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Veterans' Advocate and "all 'round good guy," Jim is available to answer questions for Veterans and their families on a wide variety of issues. He has dealt extensively with the VA and has a background in the medical field.
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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. Visit Stateside Legal (below) for assistance with legal issues.

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.

                  November 2010 Mailbag

Delay in obtaining medical supplies

I belong to the Northern California Health Care System. I'd like to know why it takes a while before the system to issue medical supplies to veterans? My doctor ordered me stockings for my leg about two months ago and I still have not received them to date.

Why does the prostetics department just sit on doctors orders. I asked my doctor why it is taking so long to get the item he ordered for me and he told me that is with all the orders that he requests. I'm not sure because of the Location of Clinics that orders are not being filled in an timely manner.

Your response will be greatly appreciated.


I have no explanation. I'd have to guess that somewhere in the system is an individual who is not fulfilling their job requirements. In the VA system that's not at all unusual.

I suggest that you file a complaint with VA OIG here

Once you do that, please let me know how they respond.

Medications and Health Hazards

I am just wanting to rant about this medication. Prior to going to Vietnam I went through 4 months of combat training at Schofield Barracks in Hawaii. The odd fact of this is that we were all Air Force personnel being trained as Combat Security Policemen under a program known as Safeside. A good number of our trainers (all Air Force) were graduates of the Army Ranger program. Our training was similar.

Any time a person went on sick call to Wheeler Air Force Base they automatically figured you were trying to get out of the program and the main prescription was Darvon. Now the FDA has stated the the drug propoxphene (which is in Davon and Darvocet N) puts patients at risk of potentially serious or fatal heart rhythm abnormalities.

Agent Orange wasn't going to hurt us, Darvon was "good" stuff. Next I suppose we will find out that our weekly malaria pills could cause something. I apologize for this email but I just had to vent.


There's a problem if you rant about the military giving you Darvon. The fact is that back then it was one of the most prescribed medicines everyone, not only the military.

Prescription drugs have that sort of history. You may be aware that cocaine and heroin were widely prescribed 100 years ago. I can't begin to name all the drugs that have been championed by scientists and then after 50 years of use we learn of hazardous side effects.

Along with Darvon I well remember APC tablets. Then there were salt tablet dispensers hanging near water spigots. Can you even imagine anyone telling you that you should take what equals two teaspoons of salt today?

It goes on today too...Celebrex was the best thing since sliced bread 15 years ago for arthritis and joint pain. Never mind that people dropped dead from heart attacks using the stuff.

It has always been that way, probably always will...

C&P Billing error

My husband just had a C&P exam for Agent Orange related Ischemic Hearrt Disease on October 4th, 2010. We just received a statement from our private insurance, BCBS, that they were billed for the exam under the exam code of "Emergent Medical Exam." The health insurance has never been billed before and he is already 100% P&T for PTSD. Is this a new VA policy? Whom do we contact to determine why the private insurance was billed.


No, this is not a VA policy, it's just another error typical of VA.

I'm seeing more of this sort of wrongful billing lately.

First...advise your private carrier they should not pay that bill.
Then file a complaint with VA OIG. That's simple to do here

I'd appreciate it if you will follow up with me to let me know the outcome as you go along.


Your name has been forwarded to me by an old friend who I believe has worked with you. On November 11 (an appropriate day for a veteran), I had quintuple by-pass surgery. The VA had determined the day before that this was a necessity as opposed to a heart attack.

The reason for this letter is that I am currently 40% disabled as a diabetic (Vietnam and Agent Orange). Both the VA and my civilian surgeon "suggested" the heart disease might be tied to my diabetes. If that should be the case I feel compelled to push for additional disability (both a matter of principle and also to help cover medical costs).

Perhaps you can suggest how to work on this in the most expeditious manner.


I may be able to steer you in the right direction.

You should file a claim for Ischemic Heart Disease. That is now an Agent Orange condition and you will be rated for it.

Filing could not be any easier. Write a simple letter to tell your Regional Office that you are filing to claim IHD. Send it via certified mail, return receipt requested. Please only use certified,
RRR as no other way provides evidence of mailing.

You will get the receipt back and then VA should soon contact you to verify that your claim is in process.

Please proceed to do that. VA will ask for records and so on later.

If you would, please tell me why you had a civilian surgeon. getting VA to pay for that will be tricky unless you had advance approval.


I talked with you about my AO claim with the VA and was amazed that the VA called to ask if I had anything to add to my claim,,well they approved my ear ringing ,,tinnitus and gave me 10%, they denied everything else except my ischemia,,they are holding that pending a echocardiogram, because at my recent C&P exam by the VA doctor, my blood pressure was normal and the EKG was normal as well

,,well my treading VA doctor had, two years earlier, diagnosed me with atherosclerotic heart disease, which is in the record and has me on Amlodipine which controls my BP,,with out it,,my BP is over 165/90 so of course those tests would be normal and now they are scheduling me for a echocardiogram and then I guess they will deny the ischemia as well. I have peripheral neuropathy but I am only pre-diabetic but the neuropathy is actually secondary to a bad landing at Cam Ranh Bay AB, where my back was fractured,,but I can't prove the incident,,no record of the event,,but I have buddy letters and my surgeon will write a support letter concerning my back and how it relates to military service.,

So I will hear from the VA for a echocardiogram exam and if that shows normal,then what,,It's the Meds!!,,but I don't think they want to hear that,,so much for the ischemic heart disease as a presumptive,,although,,all through the denial letter they concede that I had boots on the ground,,acknowledge AO my question is,,if the Va doctor diagnoses me with atherosclerotic heart disease and the "mother ship" VA denies me,,,then who's in charge and what's my recourse,,appeal of course,,but what are my chances,,I don't want to stop the meds so they can get a good look at my heart with out the drugs,,because I afraid I might hurt my self, What do you think,


The Regional Office is always in charge. Any physician report is only a part of the picture. Decisions are made at the RO.

If you have not had stents, CABG or a diagnosed heart attack, it's very unlikely you'll be awarded IHD.

We must always remember that disability compensation is meant to pay a monetary bonus to us for a disabling condition. Having a condition is not the same as being disabled by it.

If you have a normal EKG and your echo shows normal heart function (I suspect it will) then just because some doc made an obscure reference to IHD years ago does not mean you are disabled. In fact, most of us over 50 could very likely say we have IHD. It's a fact of our American lifestyle of fast food and so on. The echo will give a fairly accurate reading of how efficiently the pump function of your heart is working. If that number is normal, how can you be awarded money for a disability?

You first have to explain why you believe you deserve disability pay if you aren't physically disabled. Be thankful that you aren't...serious heart disease is not fun to live with.

High blood pressure is just the same. The medications we use today are terrific. They control the BP with few, if any, side effects. Most are inexpensive and when taken daily our blood pressure is perfectly normal. While 165/90 is high, it's on the mild side of high. Most docs aren't terribly concerned until you have steady readings of 220/120 or so...then you have troubles. I've taken BPs of people with 290/150 who seemed very healthy. To have high blood pressure many years after service will not make one eligible for a disability award. HBP is often a simple problem of aging and if it wasn't diagnosed on active duty, it can't be service connected.

Besides...where is the disability from your BP?

If your back was "fractured", didn't you seek medical attention? Why is there no record? As a rule anyone who has a fall or "hard landing" serious enough to actually cause a fracture will need immediate medical attention. If not immediate, they seek care PDQ because that can be very painful and debilitating. If you did not seek medical attention there is little chance VA will award you anything. While "buddy letters" can help support a claim there usually must be some sort of corroborating evidence.

If those letters stated that the buddy was with you, remembers the event and knows when you sought medical treatment or was at medical treatment with you, that may help.

I don't know that a physician can write a letter without evidence to support the writing. If all the doctor can say is that you told him of an in-service back injury but he has no other knowledge of such a thing, any statement by him won't be of much help.

"Pre-diabetic" is another of those conditions of aging. It's hardly disabling. If we consider the definition everyone is pre-diabetic.

In an earlier email you told me "I filed a case regarding hearing loss and tinnitus,and the usual; prostate trouble, ischemia, peripheral neuropathy, diabetes and jaw pain,,well I filed all this in June,,just to see what would stick".

You have scant evidence of ischemia. You do not have diabetes. "Prostate trouble" is not prostate cancer and most men over 50 will have some prostate issues. I can't imagine how would be service connected. You made no case to me for jaw pain so I don't understand that one at all. I see you were awarded the usual 10% for tinnitus, you make no mention of hearing loss so I'll assume your hearing test is normal.

I can't recommend that you pursue any appeal based on what you tell me. To be honest, I would not have recommended that you file for any of these conditions based on the evidence you've offered me.

Some folks would point out to you that the VA has a huge backlog of claims. Some say that at least a part of the backlog is caused by veterans who file a bunch of stuff to "see what sticks" and that makes it very difficult for vets with legitimate claims.

Veterans who need help are suffering while VA tries to catch up and decide their fate. Those same critics would accuse you of gaming the system in hopes of getting some money, not because you are disabled. Your statements give a picture of a guy who is aging and has the conditions of a man getting to be older but otherwise in pretty good health.

If I were you, I'd carefully consider all that before I continued to pursue any more claims.

Agent Orange Registry (AOR)

I have been on your website and tried to use the ‘Post Msg’ button to ask a question but it doesn’t seem to be working. So forgive me if this is not the correct way to contact you. I am not good at asking questions so maybe I didn’t know what to expect last week when I went for the AO exam at a VA facility. After all these years I figured it was time.

Anyway, they had done blood work at an earlier time, all okay. But basically all I had was a hearing test, an EKG, and a conversation with a doc who told me about his time in the Navy. He listened to my heart, lungs, etc.

My question is this… Is that all there is? I did do poorly on my hearing test. The lady who did my hearing test said it was severe, and has ordered for me hearing aids, but she noted they would not help me much. The doctor also mentioned the only thing to note was something about a ‘cor pulm’ but he said it was probably due to my COPD.

I had mentioned that I smoke about half pack a day and was diagnosed with it in 2005. But before I went to Vietnam I was in an engine room on an aircraft carrier. Plenty of asbestos.

Should I wait for a call from the VA? What do you think?


There is a lot of misunderstanding about the Agent Orange Registry (AOR). In a nutshell, the AOR is a scientific database of information about veterans like you. The data that was taken from your exam will be entered along with tens of thousands of others like you and scientists will study all the results for many years to come.

The study will benefit thousands more in the future...even after you and I are long gone. This will help guide future military people in things like how to better protect troops from dangerous chemicals like AO.

The only direct benefit to you is that you got a good physical exam. The findings can be used for you to learn how to quit smoking so you don't do further harm to yourself.

You should also proceed to file with VA for a disability benefit. Your hearing loss may be caused by your exposure to weaponry or other loud noises during your service. Many guys who have hearing loss may also have a constant ringing in their ears. That's called tinnitus and is caused by the same noises that caused your hearing loss.

You may file for disability compensation pretty easily by reading through my A to Z Guide here

There is also a lot of good information about all this to be found by clicking here

I host an Internet forum where you can go and exchange information with a bunch of veterans who are in a similar setting as yourself here

Filing for compensation is as simple as filling out a form and sending it in to VA. That will result in another physical examination and a lot of waiting and paperwork from VA and then it's likely that you'll see a monetary award for the damage that your service has caused your hearing.

If you were exposed to asbestos, you should also file a claim for asbestosis. The fact that you have COPD is enough to make me believe that you may have some exposure issues from the days spent in contact with asbestos. Because of your history of asbestos exposure, it's particularly important that you stop smoking now.
IHD vs Aortic Valve Disease

Hello and thank you for your service! My husband is a Viet Nam vet and is already receiving agent orange benefits due to his diabetes type II, but that is not my question. He developed a heart murmur 20 years after Viet Nam, and underwent open heart surgery May 11th at the VA in Gainesville, FL. They say that his aortic valve was calcified to the extent that only 20% of the blood was getting through and his heart muscle was enlarging.,.and without the surgery immediately, then he would probably be deceased within 2 years.

We filed in March 2010 for the ischemic heart disease issue...the question is does his aortic valve issue fall under the definition of ischemic heart disease, or are we kidding ourselves? He also has a bad liver due to medication (not alcohol), but we cannot prove that of course even though our primary care physician states that..but the main issue is the compensation for this heart issue.

You asked me if there were bypass grafts done during his aortic valve surgery? No, there were no bypasses done.

What is your opinion?


Aortic valve disease is a completely different problem than ischemic heart disease. The heart is a complex organ made up of a number of different parts that all function together.

His (and your) heart is a pump. It works some 70 times per minute during your lifetime to push fresh blood to vital parts of your body and to bring that blood back to the lungs for replenishment of oxygen and so on.

There are 4 chambers within that pump system, each chamber will hold blood and serve to push it along as the heart beats and squeezes. These internal chambers have valves to allow the flow of blood to move forward and to ensure that blood doesn’t flow backwards or settle in one spot.

Each of those valves is subject to have a problem if its delicate mechanical structure is damaged. The valves may become weak (incompetent) or they may become too tight (restricted) for varying reasons. Surgical repair or replacement is often required.

On the outer surface of the heart muscle are arteries that provide fresh blood to the heart. When those blood vessels become diseased, the caliber or internal diameter of the vessel is smaller and results in less flow to the heart muscle. If the artery is completely occluded, a heart attack is often a consequence.

Although all these parts are in the same organ, they are quite separate as they function.

The VA presumptive condition addresses only “ischemic heart disease” (IHD). IHD is the condition in which the coronary arteries themselves become diseased and don’t allow adequate delivery of fresh blood to the working heart muscle. IHD is a separate disease process and markedly different than aortic valve disease.

Sometimes the two problems coexist and if IHD is present during valve replacement surgery, the doctors will proceed to do a bypass graft operation simultaneously with valve replacement.

You tell me that there was no bypass grafting and that is a solid indication that he does not have IHD.

VA is not likely to approve the IHD claim.


I am a Desert Storm vet who was diagnosed with PTSD from the VAMC in San Francisco, California in 1992. It is a good thing that I kept copies from VA SF since they do not have them nor can they locate them.

After the Gulf War, I had lots of nightmares and asked a SGT about it. He told me that it was "war shock" and would go away by drinking beer at night. I was applying for law enforcement agencies and guys in my MP unit told me never to talk about PTSD since I would not be hired.

I did not become a cop but the PTSD did not go away. I went through years of hell and still do. I met a Vietnam Veteran who told me more about PTSD...I filed a claim with the VA and after months and months...I finally heard back from them in regards to them wanting stressor information as well as the VCAA .

Then all of a sudden I receive a call about a C&P and a letter in the mail with all of the information regarding the appointment.

I have a C&P scheduled for 15-Dec-2010 in Oahu. My LCSW at the VA told me that the Doc who will be conducting my C&P has a habit of doing 20 minute C&P's.

Have you ever heard of a 20 minute C&P? I thought that a C&P takes a minimum 2 hours. Also, my LCSW told me that it would be in my interest to go a bit into detail in regards to the questions asked without any fanciful tales and/or embellishment<----- which are things that I would not do.

Was curious as to your take in regards to a 20 minute C&P.


No matter about that C & P. Don't sweat it. The system works like this...

You file a claim. The claim then goes through steps to be decided. The first C & P exam is just a small step.

Quite often the C & P examiner does a poor job. That means the claim will be denied. That's actually good news. I love a claim denied that way because then you can appeal. The appeal point is that you had an "inadequate exam". It's my favorite appeal point.

Once you appeal, you get another C & P exam. This time they will schedule it with someone who will do a much better job of it all. Then the appeal and the new exam will go to a more senior person for review.

Most claims are won in the appeal.

Do not ever embellish or fake anything for C & P or any part of a claim. I have guys who ask me if they should get crutches or ride in a wheelchair and I tell them no. The worst C & P examiner can sniff a faker a mile away.

Just go in and don't do anything other than to be yourself. Be truthful, speak your mind.

Remember...most claims are denied. That is normal and routine so when it happens, don't let it upset you. Please head to the sites I post at (including this one) and read up. You'll get some knowledge about what all to expect and you'll feel better about all this.

I am a 30 percent service connected former Marine. 20 percent Chondromalacia knees, 10 for Spinal Condition. Is it possible to be deemed unemployable by my VA Doctor if my disabilities have impacted my job (mailman) to the point where I can't perform them anymore? Thx again for all your help!


Probably not. To be eligible to apply for unemployability requires (in most cases) that you have a 70% rating overall with at least one 40% rating or a single rating of at least 60%.

Read up here

It’s worth noting that your doctor doesn’t make disability rating decisions. The doctor can make notes about your condition but the final decision is made by a rater in the VA regional Office.

Your best bet is to start now to have the existing ratings increased. You'll find instructions about how to do that in my A to Z Guide.

That may take a while but it's a much more sure way of reaching 100% than any other. Slow but steady wins the day.

I have not talked to you in about a year and a lot has happened since then. First I Have been diagnosed with Peripheral Neuropathy all extremities , Hypertension, Restricted lung disease, IBD, Dry Eyes and several others. I have been diagnosed by VA doctors and others and have Nexus for all of these.

I was denied exposure at the Houston regional office and my lawyer has sent in a nod to a dro . Since then I have had a massive heart attack and have been as caused by AO.

However now I have a diagnosis now from 2007 for Dry eyes and atherosclerorsos. However the atheroschlorsis put forth into the progress notes in 07 and I suffered the ischemic heart attack.

My lawyer does not want to cause problems with the atherosclerosis which is plain an simple malpractice under 1151 FTCA. So now what do I do to keep my claim going. but I need my claim . What do I do to get a lawyer group handle this and slam them hard?? I will tallk to you about it but it reallu makes me mad. Call me if you can and God Bless you and your family.I will send whatever you need on this huge file so just get ready ....


If you have a lawyer, I won't interfere with his or her advice. I won't accept your file either. Your best bet is to work with your attorney.

When you jump around seeking advice from multiple advocates, you will often do way more harm than good. Find someone you respect and trust and stay on board for the duration.

Sorry to resort to bothering you via an e-mail ,but i feel lost enough to do this, quick story about me, had prostate cancer,local service officer did paper work for me,was rated 100% for 1 year,had radiation treatment and was reduced to 60% because of after effects,

i understood and was ok with that, vfw guy in indy called me and said he would file for IU and not to worry about it, now , i get notices for c&p for deformed penis, phyc. exam, a&a,bedridden,and s*** ive never heard of,i was ok with my 60% but like anybody else IU sounded ok with me because i have not worked since 2007 ,recieved ss disibility in 2008,ss review stated back problems etc. were related to prostate cancer,

is this turning into an , oh what a tangled web we weave thing or do i just dont go to c&p and take a big chance of losing my 60%? I truthfully am not trying to scam the system. I can not work with the urinary problems and cant walk to the mailbox without a cane and getting exhausted doing that.I am embarrassed to death to do these things. all i want is my 60% rating to not go away. Any advice?


Yeah...I have advice. Don't worry so much brother. Just chill.

You tell me that your VFW representative and you had a conversation. He told you that he would file for the 100% IU benefit for you. I'll assume that during that conversation you agreed that would be fine.

He must have done just what he told you he would do and now VA is rolling ahead with that.

If I had to fault your rep for anything it might be that he didn't explain to you what all is involved with filing for an increased benefit.

What's happening is that VA has taken a look at your file. The law requir:es them to do that when they consider you for any new benefit. They must look at any possible illness or injury you have had even if it doesn't seem to make sense to you.

Then they have to get all kinds of documentation. That often requires new and more thorough C & P exams by the doctors. I understand that you may not want to have to jump through all these hoops but there is just no way to get around it.

From what you tell me of your current health, you are in no danger of losing that 60%. I advise that you don't sweat that. It also sounds like you are a very good candidate for the IU 100% benefit. I'd put money down in favor of you getting the 100% IU award.

I would further advise that you do everything necessary to get to all those exams. Even if all that makes you uncomfortable or if it's embarrassing or a pain to do all the travel, just do it.

The ultimate benefit to you is a lot more money and a more comfortable life. I know money isn't everything but I also know that it doesn't hurt to have it. The amount of the difference between 60% and 100% is a lot...don't walk away from that.

If you insist that you do not want to do all this, you have the right to withdraw the application for IU 100%. I'd hate to know you did that but it is your right.

I hope that now that you know what's going on it'll make this process a little easier for you. Let me know if you have more questions.

My father is a veteran of WWII and is now in an assisted living residence. My mother is in a retirement home and we’ve been trying to get benefits for my father, age 90. We’ve been to the VA office here in Lincoln, Nebraska and after filling out all the paperwork and their reviewing it, they have denied my parents any benefits stating they have too much income.

I was able to get my father a 10% hearing loss disability due to his flying in WWII. Of course my mother believes they are entitled to these benefits and she has now met someone who says we went to the wrong people and that he knows the “right” people and that we need to follow him to someplace and fill out the paperwork again.

He won’t give us the address as he says it’s too hard to find, we either have to ride with him or follow him. I’m real concerned about this as my mother has already given this person more information then she should have. Have you ever heard of this type of scam before?


Benefits for older veterans are often elusive. If the older veteran doesn't have an established service connected disability or if the overall savings and income exceeds strict limits, there are often no VA benefits available.

Many VA benefits are based on overall family income and that income usually must be very low before VA benefits will apply.

Almost as if to make up for a lack of benefits are the many unscrupulous people who will prey on elderly veterans, knowing that they are often desperate to get some help.

I have heard a lot of fishy stories in my work as a veterans advocate but this one is a grand prize winner. It almost makes me believe that the fellow is trying to set you up for a robbery by taking you to someplace where he knows there won't be help or witnesses.

I'd advise that you do all you can to convince your mother that she may be setting herself up for a scam or worse.

If I were you I would probably want to call my local law enforcement agency and report that you believe a senior citizen may be being scammed. Ask if they have any special unit or a detective that might be assigned to look into such cases.

Older citizens are vulnerable to scams. They grew up in a more trusting era and they want to believe that others are sincere and good when they offer to help. The scammers take advantage of that and often get away with stealing life savings...and there won’t be any benefits for the trouble.


I've googled every combination of search terms I can come up with, but am unable to find an answer for a question I have regarding the weights given the opinion of a C&P examiner.

The short of it: Generally speaking, how are C&P exam results weighted, versus supporting evidence and, in particular, a nexus letter from a private physician?

My primary care physician wrote a strong nexus letter (actually, I wrote it and he signed it) supporting service connection for my compensation claim. I submitted the letter along with my Notice of Disagreement after the original claim was denied. The letter includes reference to my doctor's familiarity with my military and private medical records, even including a direct quote from an exam write-up in my service medical records. It also notes the length of time he's been my primary care physician (10+ years), the various medications, therapies, etc., that he's prescribed for my condition, the fact that there are no obvious factors aside from the nature of the work I performed during my time in service that could have caused the condition, the fact that none of my family members suffer from the condition, etc. It also ends with his statement that in his opinion my condition "more likely than not" was caused by my military service."

I was scheduled for a C&P exam a little over a month ago and soon after requested a copy of the examiner's report, which I received today. In the examiner's comments it is written:

The veteran has a degenerative condition (both disc bulges and mild stenosis) in her cervical spine that is not the result of any traumatic event. I am not aware of any occupational factors associated with her service duties that would predispose to development of these conditions. It does not appear that these degenerative conditions were caused by or a result of her service. She had an episode of neck pain shortly before discharge that might or might not have signaled the onset of presentation of this condition. Given that she then served for an additional 2-1/2 years in the national guard with no further documented complaints, I would have to be of the opinion, for the reasons enumerated above, that it is less likely as not that the veteran's degenerative disc disease is caused by or a result of her complaints and condition during her military service.

So, as I wrote above, I'm simply wondering if it would be typical for the VA to favor the C&P examiner's findings over those spelled out by my medical records and nexus letter.

One other thing: The C&P examiner wrote, "I am not aware of any occupational factors associated with her service duties that would predispose to development of these conditions." He did ask me what my job was, but didn't seem at all familiar with my answer: Communication and Navigation Systems Technician. He didn't appear to know what that meant, but didn't ask for any clarification. Nor did he ask what my duties consisted of. The problematic ones, which I believe caused my neck problems, included a lot of heavy lifting and standing at a workbench for hours at a time. Shouldn't he have asked about that/taken it into consideration?

I realize any specific predictions regarding this case/my question are impossible...but are the C&P examiner's notes and opinions the final word?

Many thanks in advance.


You've entered into a complex arena that is full of science, facts, opinions and biases. There is no specific rule that lends credibility to one opinion over the other. In the final analysis, the decision maker will have to weigh what he/she reads and use personal judgment to weigh one statement over the other.

If the opinions each seem valid and each opinion seems to be based in fact, any reasonable doubt is supposed to tilt toward the veteran. That doesn't always seem to happen though.

To learn more about reasonable doubt, click here

The individual who makes the call is the Ratings Veterans Service Representative...RVSR. The RVSR should compare and contrast each doctors opinion and looking at the accumulated evidence, decide which fits your scenario the best.

All too often the RVSR may believe that your civilian family doctor may be favoring you out of a desire to keep a good customer happy. The C & P examiner is often viewed as a less involved, therefore more objective, viewer of the record. This is also the reason that "buddy
letters", statements in support of your claim, from witnesses like your parents, teachers or pastors aren't likely to be given much attention. After all, what would we expect those people to say?

However, at other times the civilian physician may be more credible due to training, length of time in practice and specialty board certification. For example, if a VA examiner is an M.D. with no specialty training and then opines on an orthopedic condition, your statement from an orthopedic surgeon will almost always trump.

When we address chronic bone and joint conditions that are often described as "degenerative", it all becomes more difficult. As we age, we can all anticipate some degenerative changes in our skeletal structure. Most of us will show arthritic changes, we will lose some height and we become less flexible. These are normal changes and
generally will not be seen as service connected.

If we wish to make a nexus from a current degenerative condition and connect that condition to an event or events that occurred on active duty, VA requires that the event(s) of service be clearly recognized in the record. For example, an airborne soldier who is suffering from arthritic knees today will be required to show that he was jumping from airplanes, the frequency of the jumps and how long he was on jump status.

To further support his case for a service connection to the degenerative arthritis of his knees he should be able to show some record of a complaint of knee problems and subsequent treatment while on active duty. The two events will establish an anchor for the
service connection.

At least as important as all that, maybe more importantly, the veteran will show that within one year of ETS he was seeking medical attention for those bad knees. Credibility is lessened with passage of time to make this sort of service connection. If a year or two passes with no problems and no treatment, it may be easy to say he toughed it out and
that the condition was there all along. If a five or ten year period passes with no record of complaints or treatments, it becomes much more difficult to build a case for service connection. Beyond ten or fifteen years with no records of treatments, VA is likely to see those painful knees as a circumstance of aging and in no way service connected.

For more on the principles related to establishing service connection, click here

OK...what do we do to ensure that we have all due consideration?

If the award letter you will receive isn't favorable and you believe that is an error by VA, you appeal. As a rule I suggest that some 70% of the initial decisions will be flawed in some way and will require an appeal. I view appeal as a routine and ordinary part of the process
so nothing to be excited about.

In your case it appears that you believe that the examiner didn't give you an appropriate exam. He opined on your condition without asking questions you feel were relevant. Thus, you will appeal on the grounds of an "inadequate exam". This is simple to do and only requires that you write a letter to your regional office to notify them that you disagree with their findings and you wish to appeal. Explain why, briefly, and that will trigger a new C & P exam that is likely to be much more thorough.

While you wait for the new C & P exam, you then start to work to have an Independent Medical Examination (IME) done by an expert. The IME is often your very best evidence as it is conducted by an individual who has superior training and credentials to conduct such exams.

The IME may be done by an orthopedic surgeon or a physician who specializes in disability IME exams. I recommend the latter as they are usually much more familiar with the appropriate verbiage that VA wants to read.

The IME and report may be a full examination and records review or only a records review. The IME may be expensive and you are always required to pay in advance. If the IME happens to disagree with you and finds that your condition isn't likely service connected, there is no refund of the fee. You are paying for an honest and unbiased report and that's a risk you will take.

More about IME here

The bottom line is that degenerative and arthritic conditions are very challenging to establish as service connected for the purpose of an award of a disability rating. Without a solid chain of evidence showing the causative event in service and then a documented steady progression of the severity of the condition, VA will almost always put up a vigorous defense against these claims.    


I am a Vietnam veteran. I went to Takhli Thailand in September of 1972 with the TDY deployment of the 474th TFW F111’s from Nellis A.F.B in a classified deployment under Constant Guard operation with the 429th TFS and 430th TFS. I worked as an avionics technician on the Flight line on Com/Nav/ECM equipment on the plane.

I currently have a 10% disability for hearing loss due to working around the Jet engines while I was in the Air Force.

I have poor health. Diabetes, COPD, Enlarged Prostrate, Brachacardia with a pacemaker, Congestive Heart Failure due to diastolic dysfunction, and recently Tachacardia which my cardiologist is still investigating.

Since this was a classified mission, I have had a difficult time proving that I was ever deployed to Takhli. My DD214 only says that I was in SEA. Last night, by chance after over 10 years of searching, I finally got a copy of my TDY orders that deployed me to SEA.

It is my understanding that until recently, the VA turned down all claims unless the veteran had set a foot in Vietnam itself.

While I was at Takhli we had empty drums with orange stripes in our work area. Based on research that I have done on the internet, one of which is Operation Ranch hand, It has finally been shown that Agent Orange was used at Takhli. On one of the Bulliten Boards for Takhli, one guy even said that the VA was approving claims by security policemen who worked the perimeters of the base with the guard dogs.

Takhli was overgrown when I got there. They had to of used defoliants several times over the years to clear the flight lines and living areas of the foliage. Besides the defoliants, the insects were so thick that they sprayed a insecticide fog at least twice a day. This fog, would penetrate the screens on our hooches and we were forced to breath it multiple times daily.

I truly believe that some of my health issues are related to my time at Takhli.

What do I need to do now that I have my orders in order to approach the VA to try to get compensation for some of these problems?


You must file a claim. There is no mystery to getting started, go to my guide at

You’ll also find a wealth of good information at

The bottom line is always the same at VA. For any action to occur, you must begin at the beginning...that means telling the VA in writing just what you feel should happen with the claims you will present to them.

Whether you are making a new claim or asking for an increased rating for an established condition, you have to state your case to VA formally. You don’t have to complete a form, a simple letter will get the process rolling along.

Once your claims are recognized and in process, you will then carefully follow the instructions you will receive from VA. You’ll offer all the evidence you have and then wait for VA to adjudicate your case.

If you aren’t happy with the resulting award or if you’re denied your benefits, you go straight to the appeals process.

It really isn’t much more difficult than that. Good luck.

I follow all your notes and want to thank you for the advice.  I am handling my own claims and have been for several years now.  Still have appeals waiting, but recently they located some documents that show proof of Boots.  I wonder how they thought I received the Purple Heart without being on land.  I was attached to an aircraft carrier hundreds of miles from Vietnam.

My next question is what proof do I need for the Ischemic Heart Presumption.  In March, I had to have an AICD implanted because of irregular heart beat and a few episodes of passing out as blood pressure would drop, or heart rate would drop.  This time I went into VTAC and had to be converted.  Not recommended when you are not sedated or fully conscious.  Hurt like hell.

Cardiologist didn't even waver.  He said I was a prime candidate  for the Defibrillator.  Can I use this to add to my AO claim?


Here is how it works for you.

Boots on the ground must be proven. Once proven, you're "presumptive"
for exposure to AO.

The new pesumptives must be in effect. They aren't yet. They may not
go into effect. There are never any guarantees.

Once IHD is listed as a presumptive condition, you file. File before
if you have proof of boots on the ground.

When you file you claim IHD as a condition presumptive to your RVN service.

You tell VA that the severity of your IHD required implant of an AICD.

The AICD device is then rated as secondary to IHD. As such, the AICD
is service connected.

An SC AICD is automatically rated at 100%.

There it is.



I do read just about all of your articles and am aware of what you say about someone who is 100% for TDIU and less for service connected disability applying for additional service connected disability to achieve 100%.  I do believe that is good advice.  I would like to outline my situation and ask for your opinion.

I am currently rated at 70% for General Anxiety and 100% for TDIU.  I did serve in country in Vietnam with an Air Force Combat Security Police Squadron.  I know that you need a 10 year time period from the date of awarded disability in order for your wife to be eligible for DIC in case of my death.  I have a suggested diagnosis of Pick's disease (also known as frontal temporal dementia) based on a PET scan.  In actuality the only way this disease can be proven is by an autopsy, so I may or may not have Pick's.  If I do it is a slowly progressive disease and is always terminal.  The time frame varies from person to person. 

My latest disability percentage was awarded in Sept 2006. So I need to "stick around" until 2016 for her to be eligible for DIC unless I pass away from General Anxiety.  I think that would be hard to prove.  I am military retired, however I did not sign up for SBP

As my wife at the time had just notified me she was filing for divorce and at that time you were not allowed to change beneficiaries.  Should I die before 2016 she would lose my military retirement and my VA allowance which is roughly $4500 per month.

I do not know what type of heart diseases fall under ischemic.  I do have a heart valve in my aorta which will need replacing in 3 or 4 years, aortic regurgitation - Grade 2, aortic root, mild aortic stenosis, non obstructive coronary disease, needing medicinal therapy medium sized area of moderate ischemia in the anterolateral wall, left ventricular systolic function abnormal with wall motion abnormalities with LVEF = 62%.  I am anemic, have stage 3 kidney failure and a hearing loss.

The only thing I was seen for while in the military was a noise like a generator in my ear.  It was bothering me so badly that when the ENT doctor told me there was nothing he could do, I lost my cool and said he had to do something as it was driving me crazy.  He verbally told me to get out of his office and to never come back.  As you are a medical professional, you may find this hard to believe but the problem was accidently cured by my eating some shrimp cocktail.  The noise simply disappeared.  I do think the hearing loss is service connected as I spent considerable years on the flight line subjected to jet airplane noises with only plastic earplugs for protection.  Also have hypertension and hypothyroid neither treated while in service.

Now the big question -- do I roll the dice and apply for ischemic heart problems and hearing loss to try for a 100% service connected disability or leave well enough alone and hope I am still around in 2016.  I currently am 74 years of age.  It is thanks to you for referring me to a law firm that I have what I am currently receiving from the VA and I do appreciate what you have done for me and what you do for all vets.  I know I have laid a "biggy" on you and realize in the end I must make my own decision but I would greatly appreciate your input.


You have Ischemic Heart Disease. There is no question of that.

You are correct in your analysis of the situation.

Were I you, I'd apply for the IHD benefit today, right now...don't wait. If you apply today and die of a heart attack tomorrow, she will be able to carry your claim forward as if you were still alive. The laws changed a while back allowing a surviving spouse to do that.

It's a lot easier on her if you begin the claim now though...she could start it after your demise but it's much more difficult.

Filing is simple. Write a letter to your regional office and just say "I want to file a claim for IHD. I'm a Vietnam veteran with heart disease." Send it using certified mail and you're off to the races.

Good planning on your part. I'm impressed. Tell her again how lucky she is to have you.

(Follow-Up from the veteran: “Thank you for your answer.  Anything I have learned about the VA system has just about 100% come from reading your articles, advice to others, etc.  I will send a certified letter as you have suggested.”)



Thank you for the work you do on behalf of all veterans.

After the hearing on AO Presumptive ISH conducted 9/23/10 where does leave the veteran?  What is the next step in this process?

Will the VA start to process the previously denied claims. and if so when?


No, VA will not begin processing claims...not to my knowledge. I believe more Congressional bickering, stalling and delays will happen first. I'm not yet convinced this will pass.

Be sure to use Jim's:  "A to Z GUIDE OF VETERANS DISABILITY COMPENSATION BENEFITS" click here...  

And, for answers to questions and great advice, go to Jim's discussion board, "STRAIGHT TALK FOR MILITARY VETERANS" click here...

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