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What would be the best avenue to appeal orthopedic issues(limited range of motion, pain, etc) as well as PTSD? I currently have 0% for the former and I was told that I can "add additional information" up to one year from the date of filing my claim, after that I have to file an appeal. Problem is, I don't know where to get additional information, as most of it wasn't documented. So what are my other options? See a private doctor out of pocket? I'm thinking about stopping by the DAV and seeing if they can help me on my appeal. Apparently they can take up to 7 years though.
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Mar 3, 2011 21:13
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My GF is an Audiologist at the VA. from what her impression is, tinnitus is too hard to prove(along with PTSD). Due to recent lawsuits and how it can be ambiguous, the people on the C&P ruling boards tend to be very generous with giving out tinnitus and PTSD ratings. YMMV.
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Mar 6, 2011 09:54
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moker posted:Hearing loss is NOT easy to actually get paid for unless I guess you cheat the system like a motherfucker on the speech recognition portion. The charts for hearing loss compensation % are online and well your hearing has to be pretty hosed up to actually be compensated. IIRC they do it by the average of total levels of hearing lost so if your hearing is terrible(like mine) in only 1-2 decibel ranges you won't get paid but it does help your case for tinnitus quit a bit which is pretty easy to get compensated for with documented hearing loss and working in loud environments. I meant to correct this earlier but yes, this is entirely true. Tinnitus is one thing but hearing loss is definitely scientifically easy to test. I was unsure if I had it but filed anyway. I'm not sure what the threshold is for hearing loss but the C&P board won't give it unless it's more than X%. Like I said earlier, PTSD and Tinnitus are ambiguous but hearing loss is pretty much a science. My hearing(despite my thoughts) is good, probably because of being a self-Nazi with either foamies or Sordins at the range, etc.
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Mar 7, 2011 10:24
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I'm not sure on the difference between them all but it definitely seems like one of those 'You get what you pay for' sorta deals. I went to the DAV, paid the membership and like the OP said, I have a dedicated person working on my issues, who has done this before 100x and knows the system. Comparing to doing it yourself(in retrospect) or having a VSO who may be swamped with people is totally worth it. I look at as an investment. If its $200-500 for a lifetime membership, and my disability rating even bumps 10%, that investment pays for itself within 1 month of getting paid. Again, totally worth it.
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Mar 10, 2011 05:14
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FooGoo, I'm currently working the process with the DAV and this is what I was told. Appeals at the local level take 12-14 months from when you file. This allows you to gather new evidence, have more C&P appointments, them to review the evidence, etc. The [horrible] appeal process that most have heard of is when you take it to DC if you're satisfied with the ruling, which can take years.
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Jun 19, 2011 03:59
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Okay, I just got a re-cock on my PTSD appeal. My C&P is scheduled for July 12th, right around the corner. Anyone have advice for strengthening it for appeals? So far I've, -Had 2 appointments to the vet center in the past 2 months. More are scheduled but they are swamped. -Vet center recommended I keep a small journal of all triggers, how the occur each time, etc. This is 2 months old or so. -Been going to treatment at the VA(mental health, physical therapy, X-Rays/MRIs), switching my meds if need be, going to appointments. -Have copies of college transcripts proving that my PTSD has affected my schooling. Should I have friends and family write sworn statements for this meeting? The last C&P had the nerve to say "We all have certain types of PTSD...its just dealing with them". Like it was no big deal.
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Jun 29, 2011 23:57
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RichieHimself posted:Looks like you're well prepared to me but I have zero experience with the appeal process. Any idea what went wrong the first time? I was rated 30%, but I guess I kind of hosed myself due 'putting on the mask' while in the meeting. Not fully disclosing my problems with school, or how isolated/harmful I was being to myself along with self-medicating. Part of the 'Stay-Strong, don't be a bitch' attitude. I think its natural we want others to see us as doing well, but sadly, those doctors don't see us at our worst day in, day out. I guess I need to be completely honest this time and not hold back on what is really going on in my life, regardless of how embarrassing.
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Jun 30, 2011 01:52
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Dantu posted:Those are all great things to do, particularly the buddy statements from friends and family. When I get home later tonight I'll try to find the magic language you need to put at the end of the statement. And cult_hero is 100% correct, you really need to get that stuff into the hands of the Ratings Board at your VARO. If you could do that, that'd be awesome. I'm getting everyone to write them this week.
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Jul 18, 2011 00:45
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I'm thinking about working on a 'new guy' packet for guys getting out. Something like a checklist at for medical benefits/disability. Navigating this poo poo is hard, even after doing it for almost 2 years. I'll send it to Busket when I'm done and see if he wants to add it to the OP. EconOutlines fucked around with this message at 21:36 on Sep 8, 2011 |
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Sep 8, 2011 21:18
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Chiming in to say I love all the VA has done for me so far. I've been working with a Speech-Pathologist for help with memory loss and how it affects me in school. She recently ordered me this awesome pen which I received today. Holy poo poo this thing is awesome. Paper and digital copies of my notes, plus integrated audio? Hell yes.
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Sep 14, 2011 01:04
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I've been working on this for awhile and will still make some changes as things come up. However, I thought I'd push it out early because it seems like a lot of guys are getting hosed or need info as of late. This is purely based on my experiences and interactions with people that are VA employees that see patients on a regular basis.  ***REMEMBER, YOU ARE YOUR OWN BIGGEST ADVOCATE AT THE VA*************OIF/OEF Veteran’s Checklist: Navigating the VA********** Part I: Getting Started 1) Apply for 5 Years of Health Care Anyone who has deployed since 1998 is eligible for 5 years of free health care through the VA. You will need to fill out a 10-10EZ form and submit it to the VA. This will place you in Priority Group 6, and are now covered from 5 years from your discharge date. Now that you’re in the system, I’ll go over what will happen next, both from you and the VA. 2) Your first VA appointment, Intake and Processing After submitting 10EZ, you’ll receive an appointment either by phone or mail. This appointment will usually take you between 2-3 hours, and you’ll be all over the place. You’ll see nurses, an MD, a psychologist as well as receiving a primary care physician and OIF/OEF case manager. Anything that is wrong with you, whether it was documented while serving, tell them now. START EARLY. It will make life much easier for you down the road. 3) Get a VA ID Card Yeah, it needs to be done. They use this to identify everything about you and most VA check in places have a machine where you can ‘swipe’ in. It’s usually located in the enrollment office. 4)Sign up for full accounts with eBenefits and myHealthVet These are probably two of the most invaluable tools you can add for navigating the VA and MUCH better than dealing with the phone system. eBenefits allows you full access to your claims, education information, allows you to keep your contact info current and a whole table of other things. myHealthVet has the entirety of your medical records online, as well as the ability to renew your prescriptions only and send messages to your primary care provider. However, they both require an ‘in-person’ verification to access the full site, but one can be used to verify the other. Solution? Sign up for both, go verify your myHealthVet account at the pharmacy, and link that verification your eBenefits account. Screenshots of both accounts can be viewed here and here. 5) Get all your dental work done ASAP if you’re eligible If your papers DON’T indicate that you had dental treatment within 90 days of your discharge, you have 180 days to get your teeth taken care of and then the doors are pretty much closed forever. Unless you’re service connected for dental issues, a former POW or 100% disabled, you’re poo poo out of luck for dental for dental. Your best bet is vocational rehab if you qualify, and even then, that service is basic, such as cleanings and cavities but rather than doing crowns, will simply yank your tooth out. Get your mouth fixed or be prepared to pay out of pocket until you have dental insurance. 6) Buy yourself a reliable phonebook and calendar We all know navigating the phone system sucks, so be proactive. Every health professional you deal with has an extension and so will the front desk for that department. Ask for them and keep them handy if you need to change or cancel an appointment or get in touch with the provider themselves. It should go without saying, but when dealing with VA employees, don't be a dick even if the situation sucks. They deal with grumpy WW2/Korean/Vietnam guys all the time, so the younger generation is one they can relate to more. An MRI of mine got bumped up a month because I casually chatted with reception for awhile. Also, getting appointments at the VA can take a while, a LONG WHILE. Missing your appointments will only delay your care. It also looks bad on your record. Really bad. More on that later. 7) Finally, if you run into roadblocks, talk to your Case Manager at the OIF/OEF Office Remember that case manager I mentioned earlier? That is your lighthouse in the storm of the VA. OIF/OEF veterans are lucky enough to have this service because they are pretty much your ‘Go-To’ person in the hospital. Usually MSWs or RNs, they are assigned to get you where you need to go. They help connect and set up whatever it is that you’re seeking. I was lucky enough for mine to hook me up with a lifelong public transportation pass even. Use them if you seem lost as all hell. Part II: PolyTrauma/TBI Care System: I got blown up Due to the multiple injuries usually associated with mTBIs, most PCPs will refer you to Polytrauma if you have a plethora of things going on. This section of the hospital is a one stop shop for everything you might need under one department, and therefore, runs a lot smoother than going around to 5 different offices with different appointments. Here, they have a Polytrauma ‘team’ that includes physical therapists, a speech pathologist, a psychologist, an MD, a nurse, etc. Basically the care is much smaller, more manageable and highly personalized. I highly recommend it. Part III: Compensation and Pension: CPRS and You In the military we are often are in the mindset of minimizing problems, sucking it up, and driving on. Stand down Soldier. If you don't tell your care providers everything about what's going on, they A) can't treat you properly and B) you may miss out on benefits you have earned. CPR…wha? CPRS is the VA’s Computerized Patient Record System or pretty much your entire life at the VA since you signed up on day 1. Everything is recorded in here. EVERYTHING. Not just your condition, but your mood, appearance, history of drug/alcohol abuse is all typed up for your file each time. Inconsistencies in your file can hurt the chances for your claim, because it shows deception, at least in a rater’s eyes. So don’t be too proud about what pain you’re in but don’t exaggerate either. Everything is recorded. So how do I file a claim? Sign up online using VONAPP, where your important VA forms can be filled out and submitted online. If you signed up for eBenefits earlier, you can use that login to file form 21-526. Also submit any supplemental information (outside of the VA’s systems) to build your claim. Make sure any claims are submitted prior to 1 year after your discharge so you are able to receive back pay! ***Disclaimer: I highly recommend getting an advocate like the DAV or VSO to walk you through this process instead of going it alone*** The C&P This is the most important part of the process, your appointment where someone who is not a part of your healthcare evaluates you. Sometimes they are contracted by the VA or they may even be colleagues of the Health Care Provider you see on a regular basis. They have full access to your CPRS file as well, and will see how your history measures up to your current condition. See why I said to be honest as possible? They will take in as much as they can gather in one appointment with you and write a report. Note: Medical professionals cannot suggest a certain percentage rating. However, the language used in their reports will definitely influence the rater’s decision. You can request copies of your C&P reports after they are filled through a FOIA request at your Release of Information office in your hospital. You can also view all the forms the raters use for each condition here. Requesting copies of the C&P exams can pay huge benefits if you end up in the appeal process later, as the information they contain will be vital to your advocate. But I thought the Medical Side and C&Ps were separate? They are…kind of. The Medical Center’s sole job is to treat you, while the C&P is to evaluate you in your entirety. While your health care at the VA doesn’t directly affect anything, your records can for C&P and the ratings board. Getting Rated After your C&P is done, and all additional information has been sent to the VA, it gets passed up to the rating board. Time for the waiting game in the long haul This can be a few weeks to months depending on how backlogged they are. eBenefits has the status of all your claims as well. The rater will look at your entire VA Medical history in CPRS, including the C&P. They will also look at any supplemental evidence you submitted. Missed appointments are one of the worst things you can have on there, and will most definitely hurt your claim. The less you have on your CPRS file, the better. Part IV Appeals Ongoing from Dantu, he has experience in this area. Helpful Links!  Disability Rating Calculator Veteran's Benefits Forums EconOutlines fucked around with this message at 23:23 on Sep 30, 2011 |
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Sep 30, 2011 23:17
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No you'll be fine. They'll do a hearing test on you if you file for a C&P, and then go over your service record, including the doctor's note. The hearing test, along with the audiologist's recommendation will make or break you though.
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Sep 30, 2011 23:25
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I believe it took me somewhere around 2 months or so to get my first appointment. What did they give you to fill out and return? Just make sure you watch your phone and mail. They'll call/send you stuff once, maybe twice and if you miss it, its even more of a pain. Hence why #6 is so important once you're 'in'.
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Sep 30, 2011 23:39
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Keep in mind too that if you are SC for tinnitus, you will still receive hearing aids when you need them at 50 or whatever. $5000-6000 hearing aids are pretty pimp.
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Sep 30, 2011 23:46
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front wing flexing posted:Tinnitus without hearing loss is standard of 10%. Almost nobody gets denied for it and you don't have to have a prior history of it as long as you file with the VA before getting out. If you're already out then you would have to have something in your medical record. Quoted for truth. Even if you file after you get out, you are likely to get it without having prior records. Reason is, tinnitus is hard to scientifically prove one way or another, similar to PTSD. The VA is looking to avoid lawsuits and the such. I stated mine was varied in intensity and time intervals, but was most noticeable in quiet environments such as sleeping, reading, etc. I also was asked about being exposed to blasts, suicide bombers, IEDs. Of course, it also depends on the audiologist's recommendation and the VA Rater that your packet gets thrown upon as well.
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Dec 1, 2011 08:14
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I've got Wellbutrin for PTSD/anxiety, prazosin for nightmares and trazadone for sleep, plus some naproxen for migraines. Was tired of blacking out and doing questionable stuff on Ambien and Celexa made me empty and hate life. I've actually discovered acupuncture and yoga, along with some breathing/meditating works wonders. The Vet Center is a really good point of contact for that kinda stuff.
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Dec 24, 2011 06:41
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Mhachtx, this may be what you're looking for. http://www.benefits.va.gov/warms/bookc.asp#f
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May 7, 2013 20:49
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| # ¿ May 10, 2024 14:28 |
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You can now get dental coverage if you're enrolled in the VA healthcare system. You still have to pay out of pocket, but its pretty drat cheap and its better than having nothing. VA Dental Insurance Program (VADIP)
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Nov 17, 2013 17:19
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