Benefits

Question:

If the veteran is totally disabled and his family wants him in a skilled nursing facility (and his daughter has POA) does he have any right to his disability check? Where can he get VA representation on his behalf?

Jim's Reply:

The veterans disability money is his no matter the circumstances and he is the only one with any rights to the check. The POA doesn't give anyone the right to control his money.
 

In most cases any income he has will be used to pay for a SNF or other long term care facility. 
 

The veteran should ask the director of the facility that he may reside at how his VA disability money will be used to pay for his care.
 

If you and the veteran have concerns, he should contact a veterans law attorney. https://www.vawatchdog.org/how-to-hire-a-veterans-law-attorney.html 

Question:

Does CHAMPVA & Medicare cover cancer care?

Jim's Reply:

Yes. Heart disease and cancer are the diseases that most Americans will face as they age and these are the most often claimed treatments.

Question:

I had a C & P exam for hearing loss early in 2021. The doctor in question reviewed my military records regarding hearing tests conducted. He provided misinformation on these tests and made statements contrary to the actual results. His decision favored the VA. Is this doctor liable legally for any reason? If so, which type of lawyer would be suitable? Thank you.

Jim's Reply:

You want to sue the doctor for his/her opinion? I have doubts.
 

These health care professionals are credentialed by various organizations to offer opinions based on the evidence before them and the guidelines of their employer that they must follow. You'll have a steep uphill climb trying to sue a sub-contractor to the federal government.
 

What type of lawyer? Well, I doubt you'll have any takers for the traditional contingency fee based suit so you'll have to search around a bit and be prepared to pay the bill up front. If you have an extra 20 large in your pocket I could probably introduce you to someone who would file some papers for you but I fear the cost would just rise from there.
 

There's a better way.
 

When we have a C & P exam, we're always unhappy with the results unless the examiner agrees with everything we claim. It's a bit like traffic court, isn't it? When the officer says you were doing 83 in a 55 and you know darn well that isn't right...frustrating!
 

I write about C & P exams almost as much as any topic ever and nobody contacts me to tell me how happy they are with their professional, timely, courteous exam. The unhappiest of all are those who were denied their claim. I assume with the timing of your message you just got your denial letter.
 

There is a solution! We must formally appeal and claim that we disagree with the findings of the previous exam and thus the denial. You can use the phrase "inadequate exam" and describe why you believe that to be the case. You'll be reexamined and the points you make will be considered by the new examiner and the next rating activity.
 

And...if you want legal help. I have great news! While you can't sue that examiner, you can retain a veterans law attorney to manage your appeal and it won't cost you anything out of pocket. Click https://www.vawatchdog.org/how-to-hire-a-veterans-law-attorney.html 
 

Good luck sir.

Question:

Does CHAMPVA cover hearing aid or implants due to cancer radiation to that area?

Jim's Reply:

Coverage for procedures, devices and implants is likely to differ a bit from patient to patient so I can't give you an absolute answer. Generally speaking though, CHAMPVA will cover any medically necessary procedure. I do encourage everyone using CHAMPVA to get pre-authorization for any procedure far enough in advance that you can feel sure there won't be any upsets. 
 

CHAMPVA is outstanding health insurance that actually covers and pays more than many high priced plans, but using CHAMPVA requires patience and persistence. Give them a call and have your information handy for them and go for that pre-approval. Good luck!

Question:

I filled a claim and unfortunately did not think of all the things I should have mentioned. Also during my C & P exam I should have added some clarification on my neuropathy. It was not good and I was asked misleading questions. Thoughts?

Jim's Reply:

You're going through a phase that many vets do...post exam anxiety. I think every one of us comes away from the C & P exam and later in the day we wish we had said something different.
 

When we start thinking about all that happened during the exam a lot of it seems misguided or just plain wrong. We usually wish we could go back and do it all over again.
 

Unfortunately, you aren't allowed to go back and try and add to what took place during the exam. Once the exam is completed that info goes to a rater and the process of adjudicating your claim moves ahead. If you tried to update or change anything about the exam now, your claim would return to start and you'd have a lot of time and confusion added on.
 

Once the C & P exam is complete, you wait until you get a decision. If the decision is favorable, you're done and you'll never have to think of that exam again. If your claim is denied because of the exam report, you can now appeal for a better opportunity to explain your case. Good luck sir!

Question:

I'm also a Vietnam-era Vet; I did Advanced Training for 7 months at Ft. Devens, which became an EPA Superfund Cleanup site in '89 for things like drinking water containing Benzene, TCE, PFOS and PFAS. I also worked two years in an electronics shop, where TCE was always in the air (we had a large degreasing vat of it). It took decades for me to develop Leukemia and Hyperthyroidism - but I did. Is there any good data on how long it took for symptoms to develop before the VA will flatly deny benefits - even if I do have IMO letters?

Jim's Reply:

To my knowledge and belief, there isn't anything as precise as what you're asking for. However, it's my experience that if you can prove exposure to carcinogenic chemicals then service connection will follow even though decades may have passed.
 

This is evident in the way agent orange presumptive cancer conditions are managed. If a 75 or 80 year old boots on the ground Vietnam veteran gets prostate cancer tomorrow, the service connection is automatic although that much time has passed.
 

The same would hold true if you establish service connection for the chemicals you were exposed to and your current disease with a well written IMO or nexus letter. I think that most agree that the ill effects of chemical exposures can take decades to show signs and symptoms of harm.
 

You may benefit by researching cases similar to yours that have been denied and appealed and then won or lost at the BVA. Click here and then use the search function you'll find to look for key words like <benzene TCE hyperthyroidism> and learn what the court thought of these adjudicated claims and appeals. These cases do not set precedent so you can't cite one and then you're done...you have to duplicate every step of the winning appeal but many vets prevail in similar cases.
 

Trichlorethylene (TCE) was used by the 55 gallon drum for all kinds of applications...I remember the stuff all too well. TCE was the only thing that would remove the Cosmoline gunk that our weapons were packed in for shipment and storage. With just that thought, I can still smell Cosmoline. I was 91D20 at the 98th General Hospital in Germany and we used TCE to clean all sorts of things. Our huge steam pressure autoclaves would need flushing with the stuff to remove hard water scale.
 

I think we vented that into the open air straight out through the ceiling.
 

Now I wish I hadn't remembered that.
 

Good luck sir.

Question:

I am 70 years old. I have been receiving 100% for over 10 years due to cancer treatment which will end soon. I will soon be coming up to a future exam date and C&P to review my cancer status. There will be many residuals due to several surgeries. Will the 55 year rule or the 10 year rule, or 100% rule have any effect on how the VA rates me? I read different things about the 55 year rule and 10 year rule but it never says if this covers how they view cancer treatment. I would like to think after dealing with cancer for over 10 years they should allow me to stay at 100%. We all know cancer is really never cured, it's just hiding somewhere in your body waiting to surprise you at will.

Jim's Reply:

You will be rated on the residual effects of having had a cancer and treatments. The 100% rating is assured for a diagnosis of an active service connected cancer. Once you've had treatment and the cancer is in remission or undetectable, you can no longer be rated at 100% as if you have a cancer.
 

The way VA rates our disabling conditions is based in the 1940s-1950s when the rating schedule was developed. The whole thing was designed to benefit wounded vets who were competing for jobs in what was an agrarian and manufacturing society. While our society has changed a lot, the VA hasn't. 
 

The best that you can do is to be sure the examiner understands the day to day effects of having had your disease over time. You may end up having to apply for the TDIU benefit after this exam and new rating and that's usually more an inconvenience than a long term problem. Good luck sir.

Question:

I’m looking for a legal advisor to help my husband get all his benefits with the VA hospital so he doesn’t have to wait for months to see a doctor or pay out of pocket when he goes. Also he has to pay a civilian doctor if it’s an emergency.

Jim's Reply:

I'm afraid that I don't know of any sort of 'legal advisor' that could help you. I'm about as close to that as anyone I know and I lived in Georgia and know the system there well. You're welcome to contact me and we can see how he may better navigate the system.
 

To be honest, the VA health care system is such a disaster today that depending on where you are, there's nothing that can help you except your own effort. By that I mean that you have to keep your expectations realistic and you need a lot of patience. 
 

His ratings will play into his appointment priority as well as any copays he may be charged. It's a complex system and the more you know how it works, the better.

Question:

I am 59 years old. Since 2016 I have had a 100% rating for major depression with sleep problem. I was scheduled for a review in April 2021, but this hasn’t happened yet. I am NOT considered permanent. I have a high school senior who will be going to college in the fall. I would like to be eligible for DEA chapter 35. Is there anything I can do to get this?

Jim's Reply:

There isn't a formal path to convert a temporary rating to a permanent rating with the benefits you seek. The difference between a temporary 100% rating and a permanent 100% rating is more or less focused on 2 additional benefits...CHAMPVA and Chapter 35 DEA. It's unfortunate that you find yourself in this spot...it isn't unusual that a lot of vets are as frustrated as you are while in this predicament.
 

I recommend that since there is no formal path (no VA Form to submit, etc.) that we never ask to have our temporary 100% rating changed to a permanent status. Any action along those lines will trigger a C & P exam and there is no guarantee it would happen soon enough to be of any help to you and it could cause a problem.
 

During that exam the goal of the examiner will be to determine if your 100% rating is 'static' with no reasonable chance of measurable improvement of your disabling condition in the future. Should the examiner determine that you have measurably improved you could lose the 100% temporary rating and be left with a much lower permanent rating.
 

The determination that you have measurably improved could be supported by the fact that you're aware of the benefits that you're not receiving and since you're logically working to be eligible for a 100% permanent rating, you can't be eligible for that rating.
 

Catch-22 is alive and well at your VA! We have to be careful what we ask of your VA, we never know for sure what they'll deliver.
 

I'm sympathetic to the financial obligation you'll face and I can only offer that your 'future exam' of April 2021 isn't running as late as it may seem. The VA has lost a lot of C & P exam ground during the pandemic and they're scrambling to catch up. Estimates of how long it'll take are all over the map but if you can hang in there, your exam will be coming...eventually.
 

Keep track and carefully document financial records so that if there is an opportunity to collect some retro benefit you'll be able to do that. When you do get that exam, mention to the examiner that your rating should be permanent by now...that's where the decision will originate. Good luck sir.