16 replies to this topic

[carlie]

The Fully Developed Claims (FDC) Program :

http://benefits.va.g...ion/fastclaims/


What is a Disability Benefits Questionnaire or DBQ FAQ'S

http://benefits.va.gov/TRANSFORMATION/dbqs/Facts.asp

Disability Benefits Questionnaire :

http://benefits.va.g...exams/index.asp


Disability Benefits Questionnaire : List By Symptoms :

http://benefits.va.g...stBySymptom.asp


Disability Benefits Questionnaire : List By Condition :

http://benefits.va.g...ByCondition.asp

[meghp0405]

I have completed over 400 fully developed claims this past year. All have been adjuicated with 90 days. The only exception is those military members that are retiring that have been awarded 50% or greater. Their claims are taking approx. 30 days longer because, DFAS has to compute the pay.

[Veldrina]

Hey all, sorry for the long absence, been working 2.5 jobs.  

Anyway, we just had a team meeting & I heard something that is going to make life interesting re claims.   The VA judges have ruled that in addition to the change of all claims being put on the Form 526 EZ (whether it's FDC or not), that if a veteran does not SPELL OUT that claimed conditions are due to service, they can be denied.  In other words, say you claim a back condition.  Your service records indicate you had some treatment for you back, & you were in service about 10 yrs or more ago.  You put down "back problems" on the form, nothing else.  You do not submit medical evidence, or u might have some VA Med. Ctr treatment but neither the doc nor u ever said it was due to service.  If there is nowhere in those records or ON THE CLAIMS FORM that you have had back problems SINCE SERVICE, we do not order an exam for u & it can be denied. 

If you are filing a new claim, PLEASE write in there somewhere that your condition is since service...those 2 little magic words may mean the difference between getting service connected or not!

[Berta]

Veldrina- good to see you here again!

 

Your point is well taken!

 

I hope that doesn't happen often but it sure pays to tell the VA that the claim is for a disability that is due to one's service.

 

Particularly "back problems:' or  heart problems' , stomach problems, etc ....it is .not a good idea for using a  generic way of describing a diagnosed disability.

 

Good info . Technically if one does Not specifically claim something is due to their service, it makes sense to me that VA would not order a C & P exam at all.

 

And  I feel it sure doesn't hurt to state that the disability claimed is due to say ' my inservice jeep accident of (date) at  ----Air Base, or my inservice exposure to acoustical trauma, as a gunner,  or when describing the MOS that caused the disability ,it pays to spell out what the MOS entailed. Right away...why wait.

 

Then again, is there enough room on the Form 526 EZ to be specific and/or to refer the VA to additional Remarks?

 

Glad you are back briefly but we know how hard you work!!!!!

[Veldrina]

Good to "see" u too Berta!  :) 

 

While yes, it makes sense that they shouldn't order an exam if one doesn't say it's due to service, in the past it's been assumed.  Now you actually have to spell it out....I see a lot bad juju coming the VA's way for this just for 2 little words, so PLEASE everyone just write them in. 

There should be space right in the area where you list what you're claiming on the EZ form to just add it (i.e. "back condition SINCE SERVICE, residuals of sprained ankle IN SERVICE, hypertension due to high blood pressure readings FROM SERVICE, GERD - continuation of vomiting and abdominal pains FROM SERVICE, etc.)  

[Notorious Kelly]

Good point and glad to see ya, Veldrina.

 

Don't work yourself to death and enjoy one of them big turkey legs for me!

[meghp0405]

_Veldrina,

 

_{I took your advice and started placing those 2 words on the 21-526ez. The higher ups are saying that it doesn't need to be there. "They already know that" is what I have been told.}

_{So now, I explain to the veteran about this and leave it up to them if they want it in their claim or not. Each vet that I have filed a claim for since I was told not to do this, have expressed desire to place those two words. After all, it's the veteran's claim.}

_{Haven't received any flack since then.}

_{Thanks for your advice, anything that helps a veteran with a claim is always, most appreciated!}

[truck905]

Hey all, sorry for the long absence, been working 2.5 jobs.  

Anyway, we just had a team meeting & I heard something that is going to make life interesting re claims.   The VA judges have ruled that in addition to the change of all claims being put on the Form 526 EZ (whether it's FDC or not), that if a veteran does not SPELL OUT that claimed conditions are due to service, they can be denied.  In other words, say you claim a back condition.  Your service records indicate you had some treatment for you back, & you were in service about 10 yrs or more ago.  You put down "back problems" on the form, nothing else.  You do not submit medical evidence, or u might have some VA Med. Ctr treatment but neither the doc nor u ever said it was due to service.  If there is nowhere in those records or ON THE CLAIMS FORM that you have had back problems SINCE SERVICE, we do not order an exam for u & it can be denied. 

If you are filing a new claim, PLEASE write in there somewhere that your condition is since service...those 2 little magic words may mean the difference between getting service connected or not!

I'm new to the site and just read ur posting and you got me thinking. I just submitted to reopen a claim for Obstructive Sleep Apnea (secondary to hypertension 0%)Asthma(increase from 30%)Obstructive Sleep Apnea (secondary to headaches, chest pains, and depression) and a new claim for prostate cancer. I collected letters from 3 guys I was stationed with stating they heard me snoring,had to wake me and gaging very bad when I slept, I think the statements were pretty strong statements concerning symptoms of sleep apnea, a letter from my wife of 12 years and a old girlfriend while stationed in KY who I dated while in the military and after service.I Also had sleep study done last month that was rated severe (5 normal 30 severe) I was rated 79, stop breathing 114 times with the longest period of not breathing 47 seconds. One of the Recommendations was not to operate heavy or commercial equipment. I sent in regulations from Federal Motor Carrier Safety Administration (Dept of Trans) showing them because of the OSA and asthma I cant legally operate a semi truck, which I owned and operated as self employed under my own company. (Unemployable) I applied for OSA back in 02, 04 and again in 12. I failed to mention I'm also a (K) sexual dysfunction. I've been driving since 1995 and seems life is coming to a halt..... What's ur best guess?

[meghp0405]

truck905,

 

it is my opinion that you will need a strong nexus letter from a Doctor to validate your claim for OSA secondary to hypertension rated at 0%. Although you have been diagnosed with hypertension, a 0% is not severe enough for a diagnosis for OSA. This is my opinion, and my opinion only! I also, do not believe that the letters will suffice from those that were stationed with you. They indeed mentioned symptoms that you experienced, but I have seen too many sleep apnea claims denied because the supporting statements were from individuals that were not with a medical background so the VA disqualified the lay statements.

I'm not sure what your rating of 79 is? There is only one rating for OSA and the % for this is 50%. If you have OSA and you do not need a machine, the rating is 30% and is called hypersolomence. The flow of the oxygen for your machine can be set at different levels and that is set pertaining to the results of your testing.

 

I would obtain a pulmonary doctor or perhaps a neurologist and see what they have to say. If they agree with your claim, have them write an IMO for you. You are going to need someone with a professional background. 

 

I do hope the best for you, and please let us know upon your results!

[truck905]

truck905,

 

it is my opinion that you will need a strong nexus letter from a Doctor to validate your claim for OSA secondary to hypertension rated at 0%. Although you have been diagnosed with hypertension, a 0% is not severe enough for a diagnosis for OSA. This is my opinion, and my opinion only! I also, do not believe that the letters will suffice from those that were stationed with you. They indeed mentioned symptoms that you experienced, but I have seen too many sleep apnea claims denied because the supporting statements were from individuals that were not with a medical background so the VA disqualified the lay statements.

I'm not sure what your rating of 79 is? There is only one rating for OSA and the % for this is 50%. If you have OSA and you do not need a machine, the rating is 30% and is called hypersolomence. The flow of the oxygen for your machine can be set at different levels and that is set pertaining to the results of your testing.

 

I would obtain a pulmonary doctor or perhaps a neurologist and see what they have to say. If they agree with your claim, have them write an IMO for you. You are going to need someone with a professional background. 

 

I do hope the best for you, and please let us know upon your results!

Thanks for your reply! the 79 represents the scale base of my sleep apnea. The Dr. stated that it's based on a scale from 5 to 30 with 5 being normal and 30 severe, I was rated 79. I will keep you updated on all information received. Thank you again..

[carlie]

I'm new to the site and just read ur posting and you got me thinking. I just submitted to reopen a claim for Obstructive Sleep Apnea (secondary to hypertension 0%)Asthma(increase from 30%)Obstructive Sleep Apnea (secondary to headaches, chest pains, and depression) and a new claim for prostate cancer. I collected letters from 3 guys I was stationed with stating they heard me snoring,had to wake me and gaging very bad when I slept, I think the statements were pretty strong statements concerning symptoms of sleep apnea, a letter from my wife of 12 years and a old girlfriend while stationed in KY who I dated while in the military and after service.I Also had sleep study done last month that was rated severe (5 normal 30 severe) I was rated 79, stop breathing 114 times with the longest period of not breathing 47 seconds. One of the Recommendations was not to operate heavy or commercial equipment. I sent in regulations from Federal Motor Carrier Safety Administration (Dept of Trans) showing them because of the OSA and asthma I cant legally operate a semi truck, which I owned and operated as self employed under my own company. (Unemployable) I applied for OSA back in 02, 04 and again in 12. I failed to mention I'm also a (K) sexual dysfunction. I've been driving since 1995 and seems life is coming to a halt..... What's ur best guess?

 

truck,

Please start a new topic when you have a question and put it under the forum it would go with.

Thanks

[Veldrina]

megh did a good job answering truck...i cant add much without seeing the fact pattern, but we dont rate except in whole #s, & like megh said the 5% causing hypersomnolence & issues with work & requiring CPAP machine is the highest sleep apnea goes.  As long as sleep apnea shows it began in service (records should show complaints or treatment or at least symptoms) then u should be good.  I have never heard of apnea being secondary to headaches, chest pains, depression or hypertension, so if u claimed it like that it will most likely be denied as secondary to any of them.  

 

sorry if continuing here carlie, just hard for me to look all over the forums for stuff.  i shut up now! 

[bhoward422]

Hello Veldrina Please keep us inform your help and info is very,very helpful we need someone on the inside looking out for vets. I know I appreciate it very much, my question is do you work directly with the judges or a local VA.

[carlie]

Hello Veldrina Please keep us inform your help and info is very,very helpful we need someone on the inside looking out for vets. I know I appreciate it very much, my question is do you work directly with the judges or a local VA.

 

Veldrina just pops in once in a while right now.

For privacy /security /anonymity  reasons, she might not answer this question.

[bhoward422]

Hey all, sorry for the long absence, been working 2.5 jobs.  

Anyway, we just had a team meeting & I heard something that is going to make life interesting re claims.   The VA judges have ruled that in addition to the change of all claims being put on the Form 526 EZ (whether it's FDC or not), that if a veteran does not SPELL OUT that claimed conditions are due to service, they can be denied.  In other words, say you claim a back condition.  Your service records indicate you had some treatment for you back, & you were in service about 10 yrs or more ago.  You put down "back problems" on the form, nothing else.  You do not submit medical evidence, or u might have some VA Med. Ctr treatment but neither the doc nor u ever said it was due to service.  If there is nowhere in those records or ON THE CLAIMS FORM that you have had back problems SINCE SERVICE, we do not order an exam for u & it can be denied. 

If you are filing a new claim, PLEASE write in there somewhere that your condition is since service...those 2 little magic words may mean the difference between getting service connected or not!

You need to continue here on Hadit because you info is magical appreciate it very much keep up the good work.

[bhoward422]

Good to "see" u too Berta!  :) 

 

While yes, it makes sense that they shouldn't order an exam if one doesn't say it's due to service, in the past it's been assumed.  Now you actually have to spell it out....I see a lot bad juju coming the VA's way for this just for 2 little words, so PLEASE everyone just write them in. 

There should be space right in the area where you list what you're claiming on the EZ form to just add it (i.e. "back condition SINCE SERVICE, residuals of sprained ankle IN SERVICE, hypertension due to high blood pressure readings FROM SERVICE, GERD - continuation of vomiting and abdominal pains FROM SERVICE, etc.)  

are you taking request in the future, filling out this form.

[bhoward422]

 

Veldrina just pops in once in a while right now.

For privacy /security /anonymity  reasons, she might not answer this question.

Understood