Secondary conditions

[Army-Navy Guy]

Greetings all! I am rated at 100% P&T. I totally understand I will not increase my percentage nor va comp pay. I will focus on one issue…Chronic Pain, and Depression, secondary to residual pain from 4 knee replacements , and lower back issues. Both are service related and part of my current 100%. The related pain, limited function of my body ad a whole, has effected me so much, I am almost a total recluse. Limited driving, setting, standing…you know the drill. As a result, I have been treated for severe depression. I am maxed out on depression medications. Has anyone had positive VA secondary connection to an existing rated condition, and did you get rated. Thanks….and GO ARMY! Go Navy too, as i was a prior squid. I win every year.

[Army-Navy Guy]

Broncovet,  i agree with your statement in part. Please understand I am not new to the process. I have submitted 5 prior packets, all resulting in favorable actions. I do wholeheartedly agree that medical documents are key. However, in-this case, it was already established via the medical documents that the depression and anxiety are connected to my injuries. Many (most??) reviewers, tend to, “skim” records.  I made sure to highlight the most important documents, outlined on my cover letter. And for their viewing pleasure, highlighted the critical data on each medical document.  A cover letter summarizing your packet saves time, as well as a spreadsheet with dates and correlating medical documents. I submitted via the VA portal. That was my first time using it and it was painless. Organizing and presenting one’s case is critical. Unfortunately, or fortunately (depending on one’s viewpoint), i don't have 1 disability rated at 100%. And don’t qualify with the 60% singular + ??=100, as i am not housebound or in need of assistance. Sadly, the older we get, that could change next week, for some of us.

 But, we will have to agree to disagree on the Dr letter NEXUS as the “critical”, instrument for successful a packet. It is self evident by established docket cases, as well as by the admission of VA studies, that a service connected injury, with residual pain is linked to a veterans depression and anxiety, more so the case in veterans, vs non-veterans. If this weren’t the case, i would definitely go with the Dr NEXUS. But, no matter how it turns out, I will let you know. Another reason i don’t believe a Dr NEXUS is solely required, is the cost associated to the veterans. Cost isn’t an issue for me, but is for many veterans. Also, based on the evidence provided, the Dr can only state on the NEXUS what can be proven. Even with the letter, without the proper proof, the rater will disregard the letter as unproven. IMOHO the weight of the C&P Dr. is more critical. Thats just me. Many Dr’s will not write one. My pain clinic wont do one. My PC will, but it is a long process that may not even pan out. Shrinks and more shrinks, tests and more tests, meds and more meds….I don’t want more meds. I have more than one should have. I would rather be seen by the VA shrink, and this most likely case, and get er’ done. 

I do appreciate your response and comments as these discussions will give a different perspective on how each of us do things. I will keep you posted.

PS…..moving fast. Heres a snapshot. Submitted packet on Tuesday, Today got the call to standby for a C&P. About 45 min ago, received an e-mail that I have a C&P via FaceTime or Skype (haven't found that out, but will now), for tomorrow at 1430! Is it me, or is this moving fast? Take care.

[broncovet]

The Caluza elements with secondary conditions are abbreviated to 2:

1.  Current diagnosis of condition applied for. 

2.  Nexus, or doctors opinion that your current condition is at least as likely as not related to one or more of your already SC conditions.  

     You need not establish an in service event, as that has already been established with the primary condition.  

 

     In addition to SMC, some Veterans who are 100 percent P and T sometimes persue other claims for purposes of their family.  That is, DIC will be paid to your spouse under 2 general conditions:

1.  If you die of a Service connected condition.    OR

2.  If you die of any condition after you have been 100 percent P and T for 10 full years.  

Apart from SMC, and your family, personaly I would not put up with the VA to get additional ratings just for fun.    While it would offer some additional protection against a reduction, that is generally negligible in most cases when you are already P and T UNLESS you have returned to work full time. 

[Rattler]

On 3/21/2024 at 12:04 PM, Army-Navy Guy said:

Crazy…I just received an e-mail from the VA. I have a C&P next Friday, the 29th. Could be the fast response is because they put emphasis on mental health issues. I have no idea. Has anyone experienced such a fast response and action timeline? If so, was it similar to my issues of Depression and Anxiety?

Some of the other local Vets I am working with are having the same results.

On 3/21/2024 at 12:12 PM, Army-Navy Guy said:

Rattler, I am already rated at 100% P&T. Knees 60 and 30%, back i think is 20 or 30%, bilateral hearing loss 40%, tinnitus 10%, Gerd/barretts 30%, and a few 10% ones that i can’t remember. I was looking at it the other day. Im either getting old or forgetful….or both. But no, I don't think i have PTSD. I never thought about that. Who knows.

So from what you are saying you are 100% P & T Scheduler. That is a good thing as P & T means the likely hood of them trying to reduce you is near 0 unless your medical records state that you have improved. I agree with broncovet in that unless the VA's C & P Doc/NP agree with your Nexus there is littler chance they will agree with you. 

I to have done my own packets for a few year's and I applaud you for getting as far as you have. I am working on back pay going to back to 1977 and 1982.

Some of this may apply to you or not but it might give you amination for your gun.

- Federal statute requires VA to weigh private DBQs equally with C&Ps (38 USC 5101 as amended by Pub. L
116 315, title II, 2006(d), Jan. 5, 2021, 134 Stat. 4976). This equal status is now expressed most explicitly
by the policy regarding increased rating claims: "Do not routinely request an examination if a disability
benefits questionnaire, completed by a private or VA physician, was submitted" (M21-1 IV.i.1.B.1.g).
However, this same principle applies to all types of claims.
 

- Submitted DBQs that are adequate for rating my claim. M21-1 V.ii.1A.3.j allows that "A statement
from any physician can be accepted for rating purposes without further examination if it is otherwise
sufficient for rating purposes" and has a proper diagnosis. This policy derives from 38 CFR 3.326 which
makes a similar declaration. Further, my DBQs meet the definition of "competent medical evidence" (38
CFR 3,159(a) OD. If my DBQs are insufficient in any way, then VA must contact me or my private physician
for correction (38 USC 5101). It is improper to send a private DBQ to a C&P examiner for clarification when
they did not write it in the first place. Such action could only be construed as an effort to "develop to deny"
by VA.
 

- Congress has declared its support for Veterans using private medical evidence to support their VA claims
because it "properly protects veterans" (38 USC 5101). Consideration should be given to the DBQs (or medical evidence) 1 have
submitted with my claim. They are sufficient for rating purposes, and they make C&Ps unnecessary.

-VA cannot "develop to deny" a claim. Since I have already submitted a complete package of private
evidence, any further development with C&Ps would violate VA policy: "Decision makers may not arbitrarily
or capriciously refuse to assign weight to a claimant's evidence or develop with the purpose of obtaining
evidence to justify a denial of the claim" (M21-1 Vii..3.B.1.a). This prohibition was emphasized in a law
review article published by the BVA: "additional evidence should not be procured for the sole purpose of
denying the veteran's claim" (1 Veterans L Rev. 94 (2009)). Even CAVC has strongly affirmed this policy:
"Because it would not be permissible for VA to undertake such additional development if a purpose was to
obtain evidence against an appellant's case, VA must provide an adequate statement of reasons or bases for
its decision to pursue further development where such development reasonably could be construed as
obtaining additional evidence for that purpose" (Mariano v Frincipi, 17 Vet. App. 312 (2003)).
 

- VA cannot arbitrarily minimize or deny benefits. Rather, the official policy is to "award benefits where
supported under the facts and law or when the evidence is in relative equipoise or balance while denying
only when we must under the facts and law that require it" (M21-1 V.ii.i.A.6.b). 1 request application of this
policy to my claim and the private medical evidence I have submitted. According to the facts and the law, my
claim can be decided without C&Ps. I request that VA simply proceed with a decision on my claim based on
the evidence already in its possession.
 

We have created a form depository hear on the site. It is my intension when I get time to put some pre filled form on it and passably letters for members to us. Like FIOA request etc.

 

 

[Army-Navy Guy]

Thanks for the info. Yes 100%P&T for about 15 years. Trying to get this connected truly isn’t a pleasant process as I don’t like shrinks much. Having to bear your demons is a rough ride. It’s been so long that I have submitted a packet, many things have changed in the process. Have any of you had experience with a VA contract company called, VES (veterans evaluation services)? I thought my appointment was yesterday but it’s this coming Friday with them. Apparently the VA contracts out some Dr C&P evaluations that don’t require an actual VA hands on visit. The people that set it up from the VES were very pleasant. Hopefully the Dr is the same. I asked if my wife can be with me, during the interview, as I am hearing impaired. ………I have taken all the advice to heart and have a backup plan. I contacted my PCP and discussed a NEXUS letter. I have an appointment with him on April 30th. Even old soldiers take advice once in a while. He’s a great PCP and said he doesn’t have a problem with the letter, but wants to do a “hands on” evaluation. He’s been my PVP for 16 years. I have no problem with that. As the packet will be in development at the VA, I will submit my Dr’s letter when it becomes available, through the VA portal. Love that portal. Makes it easy and fast. I wear 2 braces and knew from prior research that the VA allows a clothing allowance. I never submitted for it as I really never gave it a second thought about the damage it does to the clothing. I submitted it last month. Some say going after additional service connected conditions, when already at 100%, is not worth the effort, but, if it isn’t documented, it isn’t a problem. I say, if uncle broke ya, he’s responsible for ya! In closing, again, thanks for the info and have a great day.

[Rattler]

You are preaching to the choir hear hat Hadit.com. I like VES they sent me to a top notch Phd. for my PTSD exam. Some others have not had as good as luck. Yes you should be able to bring your wife in with you one the exam. I am sure she has something to contribute to it and make sure she does even if he doesn't ask. If you haven't filed any thing after 2019 in the mew AMA a lot has changed as to what form and when to file. Like when to file a Supplemental Claim. (any time with new evidence.) I cant remember where I saw it but if I can find it I will post a link hear.

You PCP needs a  “hands on” evaluation" because its harder for them to challenge his Nexus.

Some say going after additional service connected conditions, when already at 100%, is not worth the effort. That is BS that well meaning or lazy VSO tell vets. Hears an example. Say you are under 10 yeas ratted and married. if you were to pass away unless it was from one of your SC disabilities on the death certificate it will be hard for you wife to get DIC that she deserves. After the 10 year mark it is much easer. Further more it will open up benefits to other SC stuff.

Just ask broncovet or the other Mod's hear how many times they have answered that questions. (Not that it's a problem that's what we are hear for.) 

 

 

[Army-Navy Guy]

Yes, I have an appointment on April 30th with my PCP dedicated for the NEXUS letter, and of any required exams he will do. My PCP is one of the rare ones who is very accommodating to the patient. That’s great to hear you had a good experience with the VES. My initial experiences with the “old school” VA doctors in 2002, wasn’t great at all.