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    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 ...
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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


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      Leading to:

      Post clear questions and then give background info on them.

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      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



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DonH

Monomelic Amyotrophy

Question

ALS Variant?

 

I'm a Vet Wife. I post on behalf of my husband, I'm his note taker at doctor's appointments and consults.  I'm his support system and all around cheerleader. Lord knows we have had our VA battles. All these years after Vietnam, the onset of my husband's emerging illnesses, obviously percolating internally has emerged  one after another. We've seen subtle signs and some not so subtle. But didn't; know what those sign meant. The VA didn't do a very good job of educating the older veterans about what to be aware of regarding SC disabilities,

My veteran husband's a Purple Heart Vietnam Veteran  served in US Marine Corps. My husband  has several service connected disabilities. My husband diagnosed with Monomelic Amyotrophy recently; it is a Motor neuron (MND) disease that is the umbrella covering all type Motor neuron diseases and variants. To which ALS/ Amyotrophic Lateral Sclerosis and variants falling under the same umbrella as being classified as Motor Neuron Disease (MND). As exhibited in cases of muscle loss: Monomelic Atrophy.

ALS causes degeneration of nerve cells in the brain and spinal cord that leads to muscle weakness, muscle atrophy, and spontaneous muscle activity. The VA Doctors pondered whether my husband had ALS or MS. Yet, the Neuromuscular Head Physician conceded that my husband's illnesses was an ALS variant because his illness fell under the umbrella of Motor Neuron Diseases as did ALS......is a Motor Neuron disease. ???? We don't know how VA will decide.

Other complicating issues:

*Spinal issue (S Curve of spine)

*Multi focal motor neuropathy associate with Diabetes 2 is a part of the mix/entwined as well. 

 

However, most severely is the inability of identifying the exact reason for the monomelic atrophy.

Although it was hoped a more exact finding will be determined when all results of updated blood tests were in.

On May 2017: *Blood test are in; determination that no immune diseases are present

Possible treatment of an intravenous treatment once every three months or medications with steroids would be beneficial. No effective treatment available.

 

MMA

Diagnosis. 

Inflammatory Arthritis is Part of the neuropathy (Special kind of neuropathy)

As well as severe spine problems. Very rare complicated illnesses intersecting and exacerbating primary and/or secondary with veteran's service connected disabilities.

 

Monomeric atrophy......Veteran has lost the use of his right hand and right forearm weakened and wasting away.

One limb atrophy

See notes…..described as one limb muscle atrophy

 

Spinal cord (S curve of spinal cord) compression on top on addition the monomeric

 

Toxic agent like Agent Orange could more likely than not" a contributor for neuropathy.

 

Immune diseases (no)

 

Deterioration. Of bones on vertebra

Spondylosis...inflammatory arthritis 

Acts like spinal cord injury 

 

(Findings of EMG) EMG to confirm the diagnosis ( Neuromuscular VA Physician at Michael E. DeBakey VA Medical Center, Houston, Texas)

Table of Rated Disabilities

Disability

Rating

Decision

Related To

Peripheral Neuropathy, Left Lower Extremity

 

Not Service Connected

Denied as…. early as 2011… Yet, D to pinpoint as severe symptomatic complexities of Monomelic Amyotrophy variant of ALS in 2017….should be cued.

Peripheral Neuropathy, Right Lower Extremity

 

Not Service Connected

Denied as…. early as 2011…  Yet, ID to pinpoint as severe symptomatic complexities of Monomelic Amyotrophy variant of ALS in 2017….should be cued

Agent Orange - Vietnam

Neuropathy, Left Upper Extremity

 

Not Service Connected

Denied as…. early as 2011…  Yet, ID to pinpoint as severe symptomatic complexities of Monomelic Amyotrophy variant of ALS in 2017….should be cued

Bilateral Hearing Loss (claimed as diminished hearing)

0%

Service Connected

 

Tinnitus (claimed as ringing in both ears)

10%

Service Connected

 

headaches

 

Not Service Connected

 

depression

 

Not Service Connected

 

skeletal arthritis aching of the joints (unspecified)

 

Not Service Connected

Arthritis denied as…. early as 2015…  Yet, ID to pinpoint as being symptomatic complexity of Monomelic Amyotrophy variant of ALS in 2017….should be cued

post traumatic stress disorder (PTSD, also claimed as depression and anxiety)

30%

Service Connected

PTSD - Combat

Hypertension

0%

Service Connected

 

Neuropathy, Right Upper Extremity

 

 

Rectal carcinoma claimed as rectal cancer, a soft tissue cancer)

 

Not Service Connected

Agent Orange - Vietnam

Still on since  12/11/14 appeal

Remand 5/15

scar, shrapnel right knee

10%

Service Connected

 

09/18/2013

diabetes mellitus type II

10%

Service Connected

Agent Orange - Vietnam

07/06/2015

prostate cancer

100%

Service Connected

Agent Orange - Vietnam

07/06/2015

erectile dysfunction

0%

Service Connected

 

07/06/2015

 

Neuropathy, Right Upper Extremity Denied as…. early as 2011…  Yet.ID to pinpoint as severe symptomatic complexities of MonomelicAmyotrophy variant of ALS in 2017….should be cued Agent Orange – Vietnam

 

Edited by DonH
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His rating is 100%---the 100% came with the Prostate Cancer diagnosis. His Prostate cancer is being 'held in check" with a hormone shot at this point and time. He began having the shot every 3 months; now it's every 6 months. As long as the hormone shots keeps the cancer maintained and his PSA low, the hormone shot will continue. If suddenly, PSA rises to not be controlled, they VA Doctors will revert to radiation. They are not desiring to do radiation due to my husband having already had radiation with the rectal cancer.

A MRI was done. But not on the brain. The did the MRI o his vertebrae.

The Neuropathy was denied prior to the DM2 diagnosis. My husband is not on medication for DM2 and prior to the Motor Neuron disease. HIs DM2 is controlled by diet at this time.. Actually in 2015, his DM2 was diagnosed. However, beginning in 2011 when my husband decided  upon my late father's insistence, as a Disabled Vet himself,, my husband sought medical treatment at the VA, the medical staff like nurses, upon perusal of vital records//charts would always inquire  did he have diabetes.  We have an Agent we work with.......so I have submitted the new diagnosis as well as my concerns regarding issues we need to revisit, My husband has been PTSD diagnosed going back to 2008-----however, we are seeking an increase. I thought he should have been at least 50% from the very beginning. The rectal cancer  was denied in 2011; It is at the BVA on appeal since 2015--it was remanded in May 2015; we had a Video conference in December of 2014. My husband turns 75 on July 19th. It's still no word from the appeal since May 2015.

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The long list of soft tissue AO sarcomas are available here under a search.

It would have an exact medical term.

Did the Rectal cancer metastasize from the Prostate cancer? Probably not but one more way to try to get it SCed. if it did. 

Prostate 100% ratings can be lowered.

Matt Hill ( vet lawyer and member here,) has a brief article on this and the VA has proposed to reduce many AO Prostate cancer vets with 100%.

https://www.hillandponton.com/video-blog-prostate-cancer-ratings/

I hope the Agent explained that and there might be more to his cancer rating than we know here.....

Can you give the BVA Docket # and Citation #? We can read the remand and hopefully help more.

Is he employed? If not does he get SSDI and is it solely for an established SC ? If not employed has the agent suggested filing for TDIU?...Unless there is medical evidence that would continue the prostate 100% rating.....

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Did the Rectal cancer metastasize from the Prostate cancer? That's a possibility when considering the nearby location of both organs. A good IMO could argue that point to make the of connection.. However, the rectal cancer was discovered first.  HIs high PSA was not noted until afterwards. It was his psychiatrist that noted his extremely high PSA. And from there began the testing/bioscopy for Prostate Cancer.

I have read BVA Opinions affirming the relationship between Colorectal/rectal cancer and the Prostate with equipoise (spelling) justification; usually an IMO making that argument. Our argument in appeal is that rectal cancer is a soft tissue cancer and its particular type of soft tissue is not in dispute as being excluded from the tisting of soft tissues cancers that were excluded.

My husband was sent to an outside C & P Exam---but, doctor confirmed that the 100% should continue.

No, my husband is not employed. When he became ill to the point that something was obviously wrong, he was retired by then. Upon retrospect, his job was actually a sheltered environment....that's a concluding reason as we reflect why he was able to last on the job until retirement.--because his attitude could be unreasonable when he experienced flair ups in temperament.

I don't have the BVA Docket # and Citation # at hand. However, I will work on trying to locate it before the week is over. We are leaving to go out of town for family reasons so I will update later.

Thanks for all the insights!

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With the Butt Cancer DX predating the PC SC Award, you're attempting a reverse Nexus. I'm not aware of any such successful Claims. As Always, I could be wrong but I don't think so. What was the date of his PC DX?

Any chance you could post a redacted copy of the C-Rectal C & P DBQs and the actual Rating/Denial Decisions? I take it that C-RC is not a listed AO presumptive, so in your husband's case, it has to be Secondary to a PRIOR Awarded SC Condition.

Generally speaking from what I've read, once a person has a DX of a certain type of cancer, is treated and the Cancer goes into remission, any future Cancer DX of another organ or internal body area is still referred to as being a metastasis of the Original Cancer DX.

Your husbands PC SC was based on an AO Presumptive, ergo, no need for a Direct or Secondary Nexus.

A good friend 70, is in Hospice with PC, maybe a week left at best. He had Radiation about 6 yrs ago, everything good till about 12 mos ago when PSA went off the charts. The PS has since metastasized to his skull, spine, lung, Bladder, Stomach, and LIVER. They tried hormone therapy, another round of chemo and even an experimental drug, no help.

Remind your husband that as of last weeks Cancer Clinicians Periodic up-date, no real (1) procedure has been determined as any better than another for treating PC, as far as Morbidity and Mortality. That being the case, especially at 75, removing the Prostate would result (besides the Physical Side-effects) in his 100% SC being reduced after about 6 mos to his actual CSC which would include a 20 or 30% PC Rating.

Semper Fi

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Prostate removal not possible due to no spinchter/ butt hole is stitched ....,it/the spinchter had to be removed during the surgery to remove the cancer from his rectum; however, what began as a Laproscopic surgery went bad..,, the laparoscopic needle went haywire and off course because of running into a build up of scar tissue and my husband's colon was punctured.....they had to change course in midstream to do traditional surgery. He bled profusely and lost a lot of blood so they had to do blood transfusions. The surgery lasted way longer than it should have. My husband went into surgery about 9:30 or 10 am and the surgery ended  around  9:45-10 pm. My husband is, now, anemic as a result of having lost so much blood and takes a medication for it.

It was a horrific ordeal! Even though they/VA Doctors had cautioned my husband of the possibility of losing his spinchter... but the odds were good that he may not.

To add insult to injury, upon follow up consult after surgery, we found out that the radiation prior to surgery had zapped the cancer. My husband and I were dumbfounded to  learn this information too late. My husband was upset because he stated had he known that the radiation had gotten all the cancer, he would have liked to be given the opportunity to weigh in to thereby not move forward with the surgery. To that effect, he would still have his spinchter and not have to wear a colonoscopy bag!

We are dumbstruck that the VA doctors would schedule a laparoscopic surgery after a patient has been given radiation. Radiation builds up scar tissue so the doctors should have known my husband wasn't a good candidate for high tech surgery and just stick with traditional surgery. Although, it was obvious after the fact that the right hand didn't know what the left hand was doing to pursue surgery when the radiation had already done the job! 

Upon further reflection my husband remembers feeling a premonition that something was not going to go well because the operating doctor had become extremely upset because the operating room had not been preped timely for the surgery that morning so surgery was late getting started. My husband stated he almost asked the surgeon for a rain check a postponement due the surgeon's angered upset mood.

Regarding Rectal Cancer being determined for a presumptive......reading over BVA cases, it can be logically connected if not presumptive via direct causation of AO exposure.

Having no spinchter makes any further surgery on the prostate risky to cause my husband to not be able to urinate without assistance of a urine bag. So, the doctors don't want to risk that occurrence nor does my husband desire to be a candidate for another bag.  

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    • By Berta
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      This came up in the above thread and although the info on Nehmer is a signifiant amount here in the AO forum, this had to be clarified as it could be hard to find under a search.
      Nehmer class action members who are the survivors of a AO veteran, under the 2010 Nehmer Court Order (which  service connects IHD, Hairy Cell B, and Parkinsons in all incountry Vietnam veterans, do not have to file for substitution or accrued benefits when they file their AO DIC claim.
      All other surviving spouses of vets who had claims pending at death must file as substituted claimant or for accrued benefits within one year of the veteran's death. Accrued benefits are defined in detail here under a search.
      I took this definition from a BVA case, which made it easier for me to find:
      This is the regulation regarding Nehmer claims, which is defined as a retroactive payment, not an accrued payment::
       
      “I.  Retroactive Benefits
       
      The appellant contends that the Veteran's heart disease was due to Agent Orange exposure and, therefore,  retroactive benefits are warranted pursuant to the Nehmer decision. 
       
      This is not a claim for accrued benefits.  The RO, on its own initiative, sent the appellant a letter in March 2011 explaining that it was going to review the matter pursuant to Nehmer v. Veterans Administration of the Gov't of the U.S., 284 F. 3d 1158 (9th Cir. 2002).  The provisions of 38 U.S.C. 5121(c) and §3.1000(c), which require survivors to file claims for accrued benefits, do not apply to payments under 38 C.F.R. § 3.816, regarding awards under the Nehmer Court Orders for disability or death caused by a condition presumptively associated with herbicide exposure.  See 38 C.F.R. § 3.816(f)(2) (2015).
       
       
      1) Applicable Law
       
      Retroactive benefits may be paid under Nehmer if a Nehmer class member is entitled to disability compensation for a covered herbicide disease.  See 38 C.F.R. § 3.816. 
       
      Nehmer class member means: (i) a Vietnam veteran who has a covered herbicide disease; or (ii) a surviving spouse, child, or parent of a deceased Vietnam veteran who died from a covered herbicide disease.  38 C.F.R. § 3.816(b)(1).  If the class member's claim for disability compensation for the covered herbicide disease was either pending before VA on May 3, 1989, or was received by VA between that date and the effective date of the statute or regulation establishing a presumption of service connection for the covered disease, the effective date of the award will be the later of the date such claim was received by VA or the date the disability arose, except as otherwise provided in paragraph (c)(3) of this section.  38 C.F.R. § 3.816(c)(2). 
       
      The covered herbicide diseases are listed in 38 C.F.R. § 3.309(e).  See 38 C.F.R. § 3.816(b)(2).  This list includes ischemic heart disease, which was added to the list of covered herbicide diseases effective from August 31, 2010.  See 38 C.F.R. § 3.309(e); 75 Fed. Reg. 53202 (Aug. 31, 2010). “
      https://www.va.gov/vetapp16/files2/1609942.txt
      (this BVA claim for DIC was denied but still held the exact regulation regarding Retroactive Benefits which made it far easier for survivors to attain than trying to claim accrued if over a year had passed after the veteran's death)
      I recall here over the past 2 decades that we never dreamed the VA would ever compensate IHD for AO exposure.
      Certainly many and probably ALL  widows with a AO IHD death claim never could have filed for accrued benefits anyhow for AO IHD because there was no regulation for AO IHD prior to August 2010.
      The above claim was denied thus:
      "FINDINGS OF FACT 1. The Veteran did not have service in the Republic of Vietnam and is, therefore, not a Nehmer class member. 2. The current effective date of November 1, 2008, represents the first day of the month in which the Veteran's death occurred where the appellant's claim was received within one year after the date of his death."
      But it did contain a good explanation of Retro payments instead of "accrued" benefits, that Nehmer Class action members, as survivors, could expect even if an accrued claim had never been filed for AO IHD. 
      And just to add....many of us Nehmer Class action survivors were also Footnote One claimants.
      I have explained Footnote One here Many times since 2010 and added Rick Spataro's emails to me on it ( NVLSP Head AO lawyer) and all of that that is easily searchable here ( I hope) and was the most important and  unique aspect of Nehmer 2010.
      Agent Orange is still harming and killing our nation's veterans. But only those vets or their survivors as defined in the above citation from the BVA and in the  the Nehmer Court Orders are Nehmer class action members.
       
       
       
       
       
       
    • By Andyman73
      Got some good news to share.  Some of you may know, or recall, that I had written elsewhere on here, that my Dad(Nam combat, 24 yr career retired, 60% SCD) and I don't exactly communicate very well.  The grapevine tells me that it's my own lack of communication skills are the problem.  Anyway, while updating my folks after yesterday's 6 month foster child case review court session, Dad went off topic to let me know that the VA has opened an AO claim for/on him.  Said they initiated it(???)and that he has a bunch of appointments scheduled over the next few months.  I was quite surprised that he wanted to tell me about that...since I'm usually the last to know, and my wife is usually the one telling me.
      So...is there anything I should tell him to tell them?  I don't know too much about his overall health, beyond his Nam related back injury.  Thanks.
      Andy
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