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Fully Developed Claims & Disability Benefits Questionnaire Info


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#1 carlie

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Posted 15 February 2012 - 03:57 PM

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

#2 meghp0405

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Posted 19 December 2012 - 04:25 PM

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.

#3 Veldrina

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Posted 18 April 2013 - 12:56 PM

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!



#4 Berta

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Posted 18 April 2013 - 01:38 PM

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!!!!!



#5 Veldrina

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Posted 22 April 2013 - 08:19 AM

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.)  



#6 Notorious Kelly

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Posted 23 April 2013 - 06:29 AM

Good point and glad to see ya, Veldrina.

 

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



#7 meghp0405

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Posted 25 April 2013 - 12:10 PM

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!



#8 truck905

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Posted 01 May 2013 - 09:42 AM

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?



#9 meghp0405

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Posted 01 May 2013 - 10:38 PM

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!



#10 truck905

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Posted 03 May 2013 - 03:10 PM

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..



#11 carlie

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Posted 05 May 2013 - 11:44 AM

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



#12 Veldrina

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Posted 15 May 2013 - 07:56 PM

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! 



#13 bhoward422

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Posted 26 May 2013 - 08:46 PM

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.



#14 carlie

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Posted 26 May 2013 - 09:44 PM

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.



#15 bhoward422

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Posted 11 June 2013 - 09:03 PM

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.



#16 bhoward422

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Posted 11 June 2013 - 09:34 PM

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.



#17 bhoward422

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Posted 11 June 2013 - 09:47 PM

 

Veldrina just pops in once in a while right now.

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

Understood



#18 Veldrina

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Posted 21 June 2013 - 08:13 PM

hey guys!   BTW if u ever need me immediately for something, Carlie knows how to get in touch with me.  Re judges, no.  I work in NY for the benefits office (not hospital) as a rater (u know, the guys who look at eerything when it's fully developed, go over medical stuff & determine what's service connected & what isn't & give u an evaluation).  ;)  I am in no means an expert on anything, & HadIt itself actually has a lot more info about the job than i do, so definitely use the resources on here, it's more or less the same charts, scales, etc we use...sometimes better!



#19 Motherof3

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Posted 21 June 2013 - 08:54 PM

Why doesn't the C&P Examiner, Individual making Rating Recommendation have the ability to "Flag" a claims file when their recommendation is for 100% and/or IU? This would be another way to move claims along and prevent/help backlog. Current claims are slowly moving into backlog status (I.e. 180 days). Depending on whose claim date you go by.

#20 Veldrina

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Posted 24 June 2013 - 06:42 PM

The C&P Examiner is not allowed to say something is service-connected, as that's a legal call, just as we the raters are not allowed to make medical judgments as that's the doctor';s call.  (i.e., even though i know there is no way in hell that your plantar warts are secondary to your service connected migraines, if you claim that I have to put in an exam for the warts becuz I can't make a medical determination, no matter how obvious...same thing with the docs).  



#21 Motherof3

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Posted 25 June 2013 - 08:17 PM

Thanks for your response. Funny example. Thanks for all you do and taking the time to assist us in this forum.

#22 Veldrina

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Posted 26 June 2013 - 07:08 AM

thank YOU and everyone else here for their service!



#23 bluevet

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Posted 09 July 2013 - 12:14 AM

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!

This is the most ridiculous thing that I've heard so far and if it is true, someone should go to jail! You can not disregard a veterans claim because they do nott put the words service connected on their condition. The entire application is for "Service Connected Disabilities", anyone attempting to deny that all conditions listed are intended to be claimed as service connected is acting in bad faith and should at the very ;east be fired and publicly shamed!!



#24 Veldrina

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Posted 22 July 2013 - 02:16 PM

i agree....the "jeenuses" in congress keep coming up with more fun things like this....PLS VOTE THEM ALL OUT!!!!  The biggest threat to your VA benefits is not the VA, it's the idiots in Congress that keep changing the rules on us!



#25 john999

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Posted 22 July 2013 - 08:14 PM

I think I did a FDC here recently. I asked for an increase for DMII. I meet requirements for 20% because VA started me on oral medications. I got paperwork from Jax. Fl instead of St. Pete.  It was a page telling me what I needed and another page asking about evidence. All my evidence is at the VA. It is no big deal since no extra money but I want an increase.



#26 Veldrina

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Posted 26 July 2013 - 08:38 PM

for an increase in DMII you either need other complications caused by DMII or regulation of activities...and for regulation of activities, it needs to be a doctor restricting strenuous activity.



#27 saints13

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Posted 16 January 2014 - 09:20 PM

 since service...those 2 little magic words. Does this include when your requesting an upgrade or a secondary condition? In my case I have 40% bilateral Chronic, Recurrent bilateral patellar laxity, subluxation, lateral instability, severe re-occurring patella dislocations. But now my lower back has been killing me due to abnormal gait. (Physical Therapist said this maybe the cause.) Everyone has been telling me to also put in for PTSD but I'm afraid to talk about my past and seem like an idiot. Also have Left hand medial nerve from when my knee gave out and shot a 3 inch nail into my hand with a nail gun by accident. Even the ER has never seen such a thing. VA told me to ask for my hand to be secondary to my fall.



#28 BIGGIEWAGZ

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Posted 18 January 2014 - 05:31 PM

Hello all,

 

I am having a hard time finding out what is going on with my Unemployability claim. I filed it back in June of 2013, and at that time I was told 90 days Needless to say it has been longer than 90 days. I wrote my local congressman and the put it under congressional review for financial hardship seriously I am close to getting utilities shut off every month. I am also trying to move back to Chicago where I have a support structure in place for me and my kids have their natural support structure. (yes there is a whole sob story but I won't go into it) long story short I thought I had submitted a FDC but I found out it wasn't. It seems that the VA is ignoring the Congressman and I need to know what I can do to expidite this claim. Any advice and help will be greatly appreciated. Thank you all in advance.



#29 Veldrina

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Posted 28 January 2014 - 04:38 PM

Biggie, I am PMing u.






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