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Your Questions and Answers
I started answering questions about VA benefits in 2006. That turned into a regular feature that we called Jim's Mailbag.
Jim's Mailbag is hosted at the Stateside Legal site today. The mission of the Stateside Legal web site is one I believe in and when I was invited to join the advisory board there, it seemed that one thing I could do to help was to contribute some of my work.
I still answer a lot of email questions. Only the most interesting are published. I encourage veterans to seek the answers on their own by searching through my already published work. Many problems at VA come up again and again so I've probably written about it somewhere along the line.
This page will introduce you to a new sort of Q & A that I've been refining for months. I get to see the search queries that you use when you search for a term and then you're directed to one of my sites. For example, if you search the Google search engine and type in <information about veterans tdiu and 4140> and you land on my site, I see that and I can copy and paste it here to reply to it.
Reviewing search queries tells me what the most frequent searches are and the sort of intel you need. It also makes for some interesting reading. I won't make any corrections to spelling or grammar as I post these for you here.
The newest posts will be those you see first as you scroll down. Questions are in parentheses.
"individual unemployability with no further examinations scheduled"
When you receive your award letter you must look for a phrase similar to "no future exams scheduled" or "future exams are scheduled" or "basic eligibility to Chapter 35 DEA is established". These phrases will give you a hint as to whether or not you've received a permanent or a temporary rating. The "no future exams" wording indicates that your rating is seen as unlikely to improve and that it will be permanent. This means that you and your dependents will be eligible to apply for many other benefits such as DEA and CHAMPVA.
"does 100% permanent and total va disability help with ssdi"
Yes, maybe. The standards for SSDI disability and VA disability are markedly different. For example, many veterans who are rated as 100% schedular are continuing to work at gainful employment. They would not be eligible for SSDI because they are employable.
"va presumptive benefit wait time after filing"
The wait time to process a benefit varies from one claim to the next. There is no preference given to a presumptive claim. VAWatchdog estimates that a claim filed in the 2010 through present time will take from 12 to 24 months. This will bring the veteran the first award/denial letter. VAWatchdog estimates that 70% of these first-round letters will have significant errors and the decision will warrant an appeal. The first step appeal should normally be at the DRO Process level and will add another 12 to 24 months to the process. If that appeal is not successful (most are) then the next appeal is to the BVA via a Form 9. The BVA appeals process may add another 2 years or more. After the BVA appeal is the CAVC and an appeal there can add many years to the wait time. There is no expedited process.
When you receive your award letter you must look for a phrase similar to "no future exams scheduled" or "future exams are scheduled" or "basic eligibility to Chapter 35 DEA is established". These phrases will give you a hint as to whether or not you've received a permanent or a temporary rating. The "no future exams" wording indicates that your rating is seen as unlikely to improve and that it will be permanent. This means that you and your dependents will be eligible to apply for many other benefits such as DEA and CHAMPVA.
"does 100% permanent and total va disability help with ssdi"
Yes, maybe. The standards for SSDI disability and VA disability are markedly different. For example, many veterans who are rated as 100% schedular are continuing to work at gainful employment. They would not be eligible for SSDI because they are employable.
"va presumptive benefit wait time after filing"
The wait time to process a benefit varies from one claim to the next. There is no preference given to a presumptive claim. VAWatchdog estimates that a claim filed in the 2010 through present time will take from 12 to 24 months. This will bring the veteran the first award/denial letter. VAWatchdog estimates that 70% of these first-round letters will have significant errors and the decision will warrant an appeal. The first step appeal should normally be at the DRO Process level and will add another 12 to 24 months to the process. If that appeal is not successful (most are) then the next appeal is to the BVA via a Form 9. The BVA appeals process may add another 2 years or more. After the BVA appeal is the CAVC and an appeal there can add many years to the wait time. There is no expedited process.
"can I use my va or medicare benefits at the hosp"
Yes, but how you choose to use either benefit is important. VA is not a supplementary payer to Medicare and Medicare won't cover any VA expenses. If you choose to enter a civilian hospital in an emergency and quickly transfer to a VA facility, only show them your VA VIC identification. If you give them both the VIC and your Medicare card, the hospital will default to billing Medicare and you'll be responsible for copays. If you would rather use a civilian hospital for elective (non-life threatening or non-emergency) treatment you must use your Medicare benefit. You'll be responsible for the portion of the bill that Medicare doesn't pay...it's your out of pocket expense.
Most veterans who are addressing service connected hospitalizations may want to choose to use their VA care facility at all times. The care may be better even if not as convenient and there won't be a copay.
"do i need a exam from the va for i if im disabled from social security"
Yes. VA will require a VA sanctioned C & P exam to ensure your eligibility for VA benefits. This is because the rules of VA are much different than the rules for Social Security SSDI. VA requires that your disabling condition be service connected and VA may rate you a a percentage of disabled while SSDI requires that you're totally disabled (and totally unable to work) regardless of the cause.
"physician-caused ptsd"
I hear from veterans often who want to sue the VA or a particular VA employee because they have caused the vet to have PTSD. This is usually a request that leads nowhere. PTSD is usually considered to be a result of an event or situation where a person believes that their life was threatened or in immediate danger. Combat with an enemy, rape, severe accidents and similar things may be at the root of most PTSD. Disagreeing with an authority figure may be stressful but isn't usually going to be viewed as a basis for a PTSD claim.
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"will i get the same medication from the va"
Veterans often seem obsessed with getting brand name medications rather than generics when they go for health care at their VHA facility. It strikes me as odd because most civilian insurances these days don't pay for most brand name prescriptions and they insist on a generic. The really odd part is that generic drugs are tested and checked to be sure they have exactly the same effect as the brand name. If you insist on the really good stuff, prepare to pay for it out of pocket. You can read a lot more about your VA pharmacy benefit if you'll click here.
"va watchful waiting"
This is a very good question. "Watchful waiting" is the non-treatment of prostate cancer rather than going all out with surgery and radiation. It just so happens that the outcomes of doing nothing (watchful waiting) are about the same as when the veteran opts for all the treatment he can get. In the VA system, a veteran with a service connected prostate cancer is rated at 100%. That's a temporary rating. Once the treatment is finished, the vet is then rated on the problems left by the treatment...the "residuals". Residuals might be leakage of urine, ED and so on. The veteran who chooses watchful waiting keeps the cancer...and the 100% rating indefinitely. Read more about prostate cancer here.
"va appeal cases for obstructive sleep apnea"
Obstructive Sleep Apnea (OSA) is a hot-button claims issue lately. The rating for OSA (if you use a CPAP) is 50%. That's very high and has gotten the attention of many veterans. You can search the Board of Veterans Appeals decisions to learn more of how others have prevailed in their claims for OSA.
"inadequate compensation and pension examination"
The C & P exam is often brisk and doesn't comply with the requirements as laid out by the VA. If the veteran believes that he or she has been subjected to an inadequate examination, I usually recommend that they do nothing until their claim is adjudicated and they receive a decision letter. If the decision does not award the veteran the compensation that the vet believes is appropriate, the denial should then be appealed. Using the "Inadequate C & P Exam" as the basis for the appeal will often ensure a repeat exam and a different outcome.
"how long will a nehmer case take"
Like any other disability compensation process at your VA, there is no way to predict how much time it will take any case to be adjudicated. Each case is unique and the circumstances of the workload at the Regional Office vary from day to day. There is also no way to speed up your claim or to track where it is in the process. The answer to your inquiry is, "It will take much longer than it should."
"if i apply for tdiu can my rating be lowered"
Yes. Applying for any modification of an existing rating opens your C-File to review. VA raters will always look for the opportunity to determine that one or more of your conditions has measurably improved. You will have a C & P examination and if the examiner agrees that your condition(s) improved, you will receive a letter proposing to lower your rating. This does not mean that the rating will be lowered automatically. This letter is only a proposal and you will have an opportunity to appeal. While there is risk to seeking a higher rating, if you believe that your situation warrants the increase and you've done your homework, you should proceed to apply. You earned these ratings!
"search Board of Veteran Appeals decisions"
To search for prior decisions of the Board of Veterans Appeals (BVA) is one of the smartest moves a veteran can make. You can learn a lot by reading just how other veterans have won cases that may be similar to yours. Searching and carefully reading these old cases and decisions isn't easy. It requires time and focus on your part. It's one of the more important things you can do for yourself.
"does va recognize watchful waiting as treatment for prostate cancer"
Yes. Watchful waiting (in the Vietnam veteran) will result in the veteran receiving a 100% rating as long as the diagnosis of prostate cancer remains. Once there is treatment and the cancer is gone, the rating can no longer be 100% and will be adjusted down based on residuals of the treatment. Many more men are choosing "active surveillance" to monitor their prostate cancer.
"va examiner didnot review c-file for opinion"
The Compensation & Pension (C & P) exam is one of the more contentious steps in receiving a proper rating. The examiner does not make the decision for a rating. The examiner has very little leeway to do any sort of exam other than what the rater has ordered. Orders for C & P exams are usually very specific, for example the rater may order an exam of a left knee. The examiner is not allowed to examine the right knee or a hip or arm condition. If the rater ordering the exam didn't tell the examiner to review the C-File, the examiner won't ask for it. If you believe that your C & P exam was inadequate to provide you with the rating you deserve, that can be your point of appeal. Be patient and wait for the decision letter to arrive. If your decision isn't all it should be, appeal.
"how to get the most out of your va compensation exam"
This is a terrific question. The veteran who approaches the C & P exam armed with knowledge is much more likely to receive a good and fair evaluation. Your VAWatchdog urges all veterans to read and then read again the pages on the C & P Exam and also the C & P Exam Worksheets.
"how is benefits calculated for widows benefit for agent orange"
There is a common misunderstanding about the existence of an agent orange benefit. There is no such thing. There are presumptive conditions that are connected to agent orange exposure such as diabetes, lung cancer, prostate cancer and others. In considering a widows (survivors, dependents) benefits after the death of a veteran we must look at what caused the veteran to die. If he was service connected for an agent orange condition and that was the cause of death, it's likely that the surviving spouse will be eligible to apply for DIC. Survivors benefits are often very tricky to sort out. We must be cautious that we don't generalize with statements like "widows benefit for agent orange" as the VBA will not recognize that term and won't know what it is you're seeking.
"what it means if the VA claim condition was less likely than not (less than 50%)"
This was probably the opinion of the C & P examiner. In very brief terms, it means that you are not going to be awarded the benefit in question without providing more evidence. The opinion is that the probability of your condition being service connected is less than 50%.
"is prostate cancer consider to be service connected through va"
Prostate cancer is one of the diseases on a presumptive list for veterans who have boots on the ground service within the country of Vietnam. This is one of the infamous agent orange diseases. The other service connections for prostate cancer must be established by direct connection or diagnosis while still on active duty.
"can i use va and see my priimary care doctor"
We'll assume this veteran wishes to see his civilian primary care doctor and have VA pay for it. The answer is no, this is not allowed by VA. Veterans may be able to see civilian doctors or have procedures done in civilian settings by using a "fee basis" approval issued by their VHA facility. These are fairly rare and not very popular with VA.
"c&p exam for prostate cancer recurrence"
On the page about prostate cancer, we tell you that prostate cancer is rated at 100% until it's successfully treated. Then the rating drops. If there is a recurrence, the rating will return to 100% until the condition is once again treated. There will be the usual C & P exam prior to the rating being returned to 100%.
"agent orange and incontinence"
When we talk about agent orange we must talk about a specific disease. Your VAWatchdog gets a ton of email that begins with "I have symptoms of agent orange...". Of course, there are no symptoms of agent orange. However, VA does recognize that agent orange may have caused certain disease (the presumptive list) and that those diseases have certain symptoms. To talk about incontinence (the inability to control the flow of urine from the bladder) and agent orange first makes the VAWatchdog think of prostate cancer after it's been treated. Many Vietnam vets who have had prostate cancer treated by surgery experience some degree of incontinence. Once the cancer is treated, the rating will be assigned based on the residuals of the treatment of the disease. If there are few problems, the vet is likely to be rated at 40%. If there is a lot of incontinence, the rating will probably be 60%. Incontinence is measured by VA as the number of pads (adult diapers) that a vet must use each day. The rating may also be judged by excessive nighttime awakenings for urination and the feeling of urgency and loss of control when the urge to urinate comes on. Don't forget to seek an SMC-k rating for erectile dysfunction. VA won't usually rate you for ED unless you ask for it.
"how to appeal a va examine"
This search query is probably trying to ask what to do if the C & P exam is inadequate. Many (most?) C & P exams leave a lot to be desired. Of course, we don't appeal an exam, we appeal a denial that may have come about because of an inadequate exam. VAWatchdog believes that if the veteran walks away from the C & P exam knowing that it was not done well, the veteran shouldn't do anything. The plan should be to wait until a decision letter comes in the mail. If the decision is an award that meets the veterans expectations, great...you're done. If the decision letter tells the vet that the benefit applied for is denied, that is when the appeal is initiated. The appeal may be based on an inadequate exam. We recommend that all veterans who will have a C & P exam prepare for it by read the VAWatchdog page on the C & P examination.
"obstructive sleep apnea and ptsd"
There is increasing evidence that supports the thought that a diagnosis of PTSD may cause or aggravate OSA. The medications taken for any mental health condition may cause or contribute to OSA. We recommend that veterans who are considering a claim for OSA read the Obstructive Sleep Apnea page as well as How To File For Secondary Conditions.
"getting veterans affairs to acknowledge receipt of evidence"
We have advised veterans consistently that there is only a single acceptable method of delivering evidence to VA. All correspondence must be delivered using certified mail, return receipt requested. To hand deliver, fax or email is not as reliable as certified mail. Of course, the veteran must be well organized and keep copies of documents sent and the green post-card receipts that are returned from the VARO upon delivery.
"can disability be considered a part of income for child support for va"
"Is child support required in Iowa when I get VA compensation"
These divorce questions roll in at a steady pace. This and TDIU are the most frequent topics I hear about. Read more about child support here.
"what is a comp and pen exam for va"
It would appear that this veteran has filed for a disability
compensation award and is being directed to undergo a C & P exam.
Although the C & P exam isn't required, every claim will result in
at least one, and often more, Compensation and Pension exams. Read about the C & P exam here.
"tips on filing disability claim with veterans affairs"
I like this one. The veteran is contemplating filing a claim and is
getting prepared to win by seeking advice. The VAWatchdog dot Org site
is all about you winning your claim and receiving exactly the benefits
you earned. The way to do that is to be prepared. You can read Pro Tips here.
"title 38 alimony veterans administration"
This veteran is undoubtedly searching for information about whether or
not he/she must pay alimony out of the disability payments. I get these
questions about divorce and child support every day of the week. The
brief answer is Yes, your disability compensation will be used to
determine what you owe for alimony and child support. Learn more by clicking here.
"is va disability able to be touched in civil court"
The easy answer is no. Veterans disability benefits can not be garnished
in the usual sense. It's very different in the family court however.
While your VA benefits aren't likely to be sacrificed in a civil action,
the family court can order you to pay a set amount and you'll abide by
the order or risk going to jail. You can learn more about garnishment here.
