What Is Best Way To Request Secondary Compensation

[toddt]

Was granted 30% for scar as a result of surgery for adenocycstic carcinoma. Surgery was radical neck dissection - which left me with limited range of motion of my right arm (due to shoulder muscles being removed). Attempted to bring this up at my C&P exam but the doctor didn't do anything about it.

Can I request another C&P exam for limited motion? If so, how would that request be made? Or,

do I need to appeal via a NOD stating that the doctor should have tested me for range of motion?

[john999]

You know your VA has the ability to write a perfect secondary condition opinion if they choose to do it. My PCP did if for me a few years ago when I wanted her to help me connect heart condition to DMII. Then VA changed their minds about helping vets do this, and I got a new PCP who was reluctant to stick her neck out for me. Since your claim is not final I don't think you have a CUE. The VA will not connect the dots for you even if it is obvious. That is why you get the private doctor to do it for you. This they will accept, sometimes. You get what you directly ask for from the VA. You have to know enough to ask, or they won't help you. This is my experience with all the conditions I have secondary to DMII. This is part of the learning curve at the VA.

[Berta]

that is ,a claimed residual......

we have to hold VA's hand on a lot of this stuff because they don't assume anything, if it could be favorable to us.

Also something triggered them to give you the scar C & P .... but no additional C & Ps...as far as I can tell.

For example a vet could have claimed DMII and then have obvious secondaries to DMII, like renal disease, candidiasis, IHD,but if the Vet didn't claim them, the C & P doc isnt obligated (or even the Raters) to address them for possible ratings.

And they would all require a C & P opinion as to the medical link to the DMII anyhow.

John is right on these points he makes and ,as a hardcore claimant myself, I learned that VA definitely cant connect the dots and it often takes an IMO/IME doc to do that.

Edited February 1, 2014 by Berta

[toddt]

Berta, I only claimed cancer, did not claim scars or anything else related to the cancer. I did have "boots on the ground" and asked that this be associated with AO, which they denied. I did get IHD AO presumed. I also got hearing loss and tinnitus. So, should this be a NOD? and if so should I elaborate on my range of motion, fatigue and pain when attempting to raise my arm above shoulder height?

On Wednesday I have an appointment at the VA in order to met with a PCP for the first time. I was thinking about taking VA Form 21-0960M-12 (http://www.vba.va.gov/pubs/forms/VBA-21-0960M-12-ARE.pdf) "Shoulder and Arm Conditions Disability Benefits Questionnaire" and having him fill it out.

Also, thought that this might fall under "Duty to Assist" because I would have thought the VA would have figured out that a radical neck dissection would have had other consequences besides just scars.

Edited February 1, 2014 by toddt

[TiredCoastie]

You're right, Berta and John. It's a gaping hole of a disability in my opinion and is so obvious that the Toddt may have a legitimate concern that it should have been picked up by a C&P or another VA exam and then compensated. But without someone connecting the dots...and we all know where that goes!

What do you think about Toddt taking a DBQ to a first appointment and asking for help, though, especially from a VA PCP? John, you've had trouble getting assistance from them and others have said as much.

Toddt, do you have an outside doctor who's working with you on your health concerns? If so, and you have an established working relationship with that doctor and can get that doctor's assistance, that's who I'd feel most comfortable approaching if it were me, even if it cost me money out of pocket. You can certainly take any and all diagnoses and records from your outside doctors to your VA primary care doc for their medical files...which may help you in the long run. But if you don't have a doc on the outside, even in the past, whom you can approach, you really don't have any choice but to approach the doctors you have now. As John points out, VA docs are not always the most cooperative with disability issues.

Edited February 1, 2014 by TiredCoastie

[toddt]

TiredCoastie, unfortunately my outside PCP who I had been seeing for close to 20 years was killed in an automobile accident. I will try the DBQ with the VA PCP if that doesn't work and I appeal shouldn't the VA schedule me for a C&P exam to ascertain my claims?

[Berta]

“Berta, I only claimed cancer, did not claim scars or anything else related to the cancer “

In that case I am quite surprised they gave you the scar C & P exam.

“Also, thought that this might fall under "Duty to Assist" because I would have thought the VA would have figured out that a radical neck dissection would have had other consequences besides just scars. “

I personally think the term Duty to Assist should be expanded to state instead....'you, the claimant ,have the duty to assist yourself ,by being as proactive as possible,in seeking all of the evidence you need for a proper decision.'

If I waited for VA to 'assist' me, all of my claims would be in the crapper by now.

You do have an good handle on all this, and seem willing to consider the excellent advice here, but dealing with the VA is not like dealing with any other federal entity. I call it VA 101 sometimes because it involves getting a real education that many of us never dreamed we would need to learn.

"So, should this be a NOD?"

A Nod , as the first avenue of attack on a faulty decision is also like a CUE claim in this way.....

(I call it the Watergate question)

What did VA know and when did they know it?

In you case they knew you claimed certain disabilities, and they knew the evidence was there for the cancer and the scar.

Are you able to scan and attach their decision here? Cover your name,address and C file # before you scan it.

I think you might have to file a new claim for the residuals. The decision will tell us more.

A NOD is a formal disagreement with their decision.

They cannot make a decision on what was not claimed.

They cannot deny what was not claimed.

And they really cannot commit a CUE (a legal error) on anything that was not claimed.

And secondaries need a medical opinion as to the secondary nature, no matter how obvious it might be,

so that VA can not only justify any comp they award for a secondary, (because the raters cant make medical decisions)

but also because a medical opinion is what they need to rate the secondary properly.

We could help more if we can read their decision.

Edited February 2, 2014 by Berta