Jump to content

Announcements



  • veteranscrisisline-badge-chat-1.gif

  • Donation Box

    Please donate to support the community.
    We appreciate all donations!
  • Advertisemnt

  • 14 Questions about VA Disability Compensation Benefits Claims

    questions-001@3x.png

    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 ...
    Continue Reading
     
  • Ads

  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • Advertisemnt

  • VA Watchdog

  • Advertisemnt

  • Ads

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

    employment 2.jpeg

    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

  • Ads

  • Our picks

    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
        • Like
      • 4 replies
    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
    • If HadIt.com has helped you or you believe in it’s mission then please donate even $1 helps. I hope HadIt.com has provided $1’s worth of help to you. Imagine waking up and there is no HadIt.com it could happen and that is why I’m asking for your help now.



       



      Our traffic is going up and so are our expenses, however revenues have gone down and so I am reaching out to you to see if you can help me keep Hadit.com up and running.
      • 4 replies
    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
      • 3 replies
    • 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.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      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?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
      • 2 replies
  • Advertisemnt

  • 0
Sign in to follow this  
AFgal

Are C&P exams done for presumptive claims?

Question

In March I filed a presumptive claim for GWI for fibromyalgia.  I know that C&P exams are not always required and so was wondering if anyone knows if they are usually required or not for a presumptive claim. I also wondered if it matters to the VA that my diagnosis was given by a military doctor at a major military hospital versus a civilian doctor. 

I included a letter in my documentation clearly stating this was a presumptive claim quoting the 38 CFR § 3.317 reg for fibromyalgia.

Edited by AFgal

Share this post


Link to post
Share on other sites

Recommended Posts

  • 0

I applied back in 2011.  Unless something has changed between then and now regarding presumptive conditions they will require a C&P. 

Share this post


Link to post
Share on other sites
  • 0

It depends on your circunstances.  If there is already evidence in your file, then it should not be necessary.

However, for example, maybe you dont even have a diagnosis of the presumptive condtion?  Also, a c and p exam may be needed to document your symptoms, as your rating will be based on symptoms.  

As far as the diagnosis military vs civilian it does not matter except in the case of PTSD, because VA thinks "only va docs" can diagnose PTSD to meet VA's criteria.  

Share this post


Link to post
Share on other sites
  • 0

If you file a presumption A.O. Claim  I believe they will send you to a C&P

Here is a little more information on A.O. Claims clink link below.

I tell every veteran I see if they were exposed to A.O. While in Military and come down with any condition that's on the presumption list and the new added conditions. file that claim ASAP.

I am not so sure fibromyalgia is on the P-List?

Although a veteran can get S.C. For it if he/she has medical records while in military that you were treated for it.

http://www.veteransdisabilitylawyersite.com/agent_oran ge_presumption.html

Share this post


Link to post
Share on other sites
  • 0

I assume this is your first VA claim and that you can prove this excerpt from 38 CFR, 3.317 puts you into the 10% manifestation criteria:

"(i) With three exceptions, the disease must have become manifest to a degree of 10 percent or more within 1 year from the date of separation from a qualifying period of service as specified inparagraph (c)(3)(ii) of this section. Malaria must have become manifest to a degree of 10 percent or more within 1 year from the date of separation from a qualifying period of service or at a time when standard or accepted treatises indicate that the incubation period commenced during a qualifying period of service. There is no time limit for visceral leishmaniasis or tuberculosis to have become manifest to a degree of 10 percent or more."

https://www.law.cornell.edu/cfr/text/38/3.317

A C & P exam is needed to confirm the diagnosis, and then determine how it should be rated. :

"Code 5025: Fibromyalgia is a disease that causes pain and sensitivity throughout the entire body. The pain must be present on both sides of the body and both above and below the waist to be rated under this code. Likewise, a rheumatologist must evaluate and diagnose the condition for it to be rated under this code.

If the pain is constant and is resistant to treatment, then it is rated 40%. If the pain is not constant, but recurring and present 1/3 of the time, then it is rated 20%. As long as the pain requires continuous medication to control it, it at least receives 10%."

http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#fibro

Share this post


Link to post
Share on other sites
  • 0
39 minutes ago, Buck52 said:

If you file a presumption A.O. Claim  I believe they will send you to a C&P

Here is a little more information on A.O. Claims clink link below.

I tell every veteran I see if they were exposed to A.O. While in Military and come down with any condition that's on the presumption list and the new added conditions. file that claim ASAP.

I am not so sure fibromyalgia is on the P-List?

Although a veteran can get S.C. For it if he/she has medical records while in military that you were treated for it.

http://www.veteransdisabilitylawyersite.com/agent_oran ge_presumption.html

Fibromyalgia is on the presumptive list for Gulf War Illness. I was in from Sept 1997-Sept 2001. 

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Answer this question...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Sign in to follow this  

  • Similar Content

    • By Goonie
      I've also posted this over at PEB forums and I'd really like to get a clear answer because I think understanding what they mean in how this is written will be very helpful. 
      So this is reproduced verbatim in text and format from a 2012 decision letter based on only my service records. In the heading, it says "(to include claim of neck condition...)," does that mean the neck condition could be rated at some % but they combined it or subsumed it with fibromyalgia to raise that rating to 40% and avoid pyramiding? 
      What about the things listed under "Additional symptom(s) include:"? Were the combined somehow or are they just noting other symptoms? 
      Thank you in advance! 
    • By jdelta
      Like the title says, i go to have an exam for fibro, gerd, and eczyma. Now the last one is a toss up, and the gerd maybe too i don't know. A doctor outside the VA diagnosed me with fibro a few years back. He was an idiot though so i don't know if it was documented(probably, but i also have 30 percent for p.s.t.d. so i'm probably being paranoid). Then again this doctor told me it was my weight blah blah blah. I told him multiple times that a few years prior i was going to the gym alot and the pain has become worse as i age amking it harder to be as active. I try to eat good(chicken and rice, oatmeal) most of the times but we are human. So back to the exam, i have only had one for the p.t.s.d. I was in Iraq day one of the war(March 2003). I was around burn pits and was exposed to the aftermaths of exploded tanks and buildings(hell some we even enter to make sure nobody was hiding or any wmd. I'm registered for the burn pits. I just don't know what to expect, will it be questions, will it be a physical? It's an outside contractor, so i'm hoping less va bias. I'm also too the point of drowning in debt. It's trigger my p.t.s.d. to the point my wife can't even sleep due to my nightmares and waking up with night terrors. I have become much angrier and lashing out. Not physically though, but i don't know what state i'll be in if i get another denial(btw with what i mentioned, i have a bva for freaking tinnitus even though i have stated where i have been. I was also a cavalry scout in the army so i was trained for combat. I have lay statements from a battle buddy, mom, wife, ex and a friend. I just need to know what to expect or what else i need to do to have a shot at an approval? I'm also filed for apnea, va diagnosed me and i have a cpap. Never had a chance to have any of this documented in service due to being told to man up. 
    • By nacole
      Hi, Berta (everyone), I am curious if there’s any instructions on how to go about:
      DIC is granted & accrued / death pension benefits are denied. My VA rep (Colorado VA office), recently explained to me that my mom was awarded DIC benefits ( I filed on her behalf ), effective the day of his death (my dad died Dec.30, 2017) of...
      1-Pneumonia  
      2-COPD
      3-CAD
      but, we (she) was denied accrued because the Army / VA did not owe him any money, since he never filed for benefits while alive. While that part is true, he never filed because he was told he did not have agent orange, he was told he “wasn’t in the right theater”, course that “theater” explanation is false. Vietnam establishes theater now, period. My dad was on ground (in air) for a year. Further my dad’s records I received from archives (medals included) do not have a lot of information in them. I have a hard time understanding what they do say. My dad was 191st Military Intellegence, not sure if that is why I have trouble making sense of the records they gave me or if that has anything to do with why I had such a trouble free approval on DIC portion of our claim (approved first time & expedited approval within 3 months)..to which we are grateful. However, I have an original document from 1989 that reads, “ In regards to YOU’RE request to be tested for agent orange...Donald L. Welch...” (my dad)..you’re appointment is scheduled for ...1989 at ... etc. then written in red pen on the top of the document is written “6-8 weeks”. I prusume his “testing” (set for an entire day 8am-6pm) did not inform my dad he had exposure, because he then would have filed! Yet, clearly he did (death certificate reads CAD) & DIC awarded for presumptive CAD! Throughout his lengthy medical history of:  Arteries blocked (multiple), Surgical stents, cardiac-arrest, COPD,  bronchitis-chronic, lung problems, etc. He believed he did not qualify for benefits. Months before his death he went to VA medical at his brothers insistence & on the way home from getting RX (for the first time ever from the VA) he told his brother he was told he wasn’t in the “theater” for agent orange benefits. By the time he got his first RX delivered through the mail...he was dead....of CAD. How do I prove establish that he would have filed for benefits (as far back as 1989, document attached), if they had not told him he didn’t qualify & wasn’t exposed? How do I get addditional records when he was military intelligence? I can’t even find out what battles, his medal citations are even from. I also know his helicopter crashed while he was in Vietnam and his back had either whipping marks or shrapnel scarred all over it...I want to know why. No records if him being a POW. Can anyone link me in the right direction? I’ll have to figure out how to attach documents to post- will follow through.
       
    • By SSGTMARINE88
      I first experienced kidney problem while on active duty as a Marine Security Guard in Addis Ababa, Ethiopia in 1994. The doctor treated me as having been dehydrated. Years later, in May 2012, I experienced my first official Kidney Stone at 9 mm on left side, which I had to have a lithotripsy. In 2016, I developed a second kidney stone measuring at 6 mm on right side, treated by VA in Ann Arbor, MI. In June 2018, I developed my third kidney stone measuring 3 mm on right side, treated by VA Ann Arbor, MI. VA doctors informed me that I still had several smaller stones in both kidneys. In July 2018, I developed a fourth kidney stone measuring 4 mm on left side, a stent was implanted, and tomorrow I am scheduled for another lithotripsy. While, awaiting the lithotripsy, it appears i have another stone developing on the right side again.
      While in Ethiopia, I was constantly in Eritrea and Massawa having swam in the Red Sea. I do know that Gulf War Syndrome lists the Red Sea as an area of claim but during the Southwest Asia Threat. It appears, that I should still be service-connected but I'm unsure as personnel at Battle Creek, VA, suggested that I couldn't claim Gulf War Syndrome. This was also prior to my diagnosis of fibromyalgia. To add, I was also stationed at MWSS 272 New River Airbase during 1990, where vehicle were being painted as well as a motor transport driver moving airplane and helicopter parts and working in the areas of jet fuel during the commencement of wartime.
      What if any course of action do I need to take to have these service-connected as it relates to kidney stones and fibromyalgia?  I am already 70% TDIU, for tennitus and PTSD. I have been diagnosed finally as having fibromyalgia in June 2017, for which previously I was denied neurological disorders. I am a diabetic with, high blood pressure and 16 of 18 points for fibromyalgia.
    • By DozerDog
      Hello all, I'm trying to find any female that was deployed to Afghanistan or Middle East during Operation Enduring Freedom 2002, that is now suffering from ovarian failure, early menopause or menstrual issues. 
      I have been trying to file a claim for over a year due to the above issues with no luck. There is no medical documentation to prove my case. 
      If there is anyone out there suffering from the same issues, or you know of anyone who could be, please get in touch with me. 
      I have no family history of ovarian failure but managed to go through menopause by 35. Looking for help! 
  • Ads

  • Our picks

    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
        • Like
      • 4 replies
    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
    • If HadIt.com has helped you or you believe in it’s mission then please donate even $1 helps. I hope HadIt.com has provided $1’s worth of help to you. Imagine waking up and there is no HadIt.com it could happen and that is why I’m asking for your help now.



       



      Our traffic is going up and so are our expenses, however revenues have gone down and so I am reaching out to you to see if you can help me keep Hadit.com up and running.
      • 4 replies
    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
      • 3 replies
    • 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.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      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?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
      • 2 replies
  • Ads

  • Popular Contributors

  • Ad

  • Latest News
×
×
  • Create New...

Important Information

{terms] and Guidelines