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  • 14 Questions about VA Disability Compensation Benefits Claims

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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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  • Most Common VA Disabilities Claimed for Compensation:   

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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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dajoker12

Best Way to Help Your Claim - From a Veteran Service Representative

Question

 I am a Veteran Service Representative for the Dept of Veterans Affairs for compensation on the rating side. For those unfamiliar with my job, there are two key figures processing compensation claims. RVSRs (raters) and VSRs; they do the medical side and we do the administrative side. Essentially my job is to do everything but rate the claims.  

I have seen some on here disputing the merits of DBQs. That being said, I think that is foolish to advocate that DBQ's for musculoskeletal exams are the only worthwhile DBQs to submit.  One very worthwhile one to submit is Sleep Apnea. Yes, the VA will do it for free, but if you have a decent insurance policy, you can get DBQs done for a $25 co-pay w/ a medical opinion. I get that that not everyone has good medical insurance and that that is a disadvantage for some, but for those that do have it, that is one course of action to take. One might make an argument that you could even essentially write up a medical opinion and save them the legwork and have them edit it to their liking...........don't like the opinion........go to the next doctor and only submit the ones that are favorable to you. 

If you want to really cement your claim, get cross disciplines to and do multiple DBQs i.e. have an orthopedic surgeon and a podiatrist do foot and ankle DBQs and medical opinions. Have a chiropractor and an orthopedic surgeon do your knees, back, neck, hips, shoulders. Want to get sleep apnea, well, get a handful of "buddy statements" from people that you served with on active duty written on 21-4138 forms so that they become affidavits if you have no complaints/treatments/sleep study while on ACTIVE DUTY, submit them so they become part of your "C-file", see a sleep specialist for a sleep apnea DBQ, get a medical opinion for direct service connectedness...........make sure that he sees the buddy statements.........if you legitimately had sleep apnea in service, your buddies will make adequate statements. Then, if you have PTSD, see a psychologist and try to get sleep apnea secondary to PTSD. Double whammy. Lots of studies out there to corroborate that.

Make sure that you have your C-file.  Doctors filling out DBQs are supposed to have access to your C-file to adequately make a medical opinion. If you don't care about the medical opinion, then don't worry about it.

For presumptive issues such as gulf war i.e. chronic fatigue, fibromyalgia, gastrointestinal, I wouldn't even bother trying to get a medical opinion as it will not carry much weight.

Again, DBQs accompanied by medical opinions, especially in number, are in your favor for getting a favorable decision. Don't like the PTSD rating that you just got last month............go right away and get a PTSD Review DBQ and Medical Opinion by a Psychiatrist, Ph.D. Psychologist or a Psychologist under a Ph.D. psychologist. 

Learn about the M 21-2 references.............google is your friend. Learn about the rating references...........google is your friend.............. Don't want your claim held up............take your damn time when filling out all of your paperwork and make sure everything is filled out completely and send us everything from the get-go.  I would suggest doing an intent to file call the 1800 827 1000 number, fax in a 21-0966 form etc.  That way everything will be back paid to whenever we receive that. Take your time filling everything out. If you want to claim dependents, have a 686c form filled out............every damn line that is there fill out.........don't have the information........get it.........I am guessing that you can get it quicker than 15-30 days, so get it. Have birth certificates of your kids and marriage certificate for your wife. We don't need social security cards....just numbers. Have records from private doctors scanned and ready to submit. If you have copies of your Service treatment records, DD 214's, OMPF (Personnel FIle) scan them and have them ready to submit (we still have to send out for them, but if we can't retrieve them, then we have them there ready to use as a last resort. If you are wanting to claim aid and attendance, have those forms scanned and ready to submit. Wanting to claim PTSD, have a 0781 or 0781/a scanned and ready to submit unless you were in combat and it is easily verified. Wanting to claim IU, have an 8940 and 4192 filled out and scanned ready to submit. I would also suggest making a brief (5-6 sentences at most) statement on a 21-4138 for each contention you are claiming; be specific with what you are claiming.............don't say foot pain..........be more specific i.e. pes plan (flat foot)..........when did it start.......was an injury involved.........where did you initially get treated..........where have you continued to get treated............etc...   When filling out the 526ez be specific............ especially if you were in the reserves or the guard..........tell us the name of unit you were with, current address and contact information. If you have a line of duty reports (again, guard and reserves) better believe that you should submit those.  

It pays to take your time. You will be more likely to have a quicker turn around if you take your time and do everything completely.  If you don't like your rating, don't appeal it right away...........that should be the last resort.  Send it new and material (relevant) information. Do not get disheartened. For direct service connected exams, we can generally only send you out for exams if there is a complaint/treatment/injury in your service treatment records for a contention that you are making.  Secondary connected issues are different. This is why it is highly intelligent for anyone wanting to file a claim to actually be in possession of their service treatment records BEFORE filing for a claim.  It would also be intelligent to have a copy of your Personnel records which you can actually get off of DPRIS which can be accessed via va.gov or e-benefits if you got out of the service within the last twenty or so years.  If not, I would recommend downloading an SF 180 form and sending it out.........hopefully the government shutdown won't slow it down too much.  

Once you have all of that done, sit back, relax and have a cold one.  Believe it or not, people sending out original claims (first time claims) that have everything put together and in which the claims are not overly complex i.e. 35+ contentions w/ aid and attendance, IU, 4142/4142a etc ad nauseum, are actually having exams ordered for them within 2-3 weeks of the claim being received. 

Best of luck. 

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Indeed, it looks as if the VA DOES MONITOR THIS SITE .

 

I have to give the VSR credit for offering useful tips.

 

But until action is taken to remedy the widespread lack of C&P examiner professionalism, the appeals/complaints will continue to pile up on the doorsteps of the VA.

 

That part of the claims process needs a big overhaul, as does the top sheeting by the RVSR at the VARO.

Edited by 63Charlie
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7 hours ago, dajoker12 said:

 I am a Veteran Service Representative for the Dept of Veterans Affairs for compensation on the rating side. For those unfamiliar with my job, there are two key figures processing compensation claims. RVSRs (raters) and VSRs; they do the medical side and we do the administrative side. Essentially my job is to do everything but rate the claims.  

I have seen some on here disputing the merits of DBQs. That being said, I think that is foolish to advocate that DBQ's for musculoskeletal exams are the only worthwhile DBQs to submit.  One very worthwhile one to submit is Sleep Apnea. Yes, the VA will do it for free, but if you have a decent insurance policy, you can get DBQs done for a $25 co-pay w/ a medical opinion. I get that that not everyone has good medical insurance and that that is a disadvantage for some, but for those that do have it, that is one course of action to take. One might make an argument that you could even essentially write up a medical opinion and save them the legwork and have them edit it to their liking...........don't like the opinion........go to the next doctor and only submit the ones that are favorable to you. 

If you want to really cement your claim, get cross disciplines to and do multiple DBQs i.e. have an orthopedic surgeon and a podiatrist do foot and ankle DBQs and medical opinions. Have a chiropractor and an orthopedic surgeon do your knees, back, neck, hips, shoulders. Want to get sleep apnea, well, get a handful of "buddy statements" from people that you served with on active duty written on 21-4138 forms so that they become affidavits if you have no complaints/treatments/sleep study while on ACTIVE DUTY, submit them so they become part of your "C-file", see a sleep specialist for a sleep apnea DBQ, get a medical opinion for direct service connectedness...........make sure that he sees the buddy statements.........if you legitimately had sleep apnea in service, your buddies will make adequate statements. Then, if you have PTSD, see a psychologist and try to get sleep apnea secondary to PTSD. Double whammy. Lots of studies out there to corroborate that.

Make sure that you have your C-file.  Doctors filling out DBQs are supposed to have access to your C-file to adequately make a medical opinion. If you don't care about the medical opinion, then don't worry about it.

For presumptive issues such as gulf war i.e. chronic fatigue, fibromyalgia, gastrointestinal, I wouldn't even bother trying to get a medical opinion as it will not carry much weight.

Again, DBQs accompanied by medical opinions, especially in number, are in your favor for getting a favorable decision. Don't like the PTSD rating that you just got last month............go right away and get a PTSD Review DBQ and Medical Opinion by a Psychiatrist, Ph.D. Psychologist or a Psychologist under a Ph.D. psychologist. 

Learn about the M 21-2 references.............google is your friend. Learn about the rating references...........google is your friend.............. Don't want your claim held up............take your damn time when filling out all of your paperwork and make sure everything is filled out completely and send us everything from the get-go.  I would suggest doing an intent to file call the 1800 827 1000 number, fax in a 21-0966 form etc.  That way everything will be back paid to whenever we receive that. Take your time filling everything out. If you want to claim dependents, have a 686c form filled out............every damn line that is there fill out.........don't have the information........get it.........I am guessing that you can get it quicker than 15-30 days, so get it. Have birth certificates of your kids and marriage certificate for your wife. We don't need social security cards....just numbers. Have records from private doctors scanned and ready to submit. If you have copies of your Service treatment records, DD 214's, OMPF (Personnel FIle) scan them and have them ready to submit (we still have to send out for them, but if we can't retrieve them, then we have them there ready to use as a last resort. If you are wanting to claim aid and attendance, have those forms scanned and ready to submit. Wanting to claim PTSD, have a 0781 or 0781/a scanned and ready to submit unless you were in combat and it is easily verified. Wanting to claim IU, have an 8940 and 4192 filled out and scanned ready to submit. I would also suggest making a brief (5-6 sentences at most) statement on a 21-4138 for each contention you are claiming; be specific with what you are claiming.............don't say foot pain..........be more specific i.e. pes plan (flat foot)..........when did it start.......was an injury involved.........where did you initially get treated..........where have you continued to get treated............etc...   When filling out the 526ez be specific............ especially if you were in the reserves or the guard..........tell us the name of unit you were with, current address and contact information. If you have a line of duty reports (again, guard and reserves) better believe that you should submit those.  

It pays to take your time. You will be more likely to have a quicker turn around if you take your time and do everything completely.  If you don't like your rating, don't appeal it right away...........that should be the last resort.  Send it new and material (relevant) information. Do not get disheartened. For direct service connected exams, we can generally only send you out for exams if there is a complaint/treatment/injury in your service treatment records for a contention that you are making.  Secondary connected issues are different. This is why it is highly intelligent for anyone wanting to file a claim to actually be in possession of their service treatment records BEFORE filing for a claim.  It would also be intelligent to have a copy of your Personnel records which you can actually get off of DPRIS which can be accessed via va.gov or e-benefits if you got out of the service within the last twenty or so years.  If not, I would recommend downloading an SF 180 form and sending it out.........hopefully the government shutdown won't slow it down too much.  

Once you have all of that done, sit back, relax and have a cold one.  Believe it or not, people sending out original claims (first time claims) that have everything put together and in which the claims are not overly complex i.e. 35+ contentions w/ aid and attendance, IU, 4142/4142a etc ad nauseum, are actually having exams ordered for them within 2-3 weeks of the claim being received. 

Best of luck. 

I completely agree with this. filing your claim get everything in it that you possible can get, medical evidence favorable to the veteran  will make it hard for a denial....

the only thing I hope will change is they read all of your evidence not just get to one part and stop reading and deny on that bases of the claim.

..I believe it matters who gets the claim in the first place..rather that rater is having a bad day or a good day   fighting with spouse the morning before coming to work   things that will put a person in a bad mood....in my opinion that   bad mood is carried out through the rater,  my reason and my opinion of this  is I've seen veterans get denied on BS reasons and I've seen veterans get approved when maybe they didn't have that one piece of evidence to help substantiate the claim, rather they read all of the claim or just get so for and decide this claim is going to be denied.

(who knows for sure?)

This VSR Has made some good points  here is one

 '' If you don't like your rating, don't appeal it right away...........that should be the last resort.  Send it new and material (relevant) information. Do not get disheartened. For direct service connected exams, we can generally only send you out for exams if there is a complaint/treatment/injury in your service treatment records for a contention that you are making. ''

However I agree with this VSR  He/She put the regulations /correct forms DBQ's  out there and what to do and how to prepare your SOC (statement of claim) how to put a good perspective on it, Gather all your evidence you can, make it easy for the raters to read and decipher, we are not medical Dr's and our speculation about any medical is not good , but we can say how we feel and have to rely on the (qualified) medical staff to help us with our claims  and get there medical opinion, I suggest to use a Medical Dr in the field of medicine that your disability is and a specialist is usually better than just an Ordinary M.D.

It's up to the Veteran to work his/her own claim and see to it that everything is spot on , if a veteran is not sure about his claim or have doubts  its best to have an experience VA Attorney or VSR./Accredited experience claims Agent help you before you submit your claim

Study the CFR'S the M21-1, Look at  the rating criteria for the disability that your claiming the whole 9 yards and put it in a perspective form favorable to you the veteran by using the CFR Regulations before you submit your claim . as this VSR MENTION ''GOOGLE'' IS YOUR BEST FRIEND.

90% of the time you will be approved fist time around  and not have to get in that dreaded Appeal line.

Just make sure your medical evidence is concrete evidence sound proof and from a qualified medical Dr!

Most claims are basically rated the same but some times under special circumstance they do make exceptions...All claims are different but  should be rated fairly and to the higher standards of the Law and in accordance to the CFR's

First time Veterans filing   take this Advice  its great Advice (in my opinion)

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I find this information very helpful. The only thing I disagree with is going to your private doctor and only paying a co-pay of $25 for a DBQ and medical opinion. I have submitted three so far and had to pay extra for two of the three medical opinions, so be prepared to pay extra for the medical opinion.

 

Quote
33 minutes ago, Buck52 said:

the only thing I hope will change is they read all of your evidence not just get to one part and stop reading and deny on that bases of the claim.

 

 As Buck states it is getting the rater to read all of the evidence instead of only part of it. If they read all of the evidence I believe more claims would be approved. JMO

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I will agree its helpful..even very helpful.  However, FROM A VETERANS POINT OF VIEW, the following advice is, well suspect:

Quote

If you don't like your rating, don't appeal it right away...........that should be the last resort.  Send it new and material (relevant) information.

This is unclear, and, perhaps Dajoker12 would like to explain.  First, the Veteran has no guarantee that the VARO will "reopen" the claim.  Then, the 1 year appeal period expires and the Vet is out of luck.  This is not a "theory", this happened to me..I reopened the claim and sent new evidence and it never got reopened.  They tell me now its "final" and I cant appeal it.  

Lets try an example: 

    You get a decision that you feel is unfair.  Most often we vets dont know what evidence the VA has because, even if we ordered a cfile, its probably not up to date.  Worse, when we do order a cfile, it often takes more than a year to get it, so we still have no idea if the evidence we submitted was there or not.  

    If we delay filing an appeal, remember we will be delaying getting a decision.  Time is a very very big deal to us.  Sometimes the difference of just a few weeks or months can mean the difference of becoming homeless or not.  Again, Im not speaking theory here, I applied in 2002, had to appeal.  The Board appeal was successful, but the VARO implemented it at 0 percent.  That meant I had 3 years into the claim, and no money to make house payments, and lost my home.  I finally got benefits, but it was too little to late to save my home.  Oh, and yes.  I sent in new evidence, but the VARO failed to reopen the claim, even now after 16 years.  They have not told me "why" they did not reopen so I can not appeal that, either!  

     Therefore, my advice is to appeal promptly..even if you submit new evidence.  The supplemental claim lane allows you to submit new evidence, so use that instead of a HLR.  

     I would be interested in Dajoker12's opinion on my post.  

Edited by broncovet

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Thank-you DAjoker for the advice.  I find it interesting that a VA worker reads this site.  It is heartening that someone would read this site and try to help out.  We see too many VA workers that are not willing to help or are hidden behind the curtain.

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