21-4138 effective communication

[Mantana]

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 December 21, 2019 by Mantana

[Mantana]

3 hours ago, broncovet said:

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.  

Thanks for the great advice. I did call the VA already and they told me it's not in there as secondary to what i claimed it for, but secondary to my tinnitus appeal.

Let me give a short background story.... I had surgery in service in 2011 on my jaw. It swelled up and bled out and literally ruined 2 pillows because of all the blood. I have scar pain and tmj due to this surgery. I am rated for those. I filed somatic symptom disorder and mood condition due to known physiological disorder (2 mental health conditions diagnosed on said DBQ) secondary to the service connection because that is what my psychologist said caused the mental health conditions. The va ignored those and attached it to tinnitus somehow. The psychologist made "more likely than not" statements and there is enough on the DBQ to get me 70%. Even the regional office told me when they called that there was plenty of information and it didn't require a c and p exam.

 

When I called VA the person sent a note to the regional office asking for the status for me because even she thought it was odd. I then sent 21-4138 with advice from my VSO. (Who hasn't been much help, hense the reason I filed on my own)

I have not done the Iris yet will try to today. 

I guess I just have to wait from there. Wait wait wait...

I swear it's all the waiting that gives us mental health conditions. 

 

[Mantana]

1 hour ago, Dustoff 11 said:

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.

Thank you for the explanation. Somatic symptom disorder is a fancy way of saying chronic pain syndrome. It actually was once called that. It's like a manifestation of physical symptoms due to a mental health condition. It's unexplainable really and sometimes can be caused by an event and sometimes not 

[Dustoff1970]

As a follow up the VA will not recognize a secondary service connected condition you are claiming that is due to a NON SERVICE CONNECTED condition (there may be a rare exception I am not aware of).  If your denied primary medical conditions are still not service connected then you won't be granted secondary SC due to these denied SC conditions.

You really need to find an experienced full time and MOTIVATED (high energy) professional VSO located at a VA regional office to assist you with your many contentions of medical conditions and claim filing. Good luck.

The above info is not legal advice as I am not an attorney, paralegal or VSO.  

[broncovet]

Yes, to get a mental health disorder service connected, you can use direct, secondary, presumptive, or 1151.  I think what dustoff is saying is that your mental health claim is acutally PTSD.  

There are some special rules with PTSD claims.  

1.  You have to confirm a stressor.  This is an "ugly" event that happened in service to cause your PTSD.  A few examples are is a woman is raped, you watch someone get killed, or even lose a good friend in the service, or you suffered a traumatic event such as a bomb blow off near you.  

If you were serving "in combat" the VA lessens the requirement to prove a stressor.  Normally a doctor wont be following you along and actually see your buddy's head blown off and say, "Would you like me to document this stressor?"  

2.  You need a PTSD diagnosis by a VA doc.  (Dont ask me why, but VA does not accept non va docs PTSD diagnosis.)

3.  You also need a "Stressor".  A buddy letter will often suffice here.  example:  Yes, I was with Joe Veteran.  He and I watch while an IED blew off the leg of our good friend.  He didnt survive.  Of course, use a real happening not my example.  

4.  Your doctor needs to state your PTSD is at least as likely as not due to (your stressor in service).  

[Mantana]

24 minutes ago, broncovet said:

Yes, to get a mental health disorder service connected, you can use direct, secondary, presumptive, or 1151.  I think what dustoff is saying is that your mental health claim is acutally PTSD.  

There are some special rules with PTSD claims.  

1.  You have to confirm a stressor.  This is an "ugly" event that happened in service to cause your PTSD.  A few examples are is a woman is raped, you watch someone get killed, or even lose a good friend in the service, or you suffered a traumatic event such as a bomb blow off near you.  

If you were serving "in combat" the VA lessens the requirement to prove a stressor.  Normally a doctor wont be following you along and actually see your buddy's head blown off and say, "Would you like me to document this stressor?"  

2.  You need a PTSD diagnosis by a VA doc.  (Dont ask me why, but VA does not accept non va docs PTSD diagnosis.)

3.  You also need a "Stressor".  A buddy letter will often suffice here.  example:  Yes, I was with Joe Veteran.  He and I watch while an IED blew off the leg of our good friend.  He didnt survive.  Of course, use a real happening not my example.  

4.  Your doctor needs to state your PTSD is at least as likely as not due to (your stressor in service).  

Good advise though I do not have ptsd. Thanks

[Mantana]

1 hour ago, Dustoff 11 said:

As a follow up the VA will not recognize a secondary service connected condition you are claiming that is due to a NON SERVICE CONNECTED condition (there may be a rare exception I am not aware of).  If your denied primary medical conditions are still not service connected then you won't be granted secondary SC due to these denied SC conditions.

You really need to find an experienced full time and MOTIVATED (high energy) professional VSO located at a VA regional office to assist you with your many contentions of medical conditions and claim filing. Good luck.

The above info is not legal advice as I am not an attorney, paralegal or VSO.  

I have a bad taste for VSOs in my area as I used the highest rated full time VSO and he jacked up my claim. I prefer to do this on my own with advise of those who have been successful