Should I file PACT Act, Depressed Mood, Coronary Artery Disease, Spine/Neck

[RichardZ]

Since 2015 when I retired I've been 80% which includes 60% Chronic Fatigue, 30% Insomnia, 10% Hemorrhoids.  My VA psychiatrist (who happens to also be the Hospital Chief of Staff) has strongly advised me multiple times to file for a service connection under the PACT Act.  I've strongly disagreed with him since I do not see a PACT Act connection (other than possibly using DEET and as supply troop regularly disposing of toxic substances - none identified in the PACT Act).   He, my psychiatrist has told me that it would likely get approved and I should say that toxin exposure has exacerbated my behavioral health issues.  I do not feel comfortable filing under the PACT Act however, I am considering asking VA to connect my Moderate/Major Depression Disorder and Anxiety disorder secondary to my rated Insomnia.  Also considering filing for my recently worsening coronary artery disease (CAD) and spinal stenosis, spinal disc disease.    Details follow and thanks in advance.  e

Recently, the VA noted my severe atherosclerosis in several CT Scans and in December 2023, I had stents put in 2 coronary arteries.  I have copies of my military medical records that show I was twice seen in the military for chest pain and several times prescribed crestor for high cholesterol.  Both of these military medical appointments were in the 1980s.   Though I've been taking crestor and other statins ever since.  

Also, since my retirement in 2015 I've had several  months long episodes of back and neck pain for which I've been seen by VA and civilian doctors.  In 2022, an MRI revealed multi-level severe disc degeneration, stenosis, and spondylosis of my sacral, lumbar, and cervical spine and ongoing tendonitus left scapula and shoulder.   I have been seen once on active duty for a cervical spine injury and one for a right shoulder injury.

So basically, I'm asking for advice on whether it's reasonable or not for me to proceed with claims for PACT Act, depression/anxiety, CAD, and/or spine/neck issues?

I only started thinking about this because my VA Psychiatrist has been almost pressuring me to file a PACT Act claim.  Until that, I never though about filing.  I'm retired, I have a good military and civil service retirement and am satisfied with the 80% rating I currently have.  Again much thanks in advance.  - Richard

 

 

Edited March 16 by RichardZ
mis spelled my name

[brokensoldier244th]

Anything you file as PACT is just your supposition that it might be. We still have to consider it on a direct basis as well. Even if you never left the States you can still fall under PACT due to TERA opinions (toxic exposure risk activities). TERA is basically anything that would show up on the hazardous in some way MSDN list as a civilian product. DEET shows up on the list under Gulf War veterans so it would also be folded into PACT. PACT isn't so much its own thing as it is an extension of what was already considered under GW but adding some locations and extending timeframes.  Youd be surprised what shows up under PACT- we run your name through a database from the DOD called ILER that cross-references your MOS, your various duty locations, and what substances you might have come into contact with. We then have to document the relative totality of your contact through your time in service. We can't just point to that time you were in Djibouti and stop- we have to list possibly significant proximal exposure wherever you were, domestic and abroad- it takes a few minutes, LOL. But, with that, if we can't point to a direct thing(s) that falls under PACT as presumptive we can still ask for an opinion about whatever contention you are claiming on the basis of overall exposure.

Hypercholesterolemia or elevated serum (blood) cholesterol is not a disability for which VA compensation benefits are payable. Diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are laboratory results and are not, in and of themselves, disabilities. 61 Fed. Reg. 20,440 (May 7, 1996). I don't write the laws that's just what they are. 

The physical pain/spine issues shouldn't be too hard to service connect provided you can identify in-service event(s) that would plausibly represent the beginning of what you have now. If you had no complaints or treatment in service, nothing on your SEP exam, and you've never been treated for it until the last few years it's going to be more difficult, though. Some MOS's we can take pretty easily as causing those types of issues- if you were an 11B or have an ice cream cone with wings or something then yeah, you probably have back, knee, foot issues. If you were an intelligence guy in a bunker in the AF for 10 yrs, well, that's more of a challenge. 

 

[broncovet]

The VA is gonna require MEDICAL EVIDENCE for service connection.  Not your opinion, not my opinion, and not the presidents opinon..but a medical opinion.  

Your doctor has just pretty much told you what you need to do to get Service connected.  You do not have to take his advice, BUT, if you do want to be service connected the easy/best way is to take his advice, and the hard way is to disagree with him.  This is especially true when he pretty much told you if you apply, he will provide the medical evidence necessary for your claim to suceed.  

If it were me, and, I was looking at the same thing a number of years ago, and, yes, I took my doctors advice and it was the best thing I did.  He provided a nexus, which is "the" evidence I needed for service connection.  

Your doctor has "handed you the W" (win), and, yes, you can be too proud to take it, but some point down the road you will likely regret not taking his advice.  

Two choices:

1.  Take the doctors advice, and get service connected.  Let's assume you are right, the doc is wrong, for a moment.  Call the VA, tell them you feel fine, you have no problems with pact act or toxic exposure, you are able to work just fine, and dont need disability compensation and they can keep their money and you have a good job and dont need it.  GReat.  

2.  Decline the doctor adivce.  Now, 2 possible things can happen:

     A.  The doc is right, you need compensation are sick and need benefits.  Now, you have to try to undo the mistake you made trying to decline the docs advice.  That may not be easy to back off.  

      B.  You are correct, and, again, you dont need the money, are not sick, and dont need the compensation as you can make good money working a job as you feel no ills from toxic exposure.  

The hard way to is to fight the doc.  The easy way is to embrace the doc and do what he says.  

     Many Vets would love to be in your shoes.  They have to fight the doc.  The doc is trying to talk them out of pact act, applying for SC.  Your doc is giving you a gift.  Accept the gift, and if it turns out you dont need it, well, give it back.  Your doc has seen many patients and understands the progression of the disease and you probably dont.  He is acting in your best interest.  

[RichardZ]

Hi brothers (and/or sisters).  Hey I'm the OP.  I sure appreciate your detailed feedback, info, advice and will read several more times.  

I've got a follow on question regarding applying for service connection under the PACT Act.   Where within the VA.gov website disability application process does one indicate that they are applying under or associated with the PACT Act? 

I was on VA.Gov for awhile today and as I progressed through starting a new claim I expected to find a screen, box, or field where a vet would indicate they were applying for service connection under the PACT Act.  Do I have to name the disability first for example recurrent major depression episodes and then subsequent to that on the website/app indicate that I'm applying under the PACT Act?  Thanks.  I'd ideally just like to apply for connection and be noted that I'm covered under the PACT Act alone without immediately naming a medical condition. 

Much thanks once again.  

 

[brokensoldier244th]

Just write it off to the side, or type it as part of the contention name - DEET Exposure-PACT; toxic Substances disposal-PACT. 

For “toxic disposal” you’ll  need to list at least something that was being disposed of, though, like chemical, or ordinance, or at least “particulate matter”. “Disposal of toxic substances” without saying what it was isn’t a claimable contention in an of itself. 
 

We (VSR) are supposed to look at your dates and locations of service and liberally consider anything that might be PACT, but we still have to know what substance(s) you are claiming. We can look you up in a DOD database but that only lists potential exposures. You have to tell us what, in general. 
 

What is your nexus for depression/etc and PACT? I’d claim the physical stuff (not under PACT- phys stuff, generally,  can’t be claimed under PACT) and the depression secondary to that, also. You can claim the same thing more than one way. I’m SC for back and related nerve pain w/ depression secondary to it, for example. 

Edited March 17 by brokensoldier244th

[Lemuel]

I wrote, PACT ACT claim for bladder cancer, Agent Orange.  Whatever you handled or were exposed to.  I do not think it matters if you are not on the presumptive list of PACT ACT exposure locations as long as the substances were where you were, and military records will show that.  Mine was easy.  For yours, it may require the RO to do a little research.  But with your medical opinion, it should not be a problem.  Just may take a lot longer than mine did.

Edited March 17 by Lemuel

[RichardZ]

OP again here - Much thanks again for the well written guidance.  it's really helped me get my brain around this. 

Pretty sure I'll complete the PACT Act request this week.  Seems having this on my VA file will qualify me presumptively for issues that may come up later.  A

s a medical logistics troop from 1981-2000 (significant AD periods 1981-1985; 1991) my daily duties included personally opening with my hands and disposing outdated and suspended medications, medical cleaners, biological agents, vaccines, laboratory reagents, and insect repellants.   In the 1980s I was the junior member of a two-person medical logistics office so was the one doing most of the hands on destructions.  I listed this and several other TDY locations in my claim where I participated in this same standard medical logistics task.

Next week or later I may request separately the cardiac stuff and back stuff.    I may also request the depression secondary to my rating for insomnia. Much thanks again.  Hoping I've enough for VA to approve the PACT Act.