tdiu Seeking Guidance From My Old Friends (And Hopefully Some New Ones)

[rentalguy1]

The folks who have been on this board for a while know me, and know what my last VA battle entailed. A quick rundown for new folks, or the old ones that have forgotten, though:

I am 90/ TDIU/ P&T since October 2008. I have not had any C&P's scheduled, and it is written in my last decision letter that no more will be scheduled. I've been around the VA long enough to know that what is written in that decision letter and a dollar will get you a cup of coffee, though. I have several conditions that are currently SC'd and rated. The list is:

Neurogenic Bladder - 60%

Intervertebral Disc Syndrome - 40%

Mood Disorder Due to a General Medical Condition - 30%

Sciatica - 10%

Left Knee - 10%

Right Knee - 10%

Hearing Loss - 10%

Tinitus - 10%

Left Foot Plantar Fascitis - 10%

I have moderate to severe central canal and foraminal spinal stenosis, facet joint arthritis, and degenerative disc disease in my entire lumber spine. I also have healed compression fractures at T-11, T-12, and L1. This has led to a foot drop on the right side that I have to wear a AFO brace for. I have a torn meniscus and sctretched PCL in the right knee, and "runner's knee" in the left knee. I have to take about 30 pills a day in order to function at a minimal level, and have been doing so for many years.

In the last 2 years, I have started to go downhill in many areas. The medicaations have caused me to have chronic abnormal liver enzymes and chronic gastritis type symptoms. I took a fall in 2010 when I tripped over my droopy foot and injured my right shoulder. Last winter I started developing sciatica on the left side, and last month I was diagnosed with bursitis in my left hip, which is every bit as debilitating as the back pain.

While researching on Hadit for a friends claim, I found a Fast Letter from 2010 regarding TDIU. It states that if a veteran is rated as IU based on a single issue, then that issue is considered a total (100%) rating for the purpose of assigning SMC - S. I am thinking about filing a claim for the S award based upon my IU for IVDS (the condition used in the VA's decision to grant me TDIU) and having a 60% award in addition. I am also thinking of filing a claim for a K award based upon the right side foot drop. Since I would already be filing, I am thinking I might as well ask for SC for the shoulder injury, hip bursitis, left side sciatica, digestive issues, and elevated liver enzymes. I would also seek a increased rating for the right side sciatica, due to the foot drop and possibly attempt to reopen a claim for GERD that they have denied a few times, but I almost got overturned on a DRO review in 2009 (they wanted to scope me for the C&P when the findings of that test weren't pertitnent to the rating criteria in any way, so I said no).

The thing is, I know I am already considered 100% P&T. I know I may get a schedular 100%, but I don't know if it would effect my P&T status. I know the additional schedular ratings would not increase my monthly compensation amount, but the two SMC awards would. However, I don't really need the extra money, since we are doing fine right now. My main points for wanting to do this is 1) I have legitimately earned the ratings, and feel I should be compensated for them, and 2) I want to have the digestive system, liver abnormalities, and GERD SC'd, because any one of them could turn into a life threatening condition down the road (should I die of a SC'd condition my family would still have some benefits).

My head is telling me to file these claims for the main reasons I just stated. My gut is telling me that I am currently off their radar screen and will be for a long time because of the OIF/OEF vets filing their claims, and the enormous backlog of claims that the VA is currently dealing with. Knowing that, my gut says to let sleeping dogs lie until they wake up on their own. In other words, my gut is saying when the VA decides that they didn't really mean P&T when they put it in writing, and call me in for a C&P, I could file the claims then. What do you guys and gals think? Go for it, or leave it be?

[carlie]

Make no mistake, I am in no way scared of waking the dog.

I just don't know that I have the fight left in me to pursue what would come next. What I do know is that I don't feel well, and it gets worse every month. I'm having near constant chest pain and shortness of breath that we have determined is not cardiac/respitory related. It could be from the GERD, but not in the location it currently resides. The pain is to high and localized. My liver enzymes are out of whack, and have been since not long after starting the opiods.

I am very near the top of the totem pole, and they can decide at any time to knock me down. Given that I know the current states of all of my medical conditions, and what each practitioner has had to say about them in my records, I am not worried about a proposal to reduce. I know that it would cause a lot of undue work on their part.

rental - the bolded and underlined above is probably the most important part of my concerns, that I am posting

about in this thread.

For myself and some vets/claimants that I know personally, I always question - will the battle and stress

be worth the possible outcome, if there might be a fight, to be had.

I have complete faith in your abilities to win a battle, if one should begin - but my concern is,

how much damage is preparing and fighting the battle possibly going to do to you and your health.

Me - I feel pretty rough many days of each month, I feel I am covered well enough but I have no one

that VA will provide any additional benefit to, should/when I die - whether I die from a SC'd condition

or not.

My train of thought is not - oh crap - vets going to submit a claim for additional issue/s and or request xyz, hb or a&a,

so right off the bat VA will do a proposal to reduce.

My train of thought is - vet is at a pretty good level of compensation and benefits - vet is considering

submitting a claim for additional issue/s and or request xyz, hb or a&a.

If there is not sufficient,current evidence of record for these issues, VA will schedule some examination/s.

In doing this/these exams, is some bone head examiner going to write a ROM, negated to verify a condition

of abc still exists and at what criteria, is this examiner going to provide medical evidence that the vet has

been RX'd steroids two or three times this past year for their SC respiratory disability -

which might increase that evaluation by 10

but then follows up in their next paragraph stating, they noticed the veteran ambulates well and shows no difficulty

in their gait.

A decision maker latches onto this one part regarding gait being OK - vet has a percentage evaluation

that the schedule of rating specifies something about gait

and BAM - this is where I see a proposal to reduce being thrown in.

Heck - this process is so screwed up, this decision maker go ahead and adjudicate a grant for the additional

claim being made for xyz - but along with it comes this little proposal to reduce something the vet was in receipt of.

I know that when they open my volumous C-file that they will see they are not dealing with a normal vet, but one who knows their games and is comfortable fighting on their level using their own weapons against them. Should a new claim on my part still make them take the decision to review my current ratings, I know how to fight back against that process as well. I have had numerous C&P exams, and I know how to handle them. I agree with your statement about all bets being off if you are under the 20 year mark,

rental and all - on the above - I suggest again to proceed with caution, weigh your risks both benefit wise

and your health wise.

Yes, in going thru your file they will probably see well written claims and that you are familiar with the va claims process.

You are not a doe-doe nor ill-informed, they will hopefully realize this.

But with the wrong or incorrect stroke of a pen - difficulties can and do occur.

If they do deny, are you prepared to file a NOD, have a De Novo Review or wait for a DRO hearing, Form 9

Substantial Appeal, BVA hearing - I see 2 - 3 - 4 - 5 years of my life and health ticking by and I'm back on that

f'ing hamster wheel, caught up in the fight and the waiting, the unknown and the raging anger -

and wonder, is the outcome worth all of this ?

I know, I know - I'm sitting right on top of that totem pole - and it sounds pretty easy in my current situation,

to see things this way -

BUT even when sitting at 20 percent SC'd - I still saw it this way . . .

I continued the fight - they FINALLY began acknowledging the evidence and it ended up resulting in

retro of 100 % back dated about eight years - I can't even figure out how many years this all took out of

my life and how much more damage was done to my health.

So, my words on this is still to use caution and choose your battles, even possible battles - very wisely.

But just like broncovet says, "That sleeping dog will wake up as soon as he is ready, whether I am or not." I think I'd prefer to be ready by throwing the first punch. It woud be one of my typical first punches, though. It would include every scrap of evidence that boosted my claim, and every regulation and law that they have to follow in order to adjudiate. I've always filed my claims by telling them "This is what is wrong with me - with documentation to back it up, this is when it happened to me - with documentation to back it up, and this is how the two are tied together - with medical documentation to back it. Then I also send in all the pertinent regs, laws, BVA opinions, and CAVC opionions - each marked up with a highlighter so they don't have an excuse for not seeing it.

rental - if all claim issues were handled as above, if all examiners and all decision makers were doing a bang up job

judged by accuracy, if notices didn't get lost or sent to the correct address in a timely manner, business around

here would be on the decline. I think for every 1,0000 vets that learn more about the VA claims process, the

BVA gets another lawyer on the payroll - hypothetical of course but I know you get the intent of this thought.

So, if I am filing those three claims, and it might wake up the sleeping dog, then I might as well file for the S and K awards. Since that increases the chances of wakig up the dog even more, then I might as well go all in, and file the new claims for the shoulder, the hip bursitis, and the left sciatica, and the increase for the right sciatica/foot drop.

Like it was said, the dog may wake up anyway at any time, so why should I wait until I am possibly in such a condition that death would be near? I'm just unsure if I lack the stamina to follow it through all the way to the end.

Maybe I should start out by gathering all the records, obtain the definitive nexus statements that I need, and writing the claim request.

Yes, if your going to submit something for additional benefits - this opens up the whole ball of wax

for a little re-inspection, then I'd go ahead and kick the doors open for everything my evidence met the criteria for.

Again - I refer to the sentence bolded and underlined above. It's your claim, it's your decision -

I will certainly support your decision - even tho you don't need my support, just please really think on it hard,

before submitting anything additional, locate possible pitfalls and prepare.

Our families go thru much of this with us so it's also important how much this effects our lives and our relationships

with them.

The only benefit I receive by continuing to point these things out - is that I know that if there are any problem down the road -

I did my best to send out caution, to the veteran/claimant.

JMHO - carlie

[broncovet]

Rental

I call this a "risk/reward" analysis. Ask yourself:

1. What are the risks of applying for more benefits? That is, how much greater, if any, is the risk of being reduced if you apply for an increase vs if you do nothing. You have to make that judgement call.

2. What are the potential rewards? It sounds like you have a potential of SMC S, about 300 per month.

3. Is the risk worth the potential reward? If the answer is yes, then file.

In a nutshell, you really dont want to take BIG risks for small rewards. You probably dont want to take your whole 401k and put it on the red 7 on the roulette wheel. The risks are too high. However, if you are passing through Vegas, you may decide to put $10 on red 7. Why? Because if you loose, it wont likely change your lifestyle. You have probably lost $10 before and will likely again. But if you won, and the odds were 100 to one, then you could win $1000. Instead take small risks for big rewards. Oh, and dont keep playing the roulette wheel with $10 a pop until your 401k is gone, either. ONE time.

[carlie]

You probably dont want to take your whole 401k and put it on the red 7 on the roulette wheel. The risks are too high. However, if you are passing through Vegas, you may decide to put $10 on red 7. Why? Because if you loose, it wont likely change your lifestyle. You have probably lost $10 before and will likely again. But if you won, and the odds were 100 to one, then you could win $1000. Instead take small risks for big rewards. Oh, and dont keep playing the roulette wheel with $10 a pop until your 401k is gone, either. ONE time.

bronco,

Oh - I just really like roulette - seriously!

I put a black chip straight up on 17 - box the corners with greens and fill in the splits with nickels.,

run it the same for about five spins - just to see what's coming home to momma !

Sometimes I get a real high and sometimes I just have to say OH Crap and walk away.

[rentalguy1]

Aside from buying a couple of lottery tickets when the jackpot gets up to eleventy bazillion dollars, I've never been much of a gambler. I do understand risk/reward analysis and opportunity costs, though. I'm weighing it all out. I didn't reallize until today that since I am rated P&T that my wife is entitled to DIC after 8 years (I think. It might be 10). If I my interpretation of that is incorrect, someone please set me straight. Does anyone know if a claim for SMC is a claim for increase, or a stand alone claim? That will be factored into whatever decision I make.

Is anybody else on the PC doc roller coaster? I have had about 6 docs in the last 3-4 years. My latest one, who was awesome, just left the VA about a week ago. He couldn't take their crap anymore. I really need to get this chest pain looked into futher, but I don't even know who I'm assigned to right now. Neither does the staff at the CBOC. They opened up that clinic and left the poor guys working there hanging out to dry. This pain is different than the pain I have had with the GERD. It's higher in my chest, and at times feels like a mild upper respiratory infection, but it's not. I am having mild shortness of breath with it, and getting physically exhausted with very little exertion, too. I seem to bounce back from the exhaustion relatively quick, though. Sorry, had to get that off my mind. It's really bugging/worrying me, amd that's out of character for me.

[jvretiredvet]

since I am rated P&T that my wife is entitled to DIC after 8 years (I think. It might be 10). If I my interpretation of that is incorrect, someone please set me straight. You're corrected. 10 Years (unless you pass from a service connected condition). The 8 years refers to entitlement to a higher rate of DIC. The regs are: 38 CFR 3.22 http://www.benefits....PART3/S3_22.DOC and 38 CFE 3.10© http://www.benefits....RT3/S3_10.DOC

Does anyone know if a claim for SMC is a claim for increase, Yes.

Aside from buying a couple of lottery tickets when the jackpot gets up to eleventy bazillion dollars, I've never been much of a gambler. I do understand risk/reward analysis and opportunity costs, though. I'm weighing it all out. I didn't reallize until today that since I am rated P&T that my wife is entitled to DIC after 8 years (I think. It might be 10). If I my interpretation of that is incorrect, someone please set me straight. Does anyone know if a claim for SMC is a claim for increase, or a stand alone claim? That will be factored into whatever decision I make.

Is anybody else on the PC doc roller coaster? I have had about 6 docs in the last 3-4 years. My latest one, who was awesome, just left the VA about a week ago. He couldn't take their crap anymore. I really need to get this chest pain looked into futher, but I don't even know who I'm assigned to right now. Neither does the staff at the CBOC. They opened up that clinic and left the poor guys working there hanging out to dry. This pain is different than the pain I have had with the GERD. It's higher in my chest, and at times feels like a mild upper respiratory infection, but it's not. I am having mild shortness of breath with it, and getting physically exhausted with very little exertion, too. I seem to bounce back from the exhaustion relatively quick, though. Sorry, had to get that off my mind. It's really bugging/worrying me, amd that's out of character for me.

[john999]

I would go outside the VA and get a second opinion on your chest pain.