Filing Claims During Presumptive Period

[glashutte]

Can someone please clarify these concerns?

1. During the presumptive period after my ETS, do I file everything under one claim? Is it better to file everything under one claim or separately under multiple claims? I'm afraid of the doctors and staff looking over my claim and think I am 'malingering' even though they are all true. 

2. I do not have my actual medical record packet but do have a generalized medical data (still quite detailed) from Tricare Patient Portal via downloading from the Blue Button. Has anyoe had experience with this?

3. When do I submit my nexus? 

4. Do I need a nexus if I was seen during service by doctors and diagnosed for the condition I am claiming?

5. Do I submit proof (being seen by doctors during service, diagnosis during service) a long with my claim? Do you just send them the entire medical record or do you organize it so they can easily match up your medical history and each claim? It would be a pain for them to search through your whole medical history and at that point they may not even want to bother anymore...I assume.

 

 

Edited March 14, 2018 by glashutte
forgot something

[glashutte]

Thanks everyone for your help and input!

 

I completely feel what Vync said, that sometimes during service I felt that even though I just went to sick call once, I had the aurora of others subjecting me to malingering. Not sure if it is true or just me though..

I did request medical records through my post's hospital. Is this different than the Blue Button found on Tricare Patient Portal? I hope so because the Blue Button medical records is surely in depth, but does not show doctor and clinic notes. It just states things like date, complaint, diagnosis, and findings (very briefly). 

 

Does the VA use the Blue Button records to file their claims, or do they go more in depth and look at the actual medical records?

[vetquest]

Do not worry about the malingering part.  I was accused of malingering before I was separated.  I was a seven year staff sergeant with a career ahead of me when I was boarded out, and some medical schlep had the gall to call me a malingerer.

Yes your medical records are different from the blue button I believe.  Do not leave without your medical records in hand.

[Carl the Engineer]

You need to look at it a different way.

The military bought you whole when you passed the entry physical.  Now you are at the end of your military career, and they will deduct any injuries that occured to you while you were in their custody, and pay you the difference via compensation.

So, what I did, and you should do, is claim everything (injury or illness) that happened during your military career.  Even if you do not think it was important.  Hopefully you have a copy of your medical file or record of when you went on sick call or to the doctor.  Also, do not forget if you were seen by a civilian while on active duty.  That counts too.  I submitted the records I had, and did not worry about the ones I did not have.  The VA found some for me and I found some later on my own.  You won't know what you need till you know what you need.  Just get the ball rolling.  It will be rolling for a long while.

Now, if I remember correctly, I initially claimed 8 issues and was service connected for 4 and denied 4.  However, two of those later became service connected.  The other two were fully recovered while in service with no residuals or ongoing issues.

And then after that first go around, you will see how the game, and it is a game, is played.

Your first question when you get the big envelope will be about VA math and how they score your percentages, and how they low-balled you.  That's just the way it is.

Anyway, send it in now....

Hamslice

 

[Carl the Engineer]

Oh, I forgot to add,

Of those original claims, I was first awarded 30%, then 40%, then 60%, then 70% and now I am at 80%.

That took 8 years.

So, it is a work in progress.  Some do not go to the top from the get go.  Others strike gold.

FWIW,

Hamslice

 

[Gastone]

Sound advice from all those who have opined.

I take it, you're still in the "What should I do" phase, correct?

It also appears that your "Shopping Cart" of disabilities are all being filed as DIRECT Service Connected issues, you believe are substantiated by your SMR's. Have you discussed your VA Claim filing with a VSO-Rep?  Having a VSO assist you in your initial Claims Filing, may be a prudent move, and something to consider.

What's your concern about the Presumptive Period Filings, if all your Medical Conditions presented and were Treated/Diagnosed while on active duty? The "Presumptive Period" relates only to New Medical Conditions that were never Treated or DX while on active duty.

[glashutte]

On 3/16/2018 at 7:38 AM, Berta said:

I think you should read this article from the VA carefully- and click on the "chronic presumptives" to see if you fall into that criteria for any of these disabilities.

https://www.benefits.va.gov/compensation/claims-postservice-one_year.asp

This article and the regulations state :

"The post-service disease must be at a compensable degree (i.e., 10% or more disabling) within one year after the date of separation from service, with certain exceptions."

I assume many of these disabilities , maybe all of them would be listed on your Discharge Certificate.

Are you still  in the ETS process ?

and mentioned Tricare- meaning you have many many years in service...?

You can get a copy of your SMRs now, while still in service.Ask for copies of your Personnel records too.

If you are already ETS and out- did you attend the VA briefing?

If you do have "chronic presumptives" as identified in the links above, diagnosed while you were in the Mil, all you would need to prove, is that that they  have raised to a 10% level(which VA would determine  when they begin to work on the claim)

If not a "chronic "presumptive, then the disability (ies) would have to be filed for Direct SC as Gastone said.

I agree that you should try to get a good vet rep because some of the disabilities you want to claim might well be 'secondary' to something the VA would SC.If so those disabilities should be filed as secondary to the prime disability.

Also -if you have not been discharged yet , Now is the time also to get contact info from any Buddies in your unit- who might have to prepare buddy letters for anything you claim ,that would require an eye witness account. ....to prove it happened.,,,

If you have not formally left the Mil yet-do you expect a medical discharge and if you do, do you have contact with a PEBLO?

Lots of questions I know but we need more info.....

Maybe you are seeking comp under the Gulf War Presumptives:

 

Presumptive Illnesses and Military Service

For Gulf War Veterans, VA presumes that unexplained symptoms are related to Gulf War service if a Veteran has experienced them for six months or more. The “presumptive” illness(es) must have first appeared during active duty in the Southwest Asia theater of military operations or by December 31, 2016, and be at least 10 percent disabling.

This is from the latest Gulf War info at VA

https://www.publichealth.va.gov/exposures/publications/gulf-war/gulf-war-spring-2015/gulf-war-presumptives.asp

Gulf War SE Asia benefits have been extended to 2021:

https://www.stripes.com/news/va-extends-deadline-for-seeking-gulf-war-illness-benefits-to-2021-1.434547

There is more info here on the Gulf War presumptives.

The VA article mentions the nine infectious diseases as well as the 3 prime presumptives...I did a radio show on that -available in our Podcast archives.

This extension " applies to veterans who served in Southwest Asia from 1990 to now, including ones from Operation Iraqi Freedom and Operation New Dawn."

https://www.stripes.com/news/va-extends-deadline-for-seeking-gulf-war-illness-benefits-to-2021-1.434547

More info will help us direct you better.

 

Thank you again Berta for your insight. 

I recently separated in July 2017 after 8 years in service. I did attend the VA briefing but little did I know it would be so challenging to file a claim properly!  I am definitely in 'what do I do and how' phase. 

 

Regarding filing my claim, should I file what I have now (all issues that were diagnosed during service) then submit little by little my conditions that were not addressed during service but will be addressed now (after service) by a civilian doc? I want to make it as perfect as possible, but at the same time do not want to take up too much time. I have until July 1 2018 until my presumptive period ends. 

 

For my Chronic Presumptive issues, I plan on getting a DBQ for each of them. For example Psychologist for PTSD and podiatrist for Flat feet with pain. 

For the C&P exam, does the examiner:

-Still examine me for all issues seen and diagnosed during service?

-Still examine and test for issues during my presumptive period with a QBD?

-I have about 10-12 total issues and can't imagine someone patient enough to go over all of them during a C&P exam.