Travel Pay

​Question:
Since the VA adopted the new mileage application via the internet, I haven't received any travel money. I checked with my travel clerk and he told me that there is a big back log here in Florida. Have others experienced this problem? Thank you Jim.

Jim's Reply:
I'm in Florida so I feel your pain.
We're supposed to be reimbursed a per mile amount for certain travel to and from medical care. In my time with VHA I've seen long lines and over an hour wait to receive a few dollars gas money. Then we went to a fill-out-the-form system. The check-in kiosks were introduced a few years back and those worked well other than you had to remember to sign out and sign in again to submit the travel voucher.
Not all that long ago I checked in to my small clinic and the kiosks were unplugged and parked in a corner. I was told to check in the old school way and only when I asked, I was given an old form to complete for travel pay. I was told the kiosks were gone forever.
I returned to that clinic 2 weeks later and the check in kiosks were back, plugged in and ready to go. There was no option for travel reimbursement, I was told to go to the Internet and figure it out. I haven't seen any deposits either.
I don't have any answer for you other than...welcome to your VA. They care!
​​

Special Monthly Compensation (SMC)

Question:
Jim is getting 100% VA disability for bladder cancer from Vietnam vet service. He’s been through a course of treatment of combined chemo and radiation. Unfortunately we are looking at removing his bladder and living with a urostomy bag for the remainder of his life. What can we expect his benefit percentage to be?

Jim's Reply:
His final rating will depend on a variety of factors like how well he recovers and how proficient he will remain with Activities of Daily Living or ADLs. I'll guess that it's likely that he could end up with SMC ratings.
Have a look at the SMC ratings here and line up all that's happening with him to learn of a potential rating. Good luck.

Citation Nr: 2104610  
Service connection for a lower back disability is granted. 
A lower back disability was caused or aggravated by service-connected right

knee disabilities, to include

due to an altered gait.

Veterans Clinical Psychologist PTSD Nexus Letter

Nexus Letter?

Question:
It appears that the VA is being more critical of IMO/Nexus letters. In the past it use to be, "More Likely than Not" was enough to get an approval of your claim. Do you know what the VA is looking for? Can you provide an example of an accepted Nexus letter that the VA will accept? I'm in the process of obtaining an IMO/Nexus and would like to avoid any pitfall. Are you in a position to call the VA and actually ask them for guidance on what they will accept now? About 3 years ago I submitted what I thought was a very good Nexus. The VA threw that out in the blink of an eye. That claim is sitting with the BVA. I just want to be in a better position to provide the VA with the evidence they require. Thank you.

​Jim's Reply:
Plugging in a phrase like, "More likely than not" isn't nearly enough. The statement would have to be supported by science and made by a qualified individual. For example, a podiatrist shouldn't opine about heart disease for your IMO. I haven't seen any particular shift in what VA accepts as an IMO.
Call the VA and ask them for advice? That's a new one on me. But no, the VA doesn't help you to win your claim by offering personalized advice.
Since I don't know where you're getting your support from, the best I can offer is that experience counts. The doctor should have a deep understanding of what VA needs to hear and must have to support your claim. Asking your family doctor to provide an IMO is usually a waste of time.
The 2002 edition of The Clinicians Guide is the tool I use most often to develop what I think VA must have in the record for you to prevail. If you'll study that guide and tie those principles to your claimed conditions in The Schedule, you should have a winner.
I'll remind you that sometimes we don't win because we don't have a well grounded claim no matter how much we believe in our cause. There's only so much that wordsmithing can do to help and legit IMO doctors won't fudge anything to help you.
In the end, if you want a great IMO these are the folks who can help https://www.vawatchdog.org/imo-ime-medical-opinions-exams.html   Good luck.

Welcome Home

Independent Medical Opinions

to Support Your Department of Veterans Affairs VA Disability Claim

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Nexus Letters   DBQs   IMOs   IMEs

Nexus Letters     Independent Medical Opinions​     DBQs

Exposures?

Question:
I'm also a Vietnam-era Vet; I did Advanced Training for 7 months at Ft. Devens, which became an EPA Superfund Cleanup site in '89 for things like drinking water containing Benzene, TCE, PFOS and PFAS. I also worked two years in an electronics shop, where TCE was always in the air (we had a large degreasing vat of it). It took decades for me to develop Leukemia and Hyperthyroidism - but I did. Is there any good data on how long it took for symptoms to develop before the VA will flatly deny benefits - even if I do have IMO letters?

Jim's Reply:
To my knowledge and belief, there isn't anything as precise as what you're asking for. However, it's my experience that if you can prove exposure to carcinogenic chemicals then service connection will follow even though decades may have passed.
This is evident in the way agent orange presumptive cancer conditions are managed. If a 75 or 80 year old boots on the ground Vietnam veteran gets prostate cancer tomorrow, the service connection is automatic although that much time has passed.
The same would hold true if you establish service connection for the chemicals you were exposed to and your current disease with a well written IMO or nexus letter. I think that most agree that the ill effects of chemical exposures can take decades to show signs and symptoms of harm.
You may benefit by researching cases similar to yours that have been denied and appealed and then won or lost at the BVA. Click here and then use the search function you'll find to look for key words like <benzene TCE hyperthyroidism> and learn what the court thought of these adjudicated claims and appeals. These cases do not set precedent so you can't cite one and then you're done...you have to duplicate every step of the winning appeal but many vets prevail in similar cases.
Trichlorethylene (TCE) was used by the 55 gallon drum for all kinds of applications...I remember the stuff all too well. TCE was the only thing that would remove the Cosmoline gunk that our weapons were packed in for shipment and storage. With just that thought, I can still smell Cosmoline. I was 91D20 at the 98th General Hospital in Germany and we used TCE to clean all sorts of things. Our huge steam pressure autoclaves would need flushing with the stuff to remove hard water scale.
I think we vented that into the open air straight out through the ceiling.
Now I wish I hadn't remembered that.
Good luck sir.

Citation Nr: A20000833   DOCKET NO. 190318-4058
The June 2018 independent medical opinion concludes that the Veteran’s right hip strain is the result of his service-connected disabilities and includes an adequate supporting rationale. 

Bladder Cancer?

Question:
I have been receiving 100% disability for 5 years for residual due to lung cancer. They removed left lobe. I also recently had tumor removed from my bladder which was low grade cancer. I am Vietnam Vet. I am not rated P & T as far as I know. Should I file for the bladder cancer or leave it alone since I'm already receiving 100%? I don't want to put up red flag. I am 78 yrs old.

​Jim's Reply:
Yes, you should go ahead and file for the bladder cancer benefit. That won't raise any sort of red flag and I'll anticipate that you'll receive a P & T rating and you may be eligible for the housebound benefit.
This will be worth your time. Good luck sir.

Cancer C & P Exam?

​Question:
My lung cancer appears inactive but I am still receiving treatment. Do I need to report a change to the VA or wait until they ask?

Jim's Reply:
I'm going to assume you're a Vietnam veteran rated at 100% during a post-treatment period while waiting on a mandatory C & P exam to reevaluate your rating.
No, you do not need to notify VA of anything. In fact, I usually coach vets to learn never to volunteer ANYTHING with VA. Ever. If they ask you any question, you should think of your answer very carefully, in the context of what they may interpret.
For example, you: "I'm an honest guy voluntarily reporting I've improved a lot after my treatments." The VA response: "Dear veteran, thank you for reporting your death. We will proceed to terminate the benefits of the deceased veteran."
OK, sure...that sounds far-fetched but it's an example of what happens on a day to day basis in my world and when you realize things have gone horribly wrong, it's too late. You're in for a nightmare.
If VA asks, answer honestly, briefly and only to the point of answering the specific question. Never volunteer information not specifically asked because VA sees that and judges your motive suspect.
You should be notified around 6 months to a year after your therapy has completed that you'll have an exam coming up. Until then, take care of yourself and don't worry about VA. Good luck sir.

Presumptive Hypothyroidism

​Question:
I filed for hypothyroidism in 2018, it was denied. It is now on the AO list. The VA is required to review every denied claim and back date to the original date of filing. My question I am TDIU and 100 percent. TDIU started in 2003. The claim is on appeal since 2019. The VA added it as a new claim on ebenefits in June 2021. If they ever get the claim completed I don't think I will receive retroactive back pay, true or false? Thank you.

Jim's Reply:
You may or may not be due for some retroactive benefits. In a previous and similar situation not all that long ago, the decision was in favor of vets who had filed and been denied to receive retroactive benefits.
I'm a bit tied to studying this as I have a distant in-law who is a retired-after-20 Blue Water Navy vet in a similar situation. His non-service connected hypothyroidism had had a deleterious effect on his service connected diabetes that was (lowball) rated at 20%. He was in and out of civilian hospitals and in critical care more than once and VA paid no attention...even though he was a DoD employee.
After a stroke the family asked for my help.
We were successful in filing an increase for his DM2 and then got an IMO to connect the hypothyroidism to his military service. (Of course we don't need the IMO now it's presumptive.)
He is currently rated as 100% with SMC-S and he is fully housebound with VA caregiving benefits kicking in.
Of course I'd hope that you never run into the illnesses my in-law has but considering all that, I think it's worth your time to aggressively pursue this benefit so you don't have to do it when you're not well. 
I've been referring these cases to a trusted veterans law attorney who has shown a particular interest and who has a great track record in dealing with these particular claims. (He did appeals for my relative)
Let him know I sent you his way and listen to what he thinks about your particular situation. He never charges veterans to provide a great evaluation of what they've got going on...he's a vet, 'nuff said.
Good luck sir.

Medicare B

​Question:
Am I required by law to obtain Medicare Part B if I am 100% disabled Vietnam veteran? Agent Orange got me. Lung cancer, neuropathy, PTSD , etc. I was 16 and a VOLUNTEER! GOD BLESS you and your efforts.

​Jim's Reply:
No, you are not required to take Medicare Part B. Many do take it and find it to be a convenient and not to costly addition to their health care but it is not required.

Discharge Upgrades?

​​Question:
I am 100% P&T with PTSD with a nexus related to my first enlistment with an honorable discharge. I also receive SSDI with PTSD as the disabling condition I received a BCD due to a Special Court Martial near the end of my second enlistment BCNR has denied my request for upgrade in part due to a lack of "Nexus" between my disability and my conduct which is in direct contradiction of the VA findings and post service medical notes. What is my next step?

​Jim's Reply:
It sounds as if you've been going it alone in your attempt to have a discharge upgraded. The success rate for a DIY attempt is low, you need professional representation.
Click  
https://www.vetsprobono.org/  and talk with the folks there. Good luck sir.​​

Citation Nr: 21022495 

 DOCKET NO. 04-04 098
Following a review of the Veteran’s claims folder in October 2007, a VA psychologist concluded that it was not possible to state with any medical certainty whether the Veteran’s single use of the preparations in question for a medical procedure while in the military could have resulted in his involvement with cocaine over the past 20 years

Cardiovascular diseases?

​Question:
I have a 10% VA rating for high blood pressure. I had a pacemaker installed on in 2016. Should I file for a VA rating? Thanks in advance.

Jim's Reply:
Yes, maybe. The need for the pacemaker must first be proven to be
secondary to your high blood pressure (HBP). If you can prove that your HBP has caused or contributed to the need for a pacer to control the timing of your heartbeats, you may have a well grounded claim that the pacer is service connected (SC) secondary to the HBP. If you're having a touch of heart failure that will be enough to require a pacer and heart failure is often secondary to very high/treatment resistant hypertension.
If you do have a diagnosis of heart failure, you should file that as secondary to the SC HBP also.
 As I so often do, I predict that to prevail you're going to have to have an Independent Medical Opinion that spells out exactly, precisely how and why your SC HBP caused the need for the device. Unless you have the IMO, the VA isn't going to see the secondary connection. More about that is here https://www.vawatchdog.org/imo-ime-medical-opinions-exams.html  Good luck.

Pre-existing conditions

Question:
When I was a pre-teenager I broke both of my wrist, two years apart. When I joined the Navy at 19 years old I noted the wrist fractures on my entrance physical. I am now having severe wrist pain and intend to file a disability claim for aggravation. I do not have any documented issues in my military medical records. So my question is: Can pre -existing conditions like these be service connected? I was a Navy (CB) Construction Battalion Builder in Vietnam in 1970. I am currently seeing a civilian Rheumatologist and am waiting on test results for arthritis. My disabilities include PTSD , Diabetes II and some others. Currently at 80%. Thank You.

​Jim's Reply:
 'Can preexisting conditions like these be service connected?'
Yes, absolutely. This is too often a steep uphill climb but with the appropriate evidence and logical presentation, you may have an opportunity to prove service connection.
You'll need an Independent Medical Opinion (IMO) written by a professional who speaks the language of the VA rater. While your rheumatologist may (or may not) agree that military service caused, aggravated  or contributed to your current disabling wrist conditions, how the opinion is phrased can make or break the claim for you. If you think your doctor is going to do a good job, go for it. Otherwise talk with an IMO doctor to have your records reviewed by a pro who does this every day.
Good luck!

Citation Nr: 2101300  
The Board of Veterans’ Appeals (Board) vacates its November 4, 2020 decision denying service connection for sleep apnea, to include as secondary to service-connected coronary artery disease and atrial fibrillation.

The Independent Medical Opinion (IMO) is often enough the single piece of evidence that you may submit that makes the difference between a correct and fair rating and an outright denial. When you have an IMO (also sometimes called a Nexus letter) done by a professional who knows what the VBA needs to see, you're almost guaranteed to win your well grounded claim. The IMO is usually accomplished by an intensive records review and interviews with the veteran. You may not need a physical exam or a face to face meeting with your consultant. Yes, you have to pay for the IMO up front and out of your pocket but when you look at it as an investment in your future, the value of getting this done becomes easily apparent. Dealing with your VA and filing a disability claim is one of the more important things you'll do in your life. Get some help and get it done right the first time.

veterans disability lawyer

Tinnitus and Mental Health

Question:
VA gave me tinnitus rating, no rating for hearing loss and no rating for depression/anxiety. Can I make my depression/anxiety secondary to tinnitus?

​​Jim's Reply:
It sounds as if you've been rated for tinnitus (10% is max) and hearing loss. I'm not sure the % of your hearing loss rating but it's usually wrong or 'lowballed'. I'm also unsure whether you asked for depression as secondary to your hearing loss and you were denied or if you thought they should infer the mental health rating?
In any case, if you're not happy with the results of your hearing loss and mental health claims status, you should go ahead and speak with a veterans law attorney. Talking with an accredited lawyer about your options won't cost you anything and you won't pay anything out of pocket for the required appeals. Outcomes in cases like yours are always better with an accredited veterans law attorney in charge.
Hearing loss and tinnitus are the leading disability claims submitted by veterans...we're exposed to a lot of acoustic trauma. The connection between profound hearing loss and tinnitus to depression, anxiety and other mental health conditions are well established.
You'll want to speak with a clinical psychologist to better establish the link or nexus between your hearing loss and tinnitus and any mental health condition you may have as VA won't accept your word for it. In other words, you'll likely need an IMO. I refer to only one clinical psychologist and he is experienced with the often devastating effects of profound hearing loss. 
Talk with Brett and see what he can do to help you. Good luck.

Stateside Legal Help For Veterans

Jim Strickland is a Vietnam era Army veteran and nationally recognized expert on VA disability benefits.

Jim writes extensively about VA and Social Security disability benefits. 
Jim's Mailbag is a regular column featured at  Stateside Legal  where veterans, servicemembers,
and family members can  ask Jim their questions  about VA and Social Security disability benefits.