Als Claim

[mom24]

Hello,

I posted a question before I believe in wrong place because I didn't get any response. So, I'll post here and try to be brief. I filed claim for ALS on 9/24/08. Had to get a VSO with PVA to get ball rolling for me. He did. I was scheduled for a C&P exam on 2/23/09. The dr who did the exam had me scheduled for an EMG to confirm the diagnosis. I wasn't happy with how exam went and let my VSO know about. On 2/27/09 I received an award letter being rated 60% for ALS for a combined 70% with my knee disability from before. I immediately called my VSO because the rating decision was made on 2/23/09, the day I had my C&P exam, which wasn't even concluded. AFter a couple of days, he got back with me to let me know the rater told him she rated me just so I could start getting some compensation because it would be 20-30 days before she got results from exam back, and when she got the results from C&P exam, she would rate me again. Fast forward to last week. On Tuesday, I emailed my VSO for an update. Didn't hear back from him by Thursday, so I called the 800# and was told my claim was closed with no further action pending unless I appealed. I then left another email for my VSO and and a voice mail message. On monday morning I got email from VSO saying he would pull my file and see what was going on. I then, that same day, went to VAMC to request a copy of C&P exam and was told it wasn't done! The lady at release of information office could only pull off a progress note dated 3/13/09 from the Dr. who did my exam stating that a C&P exam was scheduled by VARO on 2/3/09, but then cancelled before the date I had it which was 2/23/09. Nobody notified me or the VAMC of this since I had my exam as scheduled. The dr's note from 3/13/09 also gave results of EMG. The lady at release of information called down to C&P office to see what was going on. I was able to go down there and actually speak to the Dr. who did my exam. I had my award letter with him and explained to him how I was rated based on medical records from my dr that I submitted and why they were not sufficient for VA rating purposes. I asked him if he still had notes from my claim and he did. He said that after he got results from EMG and went to enter his findings in the computer, the screen for him to enter it wasn't there. HE then saw where the exam had been cancelled citing adequate medical evidence already received as the reason. He read over my notes again and actually examined me again. We talked some more and then he called the rater while I was in his office and let her know that he still had his notes from my C&P exam and he could type them up if they would be of some use to her. He told her that medical records I submitted from my dr. contained more diagnostic information about my condition than functional. I know the exam would have either brought me to 100% or the claim I filed for IU at same time I submitted back in Sept would have been approved based on his notes. Rater had also denied my claim for IU because I homeschool my children. Now, on Friday, I also submitted a IRIS inquiry and they answered me on Monday to say that they reviewed my file but needed clarification from the Regional Office before they could give me a status. I was able to update them with the information I got from the Dr. who did my exam on Monday. So, now it is Wednesday, and I still have not heard back from my VSO and still waiting to hear back from IRIS inquiry. Right now, I'm just giving my VSO and IRIS time to respond before I do anything else like a Congressional Inquiry or something. Any advice?

[ZenArcher]

Others here are much more adept at getting things done with the VA than I. I can tell you that I was initially rated at 70%. I had two choices at that point. I could appeal and wait or apply for an increase. I chose to file for an increase. I can't speak for you but I go to the ALS clinic every 3 months. That means I have new evidence every 3 months if required. I got copies of my records from the clinic looked at 38 CFR Part 4 and did some research. When all was said and done I submitted a package documenting every symptom, I tied that symptom to a neurological cause noted in the neurological section of the CFR and I pointed to its mention in my medical records. This got me another C&P with an internal medicine doctor and long story short I'm now 100% SMC L, approved SAH and auto.

My opinion is that ALS doesn't give us the time to wait on an appeal. I don't know how far you've progressed or what your current condition is but in my experience I wouldn't bother with TDIU and simply go for 100% P&T. Unfortunately ALS makes that easily attainable in fairly short order.

[Berta]

I suggest you try to re apply for SSA_ and try to get a lawyer to help-

ALLSUP inc might be able to assess your SSA case better if you contact them at their web site.

This is very unfortinate- that you dont meet that 5 year criteria to re apply now- but a good lawyer might find a way around that as the disability has been re-characterized- from the initial diagnosis-

the one they denied you on.

Zen -thank you for saying what I could not put into words here myself-better this should come from you-

Of course you are absolutely right and VA knows know this is a progressive and fatal disease.

That is why former Sec Peake told the ALS vet to pray that the regs would come through-

ALS vets dont have time to appeal for years and years like many other vets do.

I wish I had a JD and was member of the bar-I would represent this vet in a heartbeat to fight for her SSA benefits. The original SSA denial sounds to me like it was completely wrong.

Just like VA claims maybe there is potentialway to re-open that denial and then the 5 year work history criteria would be moot.

[Berta]

Mom24- did I understand in a past post that the SSA had re- characterized your disability- or used a different type of disability?

In other words was that original SSA denial based on diagnosed ALS or something else?

I might have mixed that up with some one elses post - does this apply to your first post here?

[mom24]

Berta,

SSA denied me based on a different diagnosis than ALS which was Progressive Muscular Atrophy(which essentially is the same thing, just with slower progression). I've talked to a lawyer already and according to her, there is no way around the work credit thing, except applying SSI based on income and we do not qualify for that. If I had appealed the denial before, there would be no problem, but since I didn't, I would have to re-file and they can only look at evidence from before 2006. I guess I could try and fight that because my first diagnosis was ALS, but I just don't want to.

Zen,

I agree with you about not trying for TDIU and just going for 100 P&T. I have already decided that if I'm not re-rated by schedular at 100%, I will just file for an increase after getting the proper evidence. I will enroll at the VAMC and start seeing a doctor there and continue to see my doctor at the ALS clinic. I do not attend the ALS clinics. My doctor said I should just see the occupational therapist and physical therapist there as needed. I have an appointment with her in July and I will ask to see the occupational and physical therapist. This way, I can get some better detailed evidence. I'm also going to stress every symptom I have been dealing with. From being on different ALS forums, I have been finding out that a lot of symptoms I have been dealing with are related to ALS. I wasn't aware of some of these, like frequent urination and neck clicking. I thought it was just me. Anyway, I think this is the better rate to go. Of course, I wont mind at all if they give me TIDU in the meantime.

[Pete53]

You should go back to SS and ask them to reopen your claim due to missed diagnosis. I have a friend who had the same problem and they reopened and he got 7 years of back pay. If you go back far enough the work credits should be met.

Good Luck

[mom24]

Pete,

I will look into it. They can only say no, I guess, but after fighting with the VA, I'm not up to fighting with SSA.