My 1st claim under AMA

[GeekySquid]

Hey All,

This is posted just as information and to put a clock on the claim since the AMA process that started Feb 19, 2019. I don't believe AMA will affect this claim.

I am also posting this so when I do get a decision I can come back here and review my thinking and rationalizations that I will list below. sorry it is so long.

As a note anyone with an ED award secondary to PTSD, and who has any type of leaking, might consider a claim for Voiding Dysfunction or other related Genitourinary problem.

I filed this claim today, May 8, 2019.

This claim is a Secondary Claim suggested by an existing SC award for PTSD.

In a 2018 Award for SMC (K), ED secondary to ptsd, I was notified of another potential claim for Voiding Dysfunction.

I filed an Intent to File in 2018.

This was all under the Legacy system, not RAMP.

Things I don't know about Claims processing since AMA went into effect:

1) I don't know how this claim will process since AMA seems to deal mainly with Appeals instead of a new claim filing or secondary claim filing.

2) I don't know if this will go into the national queue or be done directly by my local RO, which is Seattle.

3) I don't know for sure how the VA will view this claim, meaning will I need a C&P, since they suggested the claim and I submitted a very detailed Statement in Support of Claim form vba-21-4138-are. I know that some consider this the most useless form in the VA library, but since I want to test the process in their suggested way I will use this form. I used the DBQ criteria and Rating criteria to write the factual information for the claim. I was truthful and exact as possible.

4) To upload that vba-21-4138-are, I had to select Buddy/Lay statement as the type of document.

5) I uploaded the Award letter that contained the recommendation to file for Voiding Dysfunction.

6) Voiding Dysfunction did not exist in the category of Secondary claim I had to select from so I chose genitourinary as that is the broadest related category they showed me related to this condition and the ratings table for genitourinary contains Voiding dysfunction ratings.

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I am going to guess, and this is probably really just wishful thinking, that this will be a rocket docket process for this claim.

I think that because I am already SC for a known related condition that this is claimed secondary too. The VA has lots of medical literature connecting the two.

I think since they suggested it as part of their Duty to Assist/Notify, that will ease the processing/decision time

I think giving a detailed State. in Sup. of Claim (vba-21-4138-are) using the information from the Rating Table and DBQ, they may not even need a C&P. This is because in my case, my Primary Care Doc has ordered appropriate pads for me. I have a diagnosis of BPH. I am awarded SMC (K) for ED as a secondary, and I am 100% SC for PTSD.

I explicitly stated pad usage, urinary frequency for day and night times and the effect it has on my life. All of which are part of the Rating Table and DBQ.

I think I will get rated at the max, 60% but there is a path that puts it as SMC (K) and I think (but am not sure) that we can get multiple SMC (K) awards but I don't know if they will just 0% it and award SMC (K) or rate it at 20, 40 or 60 and award SMC (K) or bump me to SMC (S) which I have found is met with a single 100% coupled to a 60% rating (even combined I believe). Either way, if an award is granted I end up with more money each month. The third rating outcome would be 0% SC without SMC (K) or (s) and that would be depressing.

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I am also wondering if @Tbird will consider creating a user-contributed database of Secondary Conditions Connections. It could be a very helpful resource and would be a unique resource for Veterans trying to figure out what their conditions might extend too if the medical facts concur. The SEO value would be huge if done right. Veterans are searching the internet for SC conditions every single day by the thousands.

I don't now who hosts Hadit, but they should have a free SQL database engine and interface available and the design is literally the most basic. For example the user Selects from a list, I am Rated X%, then selects for Y condition from another list, and Secondary to that I am rated Z. This last could be a combo of user input and list. The ability to input could easily be condition on membership, free or paid or allow both.

Indexing the Y condition would allow displaying the listed secondaries reported by the users and even could say when they were input into the datebase to give a time reference. Indexing the Secondaries would display possible primary conditions to associate to.

The search could be that the user selects " I am primary for Y what are possible secondaries." The other search is "I have Z what is it secondary too." Only two public searches (queries) needed. 3 basic public tables (4 of date included in database is shown). Output would be a simple HTML list.

If anyone else thinks that DB would be helpful please chime in.

I will update this as I find things out.  That advent of the AMA and cancellation of RAMP changes things in ways we just don't know yet.

[Phury & Rhage]

Yep, you nailed it.  Associating something is just a fancy term (possibly a legal one?) for making sure it's in there:  we associate medical records, buddy statements, sleep studies, personnel files, etc.   Tabbing something is no different than bookmarking something.  When I write an exam request, I want to tab relevant evidence for the examiner even though they are typically required to state that they examined the whole eFolder.  It's super important to do that for contract exams because they don't get to see everything in our system; just what we tab for them.  So my tabs look like - TAB A: STRs received 12/28/18 knees pgs 4-7, 22, 89; right shoulder pg 47;  TAB B:  personnel record shows confirmed RVN service as a combat medic pg 15. ;  Duty MOS is 11B infantry with exposure to hazardous noise conceded etc.

I spend a lot of time reviewing records and I'm looking for specific stuff.  Our motto is supposed to be "Grant if you can; deny if you must."   I take that to heart.  Plus I'm a vet. 

[broncovet]

I dont have experience working for VA, but I have been answering Vets questions here since 2007.  

I do NOT recommend you getting too specific when you apply for benefits.  Its the raters job to figure out if you have direct service connection, secondary, or presumptive.  

It sounds like you have a copy of your cfile..this is good.  Remember, tho, that was likely out of date by the time you received it.  

If you insist on specifying in your application, "Secondary to _________", then I suggest you do so in such a manner as not to preclude presumptive or direct SC.  In other words, you could apply for "voiding function", both primary, secondary, and presumptive as applicable.  

You see its gonna take medical evidence anyway.  Our lay evidence wont suffice to garner all 3 Caluza elements, required for SC.  So, why burn down any bridges when you dont know how a c and p examiner will opine?  

The CAVC has ruled the Veteran can "point" to the body part he wishes to apply for, a Veteran need not have intimate anatomical and medical knowledge to receive VA benefits.  

In fact, I have seen VETS get TOO specific on applying for benefits.  One Vet mentioned he applied for c5..issues, and his back pain was later diagnosed as c7.  

It wound up delaying his claim a lot by trying to play doctor.  

Yes, I have studied Anatomy.  But you have got to realize different docs view the same thing in a different way.  So, let the doctors diagnose, treat, and supply nexus for your conditions, and I dont recommend you apply limiting to a specific diagnosis or nexus, as I often see Vets winding up getting benefits they thought they would not get, and getting denied on benefits they thought were a slam dunk.  

Remember the VA is not a unified body.  Different decision makers will arrive at different conclusions given the same evidence.  

In my case virtually EVERY decision ever made on my claim was at least somewhat of a suprise.  

Probably the least suprising was my last decision at the CAVC.  My attorney thought it would be remanded, I figured as much, and it was remanded, but not for reasons I had predicted.  

[ShrekTheTank]

There has been some great advice on here, and they are only trying to save you aggravation and years of appeals.  I know Bronco has saved me so much time and frustration!  Let them figure out where it lands and you might get a good surprise!  I always like to nudge them, but avoid the pitfall of something exact.  

[Buck52]

             Phury & Rhage  ,   Welcome to Hadit 

Thank you for helping these Veterans 

[GeekySquid]

2 hours ago, broncovet said:

If you insist on specifying in your application, "Secondary to _________", then I suggest you do so in such a manner as not to preclude presumptive or direc

@broncovet

I am not sure where you read in my post that I am specifying "secondary to......" but whatever you are reading that into is an incorrect reading.

Here on hadit, I laid out the reasons I am hopeful/thinking that my process for this claim under the new AMA process will succeed and will do so rapidly. I am setting a timer on the process as it related to my apparently simple claim. This is primary reason for the post, discussing the new AMA process in that specific context. If AMA proves to be effective and reaching its goal of cutting time off each step, this is the forum to track that right from the beginning.

I listed medical conditions, here on hadit, that are already in my record and others that I am already rated for.

I posted my thoughts about those things as they have connection to the current claim. For example Sleep Apnea is not specifically medically related to voiding dysfunctions

I stated that the "process" on VA.Gov/ Ebenefits to file that claim did NOT give me a choice to select Voiding Dysfunction as a secondary to anything so I selected Genitourinary as the type of claim. The application does not let you just say "i leak a lot".

Nowhere is the post suggestive that IN MY CLAIM, i told the RO that X is secondary to Y. I said I selected Genitorurinary problem and in other statements in that post I stated that in a previous Award for ED they stated I might have a claim for Voiding Dysfunction.

In terms of the claim itself, pointing out information in my medical file is the detail I stated and attached to the claim. That is not to say those things are secondary to anything, they just exist as medical evidence or evidence of the condition.

I don't believe that pointing a rater to specific information in a C-File of a few thousand pages is a bad thing. While it may be apparent that having my aircraft shot down and not being able to punch out until the last second required hospitalization and dozens of surgical procedures.

It may not be absolutely clear to a rater that there are specific bone or body system problems further down the road. In my view it is up to me to make sure the rater and C&P doc know about that event and treatments.

 

 

[GeekySquid]

2 hours ago, shrekthetank1 said:

There has been some great advice on here, a

@shrekthetank1

There has been great advice on hadit, there is also not-so-great-advice.

There is an old saying that the road to hell is paved with good intentions.

Some people intend well but frequently misunderstand what is posted or apply a context that is not correct. Their intention to help then takes a jump down a rabbit hole that creates further downstream commenting misunderstandings.

One of the reasons I took a break from this site was  just that. Frequently certain commenters misread/misunderstood/assumed things about posts made here by others. Then their response, out of context to the post, used that framework to make statements that ranged from mildly incorrect in context to flat out wrong and misleading in relation to the post.

This is further frustrating fact that the Regs and application of the rules are relatively fluid year over year. A court decision this year can invalidate information from last year. Or the VA can change the wording in a DBQ or process that erases past sage advice. My point is that adding misapplied advice to an already fluid situation is probably not the best situation.

Everyone has a right to their own opinion, they just don't have the right to misrepresent what others say using an "alternative facts" or an inappropriate context of their own creation.