and desperately need some advice. The question specifically has to do with my physical exam at MEPS and the presumption of soundness attached to it. If I am found 100% physically fit and did not have to sign any waivers, how can I have a disability existing prior to entry discharge for a physical disability not previously noted at MEPS or in any previous records? Am I correct that unless otherwise noted at my MEPS examination, any physical injuries thereafter besides something congenital had to have occurred in service? As in nothing was noted for me other than I was in 100% perfect physical shape. Secondary question will be about how to connect the dots with my disability and future appointments and what I should be looking for in responses from doctors which I will go into further below. Background information I am sorry if this gets lengthy or the wrong Forum to put it at but I really don't know who else to ask and have never told my story or asked any advice from anyone about this. My entire life I knew I was going to be a marine and that's all I wanted to be as my grandfather was a World War II Marine veteran my father an army veteran so I knew and trained for very young to be a Marine it was my hopes and dream. I was a high school sport standout in every sport, won the state championship football perfect physical health ( I am 6 foot 4 inches 180 lbs) the plan was to go to college then be a Marine Corps officer. This was 1988 when I graduated high school, by 1989 I was in college not enjoying it and watching the Middle East get very hot. After discussing it with my father I had his blessing to drop out of college at Eastern Michigan University and enlist in the Marine Corps. I did the Delayed Enlistment program and they actually called me up early and reported in November 1990 to Camp Pendleton California. I will mention that I got a perfect score on the ASVAB by the recruiter and offered any job and I chose and signed a contract for intelligence with a Meritorious Promotion to private first class after graduating boot camp and Lance corporal after graduating my MOS School and upon graduating my MOS school and also a $10,000 bonus. Again just establishing my sincerity and fortitude that this was my dream and purpose I had trained for my entire life And I wouldn't be signing a contract adding time to my enlistment if I truly wasn't planning on making a career of the Marine Corps. Boot camp In the Marine Corps is very stressful and it was during the very beginning of the Gulf War. Needless to say to drill instructors were hyper-vigilant in one of them even got busted from our platoon for striking some of the recruits. I am only mentioning these boot camp incidents to establish a fact. Anyone knows in boot camp unless you are on your deathbed you do not report to sickbay. I was the same way but then again I was always healthy in my entire life. In second phase my feet started hurting when we would go on marches and humps and by the time we went back for third phase in San Diego I did report to sick call. I did miss the final March because my feet and lower legs hurt too bad pins and needles numbness pain Etc and it is in the boot camp medical records that this did happen and I did go to sick call. If I recall while in bootcamp I just was on light duty for a few days and we were so close to graduating I only missed a few days and graduated with my platoon. Throughout my entire boot camp I went to Sick Bay sick call the one time for my feet they put me on light duty I missed a few days of training and that was it and I graduated February 1st 1991 with my original platoon I started with. I also had a final physical fitness test score of 299 out of 300. I was perfect in Pull-Ups, sit ups and the 3 Mile Run was 10 seconds short. I had one point subtracted because I was 10 seconds over the 18-minute mark, I'm saying this to establish I was in perfect physical health otherwise besides my feet and legs being so sore and painful. Went home for boot camp leave reported back to Camp Pendleton for Marine combat training (MCT). I was told that we had to pull guard or KP duty until space was available in the class. While in this holding platoon, doing guard Duty, the same problems occurred with my feet as they were tingly numb painful and this was after just standing post. And so I went to sick call for the second time in my life praying and hoping they would just give me some pills or something to alleviate the pain so I can go back to being a Marine. They took some X-rays put me on light duty and told me they will be back with me to see me again. 2 Days Later I am pulled into the office and told point blank that I am being discharged because I have mild bilateral pes planus or the common name flat feet and that this disability existed prior to entry into the service. And that was it! I can't even explain in words how my whole life I had been training and wanting to do this one thing and it was taken away so quickly in the blink of an eye and I had no recourse or way to get my Marine Corps career back. I was devastated. At that moment I had no clue what to do as I have said my entire life I want to be Marine and by simply reporting to sick call and having some feet pain and leg pain I am all the sudden being discharged and my whole world ended. I must include this side note below. At Camp Pendleton that day being told the horrific news there was a Vietnam veteran nurse who was assisting me. She could tell how I couldn't believe this was happening I told her I never been sick or have flat feet or problems my entire life, in bootcamp I went to sick call one time and now one time here and now I'm being discharged I was beyond upset and couldn't figure out what to do she said there was nothing I can do, the medical board is already underway. Then she did something I don't know if it was legal or not but she could tell I was upset pissed off I just was so mad I told her I didn't care what anyone did at this point she said I'm going to do something I've never done and handed me all my x-rays (she handed me everything in the original color coordinated huge folders, mine are orange, with all the Navy markings on it) The Originals as well as the original radiologic consultation request report and prognosis for all those x-rays. She told me I know you don't care about any of this right now and you're very upset and have just seen your whole life flash before you (because I did tell her I had intended to retire a Marine), but twenty or thirty years down the road maybe even sooner you are going to need medical help because I've seen your records and you had no waiver entering service stating that you had these medical problems previously and this was caused while in service and they are claiming you had it before you enlisted so you do not get any VA benefits, but I did not see it on any of your records. I'm giving you your original X-rays and the consultative reports and please hold onto them until you're ready to file for disability some time in the future, these will be your key, if you don't have these you will never see them again and it will make your claim almost impossible, the VA will contend it did not pre-exist, but these will prove it for you, she reiterated in the most passionate way that I must not lose those that I will need them to file a disability claim in the future. So fast forward until present day. I did save the original X-rays and the consultation report and have them in a safe place. It has taken me until a few months back to actually pull them out, look at them along with my discharge papers and realize that this is all wrong and I have a claim here! The evidence that I have is that the radiological report says as follows "left foot, 3 views: mild pes planus. right foot, three views: mild Pes planus. " Second consultation report from the radiologic consultation is "right lower leg, two views: possible stress fracture proximal tibia left lower leg: possible stress fracture left proximal tibia right foot, three views: hallux valgus deformity, otherwise within normal limits. left foot, three views: degenerative changes in the MP joints. What does this all mean to me and my ability for a VA claim? So move forward to current day unfortunately since I left the Marine corps I never have had any health insurance had a plethora of problems. In 2017 after years and years of back pain lower back pain ( as well as my feet and lower legs the entire time since I left the Marine corps) I finally went to a doctor and complained I was in so much pain something had to be done and he ordered an MRI. I do have an MRI establishing my s1 – l5 lower back an S5 through s1 does have sacral nerve damage bulging and deteriorating disc etc enough to meet the classification for social security disability. The MRI was in 2017 and my lower back pain has been with me since I was in the Marines. I may have had three or four emergency visits and some urgent Care but there has not been any paper trail or evidence that a normal person would have 20 to 30 years of it I have almost nothing because I never went to the doctor or hospital. The catalyst that started this was in August 2019 I had a bicycle accident I broke my scapula in five places. I had no insurance I went to the emergency room they x-rayed it said yes it's a terrible break and gave me the number of a doctor who sees patients without insurance or money. As it turns out the man retired and no one replaced him. I called every resource clinic site et cetera… they had no one to look at my shoulder for without having insurance. I never had any follow up. After being out of work 9 months and realizing it's going to be a full year I will meet the requirement for SSI disability then upon seeing the one piece of medical evidence I possessed my MRI and its prognosis I asked a doctor and yes, it appears I do meet the listing for that with my 2017 MRI, not even taking into account the new injury and the further damage it has done. The point is that it is now 2020 and I have never had a follow-up appointment for the shoulder and obviously the shoulder is horrible but the back is even much worse now after the accident than before my 2017 MRI. With this knowledge and the fact that I do not have barely any evidence I knew if I filed for SSI disability they will send me to a local doctor to verify my injury and give me a NEW MRI which should show that is is even worse now than in 2017, which was physically bad enough to qualify then, it should be more than bad enough in nature to qualify for disability now. My research into SSI disability I kept seeing about veterans and that is how I return to my discharge papers and looked at them, and am planning and filing for VA disability. I have read about obviously I need documentation to prove any of this, VA especially and I have almost none, that is my main concern. I have read a little about pyramiding and primary injury secondary at cetera. My end result of filing for VA disability in this case will be to try and achieve 100% disability. In my research it may be possible but I will put down what I am thinking now. Because of the presumption of soundness and I had no waivers they cannot deny that the mild pes planus and bunions and the other damage listed in the X-rays I had for my medical board could not have existed previous to my service in the Marine corps or else it would have to have been noted at m e p s or I would have had to have had a waiver. My VA Claim thought process? The rating for mild pes planus is 0%, after review, mine is pronounced bilateral pes planus a 50% rating (my feet have gotten terribly worse over the years, my feet truly are flat as a pancake now pronating inward and very painful, has changed my gate, this is not official as I've never been to a doctor, but this is my honest opinion). Since this had to have happened in service this will be a primary injury I believe as well as the bunions or hallux valgus deformity. They are noted in my 1991 medical x-rays so as a primary I can safely say they have gotten much worse and both toes are affected now not just the right. The rating for bilateral hallux valgus is 10% each foot or a total of 20%. Bringing the total to 70% rating. Of course that is if I am awarded the maximum for the bilateral pes planus and both feet hallux valgus. Now this is where I have some more questions? I also have all the symptoms and am very positive I have peripheral neuropathy which I'm very familiar with as my mother has it but, but the rating for that looks like it can be deemed secondary cause from my pes planus. If correct shouldn't I receive x% for bilateral peripheral neuropathy as a secondary result from my primary injury? Next,is tying in the primary pes planus to my SSI disability case that my lower back secondary (sacral nerve, herniated discs, degenerative disc disease) is aggravated and hurt from my primary bilateral pes planus as well as my bilateral neuropathy affects it as well. The listing for lower back pain is x percent up to a 100% And lastly the whole affair has caused me PTSD and that rating is 0% to 100% rating. I don't want to go into how I have it or not but I have read all the symptoms and can present a very strong case that I definitely have had PTSD since the day I was told I was being discharged. And with no insurance I have never gotten it treated but I have definite evidence of it in my life. I filed the SSI disability last week and am awaiting them to call me and set up a doctors appointment. I also called the veterans administration about filing disability. I called my local VA and ask about a veteran's service officer who could help me with filing questions. I started to go over some basics in my case and when PTSD was brought up he inquired how I could have it without being in combat and only in the service six months and I immediately shut down and felt that it was horrible a veteran service officer would make me feel as though I don't have valid reason to have PTSD. So that is why I searched the internet and found this forum. So another question since how do I establish PTSD? With no insurance can't really get a counseling thing even as a veteran I tried and since I was not in 2 years I did not qualify for any health benefits. I guess should I call the veterans hotline PTSD number and tell them I am suicidal just in order to get this documented and at least someone would have a file then from the VA about whatever I tell them my story? Also should I be trying to find my own doctors who would be favorable to my situation, and to further explore the tibia stress fractures and if I can associate that injury to another rating? I don't have insurance but I might be able to find a clinic, and my thought process is a podiatrist who will substantiate my pes planus condition. Should I be actively looking for a civilian doctor who will know the whole story I just recited and work with me to try to get my VA disability? Or should I just file my claim with just the limited information (presumption of soundness) the x-rays that I have from 1991 and prognosis and hopefully my SSI disability case once I see the doctor who will also have some more evidence, hopefully providing more evidence of my infirmaries? Also is a question that would I be getting any kind of back pay disability for all these past 30 years if the decision is in my favor? Another question is that should I contact a lawyer? Also a veteran service officer should I contact someone like the American legion or which one would someone recommend I use because I truly do not know what I'm doing and I feel if I had the right direction I'm someone who knows all the intricacies and workings of the VA if I filed this correctly the first time and knew what type of evidence to gather it would make my claim so much more positive in my favor. if I have to, I will get the money somehow,a loan from family to see the right doctor but should I be going to a doctor, a veteran Dr who will be in my corner and spend money on it before I file this claim? Thank you everyone, I'm sorry if I'm rambling, I have many questions but I've already asked too many. I am grateful for finding this forum and I really hope someone has some real answers for me that can assist me. Thank you. Happy Easter! Sincerely, Marine from MI living in central FL now.
  13. Do they qualify for a retiree ID? Do they qualify for PX & Commissary privileges? Do they qualify for state benefits for being rated 100% P&T? Even if their DD-214 states Other Than Honorable?
  14. Jerry E

    back pay

    BACK PAY: Does VA give retro back pay all at once or do they break it down...I used a va retro calculator and in low end and high end scenarios I came up with $40,000 plus....7 year back pay on one condition 5 years on another..long story short called VA because after waiting 2 plus weeks from receiving award letter they stated I had a payment of only half that being scheduled for this week couldn't give any info on any future if any payments
  15. Good Morning, I have a few questions about SMC. I currently receive SMC S, for I have 70% PTSD and have 50% for Sleep Apnia, 40% for Fybromyalgia, 30% Migranes, 20% for Cervical Spine, and 10% for TBI and a host of about 9 other things all listed at the 10% Disability rating. Would they just look at new A/A that I just submitted or would they pyramid me to the SMC t? this is so confusing. Thanks for any help.
  16. Recently I have finally decided to seek help for my PTSD. Since I got out of service almost 10 years ago I have seen the shrink on the civilian side twice. I was diagnosed with PTSD but stopped going. I was even prescribed meds but never took them out of fear. Today, I finally decided to get real help this time. During my PTSD with the VA PA. She told me that I scored really high on the PTSD screening and that she would set up a C and P exam for me. That someone would call to set up the appointment. I checked my health summary on myhealthevet a day after my phone screening. She Added "Acute stress reaction ICD10 F43.0 with Provider Comments: Acute Stress Reaction" Can someone tell me what this means? Ive been diagnosed by civilian doctors for PTSD and she writes "Acute Stress reaction".. She said she could not diagnose PTSD but she was a counselor. I am confused by this. Is she basically saying Im lying or is this normal?
  17. Night stalkers Don't Quit Filed PTSD claim back in Dec. 2019. Today logged in to my account on VA.Gov and found this Request 1 Optional - We’ve asked others to send this to us, but you may upload it if you have it. PTSD - obtain Investigative Reports. Should i be Concerned? I file a complete claim with stressors and a Award: Air Medal with v device for same time period of combat.
  18. Ok I have not posted in quite a while. My current claim just moved to complete. This claim took exactly one year. My claim was for insomnia with sleep apnea, major deppressive disorder, and ptsd. The only c&p exam i got was for a pscharist they didnt get me a sleep study. In october my house burnt down and i am now in the homeless program living in a transitional housing unit. I have been trying to get a sleep study for over two years. Last month my homeless counser made a request to get me a sleep study. I had a appointment in less then a week and recieved my cpap last wednesday and on friday my claim became complete. and there is a regulatory and prodedural review posted on ebenefits. and my folder moved from muskogee to souix falls. What does the review mean. I am still waiting on my packet and I know I will have to appeal it because of the cpap.
  19. This is my first post in hadit, but I've been reading for nearly a year, thank you for your wisdom! I've faced a lot of criticism for having a non combat ptsd claim on a different site, so I'll briefly qualify my circumstances in order to get help. I was stationed in Germany, 1990-1992. During a field exercise, at night, while in uniform, there was a large explosion near my AO at the training area, it was a German civilian transport truck and a small passenger car that had wrecked and caught fire on the nearby autobahn. I along with several other soldiers rushed to the scene and rescued the driver of the truck, and tried unsuccessfully to pull out his passenger before it went up in flames. The passenger didn't make it, and I can't forget the scene and the hopelessness of standing by... Within a few weeks I started experiencing nightmares, anxiety, panic attacks. I was under the naive assumption that PTSD was only for combat veterans until about a year ago, when I was at the VA clinic in my town to see the mental health. The Psch diagnosed me with PTSD non combat, and encouraged me to file a claim. To digress, I was diagnosed bipolar at the VA in 2002 also with a previous history of suicide attempts a year and a half after discharge. I was discharged (ETS) honorably in 1996. First suicide attempt was 18 months after. I have many similar diagnosis of bipolar, one of "reaction psychosis", and a depression diagnosis all through VA and inpatient for bipolar/suicidal ideation. I was awarded SSDI in 2003. Having filled you in, here are my questions- Do these many diagnosis other than PTSD, after discharge, completely negate this new diagnosis of PTSD? Second question, I have had a heck of a time gathering proof of my stressor. So far I've submitted a German newspaper article and two eyewitness buddy statements, as well as two family statements and all my post discharge medical history. I've written to the JSRRC, they claim no record of my Signal Battalion in Germany was ever turned in. My brigade and battalion were inactivated in 2007. I have ran into dead ends in finding unit reports of the incident. Can anyone point me in the right direction as to where to search for S-3 reports or Staff Duty journals, so that I can send the VA further proof of my stressor? Thank you for reading my thread and for your help!
  20. Tbird has very good info at the hadit Home page on IMOs. I reworked a topic I posted here some time ago.and maybe it can be found better now: Independent Medical Opinions can often be the only way a veteran or widow can succeed on a VA claim. VA plays a war game called the War of the Words. The proper wording of an IMO is critical to VA's acceptance of it, as probative evidence. Opinions obtained from private treating doctors are often free yet most independent medical opinions are needed from doctors with full expertise in the field of the disability and can be very costly. However an award can easily absorb this cost with a few comp checks or the increases in comp that the claimant might never obtain without an IMO. A Valid IMO must contain the following: The doctor must have all medical records available and refer to them directly in the opinion. In cases involving an in-service nexus- the doctor needs to read and refer to the SMRs. Also the doc needs to have all prior SOC decisions from VA ,particularly those referencing any VA medical opinions and a copy of the actual C & P results is even better. The SOC or SSOC could parse or manipulate critical statements in the actual C & P exam. The IMO doctor should define their medical expertise as to how their background makes their opinion valid. They should be willing to attach to the IMO their CV (Curriculum Vitae that contains their medical background and any other info pertinent ,such as any symposiums they attended, articles they had published etc etc,if possible, that show their expertise .) A psychiatrist cannot really opine on a cardiovascular disease. An internist cannot really opine on a depression claim. They need to have expertise in the field of the disability you have claimed to make their IMO valid. They should rule out any other potential etiology if they can-but for service as causing the disability. They should briefly quote from and cite any established medical principles or treatises that support their opinion. They should point out any discrepancies in any VA examiner’s opinion-such as the VA doctor not considering pertinent evidence of record in the veteran’s SMRs or Clinical record. They should fully provide medical rationale to rebutt anything that is not medically sound nor relevant or appropriate in the VA doctor’s opinion. They should then refer to specific medical evidence to support their conclusion. They must use these terms: (VA is familiar with these terms) "Is due to- 100% More likely than not- Greater than 50% At least as likely as not- 50% (Benefit of doubt goes to Vet) Not at least as likely as not- Less than 50% Is not due to- 0% from an post by carlie “ It helps considerably to identify pertinent documents in your SMRs and medical records with easily seen labels as well as to list and identify these specific documents in a cover letter that requests the medical opinion. A good IMO doctor reads everything you send but this makes it a little easier for them to prepare the IMO as to referencing specific records. Send the VA and your vet rep copies of the signed IMO. And make sure your rep sends them a 21-4138 in support of it- you also- can send this form (available at the VA web site) as a cover letter highlighting this evidence. PS- Mental disabilities- make sure the doctor states that you are competent to handle your own funds- otherwise, if a big retro award is due-the VA might attempt to declare you incompetent and it takes times to find and have the VA approve of a payee. (unfortunately many PTSD claims these days depend on a VA MH professionals diagnosis of PTSD and an IMO diagnosing PTSD will not be accepted by the VA. See our PTSD forum for the 2010 regs on that. I need to add here that a secondary condition to an established SC condition wold not need the IMO doctor to read all of the SMRs. They just have to state with medical rationale why the second claimed disabilty is due to (secondary to) the initial SC disability. IMO docs must avoid words like 'maybe', 'possibly', 'could ' or 'might' be related to, or any other wording that VA could construe as speculative and then disregard the IMO for that reason. On the other hand the IMO doc should look for any purely speculative statements in the C & P exam report or in the C & P and overcome those statements by stating they are mere speculation and have no medical basis. DIC claims IMOs are different and the IMO doctor needs the death certificate and any autopsy findings and any past C & Ps as well as the entire clinical record (to include SMRs in some cases) and copies of any and all private records. They need the rating info on the vet and what his or her SCs were for. If the immediate cause of death is NSC but a service connected disability substantially contributes to death, the VA should award DIC. Often this type of DIC claim definitely needs an IMO to clarify a substantial contribution to a NSC death. 1151 IMOs are different too. The IMO doctor must identify the exact nature of the negligence with direct referrals to the med recs. Then the IMO doctor must make a strong medical statement with a full medical rationale that the veteran has a documented disability that is directly due to the VA's negligence and give a full medical rational for that. It is a good idea for a 1151 IMO doc to also add abstracts or citations from known medical practices in the 'standard medical community' to bolster a 1151 claim. What I mean is showing the VA proof that non VA doctors (the standard medical community) would have taken different steps to diagnose and treat the veteran and the VA's “omission” of these proper medical steps caused the veteran's additional and documented disability. Hope this all helps someone.
  21. I have some questions and wondering what some of your observations are. I had a c and p exam recently and got ahold of the DBQ. All the boxes the doctor checked were good for me. She checked all the right boxes and checked that I had PTSD and all the symptoms they went with it but in some of the comments she made, they seem really bad. So I'm wondering what matters more, the doctors observations or the boxes she checked? I'm rated at 60% currently with anxiety NOS and Tinnitus. I did not initiate the exam for an increase. It was one of the random c&p to see how things are going. This is from the PTSD initial DBQ that she filled out 1) yes 2) PTSD, paranoid personality disorder with avoidant features, other specified anxiety disorder with depressive symptoms 3) a. Yes. B.no 4.) A.Occupational and social impairment with deficiencies In most areas work, school , family relations...etc B. Yes--most impairment is attributed to PTSD and anxiety disorder with paranoia secondary. Under PTSD criteria she checked 2 in A, 3 in b, 2 in c, 6 in D and 4 in E . 6) Argumentative and irritable veteran who is hiding behind his wife and looks at her instead of the examiner; has poor eye contact; unable to tolerate questions without interrogating examiner about "meaning" of question; makes people want to avoid him due to his paranoid arguing. Hopeless attitude; does not accept hopeful comments; arrogant and appears to think he knows more than others; thinking was designed to perceived threat, not to answer questions; emotional overactivity; exaggerated affect; affect constricted; everything annoys him; meds do not touch symptoms and he does not sleep; problems with lack of trust. 7) " he may be playing this up out of a desire to avoid working at jobs that are low pay---he has no job skills and comes from a highly educated family --father is lawyer, sister a geophysicist; he may prefer the sick role, rather than go back to school and stretch himself; there is an element of malingering and playing to an audience." I found this highly offensive because I've been going to the VA for at least 5 years. I didn't initiate the exam so I'm not trying to get more money. However, I wasn't honest in my first c&p in 2011 because I was ashamed and held back a lot of the really bad things I experienced. This time around I made sure that I was brutally honest. I know that I'm supposed to tell them about my "worst" day and how bad it really is and I did. And now my sincerity is questioned? The lady was incredulous that my wife married me even though I didn't have a job and still don't. I said that I don't believe I can work which I don't think that I can because I barely can stand to leave the house and that I hate being around people because I'm constantly thinking in my head that I'm going to be attacked or have to attack someone else. I also don't sleep, I have diagnosed insomnia from the VA. Because of all this I don't think I'd be able to hold down a serious job. Is that crazy? I haven't worked in a long time. I stay at home and take care of our kids. I said something like at least I can feel useful like that. The woman seemed stunned by this. I'll admit I was extremely uncomfortable during the exam because I hate talking about this stuff and prefer to not think about it. And she interpreted it in the way above. Her comments seem contradictory to all of the boxes she checked. If I'm "malingering and playing to an audience" why did she check all of the other boxes? It's driving me crazy. This feels really bad for me. I'm having anxiety attacks almost daily thinking about this. Am I crazy to worry about how this will turn out for me? This woman was in her late 70s or early 80s. The exam was through VES and was done at her in home practice
  22. I have 4 C&P exams this Friday. All for increases. (Migraine, PTSD/depression/anxiety/chronic pain/agoraphobia, bilateral foot pain and knee pain increase [including VA issued knee brace and civilian issued AFO foot brace]). Should I have my wife ad adult kids who both witness and suffer from my mood swings, depression, anxiety and antisocial like living on a daily basis? They can also talk about my constant leg pain and migraines. I also want my supervisor to do one regarding my migraines that have me leaving work early, alot. But that is a touchy subject, because I don't want me asking him to affect my employment. Also I hide a lot from them, to keep my job, like just suffer with headaches and migraines at work. Or fake my way through the day, pretending to want to be around people.
  23. Fifty years in the making. Five filings since 1971. Welcome home, Bob. A truly fitting Christmas present. Remember the magic words: " leave no one behind". https://asknod.org/2019/12/29/vba-portland-you-know-it-dont-come-easy/
  24. Best Practice Manual for Posttraumatic Stress Disorder (PTSD) Compensation and Pension Examinations http://www.avapl.org/pub/PTSD%20Manual%20final%206.pdf
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