The Law Offices of David Anaise, MD JD
Board Certified Physician/Surgeon Accredited Veterans Law Attorney Military Veteran
DRO, BVA, CAVC Appeals Nexus Letters Independent Medical Opinions
Has Your Claim Been Denied? Do you need an IMO or a DBQ?
You'll need to speak with an expert physician and then a veterans law attorney.
Why not speak with both at the same time?
(520) 219-7321 Free Case Evaluation (520) 219-7344
You have the right to appeal any benefits decision made by the Veterans Benefits Administration.
The VA appeals process is set in law and is different from other judicial appeals processes.
Have you already filed an appeal? When the Veterans Benefits Administration Regional Office receives your
Notice of Disagreement, you’ll be able to check the status of your appeal on Vets.gov.
How long does it take VA to make a decision? 12-18 months.
The Veterans Benefits Administration usually takes 12-18 months to review new appeals and decide whether to grant some or all of the appeal.
When you request a review from a Veterans Law Judge at the Board of Veterans’ Appeals, it could take 5-7 years for you to get a decision.
3. You've been denied a health care benefit, for example...prosthetics or dental services.
You must appeal in writing to the director of your health care facility.
To appeal a denial of a health care benefit, you'll have to contact the director of your facility, usually at the VA hospital that is the hub for the facility that denied your benefit.
You must send the letter to the director at the VAMC address and you must use certified mail.
In your letter you should be as brief as you can when describing the problem you're having with your health care benefits.
Thomas J. Seiter, Jr., M.D.
General Medical Officer - General Practitioner - U.S. Army, Fort Gordon, GA
Primary Care Physician Submarine Officer & Nuclear Engineer
U.S. Navy Warfare Badge Qualified
Independent Medical Opinions Nexus Letters Medical Records Review
Disability Benefits Questionnaires
<thomas.j.seiter@marian-medical.com>
Drew Early
Veterans Law Attorney
West Point Graduate - 20 Years Army Service - Airborne - Explosive Ordnance Badge
Free Case Review - Nationwide Representation
BVA/DRO Appeals - Fiduciary & Caregiver Issues, Trusts, Wills
Appeals of Veterans & Survivor Claims
(770) 939-1939
Prostate Cancer Evaluations
Many veterans who are diagnosed with PC choose a new way to deal with it. Men are more and more often choosing "watchful waiting" or "active surveillance." Men who choose this option receive no treatment and their cancer remains active. Thus, they are entitled to the 100% temporary rating for the duration of their disease process.
Simple enough, right? But VA will still manage to screw this up. If during the follow-up exam (this may be a phone call exam) the examiner doesn't understand that your cancer is active, he may rate you as 0% disabled because you aren't having the typical post-procedure problems like frequent urination or erectile dysfunction. If you are taking any medicine for your benign prostate hypertrophy (BPH) the examiner may note that as prostate cancer treatment and VA will propose to reduce your 100% rating. Common medicines for BPH are tamsulosin (Flomax) or terazosin (Hytrin) dutasteride (Avodart) or finasteride (Proscar).
If you take any of the above medicines for BPH the VA is likely to try and reduce your 100% PC rating to 0%.
If you are a veteran who is service connected for prostate cancer and you have chosen watchful waiting and VA proposes to lower your rating, you must take action right now.
Nobody will help you with this, you must DIY.
VA usually encloses instructions of what to do if you disagree with their decision or proposal.
Carefully read any instructions. Read them again. You must notify VA in writing that you still have cancer.
You must notify VA in writing that they made the wrong decision. You should tell them that due to an inadequate examination, they are making a mistake attempting to lower your 100% rating.
Be brief, be courteous, stick to the facts in your letter. One single page is enough.
Use certified mail to send your letter to:
Department of Veterans Affairs
Claims Intake Center
PO Box 5235
Janesville, WI 53547-5235
Then fax a copy to:
Toll Free Fax: 844-822-5246
We've used prostate cancer as our example here but the above instructions apply to other conditions as well.
4. You have had a temporary rating and VA tells you that they are going to reduce that rating.
Prostate cancer is the most frequent rating VA tries to lower. Many, many VA ratings are assigned as temporary ratings during recuperation or are conditions that VA believes will improve with treatment over time.
The term "future exams are scheduled" is your signal that a benefit rating is temporary. The term "permanent & total" is the signal that the benefit is permanent although "permanent" may not mean what you think it does.
All cancer diagnoses are rated as temporary.
VA assumes you will get treatment and be cured. This is why there is a conflict when prostate cancer (PC) is service connected.
The prostate cancer rated veteran is usually a Vietnam vet who has a presumptive agent orange associated cancer. The usual course of the claim is that the RVN veteran gets a diagnosis of PC and then files a claim.
There is always a perfunctory C & P exam. The VA will respond with a temporary 100% service connected rating. The veterans file
will be flagged to schedule a future exam, usually 6 months or so after the assumed treatment. If the veteran chooses treatment such as surgery, radiation or chemotherapy, the C & P exam will determine the residual effects of treatment and the 100% temporary rating will usually adjust downward to reflect any disabilities caused by treatment of the service connected condition.
2. You filed a claim for a benefit and the rating is too low.
File a NOD
Use certified mail and send the form to:
Department of Veterans Affairs
Claims Intake Center
PO Box 5235
Janesville, WI 53547-5235
Also send a copy via fax to:
Toll Free Fax: 844-822-5246
If you have applied for a disability benefit and the benefit is awarded but the rating is too low, you're probably going to have to manage the appeal yourself. Since you weren't denied the benefit, a veterans law attorney won't be able to help in most cases.
You can manage your own appeal. File the NOD as above. As you fill in the NOD form, tell VA that you believe you should have a higher rating.
Explain why you believe your rating should be higher. Compare ratings at The Schedule For Rating Disabilities.
Use examples from The Schedule to support your appeal for a higher rating.
How To File An Appeal Of A Benefit Denial
Notice of Disagreement NOD
We urge vets to talk with an attorney.
It doesn't cost anything to discover your options.
VAWatchdog does not recommend that any veteran proceed into an appeal unless he/she is represented by a skilled attorney.
Appeals, indeed all claims, have become much more complex. The RAMP appeals process has made the system more complex than ever. This has opened a door to the VBA making more mistakes than any other time in history
Along with all this is the fact that VBA has become more willing to fight appeals.
You deserve an advocate who is trained in law and skilled at the task.
There is no substitute
for the veteran claimant who is involved and informed. Once you've learned how the system really works, filing correctly...getting it right the first time...isn't that hard to do. Educate yourself by reading what the experts have to say.
Do you know who your doctor is?
VAWatchdog Dot Org
You've Arrived at the VAWatchdog Dot Org!
Welcome Aboard!
We've been keeping veterans informed of news and events important to them since 2005.
You'll find all you need to file your claim and referrals to professionals who can help you when things don't go well.
What you won't find here is unending chat or opinions from strangers who like to think of themselves as experts.
Our goal is to ensure that you are awarded the benefits you earned with your service to our country.
We're here to help you take charge of your benefits, and that is all.
VA Form 21-0958 - NOD
Notice of Disagreement
VA Form 21-534 EZ
Application for DIC,
Death Pension
Declaration of Status of Dependents
5. You've been notified that VA is proposing to appoint a fiduciary.
VA Form 21-526EZ
Use For...
Disability Service Connection
Secondary Service Connection
Increased
Disability Compensation
Temporary Total Disability Rating
Individual Unemployability
Compensation under 38 U.S.C. 1151
Special Monthly Compensation
Special Home Adaptation
Automobile Allowance
/Adaptive Equipment
Benefits Based on a Veteran's
Seriously Disabled Child
PAPER Evidence, Records
and Claims All Go Here
V A Claims Intake Center
PO BOX 4444
JANESVILLE, WI
53547- 4444
Toll Free Fax:
844-531-7818
Serving Disabled Veterans Nationwide
PTSD, MST, TBI, Agent Orange Exposure, Back Injuries
Gulf War Syndrome, Migraines, Heart & Vascular Disease, DIC, Unemployability TDIU
Free Veterans Disability Consultation! Call Now! (800) 742-5035
Five Reasons to Appeal
1. You filed a claim for a disability benefit and were denied.
2. You filed a claim for a benefit and the rating is too low.
3. You've been denied a health care benefit, for example...prosthetics or dental services.
4. You have had a temporary rating and VA tells you that they are going to reduce that rating.
5. You've been notified that VA is proposing to appoint a fiduciary.
How to Appeal
1. You filed a claim for a disability benefit and were denied.
File a NOD
Use certified mail and send the form to:
Department of Veterans Affairs
Claims Intake Center
PO Box 5235
Janesville, WI 53547-5235
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