Benefits

Question:

Hi Jim: I was exposed to TCE, for 14 months at Camp Lejeune. I am wondering on my VA disability claim, do I need to be specific as to what I think caused my Diabetes and neuropathy in both legs? Do I have to say it was because of TCE or will my being there over the time required be enough? I have seen where some vets got diabetes and then claimed it due to TCE at Camp Lejeune. I just put diabetes and have a nexus letter that states it was more likely then not associated with my liver cancer. But I'm not sure if the VA needs a different reason. Should I list it as that exposure or is it too late? I have already had my CP exams. 

Jim's Reply:

TCE is a commonly used degreasing chemical and it's used a lot in military applications. I remember using it in the 1960s to clean high pressure steam autoclaves at the 98th General Hospital. If you've ever known of cosmoline, you know of TCE to get rid of the stuff.
 

TCE is blamed for many illnesses in the disability claims we make and as with most claims, we win some and we lose some. If you'll follow the link to the Board of Veterans Appeals search engine and use <trichlorethylene> as a search term you'll see a lot of decisions and how they were won or denied.
 

Yes, you can and should explore TCE as a cause of your diabetes (DMII) and peripheral neuropathy (PN). If you'll use each of those terms in your search at the BVA decisions search function you'll learn that many others have reached the same conclusion...that TCE has caused serious harm.
 

You have the burden of proof. You can't just say you think that TCE has harmed you, you must prove it. VA will not help you...VA isn't your advocate in this setting. That means that you must provide evidence that you were exposed to TCE and then you must estimate how much and how often. You'll learn more about that when you search the BVA reports.
 

Then you must provide a statement from an expert physician that concludes that it is more likely than not that your DMII and PN were caused by exposure to TCE. This is called an Independent Medical Opinion (IMO) and it's up to you to provide that as a part of your claim. The IMO is written by an expert based on medical (and other) records that you provide. Any of the doctors you'll meet on that page will be happy to help you.
 

You mention liver cancer so it's apparent that you're seriously ill. The best advice I can offer is that you should talk with the IMO doctors I provide you so that your illnesses are all appropriately linked together as being caused by TCE. It's very likely that you'll be rated at more than 100% disabled...special monthly compensation (SMC) can kick in when we become very sick. You have a lot going on and you should aggressively pursue every benefit.
 

You tell me that we're coming into this late and you've already had your C & P exams. That's OK, it makes this a bit more complex but not that big of a deal. There is no way to interrupt the process now and I'm going to guess that you'll be denied. I'm not sure how liver cancer is positioned in all this, whether or not you are claiming that or already have a rating?
 

In any case you're about to have a denial or two and that works in your favor. Once you have a claim denied you become eligible for help with an appeal from an accredited veterans law attorney. The help you receive won't cost you any money out of your pocket, the lawyer will be paid a contingency fee if and when you prevail. I refer to these attorneys and any or all of them will be happy to talk with you about your claim. I suggest that you begin choosing your attorney representative now in preparation for denial.
 

In summary you have very complex and serious illnesses that are likely to be service connected. VA will not help you prove that your illnesses were caused or contributed to by exposure to TCE, you're on your own.
 

You should aggressively pursue all the available benefits today as it is likely that your conditions will not improve over time. I believe that it's time for you to seek expert guidance from experienced professionals so that your future is a bit more secure. Good luck.

Question:

What is the difference between a Nexus and IMO letter? Which is better to file a claim or appeal with? Thanks. 

Jim's Reply:

A nexus letter or an Independent Medical Opinion are more or less the same thing. 'Nexus' is simply a word meaning connection.

Either document would try to establish service connection for a disabling condition by allowing an expert to review records and make an opinion. Read more here https://www.vawatchdog.org/imo-ime-medical-opinions-exams.html 

Question:

BVA remand to the regional office. The notice shows I was granted service connection back to the date of the claim. However, no percentage of SC or amount was included in the rating?? What has happened and what's next??

Jim's Reply:

It sounds as if the BVA agrees with you and your claim is approved. The BVA will remand or return that decision to the regional office to arrange for a C & P exam to determine the % of the final rating. You'll soon be scheduled for a C & P exam and then after that you'll hear from VA as to what your rating will be as well as the amount of your retro pay. 

Question:

Hi Jim, I was receiving PUA unemployment due to COVID in April of 2020 and was awarded TDIU (total permanent) in September of 2020. I decided to quit taking the PUA unemployment for fear of losing my VA TDIU benefits. I just got an email saying the PUA unemployment was extended. Am I subject to losing TDIU if I start drawing unemployment again? Thank you.

Jim's Reply:

Your TDIU benefit won't be affected by your receiving PUA. Good luck.

Question:

I have constant back pain and have not found any treatments or medications that help. I am going to try acupuncture next. The doctor does not accept any insurance. Can I submit my bills directly to CHAMPVA for reimbursement? I live in PA.

Jim's Reply:

Before you enter such an arrangement you need to get authorization from CHAMPVA. Without pre-authorization there's a good chance any claim you submit will be denied. 

Question:

Helping a vet with a reevaluation of his benefits. He was originally awarded 0% in 1976 for SC hearing loss, 20% for diabetes in 2003, and 20% for neuropathy in both legs in 2018. Should one request for reeval be filed for all, or separate for each? I'm afraid if one gets hung up that they'll all get hung up.

Jim's Reply:

All requests for an increase should be filed simultaneously. Trying to keep the claims separate would require that you file one, wait until it is completely adjudicated and then file the next. The process would take years to complete. If you file at the same time VA will treat each portion of the claim as an individual request and schedule separate exams, etc.
 

When the claim is filed it should clearly state that he seeks an increase to each claim and if you're able, tell VA what the anticipated increase would be according to The Schedule For Rating Disabilities. For example, if his hearing is worse and he deserves a higher rating that 0%, calculate the rating he deserves and state that clearly. If he has any degree of tinnitus, this is a good time to file for that as well.

Are there any secondary conditions that might be the result of the service connected diabetes? For example, if he suffers erectile dysfunction that may be secondary to the DMII and a claim should be filed.

Thanks for helping a veteran file a claim...feel free to ask more any time.

Question:

I applied for Blue Water compensation for prostate cancer and was deemed eligible. I now have an appointment to determine percentages for disability. How is percentage determined? Do they calculate that I got the cancer in 2008? Or is it just up to date they determine percentages? Thank you for your help.

Jim's Reply:

When an eligible veteran is diagnosed with prostate cancer and he timely files a claim, he'll be rated as 100% disabled on a temporary basis that will stay at 100% until such time as he is treated for the cancer. Once treatment happens the veteran will be reexamined and rated for any conditions that may exist after treatment. Those conditions are usually erectile dysfunction and leaking or urine and a sense of frequency and urgency to urinate that can upset sleep and social habits.

Assuming you've had either surgical or chemo treatment and that your PSA has reached normal levels, your rating will be determined as much as anything by the number of absorbent pads you use each day to control leakage. If you use 6 pads each day, your rating is likely to be 60%. Using 4 pads or 2 pads will rate you at 40% or 20% respectively. If you are awakened at night to urinate or if you must wear pads to sleep, that will be taken into consideration. If you suffer erectile dysfunction you'll be rated separately for a 10% SMC rating. You must emphasize that you have ED or that will be ignored.

Your rating will be effective and you'll be paid from the time that the claim was filed. You will not receive retroactive pay back to the time of your diagnosis unless you had filed a claim then, were denied and you had managed to keep the appeal open all this time. If you have filed previous claims that had been denied in the past, you should speak to a veterans law attorney before doing anything...you may be eligible for retro pay in some very limited circumstances.

If you have practiced "watchful waiting" and you haven't had any treatment, your rating should be 100% with a future exam scheduled. Many men today don't jump at treatment since prostate cancer may be very slow growing and we die with the cancer rather than of it. All too often the treatment is worse than the disease and men are avoiding any therapy at all. 

VA doesn't ever seem to accept that men choose no treatment and eventually someone will infer treatment (you took an aspirin) and you'll get a notice that since you've cured your cancer your rating is dropping. If and when this happens (and it will) you must formally file a notice of disagreement and explain that you still have cancer. Calling VA and talking won't get your rating set straight, you must file the paperwork.

Remember that during a C & P exam we don't talk about how well we're doing, we talk about our worst days. That isn't to say we should magnify any symptoms but when asked "How are you?", our reply shouldn't be, "Never better doc...I feel great!" Good luck.

Question:

If I just lost my job and I have CHAMPVA as a second insurance. I know longer have insurance. Will CHAMPVA become my main insurance? I am only 60 and I will not be able to pay for other insurance.

Jim's Reply:

CHAMPVA is a great primary insurance. That is, it's great when you get the hang of working with the CHAMPVA offices. This is the VA after all and they aren't working with the best computer and telephone systems so it can be frustrating trying to get claims paid at times. Persistence pays...spend some time on the phone and do it until you get an answer.
 

Go to the doctors you prefer ahead of when you'll need them and ask to speak with the insurance and billing folks. They're always happy to help you and it's easier to get these things done up front. Make sure they accept CHAMPVA (most do, some don't...just as with any insurance) and learn a bit about any copays you may have as well as annual screening services that you can take advantage of for free.
 

Medicines are usually mailed to you although you can work with a local pharmacist to get any immediate need prescriptions taken care of.
 

My wife has used CHAMPVA exclusively for many years and we have always thought her insurance was better than my VA health care benefit. Work with them a bit and I think you'll enjoy the insurance.

Question:

I have been 70% PTSD for 7 years, Tinnitus 10%, left ear loss of hearing 10% - all service-connected. I am 69 and was in Vietnam in 1972. My question is, I just applied for a new claim, presumptive Hypothyroidism, AO. Will that open up a can of worms for my PTSD or are they just focused on a new claim, which says Hypo only? I have C&P soon. Thank you so much.

Jim's Reply:

No, you won't cause any problems with your current benefits. It's my experience that often enough the Vietnam veteran will suffer from hypothyroidism and diabetes concurrently. While you didn't mention diabetes I want to alert you that the combo of DMII and hypothyroidism can be a deadly combination. Keep an eye on your blood sugar particularly if you are diagnosed with thyroid disease. Good luck.

Question:

I am rated 100% P&T Schedular. I am also rated 0% for headache, can I still file more claims to include the headache increase without risk of losing my P&T status?

Jim's Reply:

Yes you may. There is no penalty for filing legitimate claims. Good luck.