The importance of VA secondary condtions.

When a Veteran files the initial claims with the Veteran Administration, he usually files for a primary medical condition. Besides filing the online VONAPP (www.ebenefits.va.gov)or the VA Form 21-52.

The evidentiary requirement are rigid and Rightardia has recommended using the Disability Benefits Questionnaires (DBQ) to make sure all the "T" are crossed and the "I's are dotted.

It is important that the doctors check the box indicating the Service Medical Records (SMR) have been  reviewed. A nexus statement connecting the military service to the medical condition must  also be written in the remarks.

In the example below,  a serviceman loses his pituitary by being exposed to radiation or chemicals in an industrial environment. Hypopituitraims is the primary condition, but the vet could also lose adrenal, thyroid and sexual function. Hypopituitarism cal also cause anosmia (loss of sense of smell ) and diabetes insipidus.  All of the latter are secondary conditions.

Many Army solders were exposed to agent orange in Vietnam which led to many cancers and heart conditions. For example a veteran could revive an award for non-Hodgins lymphoma. With chemo-therapy, the vet might survive. But there are a lot of residuals or secondary conditions associated with non-Hodgkins lymphoma.

• Immune deficiency
• Chylothorax
• Coin lesion (chest x-ray)
• Ichthyosis
• Coombs positive, direct
• Leucoerythroblastic anaemia
• Lacrimal gland enlarged
• Red cell production reduced
• Splenomegaly
• Pruritus
• Peripheral demyelination
• Thrombocytopenia
• ESR raised
• Mediastinal enlargement
• Autoimmune haemolytic anaemia, warm antibody
• Erythema nodosum
• Paraproteinaemia
• Lymphadenopathy
• Lymphocytosis
• Pyoderma gangrenosum
• Monocytosis
• Cold agglutinins
• Renal metastases
• Abdominal mass
• Peripheral neuropathy
• Orbital mass
• Osteosclerosis

If the vet develops any of these conditions, they should file for a secondary condition. Filing for a secondary condtion  has some big advantages.

38 CFR § 3.310 says:

"When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition."

This means the effective date of the secondary condition is given the date of the primary condition.  In addition, the doctors does not need to review the SMRs or write a  nexus statement. The doctor must indicate the secondary condition is  a consequence of, and linked to the primary condition. 

The vet may use a DBQ to document a secondary condition. Some DBQs are written to identify secondary conditions, other are not. A doctor's letter my suffice for a secondary condition. The letter should show:

A diagnosis for a compensable condition
A link between the secondary condition and an already service connected condition

You may think the primary condition would have a higher disability rating that secondary, but it is usually the other was y around. In fact the 38 CFR makes it clear that secondary condition may have a higher disabiliy rating than the primary.

sources:

http://www.vba.va.gov/pubs/forms/VBA-21-526-ARE.pdf
http://www.benefits.va.gov/COMPENSATION/dbq_ListByDBQFormName.asp
http://www.rightdiagnosis.com/n/non_hodgkins_lymphoma/complic.htm#complication_list
http://vets.yuku.com/topic/12131


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Where to start in VA disability compensation

First, are you eligible?

A veteran must have two years of active duty under her belt as of a 1981 service entry.

You must have a disability that the VA determines is service-connected on active duty, or was made worse by active military service. You must also have a discharge that the VA determines was under other than dishonorable conditions. For example, you are unlikely to qualify for disability compensation if you have a bad conduct discharge. 

 

The disability compensation conditions are less strict than eligibility for some other benefits such as a VA pension or VA home loans. In both cases, you must have served on active duty during a wartime period such as the Korean War, the Vietnam War or the Gulf Wars.

You have three basic options when you start a claim. You can represent yourself “pro se” or give your Power of Attorney (POA) to a Veterans Service Organization or an attorney. 

Let's look at the pros and cons of each. 

Pro Se

1, You have complete control of your claim. If you have to appeal to the Board of Veteran Appeals (BVA) you get special consideration because you do not have professional representation. You can also ask the BVA for a reconsideration of its ruling, something a veteran service organization or attorney cannot do.

You will be able to go to the VA's Veteran Center that has many experienced counselors who can access most VA claims databases.

In addition, you can usually see the same VA counselor as the claim progresses. The Veterans Center is open 5 -days a week and doesn't close during local or national VA conventions or similar events.

You will have to do all of your own research and file the claim using the On-line VONAPP or the VA paper Form 21-526. You will also have to coordinate the completion of Disability Benefits Questionnaires (DBQ) with your physicians and clinicians to document your claim.

You will have to set up a file system for incoming VA letters and outgoing claims documents. You wail need access the Internet, a PC and a printer, preferably a laser multifunction printer. You will need software that is able to edit postscript document format (PDF) documents such as Adobe Acrobat.

Attorney

An attorney can probably provide the best help up front on a claim. If an attorney takes your case, it is a good sign that your case has merit. The attorneys have paralegals who will help you with paperwork and answer questions by phone. You can expect a higher level of service with an attorney.

Most attorneys will also be able to refer you to doctors who understand the VA's documentation requirements and know how to properly complete a DBQ. The VA Regional Office is likely to take attorney representation more seriously than a claim that is represented pro se or by a veterans organization.

The attorney will receive 20 per cent of any retroactive pay that you receive. However, this does not apply to monthly compensation.in contrast, other private practice attorneys take about 1/3 of a settlement plus administrative costs.

Most veteran attorneys do not provide this services to become wealthy Most have been veterans and understand the need for these legal services to vets.

Veteran Service Organizations

Last but not least are the service organizations such as the Disabled American Veterans (DAV), the Veterans of Foreign Wars (VFW) and the American Veterans (AMVETS). There are many others. Most of the states also have state level veteran service officers(VSO).

These veteran organizations usually require POA. However, this does not restrict you from talking to the counselors in the Veteran Center, On the other hand, an attorney will probably want all conservations and documentation to go through the attorney's office.

The exception of the state service organization who usually will not ask for POA. Have found most service organizations to be the least effective way to staff a claim. Many of these offices have limited hours and may be open only 4-days a week. During a VA conventions the entire office may close. One office rotated its VSOs every 90-days and a vet could have 20 different VSOs or more during the life cycle of a claim.

Service organizations are unlikely to help you write or review claim documentation. Service orgs will represent you during a local BVA hearing, but many VSOs lack legal training. This is true in FL. However, in NY a VSO must have legal training.

The state VSOs are a different animal. Many will help you without requiring POA.Most are unlikely to represent you during a BVA hearing.

So, if you are representing yourself pro se, you can still get advice from both counselors in the vet center and from state level VSOs. In the case of the writer, this situation worked best, but it is not for everyone.

Is Pro Se is for me?

Fist of all can you or your significant other write well? Can you distinguish facts from opinion? How good is your grammar and reading comprehension? 

The BVA has strict rules on evidence. The BVA will throw out any opinion other than expert that you try to present as fact. 

Try some of these tests before you dive into pro se.  Check out the following grammar and reading comprehension tests and your ability to distinguish fact from opinion.

See http://www.grammar-monster.comtestsest_parts_of_speech.htm

http://www.ereadingworksheets.com/e-reading-worksheets/online-reading-tests/

If you are having difficulty with these tests, suggest you engage and attorney. Regardless of whether you start the claim with an attorney, you will probably eventually need one if you appeal to the BVA, which provides legal administrative hearings.

sources:

http://vabenefits.vba.va.gov/vonapp/main.asp

VA Form 21-526

http://www.grammar-monster.com/free_grammar_tests.html

http://www.ereadingworksheets.com/free-reading-worksheets/fact-and-opinion-worksheets/

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Filing a new VA claim

Many veterans get a letter from a doctor and go the a VA regional office (VARO)  and use a Veteran Service officer (VSO) from the AMVETS or DAV to file the claim. Chances are the initial claim will be rejected. In fact even after a second level review by the Board of Veterans Appeals, only bout 30 per cent of claims are approved. About 15 per cent of VA claims are fraudulent.  But what about the other 50 per cent that are rejected?

The VARO would probably say that most rejected but legitimate claims are not fully developed. The VARO wants fully developed claims (FDC). 

You can increase your chances by filing the claim pro se.  This means advocating on your own behalf before a court or board, rather than being represented by a lawyer or a VSO.

One big advantage of filing pro se is that the VA has to give your claim extra considerations because you did not have professional representation.

You do need some tools to file a claim. If you don't have these tools, you should probably work the claim through one of the service organizations or through the VA's Veteran Center. 

Rightardia recommends you have or can get access to the following:

1. The Internet. You can use the public library's if you don't have this at home.

2. A PC with any current operating system. You will need this to type letters, fill out the online VA claims (VONAPP) and respond to VA requests. 

3. MFC (multi-function) laser printer. Useful for printing, faxing and scanning. A color inkjet printer has limited use and prints far more slowly.

4. Software: You need a word processor like MS Word or Libre office aka Apache Open Office that is free. Both Libre and Open Office have both Windows and Linux versions. You can upgrade Libre office with the Language Tool plug-in that provides grammar checking. There is also a free medical dictionary for Libre/Open Office.

5. A file cabinet with both incoming and outgoing logs. All incoming and outgoing documents should be numbered and filed in chronological order. Use to the log to quickly locate documents you need to enhance or reference in your claim. 

A program such as Windows PDF Nitro that can edit DBQs and create portable document files (PDF). The PDF is a government standard and that is why most government forms are in PDF format. PDF Nitro will allow you to edit existing PDFs or save a DBQ is PDF format.

You cannot otherwise edit a PDF file such a Disability Benefit Questionnaire (DBQ). However, without a program like Adobe Acrobat, not the reader,  or PDF Nitro, you will not be able to edit existing PDFs or save them. You can also edit PDF files in Linux with graphics programs, but it is time consuming.

Before you file the claim, you should read two books. The ASKNOD  VA Claims by Gordon Graham and Claims Denied by John Roche. The latter will help you file the claim and the Asknod book will be very useful if you have to file an appeal.

Next try to define your claims in terms that the VA can understand. Check 38 CFR, Part C Subpart B to find the disability codes fit your condition (s). See http://www.benefits.va.gov/warms/bookc.asp

For example if you have diabetes mellitus, DC 7913 applies: 

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, too. Show the DC examples to your physician. Ask him or her what they think you should be rated for.

With the Affordable Care Act,  you should be able to get medial insurance and help from private practice physicians. In general, they will be the strongest advocates for you if you have a clear cut case. If a private practice doctor won't help you, fire him or her and find one who will.

You have the option of submitting a letter signed by your physician or asking the physicians to complete a DBQ. Rightardia strongly recommends the DBQ because it will provide more information to the VA than is often possible in a letter. A well written DBQ may also preclude a compensation and pension (C&P) exam.You can find the DBQs at http://benefits.va.gov/COMPENSATION/dbq_ListByDBQFormName.asp.

It is important that the physician indicate in the DBQ that he/she reviewed the claimant's service medical records (SMR). The physician can check a check box in some DBQs to show he performed a records review. The DBQ also needs to have a nexus statement added that connects the medical conditions to the claimant's time in service.

Here is the part of  DBQ for Diabetes Mellitus:

 Many vets make the mistake of submitting multiple claims that are unrelated to each with the typical vet submitting 20 different claims, hoping some will stick. It is far better to push the claims that have the most impact. For example, you might get 10 per cent for service-connected prostate condition and 50 per cent for sleep apnea. Clearly the latter condition is more important. Use the 38 CFR to help identify and prioritize medical conditions.

Are there any relationships between diabetes mellitus and other medical conditions you have? Are there secondary conditions such as neropathy, renal dysfunction and retinapathy? Diabetes can cause cardiac conditions such as hypertension, too.  Try to relate your medical conditions as primary and secondary conditions in your claim.

Have your spouse review the initial claim.  This can be important  if your spouse or other family member is a stronger writer. Make the claims process a family affair. A VA disability award and retroactive pay can greatly improve the economics in your family.

At this point you are ready to file pro se. You have read the two books, you have found DCs that correspond to you medical complaints and you have DBQs or letters from you physicians on your medical conditions. You have connected your primary and secondary medical conditions which are often referred to as residual conditions.

You have all the tools you need for further research and for the preparation of additional documentation.

You can file VA Form 21-526 (Veteran's Application for Compensation or Pension) in the VARO's Veterans Center or file a VONAPP online. See https://vabenefits.vba.va.gov/vonapp/main.asp.

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New GI Bill for the 21st Century: Information and Resources

Last year, Congress enacted the new GI Bill for the 21st Century (the "Post-9/11 GI Bill") to restore the promise of a full, four-year college education for Iraq and Afghanistan veterans. As of May 1st, veterans can begin to apply for a certificate of eligibility for the new college benefits at the VA website here, which will become available on August 1st.

FREQUENTLY ASKED QUESTIONS AND ANSWERS:

Am I eligible to receive educational benefits under the Post-9/11 GI Bill?

You are eligible for benefits if you have completed at least 90 days of active duty service on or after September 11, 2001, and were honorably discharged. It also covers individuals discharged with a service-connected disability after 30 days who were honorably discharged. The benefits are correlated on a sliding scale to years served. To receive full benefits, you must have served on active duty for three years.

This chart shows the percentage of costs covered, based on the length of your service:

What does the Post-9/11 GI Bill pay for?

* Tuition and fees of up to the maximum in-state tuition and fees at a public institution in your state;
* A monthly housing allowance at the location of the school, based on the Basic Allowance for Housing for an E-5 with dependents; and
* An annual books and supplies stipend of up to $1,000.

How do I access benefits?

You can apply for benefits under the Post-9/11 GI Bill online, using the Veterans Online Application System (VONAPP). Select Form 22-1990. You can also download Form 22-1990 here, and mail it in.

Do I need to claim my benefits before a certain date?

You generally have 15 years following release from active duty to use the benefits under the Post-9/11 GI Bill.


Can I transfer Post-9/11 GI Bill benefits to my spouse or children?

If you are a member of the Armed Forces on August 1, 2009, the Department of Defense (DOD) may offer you the opportunity to transfer benefits to your spouse or dependent children. While rules on transferability are still being finalized, for most servicemembers, to transfer benefits to a spouse, you must have served six years and reenlist to serve at least four more. To give education benefits to a child, you must have served for at least ten years.

Will the benefits cover an education at a private university or college, or those at out-of-state schools?

Because the Post-9/11 GI Bill generally only covers tuition and fees up to the maximum of a public institution in your state, the Yellow Ribbon Program is a provision of the bill that can help you to afford the higher cost of a private education. The Yellow Ribbon Program provision allows schools to enter in an agreement with the VA to fund tuition costs above the highest in-state tuition rate.

The VA will match each additional dollar that a school contributes toward an eligible student's tuition costs, up to 50 percent of the difference between the tuition and fees covered by the Post-9/11 GI Bill and the total cost of tuition and fees. You must be eligible to receive the maximum benefit rate (having served three years on active duty, or those discharged with a service-connected disability after 30 days).

What if I have additional questions?

You can call 1-888-GI-BILL-1 (1-888-442-4551) to speak with a Veterans Benefits Counselor. You can also visit the VA's Frequently Asked Questions page>>

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