The A to Z Guide to VA Disability Benefits
JimStrickland912
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Courage is being afraid but going on anyhow.
Dan Rather
Dan Rather
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Patient Record Flags
USE OF PATIENT RECORD FLAGS TO IDENTIFY PATIENTS AT HIGH RISK FOR SUICIDE
NATIONAL PATIENT RECORD FLAGS
Patient Record Flags Phase III User Guide
Pension
Pension Benefits
Permanent and Total
From Jim's Mailbag
Jim,
I wanted to say thanks for all your shared knowledge. You may remember me, I wrote to you a several months back as I started in the VA system. I was discharged with 20% from the Army and was facing a left BK amputation. I had my surgery in May and am doing great with my prosthetic. I received my initial rating from the VA for 80% (before the amputation) and had several things deferred. After the surgery I applied for temp 100% and the amputation. Over the past weekend I received my final rating,100% temp housebound for 6 months, and 100% SC with two SMC K-1 starting the day the housebound ends. I am very thankful for the rating and being taken care of by the VA after the Army dumped me with nothing. I know that there are many problems in the VA and I have seen some myself (10 months for my final rating) but am just so thankful for this rating and what it means for my family and myself. Thank you for all the advice you give.
One question if I may is in the text of the rating it states “No examination will be scheduled in the future for your permanent and total disabilities” dose this mean I am P&T? Or are they just talking about some of my problems, I know the VA has a weird way of saying things. If I am P&T will they send some other paper that will state this?
Again thanks for all your help
Reply;
Nice work. You've done very well for yourself navigating the maze of the VA. It may not have seemed too bad for you since you did it yourself and by the book.
Your attitude has been one of positive determination, no whining
allowed. You've made the best of a tough situation. I often say that
when life hands us a sack full of chicken feathers, we might just as
well get to work and figure out how to make a great chicken salad. You
did it.
The VAspeak is routine. It annoys me daily but that's the least of the
things about VA that annoys me.
In an award letter VBA communicates to you that your award is either
temporary with an expectation of measurable improvement or that it's
permanent and VA doesn't see where improvement is likely.
In your files at VA you have a "Future Calendar". If they believe
improvement is likely (a temporary award) they will create a future
date in your calendar for an examination to evaluate your condition.
If they believe improvement is not likely, there is no exam created in
the future in your calendar.
So, your letter that reads, “No examination will be scheduled in the
future for your permanent and total disabilities” means that VA
considers you permanently disabled.
Now...here comes the fun. Does that mean that VA will never examine
you because your condition is permanent?
No, of course not. In VAspeak the word "permanent" doesn't mean what
it usually means to the rest of us. Note that the letter tells you
that "No examination will be scheduled in the future...". That phrase
does not mean that they won't conduct an exam...only that one isn't
scheduled.
(In VASpeak 2 + 2 won't add up to 4 either but that's another story.)
Your rating isn't "protected" until you've held it uninterrupted for 20 years.
Why would they reexamine you? Often enough it's because when you pass
the 10 year mark your dependents become eligible for the DIC benefit
no matter the cause of your death. VA doesn't want to be paying DIC to
your dependents should you die, so all too often at 9 1/2 years you'll
get a notice for a reexam quickly followed by a proposal of adverse
action. You'll find that you've improved so much VA proposes to lower
your 100% rating to 60% or even lower.
Even after 20 years VA can lower your rating if they can prove that
some sort of fraud was involved at the time you were rated.
I like to keep veterans informed with the facts and there you are. In
this case, P & T doesn't mean Permanent & Total, at least not in the
way you would like to believe.
It's rare that VA will send you a letter that clarifies any of that.
But you'll need such a letter for your state or county benefits. Your
state may offer veterans who are P & T benefits like licenses at no
cost out of pocket or tax breaks. The agency involved will tell you
their requirements for a document to satisfy their rules. Often enough
the document must be written on VA letterhead and it must state that
the veteran is Permanently and Totally disabled due to a service
connected injury or illness. They will usually require the date of the
award, that your name and home address be on the document and so on.
In my state (Georgia) I discovered that state employees are as
confused about what "No future exams" means as you would expect. That
didn't make any sense to them and to get the DV plates for my car, I
needed much more than my award letter.
The easiest way to get such a document is to write out the details and
send a letter (via certified mail) to your VA Regional Office asking
for it.
There is even more about all this in my new A to Z Guide to Veterans
Disability Benefits at http://jimstrickland912.com As you have some
time, stop there to visit, read and keep up with any changes to the
complex disability regulations.
Good luck sir!
Presumptive Service Connection
See;
http://www.warms.vba.va.gov/admin21/m21_1/mr/part4/subptii/ch02/ch02_secc.doc
The simple explanation;
The VA awards (not grants or gives) disability compensation for injuries or illnesses (called conditions) that are determined to be caused or contributed to or aggravated by the veterans honorable military service.
This award of monetary and other benefits compensation is said to be "service connected" because there is adequate evidence of an event during service and then post service disabling conditions.
To be service connected, there must be proof that the veteran has qualifying service, that an event occurred and that a disabling condition exists today.
If "Presumption" is allowed, the burden of proof of the event is lifted from the veteran and today's documented disabling condition is presumed to have been related to a determined circumstance of that veterans service.
The recent best known examples might be the Vietnam veteran and the exposure to the herbicide known as Agent Orange. AO is thought to have contributed to a wide range of conditions and as of October 13th 2009, the "Presumptive List" for AO has again expanded.
Presumptive
Updated October 25th 2009
The National Academies Press publishes the reports issued by the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council.
Hundreds of titles in electronic Adobe PDF format can be downloaded for free by the chapter or the entire book, or you may purchase them via the web site.
These are serious studies for the veteran who is serious about researching a particular topic.
The 2008 publication;
Improving the Presumptive Disability Decision-Making Process for Veterans
issued by the Board on Military and Veterans Health is that sort of in depth publication.
From a press release:
"WASHINGTON
-- The process for awarding benefits to veterans with health conditions
presumed to be connected to military service should be improved, says a
new report from the Institute of Medicine
If you're interested in how some conditions become presumptive while others don't, this is the book for you.
Priority Group Status
How do you rate and what are the privileges?
Prostate Cancer
It's reported that 1 in 6 men in America will be diagnosed with prostate cancer. In 2008, 186,000 men will be diagnosed and over 28,000 men will die of the disease. Risk factors are age, ethnicity, family history, and lifestyle. African-American men are 61% more likely to develop prostate cancer and 2.5 times more likely to die from the disease.
The Vietnam Veteran and Prostate Cancer
Most references that provide information about prostate cancer don't list military service in Vietnam or other exposure to Agent Orange as a risk factor. This seems incongruous when we know that Vietnam era veterans constituted the largest group of veterans in Census 2000, accounting for 8.4 million people or 31.7 percent of the total veteran population.
The Prostate Cancer Foundation touts itself as, "the world’s leading philanthropic organization for funding prostate-cancer research" yet makes no mention of Vietnam veterans.
At the web site for the National Cancer Institute, no mention of either Agent Orange nor the Vietnam veteran is found. Following the trend, The Mayo Clinic and Medline Plus choose to ignore the Vietnam veteran.
The Institute of Medicine points out that, "Since Update 2004, however, new evidence has emerged that service in Vietnam itself may be associated with a higher risk of prostate cancer. Although the explanations for that are unclear, the possibility needs to be taken into account in interpreting studies that bear on the relationship of Agent Orange exposure to prostate cancer."
"Veterans exposed to Agent Orange have higher rates of prostate cancer recurrence"
Prostate Cancer Treatment
Robotic Surgery
Options
Side Effects (VA Term; Residuals)
Prostate Cancer; You should know:
When the Vietnam veteran is diagnosed, he will be rated at 100% throughout treatment. The treatment may take 6 months or so. At the end of the treatment it's usually determined (by PSA) that the veteran is cancer free.
If the veteran no longer has prostate cancer, the rating must change. The veteran is then reexamined and rated on "residuals" or after-effects of treatments.
The after effects are usually some combination of leakage and erectile dysfunction. The veteran is normally rated at 40% or 60% depending on how severe the leakage is, usually measured by the number of absorbent pads necessary per day.
ED is rated under the Special Monthly Compensation category of SMC-k, "Loss of a creative organ". Veterans must remember to ask for this benefit.
The Rating
7528 Malignant neoplasms of the genitourinary system...100%
Note--Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100% shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of Sec. 3.105(e) of this chapter.
If there has been no local reoccurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.
Voiding dysfunction: Rate particular condition as urine leakage, frequency, or obstructed voiding Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day 60%
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day 40%
Requiring the wearing of absorbent materials which must be changed less than 2 times per day 20%
Urinary frequency: Daytime voiding interval less than one hour, or; awakening to void five or more times per night 40%
Daytime voiding interval between one and two hours, or; awakening to void three to four times per night 20%
Daytime voiding interval between two and three hours, or; awakening to void two times per night 10%
Prosthetics
Public Affairs
USE OF PATIENT RECORD FLAGS TO IDENTIFY PATIENTS AT HIGH RISK FOR SUICIDE
NATIONAL PATIENT RECORD FLAGS
Patient Record Flags Phase III User Guide
Pension
Pension Benefits
Permanent and Total
From Jim's Mailbag
Jim,
I wanted to say thanks for all your shared knowledge. You may remember me, I wrote to you a several months back as I started in the VA system. I was discharged with 20% from the Army and was facing a left BK amputation. I had my surgery in May and am doing great with my prosthetic. I received my initial rating from the VA for 80% (before the amputation) and had several things deferred. After the surgery I applied for temp 100% and the amputation. Over the past weekend I received my final rating,100% temp housebound for 6 months, and 100% SC with two SMC K-1 starting the day the housebound ends. I am very thankful for the rating and being taken care of by the VA after the Army dumped me with nothing. I know that there are many problems in the VA and I have seen some myself (10 months for my final rating) but am just so thankful for this rating and what it means for my family and myself. Thank you for all the advice you give.
One question if I may is in the text of the rating it states “No examination will be scheduled in the future for your permanent and total disabilities” dose this mean I am P&T? Or are they just talking about some of my problems, I know the VA has a weird way of saying things. If I am P&T will they send some other paper that will state this?
Again thanks for all your help
Reply;
Nice work. You've done very well for yourself navigating the maze of the VA. It may not have seemed too bad for you since you did it yourself and by the book.
Your attitude has been one of positive determination, no whining
allowed. You've made the best of a tough situation. I often say that
when life hands us a sack full of chicken feathers, we might just as
well get to work and figure out how to make a great chicken salad. You
did it.
The VAspeak is routine. It annoys me daily but that's the least of the
things about VA that annoys me.
In an award letter VBA communicates to you that your award is either
temporary with an expectation of measurable improvement or that it's
permanent and VA doesn't see where improvement is likely.
In your files at VA you have a "Future Calendar". If they believe
improvement is likely (a temporary award) they will create a future
date in your calendar for an examination to evaluate your condition.
If they believe improvement is not likely, there is no exam created in
the future in your calendar.
So, your letter that reads, “No examination will be scheduled in the
future for your permanent and total disabilities” means that VA
considers you permanently disabled.
Now...here comes the fun. Does that mean that VA will never examine
you because your condition is permanent?
No, of course not. In VAspeak the word "permanent" doesn't mean what
it usually means to the rest of us. Note that the letter tells you
that "No examination will be scheduled in the future...". That phrase
does not mean that they won't conduct an exam...only that one isn't
scheduled.
(In VASpeak 2 + 2 won't add up to 4 either but that's another story.)
Your rating isn't "protected" until you've held it uninterrupted for 20 years.
Why would they reexamine you? Often enough it's because when you pass
the 10 year mark your dependents become eligible for the DIC benefit
no matter the cause of your death. VA doesn't want to be paying DIC to
your dependents should you die, so all too often at 9 1/2 years you'll
get a notice for a reexam quickly followed by a proposal of adverse
action. You'll find that you've improved so much VA proposes to lower
your 100% rating to 60% or even lower.
Even after 20 years VA can lower your rating if they can prove that
some sort of fraud was involved at the time you were rated.
I like to keep veterans informed with the facts and there you are. In
this case, P & T doesn't mean Permanent & Total, at least not in the
way you would like to believe.
It's rare that VA will send you a letter that clarifies any of that.
But you'll need such a letter for your state or county benefits. Your
state may offer veterans who are P & T benefits like licenses at no
cost out of pocket or tax breaks. The agency involved will tell you
their requirements for a document to satisfy their rules. Often enough
the document must be written on VA letterhead and it must state that
the veteran is Permanently and Totally disabled due to a service
connected injury or illness. They will usually require the date of the
award, that your name and home address be on the document and so on.
In my state (Georgia) I discovered that state employees are as
confused about what "No future exams" means as you would expect. That
didn't make any sense to them and to get the DV plates for my car, I
needed much more than my award letter.
The easiest way to get such a document is to write out the details and
send a letter (via certified mail) to your VA Regional Office asking
for it.
There is even more about all this in my new A to Z Guide to Veterans
Disability Benefits at http://jimstrickland912.com As you have some
time, stop there to visit, read and keep up with any changes to the
complex disability regulations.
Good luck sir!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Presumptive Service Connection
See;
http://www.warms.vba.va.gov/admin21/m21_1/mr/part4/subptii/ch02/ch02_secc.doc
The simple explanation;
The VA awards (not grants or gives) disability compensation for injuries or illnesses (called conditions) that are determined to be caused or contributed to or aggravated by the veterans honorable military service.
This award of monetary and other benefits compensation is said to be "service connected" because there is adequate evidence of an event during service and then post service disabling conditions.
To be service connected, there must be proof that the veteran has qualifying service, that an event occurred and that a disabling condition exists today.
If "Presumption" is allowed, the burden of proof of the event is lifted from the veteran and today's documented disabling condition is presumed to have been related to a determined circumstance of that veterans service.
The recent best known examples might be the Vietnam veteran and the exposure to the herbicide known as Agent Orange. AO is thought to have contributed to a wide range of conditions and as of October 13th 2009, the "Presumptive List" for AO has again expanded.
Presumptive
Updated October 25th 2009
The National Academies Press publishes the reports issued by the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council.
Hundreds of titles in electronic Adobe PDF format can be downloaded for free by the chapter or the entire book, or you may purchase them via the web site.
These are serious studies for the veteran who is serious about researching a particular topic.
The 2008 publication;
Improving the Presumptive Disability Decision-Making Process for Veterans
issued by the Board on Military and Veterans Health is that sort of in depth publication.
From a press release:
If you're interested in how some conditions become presumptive while others don't, this is the book for you.
Priority Group Status
How do you rate and what are the privileges?
Prostate Cancer
It's reported that 1 in 6 men in America will be diagnosed with prostate cancer. In 2008, 186,000 men will be diagnosed and over 28,000 men will die of the disease. Risk factors are age, ethnicity, family history, and lifestyle. African-American men are 61% more likely to develop prostate cancer and 2.5 times more likely to die from the disease.
The Vietnam Veteran and Prostate Cancer
Most references that provide information about prostate cancer don't list military service in Vietnam or other exposure to Agent Orange as a risk factor. This seems incongruous when we know that Vietnam era veterans constituted the largest group of veterans in Census 2000, accounting for 8.4 million people or 31.7 percent of the total veteran population.
The Prostate Cancer Foundation touts itself as, "the world’s leading philanthropic organization for funding prostate-cancer research" yet makes no mention of Vietnam veterans.
At the web site for the National Cancer Institute, no mention of either Agent Orange nor the Vietnam veteran is found. Following the trend, The Mayo Clinic and Medline Plus choose to ignore the Vietnam veteran.
The Institute of Medicine points out that, "Since Update 2004, however, new evidence has emerged that service in Vietnam itself may be associated with a higher risk of prostate cancer. Although the explanations for that are unclear, the possibility needs to be taken into account in interpreting studies that bear on the relationship of Agent Orange exposure to prostate cancer."
"Veterans exposed to Agent Orange have higher rates of prostate cancer recurrence"
Prostate Cancer Treatment
Robotic Surgery
Options
Side Effects (VA Term; Residuals)
Prostate Cancer; You should know:
When the Vietnam veteran is diagnosed, he will be rated at 100% throughout treatment. The treatment may take 6 months or so. At the end of the treatment it's usually determined (by PSA) that the veteran is cancer free.
If the veteran no longer has prostate cancer, the rating must change. The veteran is then reexamined and rated on "residuals" or after-effects of treatments.
The after effects are usually some combination of leakage and erectile dysfunction. The veteran is normally rated at 40% or 60% depending on how severe the leakage is, usually measured by the number of absorbent pads necessary per day.
ED is rated under the Special Monthly Compensation category of SMC-k, "Loss of a creative organ". Veterans must remember to ask for this benefit.
The Rating
7528 Malignant neoplasms of the genitourinary system...100%
Note--Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100% shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of Sec. 3.105(e) of this chapter.
If there has been no local reoccurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.
Voiding dysfunction: Rate particular condition as urine leakage, frequency, or obstructed voiding Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day 60%
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day 40%
Requiring the wearing of absorbent materials which must be changed less than 2 times per day 20%
Urinary frequency: Daytime voiding interval less than one hour, or; awakening to void five or more times per night 40%
Daytime voiding interval between one and two hours, or; awakening to void three to four times per night 20%
Daytime voiding interval between two and three hours, or; awakening to void two times per night 10%
Prosthetics
Public Affairs