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]

Hello,

I'm probably missing something here but I want to make sure that you didn't file the claim on the 4138, right?  You included a detailed statement on a 4138, but you filed a 526EZ for the new condition?

Thanks,

Phury

[GeekySquid]

25 minutes ago, Phury & Rhage said:

526EZ for the new condition?

@Phury & Rhage

thank you for asking and the answer is yes.

as a matter of fact I was going to post as part of my timeline that I got the call for my C&P on the 16th of May. 8 days from filing. They are looking for one since I have some travel restrictions right now. In a wheel chair after Lis France Fracture surgery and having my car totaled, I am sorta limited in when and how I can move around.

I see you are up here in the Seattle area so you get that using a manual wheelchair on some of these hills is a non-starter for most people.

 

[Phury & Rhage]

You're welcome and good luck with the exam!  I can't imagine having to use a manual wheelchair.  I work from home full-time as a reasonable accommodation, so I'm fortunate not to have to navigate much.  So...I just passed my one year mark working for the Agency Who Shall Not Be Named.  But I do want to say that I spend virtually all day, every day processing...appeals - strictly RAMP and AMA.  It's obviously very new and the learning curve is steep.  I look forward to contributing here for those who might have questions.  I certainly don't have all of the answers, but I know where to find them

Phury

[GeekySquid]

14 minutes ago, Phury & Rhage said:

working for the Agency Who Shall Not Be Named.

@Phury & Rhage

that might be good to put in your profile. If legit, you will become a valued resource here.

There are a lot of questions on how the raters apply different sections of the MR21-1 to specific instances. Particularly in cases of Duty to Assist, Duty to Notify, Duty to Infer, Issues in Scope etc. There are a lot of CUE questions

Generally speaking we know the regulations and 38 USC 38 CFR sections that apply it is how the raters will review the claims using the MR21 to review the individual claim.

For example in my original claim in 2013 my Audiologist ignored over half of my service record, stated the years she looked at, said I had a rateable hearing loss for VA standards but could NOT Service Connect me.

The decision letter stated my Full years of service.

The raters and reviewers failed to see her error and when they wrote the reason the did not include her specific statement of which years to include. That led me to read the results as being inclusive of my entire service. Had the denial included saying she had only looked at one period of service I would have filed a NOD back then.

In my complicated 2018 claim to reopen that issue (I had just gotten my Cfile and found her error) they denied saying it was not New and Material. (how that she did not look at my whole file is not new and material I don't get).

but then in a deferred part of that claim it was decided and they Service Connected my hearing loss but only gave me a 2018 date.

I am going to file a cue on the 2013 under 4.6 since they failed to do a thorough review and I am going to also file a NOD on the 2018 denial and the 2019 approval asking for an Earlier Effective Date. I am also going to ask for a higher rating on the other part of the 2019 approval once I get the C&P from the Seattle RO  office on Monday.

I am also considering a CUE under 4.6 related to an Issue in Scope as the same files the Audiologist DID NOT look at in 2013 included all the tests the VA did on my Vertigo and my having a partially empty sella. Since they did not look at those files they did not infer an issue in scope and did not notify me of the evidence i would need  to succeed with such a claim.

The Sella covers the pituitary gland and when crushed or damaged it can affect all your hormones, including those that affect cortisol, anxiety and depression. It also has a direct medical connection to Erectile Dysfunction, Sleep Apnea (which I have and they gave me a CPAP for in 2013 but did not tell me it was a rateable condition). Even the bladder is affected when your hormones go wonky. Further it has a direct connection to MS developing later in life.

As I said it is complex and there are lots of questions on here like that.

 

[Phury & Rhage]

I'd like to be a resource, just not an advertised one   There are regulations that govern (and I sign a statement and get training every year!) what folks in that agency can do in public and online.  Love my job (seriously) and not trying to lose it.  Here's some other framework.  I have been trained and work exclusively in "pre-development".  That means I'm pulling in all of the records and reviewing them for specific stuff.  Even working appeals, there is a ton of "dev".  For instance, you appeal a denial for PTSD on a Supplemental claim and you say that you more documentation on your stressor that didn't make it in front of the decision maker.  You point to deck logs or OSI investigations of incidents.  I'm going after those records.  You say that it looks like your in-service mental health treatment didn't make it in the file with the rest of your STRs/SMRs, I'm going looking for them.  When I gather all of that information, I'm going to be looking to send you to get that exam you didn't get last time.  Or an addendum to the medical opinion because we have more facts to put in front of the examiner and we can concede your stressor.

I'm not a rater.  I can only guess why they make the choices they do unless I've personally seen a case (and THAT won't be anywhere near a website).  But I do get a sense over time so I might be able to offer some tidbit or suggestion.  I'm working with a really small team that has all of the "roles" you'll see in an appeal case - without naming titles.  It does give you a broader perspective, but not enough depth to be considered an authority.  Anyway, your specific stuff runs throughout the life of a claim, so I'm not going to be knowledgeable about most of it.  But I'm a good researcher with good resources, so bounce specific questions off me and I'll do what I can  

[GeekySquid]

20 minutes ago, Phury & Rhage said:

'd like to be a resource, just not an advertised one

@Phury & Rhage

no one would want you to risk your job or divulge other veterans info.

20 minutes ago, Phury & Rhage said:

I have been trained and work exclusively in "pre-development". 

curious about this from reading the MR21. There are frequent references to "associating files" and to "tabs".

so my first question is about what pre-development relies on and looks at in relation to those terms. For example if you get a claim for PTSD which include specific sleeping issues but not a specific claim for sleep apnea, do you look for things like a Sleep Study, in service medical records related to sleeping problems etc and then associate those records to the file?

Edited May 19, 2019 by GeekySquid