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Okay quick question and I hope I get some quick advice before its too late. Okay so I put in for an increase in my husband's ihd, and his lungs because he's had terrible residuals since he had radiation for lung cancer. We applied for the caregiver program and was approved but the lady told me that his 100% for his lungs was temporary (which I knew) and that I should be trying to get him increased or made P&T so that his overall average would never go below 70%. So I put it in. Well the rep at the VA went in and said that he was Permanent and Total...yay. So I thought they were done because I saw the notice saying a decision letter was being mailed. However, today a lady calls and says she will be scheduling him for a c&p for his lungs. Well as it stands he has 100% for his lungs. They have not set the appointment yet...should I go in and request this cancelled? THere is nothing to gain and I'm thinking the wrong doc could certainly give something to lose especially since she said they will be using a community doctor. It's a moot issue right now right? If they haven't made a decision which obviously they haven't can I cancel or is it too late?
Okay my husband is rated as follows: 10% tinnitus, 30% Ischemic heart, 40% hearing loss and 100% temp lung malignancy. He's had that temp 100% for over two years. He's had all kinds of heart issues since the original heart rating to include two stents, a new aortic valve and chronic congestive heart failure, all of which are documented in his VA file. He is a mess and I take care of everything for him. I applied for the caregiver program and have just been approved. The people with that program told me I need to see about getting his heart rating up and to request he be rated permanent and total.
I put in the completed claim and they did a C&P in December. I just saw the c&p report. Here is what it says:
PERTINENT HISTORY:1966-1968 USA Viet Nam 1968. OCCUPATIONAL HX: Retired 1993. PMH: SC CAD, SC Lung Cancer S/P Radiation, COPD. PSH (with results): TAVR. 2019. SH: 50 pk/yr of tobacco use, stopped 2014. Denies ETOH.
1. Diagnosis ------------ Does the Veteran now have or has he/she ever been diagnosed with a heart condition? [X] Yes [ ] No [X] Coronary artery disease Date of diagnosis: SC [X] Heart valve replacement Date of diagnosis: 2019 2. Medical History ------------------ a. Describe the history (including onset and course) of the Veteran's heart condition(s) (brief summary): Veteran is SC for CAD. Reports having several stents in past several years, no stents in past year. Veteran reports a significant noncardiac hx, has a hx of COPD and non small cell lung cancer s/p radiation. Currently using 5 l O2 for COPD. b. Do any of the Veteran's heart conditions qualify within the generally accepted medical definition of ischemic heart disease (IHD)? [X] Yes [ ] No If yes, list the conditions that qualify: CAD/IHD. c. Provide the etiology, if known, of each of the Veteran's heart conditions, including the relationship/causality to other heart conditions, particularly the relationship/causality to the Veteran's IHD conditions, if any: Heart condition #1: Provide etiology Presumptive AO exposure.
Heart condition #2: Provide etiology Hyperlipidemia d. Is continuous medication required for control of the Veteran's heart condition? [X] Yes [ ] No If yes, list medications required for the Veteran's heart condition (include name of medication and heart condition it is used for, such as atenolol for myocardial infarction or atrial fibrillation): ASA, Meotoprolol 3. Myocardial infarction (MI) ----------------------------- Has the Veteran had a myocardial infarction (MI)? [X] Yes [ ] No MI #1: Date and treatment facility: 1/16/2002 Fort Myers, Florida. 4. Congestive Heart Failure (CHF) --------------------------------- Has the Veteran had congestive heart failure (CHF)? [ ] Yes [X] No 5. Arrhythmia ------------- Has the Veteran had a cardiac arrhythmia? [ ] Yes [X] No 6. Heart valve conditions ------------------------- Has the Veteran had a heart valve condition? [X] Yes [ ] No a. Valves affected (check all that apply): [X] Aortic b. Describe type of valve condition for each checked valve: AS. S/P TAVR. 7. Infectious heart conditions ------------------------------ Has the Veteran had any infectious cardiac conditions, including active valvular infection (including rheumatic heart disease), endocarditis, pericarditis or syphilitic heart disease? [ ] Yes [X] No 8. Pericardial adhesions ------------------------ Has the Veteran had pericardial adhesions? [ ] Yes [X] No 9. Procedures ------------- Has the Veteran had any non-surgical or surgical procedures for the treatment of a heart condition? [X] Yes [ ] No If yes, indicate the non-surgical or surgical procedures the Veteran has had for the treatment of heart conditions (check all that apply): [X] Percutaneous coronary intervention (PCI) (angioplasty) Indicate date of treatment or date of admission if admitted for treatment and treatment facility: 1. 2002 Coronary Stent, Charlotte Florida. 2. 5/2015 Stents Mid RCA/Proximal Circumflex, Keesler AFB. Indicate the condition that resulted in the need for this procedure/treatment: 1. CAD 2. CAD. [X] Valve replacement If checked, indicate valve(s) that have been replaced (check all that apply): [X] Aortic Indicate date of admission for treatment and treatment facility for each checked valve: 12/2019 TAVR Ocean Springs Indicate the condition that resulted in the need for this procedure/treatment: Hyperlipidemia. 10. Hospitalizations -------------------- Has the Veteran had any other hospitalizations for the treatment of heart conditions (other than for non-surgical and surgical procedures described above)? [ ] Yes [X] No
11. Physical exam ----------------- a. Heart rate: 90 b. Rhythm: [X] Regular [ ] Irregular c. Point of maximal impact: [X] Not palpable [ ] 4th intercostal space [ ] 5th intercostal space [ ] Other, specify: d. Heart sounds: [X] Normal [ ] Abnormal, specify: e. Jugular-venous distension: [ ] Yes [X] No f. Auscultation of the lungs: [X] Clear [ ] Bibasilar rales [ ] Other, describe: g. Peripheral pulses: Dorsalis pedis: [X] Normal [ ] Diminished [ ] Absent Posterior tibial: [X] Normal [ ] Diminished [ ] Absent h. Peripheral edema: Right lower extremity: [ ] None [X] Trace [ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+ Left lower extremity: [ ] None [X] Trace [ ] 1+ [ ] 2+ [ ] 3+ [ ] 4+ i. Blood pressure: 126/70 12. Other pertinent physical findings, complications, conditions, signs, symptoms and scars ------------------------------------------------------------------------ a. Does the Veteran have any other pertinent physical findings, complications, conditions, signs or symptoms related to any conditions listed in the Diagnosis Section above? [ ] Yes [X] No b. Does the Veteran have any scars (surgical or otherwise) related to any conditions or to the treatment of any conditions listed in the Diagnosis Section above? [ ] Yes [X] No c. Comments, if any: No response provided 13. Diagnostic Testing ---------------------- a. Is there evidence of cardiac hypertrophy? [ ] Yes [X] No b. Is there evidence of cardiac dilatation? [ ] Yes [X] No
c. Diagnostic tests Indicate all testing completed; provide only most recent results which reflect the Veteran's current functional status (check all that apply): [X] Echocardiogram Date of echocardiogram: 7/10/2019 Left ventricular ejection fraction (LVEF): 55 % Wall motion: [X] Normal [ ] Abnormal, describe: Wall thickness: [X] Normal [ ] Abnormal, describe: [X] Coronary artery angiogram Date of angiogram: 8/6/2019 Result: [ ] Normal [X] Abnormal, describe: Prior stents patent. No new significant lesions. 14. METs Testing ---------------- Indicate all testing completed; provide only most recent results which reflect the Veteran's current functional status (check all that apply): a. Exercise stress test No response provided. b. If an exercise stress test was not performed, provide reason: [X] Exercise stress testing is not required as part of Veteran's current treatment plan and this test is not without significant risk c. [X] Interview-based METs test Date of interview-based METs test: 12/7/2020 Symptoms during activity: The METs level checked below reflects the lowest activity level at which the Veteran reports any of the following symptoms attributable to a cardiac condition (check all symptoms that the Veteran reports at the indicated METs level of activity): [X] Dyspnea [X] Angina [X] Syncope Results of interview-based METs test METs level on most recent interview-based METs test: [X] (1-3 METs) This METs level has been found to be consistent
a shower, slow walking (2 mph) for 1-2 blocks d. Has the Veteran had both an exercise stress test and an interview-based METs test? [ ] Yes [X] No e. Is the METs level limitation provided above due solely to the heart condition(s) that the Veteran is claiming in the Diagnosis Section? [ ] Yes [X] No If no, complete Section 14f. f. What is the estimated METs level due solely to the cardiac condition(s) listed above? (If this is different than METs reported above because of co-morbid conditions, provide METs level and Rationale below.) METs level METs level on most recent interview-based METs test: [X] The limitation in METs level is due to multiple medical conditions including the heart condition(s); it is not possible to accurately estimate the percent of METs limitation attributable to each medical condition g. Comments, if any: METS is based on general conditioning, natural age and combined medical conditions. Most middle aged individuals have a METS 5-7; and most elderly individuals have a METS of 3-5 - irrespective of heart function. Therefore, the veterans LVEF is more accurate representation of his/her cardiac function at this time. 15. Functional impact --------------------- Does the Veteran's heart condition(s) impact his or her ability to work? [ ] Yes [X] No 16. Remarks, if any ------------------- No remarks provided.
Okay so I don't have a clue how this will come out. Ebenefits says that a Regulatory and Procedural Review opened on Dec 15 and closed on December 23. Decision letter mailed, allow 7-10 days.
Any thoughts on this report? One issue I have with this and its a big one if he is denied or lowered and that is that my husband has Chronic Congestive heart failure and has been in the hospital twice this year for treatment of this and pneumonia. It is on his active list of things wrong with him and is documented as being treated when in the hospital. So I don't get how this guy could so blatantly say he doesn't have it.
Any insight would be appreciated and who should I call if I don't get this letter soon? I'm trying to be patient because I know the mail is really messed up out there. Thanks in advance.
I filed for an increase, with a fully-developed claim, on an issue that I'm currently rated at service-connected 0%. I established my "Intent to File" on the 24th of September. The file was submitted/received on the 30th of December 2020 and moved to "Evidence gathering, review, and decision" on the 4th of January 2021. This morning (6th of January), a call came in and I was told that I would be scheduled for a C&P Exam. They needed to know if I was available due to Covid, to which I told them that I was. The woman informed me that within 2-3 weeks I would be notified of the date/time of my appointment.
I thought I would be able to avoid a C&P Exam, because since October 2020, I've had 20+ VA appointments, 1 VA hospitalization, 1 VA MRI, 2 VA ultrasounds, 2 VA blood transfusions, and numerous VA blood draws, in regards to the issue that I'm asking an increase for. I'm even tentatively scheduled for surgery on the 26th of January (depending on how Covid issues play out here in California). I purposely waited, until I had gone through all those appointments/procedures/tests, so that I could include them in my fully-developed claim.
I've had my fair share of C&P Exams, which have always been brief and perfunctory. I'm concerned about how much that exam will play into the rater's decision, when they already have a wealth of information from doctors/surgeons at the VA, all of which has been recently documented over the last 3 months. Has anyone experienced a situation similar to this? Did they end up changing their mind about making you submit to a C&P Exam? If not, did the C&P Exam weigh heavily on the type of decision the rater made?
I have roughly one million questions but I'll try to keep it simple. This is the first time I am appealing a denied claim (though not my first denied claim - I currently have 50% combined). Almost exactly one year after my C&P exam I finally got a denial for both of my knees). I did a HLR informal conference and now my va.gov status says "The VBA is correcting an error". Here is the decision I received on Dec. 7th after the Higher Level Review (sorry I couldn't figure out how to add image) and below that are my questions.
1. A duty to assist error has been identified during the Higher Level Review of left knee pain. 2. A duty to assist error has been identified during the Higher Level Review of right knee pain. Evidence: Timeline from intent to file on 10/2/19 to HLR informal conference on 12/2/20 Reasons for Decision: 1. Higher Level Review for left knee pain The issue of left knee pain was returned for correction of a duty to assist error in the prior decision. We failed to get other records. We will develop for lay statements and if warranted additional opinions. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.159, 38 CFR 3.2502, 38 CFR 3.2601) Favorable findings identified in the decision: You have been diagnosed with a disability. The VA exam dated 11/7/19 showed a diagnosis of patellofemoral pain syndrome. 2. Higher Level Review for right knee pain The issue of right knee pain was returned for correction of a duty to assist error in the prior decision. We failed to get other records. We will develop for lay statements and if warranted additional opinions. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.159, 38 CFR 3.2502, 38 CFR 3.2601) Favorable findings identified in the decision: A nexus or link has been established between your claimed issue and an in-service event or injury. During VA exam dated 11/7/19 the VA examiner provided a positive medical opinion linking your right knee to service. You have been diagnosed with a disability. The VA exam dated 11/7/19 showed a diagnosis of right meniscal tear, right knee instability, and patellofemoral pain syndrome. MY QUESTIONS
1. Am I just out of luck because I didn't seek treatment during Active Duty?
2. Under "favorable findings" it states that "a nexus, or link, has been established between your claimed issue and an in-service event". Isn't that the literal definition of a service connected disability?!
3. What is the error? What have you all seen as timelines and outcomes for this?
Thank you to everyone who takes the time to respond and post. Reading these questions/answers over the last year has been both educational and comforting.
Hey all. Hoping you guys can help me out with what to expect.
In 2010 while I was active duty I went to medical over what I thought was a potential hernia. They did an ultrasound and felt around but told me they didn't see anything and that if it continued to hurt come back. I got my honorable in January of 2011.
A couple months ago, the pain occasionally still persisted so I filed a claim for a hernia/groin condition and they scheduled me within a few weeks. I just went to my appointment and the Dr. asked me if I had the hernia taken care of yet. I told him that I was never diagnosed with a hernia which is why I also choose "groin condition" on the drop down menu. He help up a paper from my file and said that back in 2010 I was diagnosed with a inguinal hernia and that It says that I never made an appointment to meet with a surgeon. I told him that wasn't the way that I remember the scenario going, I believe I was told they found nothing and to come back if it still consisted or got worse. So we spoke for a few moments and he said that he's going to put that it is service connected, as I WAS diagnosed while I was still active duty. He also said since it's considered elective surgery if I wanted to have it taken care of I would need to talk to my private doctor.
Has anybody had any experience in how this would be rated? He told me that it is service connected but he wasn't sure how the rating would go.
I'm currently at 30% disability. I also recently received my C-file so I put it in my computer and found the page the doctor referenced and yes, it does say that I was diagnosed back in 2010.
rebabevets posted a question in VA Disability Compensation Benefits Claims Research Forum,I already get compensation for bladder cancer for Camp Lejeune Water issue, now that it is added to Agent Orange does it mean that the VA should pay me the difference between Camp Lejeune and 1992 when I retired from the Marine Corps or do I have to re-apply for it for Agent Orange, or will the VA look at at current cases already receiving bladder cancer compensation. I’m considered 100% Disabled Permanently
Ddsr posted a question in VA Disability Compensation Benefits Claims Research Forum,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)
broncovet posted an answer to a question,While the BVA has some discretion here, often they "chop up claims". For example, BVA will order SERVICE CONNECTION, and leave it up to the VARO the disability percent and effective date.
I hate that its that way. The board should "render a decision", to include service connection, disability percentage AND effective date, so we dont have to appeal "each" of those issues over then next 15 years on a hamster wheel.
Ztmiller8 posted a question in Appealing Your Veterans Compensation Disability Claims NOD, DRO, BVA, USCAVC,Finally heard back that I received my 100% Overall rating and a 100% PTSD rating Following my long appeal process!
My question is this, given the fact that my appeal was on the advanced docket and is an “Expedited” appeal, what happens now and how long(ish) is the process from here on out with retro and so forth? I’ve read a million things but nothing with an expedited appeal status.
Anyone deal with this situation before? My jump is from 50 to 100 over the course of 2 years if that helps some. I only am asking because as happy as I am, I would be much happier to pay some of these bills off!
Joey Ross posted an answer to a question,I told reviewer that I had a bad C&P, and that all I wanted was a fair shake, and she even said, that was what she was all ready viewed for herself. The first C&P don't even reflect my Treatment in the VA PTSD clinic. In my new C&P I was only asked about symptoms, seeing shit, rituals, nightmares, paying bills and about childhood, but didn't ask about details of it. Just about twenty question, and nothing about stressor,
Picked ByJoey Ross,