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Why You Need An IMO!
VETERANS BENEFITS ADMINISTRATION
The OIG determined that VBA incorrectly processed more than half of the 62,500 veterans’ claims.
Processing errors included improper evaluations, missed secondary conditions,
and evaluations based on inadequate exams.
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Rate particular condition as urine leakage, frequency, or obstructed voiding.
Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day...60%
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day...40%
Requiring the wearing of absorbent materials which must be changed less than 2 times per day...20%
Daytime voiding interval less than one hour, or; awakening to void five or more times per night...40%
Daytime voiding interval between one and two hours, or; awakening to void three to four times per night...%20
Daytime voiding interval between two and three hours, or; awakening to void two times per night...10%
(This is service connected prostate cancer.)
Note: Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.
Prostate cancer is the most common cancer among men (after skin cancer), but it can often be treated successfully. If you have prostate cancer or are close to someone who does, knowing what to expect can help you cope. Here you can find out all about prostate cancer, including risk factors, symptoms, how it is found, and how it is treated.
If you choose watchful waiting (many men today make that choice) your rating will continue at 100% temporary. You will have regular C & P exams to determine whether you still have cancer.
Your VA isn't really prepared for the recent trend to choose watchful waiting when diagnosed with prostate cancer.
The reasoning behind watchful waiting is simple. Most prostate cancers are very slow growing, men often die with prostate cancer but not of prostate cancer. The treatment for prostate cancer is brutal, surgery will often leave you leaking urine and impotent. Statistically you're more likely to die of another cause than you are your prostate cancer.
In the ratings schedule VA assumes that every veteran diagnosed with a cancer will choose to be treated. VA also assumes that every cancer treatment will be succesful and the cancer will be cured. Ratings for service connected cancer are always 100% and they are almost always temporary ratings.
Once you've declined treatment you have to be alert because VA will assume you've been treated even when you tell them you haven't.
After a C & P exam you may get a letter telling you that since your cancer has been treated and your symptoms aren't really present, VA is proposing to lower your rating from 100% to 0%. The examiner paid no attention at all to you when you told him you still have cancer.
Don't panic, this is pretty easy to resolve and you can DIY this one. You appeal promptly and that usually fixes the issue right away. In your appeal you briefly explain that you have cancer and that you have had no treatment. Bingo, that usually gets the job done.
No, you do not have to have any further prostate biopsies done to prove you have the cancer. VA can monitor your PSA and the lack of any records of treatment is enough to show you continue to have an active cancer.
Prostate cancer reduction-ratings (medical diagnostic codes) are confusing because often the patient has a 100%
disease cancer code for 6 months then the code is reduced and the reasoning is often unclear to the patient.
§4.115a Ratings of the genitourinary system—dysfunctions.
Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following section provides descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decisionmaker to these specific areas of dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis.
Prostate cancer & the Future Exam
Thanks for the solid advice in the past. I received a 100% Compensation Rating in 2012 for Agent Orange Viet Nam Prostate Cancer. I had my first Reevaluation test in 2015 with a Contractor Doctor. He sent in some false reports saying I wasn't seeing a doctor and was in remission. I had all my info with me, which he didn't look at, I answered all his questions politely, and was denied. I appealed and won, receiving all back pay and started receiving checks again in march of 2017. It took 2 years for them to read my appeal, which was basically My doctors letter simply stating that he saw me regularly, that my cancer was not in remission, and was active prostate cancer. My question is, I have a Re evaluation C & P test coming up in 2018. Any advice for this C & P test, and how to avoid another failure?
Your story is very typical, this happens daily. VA rates all cancers as temporary. VA assumes every patient will be treated promptly and that every treatment will be successful and that every cancer will disappear. Once the cancer is gone they rate you on the residuals of treatment and most ratings for prostate cancer are 20% to a max of 60%. The post-treatment rating is usually based on how many absorbent pads the veteran must use each day to control leakage of urine.
I don't understand the disconnect. Active surveillance or "watchful waiting" is an accepted process in our modern era since the treatment for prostate cancer is often worse than the disease. I have to think that the C & P examiners must know about watchful waiting but if so, they don't explain that to the rater back at the regional office.
All too often the active surveillance veteran patient will have been on a prostate medicine for benign prostatic hypertrophy (BPH - or enlargement of the prostate) and the rater will see that and assume that is treatment for prostate cancer. But the patient has no symptoms, uses no disposable pads so the rating comes back as 0% service connected even though the veteran still has an active cancer.
This has been the status quo at VA for years. I've talked with dozens and dozens of veterans over the years who have had to do just what you did...appeal. VA has had zero interest in any fix to the problem...fixing this won't add to their bonus so why would they?
In the future, you can try to talk with the C & P examiner like he's a 6 year old. Carefully explain what you're doing and that your cancer is active.
Keep your fingers crossed.
The Vietnam veteran who served with "boots on the ground" in the Republic of Vietnam is generally eligible for Service Connected Prostate Cancer & Disabled Veterans Benefits once the medical diagnosis of prostate cancer is made.
Prostate Cancer Disability Benefits Questionnaire (Fillable)
File Type: PDF Issue Date: 06/01/2017
Revision Date: 02/2015 Total Pages: 3
Watchful Waiting or Active Surveillance for Prostate Cancer
If you are a Vietnam veteran (or any other veteran who believes your prostate cancer may be service connected for any reason) and you are diagnosed with prostate cancer, your first move should be to file a claim. Filing the claim sets the effective date and no matter how long it takes VA to sort out the claim, the effective date will ensure that is when your disabled veterans benefits will begin.
Your rating will be 100% but it will be a temporary rating subject to a future exam, usually 6 months or so after treatment.
Now you have choices to make. You can choose treatment (surgery, radiation, chemoterapy or a combo of all the above) or you can choose active surveillance...often called watchful waiting. More on watchful waiting in just a minute.
If you choose treatment, the rules you see above will apply. Your rating will fall from 100% to 60% or less determined by your symptoms of leaking urine requiring absorbent pads, the frequency of your daytime urination and the frequency of awakening at night to urinate.
When you claim that a disabling condition is caused by military service, you have to prove that allegation.
Or do you?
How to Fight VA Debt
Military members know that when DoD gives
you too much money, it will come back for it.
The VA is similar, but the system is worse.
It Could Reduce Your Social Security Benefits
Think twice before taking on certain loans.
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The Department of Veterans Affairs (VA) Launchpad
App for Veterans (VA Launchpad) contains select VA applications (apps) for Veterans and their Caregivers.
New apps will automatically appear in the VA Launchpad when they become available. Organizing VA health information and resources into five categories, it quickly accesses and launches the VA app of your choice. With VA Launchpad, VA intends to save you time and help you better integrate available VA apps into your life.
If you're thinking of filing a claim or initiating an appeal of a denied claim, this is your new best friend. The details of exactly what you need to meet a rating are here and in use every day. Yes, it's complex. Yes, it's cumbersome. Yes, knowing how to use The Schedule is a necessity if you want to file a successful claim. Go for it!
Vets being duped by Social Security rumor mill
Owe VA Money???
Did you know that hearing loss and tinnitus are the
most commonly rated veterans disabilities? Did you
know that hearing loss and tinnitus can cause
other secondary conditions, particularly mental
health problems like depression and loneliness?
Jim Strickland is a Vietnam era Army veteran and nationally recognized expert on VA disability benefits
You can browse all of these Q&As here, and search the Jim's Mailbag archives for helpful answers.
Email Jim your question for a quick and confidential reply. firstname.lastname@example.org
Getting Social Security disability benefits when you’re unable to work can be challenging. Last year, more
than 2 million people applied for Social Security
disability benefits, but two-thirds of them
were denied, because most applicants fail to prove
that they’re disabled and can’t work. Here are some
steps you can take that can help improve your odds.
Scheduled For A C & P??? Filing A Claim?
I've been posting this again and again over the years
and it's still one of the best ways I know to win
your case. Published in 2002 the principles and much of
the verbiage still applies and is in daily use at the VA.
How to download VA benefit letters
To receive some benefits, Veterans need a letter proving their status. Access and download your VA Benefit Summary Letter (sometimes called a VA award letter) and other benefit letters and documents online.
There Are Protections...When it comes to debt collection, disability income enjoys special status.
Overpayment? VA proposing to claw back
money from your benefits? Submit a Compromise Offer to the Debt Management Center.
Do You Need Medical Care
You are already authorized
to use an urgent care clinic!
Physician - Surgeon - Veteran
Veterans Law Attorney
Answers to the top five questions about urgent care
Urgent Care Centers
One of the most important benefits you have today is
the authorization to use an urgent care center
near to you. But first, you have to
to take with you. Don't wait until you need this
benefit to prepare for it. Read this now,
print your papers and be prepared!
The moment that you file a claim someone will be waiting to schedule you for a Compensation and Pension (C & P) Exam.
The C & P exam is the precise point where so many claims go south. The C & P examiner is often not qualified to render an opinion of the condition in front of them. I recently received an email from a veteran who I had advised to file a claim for his carotid artery disease as secondary to his service connected diabetes. His claim was denied because the C & P examiner opined that there was no medical evidence that diabetes caused or contributed to carotid artery disease. That it is well known that diabetes is a leading cause of atherosclerosis didn't phase anyone at VA and now we have to have a doctor and a lawyer get involved in a lengthy appeal.
Think about it...the veteran was denied service connection because the VA examiner reported that there is no medical evidence that diabetes causes carotid artery disease. Now read this.
Months ago when I first advised the veteran to file the claim for a secondary condition, I didn't advise him to get an IMO. I couldn't have believed that VA would deny a vascular condition as secondary to DMII...it defies all logic. But here we are and it's become very apparent that if you want to avoid an appeal, you'll get an IMO as you file the initial claim.
The report above is a confirmation of this...the VA does a very poor job of C & P exams. Avoid the fuss of an appeal...get an IMO.
your disability claim
If you’ve filed a claim for disability compensation, you can continue uploading more evidence for up to one year to support your claim. Evidence may include supporting documents like medical test results, doctor’s reports, and other records. Upload your evidence online now.
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