diabetes Va Ratings Seem To Have Disappeared

[Stan n Pam]

I'll try to explain this – I feel like I need to tell you all that have responded that I have a pretty healthy case of good 'ole ADD. I really struggle reading, especially instructions – so keep that in mind when I don't seem to click right a way on something – I'm a visual learner….so if you guys wouldn't mind drawing a few pictures now and then, that would probably help a lot……. Just kidding J …but if they could be in color……..

In going thru the ROI packet that was printed on 10.10.06 – there are some discrepancies that I need help understanding –

It shows Stan as having a 60% disability rating. It is broken down like this:

"CONSULT REQUEST" (is the title on the top of the page) page 53

Provisional Diagnosis: PTSD CHRONIC SEVERE

Eligibility: SERVICE CONNECT ED 50% to 100% VERIFIED

Total S/C %: 60

FOREARM MUSCEL INJURY 30% S/C

FACIAL SCARS 0% S/C

DIABETES MELLITUS 10% S/C

POST-TRAUMATIC STRESS DISORDER 10% S/C

ARTERIOSCLEROSIS 0% S/C

ARTERIOSCLEROSIS 0% S/C

PARALYSIS OF SCIATIC NERVE 10% S/C

PARALYSIS OF SCIATIC NERVE 10% S/C

Then……………………..

On October 12, 2006 Stan received notice that his disability had been increased to 70% - and that breaks down like this:

….decision on your claim for service-connected compensation received on December 29, 2005….

….Payment start date: Jan 1, 2006 for increased service-connected compensation evaluation; monthly entitlement amount $1,280.00 this includes an additional amount for your spouse, Pamela…..

….We determined that the following conditions were related to your military service, so service-connected has been granted…

<H1 style="MARGIN: 0in 0in 0pt">Medical Description percent assigned effective date</H1>Bilateral hearing loss 0% May 19, 2006

Tinnitus 10% May 19, 2006

…..we determined that the following service-connected conditions have worsened, so we granted an increase in your assigned percentage:…..

<H1 style="MARGIN: 0in 0in 0pt">Medical Description old % new% assigned effective date</H1>Diabetes mellitus, type 10% 20% Dec 20, 2005

II w/nuclear cataracts

Residuals, shell fragment 30% 40% Dec 20, 2005

Wound, right arm

Scar, fragment wound, right and left periorbital areas 0% assigned

…….we denied entitlement to the 100% rate because it wasn't shown that you are unable to work as a result of your service-connect disabilities……

My question here is: What happened to the previous ratings on these:

POST-TRAUMATIC STRESS DISORDER 10% S/C

PARALYSIS OF SCIATIC NERVE 10% S/C

PARALYSIS OF SCIATIC NERVE 10% S/C

Another question is: I wonder where the heck that 10% rating on the PTSD came from in the first place? I'm still in the process of going thru papers so I may find that out – Stan is hoping to be rated 100% on PTSD (his VA doctors seem to think that is a distinct possibility, we'll see) – if that happens will he lose the ratings on everything else? Will they all be absorbed into one single diagnosis of PTSD? I have a problem with that! He was shot serving his country before he developed PTSD! To me everything should be absorbed into that rating. Maybe I'm being too emotional here and I probably haven't thought this thru enough, but most of the time my first instincts seem to be the right ones. ….BUT… then on the other hand – I do have to realize who we are dealing with here!!!! The VA and The Government…….. 'nough said.

Thanks for any direction anyone can give me on this,

Pam

If you need any more background – I'd be happy to supply it – one thing about this board that is so cool, is, that everyone has their own dirty laundry, and we all have to hang it out to dry sometime – and this seems to be the best place to do that.

[Stan n Pam]

Hey Berta -

just read your profile...sounds like you must sit around all day and eat bon bons.....

on top of that - 40 posts a day???

when do you sleep???

I have to round up some records from the VA because it looks like Stan didn't keep most of what I need to answer your questions - I am a little frustrated that I have very little correspondense from the VA for the last 4-5 years - seems to be missing since 2002 - not sure why he threw this stuff away

I do have something from 2002 that does show that he requested compensation for PTSD along with about 10 other things - I guess that is when he received the 10% rating - however I don't have any paperwork at this time that actually shows/says that

I think I need to work on getting "my ducks in a row" before I bother you all too much with this stuff

It's just that this stuff is so confusing to me! (that's the 'ole ADD kicking in) But I know that I have to do this - Stan just can't. It may just take a while - so thanks for the help so far and I so appreciate the time and knowledge that you all are so willing to share with so many.

Pam

ps...the 2002 correspondense from the VA - DOES show the syatic nerve damage only ONE time - it was a VA typo on the later correspondense

ppss... a little note to Berta - since I see you are also a fan...I have to tell you that I do have one (probably only one) claim to fame! While my dad was stationed at Ramstein in the last 60's - I went on a teen club trip and I got to see and hear Hentrix's in concert!! - I really didn't pay too much attention to who he was then - but at least now I get to say I saw him........ :) my kids were even impressed - and that doesn't happen much! :)

[Berta]

Jimi Hendrix was an Army Paratrooper and some say he was discharged under OTH conditions-

I dont know if that is true-he was certainly an important part of American culture.

NARA provides the military info on persons of "exceptional Promenence" and he certainly is listed there-

for 50 cents I think the access costs- the list is for all open files from NARA on many individuals-

and you can get their mil info-

Pam- if he had a service officer or vet rep- they might well still have a file on your husband with copies of a lot of VA stuff-

then again there is nothing better than the c file itself-

if you write to the VARO where his c file is- to the Records Access officer-asking for a complete copy of the c file they should send it in a few weeks-

it can hold up anything in progress when they copy it -but still believe me-

a c file can be very revealing-

My c file had all the stuff they "never got" and "lost" many years ago.

It also shows that a recent decision I got was completely wrong-

They said my husband had never filed a Sec 1151 in his lifetime-I told them

It is right on top of the whole c file-dated as received by VA, and with the PO cert number on it-

I re-opened this claim word for word in 1995 so how could I do that if they never had it in the first place?

They told Rod the AM he died that this Sec 1151 claim and his increase in SC for PTSD was at rating board and my rep had told me that Section 1151 was written all over the c file cover that they kept. Makes you wonder how they come up with statements like that-

Getting organized sure saves a lot of time and stress

there are many tips here at hadit for that-

Gee I thought by now I Would be sitting around eating Bon Bons and watching all the Star Wars movies over again and again-and practicing my moonwalk-and fly casting-etc

as it is I dont have time for any of that-

It often takes me hours just to re-sort my VA paperwork and stuff-

But Pam- there is a lot of security knowing that if the VA-or my vet rep- or the RC calls me-

I can whip out the right stuff in a heartbeat--

Having all VA letters in one spot, all SOCs and award letters, and separate files for evidence for separate conditions-and using highlighters and colored tabs-

it really helps alleviate the stress of all the VA crapola-

I hope everyone here is well organized for their claims or at least uses some of the great tips here for getting it all together.

[Pete53]

Pam:

Berta is the best thing since sliced bread and has become a real expert in a lot of VA Claims areas. However she does not post 40 times a day. I think that T-Bird bumped a few of us up to 10,000 posts to make us Elders on Hadit.

Berta is self taught and has formal schooling on Veterans issues and it all started cause she was trying to help her husband with his claims.

I hope that you become another advocate for Veterans and thier sposues on hadit just like Berta did.

Edited January 30, 2007 by Pete53

[Stan n Pam]

I have tried to answer the questions, about Stan's situation, that Berta and others have requested - let me know if I need to clarify anything.........

I noticed they did state chronic and severe-so there must be evidence there already beyond the 10%-that can be Nodded-(Notice of Disagreement)---then again could it be NOdded ?-hope Vike comes back-can you NOD part of a decision where no formal claim for increase was raised?

”Did he ever ask for higher PTSD rating?”

<H1 style="MARGIN: 0in 0in 0pt">Pam’s reply--- </H1>Yes, but I haven’t actually got my hands on documentation – also, I just found out (today) that the PTSD part of the claim went to the Rating Board on Jan 17, 2007 – Stan has some pretty strong wording in his diagnosis report from his VA doctors… (I sure hope we don’t have to fight this)

”something here is really sticking out to me-

DMII % was raised-but what was the rating for the nuclear cataracts- and how could a DMII vet have cataracts (I assume they are definitely due to the DMII) if they did not rate the atherosclerosis as service connected too at a ratable % beyond "0"?

DMII can cause atherosclerosis that also can cause cataracts-

I have vets who have this progression of their DMII. These are secondary conditions of their SC Diabetes. But their claims were specifically for the rating of these secondary conditions.

Even the VBM makes the point of the nexus between these conditions and also the VA training letter on DMII does too.”

Pam’s reply---

…Berta – I really have no clue what you just said….but this is what we received from the VA…

This is the REASON FOR DECISION – copied right off the Entitlement letter from VA: (received around end of Dec)

Evaluation of diabetes mellitus, type II with nuclear cataracts currently evaluated as 10% disabling.

The evaluation of diabetes mellitus, type II with nuclear cataracts is increased to 20 percent disabling effective December 20, 2005.

The evidence shows you have a requirement for insulin and restricted diet, or oral hypoglycemic agent and restricted diet to control your diabetes mellitus, allowing a higher evaluation. The most recent examination by Dr Beldick indicates that you have no diabetic retinopathy, however, you do have cataracts likely due to your diabetes mellitus. Your vision is 20/25 corrected in both eyes. Although the optometrist indicates that you should be followed up for diabetic retinopathy, the examination by the specialized eye doctor, Dr Beldick does not show that you have this complication. However your diabetes induced cataracts are included in this rating evaluation. Any noncompensable (I don’t know what this means, I don’t think that it’s a word) complications are considered a part of the diabetic process, and are considered within this rating decision.

An evaluation of 20 percent is assigned from December 20, 2005. An evaluation of 20 percent is assigned if there is a requirement for insulin and restricted diet, or oral hypoglycemic agent and restricted diet. A higher evaluation of 40 Percent is not warranted unless insulin, restricted diet, and regulation of activities are required. Regulation of activities indicates avoidance of strenuous occupational and recreational activities, and is needed for diabetics who have a difficult time keeping their blood sugar within normal. You are likely to have difficulty with such symptoms as: episodes of hypoglycemia, frequent doctor visits and changes in insulin dosage.

”Is your husband unemployable due to his service-connected conditions?”

Pam’s reply ---

Not according to the VA (yet)

We were very fortunate that Stan has not had to work, because for 25 years when we lived in Orlando, we owned a small Commercial Janitorial Business. The business was in my name and he showed no income.

Stan was medically retired from the PO in 1984 – because he could not use his arm any longer to do his assigned position – this was due to the GSW from Viet Nam and also his right shoulder had developed a chronic problem after 11 years of repetition and stress. It had compensated for the weakness in his right arm and just basically wore out. He had surgery on it in ’83. The surgery was for: chronic impingement syndrome, namely a Neer acromioplasty and AC arthroplasty of the right shoulder.

…….so to make a long story short… instead of transferring Stan to a job in the PO that he could do within his limitations, the Postmaster, in all his wisdom, decided to medically retire Stan at that point.

We were scared to death! At that time (and probably still is) PO pay was pretty darn good, especially compared to E-5 pay in the Army.

Because he was medically retired we had the opportunity to keep the medical insurance that we had at the PO. But in order to keep the health insurance, Stan could not make over $600 a year. Hence the business and most everything else was put in my name.

Because of that restriction - Stan going to try to find a “real job” was absolutely out of the question!

I spent last night reading some of the old medical records from way back then – sure do wish I knew then what I know now….. oh well – we’ll just take it from here

”Does he get SSA for his service-connected conditions?”

<H1 style="MARGIN: 0in 0in 0pt">Pam’s reply ---</H1>Stan is not eligible for SSA because he does not have enough work credits (he only has 35 or 37, I think) and hasn’t worked in the last 10 years. He can not draw on mine because I am not retired (62) and I’m not dead yet

I’ve checked this out pretty well – I even called and talked to a representative at allsupinc.com and he told me the same thing that the SS office did

”Did he ever have an ECHO test to determine what level of atherosclerosis he really has?”

Pam’s reply ---

I don’t have VA documentation of that right now – but I’m sure he would have had the ECHO test. I can tell you that we have plenty of results from tests to verify just about any level of atherosclerosis – Stan has severe hardening of the arteries. He has had 2 separate open-heart surgeries, 3 carotid bypass surgeries (1 carotid was bypassed twice), kidney stints etc. Just today he had a full body cat scan because he is having head aches and pain in his legs again – the tech told him (off the record, of course) that there was some more plaque building up in one of the carotids). We’ll have to wait for the radiologist report for fill details. We would love for him to be able to have an MRI instead of a cat scan, the MRI has such a clearer picture than a scan – but that is impossible because he has shrapnel behind his left eye, and the doctors say that a MRI would most likely cause the shrapnel to come out right thru his eye. So there again, he cannot get the medical treatment he really needs because of remnants of the war. (FYI – the scan today and all of his surgeries have been in private hospitals – he has had only one major procedure at a VA Hosp and that was in Boise, ID, around 1976. He had an ulner nerve transplant due to the GSW in Viet Nam – I can’t tell you how thankful we are and fortunate we feel to have private insurance – I won’t even go into the experience we had there!)

”Did he in fact ask for increase in the % for atherosclerosis?”

Pam’s reply ---

I don’t know that

”Has any doctor said he was unemployable due to his service connected conditions-”

Pam’s reply ---

Yes – both doctors at the VA have stated that very clearly in their diagnosis letters

I will attach a TDIU form- if he believes and can prove with medical evidence, that his service connected conditions render him unemployable. TDIU is the same $ as the 100% rate.

Interesting- they considered 100% but did not infer TDIU-----

”Did the initial claim request 100%?”

Pam’s reply ---

The initial claim – I’m not sure about that one, but I know this last appeal did

“1 thing I did notice was you stated there was two 10% ratings for the sciatic nerve. Was this just a typo? The reason why I ask is normally that isn't allowed under "pyramiding," meaning two disability ratings for the same disability. Could you clarify that?”

Pam’s reply ---

The 2 - 10% ratings were actually on the decision from the VA that was dated 2004 and that was repeated on several other papers – however on the latest thing we received from them, the duplication was not there – so I have to assume that it was a typo that the VA made

[carlie]

Pam,

”Does he get SSA for his service-connected conditions?”

Pam’s reply ---Stan is not eligible for SSA because he does not have enough work credits (he only has 35 or 37, I think) and hasn’t worked in the last 10 years. He can not draw on mine because I am not retired (62) and I’m not dead yet

I’ve checked this out pretty well – I even called and talked to a representative at allsupinc.com and he told me the same thing that the SS office did

______________________________________________________________________________

The Social Security Administration has SSD - based on disability and past work history (earning quarters),

or SSI - based on disability with limited income. SSI does not pay much - but it DOES NOT require any earning quaters.

I don't remember seeing in your postings whether the Social Security Administration provided any

information or consideration in regards to SSI for Stan's situation.

Here's a link for SSI just incase you would like to check into it, the income limits are pretty low,

but they do exclude larger assets such as a home or most automobiles.

Hope this helps a vet.

carlie

http://www.ssa.gov/OP_Home/handbook/handbo...book-toc21.html

Edited January 31, 2007 by carlie

[Vike17]

Pam,

I kind of got lost in this whole claim senario of your husbands, so if I ask something that is redundant and someone else already addressed it, I'm sorry!

In response to Berta's question of being able to file a NOD on a decision that actually wasn't initially formally claimed or asked to be formally increased, I would have to say, yes, one should be able to do so; any decision by VA can be appealed. However, I have never seen such a claim/decision because if there wasn't a formal claim by the veteran, that means the VA "inferred" the issue and the veteran was actually happy to get compensation for a condition without claiming it themselves, or at least the VA addressed a condition that the veteran felt wasn't service-connected. The same holds true if the veteran "re-opens" their claim(s)s by requesting an increase in one evaluation and the VA took a look see at another and came back increasing the one requested and affirming a prior decsion on the one that wasn't requested. Therefore, actually not warranting a NOD. Does this make any sense, Berta?

From the way things look, it appears that your husband requested an increase for his PTSFD and the VA is now considering that issue because it's at the "rater."

”something here is really sticking out to me-

DMII % was raised-but what was the rating for the nuclear cataracts- and how could a DMII vet have cataracts (I assume they are definitely due to the DMII) if they did not rate the atherosclerosis as service connected too at a ratable % beyond "0"?

DMII can cause atherosclerosis that also can cause cataracts-I have vets who have this progression of their DMII. These are secondary conditions of their SC Diabetes. But their claims were specifically for the rating of these secondary conditions"

I think this is what VA was referringto in their decision;

7913 Diabetes mellitus

Requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated ...... 100%

Requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated ......60%

Requiring insulin, restricted diet, and regulation of activities ............. 40%

Requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet ......20%

Manageable by restricted diet only .........10%

Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913.

Note (2): When diabetes mellitus has been conclusively diagnosed, do not request a glucose tolerance test solely for rating purposes.

Having said that, I'm not sure, accordingto the medical write-up from the doctor, if the cataracts warrant a higher rating than 0% or not. If the cataracts warrant a higher rating than 0% by themselves, then they would be rated seperately.

"Stan was medically retired from the PO in 1984 – because he could not use his arm any longer to do his assigned position – this was due to the GSW from Viet Nam and also his right shoulder had developed a chronic problem after 11 years of repetition and stress. It had compensated for the weakness in his right arm and just basically wore out. He had surgery on it in ’83. The surgery was for: chronic impingement syndrome, namely a Neer acromioplasty and AC arthroplasty of the right shoulder.…….so to make a long story short… instead of transferring Stan to a job in the PO that he could do within his limitations, the Postmaster, in all his wisdom, decided to medically retire Stan at that point"

If Stan was medically retired because of his Service-connected left arm (I assume it's service-connected because of the GSW), then that would certainly help subtantiate a claim for IU. However, the right arm contributed to his medical retirement and that isn't service-connected, but may warrant service-connection as secondary to his service-connected left arem. I would pursue this claim and ask Stan's doctor to write an IMO. This will not only help substantiate Stan's claim for IU, but will actually help in the over all disability percentage if IU isn't warded.

I hope this makes sense?

I'm going to have to take a look at the rest of this thread to see if I can answer the other questions in the rest of the discussion posted here.

Vike 17

Edited January 31, 2007 by Vike17