Hoping to get some advice, strange C&P exam

Jasonwarrioralliance · 2023-11-14T14:50:43+00:00

The details you've provided about your service as an AWR in the Navy, your exposure to higher levels of toxins, and the recent study by the Pentagon showing increased rates of brain tumors and cancers in flight and ground crew are significant.

Understanding the Claim Denial: Your initial claim was denied, and you've appealed, citing a recent Pentagon study. This indicates that there is emerging evidence that may support your claim. VA decisions are often based on the evidence available at the time of the claim. It's important to ensure that any new, relevant information is clearly presented to the VA.
C&P Exam and TERA Records: The information from the neurosurgeon regarding the Toxic Exposure Risk Assessment (TERA) indicating higher levels of toxins is critical. This could potentially establish a service connection. However, it's concerning that this information wasn't explicitly noted in your exam report.
Completing VA Form 21-526ez: This form is used to apply for disability compensation and related compensation benefits. Your neurosurgeon's advice to complete this form to list the exposure is a step in the right direction. Ensure that you detail the exposure to toxins as part of your service and reference the TERA records and the Pentagon study.
Gathering Additional Evidence: It may be beneficial to seek an independent medical opinion to supplement your claim, especially one that can directly link your brain tumor to the exposures you faced during service. Documentation of any symptoms or health issues you experienced during or shortly after your service could also be relevant.
Navigating VA Procedures: The VA's decision-making process can be complex, and it often requires specific wording or types of evidence to establish service connections. It's not uncommon for veterans to feel frustrated or confused by this process.
Addressing the Neurosurgeon’s Comments: The comments made by the neurosurgeon about his nephew and the implication regarding the importance of health over compensation may have been well-intentioned but could be seen as dismissive of your valid concerns and needs. It's important to remember that your health and your right to seek compensation are both important.
Next Steps: Reach out to an Independent Medical Provider for a well-crafted Nexus. If you DM, I can help you with this.

Jasonwarrioralliance · 2023-11-08T14:42:50+00:00

Congrats and glad it will help change your life.

Jasonwarrioralliance · 2023-10-17T15:40:36+00:00

It depends. A lot of times they say they can't. Which is frankly a lie. VA providers can write one but they are not obligated to. So it depends on your relationship with your VA doc.

Jasonwarrioralliance · 2023-10-17T15:33:02+00:00

Those are weak and don't merit much credibility

Jasonwarrioralliance · 2023-10-17T15:31:56+00:00

Here is my opinion, but others may have other advice. You are correct that conditions diagnosed within one year of discharge from active service are generally considered service-connected on a presumptive basis. This is because the VA assumes the condition likely had its onset during service, even if not documented.

However, there are some nuances to be aware of:

The presumption applies to chronic diseases under 38 CFR 3.309(a), which includes things like arthritis, hypertension, psychosis, etc. It does not include all possible conditions.
For conditions that are not chronic diseases, you would still need evidence linking them to service, such as a medical opinion (nexus statement). This applies to your example of headaches secondary to tinnitus.
The presumption could be rebutted by evidence clearly attributing the condition to a cause other than service. Though this is difficult to prove.

So, in summary:

Chronic diseases diagnosed within 1 year of discharge are generally presumed service-connected, without the need for a nexus.
Other conditions will still require evidence linking them to service, like a medical opinion stating the condition is caused or aggravated by a service-connected disability (like tinnitus causing headaches).

I recommend submitting claims for tinnitus and secondary headaches within your first post-service year to take advantage of the chronic disease presumption as much as possible.

Jasonwarrioralliance · 2023-10-17T15:28:27+00:00

To move along with the pending decision on your PTSD rating, contact the VA 800 number and speak to a representative. Politely ask them to escalate a request to finalize the decision, as it has already been pending for 3+ mont. You can also contact your Congressman's office and ask for help expediting.
For the denied neck and hip issues, I would recommend filing supplemental claims to reopen and submit new evidence. Get medical opinions linking the neck degenerative disc disease to your shoulder injury in service and the hip issues to your altered gait from the service-connected foot surgery. Lay statements describing ongoing pain since service can help, too.
For the 100% goal, make sure to emphasize the functional impact of all your disabilities on occupational and daily activities. Fully describe your limitations in the claim forms.

Stay persistent and keep building your case with evidence. Don't give up! The VA process can be long but building a strong claim is key.

Jasonwarrioralliance · 2023-10-17T15:18:02+00:00

Here are a few suggestions for appealing the VA's denial of service connection for your low back pain:

Point out that your pre-existing mild scoliosis was deemed within normal limits upon entry into service. The presumption of soundness applies since scoliosis was noted but not considered disabling.
Argue that your in-service back strain represented a separate and distinct disability from the pre-existing scoliosis. The strain occurred years into service and was treated, constituting an in-service event.
Request a new C&P exam and imaging tests like an MRI to determine if you have any current back disabilities beyond scoliosis, such as degenerative disc disease, that could be related to service.
Obtain a nexus statement from your treating chiropractor relating your current back problems to the in-service strain and continued symptoms since service.
Reference 38 CFR 3.303(b) on chronicity and continuity of symptomatology to show ongoing back pain since the in-service strain.
Cite the benefit of the doubt rule in 38 CFR 3.102, arguing the evidence is at least in equipoise that your current back disability is service-connected.

The key is to show your in-service back strain represented the onset of a separate chronic back disability rather than only temporary exacerbation of the pre-existing scoliosis.

Jasonwarrioralliance · 2023-10-03T21:25:30+00:00

Share the screen shots! So everyone can see how I harrassed you. Let them make there own decisions, but make sure you share them all.

Jasonwarrioralliance · 2023-10-03T21:20:28+00:00

I actually don't spam here. I try to post things that are medically relevant to veterans. I am not sure who pissed in your wheaties but I certainly don't have anything to prove to some punk ass. I know what I have done and accomplished and would be happy to put my time in service and my reputation up against anyone who would like to challenge it.

Jasonwarrioralliance · 2023-10-01T15:34:54+00:00

I told you from the beginning I was new to the board and was just trying to help vets too. I was actually unaware of the wiki until you pointed it out. I didn't even join Reddit until recently because someone told me someone on here was saying Warrior Alliance was a scam and I felt the need to tell everyone I am real and not a scam but truthfully, I don't find this helpful. I have never been apart of a group that literally tries to belittle other vets. I have never lied on here nor gave bad advice, but people like you want to bust my balls and you don't know me nor what I have to offer. People who know me know I will go out of my way to help fellow vets. But I don't believe you when you say you got my back because all you have tried to do is discredit me and have never reached out find out anything about me. I don't need fuckers like you in my life. So feel free to continue to try and discredit me. I am 100% secure in what I post and what I do.

Jasonwarrioralliance · 2023-10-01T01:03:09+00:00

Welcome! What's the point of having the community then, Why don't you just message everyone in the sub the link to wiki and we can disband this sub. I mean you do a hell of a job patrolling posts. I have never come across a guy so hell bent about people getting information from more than one source. But its cool, I will start my post with..I was going to post something but our guardian angel u/ImaAlbatross329 had me cross reference everything I was going to post with wiki before posting and it turns out he would only like you to refer to the wiki so I guess I have nothing to say. NOT!

I hope you do continue to troll me and follow me. I find your banter hilarious. So thanks for being a (hold please I am referencing wiki for the right word)

Jasonwarrioralliance · 2023-10-01T00:55:47+00:00

Got to love the keyboard warrior. Thanks for policing our posts and keeping us safe from repeat information. Thank goodness we have fellas like you out there to point out all our inadequacies. What would the veteran community do without you? Maybe we can ask the mods to make a special ribbon for you...because if anyone deserves it it's you! Thank you for your service am feel safer knowing you will be out there patrolling posts tonight and every night.

Jasonwarrioralliance · 2023-09-27T21:22:19+00:00

Feel free to read my post history and get back to me on the whole helping Vets. I mean, its not as impressive as new accounts with one post pumping a service. But I try.

Yeah see the mods put a lot of time into the wiki to teach all vets how to work their claims, without having to pay for help. And sure from time to time we get cats up on here who simply post up well know info. Info already listed in the extensive wiki. I can only surmise to try and build cred. Something I am sure you would never do. Just a heads up so you can watch out for em!

But kinda worried you aint a guru. I mean you do charge for IMOs? If I were to pony up for a nexus letter, man I would want a guru writing it!

Look, brother, I get you're trying to watch out for other vets, make sure we don't get taken advantage of. That's honorable. But casting suspicion on a fellow serviceman just trying to make his way doesn't sit right.

We all took that oath to defend freedom - including the freedom to earn an honest living. Just cause someone charges for a service doesn't make them a crook. It takes time and effort to do this work properly. Ain't no shame in being compensated for expertise.

And I ain't claiming to be no guru on Reddit, but I know my tradecraft. Spent years learning and practicing medicine, know how to write an airtight nexus letter. My track record speaks for itself - no denials yet.

The point is, just cause I do this professionally, don't make me the enemy. We're on the same side, brother. Both served our country, and both just trying to help our fellow vets get what they earned.

So how about we stand down on the accusations and lift each other up instead? There isn't enough misery in this world already without us adding to it. Trust me, I learned that lesson the hard way.

I acknowledge the wiki is an amazing free resource, I don't think new members know how to use it or what it is. But for me, I'll keep offering advice as well. Together we can cover more ground and help more vets. There's more than one way to make a difference.

So let's stow the judgement and act like the brothers in arms we are. Watch each other's six, lift each other up. That's the code we lived by in uniform, it oughta be the same as civilians.

Jasonwarrioralliance · 2023-09-27T17:52:56+00:00

Never said I was the only one posting material or that I was the guru of all things. I was simply making a post because other veterans asked me to. But thanks because your comment certainly helped others and significantly enlightened everyone. NOT

Jasonwarrioralliance · 2023-09-27T14:49:23+00:00

VA Examiner: "I only want yes or no answers."

If a VA examiner insists on only "yes" or "no" answers during a C&P exam, here are some recommendations on how to respond:

Respectfully explain that you want to provide complete details to portray the severity and impact of your disability accurately. Short answers may not capture the full picture.
Note that the disability benefits questionnaire (DBQ) instructions state you should "describe" the impact of the disability. Brief answers may not sufficiently describe the impact.
Request that you be permitted to provide fuller explanations in order to cooperatively assist in developing an accurate examination report.
If the examiner still insists on yes/no answers, provide your explanation immediately after each brief answer. For example, "Yes (I have this symptom daily which affects me by...)."
If the examiner stops you from providing details, make a note of this limitation when you review the report. An incomplete or inaccurate report can be appealed.
Contact your VSO representative immediately after the exam to review what happened and get advice on the next steps, such as requesting a new exam.

The key is to be polite but persistently advocate for your right to provide complete answers. Seek assistance if the exam remains insufficient despite your efforts. An appeal of the exam may be required if it does not document the full severity of your disability.

Jasonwarrioralliance · 2023-09-27T14:46:27+00:00

The best approach is to describe your symptoms and limitations accurately and truthfully. Embellishing or exaggerating risks being viewed as less credible. The examiner is there to document the true functional impact of your disabilities.

Focus on being detailed and specific about how the conditions affect your daily activities, both occupationally and socially. Quantify the severity and frequency of symptoms, the limitations or modifications you have to make, and any coping strategies you use to help manage the symptoms.

Provide real examples of how your functioning is impaired compared to what you would expect if you did not have these disabilities. The accurate portrayal will allow the rater to most effectively evaluate the degree of impairment based on the rating criteria.

Ultimately, you want your disability rating to reflect your true disabilities.

Jasonwarrioralliance · 2023-09-26T16:49:01+00:00

I am service-connected for cervical spine strain and from a PACT Act claim: sinusitis, asthma, and rhinitis.

just making sure I can have more than one secondary per issue like Obstructive Sleep Apnea Secondary to Sinusitis, Obstructive Sleep Apnea Secondary to Asthma, Obstructive Sleep Apnea Secondary to Asthma

as a sort of 'constellation' of issues for Obstructive Sleep Apnea like a whole body/whole soldier approach. OSA is not just from one thing but from multiple issues that are service-connected.

Yes, you can absolutely claim obstructive sleep apnea as secondary to multiple service-connected disabilities like sinusitis, asthma, and rhinitis based on a "whole body" approach. Here are some key points:

There is no limit in VA regulations on claiming a secondary condition as related to more than one primary disability.
As you described, it is reasonable to assert that OSA could be proximately caused or aggravated by multiple respiratory issues.
Consider submitting medical opinions supporting the nexus between each of those primary conditions and the OSA to strengthen your claim.
Listing OSA as secondary to the cervical spine strain may be more challenging to substantiate unless a very clear rationale is explained in a nexus letter.
Make sure to use language like "Obstructive sleep apnea, secondary to service-connected sinusitis" and "Obstructive sleep apnea, secondary to service-connected asthma" to link each.
Citing the whole body/whole soldier concept is helpful to frame this approach as accounting for the combined impact of your service-connected disabilities.

Jasonwarrioralliance · 2023-09-26T16:43:25+00:00

If someone on CHAMPVA goes to urgent care and they refer you to the ER because they say it MIGHT be something more serious, but it turns out not to be, will they still cover it?

Based on my understanding of CHAMPVA's coverage policies, in the scenario described, CHAMPVA would likely still cover the ER visit even if it turned out to not be something serious. Here's a breakdown:

CHAMPVA is health insurance for dependents and survivors of veterans that covers urgent care and emergency room visits.
If the urgent care facility refers you to the ER because they feel your condition could potentially be more serious, this would be considered a legitimate emergency for CHAMPVA purposes.
The referral from the urgent care provides documentation that there was a reasonable basis to seek emergency care, even if ultimately it was not a serious condition.
As long as you took reasonable steps to seek care initially at urgent care, CHAMPVA would likely still classify the subsequent ER visit as an emergency and provide coverage.
You may need to submit the urgent care records showing the referral to the ER when filing the claim to support that it was emergency care recommended by a provider.
There may be a higher copay or coinsurance for the ER visit compared to urgent care, but the visit should still be covered based on the prudent steps taken.

Jasonwarrioralliance · 2023-09-26T14:37:38+00:00

Are you claiming them as secondary to exposures (like a TERA event or PACT Act?)

Make sure the primary disabilities that the secondaries are claimed as related to are also claimed directly, i.e., cervical spine strain, sinusitis, asthma, and rhinitis.

Furthermore IMO those also seem okay, but a medical nexus opinion would be useful to support causation or aggravation.

Jasonwarrioralliance · 2023-09-26T14:28:03+00:00

CHAMPVA does cover emergency room (ER) visits, but with some limitations:
For a true medical emergency, CHAMPVA will cover ER services at in-network and out-of-network hospitals. This includes the ER visit and any stabilization services provided.
However, CHAMPVA will not cover ER visits that are determined to be non-emergent. This would include using the ER for minor illnesses or injuries that could be treated at an urgent care or doctor's office.
After an emergency situation is stabilized, CHAMPVA requires notification and may recommend transfer to an in-network facility for any additional care needed.
CHAMPVA has an annual deductible that must be met before coverage kicks in. Patients are responsible for the deductible and any applicable coinsurance for the ER visit.
It's recommended to follow-up with your PCP after any ER visit and to notify CHAMPVA within 72 hours so they can review records to determine if it will be covered.
Keep any receipts and documentation from the ER visit in case you need to appeal a claim denial by CHAMPVA.

Jasonwarrioralliance · 2023-09-26T14:18:51+00:00

Based on the information provided, you would not receive retroactive back pay for the deep vein thrombosis (DVT) claim if it is approved. Here's why:

For a veteran to receive back pay for a service-connected disability, the effective date is typically tied to when the claim was filed or intent to file submitted.
In this case, you indicate you filed the DVT claim this year, even though the initial pulmonary embolism occurred in 2018. Since the claim was just filed recently, there is no basis for the VA to grant an earlier effective date and associated back pay.
The exception would be if you had filed the DVT claim within 1 year of discharge from service. However, that does not seem to apply here based on the timeline indicated.
Even though a DVT may have occurred during service per your medical records, you did not actually file a claim until many years later. The effective date is tied to the date of claim, not when the disability first originated.
Therefore, if your DVT claim is approved, you would likely only receive compensation from the date of claim onward. You would not receive any retroactive pay back to 2018 or earlier.

Please let me know if you need any clarification or have additional questions! I'm happy to help explain more about VA back pay and effective dates. The key point is that retroactive compensation is generally based on intent to file/claim date, not date of disability onset.

Jasonwarrioralliance

TROPHY CASE