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New Guy- Middle Of Claim, Have Questions


Nathan104

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Hello all. I am freshly out of the Army after 8 years of service. Im 27 yo and Ive been out since 1 DEC. I was put out by MEB after knee surgery. Army rated my knee 10% and gave me a large severance pay. I have made my initial claim with the VA for several things including chronic right knee pain patellofemoral syndrome and chondromalacia patella post arthoscopic repair with disfiguring scar, chronic lower back pain with radiating sciatic nerve, Acid Reflux, right hip DJD,achilles tendonitis, hemorroids, bilateral tinnitus,stomach condition with pain,cramping,diahrea. My claim was written up before I got out by a local VA rep. I have had my initial C&P evaluations around the last week of Dec for the listed conditions.

During the first part of Jan, I was diagnosed with high blood pressure and put on Lisinopril. I called the VA and added hypertension to my claim with copies of about 6 pages from my SMR that show in service high blood pressure. Im not sure whether it will matter that I wasnt actually diagnosed with it in service. Hopefully since I am recently out it will still count? Should I send in copies of med records from my Dr's visits on this since Ive been out showing they put me on BP meds? I have not received a C&P appt for that one although I did receive the form letter that they are working on my app for it.

Well, I also suffer from sleeplessness(best I can call it). I had it for the last two years in service. I had a sleep study performed in service and found very mild apnea that they said should not matter. I have been on Ambien for over a year for it and recently had to up my dosage as its getting much worse. I did not claim this based on what they said about the apnea. Im wondering about adding this to my current claim. Ive got what seems like a long list already and have already added the hypertension. I am wondering if by adding this they will look at everything negatively since I have a claim in for so many things. Although so far, everything is documented in the SMR except the actual diagnosis of hypertension.

I have not heard anything since my C&P appts the end of Dec. I have read on here that a copy of these can be obtained through FOIA but not sure where exactly that is? Also wondering if adding the new condition is just pushing my rating determination back further and further? I have no clue how long this will take for the initial rating at the Little Rock AR VARO.

Ive asked many questions already but one more. I know that when I receive my rating, my monthly payments will all go to the army until my severance pay is repaid in full(roughly $47K), then I will begin getting it every month. Ive heard from several people that after getting my VA rating, the lump sum severance pay becomes retroactively tax free? Anyone know any more info on this? Ive had no luck searching IRS or here.

Sorry for such a looong first post and so many question. Thanks for any info and feel free to give me any advice you can offer about the process in general.

On a side note, I have not seen a VA Dr for any of this besides the C&P's. they told me I cant get care there until I get rated. I have 6 months of Tricare coverage though so prefer the civilian Dr anyways.

EDIT- I received a VA form 21-4138 statement in support of claim to fill out. Is this something I need to fill out or is it best to just see what the rating comes back as and then worry about it if an appeal is needed?

Edited by Nathan104 (see edit history)
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Nathan=Welcome aboard here and thank you for your service!

For a copy of the C & Ps- just write a letter to the Records Access Officer at the VAMC which gave you the C & Ps and request a copy of them-

State you are requesting a copy of it (with the date of exam) under the FOIA/Privacy Act , 5, USC, 552, and put your c file number (if you have one yet) or your service or SSA number on it.

I suggest that you add everything you mentioned to your claim.

How is the HBP noted on your discharge papers? The medical records on this that you have- I would send the VA copies of them-to suport as well as copies of the SMRs where this is mentioned- you could highlight the SMR copies with a highlighter pen. I sure would put the sleep aphnea in the claim too.

Dont know about the tax question-

I would file out the 21-4138 (guess you do have a c file number-this number will never change and should be on all of your correspondence to the VARO.)

To all here- the 21-4138- if I fill this out for a vet I type the Statement, but leave 2-3 inches at bottom of the

Word screen and then I cut it to fit onto the 21-4138 and then copy it that way-

When they send these blank forms and they usually cannot be put into the printer to type on because it is hard to

align them-but they can be copied with the statement taped to them and then signed.

That way they have a typed statement- handwritten claims and statements are often too hard for them to read.

Maybe I didn't say this too clear-

List the conditions on it that you are requesting service connection for and that your SMRs will show their nexus to service. You can add the HBP claim you mentioned here and detail it as you did with your post.

Sounds like you have very good documentation in your SMRs- dont worry about the lack of HBP diagnosis at this point-at least they documented the readings-

Veteran- now is the time to get some Manila folders for the claims and any VA letters you get-

It is a good idea to have the vet reps phone number and address handy and the VA can be called for a status of your claims at 1-800-827-1000- Hit #1 when the robot asks if touch tone, then hit 0 and hang on for a vet rep at the VARO.

Your claims will take time but it sounds like you sure have anticipated what they will need.

Berta

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Berta,

Thanks for the reply and the info provided. I am sending the request for copies of my C&P's tomorrow via mail. I also sent out copies of my post-service records and a request to add sleeplessness/insomnia to my claim.

As for the HBP, its only noted in my SMR where my BP was taken while at sick call for other things. They never pointed it out to me that it was high. But, the first civilian DR I went to with the FLU after getting out jumped right on it. Now I record my BP every day and it stays insanely high. They just raised my Lisinopril dose, hopefully that helps some.

As for the tax question, I called the IRS today and after spending an hour on hold and being transfered 3 times, I found out that the lump sum IS retroactively tax free after getting a VA rating. I have to file as is now, then after getting my rating, do an ammendment to my return to get the rest of the withheld tax back. If anyone else has needed to know this, its in IRS Pub 525 under sick/injury pay.

As for the 21-4138, I guess I will try and fill it out the best I can. I just dont want to say the wrong thing or say something the wrong way.

Any further advice or guidance would be greatly appreciated from anyone. Thanks and good luck to us all.

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I will throw in a little of what we went through in trying to get my husband service connected for HBP. This was for direct service connection and not as secondary to anything. On his enlistment exam, it showed a good blood pressure reading. He was in the Navy for over 4 years. Two tours in Vietnam. In his SMR's, he was lucky if more than a couple of words were written in his records each time he went to sick bay, much less that they never took a blood pressure reading. On his discharge exam, it showed a high blood pressure reading, but did not actually put the word "hypertension" next to it. My husband told me that in order to get this reading, he had to sit and wait in between blood pressure readings in order for them to get it that low, which according to the AMA and the AHA, it was considered high and should have been monitored. No one told him this. After he got out, he visited a primary care doctor for some other problem and he told him he had HBP and prescribed blood pressure medication. Well, he has been medicated for this ever since. The problem is, when I realized that we could file for his HBP, the original doctors records were no longer available to him. We have been denied on several occasions, not because of the blood pressure reading on his discharge exam, but they stated that the word "hypertension" as a diagnosis was not shown on this exam, therefore, they were denying the claim based on this. They also stated that due to the fact that we could not retrieve his early medical records to show his treatment, then that was another factor taken into account for denying the claim. When he did change doctors, the next doctor did state in his med records that he had previously been treated by Dr. ? for HBP. Since I have been married to him all of these years and have knowledge of his early blood pressure problems, I wrote a letter on his behalf, only to be used as lay evidence and not medical evidence. Didn't seem to help at all. Not even sure they read it.

Well, he finally went to a C & P exam and I got a copy of the results. The exam stated that that it was as least likely as not that his HBP was due to his military service. I was shocked to see it. During the exam and my showing the doctor records that I had to show a nexus, she still didn't seem like she was in our corner. But, we still don't have a decision on this claim yet, so we are still not getting our hopes up. Everything sounds like it is in our favor, but this has happened before, only for the VARO to find something else to come up with to deny the claim.

Hope this short description of what we have had to go through might help someone else. Again, no two claims are alike and while one veteran may not have any problem what so ever with their claim getting approved based on their evidence, another veteran with similar evidence may get turned down. But, a little detailed knowledge from others on how their claim has gone through the process can be of great benefit to others in figuring out how to handle their claims.

mssoup

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  • HadIt.com Elder

Mssoup1:

You can cure this with an Outside Medical Opinion that links HBP to his service. Anyone who has a problem when the VA says that a diagnosis was not made in Service needs this.

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Pete,

Thanks fo your reply. We have finally gotten the evidence required for the nexus in the recent C & P exam. They specifically state that his current HBP is at least as likely as not related to his military service. I don't see how they can turn his claim down this time. Since they generally take the opinion of the C & P examiner over an IMO (have already experienced this), then an IMO opinion should be moot at this point.

Even with that being said, it is so hard after so many years to get a physician to want to put in writing that his HBP was a result of his military service. Heck, you only get no more than 5 minutes of their time anyway, so trying to get them to rule on something like this would, for the most part, be almost impossible. I can't even get them to stay in the office long enough to communicate with me fully on any current problems. I have to keep talking to them while they are walking out the door. Then, I get a bill for over a hundred dollars for their less than 5 minutes that they spent with me. The only IMO opinion we ever got for any of my husands claims was for his eye problems. It took us a while to finally get the doctor to agree and write a letter that his eye problems were related to his miitary service. He even used the words the VARO wanted to see, but they still turned him down. They wanted to know where the doctor got his medical opinion from. We took the denial letter to the doctor and he was floored. Could not believe it. When we went to the BVA with the same evidence, they gave him an instant approval for his eyes. But, the VARO denied him using the same evidence presented at the BVA hearing. Then we wonder why it takes so long to get claims processed.

mssoup

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Nathan104, do claim all of your ailments that you encountered while on active duty, there is no limit! If it happened while you served, then you should be compensated. I, too was discharged for DJD bilateral knees but I truly believe the reason they let me go was because it doesn't get any better. DJD at the early stage warrants 10% but it does get worse. All it takes is 30% or more medical discharge to warrant a retirement. Yeah Right, here comes the boot!! Claim everything because it is rightfully yours! Another thing to consider is, if the Army discharged you with a lump sum because of your knee problem, that is the only money they can recomp. If you received an award for HBP, do not even let them believe they can touch that money! You were discharged for one knee and that's the only money they can recoup if you were to get an increase.

Swan ;)

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Another thing to consider is, if the Army discharged you with a lump sum because of your knee problem, that is the only money they can recomp. If you received an award for HBP, do not even let them believe they can touch that money! You were discharged for one knee and that's the only money they can recoup if you were to get an increase.

Swan ;)

Swan, thanks for the reply. I didnt know that. So if I get 30% with 10% of it being for the knee, then I get a check for 20% worth and the Army gets the 10% worth every month towards the lump sum? That could help quite a bit. I was thinking the total went every month. Thanks for the info.

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Oh and by the way, I was given a lump sum when I was medically discharge and the IRS did take their share but about six months later, all taxes taken were given back. We all know that veterans pay is non taxable. If money is taken out for taxes, do investigate! Again, that was then (1998), this is now!

Swan

;)

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Swan, thanks for the reply. I didnt know that. So if I get 30% with 10% of it being for the knee, then I get a check for 20% worth and the Army gets the 10% worth every month towards the lump sum? That could help quite a bit. I was thinking the total went every month. Thanks for the info.

Absolutely! If you get an increase for 100%, all they can recoup for backpay is 10% which you were originally discharged for!

Swan ;)

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  • HadIt.com Elder

Nathan

If you served in a combat zone I think you are entitled to 2 years of care at the VA after discharge. I think they are BSing you about not being able to be seen at the VA until you are rated. Most vets who go there are probably NSC anyway.

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I will throw in a little of what we went through in trying to get my husband service connected for HBP. This was for direct service connection and not as secondary to anything. On his enlistment exam, it showed a good blood pressure reading. He was in the Navy for over 4 years. Two tours in Vietnam. In his SMR's, he was lucky if more than a couple of words were written in his records each time he went to sick bay, much less that they never took a blood pressure reading. On his discharge exam, it showed a high blood pressure reading, but did not actually put the word "hypertension" next to it. My husband told me that in order to get this reading, he had to sit and wait in between blood pressure readings in order for them to get it that low, which according to the AMA and the AHA, it was considered high and should have been monitored. No one told him this. After he got out, he visited a primary care doctor for some other problem and he told him he had HBP and prescribed blood pressure medication. Well, he has been medicated for this ever since. The problem is, when I realized that we could file for his HBP, the original doctors records were no longer available to him. We have been denied on several occasions, not because of the blood pressure reading on his discharge exam, but they stated that the word "hypertension" as a diagnosis was not shown on this exam, therefore, they were denying the claim based on this. They also stated that due to the fact that we could not retrieve his early medical records to show his treatment, then that was another factor taken into account for denying the claim. When he did change doctors, the next doctor did state in his med records that he had previously been treated by Dr. ? for HBP. Since I have been married to him all of these years and have knowledge of his early blood pressure problems, I wrote a letter on his behalf, only to be used as lay evidence and not medical evidence. Didn't seem to help at all. Not even sure they read it.

Well, he finally went to a C & P exam and I got a copy of the results. The exam stated that that it was as least likely as not that his HBP was due to his military service. I was shocked to see it. During the exam and my showing the doctor records that I had to show a nexus, she still didn't seem like she was in our corner. But, we still don't have a decision on this claim yet, so we are still not getting our hopes up. Everything sounds like it is in our favor, but this has happened before, only for the VARO to find something else to come up with to deny the claim.

Hope this short description of what we have had to go through might help someone else. Again, no two claims are alike and while one veteran may not have any problem what so ever with their claim getting approved based on their evidence, another veteran with similar evidence may get turned down. But, a little detailed knowledge from others on how their claim has gone through the process can be of great benefit to others in figuring out how to handle their claims.

mssoup

It is important to keep fighting for the sced benefit. I was diagnosed with hypertension after my return from Vietnam and it took me 3 years 67-70 to finally get it sced and 35 years later I had a heart attack and 2 open heart surgeries. I was raised to 60% because the hypertension was a contributing factor relating to coronary artery disease.

Jim Lane

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mssoup: You said that your husband was treated for his HBP, but his Drs. records are long gone. If he was being treated, then you needed to get his medication through a Pharmacy, and their records showing treatment would be the next best thing to prove HBP after service years. And If someone took over your old Dr's practice, is supposed to take custody of his records as well. I went to a clinic for a private Dr. for many years after service, and although he can not show treatment for what I needed, when he retired and the clinic closed, my records were sent to the Dr. who took over his patients. It took a little work, but those records may still be out their. If he is deceased, then try to locate a wife or check with the licensing board to find out what happens to his dead files.

good luck.

Jim S. ;)

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Jim,

Thanks for your reply. When he changed doctors, no records from the previous doctor went with him. He didn't like the doctor he was seeing, so he just changed doctors and apparently did not ask that any records be transferred. The only thing we could find documented was that this new doctor did note that he had been previously treated for some time for HBP by Dr. ?

This has been 30+ years ago and kinda hard to remember exactly what happened when he transferred doctors. Also, at that time, we knew nothing about filing claims for service connected issues, therefore, it would not have seemed that important at the time. I'm sure that has happened to a lot of veterans and now they wish they had known more at the time and done things differently. But, no one at that time was out there telling Vietnam veterans that if they had problems which could be service connected that they could file a claim and receive compensation for it. Now years later and they need this type of evidence, it is long gone. But, his discharge exam did show a high blood pressure reading and the C & p examiner did relate his current HBP to his military service. Also, the doctor who stated that he had been seeing Dr. ? for some time for HBP should have some bearing on the claim. This in itself should be enough to grant him service connection. But, I have thought before on other issues that all the evidence was in his favor only to have the VARO deny it.

The most you can do is send in everything you can and keep your fingers crossed that you are lucky enough to get a rater who will read the evidence and rate it fairly.

mssoup

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