Thursday, July 31, 2014

Veterans Disability Strategy

Many vets become aware of medical conditions that appear to be service connected. Often the vet will walk into the local Veteran Affairs  Regional Office and bring a physicians letter with them hoping to be awarded a disability rating in a few months.,

As most vets know, this approach will  usually results in a denial.

38 CFR Pensions, Bonuses, And Veterans Relief

What vet should have done is first is to review 38 CFR, Part C and work with the physicians to define his or her disability in VA terms. 

Disjunctive v. conjunctive ratings

If the Vet has Diabetes Mellitus , he or she should check out The Endocrine System, 4.119 - Schedule of Ratings - Endocrine System

The vet would find these ratings for Diabetes Mellitus

7913     Diabetes mellitus

            Requiring more than one daily injection of insulin, restricted diet,
            and regulation of activities (avoidance of strenuous occupational
            and recreational activities) with episodes of ketoacidosis or
            hypoglycemic reactions requiring at least three hospitalizations per
            year or weekly visits to a diabetic care provider, plus either
            progressive loss of weight and strength or complications that
            would be compensable if separately evaluated     100

            Requiring insulin, restricted diet, and regulation of activities with
            episodes of ketoacidosis or hypoglycemic reactions requiring one
            or two hospitalizations per year or twice a month visits to a diabetic
            care provider, plus complications that would not be compensable
            if separately evaluated     60

            Requiring insulin, restricted diet, and regulation of activities     40

            Requiring insulin and restricted diet, or; oral hypoglycemic agent
            and restricted diet     20
Manageable by restricted diet only     10
Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913.

Note (2): When diabetes mellitus has been conclusively diagnosed, do not request a glucose tolerance test solely for rating purposes.

Pay close attention to the notes and be aware that Diabetes Mellitus is rated conjucntivley. To be be rated 40 per cent, you have to meet all of the examples for the 10 and 20 per cent ratings as well.

Some endocrine rating are rating disjunctively. The top level ratings are inclusive of the lower level such as  DC 7903 which addresses Hypothyroidism 

7903 Hypothyroidism

Cold intolerance, muscular weakness, cardiovascular involvement,
mental disturbance (dementia, slowing of thought, depression),
bradycardia (less than 60 beats per minute), and sleepiness 100

Muscular weakness, mental disturbance, and weight gain 60

Fatigability, constipation, and mental sluggishness 30

Fatigability, or; continuous medication required for control 10

In The UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS (USCAVC), NO . 07-2728 DIANNE C. TATUM , APPELLANT (2009) argued successfully for a higher rating.  The USCAVC ruling explains disjunctive ratings.

The USCAVC agreed with Ms. Tatum on her entitlement to a higher disability rating. The USCAVC noted that all of the examples in DC 7903 did not need to be present for a higher level rating. The USCAVC said that the higher level examples in DC 7903 were inclusive of the lower level examples. 
Because this case was decided by a a panel of three judges, it is binding to the VA. 
Therefore, hypthyrodism is rated  disjunctively, unlike daibetes mellitus. 


Letters v. Disability benefits questionnaires

A veteran can get a letter from a a physicians, but Rightardia recommends the new Disability Benefits Questionnaires (DBQ) which provide more comprehensive information to the VA .

Below is a link to VA DBQs. 

it is important the physician check the box that indicates the Service Medical Records (SMR) have been reviewed. How can the physician connect the medical condition to service in the armed forces with reviewing the SMRs that the veteran should provide to the physician? 

After the SMRs are reviewed the physician should be able to write a nexus statement that connects the vet's medical condition to his or her service. This needs to be added as a remark to the DBQ,

Rightardia recommends you get a minimum of two DBQs: one from the primary care physician and one from a specialist. You should probably get a specialist diagnosis first that your primary car physicians will review before he or she completes their DBQ.

If the DBQ provides sufficient evidence, the VA may waive Compensation and Pension exam. Rightardia considers these exams redundant. Initially, the C&P doctors were funded to help indigent vets who couldn't get a private practice exam. Then the VA then required all vets to complete these exams which are often superfluous if a DBQ has been submitted.


Get the right attorney

Some legal firms will coach vets off the record on how to pass C&P exams and charge a fee. Rightrdia considers this unethical and unnecessary, If you get a proposal like this from an attorney, report the firm to the VAOIG.

If you need an attorney, use to find a top rated attorney on VA or military law in your locality. 

If you need some prepping for a C&P exams, you may want to peruse some of the VA physician and clinician guides. Most of these are older documents, but they are the most current Rightardia could find.

Disability Worksheets

Clinicians's Guide


Amazon: Old Physician's Guide

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