Benefits

Question:

Hi Jim, I’m 60% service connected for sinusitis and hypertension combine can I file secondary disability for Sleep Apnea (I have sleep study done and using CPAP machine and also had Diabetes secondary to Hypertension) please advise. Thank you.

Jim's Reply:

Yes, you may file any secondary claim you believe is legit. Whether you can win such a claim depends on a lot of things. First up, you'll need an expert physician who agrees with you and who will review your records and write all that into an IMO.
 

The Independent Medical Opinion is the best option I know of when we need to win a VA disability claim. Learn more here.  https://www.vawatchdog.org/imo-ime-medical-opinions-exams.html  

Question:

Who can help me fill out the paperwork for death benefits from VA and DFAS in the state of Washington? 

Jim's Reply:

The fact of the matter is that this may be a tall order. The COVID pandemic has been hard on veterans service organizations and the veterans they serve. 
 

Having said that, I'd like for you to start here https://www.dva.wa.gov/  These folks will be able to offer you some guidance. Good luck.

Question:

Dear Jim,

My brother is a disabled Vet with a mental illness. I was appointed his fiduciary 10 years ago. A few years ago he was placed in the VA hospital in Massachusetts, as he is incapable of living in apartment or community care home. I live in California so this is a long distance care situation. I volunteered to be fiduciary because my brother begged me & because the attorney the VA first assigned made life difficult for him by being unresponsive & never giving him money when he needed it.

Caring for my brother from a distance has been very difficult & being his fiduciary is a LOT of work, plus I am getting on in years with my own health issues. I understand that family members don't receive compensation even though the VA continues to give lawyers 4% of the Vets compensation, many of whom are dishonest. 2 years ago a VA field examiner decided to put $1100 in my brothers annual budget for me to use for airfare & hotel to visit him. Then the pandemic hit & I wasn't able to use it. Looks like COVID is surging again & who knows if or when flying will be safe. How can I get the VA to change the travel funds to a direct payment to me instead? And don't you think family members should get some kind of compensation for this work? Many thanks for your help. 

Jim's Reply:

Yes, I agree with you. The VA fidu program is often unnecessary and is always a burden that should be better administered. The fiduciary appointment program is at the top of my list for VA inefficiency and lack of caring for the veterans in their charge.
 

Having said that there are only 3 avenues to take if you want changes. You can work with your Congressional representative or you can work with the VA staff who you report to or you can speak with a veterans law attorney. 
 

I wish I had more to offer but in my experience, this is all there is.

Question:

Hello Jim,

I hope this message finds you well. First, I want to thank you for all that you do for veterans and their families. I need assistance with recovering due benefits to my family after my father passed. He was a veteran, was receiving monthly benefits, and unfortunately it all stopped after he passed. My mom was a young widow and life was very challenging for us. Can you please help point me in the right direction to get to the bottom of this matter? I appreciate your time and help, looking forward to hearing from you soon.

Jim's Reply:

I'm sorry for your loss.
 

When a veteran who is receiving disability benefits dies the surviving dependents aren't automatically awarded any benefits other than some burial and funeral expenses. If the veteran died of a service connected condition, the surviving dependent is allowed to apply for DIC.
 

To be eligible for the DIC benefit the veteran must have either passed from a service connected condition or have been rated as permanently and totally disabled for an uninterrupted period of ten or more years. If your father had a relatively minor disability rating and didn't die of that condition your mother may not be eligible for any VA benefit.
 

I get the idea that this may have happened a long while ago and that complicates everything. If an application for DIC benefits isn't received in the first year after death, the record closes and can be very difficult to reopen.
 

You're welcome to get back to me if I've missed something.

Question:

Hi Jim,

When the VA rates you 100% P&T, do all of your disabilities have to be static to get the permanent rating? Can there be any disabilities left as non-static with a request for evidence (RFE) after being rated P&T?

Jim's Reply:

There are ways to have a 100% permanent rating and then above and beyond that have temporary (future exam) ratings. For example, the veteran who has a rating of 100% permanent for physical injuries may at some point be diagnosed with a secondary mental health condition that could be rated as a temporary status.
 

These are very unusual circumstances though and won't affect many.

Question:

Jim,

If a Veteran that is rated for PTSD is in therapy with VA Healthcare, and stops therapy themselves, or the VA no longer continues with therapy, could that affect the rating or compensation? Rating is 50% PTSD, combined rating P & T 100% schedular.

Jim's Reply:

As a rule, no. If your rating is temporary with a future exam scheduled, then you should do all you can to keep the record of treatment intact.
 

Otherwise, you aren't required to be treated if you have a permanent rating. 

Question:

I filed for a disability for hearing loss. The VA scheduled a C & P exam with a contract company in January. I have submitted three FOIA requests asking for a copy of their report. These FOIA requests were sent over three different months. The VA has not provided the report and I have submitted assistance from Senator Feinstein. Can I do anything else? What are options? Thank you in advance.

Jim's Reply:

Many requests for documents of all sorts are running weeks and months or even years behind because of the pandemic. There is nothing else for you to do. Your Congressperson has no authority to make VA dig out your C & P exam.
 

The fact of the matter is that the more you insist on your record being pulled to satisfy your request, the further behind it puts your claim for processing. You're apparently raising a fuss so that you can get a copy of your hearing test and even if you got it, there is nothing to be done about it. Every time you make these requests your file is set aside and processing the claim takes longer.
 

Options? I'd advise you leave that alone and just wait for the result of your claim. If you don't like the result you then appeal. This is how the system works and working with the flow is a lot easier than doing what you're doing. 
 

VA staff are human and if you push hard enough and annoy the wrong person, your claim can take a long time to resolve. Good luck.

Question:

Hi Jim, My question is about the pyramiding. I have a service connected broken clavicle with severe ac joint separation as well as a torn rotator cuff. Should both of these be rated under one rating? I get 10% right now.

Jim's Reply:

In a nutshell, pyramiding is rating the same or similar symptoms under different diagnostic codes. Without having your records in front of me I'd guess that your formerly broken clavicle is healed and not disabling. That we've had an injury such as a broken bone doesn't automatically produce a rating unless there are residual disabling components like non-union or deformity.
 

AC joint separations aren't generally viewed as disabling, that's another finding that may get a 0% rating if it is rated at all. The 10% rating for a torn rotator cuff is the lowest rating you can have for that condition and that tells me that you may have an opportunity to increase that to as much as 30%.
 

If the shoulder is causing you pain upon motion and limited movement because of pain, you can file for an increase. The schedule for what it takes for an increase can be found here. Good luck.

 

§4.14 Avoidance of pyramiding.

The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation and the evaluation of the same manifestation under different diagnoses are to be avoided.

Question:

I just received a proposed reduction after having a continuous rating (subject to future exams) for the past 20 years and 5 months. I am aware of the 20 year rule, but are there any exceptions other than fraud where the VA could reduce the rating? I was told they could in special circumstances, but nobody can show me or tell me what those circumstances are.

Jim's Reply:

Most rules apply to benefits that are permanent and total. Since your benefit was rated as temporary with future exams scheduled, longevity rules won't apply.
 

However...I question how you managed to keep a temporary rating (future exams scheduled) for over 20 years? Since I don't know what the rating is or how old you are, it's tough for me to understand why your ratings wasn't made permanent over all those years?
 

I'd urge you to speak with a veterans law attorney pretty quickly. That won't cost you anything but some time and we'll be sure that VA isn't making a mistake here. Meet your lawyer here. 

Question:

My husband died from lung cancer and was classified as service-connected from Agent Orange. I found out I am eligible for CHAMPVA as his employer insurance is over $500/month and they will drop me in 2 years anyway. The local hospital and doctors all take CHAMPA, so is there any hidden downside to taking it?

Jim's Reply:

No, no downside. CHAMPVA is one of the better insurance policies out there. Be patient, get pre-approvals and you'll like what you'll get.