Should I Apply For Increase In Rating

[Penelope]

Hi Folks -- I have just joined the forum, although I have stopped by in the past. I am at a point where I need some independent advice from those that have dealt with VA.

I have been service connected for Chronic Fatigue Syndrome since 1990. For the first 4 years, the rating was 30%, then they finally determined a rating code and it has been rated at 60% since 1994. Symptoms of chronic fatique syndrome include, but are not limited to sleep apnea, as well as muscle aches and pains, allergies, etc.

My condition has declined in that I now require a CPAP machine any time I sleep, as well as undergoing allergy shots, and injections for various joint pain. I have pretty much dealt with this, however it is getting to a point that I don't know for how much longer I can cope with it all. I currently work a reduced work schedule of 4 days of week, which has helped, but I don't know how much longer I can continue.

It was such a long drawn out process to get my claim finally appealed that I am hesitant to apply for an increase. Most of my medications VA doesn't carry and I use an outside pharmacy. Work is giving me more and more problems about the reduced schedule and it looks like the job I am working may be eliminated in the future. It is a job I can do and have done it for more than 18 years. My husband is a disabled vet, as well, although not service connected. Therefore it would be difficult to face a decrease in my rating. If I wait until 2010, does that mean my rating can't be reduced below 30% because I had 30% for 4 years and 60% for 16 years, or do I start again at 60%.

Any thoughts or advice would be appreciated. Thank you for your time.

[navydoc2]

'Penelope' date='Aug 31 2009, 09:38 PM' post='163577']

Hi Folks -- I have just joined the forum, although I have stopped by in the past. I am at a point where I need some independent advice from those that have dealt with VA.

I have been service connected for Chronic Fatigue Syndrome since 1990. For the first 4 years, the rating was 30%, then they finally determined a rating code and it has been rated at 60% since 1994. Symptoms of chronic fatique syndrome include, but are not limited to sleep apnea, as well as muscle aches and pains, allergies, etc.

My condition has declined in that I now require a CPAP machine any time I sleep, as well as undergoing allergy shots, and injections for various joint pain. I have pretty much dealt with this, however it is getting to a point that I don't know for how much longer I can cope with it all. I currently work a reduced work schedule of 4 days of week, which has helped, but I don't know how much longer I can continue.

It was such a long drawn out process to get my claim finally appealed that I am hesitant to apply for an increase. Most of my medications VA doesn't carry and I use an outside pharmacy. Work is giving me more and more problems about the reduced schedule and it looks like the job I am working may be eliminated in the future. It is a job I can do and have done it for more than 18 years. My husband is a disabled vet, as well, although not service connected. Therefore it would be difficult to face a decrease in my rating. If I wait until 2010, does that mean my rating can't be reduced below 30% because I had 30% for 4 years and 60% for 16 years, or do I start again at 60%.

Any thoughts or advice would be appreciated. Thank you for your time.

Sounds to me like you may be depressed. I would file a claim for depession secondary to primary rating, I would describe the issues you are having at work, the tough time you are having in general. It is keeping you from having a quality of life. I would file for the increase based on that issue. You may have to have repeat cp exams for your initial rating but that is par I'm told. If your husband is disable why not get him to apply for whatever he is disabled for as well. Welcome I hope this helps. Good luck.

Someone smarter than me will come along and answer you too I'm sure.

[carlie]

Hi Folks -- I have just joined the forum, although I have stopped by in the past. I am at a point where I need some independent advice from those that have dealt with VA.

I have been service connected for Chronic Fatigue Syndrome since 1990. For the first 4 years, the rating was 30%, then they finally determined a rating code and it has been rated at 60% since 1994. Symptoms of chronic fatique syndrome include, but are not limited to sleep apnea, as well as muscle aches and pains, allergies, etc.

My condition has declined in that I now require a CPAP machine any time I sleep, as well as undergoing allergy shots, and injections for various joint pain. I have pretty much dealt with this, however it is getting to a point that I don't know for how much longer I can cope with it all. I currently work a reduced work schedule of 4 days of week, which has helped, but I don't know how much longer I can continue.

It was such a long drawn out process to get my claim finally appealed that I am hesitant to apply for an increase. Most of my medications VA doesn't carry and I use an outside pharmacy. Work is giving me more and more problems about the reduced schedule and it looks like the job I am working may be eliminated in the future. It is a job I can do and have done it for more than 18 years. My husband is a disabled vet, as well, although not service connected. Therefore it would be difficult to face a decrease in my rating. If I wait until 2010, does that mean my rating can't be reduced below 30% because I had 30% for 4 years and 60% for 16 years, or do I start again at 60%.

Any thoughts or advice would be appreciated. Thank you for your time.

Penelope,

Welcome to Hadit.

You posted,

"Symptoms of chronic fatique syndrome include, but are not limited to sleep apnea, as well as muscle aches and pains, allergies, etc."

Any additional symptoms you feel may be related to your CFS will ned a doctor's statement

saying these medical problems are at least as likely as not related to your CFS.

Does your husband have any disabilities that are connected to medical evidence shown in his SMR's ?

Here's the information on Protection for Ratings.

Borrowed from elsewhere.

carlie

10/20 Year Service Connection/Ratings Protection

The 10 year mark for is for service connection. A condition that has been service connected for 10 years can not be severed unless fraud is involved. The clock starts ticking for conditions based on the effective date(s). This does not mean compensation can't be reduced.

The 20 year mark protects ratings. Absent fraud, disability ratings can not be reduced after they have been going 20 years. See your award letter for effective dates on each disability. Combined ratings are also protected after a 20 year period.

Example: You have been rated 50% for Condition A since 1990. You apply for SC for 4 more conditions and VA grants them in 2007. Because of VA granting them your new combined rating is 100% as of 2007. Condition A is protected from severance in the year 2000 and protected from reduction in the year 2010. The new service connected conditions would be protected from severance in 2017 and reduction in 2027. The clock started ticking on your combined 100% in the year 2007 so it would be protected from reduction in the year 2027.

If you apply for an increase for Condition A and are bumped from 50% to 70%, the 50% number is still protected from 1990 but the new 70% would start a new clock ticking (using the dates above). Meaning until you have held that 70% rating for 20 years, the lowest they can reduce you is back to 50% based on the fact that it was in effect for 20 years.

Even if a rater plugged the wrong numbers and wrongly awarded a combined 100%, they still can't reduce. Again, this is all assuming no fraud is involved. You can do the math by using the effective dates on your award letters.

"P&T" can be established at any time regardless of how long ratings have been held (via 100% scheduler or TDIU). If VA plugs all of your conditions and there are no future exams scheduled, then entitlement to Ch. 35 and ChampVA will be granted. If VA determines that there is a chance of improvement, there will be a future exam scheduled and "P&T" will not be established.

[Pete53]

Welcome to Hadit.

[Aquabear]

Hello Penelope. My advice and I'm a newbie so I won't be technical

File for an Increase

Be patient or try at least try to be

Read stuff on hadit, look on here for questions you have that someone may have already asked and answered; if not then ask them on here- most of the people here are great, sincere and helpful-

Find someone to help you- I got really lucky and have a great lawyer that used to work for the VA(super rare) but there are people out there to help you file claims papers, lawyers, veterans groups and more

Please don't go it alone as I did years ago- if I only knew now what I now (you havent heard that one before I bet )

Good luck, peace be with you

[Penelope]

Thank you very much for your help. You have given me a lot to think about. Your answers have prompted another question with regard to my husband.

My husband has degeneraqtive disc disease. Has had one hip replaced and the other needs to be done. His military medical records does show one instance of a a back injury. However, it wasn't until several years after military service that he started having recurring flare ups. We went to a service officer once and he said there was no way to prove that the back problems he was having now were related to the injury in the military. that We filed a claim, but I don't remember if we ever heard anything back from anyone and we never investigated further. He has been on Social Security Disability since about 1996. Do you think we should investigate filing his claim again. I just don't know what to think about it.

Thank you very much for your time and advice.

[LarryJ]

The Service Officer is not a medical doctor.

He should have never given you that advice.

Your husband should file a new claim.

If you have already filed for what you would be filing again for, then you need to come up with new and material evidence, etc.

But, according to what I've heard you say so far, then a "re-open" of an old claim may NOT be the way you want to go. There are other claims lurking here methinks.

Get your husband's SMR's (Service Medical Records). You can "order" them online from the National Personnel Records Center in St. Louis. If he does not have a copy of his DD214, get that from them also. Get ALL of his service records, essentially.

Then let's have a read-through and see what they actually say.

Then let's go from there.

Do not go off half-cocked and just "file a claim", before we get a chance to talk about it.

I am assuming that your husband's SS is from his DDD and hip replacement, etc.?

[Penelope]

Larry -- Thank you for answering. I know I have his military medical records and his DD-214, as well. I will look for them today and let you know if I need to order anything additional. Thanks again.

[Pete53]

Like PTSD many times a injury like a back can be figured out by an event that may or may not have been treated by medical doctors. A good example is falling off a truck or something else that may have been toughed out,

I Doctors Medical Opinion linking such an event can be enough to service connect your husband. Its not easy but can be done.Thios is where a buddy testimony can be of help also.

[LarryJ]

Larry -- Thank you for answering. I know I have his military medical records and his DD-214, as well. I will look for them today and let you know if I need to order anything additional. Thanks again.

One other thing.

Get ahold of the VA Regional Office where he filed his original claim and obtain his C-file (claim file). Do this ASAP because we'll not be going anywhere with his claim until we know what disposition was made of his last claim.

1-800-827-1000

[Penelope]

Thanks folks. I appreciate the help. I will get busy on all this today.

[Penelope]

One other thing.

Get ahold of the VA Regional Office where he filed his original claim and obtain his C-file (claim file). Do this ASAP because we'll not be going anywhere with his claim until we know what disposition was made of his last claim.

1-800-827-1000

[Penelope]

In July 2006, I have a letter from the St. Petersburg Regional Office, stating that we had submitted an informal claim. They asked us to complete additional forms, which we never did. I also have papers that the Service Officer sent to us for signature, but they were not submitted. My husband will call St. Pete today and request a copy of his c-file.

I looked over his military medical records this morning. In June, 1979 it says that he had lower back pain and been hurt since last week. Painful Palpitation of L lumbar ?? No xrays done. Gave him a profile for 3 days of no PT and no heavy lifting for 4 days. He got out in 1980, and there was no further mention of back issues. He also had surgery for a knee problem in the Army. In his medical records there are mentions of anxiety issues.

He was in supply in the army and had always done heavy work. After the army he was in shipping and receiving, again with heavy work. I think the next time he had a back issue was about 1984. The routine was that when his back went out they had him on bedrest for a few days and then he would go back to work. That continued off and on for years. This all being said, in about 1982 he was in a motorcycle accident and was thrown down the road. He was later diagnosed with hip problems and had his right hip replaced.

He declined an ETS physical when he got out of the Army. He has so many medical issues now, but I am not sure if we can tie them back to his service.

Any help is appreciated.

[pacmanx1]

More homework for you, reading your post, I see you started off by requesting advice about your claim and not your husband’s. Since you have gotten information on your husband’s claim let’s talk about yours. You say you are SC for Chronic Fatigue Syndrome. In some cases people who have CFS also have: IBS, Fibromyalgia, Depression, headaches, Sleep apnea and other conditions. If you have been treated for these conditions you can file a claim for them as being associated to your already service connected CFS without claiming an increase for CFS. If you have not been treated for these conditions you can have your doctor review your treatment records or perform an exam or refer you to a specialist to determine if you have these conditions and if you do write a statement that he/she believes that they are related to your CFS and then file for service connection for them. Since you are already 60% for CFS and working it would be almost impossible to get 100% for it so try to look at other disabilities to increase your overall service connection. Now back to your husband's if he got out in 1980 and had a motorcycle accident in 1982, he may have a problem with getting service connection for back and hip even though it is in his SMRs. VA may say that his current problem is because of the accident and not his military duties. Hope the best for the both of you.

Hope this make sense.

Edited September 2, 2009 by pacmanx1 (see edit history)

[Penelope]

More homework for you, reading your post, I see you started off by requesting advice about your claim and not your husband's. Since you have gotten information on your husband's claim let's talk about yours. You say you are SC for Chronic Fatigue Syndrome. In some cases people who have CFS also have: IBS, Fibromyalgia, Depression, headaches, Sleep apnea and other conditions. If you have been treated for these conditions you can file a claim for them as being associated to your already service connected CFS without claiming an increase for CFS. If you have not been treated for these conditions you can have your doctor review your treatment records or perform an exam or refer you to a specialist to determine if you have these conditions and if you do write a statement that he/she believes that they are related to your CFS and then file for service connection for them. Since you are already 60% for CFS and working it would be almost impossible to get 100% for it so try to look at other disabilities to increase your overall service connection. Now back to your husband's if he got out in 1980 and had a motorcycle accident in 1982, he may have a problem with getting service connection for back and hip even though it is in his SMRs. VA may say that his current problem is because of the accident and not his military duties. Hope the best for the both of you.

Hope this make sense.

Pete -- Your reply makes sense to me. That is the reason we never proceeded any further with my husband's claim 3 years ago. As far as my claim goes, I wouldn't qualify for 100% for CFS as it is listed in the rating codes. I more than qualify for the 60% rating, though. Over the years, I have had my same family doctor who helped me with my VA claim in 1990 and my VA doctor has helped me since I was granted service connection. My VA doctor has stated my medical restrictions are permanent. My VA doctor has stated in my records that I am now diagnosed with Sleep Apnea, and Diabetes and he referred me to another doctor for depression. After a change of hours at work, last year, my CFS episode, was devastating. My original thought was that the initial incident was due to low sugar. My VA doctor didn't seemed to concerned, but after a few days where I was in a fog, I went to the family doctor and he had the sleep studies done. I haven't had another incident, since I was put on the CPAP. The one incident made it clear to me that although I have dealt with my situation, the problem could be more serious than I realized. It is hard for me to determine what is actually a secondary condition to Chronic Fatigue. The sleep apnea makes sense to me as sleep disturbances are a part of CFS. For me this is a slow process because I want to make sure I have everything together before I submit a claim.

I appreciate all the information and advice. It sure is a lot easier talking to people about this now than it was 19 years ago. I thank you all for your participation in this site.

[pacmanx1]

OK, I am a little slow and my brain don't always work right but it does work. If you are rated for one condition at 60 % you can file a claim for IU. which means they will pay you at the 100% rate even though you are not rated as 100%. If your doctor states that your conditions are permanent than you should also think about this.

4.16 Total disability ratings for compensation based on unemployability of the individual.

(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination.

[LarryJ]

That's correct, pete, she has been rated at 60% since 1994.

Essentially, all she needs is a doc to say that the disability that got her the 60% is also the disability that has caused her to not be able to be "Gainfully Employed" and that this disability is not going to get better, ever.

That'd take care of her and get her the TDIU and the P&T (permanent and total), no future exams scheduled, and that'd open the box for her to get her Chap 35 benefits!

[Penelope]

OK, I am a little slow and my brain don't always work right but it does work. If you are rated for one condition at 60 % you can file a claim for IU. which means they will pay you at the 100% rate even though you are not rated as 100%. If your doctor states that your conditions are permanent than you should also think about this.

4.16 Total disability ratings for compensation based on unemployability of the individual.

(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination.

Pete -- Thanks again for your reply. At this point, I am employed and don't feel that I would qualify for unemployability. My income is above poverty level for one person. I need to hang on to my job as long as I can. My working environment has changed so much that it is possible my position will be eliminated and I am not sure I will be able find another. The medical insurance is important to my family to cover all the medical expenses. I am not sure how much longer I will be able to continue. I have already had to fight to keep this job twice. They have made it clear that they don't want anyone with medical restrictions. My condition is getting worse, and I am trying to prepare us for down the road. I think it might be best to try see if I would qualify for an increase due to secondary condition. Your help and insight is appreciated.

I really appreciate this board. After reading another post today, I was able to find my BVA decision online. I know I have the orignal here, but haven't read it in a long time. Today, I printed it off and read it. When they made the decision, they considered me for 100% at that time. I forgot all that I went through in working toward that decision.

Again, thanks for your time.