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Secondary And Claims Questions


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9 replies to this topic

#1 roses15534

 
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Posted 22 September 2012 - 05:35 AM

Questions
I am 80% service connected and a Gulf War Veteran
I am service connected for fibromyalgia 40%
I am service connected for post cholecystectomy with scars 10%
My questions are on the above 2 and another one that I am trying to get service connected for.
First I was diagnosed with keratoconus in service and was denied service connection in 2001 upon retirement I now have precedent opinions I will submit for a CUE now here are some of my questions about that. Do I just ask for the service connection? I have had both corneas’ transplanted do I let them know that upfront or let them find that out? I was 20/200 in service and required to wear contact lens then before my transplants I was 20/400 those would have warranted a % rating, but now that I had the transplants I can see again and can wear glasses or contacts but I do have sensitivity to light and glare. So what do I ask for exactly? Do I ask for diagnostic code 6035 or 6036 or both? The VA does pay for by way of fee basis for me to have checkups every six months to check my graphs.
I was serviced connected for gastritis 7307 known as heartburn as diagnosed on 04/24/2001. I was service connected. In my medical record I was diagnosed with GERD Nov 1999 but was service connected for gastritis. I want to ask for increase and was wondering about asking secondary conditions how does that work? Like I have barretts esophagus and hiatal hernia found on a scope done by VA, would that be secondary to this? If so are they rated on their own? Or do they pyramid those ratings? How to I ask for that or word it? Also I have taken and still take and have for years NSAIDS medication this could also be part of the problem as well what do I do with that? I take meds from VA for this.
I was service connected for fibromyalgia and recently awarded 40% up from 10% with a note that in the near future they would examine me again to evaluate the severity of this condition. I was wondering about secondary’s to this like I have fatigue, sleep disturbances I take sleeping pills prescribed by VA and stiffness, headaches I have meds from VA for this and IBS I have meds from VA for this and anxiety I have meds from my private doctor for this. What and how do I ask for these and word it?
How does the pyramiding work as well? I have 100 or 110% total and 80% combined how many % do you need in the pyramiding to actually get another 10% combined?

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#2 Berta

 
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Posted 22 September 2012 - 06:59 AM

Lots of questions here......I focused on 2 of the issues.

“I was diagnosed with keratoconus in service and was denied service connection in 2001 upon retirement “

“I will submit for a CUE now here are some of my questions about that.”

Can you scan and attach (cover personal identifying stuff) the Reason and Bases part of that decision?

We have a wealth of CUE info in the CUE forum as well as the CUE criteria.

Not enough info here to know if you should file a CUE.


“I have had both corneas’ transplanted do I let them know that upfront or let them find that out?”

I think you need to re-open the keratoconus claim with this , as New and Material evidence.

We cannot assume VA will 'find out' anything. They need documented evidence.





“I now have precedent opinions “
Can you explain what you mean by that?

If you mean Office of General Counsel -VA Precedent Opinions, can you give us the numeric on them so we can access them at OGC site to determine the relevance here?






“still take and have for years NSAIDS medication this could also be part of the problem as well what do I do with that? “

The VA has SCed GERD in many vets who were prescribed NSAIDs by the VA.

There is info and discussion on that association at hadit under our search feature.

Can you give us the breakdown of the 80% disabilities?

#3 roses15534

 
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Posted 22 September 2012 - 10:32 AM

VA Precedent Opinions VAOPGCPREC 82-90, VAOPGCPREC 1-90, and VAOPGCPREC 67-90 pay special attention to VAOPGCPREC 82-90.

So do I tell them I had corneal transplants and where to get the documentation?


I was service connected for gastritis not gerd but diagnosed with gerd before gastritis

my % is as follows
10% residuals post operative right shoulder
10% tinnitus
40% fibromyalgia
20% lumbar spondylosis and degenerative disk disease
10% left knee patellofemoral syndrome
10% right knee patellofemoral syndrome
10% post cholecystectomy with scars
10% lipomas abdomen and stomach

can you help me with the filing of secondary i never did that before and don't know how or what to do?

Do I go for gerd also since I already have gastritis?

Attached Files

  • Attached File  Ker1.jpg   75.21KB   10 downloads
  • Attached File  ker2.jpg   108.54KB   10 downloads


#4 USNDW

 
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Posted 22 September 2012 - 11:06 AM

6035 Keratoconus: Evaluate based on impairment of visual acuity. 6036 Status post corneal transplant: Evaluate based on visual impairment. Minimum, if there is pain, photophobia, and glare sensitivity 10 6037 Pinguecula: Evaluate based on disfigurement (diagnostic code 7800).


If you have sensitivity comparable with the rating codes above, then yes, you should file for a New & Material evidence and ask for a 10% rating for status post corneal transplant. If that was necessary because of your loss of vision, then they should entertain it.

If a Veteran has service connected orthopedic conditions, and the treatment has been NSIADS for a long period of time, and the use of NSAIDS has caused GERD. The Veteran can file for GERD as a claim-Secondary to the orthopedic conditions that required the use of NSAIDS.

Another way of looking at it is if a Veteran has a service connected right knee condition, and that causes the Veteran to limp putting more weight and stress on the left knee. If the left knee develops a disability like Meniscus tear, arthritis, or any other condition that can be rated by the VA, the Veteran can file for the left kne condition secondary to the right knee condition.

Secondary simply means that a new condition was caused by a service connected condition.

If you can get to a doctor and they agree that the GERD is most likely caused by the NSAID use, then ask them for a letter, that would be your Nexus letter. If you don't, then you can still file and the VA will send you to a C&P exam.

I would recommend you file as quickly as possible for both, the claim time length now is so long, sometimes over 18-24 months. File now and work on the evidence and the specifics as you go.

#5 broncovet

 
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Posted 22 September 2012 - 05:19 PM

You asked "Do I ask for Service connection?"

Yes. You ask for sc for secondary conditions the same as before, except you should so state:

"I am applying for ............secondary to ......................

You need to "specify the benefit sought". And yes, I would most certainly inform them of any evidence you have supporting your claim, such as a cornea transplant. That would certainly seem relevant. The VA would find out anyway, because they will ask for and get a copy of all your records, anyway. The VA knows more about us than our own mother.

Condition "B" is secondary to condition "A" by medical evidence. This means your doc needs to opine that it is at least as likely as not that your condition B was caused by service connected condion A. Sometimes medications can cause problems, for example. Almost certainly you will need a docs opinion to get secondary service connection just like you needed it to get sc in the first place.

As far as pyramiding, no, the VA does not allow any condition to be counted twice. They are anal about that.

#6 jvretiredvet

 
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Posted 22 September 2012 - 05:51 PM

VA Precedent Opinions VAOPGCPREC 82-90, VAOPGCPREC 1-90, and VAOPGCPREC 67-90 pay special attention to VAOPGCPREC 82-90. You have learned well, grasshopper.

38 CFR 4.9 is/was used inappropriately to deny service connection http://www.benefits..../PART4/S4_3.DOC . Very little overrides 38 CFR 3.303(a) .

Addendum dated 9/24/2012: Three of the aforementioned VAO General Counsel Precedent Opinions are attached. FWIW, I've seen these posted by another user in times gone by.

VA Precedent Opinions VAOPGCPREC 82-90, VAOPGCPREC 1-90, and VAOPGCPREC 67-90 pay special attention to VAOPGCPREC 82-90.

So do I tell them I had corneal transplants and where to get the documentation?


I was service connected for gastritis not gerd but diagnosed with gerd before gastritis

my % is as follows
10% residuals post operative right shoulder
10% tinnitus
40% fibromyalgia
20% lumbar spondylosis and degenerative disk disease
10% left knee patellofemoral syndrome
10% right knee patellofemoral syndrome
10% post cholecystectomy with scars
10% lipomas abdomen and stomach

can you help me with the filing of secondary i never did that before and don't know how or what to do?

Do I go for gerd also since I already have gastritis?

Attached Files


Edited by jvretiredvet, 23 September 2012 - 02:43 PM.


#7 broncovet

 
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Posted 22 September 2012 - 08:13 PM

The question of whether a condition is congenitial or acquired in service would normally be answered by a doc, probably at a c and p exam.

Laypersons, including judges and rating specialists can not substitue their own opinion for those of a qualifed medical professional on matters of a medical nature.

#8 jvretiredvet

 
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Posted 24 September 2012 - 12:00 PM

There's can be world of difference, sometimes subtle, between hereditary/familial/genetic versus developmental.

What was written generally can be true, however I can envision some circumstances where a non-physician opinion on a developmental issue would not be inappropriate.

The question of whether a condition is congenitial or acquired in service would normally be answered by a doc, probably at a c and p exam.

Laypersons, including judges and rating specialists can not substitue their own opinion for those of a qualifed medical professional on matters of a medical nature.



#9 jvretiredvet

 
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Posted 11 October 2012 - 12:22 PM

I finally got around to reading my gmail and found your message from September 22. I really prefer answering these questions publicly, unless the subject matter is extremely sensitive or extremely detailed As it appears that your PM is neither and there is no indication that your PM to me has been answered publicly, here goes ...

You wrote: so do I file for a cue or file to reopen due to new and material evidence for my karetaconus?

CUE.

Questions
I am 80% service connected and a Gulf War Veteran
I am service connected for fibromyalgia 40%
I am service connected for post cholecystectomy with scars 10%
My questions are on the above 2 and another one that I am trying to get service connected for.
First I was diagnosed with keratoconus in service and was denied service connection in 2001 upon retirement I now have precedent opinions I will submit for a CUE now here are some of my questions about that. Do I just ask for the service connection? I have had both corneas’ transplanted do I let them know that upfront or let them find that out? I was 20/200 in service and required to wear contact lens then before my transplants I was 20/400 those would have warranted a % rating, but now that I had the transplants I can see again and can wear glasses or contacts but I do have sensitivity to light and glare. So what do I ask for exactly? Do I ask for diagnostic code 6035 or 6036 or both? The VA does pay for by way of fee basis for me to have checkups every six months to check my graphs.
I was serviced connected for gastritis 7307 known as heartburn as diagnosed on 04/24/2001. I was service connected. In my medical record I was diagnosed with GERD Nov 1999 but was service connected for gastritis. I want to ask for increase and was wondering about asking secondary conditions how does that work? Like I have barretts esophagus and hiatal hernia found on a scope done by VA, would that be secondary to this? If so are they rated on their own? Or do they pyramid those ratings? How to I ask for that or word it? Also I have taken and still take and have for years NSAIDS medication this could also be part of the problem as well what do I do with that? I take meds from VA for this.
I was service connected for fibromyalgia and recently awarded 40% up from 10% with a note that in the near future they would examine me again to evaluate the severity of this condition. I was wondering about secondary’s to this like I have fatigue, sleep disturbances I take sleeping pills prescribed by VA and stiffness, headaches I have meds from VA for this and IBS I have meds from VA for this and anxiety I have meds from my private doctor for this. What and how do I ask for these and word it?
How does the pyramiding work as well? I have 100 or 110% total and 80% combined how many % do you need in the pyramiding to actually get another 10% combined?



#10 john999

 
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Posted 11 October 2012 - 02:26 PM

When you file for a secondary condition you really need medical evidence that spells out how, why, when your primary condition led to the secondary condition. With DMII, for instance, if you have heart problems or PN or any other secondary DMII condition you need a doctor to say that you heart or PN is a direct result of your DMII. My PCP at the VA did this for me for my PN and artery disease. If you could get a non-VA doctor to do the same thing that would work but you want to use a format the VA accepts.




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