Benefits

Question:

Jim, you have been a valuable resource in my education of the VA claim process. I was awarded 100% TDIU P&T and no future exams on October 29, today I received a call from QTC saying that the VA has requested that I attend an exam for my feet which is only one of the service connected disabilities. Any insight into why they would schedule this exam after awarding me with no future exams required? THANKS for your time and attention.

Jim's Reply:

I can only guess...a similar thing happened to me some 20 years after my rating and nobody ever figured out why the exam was scheduled.

I received a notice for an exam of a rated condition that wasn't particularly important to my overall rating and that had been in place for nearly 20 years. I went to the exam (we NEVER miss an exam) and the doctor was a really nice guy who had no idea why I was there. We did the exam and parted company, I had lunch and went home. Maybe 6 months later I had a poorly written letter saying my rating for my condition wouldn't change since it was the max for that condition.

The letter made zero sense so I knew it was authentic and from VA.

The VA has an army of people who do nothing but check the quality of the work of everyone else. Claims and decisions are under constant review and t's get crossed and i's get dotted during the process of quality review. I assume there was something that wasn't quite completed in my file so they ordered that exam. I think we can assume the same for your situation.

You don't really have any choice but to go so do that and if you have time, let me know how it works out.

Question:

I have filed a claim for Mental Health Issues. I have been seen and evaluated by both a Private Psychologist and one from the VA for my C&P exam. The VA's doc put " not at least as likely as not" in her Nexus and the Private Doc put "at least as likely as not" in her Nexus. How will the VA rater look at this ? What is your opinion?

Jim's Reply:

I'm sorry to say that the phrases you cite may not win the claim. The preferred phrase is "more likely than not". The guide that this is from is a 2002 publication and over all that time these phrases still make an impact. 

You can read more about that here. See page 14 /1.16.

Question:

I am a Vietnam veteran and have been diagnosed since my first cardiac exam in 2016 with a low left ejection factor of 45%. My family has no history of heart problems. I have had multiple test over the past years that document this, Stress Echo, Radionuclide Imaging, Left Ventriculogram, Coronary Angiogram, etc. The doctor’s report states 20-30% luminal irruguarities. However, in his report he concludes: 

1. Non obstructive coronary heart disease, and

2. Nonischemic cardiomyopathy with anteroapical dyskinesia and ejection fraction 40-45%.

Would this be a presumptive heart issue for agent orange exposure that would be covered by the Veterans Administration?

Jim's Reply:

Yes, this is an agent orange presumptive condition and yes, you should file a claim today. The effective date of your claim will be when you file it so don't delay. You can start by filing an Intent To File form and that will lock in the effective date. 

You have coronary artery disease. the VA calls that Ischemic Heart Disease or IHD. You have a low ejection fraction and the EF is where VA rates you.

You obviously have a conflict when we look at the verbiage your doctor used. That he calls it "nonobstructive coronary heart disease" is an opinion open to debate. (I'm a retired cardiovascular health care professional and know a bit about this topic.) 

You may want to consider an IMO by a disability professional to ensure that the verbiage in the record isn't going to cause a denial. In any case, do file a claim and pursue it because your heart disease is likely to continue to get worse and you'll want the benefits.

Question:

I was awarded TDIU permanently and totally, does the rating stays the same for life? Or can you please tell me what permanently and totally mean?

Jim's Reply:

Yes, the phrase permanently and totally disabled means just what it says in VA terminology. The 100% rating stays the same with yearly opportunities for a monetary increase, usually somewhere between 0% and 3%.

Since you're TDIU or the unemployability benefit you won't be allowed to work at full time or gainful employment. Otherwise you're free to do as you please and focus on healing.

Question:

I am rated at 90% and receive TDIU benefits by the VA. I have had this rating and designation since 2017. When will the VA consider me P&T.

Jim's Reply:

There are a lot of different factors that cover whether or not a given rating is or will become permanent. You already have the total part covered since TDIU is a total disability rating.

Most 100% mental health ratings are temporary until age 55 unless there are exacerbating conditions that tell the VA that there is very little chance of improvement. Otherwise, VA looks for stability and that occurs over 5 year periods in the VA playbook. The next time you have an exam, ask the examiner to note that you have seemingly stabilized and that you'd like to be rated as permanently 100% disabled. If the examiner makes that note, the rater will follow along.

Question:

I am currently on permanent unemployabilty income. I was given this while in PTSD treatment. I want to try and work again but I am not sure how to go about this. I am also concerned that once I get into the workforce, I will not be able to handle it and mess everything up. Is there are trial time I can work and see how everything goes?

Jim's Reply:

The VA doesn't have a formal return to work program like the SSA does. However, returning to work for the TDIU (unemployability) veteran is pretty simple. You just do it.

You don't need to notify anyone or ask permission. VA will track your SSA and IRS records to see if you're making more than the allowed ceiling of the federal poverty level and if you are, they'll send you a letter asking about what's up? The process seems to take a couple of years to catch up so no matter whether you're successful or not, you wouldn't hear anything for a while.

If you work for a while and can't manage it, no problems. You can go in and out of the work force as often as you need to so long as you don't earn more than the federal poverty wage limit.

Many people believe that work is the best therapy of all so if you can do it, go for it! Good luck.

Question:

With an IU rating, will my spouse qualify for DIC? I thought that to qualify for DIC after I die the condition must be service connected that caused my death. Is IU not based on any service connection, just inability to work full time.

Jim's Reply:

TDIU is grounded in service connection. You won't get a TDIU rating unless your service connected disabling conditions keep you from productive work. 

The 100% permanently TDIU rated vet has exactly the same benefits as the 100% permanently schedular vet rated except that the TDIU vet can't work at gainful employment. There are no other differences.

Survivors of the 100% rated TDIU veteran will receive the same benefits as the survivors of the 100% schedular rated vet. In each case the veteran must either die of a rated service connected condition or the 100% rating must have been in place for 10 or more years. After 10 years the vet can pass from any cause and survivors are eligible for DIC.

No matter the overall rating, any veteran who dies of a service connected condition will leave dependents eligible to apply for the DIC benefit.

Question:

I've been 100% SSDI. I also receive Workers Compensation. I was poisoned at Camp Lejeune. I was not aware of this historical mass poisoning. I worked full time while having spells and have had massive seizures. I am fully disabled. Any thoughts?

Jim's Reply:

If you believe that you were harmed during the period of water contamination at Lejeune you should file the appropriate claim(s). Click https://www.va.gov/disability/eligibility/hazardous-materials-exposure/camp-lejeune-water-contamination/ 

Question:

I am a Vietnam veteran and have hypothyroidism. Is it worth filling a VA claim?

Jim's Reply:

Yes.

While hypothyroidism isn't an agent orange presumptive benefit, it is linked to diabetes and that is an agent orange presumptive condition. A great many Vietnam veterans are diagnosed with service connected diabetes and if that's the case for you, you can link the 2 conditions and seek benefits as a secondary condition for the hypothyroidism.

As you go forward be sure to monitor both your blood sugar and your thyroid hormone levels since the effects of one on the other can be devastating to your health.

Question:

My husband is a Vietnam veteran fighting his second round of lung cancer in 13 months. He is rated at 100 percent but only temporary. It has spread to his liver and is now stage 4 but they still left it as temporary. Will this make any difference for me? He is worried about me when something happens to him. Do I need to push for permanent? I did have the doctor send a letter that it will never go away he is 71 years old. Thank you

Jim's Reply:

The VA disability system holds some interesting and very outdated views of how disabling conditions will affect the veteran. When it is a service connected cancer we're talking about, VA will rate all cancer as a temporary condition that can and will be cured. How this thought process came to be isn't exactly clear but like so many processes at your VA, there doesn't seem to be any way to change this behavior.

Thus a veteran who has a service connected lung cancer (an agent orange presumptive cancer) will be rated as 100% temporarily disabled until such time as the vet has surgery or other curative treatments at which time the veteran will then be rated to determine the permanently disabling conditions left by the treatments.

For the purposes of a dependent potentially receiving the DIC benefit a veteran most often must die from a service connected condition for the dependent to be eligible. In the circumstance you and he face today it's likely that he will pass from the cancer and even though it is rated as a temporary benefit you will be eligible for the DIC benefit.

Give him my best. Good luck.