Richard T. Riehle posted on July 27, 2014 11:18
Many of us now are bent and bowed when we walk. The most common type of physical ailment that VA receives requests for medical treatment and/or disability compensation is "Muscular-Skeleton". Studies in the U.S. and other countries have shown that Veterans get Arthritis at getter rates than their civilian counterparts who never served.
So, the following may be of interest to many Vets over 65-years.
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BACKGROUND: I received the following from a Vietnam Vet:
"My back went out on me last September before wife and I were to head off to Europe for three weeks.
"Diverticulitis kicked in just before the back went out so I was a total mess which caused us to cancel the trip. The back pain was unrelenting and I am just now coming out of the pain problem due to some meds I am now taking and I am now wearing a back brace that seems to help a bit.
"I should go back to the VA and get my 10% bumped up because the back problems started in the Army after I took a fall, and have I have been sucking up the ever-increasing pain
ever since. "
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MY REPLY:
Attached is the form for enrolling in VA heathcare.
-- If you don't have a VA heathcare ID card, you're most likely not a current active enrollee.
-- When you go for a "C&P Exam" after submitting a disability claim, the VA Benefits side of the VA uses that ID card for documenting your check-in and for reimbursing you for travel expenses.
Also attached are the following VA forms. They're "fillable" using your computer, then print hard copies to sign and mail directly to VA or to the VFW Veterans Service Officer who will represent you.
1. VA Form 21-526b - Supplemental Claim for Compensation
-- Use this form for both an increased rating if its your back that was already rated 10% OR if the back is a new issue.
2. VA Form 21-4138 - Statement in Support of Claim
-- Use this one to provide the details around your claim.
If this is the first VA claim on your back, this is where you provide all the details of the original injury and its aggravation while in the Army. Include the location of the military hospital or clinics where you were examined. The VA can go check for those facilities' records on you when your personal military medical file does not provide the details.
Tell how later military activities ( such as lifting trailer tongues to hook them onto trucks, carrying large tents, helping move ammunition crates or artillery rounds by hand, doing sit-ups during PT) aggravated the initial injury.
Tell how its recently affected your ability to move and to perform daily activities.
Identify by date & name the doctors and hospitals that have examined, x-rayed, tested, evaluated, diagnosed, and/or treated your back. Tell which written diagnoses are attached to your claim. (I label each one with an exhibit number.) Include the names and dosage of the medications prescribed, and which ones you're currently taking. THIS IS KEY to documenting the need for continuing medication for a chronic condition.
If you need more than two pages, use the 2nd page of additional VA 21-4138 and put a page number on them. You'll be printing out the form anyway.
-- You can have your wife or others that you live with provide a separate statement of what they've personally seen. They can describe the effect of the condition on your activities (for example, can't bend over enough to tie your shoes, need a cane or walker to move on your own), what activities aggravates the condition (such as driving or siting in a car for 30-minutes or more), etc... Your wife/children/friend/care-giver should not include medical diagnosis unless they're a medical professional. And, if they are one, the statement should state that fact, too, because then their statement will carry more weight.
3. VA Form 21-4142 - Authorization & Consent to release information to the VA
-- Fill out one of these for each medical provider. Where you've had lots of exams & treatments, no need to list every individual date. Instead, provide the span of dates.
-- Fill out one for each place where you've had x-rays, MRI's, CT-scans, etc on your back. These reports as interpreted by a radiologist or physician ARE KEY to VA accepting that you have old, prior injuries and the extent of the deterioration of bones & joints. Also, VA rules/practices for evaluating claims of arthritis could require these tests.
-- Fill out one for each place you've had physical therapy, particularly if they measured the range-of-motion for bending, twisting, etc. This is ANOTHER KEY that VA uses to determine the percentage rating.
4. VA Form 21-686c - Declaration of Status of Dependents
-- The VA pays an additional amount for all disability ratings 30% or greater when you have a wife or minor children. You'll need to attach a copy of your marriage license.
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Here's how the VA will evaluate your back for an increased disability rating:
When you're notified by phone, mail, email, postcard that you're to come for a "C&P Exam", the purpose will be for the VA med examiner to fill out this questionnaire. (There's one for each major body part and are called DBQ).
VBA-21-0960M-14-ARE Back & Thoracolumbar Spine
-- You can have your own doctor do it, but VA won't reimburse the cost.
-- Note all the range-of-motion readings. The examiner may do these during the "C&P" exam.
IMPORTANT: Do NOT skip or be late for your C&P Exam. You'll have to call to reschedule if you don't go....after a second missed appointment, the VA can just deny your claim or move it to the backlogged pile.
IMPORTANT: The "C&P Exam" recorded observations on your condition begins as soon as they can lay eyes on you...as you are walking to the building, sitting in the waiting area, or being escorted to the exam room. They examiner will include in their report how well you move, sit, etc, particularly if that's indicative of the claimed condition not being serious enough to get compensation.
IMPORTANT: DO NOT double down on medication, to include aspirin or tylenol before the exam. Do not restrict your normal, regular activities in the days before the exam. Remember, the purpose is for the examiner to see your limitations as they exist on a regular day.
IMPORTANT: The "C&P Exam" is NOT THE TIME to demonstrate manly fortitude. When a movement hurts, say so. Whether or not you wince or have other involuntary reactions to pain as a joint is manipulated or tested by the examiner WILL BE INCLUDED in the report of the examiner's observations.
During the "C&P Exam", It won't be a traditional "turn your head and cough" physical exam. Instead, you'll be asked a lot of questions about your condition. If you might not remember accurately, bring your wife with you into the room.
After the exam, the file goes to a Rater, who uses the attached extract from the Federal Code of Regulations, Title 38, to determine the percentage of disability.
-- Its a large file, The first couple of pages tell about evaluating Arthritis. Skip down to page 19 where it covers the spine.
-- Note that the measurements of motion, rounded to the nearest five degrees, will determine your percentage of disability.
-- Note that having your doctor PRESCRIBE BED REST for severe attacks is important. If you stay in bed on your own volition and doctor isn't notified, concurs, and documents it, that episode doesn't count.
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MEDICAL RECORDS:
Lastly, as you start to prepare your claim, I recommend that you gather up and keep copies of your medical records. The current practice is that doctors shred your records after a few years, or they switch to newer electronic systems which don't bring forward patient files from the previous digital system.. Hospitals retain electronic versions of reports of testings.
When you ask for records, tell them that you want Physician Notes, all records of consultations with specialists, test reports by third party providers, etc.
Put your name & SSN at the top of all copies of these records that you attach to the VA claim.
So, why do it yourself if the VA is going to consult those medical offices anyway to get records?
-- You'd like to know at the start of the process exactly what supporting medical evidence the VA will have in rating your claim.
The alternative is to HOPE that the germane records are (1) still available, (2) that the overworked, low-paid office clerk who's researching the files in the hospital or doctor's office finds what specifically is required by the VA, (3) that time and cost pressures don't effect the clerk determining which of the records that they found get xeroxed and mailed to the VA, (4) that the equally overworked, low-paid office clerk in the VA mail room knows which VET claim those records go will and get them there versus just puting them aside where they sit as "unidentifiable" for a couple of years before being shredded.
(This last event is exactly what has happened to thousands of records at one Regional VA Office's mail room.)
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Let me know if I can help you. More to come in future emails.
Butch