Have A Few Ratings Over The Years, All Basically The Same?

[MartyL16]

All the way back to 1987. Usually with the same denials. Never did they ever go back to the active duty records to "confirm" what I was telling them.

Rating usually stated "...is continued at %". or "remains denied" and you know what. I was too depressed and sick, and ignorant of how to proceed, how to fight for me, until lately!

My questions: Since they referenced no "codes", never explained why, and even when I stated extreme pain, on movement, did the wincing, refused to go past my "pain point", the ratings always said "mild pain". Since 2009 they stated they had no access to my records on the computer, so the only info that they had was my verbal answers to their questions.

Have to mention that I have NEVER seen "them" use a worksheet from the VA. Always saw them scribble a word or two on a regular tablet. Also never had an exam that went more than about 15 minutes.

I am thinking maybe since the info does not actually reflect what is in my "actual" records(that are only) referenced by "clinic name" but no specifics confirming my claims, shouldn't I have other appeal or legal rights?

Maybe their failure, over at least 4 separate ratings, to give me my rights of "due process", or whatever.

Since they always failed to describe the details, or use codes, maybe I can submit as "reopened claims" based on facts that they "missed"? Afterall, they now at least "mention" records that they have and should have had since 1967 and beyond.

For the record, I have an SC 0 from active duty, DM II from 2004 with a marginal SC % presumptive to AO from 'Nam and Thailand.

Thanks

[free_spirit_etc]

That is the question... how do I find what the rating criteria was in 1987?????

It looks like they didn't have a separate rating code for sarcoidosis in 1987. They rated it under something "close." So the part about the low-dose maintenance drugs wasn't even in the ratings. It was mostly based on pulmonary function and fibrosis.

http://www.va.gov/vetapp06/Files3/0614618.txt

In July 1987, the RO granted service connection for

sarcoidosis and assigned a 10 percent disability rating

under Code 6699-6802, effective from March 1, 1987, the day

after the veteran's separation from service. 38 C.F.R. §

4.97, Code 6699-6802 (1994). Code 6699-6802 was used to

rate the disability as the rating code does not contain a

separate listing for sarcoidosis. When an unlisted

condition is encountered it is permissible to rate under a

closely related disease or injury in which not only the

functions affected, but the anatomical location and

symptomatology are closely analogous. 38 C.F.R. § 4.20.

Thus, the veteran's sarcoidosis was evaluated by analogy to

pneumoconiosis. 38 C.F.R. § 4.97, Code 6802. This was the

most appropriate code since only lung involvement was

demonstrated, and the symptoms are essentially the same.

http://www.va.gov/vetapp95/files6/9526559.TXT

After reviewing all the evidence of record, the Board finds

that the 10 percent disability evaluation currently in

effect for the veteran's sarcoidosis is appropriate. In

order for the veteran to receive a higher rating for

sarcoidosis by analogy to pneumoconiosis, his symptomatology

must meet the criteria set forth in Diagnostic Code 6802 for

those ratings. To receive a 30 percent rating, there must

be moderate disability as manifested by considerable

pulmonary fibrosis and moderate dyspnea on slight exertion,

confirmed by pulmonary function tests. For a 60 percent

rating, there must be severe disability, as manifested by

extensive fibrosis, and severe dyspnea on slight exertion

with corresponding ventilatory deficit confirmed by

pulmonary function tests, with marked impairment of health.

38 C.F.R. § 4.97, Code 6802

Edited November 3, 2013 by free_spirit_etc

[MartyL16]

I am stumped by the VA treatment records discussed for treatment you stated you did not receive. These are not one time exams. They are records of treatment spanning several months. If they actually had other veteran's records in your file that affect the decision they made on your claim - they should readjudicate it as the file was tainted.

I guess I missed this one. The ratings for 2011 and before always state VA TREATMENT RECORDS, and until this rating I never "made anything out of this".

I don't use the VA for medical treatment, except optical, hearing, "shrink", and PTSD/Depression counselor. That has always been their "clear and unmistakeable error". That is why my ratings refer to CIGNA, and ASSOCIATED INTERNISTS since 1990.

Because of their error, they say no evidence found in VAMC medical records. You have to be a pretty dumb rater to not be able to figure this out for all of these years. Actually, I have found a few court citations the actually refer to what the VA needs to do when no evidence is found.

There is law established that states (specially, related to a VCAA letter), that if "they" cannot found evidence/records where the claimant states there are, or in the cases where doctors and hospitals fail to provide those records, "they" are required to notify the claimant, or the representative, of that "result".

Citation NR: 9634762 Decision Date: 12/09/96 Archive Date: 12/19/96 DOCKET NO. 94-24 656 ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida

The veteran should be requested to provide names, addresses, and approximate dates of treatment for all health care providers who have treated him for his respiratory disorders since January 1995. With any necessary authorization from the veteran, the RO should attempt to obtain and associate with the claims file copies of treatment records identified by the veteran. If no records can be obtained, the veteran and his representative should be informed of the negative results. 38 C.F.R. § 3.159 (1995)

Marty

[MartyL16]

http://www.healthvermont.gov/prevent/Sarcoidosis.aspx

What are the signs and symptoms?

Many people who have sarcoidosis have no symptoms. Often, the condition is discovered by accident only because a person has a chest x ray for another reason, such as a pre-employment x ray.Some people have very few symptoms, but others have many. Symptoms usually depend on which organs the disease affects. Symptoms from sarcoidosis in the lungs and lymph nodes include shortness of breath, a dry cough, wheezing, and enlarged and sometimes tender lymph nodes. Changes in sarcoidosis usually occur slowly (e.g., over months). Sarcoidosis does not usually cause sudden illness. However, some symptoms may occur suddenly. They include:

• Disturbed heart rhythms
• Arthritis in the ankles
• Eye symptoms.

This is good, no great!

Thanks

Marty

[MartyL16]

That is the question... how do I find what the rating criteria was in 1987?????

It looks like they didn't have a separate rating code for sarcoidosis in 1987. They rated it under something "close." So the part about the low-dose maintenance drugs wasn't even in the ratings. It was mostly based on pulmonary function and fibrosis.

http://www.va.gov/vetapp06/Files3/0614618.txt

In July 1987, the RO granted service connection for

sarcoidosis and assigned a 10 percent disability rating

under Code 6699-6802, effective from March 1, 1987, the day

after the veteran's separation from service. 38 C.F.R. §

4.97, Code 6699-6802 (1994). Code 6699-6802 was used to

rate the disability as the rating code does not contain a

separate listing for sarcoidosis. When an unlisted

condition is encountered it is permissible to rate under a

closely related disease or injury in which not only the

functions affected, but the anatomical location and

symptomatology are closely analogous. 38 C.F.R. § 4.20.

Thus, the veteran's sarcoidosis was evaluated by analogy to

pneumoconiosis. 38 C.F.R. § 4.97, Code 6802. This was the

most appropriate code since only lung involvement was

demonstrated, and the symptoms are essentially the same.

http://www.va.gov/vetapp95/files6/9526559.TXT

After reviewing all the evidence of record, the Board finds

that the 10 percent disability evaluation currently in

effect for the veteran's sarcoidosis is appropriate. In

order for the veteran to receive a higher rating for

sarcoidosis by analogy to pneumoconiosis, his symptomatology

must meet the criteria set forth in Diagnostic Code 6802 for

those ratings. To receive a 30 percent rating, there must

be moderate disability as manifested by considerable

pulmonary fibrosis and moderate dyspnea on slight exertion,

confirmed by pulmonary function tests. For a 60 percent

rating, there must be severe disability, as manifested by

extensive fibrosis, and severe dyspnea on slight exertion

with corresponding ventilatory deficit confirmed by

pulmonary function tests, with marked impairment of health.

38 C.F.R. § 4.97, Code 6802

WOW, this explains a lot. They didn't have a rating, so they "dumped" it into the bag of tricks.

Where did you find this?

Under the last paragraph, IF they had looked at my X-rays from '85-87 for the extensive fibrosis, took the Cushing's into consideration, the final doctor's notes that I was still "active" sarcoid, tested for the severe dyspnea on slight exertion and obviously, the "ventilatory deficit", I might have been given a 60%. One can dream......

This info is terrific.....I think.

Does anybody have any ideas on what to do with this info?"??????

If I can get them to reevaluate back to then, or after 1988, when I again asked for an increase, and was denied from then to now.

It appears that they "NEVER" actually looked at my records in depth. You see some of my court citations. Could this be a CUE, or should I just try the "reopen" on new and material as it is apparent they never reference and PFT exams from '85 except their own.

Wonder what the laws were, or where to look. I see a lot of VN and KOREA vets using the "due process" approach. This from a rebuttal to a SOC:

The American Constitution requires that a person cannot “be deprived of life, liberty, or property, without due process of law.” The Federal Circuit also stated, “We find that a veteran alleging a service-connected disability has a due process right to fair adjudication of his claim for benefits.”

Thank you so much for this info, your research is so valuable and appreciated

Marty

[MartyL16]

For the increases: What I suggest you do is look at the rating schedules and see what the rating schedules say about the conditions you are claiming. And then see how your evidence lines up with meeting those rating schedules. That way you will be setting a good foundation for building your claim on those.

The court cases can be very helpful in how the law is applied. But first, you need to make sure you are meeting the requirements of the ratings.

Yes, thanks.

Actually, and there was no way for you to know it but since 2011, I have been puting the "pieces" together on their errors, my "evidence" supporting my increases, where I am telling them the % shoul be, and then finding the 'perfect" case law supporting it and my appeal. I have 2 years of "printed" to PDF cases, with keywords in the title, stored on an external hard disk. Maybe 400 cases or links.

Since I never explained that I was somewhat organized, I will just reiterate, that for the most part, I understand the laws and rules but don't know, pretend to know, or do more than guess at "what are the best practices"

For those answers, I come to all of you for "guidance"

Marty

[free_spirit_etc]

"Where did you find this?"

Went to BVA search http://www.index.va.gov/search/va/bva.html

typed in sarcoidosis and 1987 and read a few cases that discussed people being granted SC for the condition back then. The old rating schedules should also be in the older editions of the Veterans Benefits Manuals. The VSOs should have copies they would let you read. (But they won't let you take them...)

They should also be available through the Dept of Veteran's Affairs.

Keep in mind if you are going to try to argue CUE, it will be based on the laws that were in effect at the time. So in order to effectively argue them - you would need to get a copy of laws that were in effect at the time the decisions were made.