Ongoing symptoms from prostate cancer treatment: What level of compensation?


Jim: In Nov 2012 I had my prostate removed for cancer I was awarded 100% for 6 Months and then reduced to 60% in amount of $1100 a month it has been over two years and I  still have no erectile function or when I do use alprostadil suppository it hurts so bad I can't do anything, I cannot wait more than half hour or before I have to urinate if I drink water, beer, gatorade, pepsi go longer. Do you think I am getting enough compensation?

Jim's Reply: No, if you aren't rated for erectile dysfunction (ED), you should be. ED is a separate rating and is referred to as SMC-k. You must apply for the SMC-k benefit as you would any other.

Compensation Ratings and Work Restrictions

Jim, I have been 70% diabled with a 100% IU rating for the last 8 years for mental health. As of recently, I was awarded 100% P&T with  "no future exams scheduled." However, I was sent a questionnaire about my work history for the last year that said I must get it in or else they could re-evaluate. I did fill it out and stated I haven't worked. Is this form something I will have to fill out every year or on a consistent basis? Also, just for curiousity, when someone is rated 100% P&T can they work at all in self-employment or W2? If so, how much can they work without being penalized or jeopardizing their 100% status? Thanks, for your time. Dan

Jim's Reply: Every veteran who has a TDIU rating should complete the VA Form 21-4140-1  each year about the time of the anniversary of the award. VA should mail the form to the veteran but often enough, that doesn't happen. The veteran is responsible for getting the form in, so download it if necessary. Veterans can stop worrying about the form at age 70.
  I believe that you mean you've been awarded a 100% schedular rating to replace the TDIU rating. If that's correct, you don't have to worry about that form. If you have a 100% schedular rating, you can work all that you're capable of. Only the TDIU rating restricts gainful employment.
DIC benefit for Surviving Spouse
Jim: I am 100% service connected disabled. If I live 10 years then die of natural causes, will my wife recieve a monthy check of any kind?
Jim's Reply: Yes, if you die of any cause after 10 uninterrupted years of a 100% P & T benefit, your surviving dependent will be eligible for the DIC benefit. More ore detailed information here:
Dependency and Indemnity Compensation
Dependency and Indemnity Compensation (DIC) is a tax free monetary benefit paid to eligible survivors of military Servicemembers who died in the line of duty or eligible survivors of Veterans whose death resulted from a service-related injury or disease.
Eligibility (Surviving Spouse)
To qualify for DIC, a surviving spouse must meet the requirements below.
  The surviving spouse was:
Married to a Servicemember who died on active duty, active duty for training, or inactive duty training, OR
Validly married the Veteran before January 1, 1957, OR Married the Veteran within 15 years of discharge from the period of military service in which the disease or injury that caused the Veteran's death began or was aggravated, OR Was married to the Veteran for at least one year, OR Had a child with the Veteran, AND Cohabited with the Veteran continuously until the Veteran's death or, if separated, was not at fault for the separation, AND
Is not currently remarried
Note: A surviving spouse who remarries on or after December 16, 2003, and on or after attaining age 57, is entitled to continue to receive DIC.
Eligibility (Surviving Child)
Not included on the surviving spouse's DIC, AND Unmarried, AND Under age 18, or between the ages of 18 and 23 and attending school.
Note: A child adopted out of the Veteran’s family may be eligible for DIC if all other eligibility criteria are met.
Evidence Required
  Listed below are the evidence requirements for this benefit:
  The Servicemember died while on active duty, active duty for training, or inactive duty training, OR
The Veteran died from an injury or disease deemed to be related to military service, OR
  The Veteran died from a non service-related injury or disease, but was receiving, OR was entitled to receive, VA Compensation for service-connected disability that was rated as totally disabling
  For at least 10 years immediately before death, OR
Since the Veteran's release from active duty and for at least five years immediately preceding death, OR
For at least one year before death if the Veteran was a former prisoner of war who died after September 30, 1999
How to Apply
Complete VA Form 21-534, "Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits by a Surviving Spouse or Child and mail to your regional office, OR
Work with an accredited representative or agent OR
Go to a VA regional office and have a VA employee assist you. You can find your regional office on the VA Facility Locator page OR If the death was in service, your Military Casualty Assistance Officer will assist you in completing VA Form 21-534a, " Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits by a Surviving Spouse or Child" and mail to the Philadelphia Regional Office
Survivors Pension
The Survivors Pension benefit, which may also be referred to as Death Pension, is a tax-free monetary benefit payable to a low-income, un-remarried surviving spouse and/or unmarried child(ren) of a deceased Veteran with wartime service.
Eligibility
The deceased Veteran must have met the following service requirements:
For service on or before September 7, 1980, the Veteran must have served at least 90 days of active military service, with at least one day during a war time period.
  If he or she entered active duty after September 7, 1980, generally he or she must have served at least 24 months or the full period for which called or ordered to active duty with at least one day during a war time period.
  Was discharged from service under other than dishonorable conditions.
Survivors Pension is also based on your yearly family income, which must be less than the amount set by Congress to qualify.
  While an un-remarried spouse is eligible at any age, a child of a deceased wartime Veteran must be:
Under 18, OR
Under age 23 if attending a VA-approved school, OR
Permanently incapable of self-support due to a disability before age 18
  Your yearly family income must be less than the amount set by Congress to qualify for the Survivors Pension benefit. Learn more about income and net worth limitation, and see an example of how VA calculates the Survivors Pension benefit.
How to Apply
  To apply for Survivors Pension, download and complete VA Form 21-534EZ, “Application for DIC, Death Pension, and/or Accrued Benefits” and mail it to the Pension Management Center (PMC) that serves your state. You may also visit your local regional benefit office and turn in your application for processing. You can locate your local regional benefit office using the VA Facility Locator at the VA website.
Family Caregiver Program: The Family Caregiver Program is a fairly new program being run by the VA that provides financial assistance, among other things, to family members who are caring for severely injured Post-9/11 war veterans. To find out if you qualify and to apply for the program, visit the VA's website . You may also call the VA at 1-877-222-8387.


Double Compensation
Hi Jim,
  I am at a loss regarding the way my Regional office is implementing the use of  SMC - "K". As far as I can see from the rules and regulations, this Special Monthly Compensation is usually added to basic rate or other SMC but with amount limitation. I had been awarded SMC - "M" for lost of function of both feet. When I applied for SMC - "K" for losts of function of both feet, it was denied. Their reason is double compensation because I am already being compensated under letter "M". Can you give me your professional opinion regarding such regulation?
Reply,
It seems apparent to me that you aren't allowed to be paid for the same condition twice.
  If you could be paid twice, why not 3 times? Or 4? Double-dipping or collecting twice for the same reason is generally forbidden, not only at VA or DoD but in almost any compensation or insurance scheme I can think of.

Must I  Use VA Providers? 
Dear Jim,
I received my 100% rating with reexam scheduled in 2020.   I am retired and use civilian providers for treatment especially psychiatrist. My concern is that I will be unable to submit records before reexam?  I have good relationship with providers and hate to only use VA.  What do you recommend? Thanks so much
Reply,
Any qualified provider you choose is fine. VA doesn't demand that you use a VA provider. All you'll need to do is to be sure that at the appropriate time, you can provide copies of all your records to the VA.
  We urge veterans to keep copies of all their records and send copies to VA when needed.
Don't rely on VA or others to retrieve records for you. Do it yourself.

Should I File for An Increase?
Hello Jim,
  I am currently receiving 60% disability for multiple combat related injuries. I thought that I received it for just my back and maybe my ankles but after requesting and then receiving my disability information through the VA, I found out that I am 10% in each: both knees, both ankles, one wrist, and my lower back(bulging disc/degenerative disease).

I believe that all is accurate minus my back. I think that I should have more of a percentage of disability for my back since it has not only gotten worse, but it has prevented me fromworking multiple jobs and bothers me in my job now. 

  Would it be a good idea to request an increase or not chance losing percentage? I go to the VA often but mainly for mental health for PTSD and because I am a recovering opiate addict. I haven't been to the VA much for my injuries. Also, should I request a percent increase for my mental issues? Thank you!

Reply,
I can't advise you about what you should do. I can only tell you that requesting an increase to existing ratings is pretty common and not all that hard to do. If you believe that you have disabling conditions that have gotten worse over time or if you feel that there are conditions that should be service connected and rated, then you may want to file for an increase. Good luck sir!

Social Security, VA, and Medicare-HELP!
Hi Jim,
  My father recently turned 65.  He’s 20% disabled by the VA and has been receiving VA benefits prior to his 65th birthday.  We are trying to determine the route to take with Medicare and growing more confused with each call we make.
  I’ve reached out to Social Security, VA, and Medicare in hopes of gaining clarification. Each entity tells me to call the other.   I’m hoping that coming across your website while doing a Google search is a godsend.
  If we keep Part B of his Medicare coverage, how do we blend the VA, Medicare, doctors visits, testing, and prescriptions? If we keep only Part A, are we making a mistake by dropping part B. Any suggestions, opinions, insight you can offer will be greatly appreciated.  We need help making a decision.

Reply,
VA health care and Medicare are sort of complimentary although totally separate.
How much of each the veteran should use depends on the convenience he wants and how much Medicare deductible his wallet will stand. I use both. I have Part A and Part B.
  I rarely use them but sometimes I need something (podiatry for example) that VA seems to have a hard time delivering, so I go to the civilian sector. VA and Medicare won't cover deductibles for each other. You can use one or the other but not both simultaneously.
  If you go to a civilian provider, you'll use Medicare and pay the requisite deductible.
  If you go to VA you'll have the same scenario...Medicare won't help with a VA deductible.
I elected to take Part B. Part B is actually the most useful. It covers doctors and things done in doctors offices. Part A isn't elective, it's required along with SSA retirement. If you don't elect Part B now and want it in the future, the monthly payment goes up year by year as a penalty. Most experts recommend that veterans do not take Part D, the prescription coverage benefit. There is nothing that we can't get through the VA pharmacy so that's an unnecessary expense. I don't have a Medicare supplement plan like that AARP offers. Those plans are expensive and still don't cover everything. I set enough money aside so that rather than paying to AARP, I keep the money to pay for my deductibles. The only time that a supplemental plan helps is in the event of a catastrophic illness and if that happens I'll head to VA.
  It's a very personal decision with a lot of alternatives for every veteran to consider.
  I'm fortunate that my overall health is pretty good and other than some chronic problems, I don't need hospital services or specialist services very often. I see my VA doc about once a year or a bit more if I need to. I live in the small town of Fernandina Beach where I have a civilian family practice doc who is officed about 10 minutes from me.
  I've seen him and a Jacksonville eye doc this year because of the convenience factor and I've paid the deductibles out of pocket. Those deductibles aren't much as a rule. If a doctor charges $100.00 for a service, Medicare may allow $40.00 as the final fee. Of that you pay 20% out of pocket. The hospital (Part A) side works in a similar fashion although those deductibles can grow PDQ.  Hospital care is least expensive at VA.
  I hope this helps. If you have other questions, please feel free to ask.

How May My  Surgery Effect My Rating?
Mr. Jim,
  I am rated 30% chronic sinusitis and 10% rhinitis. I am scheduled for sinus surgery.
  After surgery would they lower my rating or could it possibly be raised to 50%?
They re doing the endoscopic surgery to drill out sinuses.
Reply,
  If your condition improves to a measurable degree, of course the rating may be lowered.
A disability rating should reflect the condition as it is, not as it was. If the surgery were to make it worse, then it could be raised to a higher %.
  Determine exactly what your current ratings are before you proceed.
  Dig out those original award letters so that you know exactly what sort of benefits and ratings you have. Don't just guess at it, get the facts. You may need
to check your records at the eBenefits site.
  This will be a good time to initiate the VA Form 21-0966. Using the VA Form 21-0966 will establish the effective date of your claim to increase the ratings of your existing benefits.
  Look at the ratings table for your existing benefit.
The Schedule For Rating Disabilities is your guide to what you may be eligible for.
  You may learn that your current rating is already at the maximum or that you're current rating is seriously deficient. You have to research it to know.
  Gather your evidence and records to support the increase.
  If there are civilian medical records, you have to gather those for yourself.
Do not rely on VA to obtain your civilian records.
  Consider having an IMO completed.  The IMO is the most efficient way to provide evidence in support of your claim.
  It's time to file the claim.
Use VA Form 21-526EZ
Be as precise as you can to describe just what it is that you want.
Provide supporting evidence.
Proceed With Caution
Any time we ask VA to open our file to make any adjustment, we open ourselves  up to a complete review of all ratings.  Many veterans get an unpleasant surprise when they discover that their request for an increase leads to a proposal to decrease a rating.
You have an absolute right to be rated appropriately for each disabling condition you may have incurred during your honorable military service.
  If you feel that your rating is not correct for your condition, by all means seek an increase.
  Before you do...be sure that you can't lose.
  Check your current condition's symptoms against the standards you find in The Schedule For Rating Disabilities. Match your physical or mental health status to the ones you find there.


The VA fumbled, they should pay up
  I have an appeal for a heart condition that was filed in 2011 to raise my rating from 60 to 100.  While waiting on VA I was granted 100% P and T Schedular on a totally separate claim I filed in 2013.  VA obviously dated the 100% rating from the 2013 date.  After about a month or so VA suddenly sent me a SOC on my appeal for the older issue that was pending since 2012 which is when I filed the appeal and NOD.
  My question to you is should I continue my appeal on the older claim?
  Basically all it would do is move the 100% rating back to the 2011 date which would be about 2 years of retro pay if granted.  Or should I just drop the older claim not wanting to rock the boat?  I'm concerned also that even though VA has granted P & T and no future exams scheduled that they will suddenly try reducing my ratings anyway because I'm appealing the older issue.  My VSO says to still keep the appeal because there's always a 50/50 chance the judge will side with me and it's also the principle that it's the correct rating for that claim.  What advice do you have Jim?
Reply:
I agree with your VSO. Frankly, I can't imagine that even VA would try to lower an existing rating under these circumstances. It sounds as if they fumbled the ball and the record should be corrected. I think we agree that the money isn't the important thing...it won't be a fortune. But you earned it and VA should graciously settle up.
VA is taking forever! Did my claim even get filed?
  My husband was drafted into Army during 1962-64 and did several tour of duty to Viet Nam setting up radio contact; he was stationed in Japan.
  Last year he was diagnosed at Tucson VA with stage four lung cancer and never smoked. He also has Prostate cancer which was detected at the same time. We filed Agent Orange claim at VA months ago and heard nothing. When I call the Legion fellow that did paper work (and we supplied him with all health records and the document showing he was in Army) he said we should get a letter within six weeks, but that has not happened.When I called the 800 number for VA claims the answering device says they are behind six months.
  We also believe Bill’s military records might have been in the 70s fire.
  Should we do anything or just wait?
  He is on a chemo maintenance program at this time after having six chemos and suffering through it all. We assume he will be turned down and then the fight begins. We hope he is around to do what it will take.
  Any advice is greatly appreciated.
Reply:
  If you used an American Legion service officer, that should be your point of contact.
  If you filed a claim months ago and you haven't heard anything yet, I question whether the claim was filed. VA takes forever to make a decision about a claim but they always notify the veteran within weeks by letter. The letter usually says something like, "We're working on your claim...". If you don't have that letter, you should be sure the service officer actually filed the claim for you.
  The VA is some 6 to 24 months behind on most claims. There is no way to speed up a claim or to prioritize it. It's particularly important to submit the claim perfectly when that's done. If the service officer did a good job, the VA will get to your claim in the order it was received. If everything is in order, VA should notify your veteran of a C & P exam that he is required to attend.
  Otherwise, there's nothing to do but wait. Attempting to track the claim and make it move faster often slows it down.
  If his claim is denied, you should quickly speak with a veteran’s law attorney.
Why is the Board of Veterans' Appeals mailing my decision to my regional office?
Just saw on e- benefits my BVA appeal in Washington has made a decision on my claim and are mailing to the following: me, my rep, and back down to RO.
Why back to RO?From what I have read does this mean I possibly won after all these years?
Any opinions on this?
Reply:
  When BVA sends a claim back to the RO it's often called a "remand".
  There are any number of reasons that BVA could remand your claim back to the RO. The usual reason is that you won service connection that had been denied and now the RO has to determine a rating %. The BVA can determine service connection but they can't assign a rating %. The RO would then schedule you for another C & P to determine the rating.
  BVA may have determined that the RO didn't do all they should have earlier. The BVA may order the RO to do a more thorough C & P exam or to collect more records and then make another decision based on that new evidence.
  The bottom line is that the BVA has a dozen or more ways to send a file back to the RO for rework. You may be on the way to getting the benefits you seek, you may be staring at 5 more years of paperwork.You won't know until you see your letter.
  Just curious...why aren't you asking your "rep" these questions?
  Did you know that I'm recommending that every BVA claim be handled by a veteran’s law attorney...not a "rep"? I know that these VSO people are free...but you get what you pay for, don't you?
Jim explains the importance of completing paperwork
Dear Jim,
  My father was discharged from the Army in the early 70's, he was given a piece of paper that stated he had hearing loss. He went to the VA in La Jolla 2 or3 yrs later and was told learn to read lips.
  After I got out of the Navy I was awarded 100% for PTSD, he put in a claim for a hearing loss. Well, during his C&P they only did a physical, he was denied for not having a Maryland CNC Exam.
  We move to Tampa, FL in mid 2013 and is trying to get it done again & is getting the run around.
How does he get the proper exam's needed? We both go to the James A. Haley VA. Any help would be greatly appreciated in this matter. Thanks!
Reply:
You mention that your father has filed a claim in the past for hearing loss. It seems he was denied because of an inadequate C & P exam. The C & P exam should have included the standardized audiology testing required by VA.
  That's an oversight on the part of the VA. Once he received the denial letter he had one year to appeal that denial. If he didn't formally appeal during the one year period after denial, the claim is considered to be permanently adjudicated and it's closed.
  It sounds as if he's now using health care services in West Florida. That's fine but he still has to file a formal claim for hearing loss. Talking with health care providers won't do the trick. Until a formal claim is filed, nothing will happen.
  Once a formal claim for hearing loss if filed, he should be scheduled for an audiology exam at the VA facility closest to him that conducts these exams. That is all a part of the process after a claim has been filed. He doesn't have to do anything to schedule the exam.
  Once the exam is completed, he has nothing else to do other than to wait. It is taking VA 6 to 18 months to process claims. There is no way to speed that up.This will be a new claim
More questions about TDIU
  I am 100% and it says total and permanent on my Service letter. I never saw anything on my original letter (which I can not find) about a scheduled date for a new exam, which confused me. On top of that, I don't see anything about the TDIU. I was reading on the back, and it said under VA Benefits Details, something about Individual Unemployability. Is this just across the board under benefit’s detail? Would the TDIU be stated under VA Benefits Information? I am just curious. I have not had a job in two years, and was unsure if I am allowed to get one, as I have been told I can and then others told me I can not. If you could let me know any information I would be grateful.
Reply:
  VA does a terrible job of telling veterans the simplest details. This leads to a lot of confusion for everyone. What I can interpret from what you tell me is that you are rated as 100% TDIU. This is a permanent rating and there are no future exams scheduled.
  This means you aren't allowed to work at "gainful employment". The VA defines gainful employment as a job that will pay you more than the poverty rate for your region.
  You can have a look on eBenefits to see if it will generate a letter for you. The letter often defines your benefits better than the documents you receive in the mail.
Increasing Benefits Award
  My dad is a WWII vet, served in Europe and developed trench foot, arthritis of the shoulders and hips due to extreme conditions carrying a 30 caliber machine gun up and down mountains in France. He has been rated at 60% disability for a number of years, but now he has been found to have PST as well, probably had it before it was even a known disability. He is 91 this May and has memory and balance issues as well.
Do you see any danger of them taking away his 60% if he applies for an increase?
Reply,
  I don't think there's much risk. But I have to question what sort of evidence you'd present to seek an increase? At age 91 arthritis, balance and memory problems are sort of expected and may be a challenge to service connect.  In any case there is always some slight risk of VA modifying benefits when we seek additional benefits. Any time our file is opened one of the first things they do is to look for benefits that may be due for a review.
  Once that starts, we can't predict where it may end.  If you aren't extremely confident of the evidence you have to support an increase, I'd give it a lot of thought.
Prostate cancer and incontinence rating C&P
I will undergo my compensation and pension examination this week for incontinence issue relating to my prostate cancer.  I was given a 20% disability rating 5 years ago and I am seeking a 60% disability rating because of the frequency and number of pads I have to use each day.  I've submitted the required forms from my doctors showing the incontinence issue but what will I have to go through during the exam and what should I be prepared for?  Thank you for any assistance.
Reply,
It sounds like you're as prepared as it gets. Be firm that you use (x) number of pads each day and that you experience urinary incontinence. If you have nighttime awakenings to urinate
or if you must get up to change pads, be sure to tell the examiner. If you have experienced erectile dysfunction (ED) be sure to stress that to the examiner.
If you do experience ED, you should receive the SMC-k rating for that.
Good luck sir.
100% covered by VA medical? Do you still need medicare part B?
  My husband is 100% covered under VA Medical. Should we continue to pay for Medicare part B? We are a Triple A member so if we travel we can buy special medical coverage for the trip.
Reply:
It's a personal choice. I pay for Part B because I like the flexibility it gives me. For example, I didn't care for the VA orthopedic care I was receiving so I used a civilian surgeon with my Part B. I paid a small copay and I was finished with my treatments before VA could even line up my appointment.
My VA primary care guy is pretty good but I don't trust a lot of the specialty care VA offers. So...I'll keep my Part B.
  For what it's worth, I get a lot of email from vets who didn't sign up for Part B early on. Now they want it but there are penalties built in for the delayed onset of Part B. It costs more than it would have. Good luck.
Family members want to know what benefits they are eligible for
  I am the daughter of a Marine who is 10% disabled. I applied for financial assistance for school and was denied because my father is not 100% disabled. I had initially applied because a friend of mine applied for her children whose father is also a veteran with 10% disability and was given the assistance. I am reaching out to you to see what my rights are from here and if it is worth my time to pursue the matter. When the Department of Veteran Affairs replied to my initial application, they said I was denied on the grounds that my father is not 100% disabled and the only way I could appeal it is to prove that he is 100% disabled. I greatly appreciate your time and assistance in the matter.
Reply:
In broad terms, the child must first be a dependent. If the child is emancipated...living away from the veteran parent, married and so on...they are no longer dependents.
  Then the veteran must be 100% disabled, and his rating must be permanent and total or P&T.
  I generally advise that we do not compare our benefits with others.
  Your friend may have received some other sort of benefit that has a different requirement. When we start comparing notes but we don't have all the documentation in front of us, we can't determine exactly why your friend got some sort of benefits.
  The upper tier of benefits for dependents (education, CHAMPVA health insurance, etc.) doesn't become available until the veteran is declared 100% P&T. I'd guess that if you explored your friends case a bit you'd learn that there are circumstances other than C35 DEA involved.
  A 10% rating gets the veteran very little in the way of any substantial benefits and no benefits for dependents. The vet gets a small monthly check but no real health benefits or privileges.

Jim explains the importance of keeping personal information updated with the VA
  A disabled vet I know is really having problems with his ACH deposit this month. He changed bank accounts and his payment is lost they have placed a "tracer" on it. They are now saying 6 weeks. If he doesn't pay his rent tomorrow, he will be evicted, he wants me to drive 6 hours each way to Nashville office to see if they will cut him a check on the spot or find his deposit. Do you have any idea before I drive 12 hours if they will help him or turn him away?Thank you so much!
Reply:
No, the VA Regional Office won't cut a check in that way. The regional office isn't the place where payments are made from so driving there won't help. They will want to complete the "tracer" process in the way they usually do that and won't consider anything else.
  Changing any record at VA is a serious problem. A change of address, a change in the veterans telephone number, changes to banks and even email addresses seem to be beyond the capability of the VA. If we change our mailing address at the VA hospital or clinic we use, that doesn't get transmitted to the regional office...or anywhere else within the VA. We have to go through any number of cumbersome procedures to properly change all our data if and when we need to.
  It's unfortunate when these things happen and thousands of similar situations occur every day at VA. I advise veterans to plan their finances far enough in advance to anticipate that something like this will happen and to prepare for it.
  Ultimately, we cannot depend on VA to be prompt or to care if a mistake brings a crisis into our lives.
  Trying to seek any sort of shortcut from VA may even delay the resolution to your veteran’s dilemma. Sometimes the faster we try to push them to go, the slower the process will become.
  I'd suggest that his best bet is to work with his landlord to avoid eviction. He may want to seek help from some local social agencies.

Why does the VA want to re-evaluate my PTSD rating?
I was med boarded last year for ptsd @ 70% my back @ 20% and a list of other things that have me at an 80% rating from the army and 100% from the VA.
  I was called to schedule a revaluation.  Do you think they are trying to reduce my compensation even with all the evidence that has been presented to them for my condition? The appointment is only for my PTSD, all my other disabilities have received their final ratings. I knew at some point they would call me in for a revaluation but is it to attempt to reduce my compensation or to see where they go from there because my condition hasn't improved at all from what my psychiatrist and therapist have said, so I'm confused. Is this just routine or are they trying to lower my rating?
Reply:
It's routine. Almost all PTSD or other mental health ratings are temporary and require future exams. The exam is to determine whether or not you have improved or maybe gotten worse. If you've improved, your rating may be lowered. If you're worse, the rating may increase.
  It's the law. VA isn't doing this just because, they have to examine you on a regular schedule.
What happens to my benefits after my death?

I am rated 80% SC Unemployable Total & Permanent.
  I have been married for 5 years.  I would like to know what the spousal benefits are, should I pass away.  I appreciate your help in advance!  Great job you do and you are a great guy!
Reply:
Thanks for your kind words.
The benefits that would apply are called Dependency and Indemnity Compensation (DIC). Whether your spouse would be eligible for any benefit will be determined by the cause of your death and/or the length of time that you've been rated as 100% P & T.
  If a veteran dies of any service connected condition, the surviving spouse is usually eligible for DIC.
  If a veteran dies of any cause that isn't rated as service connected (in an auto accident, for example) then the surviving dependent spouse may or may not be eligible.
  To be eligible in that circumstance requires that the veteran be rated as 100% P & T disabled for an uninterrupted period of 10 or more years. Thus, if you die in an auto accident today and your P & T rating hasn't been in place for 10 years, she's probably not eligible for any benefits.

No such thing as a "Reconsideration"?
  I was diagnosed with prostate cancer in August, 2013. Since I am a Vietnam veteran and served on a brown water ship, the USS Krishna, I filed a claim with the VA in September 2013 for exposure to Agent Orange. At first, the VA said that I had not been in VN. After proving through DD214 and a copy of my original orders, they said that they did not have proof that the ship I was on was in an area that was exposed to Agent Orange, even though my ship was listed as one of those on the presumptive list for Agent Orange exposure. Finally, they denied my claim and gave me a 0% rating.
  My urologist and I decided to go the "watchful waiting" route and I was prescribed Finasteride for three months to shrink the prostate. I am still on "watchful waiting" and see the doctor every three months for a PSA test and a DRE, as well as a possible biopsy every year. The VA's reasoning for my denial was that I had undergone androgen deprivation treatment for taking Finasteride and had no residuals. My research on Finasteride indicates that it really is not a treatment for prostate cancer, but a treatment to shrink the prostate. The cancer still exists even after taking the Finasteride. I understand that based on the diagnosis, a 100% rating is demanded and that rating continues until a treatment is completed. Am I correct and what should be my next step? Should I just ask for reconsideration and provide information regarding medical expert’s opinions on Finasteride as not being a true treatment for prostate cancer? Thanks for any assistance you can provide.
Reply:
There is no such thing as reconsideration. Although the term is used a lot on the Internet and by "experts", it doesn't exist.
  You should formally appeal. That means to file a NOD and then state your case.
  As it happens, I agree with you. I see this all the time.VA tries to interpret watchful waiting as some sort of magic cure if you're given any of the prostate size reducing medicines.
If you got a 0% rating for prostate cancer, the claim was not denied.
  It was approved as service connected at a 0% disabled rating. I know this makes no sense at all but it's a constant state at the VA...they pull this all the time. Finasteride is absolutely not a treatment for cancer, it's a treatment for BPH.
  So, your nest step is to mail a NOD. You will find this form at: http://www.vba.va.gov/pubs/forms/VBA-21-0958-ARE.pdf.   In the NOD tell VA what you told me. If you can get a statement from the urologist that you have had cancer continually since the date of diagnosis, that would help a lot.
  Get the NOD into the mail. Mail it using ONLY certified mail, RRR.
  Don't deliver it any otherway. Then wait patiently.

I'm 100% P&T schedular, can I go to college or work without worrying that my rating will be in jeopardy?

Jim,
  I'm 100% P&T schedular. Can I go to college or work without worrying that my rating will be in jeopardy? The only type of work I've been able to handle this far is as a substitute teacher, (I work when I can, at my choice). Lately I've been thinking of going to college or a vocational school. Yet, I worry that my rating could be in jeopardy.
70% Eyes (20 surgeries)
70% for PTSD (Iraq X2, Afghan)40% back,10% neck, 10% rashes, 10% tinnitus.
Reply:
  Yes, you may work as you please and as you're able to. The only restriction against work is the TDIU benefit. Since that's an "unemployability" benefit, the veteran isn't allowed to be employed.

  I put in a claim and was denied...How do I file another claim for the same issue?
Hi Jim,
  I have questions about claims. I put in for claim and was denied the majority of what I was claiming. I was diagnosed with Tietze Syndrome.  It’s basically inflammation of my rib heads. I have slight constant pain but when it’s at its peak, I can't do anything besides to curl up and try not to make any sudden movements. I can't pick up anything heavier than a gallon of milk. How do I file another claim for the same issue?
Reply:
If you were denied a claim, you have one year to appeal. We urge veterans to speak with a veteran’s law attorney about the appeals process. That won't cost you anything.

My husband is rated 40% disabled...he wants to apply to increase his rating
Hi Jim,
Currently my husband is rated 40% disabled.  He has 10% for sinus, 20% for a back injury, and 10% for a seizure.
  He has been retired for 15 years.  During the 15 years his sinus problems have increased to the point he recently had sinus surgery.  We were hoping this would clear up his problems but that doesn't seem to be the case.  So, he wants to apply to increase his disability rating for his sinuses.  You state on your website that he needs to write a letter to the VA regional office.  Isn't there an application to complete?  Also, if his rating is increased he will be at or over 50% disability.

Will he be eligible for concurrent receipt?

Reply:
  I can't advise about the concurrent receipt. That can get complex and I don't know all the details of his service.
  If he had surgery for a service connected condition, he should have notified the VA at that time. He may have been eligible for a 100% recuperation allowance as he recovered.
  He may still simply write a letter. That changes early next year(‘15) and a form will be required then. I suggest using the form now.
Good luck.

Doctors have very little to do with the process of filing disability claims
  I have a quick question on filing for service comp. increase. I went down to a Veteran service counselor last month and brought a DBQ form that my doctor filled out. He put in through his computer notifying the VA that I want to increase my service connection to "Save the date" as he said. Now no documentation or medical records have been sent to the St. Petersburg headquarters.
  My doctor is now being difficult and back tracking her words and doesn't feel comfortable now sticking up for me in the battle. Is it possible to ask the VA service counselor that I no longer wish to pursue the increase at all until the time being that I can find a non VA doctor on the outside to handle my care?
Thank you for your service.
Reply,
I'm unsure about what you think may have happened? It sounds as if you believe that your doctor submitted a claim for you through his computer.
The VA disability claims process doesn't work that way. I have no idea what your doctor may have done but it's not very likely that she could have filed a claim for you.
  You more or less confirm that when you say, "no documentation or medical records have been sent to the St. Petersburg headquarters".
  Doctors have very little to do with the process of filing disability claims. They usually provide an opinion along with a DBQ or some other documentation and that is considered when a "rater" begins to adjudicate the claim. VA health care providers...doctors, nurses, technical staff...are not experts in the VA disability compensation process. They really shouldn't be offering veterans advice or opinions about their disability claims. All the health care people should do is to provide good care along with appropriate documentation. The claims process will take it from there. Whether you visit a civilian doctor or stay with your VA doctor will have very little to do with your claim. You are free to withdraw a claim at any time.
Possibility of Changing Temporary Rating to Permanent
  I was award 100% disability for CLL (temporary) I am currently in the process of having to go through chemo treatments. Since CLL is a cancer that never goes away (can be in remission) but still considered there, what in your opinion would be the chances of getting my rating changed to permanent?
Reply:
  The VA is required to use "The Schedule For Rating Disabilities" when making determinations about disability ratings.
  Your statement that "CLL is a cancer that never goes away (can be in remission)" isn't quite correct. If a cancer is in remission, it has gone away. While a remission may or may not be a permanent condition, while a patient is in remission, he no longer has a cancer. If he no longer has a cancer, he can't be rated as if he had a cancer. The law requires that the veteran patient who is in remission be rated according to the residual effects of the disease and treatments.
  In The Schedule, you'll find the rating specifics for 4.117 - The Hemic and Lymphatic Systems.
  "The 100 percent rating shall continue beyond the cessation of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. 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 recurrence, rate on residuals."
  The bottom line is that if your therapy is successful and you are declared to be in remission, your temporary 100% rating will be reduced to compensate you for any residual effects of treatment. Unless and until you have a recurrence of the disease, you won't receive a 100% rating, either temporary or permanent.

Question on Bilateral Ratings
Jim,
  I recently applied for an increase to my disabilities. Everything was going great  and the Cleveland; Ohio VA Regional Office granted my increases. According to the  VARO, I went from a 70% rating to 80% during the first round of awards.
  The VARO divided my request for increase into two rounds of appointments and awards.
  While waiting for the second award, I was sure the VARO would increase to 90% due to the disabilities still being reviewed. When I got my second award letter they had changed a few numbers to suit the calculation and insisted I was going to remain at 80%. I looked over everything they did and requested a re-comp of the rates.
  My individual rates are 30, 30, 10, 10, 10, 10, 10, 10, 10, 10, and 10. Six of the 10% ratings are bilateral and thus require an additional Bilateral Factor. In the letter from the VARO they explained that my six bilateral conditions became 47%, plus a Bilateral Factor of 4.7 to  make the final percent 51.7% rounded up to 52%.
This is where they (VARO, Ohio) do the funny math. They explained to me in this letter that my rates are 52, 30, 30, 10, 10, and 10, which equates to 82% rounded to 80% for a final disability rating.
  What happen to the six 10’s? Shouldn't they have become 60% plus a Bilateral Factor?
How does anyone get a Bilateral Factor of 4.7 from 60?
Reply:
It's no surprise to you that you've hit upon one of the trickier parts of VA math.
Let's begin with the Bilateral Factor rules:
38 CFR Book C Schedule for Rating Disabilities 
Subpart A - General Policy in Rating
§4.26  Bilateral factor.
When a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before proceeding with further combinations, or converting to degree of disability.
  The bilateral factor will be applied to such bilateral disabilities before other combinations are carried out and the rating for such disabilities including the bilateral factor in this section will be treated as 1 disability for the purpose of arranging in order  of severity and for all further combinations.
  For example, with disabilities evaluated at 60 percent, 20 percent, 10 percent and 10 percent (the two 10’s representing bilateral disabilities), the order of severity would be 60, 21 and 20.
The Schedule §4.26 Bilateral factor
§4.26 Bilateral factor
When a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and 10 percent of this value will be added (i.e., not combined) before proceeding with further combinations, or converting to degree of disability. The bilateral factor will be applied to such bilateral disabilities before other combinations are carried out and the rating for such disabilities including the bilateral factor in this section will be treated as 1 disability for the purpose of arranging in order of severity and for all further combinations. For example, with disabilities evaluated at 60 percent, 20 percent, 10 percent and 10 percent (the two 10’s representing bilateral disabilities), the order of severity would be 60, 21 and 20. The 60 and 21 combine to 68 percent and the 68 and 20 to 74 percent, converted to 70 percent as the final degree of disability.
(a) The use of the terms “arms” and “legs” is not intended to distinguish between the arm, forearm and hand, or the thigh, leg, and foot, but relates to the upper extremities and lower extremities as a whole. Thus with a compensable disability of the right thigh, for example, amputation, and one of the left foot, for example, pes planus, the bilateral factor applies, and similarly whenever there are compensable disabilities affecting use of paired extremities regardless of location or specified type of impairment.
(b) The correct procedure when applying the bilateral factor to disabilities affecting both upper extremities and both lower extremities is to combine the ratings of the disabilities affecting the 4 extremities in the order of their individual severity and apply the bilateral factor by adding, not combining, 10 percent of the combined value thus attained.
(c) The bilateral factor is not applicable unless there is partial disability of compensable degree in each of 2 paired extremities, or paired skeletal muscles.


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Jim Strickland 2012 Mailbag
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NOTE:  Letters in my Q&A columns are reprinted just as they come to me. Spelling and grammar are left as is and only small corrections are made to improve readability, ensure anonymity or delete expletives that may offend some readers. This is not legal advice. You should always seek the advice of an attorney who is qualified in Veterans' law before you make any decisions about your own benefits.
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