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14 Questions about Veterans Disability Compensation Benefits Claims 

When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about when it comes to filing VA Disability Claims.









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JustGettingStarted

CUE for Eczema-like condition denied :-(

Question

I sent this CUE to Berta on another thread and she thought it was really good.  However, I just got a denial from the St. Pete VARO today (they are really illiterate).

At issue is the fact that any conditions similar to dermatitis or Eczema are rated under code 7806.  These conditions can be rated on amount of body they cover, or more importantly, how often you have to take "systemic medication" for them.  Systemic medication is usually defined by the VA as oral medications or injections, but not topical medications and if you take it constant or near constant, the rating is 60%.

In the denial letter, I am still service connected for a skin condition at 0% as I was in 2009, but the VARO completely ignored the fact that I have been on constant systemic medication since 1998 and should be rated at 60%. The medication was completely ignored in the decision.  I provided military medical records from 1998 where I was put on constant medication, and Bluebutton pharmacy records from a military facility that date back to 2004.  All that evidence was submitted with my CUE.  

I thought this was going to be so cut and dried, and now I know why so many people complain about the VA ignoring the evidence and why the appeal system is so backed up.  I guess I will be getting on the hamster wheel and ask for a reconsideration/DRO Review/Appeal.  

Anyway, I attached a redacted copy of the CUE that I did in the event someone can use it as an example. I hope it works better for them than it did for me.

JustGettingStarted

Motion for Cue-REDACTED.pdf

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After typing the above, I received a copy of my decision letter.  It says:

"Evaluation of [skin condition] currently evaluated at 0 percent disabling.  We received your request for reconsideration of the evaluation for your service-connected [skin condition].  We scheduled you for a VA examination and a medical opinion regarding your current continuous treatment.  However, we received notification that you were unavailable for your scheduled VA examination on September 8, 2017.  The results from this scheduled exam may have allowed us to grant an increase in your service-connected disability compensation.  If in the future you provide us with your good cause reason for missing your scheduled VA examination and you indicate a willingness to report for another VA examination we will reconsider your claim.  We have continued our non-compensable evaluation for [skin disease]."

I already contacted the VA and told them I was never notified of an exam for 8 September.  When LHI had called to try and schedule an exam, I let them know I was out of town all but 3 days of the days they wanted me to schedule me.   I never received an appointment packet and I called VA 3 times asking when the exam would be scheduled.  When I found out a decision letter was being sent, I contacted VA, I was told an exam had never been scheduled and they would request a new one.  Now I have a new skin exam next week, but I am a bit concerned it won't cover my eczema-like condition.  The decision letter I just received says they have deferred a decision on "verrucae vulgaris, left hand (also claimed as neoplasm benign)".  That does not make any sense at all.  I am service connected for chronic warts (verrucae vulgaris) on my left hand, and have 10% for the basal cell I had on my left calf.  This VA cannot get anything correct it seems.

JustGettingStarted

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This just gets weirder and weirder.  I got a decision letter today basically denying everything except giving me a rating a did not request and am not warranted.  However, since I won't get a copy of the C&P exam that was done by a contractor for 8 or 9 months, I don't know how to even go about fixing it.  

Under Entitlement to Special Monthly Compensation, loss of use of a creative organ benefits I was denied.  "During your rmost recent VA Gynecological examination the VA examiner reported that you underwent a dilation and curettage procedure with hypothermal [sic] ablation after a hysteroscopy.  This procedure did not result in the removal of your Vulva, Uterus, or cervix injury.  The VA Examiner did note a history of friable cervix, but did not report this as current active condition.  The VA Examiner stated upon examination that you have not had a hysterectomy, uterine prolapse, removal of fallopian tubes or ovaries.  The VA Examiner reports that you underwent natural menopause without complications from a pregnancy or any gynecologic condition.  The Examiner found no objective medical evidence of endometriosis, incontinence, constipation, leakage or rectofabginal fistula and no benign or malignant neoplasm or metastases was found on examination.  Therefore, without a current diagnosis of a service-connected condition that would cause loss of use of a creative organ entitlement to Special Monthly Compensation, loss of use of a creative organ benefits is not met."

They completely ignored the fact that endometrial ablation is a form of sterility whether or not the uterus is removed.  There is precedence for this and I am going to keep fighting:  

Citation Nr: 9914661:    The examiner remarked that the only chronic residual of the veteran's endometrial ablation was sterilization.  A VA medical opinion in February 1998 stated that endometrial ablation usually resulted in sterility.  However, if a patient did become pregnant following such a procedure, it was highly unlikely that she would have a normal pregnancy and delivery....However, the RO did grant special compensation for the loss of use of a creative organ....The Board further finds that the veteran has should be service connected for all the residuals of her surgery, not just for the loss of the creative organ, as well as the underlying disability that necessitated her surgery."

Citation Nr: 1026353:  Likewise, based on the objective medical evidence of record, the Board finds that the Veteran's disability is not for consideration under the rating criteria of Diagnostic Code 7618, as the evidence of record fails to show that her uterus has been removed.  While the Veteran's ablation has rendered her sterile, she has been awarded special monthly compensation for the loss of use of a creative organ.  The ablation, while destroying the endometrial lining of the uterus, has not caused the removal of the uterus, including its corpus as required for consideration under Code 7618.  

The VA is even considering a code for Female Sexual Arousal Disorder so women can receive SMC-K for it, and that does not involve the loss of any sexual organs.  "In order to ensure gender parity, VA proposes the creation of a new diagnostic code 7632 “Female sexual arousal disorder (FSAD).” There is no diagnostic code in current § 4.116 which allows for analogous rating of female sexual arousal disorder, to include consideration of special monthly compensation. Under proposed diagnostic code 7632, female Veterans with service connected FSAD but without physical damage to female genitalia would be evaluated at 0 percent with a note directing rating personnel to consider eligibility for special monthly compensation (SMC-K)."  https://www.federalregister.gov/documents/2015/02/27/2015-03851/schedule-for-rating-disabilities-gynecological-conditions-and-disorders-of-the-breast
 

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I wanted to separate out the really weird part of my decision letter.  In my decision letter they have raised my rating from 0% to 30% for "Early uterine fibroids status post hysteroscopy and uterine hydrothermal endometrial ablation."  This is really weird because I didn't request it and the statements under the reasons for decision are totally out of sync with what I told the examiner, and gave her in writing. 

It says they have assigned 30-percent based on  "Symptoms not controlled by continuous treatment.  This is the highest schedular evaluation allowed under the law for disease, injury, or adhesions of female reproductive organs (uterus).....NOTE: The VA Examiner states that you experience "metrorrhagia and Menorrhagia Bleeding in between periods an [sic] prolonged periods."  Since the continuous medication you take does not completely control the condition a 30 percent evaluation is assigned.  The effective date of increase is the date we received your formal claim and your Intent to file a claim.  Since both claims forms were received on the same day your date of increase is June 5, 2017."

First of all, I was still in my original intent to file date of Oct 2016 so that should be the date of increase Vs Jun 2017, but that isn't the real issue.  The real issue is that all these symptoms were from 2006 and led up to my endometrial ablation in 2007.  After the ablation, I was fine.  

How do I tell the VA to keep the 30% I don't deserve and give me SMC-K that I do deserve?  This is insanity.

JustGettingStarted

Edited by JustGettingStarted

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Another SNAFU on the Skin Exam!

I noticed a couple of weeks ago  there was a claim in eBenefits that I did not initiate for “VERRUCAE VULGARIS, LEFT HAND (ALSO CLAIMED AS NEOPLASM BENIGN) (Increase)”.

I did not initiate an exam for warts, and the only benign neoplasms I have claimed were colon polyps.  

I was concerned the skin exam I was scheduled for would focus on this instead of my claim for the eczema condition.  Because of this, I sent an inquiry via IRIS with my concern.  I received a response for inquiry that stated: “We are currently waiting for: The records indicate VA has requested examinations for skin diseases and scars disfigurement be conducted to support your claim.” 

When the exam began this morning, the examiner explained to me that she had only been authorized to do the exam for left hand warts and benign neoplasm.  I explained to her that I was expecting a full skin exam and asked if there was anyone she could call.  She left to make a phone call and I proceeded to call the VA at 1-800-827-1000.  Neither call succeeded in getting the exam changed to a full skin exam.

I do not blame the examiner in what happened.  She was doing what she was told to do by the VA. 

I also contacted the VA rep at my Congressman's office.  He said he will be discussing my case with a caseworker next week that specializes in these things, and she should be in touch with me soon.  I hope I can finally get all this straightened out.

___________________________________________

On the other hand, I contacted my dermatologist’s office to see if they had completed any of the forms I had requested at my appointment last week.  The nurse told me there was a note on the file that the information had been faxed to the VA, however she did not know if they had copies, and the person that had faxed the information was going to be gone for quite some time due to knee replacement surgery.

I contacted VA again and asked if they had received the information.  The person on the phone confirmed that they had received several documents from Dermatology Associates and PA Byron to include the Skin DBQ, a Nexus letter, and a statement.  The person I talked to did not know if the information would eventually show up in eBenefits and said the only way for me to get a copy was to do a FOIA request.  

I've asked my VSO to review the files.

Still,

JustGettingStarted

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