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Mantana
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Question

I'll try to be brief.

 

Va claim filed April 2019 for sleep disturbances, jaw condition, scar in mouth, painful scar. In June my scar was rated 0% and pain 10%. Jaw condition was deferred and sleep disturbances ignored.

 

In July I filed somatic symptom disorder and mood condition secondary to all my denied disabilities and current ones. I received a letter saying I did this incorrect and ebenefits updated accordingly deleting the claims. Then in August I filed somatic symptom disorder and mood condition secondary to jaw condition and scar pain. I also filed hearing loss primary. Ebenefits updated accurately showing what i claimed. 

In October I get a call from the regional office wanting to clarify what I was trying to claim. They then attached my somatic symptom disorder and mood condition to my sleep disturbances claim. The person told me I would retain my original effective date of the April claim. 

I attended c and p for jaw condition and hearing loss. I submitted a dbq from a board certified psychologist. The October called said I had plenty of information to get it rated.

 

I looked at ebenefits December 14th and have now been rated 20% combined due to my scar pain and TMJ. Claim CLOSED.

I called VA 1800 number and they tell me the somatic symptom disorder and mood condition, as well as hearing loss are attached as secondary to tinnitus which is pending appeal (and nothing else).

What I did from there this week was submit a 21-4138 explaining I claimed those secondary to tmj and scar pain, not tinnitus. Also hearing loss as primary. I then called the VA and they took a statement to send to the regional office. 

 

Has anyone had experience with this and should I be worried?

Will I still retain my effective date with my original claim? 

 

Edited by Mantana
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It sounds like you need some help.  I will try. 

First, It sounds like you are relying upon ebenefits "assuming" its correct and accurate, and up to date.   That is like going fishing, and assuming the fish will just jump in your boat, clean themselves and put themselves in your freezer, and, do that at precisely at 11:00 AM when you arrive with your boat.  

My advice is as follows:

1.  Wait for the envelope, and dont be sending VA 21-4138's based on what ebenefits says.  If a fish should jump in your boat and ebenefits is accurate, you really need the reasons and bases of the decision anyway, to decide whether or not to appeal, or, more importantly, whether to file an HLR, SCL, or board appeal.  The decision should show the evidence considered and the effective date, and you need those things to know whether to appeal.  

2.  When you file for benefits dont "rule out" primary, secondary, or presumptive conditions.  Unless you have memorized the 38 CFR,    let the VA rating specialists feel like they are smarter than you, and know in which category to put your claim in order to maximize your benefits.  Even if you have memorized the entire CFR, you need to understand some decision maker will be interpreting it HIS way, not your way.  

 3.  After you get the envelope, read the decision carefully, and compare what the decision says, with the evidence in your cfile.  This means you need to order your cfile, if you have not already.  

Also, you posted:

Quote

I attended c and p for jaw condition and hearing loss. I submitted a dbq from a board certified psychologist.

One of us is not understanding this.  Unless you are seeking benefits for a mental health disorder, then a "board certified psychologist" wont help you get benefits for hearing loss, jaw conditions, or a painful scar.   Maybe you are seeking benefits for a mental health disorder, and that is fine, but your post did not so indicate.  Perhaps that is what you meant by a "mood condition", but that sounds like you had a bad day, not like you are seeking benefits for a mental health disorder.  

When you submit a (medical opinion) this medical professional needs to be an "expert witness" in that field.  A psychologist is not an expert in hearing loss, jaw condition or scars, or even sleep medicine.  You need the appropriate medical specialist with experience and training in that field.  

I will apologize if I offended you, but I make a habit of "not" telling people just what they "want to hear", but rather, assisting them with benefit questions.  There are people who do a great job encouraging you...and that is great.  However, Im a little more "task" orientated as opposed to people pleaser.  

Edited by broncovet
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3 minutes ago, broncovet said:

It sounds like you need some help.  I will try. 

First, It sounds like you are relying upon ebenefits "assuming" its correct and accurate.  That is like going fishing, and assuming the fish will just jump in your boat, clean themselves and put themselves in your freezer.  

My advice is as follows:

1.  Wait for the envelope, and dont be sending VA 21-4138's based on what ebenefits says.  If a fish should jump in your boat and ebenefits is accurate, you really need the reasons and bases of the decision anyway, to decide whether or not to appeal, or, more importantly, whether to file an HLR, SCL, or board appeal.  The decision should show the evidence considered and the effective date, and you need those things to know whether to appeal.  

2.  When you file for benefits dont "rule out" primary, secondary, or presumptive conditions.  Unless you have memorized the 38 CFR,    let the VA rating specialists feel like they are smarter than you, and know in which category to put your claim in order to maximize your benefits.  Even if you have memorized the entire CFR, you need to understand some decision maker will be interpreting it HIS way, not your way.  

 3.  After you get the envelope, read the decision carefully, and compare what the decision says, with the evidence in your cfile.  This means you need to order your cfile, if you have not already.  

Also, you posted:

One of us is not understanding this.  Unless you are seeking benefits for a mental health disorder, then a "board certified psychologist" wont help you get benefits for hearing loss, jaw conditions, or a painful scar.   Maybe you are seeking benefits for a mental health disorder, and that is fine, but your post did not so indicate.  Perhaps that is what you meant by a "mood condition", but that sounds like you had a bad day, not like you are seeking benefits for a mental health disorder.  

When you submit a (medical opinion) this medical professional needs to be an "expert witness" in that field.  A psychologist is not an expert in hearing loss, jaw condition or scars, or even sleep medicine.  You need the appropriate medical specialist with experience and training in that field.  

I will apologize if I offended you, but I make a habit of "not" telling people just what they "want to hear", but rather, assisting them with benefit questions.  There are people who do a great job encouraging you...and that is great.  However, Im a little more "task" orientated as opposed to people pleaser.  

hey thanks for the reply I'm not offended at all. I claimed somatic symptom disorder and mood condition (diagnosed on the DBQ by the board certified psychologist) primary and secondary because i was unsure which to file. Also the reason I know the claims were ignored is the VA person I spoke to this week said they are in the system as secondary to tinnitus, AND she stated my decision letter only includes TMJ. She stated the somatic symptom disorder and mood condition as well as hearing loss are no longer open. But they have been attached to my tinnitus appeal 

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@broncovet, they said they filed for somatic symptom disorder.  Most people would miss this.  It is a mental health disorder where your symptoms are amplified by your injuries.  I was diagnosed with this at one time, they tried to tell me that my temperature went to 108 degrees because my mind was powerful and caused the condition.  That's responsible medicine for you, at least at the VA.

I would still hold onto broncovet's advice and wait to see what they decide before starting to worry.  When I filed an NOD for earlier effective date they added claims for increased peripheral disease, the VA does what they do and we are left wondering what is going on until we get the decision, even then we may wonder what is going on.

When you get your decision please post it and we can try to help you more. 

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Ok. I did look up "Somatic Symptom disorder" (I confess to not having a clue what that was) and its in the cfr as a mental health disorder. https://www.law.cornell.edu/cfr/text/38/4.130   I failed to make that connection in my previous post, so please amend my advice as follows.  

1.  Ensure you have the caluza elements documented for this disorder.  I have no idea what "in service event" would trigger Somatic Symptom disorder, but maybe your psychologist does.  It sounds like you have a diagnosis.  Now, if you have an in service event docuemtned in your records that your doctor said its at least as likely as not that your (somatic symptom disorder) is related to the in service event.  Absent even one of these 3 caluza elements your chances of getting SC for it are near zero.  If you read your DBQ and it so stated, and you have all caluza elements, you are good to go. 

2.  Beyond the Caluza elements, you need documentations of symptoms for compensation.  Hopefully your doc documented those.  

3.  Get your Cfile, and read to see if the above is included in your file.  If not, you will need that included.  

     Now, VA "dropping" one of your claims happens somewhat frequently.  They hope you dont notice.  You need to force the issue.  Do these things, in this order, if VA "blows off" an issue you claimed.  (ITs a violation of 38 CFR 3.103)  https://www.law.cornell.edu/cfr/text/38/3.103  You wont know if its been disregarded until you get the envelope. 

   1.  You can send the 21-4138 asking for a status on your "somatic symptom disorder" claim filed on (date).  

   2.  Send an IRIS email inquiring the status of your somatic system disorder claim.  

   3.  Call Peggy and ask the status.   

     Depending on the outcome of the above, you may need to refile this claim, but keep that documentation in case you have to fight va on the effective date.  

    Document all the above in preperation for a fight with VA, tho it may not get there.  

    4.  If you have documentation of all the above, then you may need to file a writ of mandamus to compel VA to comply with 38 cfr 3.103 and adjuticate that issue which was ignored by the decision.  

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It's always good to send in a brief definition of what some speciality  condition or diseases diagnose mean, from well respected medical internet sites AMJ, Mayo Clinics ect,,,ect,,,, ,you can be specific and say although I am not a Dr but I have did research on this (particular diagnose)  "somatic symptom disorder"

Please read the following (keep it short but to the point)  or ask your Dr to give his impressions of this particular diagnoses.

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somatic disorder like conversion reaction and psychosomatic are similar and are often caused by exposure to extreme traumatic events including physical and emotional injuries (either or).

During the Vietnam war many soldiers were diagnosed with the above disorders and others when in fact they were suffering from combat stress that would later in early 80s be officially called PTSD.  In WWII and Korea soldiers and veterans of those wars were given the cruel designation of schizophrenia or psychotic by VA and military when again it was actually combat stress of the severe sort.

The dishonest hypocritical military and VA on behalf of crooked politicians has extremely downplayed the sheer numbers of combat soldiers suffering from combat stress/PTSD in WWII, Korea and Vietnam until finally forced to recognize the prevalent amount of combat stress among the troops in Vietnam and later wars. 

In the 80s the Waco and Temple, Texas VA hospitals were still full of WWII veterans diagnosed and treated for schizophrenia with extremely powerful anti-psychotic medications due to combat stress and alcohol abuse.  I saw this with my own eyes and very sad indeed the way they were warehoused and used as pharmacy test subjects and I was briefly one myself in 85 to 86. 

After the second total loss of a UH-1H Army medevac Dustoff helicopter with a different crew each time due to NVA and VC ground fire in Vietnam and Cambodia (1970) with death of our young crew chief within feet of us I was grounded in Chu Lai by Army Flight Surgeon and diagnosed suffering from severe combat stress and placed on Valium.  I was shot down twice within a 30 day time period and my Dustoff was damaged on another occasion by near miss RPG explosion while we were doing a high hover rescue hoist mission.

I was lucky the Army doctors diagnosed me with combat stress as they usually called it something else that usually sounded derogatory.

The Army Doctors at 67th Evac hospital in Qui Nhon sent my butt to Camp Zama Army hospital in Tokyo for treatment of a bad urinary  tract infection and after many meetings an Army Psychologist also diagnosed me with conversion reaction due to Vietnam combat and placed me on seconal.  So this is a real live account of just one soldier being treated by both Army and VA doctors for combat stress a term they still do not like to use today.

From 1985 to present day I have been diagnosed dozens of times by VA psychiatrist and psychologist as suffering from moderate to severe PTSD and now TDIU P&T for over 20 years.

Edited by Dustoff 11
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