Category Archives: Submitting Claims

Seeking Help & Compensation for PTSD


ptsd3Thousands of Veterans are struggling with the problems associated with post-traumatic stress disorder, or PTSD. Many of these men and women are reluctant to get help for this problem. Let’s face it, it can be very hard to tell a complete stranger deep secrets. Sometimes there feelings are very violent and therefore they may fear reprisal by authorities. Or there are those who just don’t recognize the signs of PTSD and keep themselves isolated so it is hard for others to detect. This is often associated with not just PTSD, but depression and possibly other mental disorders. The VA Mental Health departments at any VA medical facility are no strangers to PTSD. Their doctors and therapists are used to dealing with Veterans with combat-related problems and they have some wonderful methods of dealing with them and some great programs as well. The first step is to ask for help. If you are really bad you may want to suggest that they keep you there for a while in a hospital setting and voluntarily, unless of course you are suicidal, in which case you should seek help immediately by calling the VA Suicide Hotline at: 1-800-273-8255. I have a friend who called and he is so much better today. He can’t talk about it, but let’s just say that he is looking to the future and on the right path.
ptsd1PTSD is also a service-connected disability. I have taken the test and I’m not sure if it is the same everywhere, but when I took it their where several questionnaires and scan-tron type tests. They ask a series of questions such as do you hear voices, do you like being in crowds etc.. and then you have a confidential meeting with a psychiatrist who is there to determine if you qualify for service-connected PTSD. He will most likely ask you about combat related incidents that disturb you to this day, how often you have nightmares and do you feel like hurting yourself or others. If you have claimed other mental disorders as service-connected he will ask you about these as well. Do not be offended by his demeanor as his job is to prove you are not service connected. You will most likely be turned down on the first try for this and have to repeat this exam which is called a compensation and pension exam. Remember not to take anything personally, but make sure to prove your case and do not hold back. If you are suffering let them know and don’t be afraid to answer their questions truthfully. If you don’t know the answer tell them that. It’s a pain, but it’s a necessary process, because unfortunately there are those who are looking to claim things that are untrue. It is a blow to those of us who suffer from these problems. ptsd2The main thing is just be yourself and it should go fine. If you do not get approved you can appeal.
Often times it is suggested that you also try and get a diagnosis from a regular physician outside the VA. This will not hurt your case at all and is worth the expense if you can afford it. See if you can get a list of physicians in your area from your VSO or your representative of physicians who see veterans and are familiar with PTSD and similar mental disorders. If you can’t get a list, try and call around and ask the person who answers the phone if their doctor would perform an evaluation for PTSD. Veteran’s organizations may know of Veteran doctors as well or you can ask your family doctor for a referral to a psychologist.
Vets with PTSDAs we are talking about PTSD anyway, I’d like to take a moment to address a myth. A lot of Veterans I speak to think that you have to be in combat to receive disability compensation for PTSD. That is simply not true. While I will admit that a combat Veteran is more likely to get this benefit, we have seen a lot of cases in which Veterans who served in peacetime, or never left the United States, were granted service connection for PTSD. Remember, Service Connection refers to disability that occurred while in service, as a result of your time in service, or made worse from your time in service. Many traumatic events from a Veteran’s time in service may cause PTSD. So, if you are a non-combat Veteran and experienced a traumatic event in service, you can still be granted service connection if you have a diagnosis from a mental health professional. Why are we making such a big deal about getting diagnosed? To put it simply, the lack of a diagnosis will automatically result in a denial for a PTSD claim.
I am writing this in honor of all those Veterans who did not get help and are not with us anymore. This is a very serious problem in the United States and with our allies as well. If you know a Veteran who is suffering from PTSD, please urge them to get help today. Time is very important and even though some people may seem okay does not mean anything, some people hide their emotions to avoid treatment. God bless.

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The Code of Federal Regulations (C.F.R.) and Why it’s Important to Your Claim


howdoIappeal

cfr1The Code of Federal Regulations or C.F.R. is important to veterans filing claims for the first time or in appeal because there are laws protecting us from the mistakes that can be made by the V.A. in the process of reviewing your information. Be sure to check the links section of the site to find out more about the C.F.R. You should look only for title 38 Pensions, Bonuses and Veteran’s Relief. Below are some examples of some of the codes that may apply to your case. I also recommend looking up some of the previous cases online from veterans who challenged these codes. You may be surprised what you can find in research. I will post anything I find as I am just starting this process myself. Feel free to share with me any links you have that I don’t.

38 CFR 3.103
Procedural due process and appellate rights

Every claimant has the right to written notice of the decision made on his or her claim, the right to a hearing, and the right to representation….Claimants and their representatives are entitled to notice of any decision made by the VA that affects payment of benefits. The notice must state the decision made, effective dates, the reasons for the decision, the right of the veteran to a hearing on any issue involved in the claim, the right of representation, and the right to appeal.

38 CFR 3.159
Department of Veterans Affairs assistance in developing claims

cfr2The VA is obligated to complete applications. This substantial completion includes the claimant’s name, his or her relationship to the veteran if applicable, sufficient service information for the VA to verify the claimed service, the benefit claimed and any medical conditions on which it is based, the claimant’s signature, and (for claims of nonservice-connected disability or death pension and parents’ dependency and indemnity compensation) a statement of income.
The VA is also obligated to accept “Competent medical evidence” provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements or opinions. “Competent medical evidence” may also mean statements showing sound medical principles found in medical treatises. It would also include statements contained in well-respected in medical and scientific articles and research reports or analyses.
The VA also accepts “competent lay evidence” which is defined as evidence not requiring specialized education, training, or experience from the person offering the evidence.

cfr5These are just a few examples from the C.F.R., Title 38. You can look up more via the links page. As you can see these codes are very important to your case. Remember, when you enter the appeal process if you are trying to prove service-connection the burden of proof is on you. You must use all the tools available to you to prove your case. Do not rely on your veteran representative to do this for you. There are some great reps out there who sometimes are willing to go above and beyond and have vast knowledge of this process and may know these things and guide you correctly to getting your case approved, but unfortunately a lot of these guys are very over-worked and underpaid and although they do their level best to help veterans they sometimes do not have the knowledge or time to go that far for you and so it is up to you to try to prove all you can by yourself. I had to find this out the hard way and now I am about to have my second compensation and pension exam for my appeal for service-connection for gulf war illness related medical conditions.
If anyone would like to contribute anything they know about this article please contact me. I am learning as I go and sharing it with my readers, but I am far from an expert and don’t think I would ever make that claim. If I ever get my case approved I hope to never look at any codes or regulations again! I would be happy to share what I know or my opinions here as usual and help other vets, but I will be happy to not fall asleep with books on how to appeal VA claims on my lap again!
Good luck to you all on your claims and I hope that somehow you are able to muddle through this fight. The important thing is to never give up! The VA will send you confusing letters, try to intimidate you by saying that “it’s all in your head” or you are trying to “prove a conspiracy theory” and silly things like this. Don’t be intimidated and don’t get angry. Just get your case approved and get the benefits that you fought for! God bless.

Veterans are Worst Enemy When Dealing with VA Disability Claims


dis1A veteran can be his or her own worst enemy when it comes to dealing with their VA disability claim. Common examples include repeatedly sending in the same evidentiary documents, and not taking the time to thoroughly read through the Statement of Case (SOC) that the VA sends to the veteran after you give your request for disability benefits.

Once you send any medical documents or other evidentiary evidence to the VA, all that needs to be done then when you communicate with the VA is to remind them that you had before submitted those documents. Even better, if you can remind them of the date that you originally sent them the documents, this helps keep things organized and will most likely result in the case manager being able to find the information quicker. That is why it is imperative that veterans dealing with the VA keep copies of everything on their case in a well-organized home filing system. This applies even if you are being assisted by a Veterans Service Officer or V.S.O. or a representative from one of the approved veteran’s organizations. (refer to my links section of the site for a complete list).

dis2Personally, I prefer the Disabled American Veterans (D.A.V.) because they have a higher clearance rate than any other group. They are especially effective in service-connected claims. However you are free to choose who represents you and remember that you are not required to be a member of the organization. You are also now allowed to hire an attorney to represent you in your case appeal. Make sure that you and your representative work well together on your case and that you are happy with what you hear. If you suspect you are receiving bad information or that you are being lied to then I would switch. I have had this happen to me so be careful of certain representatives, especially the Veteran’s Service Officers. Keep in mind that the VA does not want you to get your benefits approved. They will do every thing in their power to confuse you, discourage you and flood you with disinformation. Don’t ever give up!

dis3Repeatedly sending the VA copies of documents that you’ve already submitted is time wasted and can lead to confusion on the part of the VA claims administrator and can cause further delays in the completion of your case.

Also, failure to thoroughly read and scrutinize the SOC that the VA sends you is risky as well. For example, the first few pages of the SOC will usually include a paragraph informing the veteran how long he or she has to give a Notice of Disagreement (NOD). A NOD letter is a simple letter for you to write back to the VA essentially telling them that you disagree with their decision, and why you disagree. If you do not know consider what it is you are claiming and reconsider. If you are worried about what you say then run it by your representative or someone else you trust such as a good friend, family member or spouse. It does not have to be perfect, just on time.

dis4With new claims the VA allows one year from the date of the SOC for you to give a NOD letter. This is not the case with existing claims wherein you are requesting an increase for an existing disability. In those cases you will usually be given only 60 days to give a NOD letter.

It is vital that the veteran read the SOC from start to finish, and pay particular attention to the deadline that the VA has established for your response. When that deadline passes and you have not submitted a NOD postmarked no later than midnight of the last deadline date, the VA’s decision becomes final. So it is imperative that you are timely in this matter.

dis5Also advisable is to use the Post Office’s green “Certified Mail” tag when sending documents or correspondence to the VA. This will need the VA to sign a receipt when your letter is delivered to them, which the Post Office then mails back to you for your records. This receipt is legal proof that you submitted your response before the deadline. File it in your home records system.

Why are these things so important? Because you can lose out on substantial sums of back pay in cases where the VA has approved your claim, but not at the percentage that you feel is commensurate with the effects that your disabilities have on your lifestyle or earning capacity that you have lost as a result of your disabilities.

When a claim becomes final, you will have only two ways to reopen it. The first is by submitting “new and material evidence” that clearly bolsters your case, and the other is when you or your VSO or representative find what you believe to be “clear and unmistakable error” (CUE) in the VA’s decision-making process. If you would like more information on the legalities of this you can e-mail me at rockstarinart@gmail.com. I have a book that lists examples of errors and references to earlier cases where examples of errors were pointed out and the veteran’s appeal was ruled in their favor. I will try to put up a link to this information as well as soon as I have it available.

dis6New evidence is just that. It has to be new to your case. Submitting a doctor’s note that repeats what has already been said before by that doctor or another is not new and material evidence.

So just what is “new and material evidence”? Let’s say you were denied for fibromyalgia and you allow your claim to become final on this issue by failing to submit a NOD. Then, two years later the doctor starts to give you medication for fibromyalgia. Since you were not taking this medication previously, this becomes new and material evidence.

As a Persian Gulf War Veteran, fibromyalgia is a “presumptive” condition that is listed under Section 3.317 of the Code of Federal Regulation (CFR); “Compensation for certain disabilities due to undiagnosed illnesses”. But the fibromyalgia must be serious enough to call for at least a 10% rating. For a veteran to get to the 10% level for fibromyalgia he or she will need to be receiving medications specifically meant to treat fibromyalgia. So if you are prescribed new medications for this or other conditions, it’s important that you recommend the VA so that this can be considered in reevaluating your case. This is how “new and material evidence” comes in to play.

On the other hand, a claim wherein you have discovered what you believe to be “CUE” is a little harder. In these cases it is advisable for the veteran to seek out a good VSO or someone who understands the laws of veteran’s disability claims. A good VSO will be aware of the relevant court cases that have been decided in favor of veterans with issues like yours.

donttreadonmeflagBottom line, be ever mindful of response deadlines that are included in the Statement of Case (SOC), and consult with the experts if you believe that the VA has made an error or errors in deciding your case.

Finally, always remember that YOU are your strongest advocate. Be always on the alert, read everything that the VA sends you, and then act accordingly. The old adage applies; “if you snooze, you lose