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    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
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    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
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    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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Michvetinfla

1st VA claim, presumption of soundness Q's

Question

I found your website. I have never posted anything asking anyone about this but I'm finally doing something about it and desperately need some advice. 

 

The question specifically has to do with my physical exam at MEPS and the presumption of soundness attached to it. If I am found 100% physically fit and did not have to sign any waivers, how can I have a disability existing prior to entry discharge for a physical disability not previously noted at MEPS or in any previous records? Am I correct that unless otherwise noted at my MEPS examination, any physical injuries thereafter besides something congenital had to have occurred in service? As in nothing was noted for me other than I was in 100% perfect physical shape. Secondary question will be about how to connect the dots with my disability and future appointments and what I should be looking for in responses from doctors which I will go into further below. 

 

Background information  

I am sorry if this gets lengthy or the wrong Forum to put it at but I really don't know who else to ask and have never told my story or asked any advice from anyone about this.

 

My entire life I knew I was going to be a marine and that's all I wanted to be as my grandfather was a World War II Marine veteran my father an army veteran so I knew and trained for very young to be a Marine it was my hopes and dream. I was a high school sport standout in every sport, won the state championship football perfect physical health ( I am 6 foot 4 inches 180 lbs) the plan was to go to college then be a Marine Corps officer. This was 1988 when I graduated high school, by 1989 I was in college not enjoying it and watching the Middle East get very hot. After discussing it with my father I had his blessing to drop out of college at Eastern Michigan University and enlist in the Marine Corps. I did the Delayed Enlistment program and they actually called me up early and reported in November 1990 to Camp Pendleton California. I will mention that I got a perfect score on the ASVAB by the recruiter and offered any job and I chose and signed a contract for intelligence with a Meritorious Promotion to private first class after graduating boot camp and Lance corporal after graduating my MOS School and upon graduating my MOS school and also a $10,000 bonus. Again just establishing my sincerity and fortitude that this was my dream and purpose I had trained for my entire life And I wouldn't be signing a contract adding time to my enlistment if I truly wasn't planning on making a career of the Marine Corps. 

 

Boot camp In the Marine Corps is very stressful and  it was during the very beginning of the Gulf War. Needless to say to drill instructors were hyper-vigilant in one of them even got busted from our platoon for striking some of the recruits. I am only mentioning these boot camp incidents to establish a fact. Anyone knows in boot camp unless you are on your deathbed you do not report to sickbay. I was the same way but then again I was always healthy in my entire life. In second phase my feet started hurting when we would go on marches and humps and by the time we went back for third phase in San Diego I did report to sick call. I did miss the final March because my feet and lower legs hurt too bad pins and needles numbness pain Etc and it is in the boot camp medical records that this did happen and I did go to sick call. If I recall while in bootcamp I just was on light duty for a few days and we were so close to graduating I only missed a few days and graduated with my platoon. Throughout my entire boot camp I went to Sick Bay sick call the one time for my feet they put me on light duty I missed a few days of training and that was it and I graduated February 1st 1991 with my original  platoon I started with. I also had a final physical fitness test score of 299 out of 300. I was perfect in Pull-Ups, sit ups and the 3 Mile Run was 10 seconds short. I had one point subtracted because I was 10 seconds over the 18-minute mark, I'm saying this to establish I was in perfect physical health otherwise besides my feet and legs being so sore and painful. 

 

Went home for boot camp leave reported back to Camp Pendleton for Marine combat training  (MCT). I was told that we had to pull guard or KP duty until space was available in the class. While in this holding platoon, doing guard Duty, the same problems occurred with my feet as they were tingly numb painful and this was after just standing post. And so I went to sick call for the second time in my life praying and hoping they would just give me some pills or something to alleviate the pain so I can go back to being a Marine. They took some X-rays put me on light duty and told me they will be back with me to see me again. 2 Days Later I am pulled into the office and told point blank that I am being discharged because I have mild bilateral pes planus or the common name flat feet and that this disability existed prior to entry into the service. And that was it! I can't even explain in words how my whole life I had been training and wanting to do this one thing and it was taken away so quickly in the blink of an eye and I had no recourse or way to get my Marine Corps career back. I was devastated. 

 

At that moment I had no clue what to do as I have said my entire life I want to be Marine and by simply reporting to sick call and having some feet pain and leg pain I am all the sudden being discharged and my whole world ended. I must include this side note below.

 

At Camp Pendleton that day being told the horrific news there was a Vietnam veteran nurse who was assisting me. She could tell how I couldn't believe this was happening I told her I never been sick or have flat feet or problems my entire life, in bootcamp I went to sick call one time and now one time here and now I'm being discharged I was beyond upset and couldn't figure out what to do she said there was nothing I can do, the medical board is already underway. Then she did something I don't know if it was legal or not but she could tell I was upset pissed off I just was so mad I told her I didn't care what anyone did at this point she said I'm going to do something I've never done and handed me all my x-rays (she handed me everything in the original color coordinated huge folders, mine are orange, with all the Navy markings on it) The Originals as well as the original radiologic consultation request report and prognosis for all those x-rays. She told me I know you don't care about any of this right now and you're very upset and have just seen your whole life flash before you (because I did tell her I had intended to retire a Marine), but twenty or thirty years down the road maybe even sooner you are going to need medical help because I've seen your records and you had no waiver entering service stating that you had these medical problems previously and this was caused while in service and they are claiming you had it before you enlisted so you do not get any VA benefits, but I did not see it on any of your records.  I'm giving you your original X-rays and the consultative reports and please hold onto them until you're ready to file for disability some time in the future, these will be your key, if you don't have these you will never see them again and it will make your claim almost impossible, the VA will contend it did not pre-exist, but these will prove it for you, she reiterated in the most passionate way that I must not lose those that I will need them to file a disability claim in the future.

 

So fast forward until present day. I did save the original X-rays and the consultation report and have them in a safe place. It has taken me until a few months back to actually pull them out, look at them along with my discharge papers and realize that this is all wrong and I have a claim here! The evidence that I have is that the radiological report says as follows

 

    "left foot, 3  views: mild pes planus. 

 right foot, three views: mild Pes planus. " 

 

Second consultation report from the radiologic consultation is

 

 "right lower leg, two views: possible stress fracture proximal tibia

 

 left lower leg: possible stress fracture left proximal tibia

 

 right foot, three views: hallux valgus deformity, otherwise within normal limits.

 

 left foot, three views: degenerative changes in the MP joints.

 

What does this all mean to me and my ability for a VA claim?

 

So move forward to current day unfortunately since I left the Marine corps I never have had any health insurance had a plethora of problems. In 2017 after years and years of back pain lower back pain ( as well as my feet and lower legs the entire time since I left the Marine corps) I finally went to a doctor and complained I was in so much pain something had to be done and he ordered an MRI.  I do have an MRI establishing my s1 – l5 lower back an S5 through s1 does have sacral nerve damage bulging and deteriorating disc etc enough to meet the classification for social security disability. The MRI was in 2017 and my lower back pain has been with me since I was in the Marines. I may have had three or four emergency visits and some urgent Care but there has not been any paper trail or evidence that a normal person would have 20 to 30 years of it I have almost nothing because I never went to the doctor or hospital.

 

The catalyst that started this was in August 2019 I had a bicycle accident I broke my scapula in five places. I had no insurance I went to the emergency room they x-rayed it said yes it's a terrible break and gave me the number of a doctor who sees patients without insurance or money. As it turns out the man retired and no one replaced him. I called every resource clinic site et cetera… they had no one to look at my shoulder for without having insurance. I never had any follow up. After being out of work 9 months and realizing it's going to be a full year I will meet the requirement for SSI disability then upon seeing the one piece of medical evidence I possessed my MRI and its prognosis I asked a doctor and yes, it appears I do meet the listing for that with my 2017 MRI, not even taking into account the new injury and the further damage it has done. The point is that it is now 2020 and I have never had a follow-up appointment for the shoulder and obviously the shoulder is horrible but the back is even much worse now after the accident than before my 2017 MRI. With this knowledge and the fact that I do not have barely any evidence I knew if I filed for SSI disability they will send me to a local doctor to verify my injury and give me a NEW MRI which should show that is is even worse now than in 2017, which was physically bad enough to qualify then, it should be more than bad enough in nature to qualify for disability now. My research into SSI disability I kept seeing about veterans and that is how I return to my discharge papers and looked at them, and am planning and filing for VA disability.

 

I have read about obviously I need documentation to prove any of this, VA especially and I have almost none, that is my main concern.

 

I have read a little about pyramiding and primary injury secondary at cetera.

 

My end result of filing for VA disability in this case will be to try and achieve 100% disability. In my research it may be possible but I will put down what I am thinking now.

 

Because of the presumption of soundness and I had no waivers they cannot deny that the mild pes planus and bunions and the other damage listed in the X-rays I had for my medical board could not have existed previous to my service in the Marine corps or else it would have to have been noted at m e p s or I would have had to have had a waiver.

 

My VA Claim thought process?

 

 The rating for mild pes planus is 0%, after review, mine is pronounced bilateral pes planus a 50% rating (my feet have gotten terribly worse over the years, my feet truly are flat as a pancake now pronating inward and very painful, has changed my gate, this is not official as I've never been to a doctor, but this is my honest opinion). Since this had to have happened in service this will be a primary injury I believe as well as the bunions or hallux valgus deformity. They are noted in my 1991 medical x-rays so as a primary I can safely say they have gotten much worse and both toes are affected now not just the right. The rating for bilateral hallux valgus is 10% each foot or a total of 20%. Bringing the total to 70% rating. Of course that is if I am awarded the  maximum for the bilateral pes planus and both feet hallux valgus.

 

Now this is where I have some more questions?

 

I also have all the symptoms and am very positive I have peripheral neuropathy which I'm very familiar with as my mother has it but, but the rating for that looks like it can be deemed secondary cause from my pes planus. If correct shouldn't I receive x% for bilateral peripheral neuropathy as a secondary result from my primary injury?

 

Next,is tying in the primary pes planus to my SSI disability case that my lower back secondary (sacral nerve, herniated discs, degenerative disc disease) is aggravated and hurt from my primary bilateral pes planus as well as my bilateral neuropathy affects it as well. The listing for lower back pain is x percent up to a 100%

 

And lastly the whole affair has caused me PTSD and that rating is 0% to 100% rating. I don't want to go into how I have it or not but I have read all the symptoms and can present a very strong case that I definitely have had PTSD since the day I was told I was being discharged. And with no insurance I have never gotten it treated but I have definite evidence of it in my life.

 

I filed the SSI disability last week and am awaiting them to call me and set up a doctors appointment. I also called the veterans administration about filing disability. I called my local VA and ask about a veteran's service officer who could help me with filing questions.

I started to go over some basics in my case and when PTSD was brought up he inquired how I could have it without being in combat and only in the service six months and I immediately shut down and felt that it was horrible a veteran service officer would make me feel as though I don't have valid reason to have PTSD. So that is why I searched the internet and found this forum.

 

So another question since how do I establish PTSD?

 With no insurance can't really get a counseling thing even as a veteran I tried and since I was not in 2 years I did not qualify for any health benefits. I guess should I call the veterans hotline PTSD number and tell them I am suicidal just in order to get this documented and at least someone would have a file then from the VA about whatever I tell them my story?

 

 Also should I be trying to find my own doctors who would be favorable to my situation, and to further explore the tibia stress fractures and if I can associate that injury to another rating?

 

 I don't have insurance but I might be able to find a clinic, and my thought process is a podiatrist who will substantiate my pes planus condition. Should I be actively looking for a civilian doctor who will know the whole story I just recited and work with me to try to get my VA disability? 

 

Or should I just file my claim with just the limited information (presumption of soundness) the x-rays that I have from 1991 and prognosis and hopefully my SSI disability case once I see the doctor who will also have some more evidence, hopefully providing more evidence of my infirmaries?

    

Also is a question that would I be getting any kind of back pay disability for all these past 30 years if the decision is in my favor?

 

Another question is that should I contact a lawyer? Also a veteran service officer should I contact someone like the American legion or which one would someone recommend I use because I truly do not know what I'm doing and I feel if I had the right direction I'm someone who knows all the intricacies and workings of the VA if I filed this correctly the first time and knew what type of evidence to gather it would make my claim so much more positive in my favor. if I have to, I will get the money somehow,a loan from family to see the right doctor but should I be going to a doctor, a veteran Dr who will be in my corner and spend money on it before I file this claim?

 

Thank you everyone, I'm sorry if I'm rambling, I have many questions but I've already asked too many. I am grateful for finding this forum and I really hope someone has some real answers for me that can assist me. Thank you.

 

Happy Easter!

 

Sincerely,

Marine from MI living in central FL now.

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Posted (edited)

Welcome to hadit.  You came to the right place. 

Ok, this is a lot of questions.  I believe in the KISS concept.  This is what you need for VA service connected disability:

1.  You are going to need to establish eligibility.  You mentioned you served less than 2 years,  read these next 2 links to see if you meet that criteria:   https://www.va.gov/disability/eligibility/   To get benefits for PTSD you are going to need a diagnosis of PTSD BY A VA DOC, which means you will need to fix whatever problem you mentioned with getting into VA healthcare: https://www.va.gov/health-care/eligibility/   

2.  Once you have established eligibility, you need to meet the 3 Caluza elements for SC.  You need to have the following documented in your records:  

a.  Current diagnosis.  VA insists for PTSD, this diagnosis must be made by a VA doc.  

b.  In service event or aggravation.  

c.  Nexus, or doc opinion that your current diagnosis is at least as likely as not related to an in service event or aggravation.  

     In the case of PTSD the VA calls it "documentation of a stressor". 

  There you have it.  In summary, Establish Eligibility and document Caluza elements for Service connection.  Once SC, your rating will be based on symptoms.     Most of the rest is just "noise" to VA.  

ONE MORE THING:  Do NOT revolve your life around what one VA employee or VSO tells you.  Instead, tatoo this on your chest if you need to remember it:

Quote

You can not always trust what VA employees or VSO's tell you.  

 

 

 

 

Edited by broncovet

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Posted (edited)
7 hours ago, broncovet said:

Is this the correct way to reply? (meaning I dont know how to reply to a post?)Its not very intuitive, anyhow I do not have any disability rating.  Did you read my post? I explained My total time in Service was 6 months, 14 days.  And no I don't have a disability rating. The link says that is a requirement? That is why I am going to the VA. To apply for disability. How can I already have a rating without ever applying? I just am confused.  If I am not clear in my post, please tell me what to clarify or make more clear. Thank you.

 

 

 

Edited by Michvetinfla
clarification as I wasnt trying to sound or be a jerk

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"So another question since how do I establish PTSD?"

As Broncovet said, the MH diagnosis of PTD must come from a VA MH doctor.

If you file for PTSD, your will get a C & P exam for it.And you will need a valid stressor.

A valid stressor is defined here:

Also -here are many veterans  here who have pes planus from service-if you search for Pes planus and/or Flat feet, you will see how they shaped their claim.

"Also is a question that would I be getting any kind of back pay disability for all these past 30 years if the decision is in my favor?"

No- if this is your first VA claim, and if it succeeds, they will pay you back to the date of the claim, the date -when you file it.

Also if you are claiming secondaries ( you mentioned PN as due to the per planus, ) that would take a SC for the pes planus as well as medical evidence , to include a diagnosis of PN, that the pes planus  caused the PN. You might need a IME from a podiatrist for the Pes planus claim.(Independent Medical EXam).

I have pes planus , and am a civilian. My podiatrist has years of medical records as to his treatment of my condition. It does get worse with time. You need to establish some sort of treatment for this- as, the VA will want to see whose treatment records, and it will help you deal with it better. 

My case is severe pronation. ...ratable at 40 0r 50% ,if I was a veteran.I need custom orthotics and they could help you too.They are however an expense that my insurance does not cover.

A piece of advice- I have never filed a claim I didnt think I could win.

Thoe claims regarded my husband's 2 claims pending when he died and multiple claims I had, as his surviving spouse.

"since I was not in 2 years I did not qualify for any health benefits. "

Did you fit into any of these criterias:

 

https://www.va.gov/disability/eligibility/ this is a different criteria than the Health care criteria and seems to cover you as far as filing a claim.

 

 

You may be able to get VA health care benefits if you served in the active military, naval, or air service and didn’t receive a dishonorable discharge.

  • If you enlisted after September 7, 1980, or entered active duty after October 16, 1981,you must have served 24 continuous months or the full period for which you were called to active duty, unless any of the descriptions below are true for you.

    This minimum duty requirement may not apply if any of these are true. You:

    • Were discharged for a disability that was caused—or made worse—by your active-duty service, or
    • Were discharged for a hardship or “early out,” or
    • Served prior to September 7, 1980
  • If you’re a current or former member of the Reserves or National Guard, you must have been called to active duty by a federal order and completed the full period for which you were called or ordered to active duty. If you had or have active-duty status for training purposes only, you don’t qualify for VA health care.

  • https://www.va.gov/health-care/eligibility/

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Posted (edited)

I agree with the above info from Ms berta and broncovet

However the VA is really cracking down on these C&P Exams for PTSD. 

They are cracking down on veterans that use a private Dr  not for nexus but for examinations.

  with the exception of the CIB ON dd 214...also if veteran does not have the strssors on record   only a buddy statements can be used if they find that to be credible.

This means the veteran will need  the unit he served with ,the dates within 10 days of an event/operation location morning reports and date this event/operation was traumatizing to the Veteran if no SMR'S Can be found.

It helps if you can remember the operation you were in.

They do check all this stuff out.

Edited by Buck52

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Welcome to hadit!

FYI, your VA math is incorrect. A 50% + 10% + 10% disabilities would not give you 70% but rather 60%.

For example, if a veteran has a 90% rating, the veteran would need another disability rated at 50% or more to get to 100%.

Disability calculator

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      A little background first on this specific claim to provide greater context for the readers.
      I had no idea that i had OSA until i got married and through the years my wife has told me about how i would snore really loud, stop breathing at night, choke, etc. pretty standard stuff for anyone that has it.  I had buddies in the Marine Corps who told me the same thing after our first deployment, but i had always chocked it up to my dad snored so i snored, the stopping breathing thing was weird but i was 18/19 so your health isnt a primary concern and BAS is only for bones sticking out.  I got out in 2006 and didnt make a claim for OSA until 2016.  First i talked to my primary care then was referred to a VA pulmonologist. He ordered a sleep study and the VA fumbled it sending me to a private facility and did a in home test. When the results came back i saw in my VA health record the Pulmonologist was terse with his message saying he wanting a in facility sleep study so a month later i did mine at the VA overnight.  I was diagnosed with Mild OSA and given a CPAP.
      When the CPAP arrived i spent a month trying to get it to work but every morning it would show only 45-60 minutes of time.  I have nightmares at night, some i remember some i dont but would rip off the mask or when i woke up would be so worked up i didnt put it back on.  I do cycles of trying it for awhile and stopping for awhile, giving it a chance because my wife is worried about the OSA and its health effects. 
      My claim history was this, as i stated i made my first claim in 2016 and was denied.  I reopened the claim (when that was still an option in 2018) and was denied again.  What i submitted was bascially the VA medical record showing that i had it, that i was ordered a CPAP and sworn statements by myself, my wife and buddies in the Corps that stated they saw symptoms in 2003-2006.  I had NO nexus or medical proof that it began in service
      I made a mistake in 2019 when it was denied again and NEVER filed a NOD as i kindof gave up when that and other new claims for increases were denied, but I DID make a intent to file back in July 2019.  I was out of the VA regulation changes loop and didnt know that they had gotten rid of reopening and moved to the Supplemental evidence route so in February through April i decided to really focus on making a quality claim since my 2016/2018 claims were more shot in the dark hoping that the VA would just grant it.  I went to specialists in the field for the claims i was making and got updated diagnosis of symptoms and effects, got my sworn statements (which in my opinion has more 'umph' than a buddy statement) more detailed in terms of observed symptoms, timelines and effects upon my life as well as i went out and got two IMO's. The first IMO was for PTSD from Dr. Elaine Tripi in Michigan whos IMO got the VA to drop their attempt to reduce my rating in 2015/2016 (and i suspect it was because her IMO made a case for an increased rating). In that IMO she detailed my history, current symptoms, etc as well as opined on how my PTSD affected my OSA symptoms and how it interfered with its treatment.  I also got a IMO from Dr. Anaise who wrote a lengthy (near 50 pages) on how my OSA is aggravated by Tinnitus and PTSD and interferes with my ability to go to sleep, stay asleep and interferes with my treatment.  
      When i submitted the claim (reopen was still available as an option on ebenfits) my new claims, increase and "reopen" were all lumped together as one big claim and sent off in April. As a sidenote whenever i send my claim i do so through ebenefits as well as fax AND send CERTIFIED MAIL WITH RETURN RECEIPT. i keep a copy of the USPS receipt with tracking, Cert Mail receipt and the return receipt and staple that together with my hard copy claim evidence in a folder for each claim ive ever made.  The VA has a way of "losing" evidence and if you ONLY submit via ebenefits, regular mail and/or fax you cant prove they received it per say.  This DOESNT mean they wont pretend they didnt get it but what it does is allows you to prove upon appeal that YES you did send it in the time window necessary for your claim AND that they did receive it because the return receipt shows Jim VArep did in fact get it on such and such day. So if you get denied its really important to look at your cfile after to see what evidence the rater actually looked at and if they dont have ALL the evidence in that file you can appeal on those grounds in conjunction with more evidence if necessary that X doctors exam or IMO proves your case, wasnt considered AND the VA had received it.
      So a few weeks after i submitted it, the VA sent me the normal letter stating they had received my claim for X,Y,Z  New & increased claims but i didnt see anythign about OSA which was weird.  a week later i got a letter from the VA saying that my claims for OSA were not new, had been denied previously and were not on appeal and gave me a list of options. I chose Supplemental Evidence since the IMO's were "new evidence"  to be considered and met the criteria and it had been over a year since my denial so i couldnt submit a NOD and get the backdated effective date.  This was my fault. One i gave up in 2019 and didnt file a NOD to hold my place and Two i didnt keep up to date with new VA regs regarding reopened claims, etc.

      Since that supplemental claim was received on 4/24/20 (todays date is 6/18/20) I have had two psych exams and two records reviews through QTC (private company the VA contracts to do DBQ/exams).  The first pysch exam was related to my request for an increase for PTSD back in April and in May i had a NP contact me who was reviewing my med records for OSA and had follow up questions regarding my condition both current and past.  In that conversation i talked about how i never went to go get checked because i never knew what OSA was at that time, thought it was normal to snore, etc., how BAS is frowned upon in the Marines for things like that, my history with it since i got out up to now and how my nightmares make me rip off the CPAP at night.  I did ask her if she had seen my imo, other evidence and she said no JUST my medical record.  I know examiners arent raters and all but I find it weird that VA will deny IMO's as valid if they dont "review veterans entire file" but will accept something from a examiner if its negative when only their VA med file is shared.  Its great advice to always bring your evidence with you to a exam but given the current COVID situation ALL of my exams thus far have been telephone or video. I asked her what the exam was specifically for or what they asked her to examine and she said it was basically whether or not my OSA was service connected and occured in service. I do believe it was but i was making the claim as SECONDARY to PTSD and/or Tinnitus as an aggravation which she was unaware of. I fired off some angry messages via the IRIS system to the VA regarding this (no idea if they got included in my record or reached a rater since the only response i got was "thank you for contact us heres how to make a new claim").  
      Within the last 3 weeks i had a 3rd & 4th "exam". The third was a MD who was reviewing my records as well and asked alot of the same questions, she was also unaware this was a secondary claim for aggravation and had seen no evidence submitted or my entire file so i went through it with her again.  The 4th exam was another psych interview which i was told was to examine my secondary claims to OSA, but knowing the VA i knew it was basically another review of my ENTIRE PTSD claim ive had as well.  Vets should be aware that even if a exam is about something specific any evidence or statements made that can negatively effect an existing general disability & will be held against you.  This was quite clear when he just asked about current PTSD symptoms and never ONCE asked about my OSA, etc. So i had to bring that up myself. 

      VA.gov check claims hasnt been updated since a week after my claim submission. my OSA claim has said "we dont know your status" even now and my other new/increased claim stopped after "request for more information" (i.e. requesting new QTC exams).  So ever few days i check that as well as ebenefits to see if any of the DBQ's show up in my blue button (none have but im guessing because QTC doesnt have to update the way in house VA does).
      Finally today i see on my disabilities list that OSA was granted secondary to PTSD for 50% bringing me to 90% with an effective date of 4/24/20.  I know that this ISNT the same as a letter from the VA but i know someone who is a VA rater who has been giving me updates on my record so im 99% certain this ebenfits update is accurate.  
       
       
      The takeaways are this.
      1) Do the damn research and work the claim yourself, no VSO or rep is going to care as much as you do. You care about your case, they have 15,50,100 other vets whos cases they are working and even if they are a great VSO/rep they cant possibly give a crap as much as you do.  dont hope the VA just "gives" you the rating you deserve make it so they cant NOT give it to you with the proper evidence.
      2)IMO's are golden. I know not everybody can afford them, i couldnt per say and had to sell some things to come up with the $500 for Dr. Tripi and $1500 for Dr. Anaise, but they were well worth it, without them i definitely wouldnt have gotten my OSA approved. I think have both a MD stating both the phyiscal and mental nexus and a Psychologist stating the pure mental side gave it a one two punch.  
      3) Along with the IMO go to doctors/specialists in your area and get documented evidence of you issue, ask them to be detailed in the exam notes.  I even emailed a couple time asking the doc (this wasnt for OSA but a different claim, but good general advice) asking them to update the notes to specifically include certain symptoms and effects upon quality of life.  Having this helps alot, combined with IMO's its very difficult for a random NP to override their  findings with one exam or phone interview.  Remember the VA is military based in that the ranking officer rules.  So if you only have a NP (nothing against NP's this is just how the VA works) from a urgent care saying you have OSA caused by PTSD or that your shin splints are 8/10 pain and they have a pulmonologist, MD or specialist say its only 1/0 and doesnt effect guess who wins. If you have two psychologists but yours has great bonafides and background and theirs has only been practicing for 5 years solely at the VA yours wins.  Im not saying dont go to a primary care to document because youll only see a NP all evidence helps but be aware if they pull out a MD who counters that exams findings youre likely to lose. Because they will always want to lean to denial and if their person has more experience or is a specialist that will win over what  you submit. Dont give them an option, and even if they do decide to rule against you, you can make a great appeal based on the fact they sided with their NP over a specialist in the field your making a claim for who knows more.

      4) Never let claims die. Dont make a new claim until your ready to with great evidence (file a intent to file first though to preserve backpay/effective date) If denied make sure you keep a reminder about the NOD date and when you do file a NOD make sure that is certified mail with return receipt to prove you mailed it/VA received it before the deadline, because if you dont and they can make a case it was received 24 hours after the NOD deadline you lost you backpay date and possibly years of backpay.  Now there are situations where claims die but if theres a opportunity to still make it on appeals hire a GOOD (there are alot of crappy ones) appeals attorney and move forward. I know they take 20%+ of your backpay but if you aent comfortable enough to navigate the appeals process its well worth it.  
      5) stay up to date on new VA regs, Hadit is a great source for this you dont want to be like me thinking that certain avenues are still open and they arent. If I had stayed up to date i wouldve been able to file earlier for the OSA and preserve YEARS AND YEARS of backpay now im only going to get 2 months.
      6) I didnt do this for this claim although i should've and kept a diary of when i was using the CPAP, roughly when i ripped it off, data on how long i wore it, frustrations over not being able to wear it, info on my nightmares causing me to rip it off etc.  years of diary entries wouldve been a help. I didnt need it in the end but if you cant afford a IMO things like this can help because theres NO SUCH THING AS TOO MUCH EVIDENCE.  A diary is one of the key things that helped me win my migraines case.  for months prior I kept a diary of my headaches and effects, then transcribed them into ebenefits health diary.  I am not perfect at it but i now write as much as i can as often a i can in this diary about ANY service connected or possibly service connected illness (especially things that could be considered aggravated by a service/possible service connected disability).  That way when you are making a claim or fighting a reduction you can pull out timestamped entries for months/years relating to it and it makes it harder for a rater to think you pulled this out your but last month to make a claim. 
       
      A big thanks to everyone on HADIT.  i did alot of research here through the years to help make my claims better and it worked
      Another big thanks to Dr. Anaise and Dr. Tripi for their outstanding IMO's that helped me win this. 
    • By ThomasGray
      First off, hello and thank you in advance for any help that can be provided. Also, I apologize if something is not clear, trying my best to keep things concise.
      On Friday, May 15, I received letter from the VA, dated May 11, proposing a rating reduction from 100% to 70% for PTSD. The only evidence for the change listed is Rating Decision - Narrative(17SEP18) and DBQ PSYCH PTSD Review(06MAY20), whereas on my initial decision letter there was an abundance of evidence used. The major takeaway appears that my medical records(both prior to and after the initial rating, also from VA facilities) were not considered in this proposal. Is this normal?  
      I have yet to obtain the most recent C&P as I just received the proposal letter, but intend to attempt on Monday, May 18. Looking at the proposal letter though it seems that examiner didn't check a few specific boxes that were checked on my previous C&P. Other than that the differences appear to be minor. The two lists are as follows: Original C&P Gross impairment in communication Suspiciousness Depressed mood Suicidal ideation Near-continuous depression affecting the ability to function independently, appropriately, and effectively Disturbances of motivation and mood Chronic sleep impairment Near-continuous panic affecting the ability to function independently, appropriately, and effectively Difficulty in understanding complex commands Total occupational and social impairment Panic attacks (weekly) Difficulty in adapting to stressful circumstances Neglect of personal appearance and hygiene Difficulty in adapting to work Inability to establish and maintain effective relationships Flattened effect Panic attacks (less than weekly) Intermittent inability to perform maintenance of minimal personal hygiene Difficulty in adapting to a worklike setting Anxiety Difficulty in establishing and maintaining effective work and social relationships Intermittent inability to perform activities of daily living Gross impairment in thought processes New C&P Forgetting names Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and mood Depressed mood Suicidal Ideation Near-continuous depression affecting the ability to function independently, appropriately, and effectively Disturbances of motivation and mood Mild memory loss Forgetting recent events Chronic sleep impairment Near-continuous panic affecting the ability to function independently, appropriately, and effectively Difficulty in understanding complex commands Panic attacks more than once a week Difficulty in adapting to stressful circumstances Neglect of personal appearance and hygiene Difficulty in adapting to work Inability to establish and maintain effective relationships Impairment of short- and long-term memory Flattened effect Difficulty in adapting to a worklike setting Anxiety Difficulty in establishing and maintaining effective work and social relationships Forgetting directions I bolded the important items not that were not checked on the new c&p which led to the reduction proposal. It seems strange to me that new symptoms were added, however the very specific ones that would've caused the rating to remain the same all disappeared in just 1.5 years even though there is no noted improvement in my actual medical records.  
      What exactly is my next step? I have written a few statements of disagreement contesting the proposed reduction and pulled my VA medical records and will be getting a copy of the new C&P shortly. I have no idea were send the items as it is unclear in the packet. It says I have 30 days for one option and 60 days for the other. I don't think I need a notice of disagreement or start the appeal process as the final decision hasn't been made(this is a poorly worded question)?  
      Can I also request that they consider TDIU if the rating reduction is finalized or will I have to start a new claim for that? Should i send TDIU forms with my statements of disagreement and records?  
      I have been avoiding poking the bear and not filing claims for other conditions, some of which are caused by the various medications they have me taking, should I start filing claims for those as well?  
      And finally, if I do have to file for TDIU separately, should I start the claim now so that the date is saved? Do I submit the claim before or after I receive the final decision on the proposal? Sorry for the long post. I'm lost as to what to do next. It took me over 5 years of being denied before they would actually service connect anything and now this. Thanks again for any help, it is appreciated.
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    • The 5, 10, 20 year rules...



      Five Year Rule) If you have had the same rating for five or more years, the VA cannot reduce your rating unless your condition has improved on a sustained basis. All the medical evidence, not just the reexamination report, must support the conclusion that your improvement is more than temporary.



      Ten Year Rule) The 10 year rule is after 10 years, the service connection is protected from being dropped.



      Twenty Year Rule) If your disability has been continuously rated at or above a certain rating level for 20 or more years, the VA cannot reduce your rating unless it finds the rating was based on fraud. This is a very high standard and it's unlikely the rating would get reduced.



      If you are 100% for 20 years (Either 100% schedular or 100% TDIU - Total Disability based on Individual Unemployability or IU), you are automatically Permanent & Total (P&T). And, that after 20 years the total disability (100% or IU) is protected from reduction for the remainder of the person's life. "M-21-1-IX.ii.2.1.j. When a P&T Disability Exists"



      At 55, P&T (Permanent & Total) or a few other reasons the VBA will not initiate a review. Here is the graphic below for that. However if the Veteran files a new compensation claim or files for an increase, then it is YOU that initiated to possible review.



      NOTE: Until a percentage is in place for 10 years, the service connection can be removed. After that, the service connection is protected.



      ------



      Example for 2020 using the same disability rating



      1998 - Initially Service Connected @ 10%



      RESULT: Service Connection Protected in 2008



      RESULT: 10% Protected from reduction in 2018 (20 years)



      2020 - Service Connection Increased @ 30%



      RESULT: 30% is Protected from reduction in 2040 (20 years)
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    • Wonderful news way to hang in. I hope this gives you some well deserved peace. 
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    • https://community.hadit.com/searching-for-va-claims-information-on-hadit.com/

       

      Your question has probably been asked before so the fastest way to find the information you need is to search for it.
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    • How to get your questions answered...


      All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

      Tips on posting on the forums.

      Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.


      Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.


      Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.


      Leading to:

      Post clear questions and then give background info on them.

      Examples:

      A. I was previously denied for apnea – Should I refile a claim?


      I was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?



      B. I may have PTSD- how can I be sure?

      I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?



      This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

      Note:

      Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

      This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.
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    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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    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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