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  • 14 Questions about VA Disability Compensation Benefits Claims


    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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Bruce Fox

Still Need Medicare Coverage?


I currently am covered under Medicare Part 1, 2 & 3 because I was told that the VA would not reimburse for ER visits and a lot of the things that a local hospital visit ER would entail.

I just read an article saying that they now have to pay for ALL non-VA emergency care.  ( https://www.nbcnews.com/news/veterans/court-rules-va-must-pay-veterans-emergency-room-care-decision-n1052131?fbclid=IwAR39i1ses23bqJuV3prHoeEi2Xi4Pa_xKmWkAnx2OmlVAw4DWiXnuFb0BrE ).

Do I still need to have Medicare insurance???   I don't want to pay an extra $135 per month I don't have to!

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Excellent question, and one I went through a few years ago.  

I can not decide for YOU, but here was my reasoning.

If you are satisfied with your VA care AND are certain you will be satisfied in the future, then you can skip Medicare Part B (That is the part that is 135 per month..Part A is at no cost).  

However, if you feel that all or some of your VA care is substandard, and that you may want medical care outside of the VA (now or in the future) then pay the 135 per month.  

If you opt out now for medicare part b, then a couple years later, opt back in, you can do so, but you will be penalized (pay more than 135 per month, and its a big penalty, too)

Here is what I did.  I was disabled and became eligible for medicare before I was 65 because of disabilities.  At that time, I opted out of medicare.  

However, when I became 65, I also became eligble for medicare AGAIN.  This time, I opted "into" medicare part b with no penalty.    I felt later I did not want to be "trapped" into VA care, and it was worth it for me to pay the 135 per month to be able to get private care when I wanted it.  

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Its really a personal decision to keep Medicare or not.  I have three choices for medical care and I like to be able to pick and choose.

For me I have Tricare ( military insurance) since I am a retiree,  in my case if I want to use Tricare I have to pay for Medicare by Law. 

I can use any Military Hospital,  and I have been admitted twice this year once into  Darnell Medical Center,  and once into Brook Army Medical Center.  In the first instance, the military doctor literally saved my life. In the second instance, a military doctor performed surgery that no one else  wanted to do because of my numerous medical issues.  So, my first choice for care is the Military Medical system, its the best in the world always has been always will be.  My second choice  for SERIOUS medical issues,  is a private medical facility,  this would only happen if the military could not treat me in a given situation. If this happens, ( and it has a few times)  I don't pay a penny out of pocket. Medicare pays 80% , Tricare pays 20%. 

My last choice is to use VA Medical care.  I have found because of the VA rules that I must at least see a primary doctor at the VA every six months. This is because of my medical issues and the need for prosthetic items, like my AFO, wheelchair issue and repair and other items  the VA will not give me if I do not get medical care from the VA.  In  a few instances, I have opted to use Medicare and Tricare to pay for medical devices like my portable oxygen concentrator , or my INS blood testing equipment. This is because even though I am 100% for my lungs the va will only pay for oxygen tanks not a portable concentrator, and my INS levels for blood clotting is monitored by a military doctor, so again its a personal choice. 

 I don't trust the VA to provide quality medical care, sorry but they see  too many veterans in one day and don't spend enough time with the veteran when they do treat you. Also,  the VA hires too many foreign born doctors, some of which you can barely understand because of accents and other issues.   I also don't like to use private facilities either but only because I think they just charge too much for medical care, like $10 for an aspirin.. ( I saw this first hand when I worked for a year as a computer specialist in the Cape Valley Medical Center, in Fayetteville NC. )  

Having three choices insures that no matter what  I can get medical care almost anywhere at any time, and it never cost me anything out of pocket.  If I were to stop paying for Medicare, I would not only lose Medicare but tricare as well.

I've had Medicare since I was 45... in my situation,  if I had refused to pay for part B,  I would not have been able to keep Tricare and would only get Emergency care at a Military hospital, thus limiting my options to VA care only.   In fact,  I remember specifically in 1999, I was told that I would pay a penalty if I refused Medicare at 45 and  tried to get Medicare at a later date regardless of when I decided to opt in.... I wonder about Broncovet statement saying he didn't have to pay a penalty when he turned 65 after refusing Medicare part B at a younger age. 

You have to decide based on your situation.. I personally think its a good deal and smart to have more than one option.

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IMO, if you are not at least 50% rated combined, I wouldn't drop it. At the 50% marker the veteran doesn't have to pay any co-pays for VA hospital stays, drugs etc. Less than 50% and you have to pay co-pay for some hospital stays, non S-C prescriptions, etc. Anyone who thinks medical care in the US isn't dynamic and will have many changes in the near future is living under a rock. Medicare and Medicaid costs are skyrocketing, and insurance companies are making people pick up more and more cost, while dropping coverages and raising premiums. Legislators are trying to add more and more Free stuff to buy more votes. The VA is cutting back on the number of medical staff, and there are less veterans to participate in the VA Health System every year. When Vietnam veterans pass away, they will be closing many VA clinics and hospitals. If they close the one you use, are you able to travel  to the next one you have to go to? It just is too dynamic to think this is a good option. Again, IMO

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As it is well stated it is a personal decision.  I also have Tricare being medically retired and have to pay for Medicare.  If I did not have to I still would, GBArmy gives a fine reason but I believe there is another and that is that at some time in the future you may come to a place where you want to be served on the private market instead of the VA.  My situation changed when I had a bad neurologist.  At this time I stopped going to VA neurologists.  No Medicare and you do not have this option.

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The four posters before me all have good points, but Broncovet is dead on about a reason most people don't think about concerning Part B.

If you opt out, the cost to opt back in is ridiculously huge.

That 135 now is peanuts compared to what you might have to pay if your VA care becomes harder to get to, or limited.

Bronco is right. Our benefits can change at any time. Political will is a joke when it comes to helping vets, and I mean from the Oval Office to the janitor at your local VAMC and everyone in between.


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    • Yes 

      After a PTSD/Unspecific MDD Diagnose From the VA Dr's

      The gold standard for diagnosing PTSD is a structured clinical interview such as the Clinician-Administered PTSD Scale (CAPS-5). When necessary, the PCL-5 can be scored to provide a provisional PTSD DSM 5 diagnosis.

      Any clinical clinician such as MD ,Psychiatrist even a L.C.S.W. (Certified)can perform the Diagnostics Evaluation Employed by the the VA

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        you learn the tools to cope with and depending how severe your symptoms are ? 

       They test /screen you with phychoeducational type therapy treatment usually at first.

       Warning  some of this therapy can be very rough on a Veteran  from holding on to guilt  from the trauma its self or you maybe in a  ''stuck point''from memories and guilt or from the stressor's or anything that reminds you of the trauma you endured.

      The therapy works  even if we think it don't,  I recommend Therapy for all PTSD Veterans  it could very well save your life once the correct therapy is in place and the Veteran makes all his Clinical Appointments.

      I still have Combat PTSD it probably will never be cured completely but we can learn the tools it takes to cope with this horrible diseases 

      even learning breathing techniques  Helps tremendously during a panic attact.

      I have guilt from the war in Vietnam  ( I ask my self what could I have done to make a better outcome/difference?..and also I am in what the therapist calls stuck points. working on that at present once a week for 90 minutes.  I am very fortunate to have the help the VA gives me and I am lucky I have not turned to alcohol or drugs to mask my problem.

      But I have put my family through a living hell with my angers of burst.and they all stood by me the whole time years and years of my family life was disrupted because of me and my children &spouse  never deserved it one bit.

      That's all I want to say about that.

      At least I am still around. and plan to be tell my old age dying day.
    • No timeframe gotta love that answer it’s even better when you ask 1800 people or call the board directly they’ll say you’ll know sooner then later. I had mine advanced and it was about 2 months later until I had the decision in my hand which seems forever but in the present system in 2016 lightning fast...
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    • I am serviced connected for ankylosing spondylitis back in 1985. I had a C&P exam on 7-7-19 since I am asking for an increase in my cervical, thoracic, and lumbosacral ratings. After speaking with the DAV to find out progress and info on my exam, the Rep. noted sort of what I expected. Radiculopathy was noted and ROM was 0-15 for cervical, and 0-25 for back. I am currently rated as Cervical 30%, Thoracic 10%, and Lumbosacral 40%. The main question that I have is relating to the thoracic 10% and lumbosacral 40%. I am confused on these two. Is Lumbosacral separate from the thoracic/others ? Since my back ROM is at 0-25, does this mean that my thoracic might increase from the 10% to a higher rating ? I am confused how they break down my ratings from cervical at 30%, Thoracic at 10%, and Lumbosacral at 40%. Also, with the radiculopathy, is this something that they will rate also ? I am currently at 90% total combined for all my disabilities. I hope this helps for someone to give me advice/answers.
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    • Thank you @GeekySquid for your reply. 


      I have redacted personal information for my documents listed below. 

      I look forward to your reply. 

      HEADACHE STR 2006 copy_Redacted.pdf


      Pages from Original Denial-Grant Reasons_Redacted.pdf
    • Hello Defenders of freedom!

      I have a question pertaining to this denial for headaches. The decision letter is quoted below. 


      3. Service connection for headaches.

      "We may grant service connection for a disability which began in military service or was caused by some event or experience in service.

      Your STRs are negative for any treatment of or diagnosis of headaches. On your post-deployment exam in 2005 you denied any headaches. On separation, you denied any headaches. VA treatment records are negative for any treatment of or diagnosis of headaches. On VA exam, the examiner stated there was no evidence of any residuals of a traumatic brain injury.

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       (1) either the correct facts, as they were known at the time, were not before the adjudicator or the statutory or regulatory provisions in existence at that time were incorrectly applied; 

      (2) the error must be undebatable and of the sort which, had it not been made, would have manifestly changed the outcome at the time of the prior determination

      and (3) a determination that there was CUE must be based on the record and law that existed at the time of the prior adjudication in question.  

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      • 14 replies
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