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Guideline For A 1151 Claim?

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Guest Jim S.

Question

Does the failure by the VAMC Primary Care Dr. and/or Psychiatrist, to test and evaluate the Veteran's history of a mental disorder during service and/or if it may have some bearing on their current diagnoses of an associated mental disorders and/or conditions, rise to the level of a 1151 claim for failing to address the in service diagnosis for treatment and/or how it may bear on the effect and/or treatment of the current diagnosed mental disorder?

I have repeatedly asked to be evaluated for my inservice diagnosis of an acute schizophrenic episode, to determine it's state of remission and or how it may have some bearing on my current diagnosis, but I am rebuffed each time that they are only interested in treating me for my current diagnosis.

Must the Veteran exibit the extreme symptoms of his mental disorder, in order for the VAMC Dr's and/or Psychiatrist's to take notice and do something to help the Veteran cope with the total picture, of his mental disorder?

Jim S. B)

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  • HadIt.com Elder

I don't understand why everyone is so interested in 1151 Cliams as they will deduct it from your check.

Veterans deserve real choice for their health care.

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Pete

I thought Berta said they added the 1151 rating to your check?

Pete,

The 1151 can add compensation if the severity of a service-connected condition has been increased/aggravated by some type of VA medical negligence; the amount of compensation would be determined by the ratings criteria and the severity of the condition before and after the incident. Also, if the veteran wins an 1151 for something not SC then the VA has to pay "as if" it were SC.

The VA takes the 1151 claims seriously--each claim REALLY is a big deal--so these claims are not to be entered into lightly. Every jot and tittle of the veteran's medical record will be reviewed, if need be. I say "if" because sometimes the case is so clear that the facts "jump out" at the higher ups and they have no reasonable defense against the claim. It's not a matter of "as likely as not" or "more than likely" in these claims, rather the veteran must prove that the VA negligence CAUSED the injury. It is not a clear-cut case just because something happened right after VA-prescribed medication, treatment, etc.

The offset you might be thinking about is the tort settlement. If a vet wins an 1151 claim and a tort claim for a NSC, the VA compensation is offset up to the tort amount. In other words, the offset avoids duplicate payments for the same negligence/injury. However, if the injury involves an already SC condition, the offset does not apply. In that case, I interpret the law to say the vet could be paid twice for the SC condition. It's confusing, as are most VA issues past reading the compensation rate table. Come to think of it, even that is a little weird. B)

Carrie

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  • HadIt.com Elder

Thanks Carrie and John I think I can understand it a little better.

Veterans deserve real choice for their health care.

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I certainly hope the 1151 adds to my check... It had better considering they wastedmy life and shortened it without doubt. Because of thier wanting to cover up the error, I spent 5 friggin years in a wheelchair and will more than likely be back in one soon if I don´t got physical therapy soon.

Hmmm I am looking for 100% with SMC R1. This and nothing less... period... end of story.

[font=Verdana]

Joseph Hertrich (Josh)

Cartagena Colombia

Boulder Colorado

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I certainly hope the 1151 adds to my check... It had better considering they wastedmy life and shortened it without doubt. Because of thier wanting to cover up the error, I spent 5 friggin years in a wheelchair and will more than likely be back in one soon if I don´t got physical therapy soon.

Hmmm I am looking for 100% with SMC R1. This and nothing less... period... end of story.

Josh,

Sorry you have gone through so much. Are you getting PT set up now? It would be a shame to end up back in a wheelchair when you can do something to head it off. What about Aid and Attendance, do you need that?

I know it is intense to fight through this, but be sure to push for everything that is rightfully yours. I am working through much of the same for my husband. He's in a wheelchair, too, because of poor VA medical care. He's getting PT three times a week now, but there's not much hope of it helping him. His claim for SMC R went to a rater last Friday, and she called me at 6:00 pm for a follow up, so I guess she must have been working late. We're hoping it was his claim that kept her there so late. I guess we'll find out soon. We revoked the POA with his SO because he made such a mess on the last claim. I finally fixed the trouble he caused and we won the claim and SAH entitlement. Now we are on our own again. This is too important to let an uninformed or untrained SO make it harder.

I've done a lot of research on Sec. 1151 and SMC R1/R2 so let me know if you think I could do anything to help you. (But you might want to wait and see if I win the claim for my husband. B))

Thank you for serving our country.

Carrie

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