I would like to thank Steve Mackey and especially the director of this program, Dick Southern for this opportunity.

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Joella Simon
5 years ago
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1 CSC meeting--issues to discuss I would like to thank Steve Mackey and especially the director of this program, Dick Southern for this opportunity. This is not intended as claims training, but is current info that you can take back to your chapter members and to discuss with your NSO. This is what is now available; your NSO can let you know the specifics as to your eligibility and actual process. Explain the 3 branches of the VA. There are three divisions of the VA: the cemetery, the medical system---the VHA and the benefits system---the VBA. They are completely separate; with totally different computer systems. They don t interact or communicate with each other. Example: if you change your address at the medical facility you use, the Regional Office has no idea you have moved. That takes another phone call. Meanwhile, if you file a claim, and use the VHA, you tell them or they won t look. Always change your address with the Regional Office right away. If you don t respond to correspondence, they drop the claim. New Forms *DBQ s---the new illnesses added to the A/O list are accompanied by specific forms that detail the symptoms. They must be filled out by a doctor. The VBA is planning on using this process for other illnesses, (we don t know what yet). *526b the 4138 s are no longer used for increases, additional items, etc. Use it for informal claims, change of addresses, etc. *526ez---FDC the way a claim should be done, as little as 3-5 months. Can be used to re-open a claim, or do an increase---as long as everything is turned in at once, no further communication until decision. YOU MUST TURN IN EVERYTHING AT ONCE. No requests for SMR s or s

2 This is exactly why this is not training, this is a highly complicated, ever changing process that Congress controls and is managed by the federal government. It takes a person that does this everyday to get it done right. APPEALS---try NOT to do it unless you have to. Get the missing info (new & material) and re-open a denied claim. MORE TO COME LATER, it must use the correct words, maintaining the appeal date, and have pages physically attached to it. 5-6 months instead of 18 months to 5 years. NEW ITEMS TO FILE FOR: Post-concussive syndrome (resulting from TBI). The signature wound of these current conflicts. A new field of medicine, symptoms overlap PTSD (memory loss and unprovoked anger). Any veteran that got blown up, esp. if there was LOC (loss of consciousness) needs to ask his PCP to put in a consult for a TBI eval, if positive, add to claim. (More to come) 3 new conditions, including IHD. Secondary conditions: Any medication or treatment used for a service connected treatment, if it causes a disability, can be filed. (Nexus required, from the PCP, at least as likely as not) Example: tinnitus resulting from chemo for lung cancer. There are several conditions that can be secondary to SC PTSD--- GERD---acid reflux, acid stomach from constant tension, nexus from primary doctor. Bruxism---grinding of teeth from constant tension (many current veterans coming home with molars ground down, or teeth broken). Nexus from dentist.

3 Sleep apnea --- (which can be fatal) the PCP can relate that the depressive component of PTSD leads to isolation, overeating, weight gain=sleep apnea. Nexus from primary doctor. HTN --- (sometimes) about two thirds of the medical field accept that PTSD can lead to high blood pressure. This one needs the citing of medical articles or scientific studies. Also, primary doctor writes up connection. THIS CAN BE A BIGGIE--- heart conditions and liver problems as self-medication--- They will not SC any substance abuse, but they will sc the effects--- IF the veteran has reported to his psychiatrist that the drinking or intravenous drug use was an attempt to block out the memories of war (or whatever the PTSD incident was), hepatitis C or liver cirrhosis can be sc as secondary to the symptoms of sc PTSD. Quick review of what made Vietnam a different kind of war The draft, individual replacement, no chance to grieve, etc. PTSD is a normal reaction to an abnormal situation. Notice the D ---it is for disorder, not P for psychosis. In fact, the mere fact that combat PTSD vets wonder if they might be crazy is medical proof that they are not, since the truly insane NEVER question their sanity---they think they are fine. Post means it can come out any time after the event, months or years. Traumatic stress is far different from cubicle stress, or freeway stress. The adrenalin flooding the brain when the initial traumatic event occurred had burned that image into the brain in perfect clarity. It is just as crystal clear today as the day it happened. This is even true for WWII veterans. The memory never goes away, current therapies can take the gut wrenching emotional pain away, but only brain surgery will remove the memory. And we don t want to do that.

4 Let me tell you a few things that make Vietnam veterans a bit different than previous combat vets. (A lot of these things will apply to the current combat vets). When Vietnam veterans came home, no one in the American civilian medical field or society in general knew what PTSD was, it had never come up in conversation. Meanwhile (More to come) ALWAYS ACCEPT ANY MEDICATIONS OR TREATMENT OFFERED. The VBA see your refusal for pills or therapy as your way of saying, I m not that bad off. If you are really worried about the pills, ask the doctor to explain it, they get paid a lot of money to be experts. Express your concerns, but pick it up from the pharmacy. I recommend you take it, try it for the appropriate amount of time, and report any problems. They have other things to offer. Personally, I do not recommend reading or researching the side effects. The idea is, there is always side effects, the doctor has determined the benefits are higher. Most PTSD medication was developed for other reasons. *Alert your members to the fact that any Non-service connected war era veteran could be eligible for NSC with Aid and Attendance. Many WWII and Korea vets are struggling with health care costs, especially if they need assisted living or constant care facilities. This benefit could help them, income and expenditure contingent. (More to come) Relaxed stressors for PTSD---they finally figured out Vietnam was a terrifying place to be, so all the Nam vets that couldn t prove an ambush on Hwy 1, or taking sniper fire while on guard duty NOW have an opportunity to get their claim through. (More to come) The stressors for MST were also relaxed.

5 How to get an increase. The actual percentages are determined by the severity level of symptoms reported to your doctor. If you tell them you are doing ok, that s what they write. If you have a service connected knee condition, I recommend making notes of a 24 hour period, A Day in My Life, with my Left Knee. Begin upon awakening; jot down pain levels, extension degrees, how it affects your lower back, left hip, and especially your right knee. Continue making notes until you go to bed, and what your night was like when you wake up. Take this to the doctor and ask him to put it in the computer. Ask him if there are other diagnoses connected to the left knee. Then ask your NSO to write up an increase, to include any and all other conditions that are secondary to the left knee. Keep in mind, it may not be worse enough to get an increase, but at least you have given your doctor ALL the info, a comprehensive picture of the problem. The same process can be used for PTSD increase, since you guys don t talk about it. (More to come). TDIU---if a veteran is 60% for one item, or has a combination or 70%, 80% or 90% with at least one item at 40%, he is eligible for the TDIU program, which pays at the 100% amount, since he can t find a 30%, 20% or 10% job---if his doctor will put in the appropriate statement, as follows: As a result of his combined service connected conditions, and without regards to other factors, he is unable to obtain and maintain substantial employment. If putting in an increase on PTSD from 50% to 70%, do the IU claim at the same time. When your total gets that high, you are also eligible for another program. It is offered by Voc Rehab and called Independent Living. There aren t any memberships to Hooters, but you might get fishing equipment, a camera, a laptop. Depends on what they determine might help you socialize into the community.

6 Direct Connection for items not on a list. (More to come) Explain the 3 basic Hickson elements. 1 diagnosis of a current disability 2 documentation of an incident in service 3 a doctor s statement connecting the two. Regardless of if you are applying for toe cancer (no such thing) there MUST be something in black & white that indicates you stubbed your toe while on active duty or within one year of discharge. Maybe light duty pay, with a note saying put on light duty as a result of severe toe stubbing or a copy of your Performance Ratings unable to accomplish assigned task of climbing rooftops because of toe injury. Since it would take years to develop into toe cancer, the current physician would need to see the actual military documents, and in a statement create a nexus. After reviewing the STR s it is at least as likely as not the original injury is related to the development of the toe cancer x # of years later. Without that statement, there will never be a direct service connection. You could have truck loads of evidence about the condition, but VBA raters are not allowed to draw a conclusion. It is their job to interpret what the doctor has noted. Now presumptives don t require a nexus, that determination has been made by Congress. Example: Agent Orange, aka dioxin, has been known to cause a limited list of illnesses. Hickson element #1 is satisfied by documentation of boots on ground in the country or inner water ways of Vietnam. VSM is no longer enough. Recap---ALL claims require, at the minimum, the 3 basic Hickson elements. Some need the 4 th, continuity of care.

QUESTIONS ANSWERED BY

Module 16 QUESTIONS ANSWERED BY BERNIE SIEGEL, MD 2 Q How do our thoughts and beliefs affect the health of our bodies? A You can t separate thoughts and beliefs from your body. What you think and what