Benefits

Question:

I have been 90% disabled with IU P/T for 19 years and 2 months. I’ve just been diagnosed with Prostate cancer. Should I go for straight up total 100% or leave well enough alone?

Jim's Reply:

You're already "straight up total 100%"...that's what the TDIU benefit is, a 100% total rating. However, you can add another 100% rating (prostate cancer) to that and that will likely take you to an SMC rating (housebound) that will increase your benefits. You don't have to be housebound to get the housebound benefit.

If you have the prostate cancer rated today and it gets worse in the future, you're ahead of the game. Good luck.

Question:

Hi Jim, my husband is a retired Marine. He is 52 years old and was recently diagnosed with advanced Prostate Cancer. It has metastasized into his abdomen, throat, and the bone near the sternum. He was stationed at Camp Lejeune where there was water contamination but I read that the VA is not recognizing prostate cancer as a connection to the contaminants. He was rated with erectile penile dysfunction. I’m trying to figure out a connection for a rating. We do have Tricare but need to connect to service related to help with the portion of medical bills that Tricare does not cover. Any advice you can give will be greatly appreciated. Thank you.

Jim's Reply:

Hello,

There are 3 steps I'd like for you to take. It would be best if you could prioritize these in your agenda so that there's little delay. He will very likely receive 100% disability benefits but there's paperwork to be done. Nothing at all can or will happen until the claim is filed. This isn't terribly difficult but will require some focused effort.

(1) Read this decision from the BVA. Read it again. Some of the language is obtuse but you'll get the general idea of what needs to be done. 

https://www.va.gov/vetapp15/Files4/1536556.txt

(2) Contact this lawyer. Tell him I referred you. He may or may not be able to dive in at this time but I want you to meet him with a phone call. This is the lawyer who will guide you should VA be a problem.

http://www.militaryveteransadvocate.com/

(3) After you speak with the lawyer you'll probably be lined up for an IMO. The lawyer is likely to ask you to talk with a doctor he prefers or you may need to choose your own. The lawyer will advise you. Learn more about an IMO here.

https://www.vawatchdog.org/imo-ime-medical-opinions-exams.html

In a nutshell, prostate cancer is not presumptive to the water contamination. However, an Independent Medical Opinion (IMO) by an expert physician will allow the service connection to be made and benefits will be awarded. You'll read that in the BVA decision. You must apply as usual for the VA disability benefit. 

https://www.vawatchdog.org/how-to-file-a-claim.html

I'm the son of a retired marine and spent my time as a child living at Tawara Terrace at Lejeune during the height of the contamination. My mother and my retired USMC E-9 father both passed of unexpected cancers...this before the connection to Lejeune was made.

You'll understand I have a personal interest to the Lejeune contamination debacle since it may directly affect me some day. 

Question:

I have been rated for sleep apnea, right shoulder (chronic torn labrum), migraines, and a few other conditions for 10 years now. I have a total rating of 90%, and have filed an increase which may put me at 100%. Given the length of time for my initial ratings, with no improvements, what are the chances of getting P&T? Thank you!

Jim's Reply:

This is a tough one that I get a lot. First up...without knowing precisely what your ratings are today and exactly what you've done to file for an increase, I'm just guessing here. 

The length of time your current ratings are in place won't have any effect on an increase to 100%. What will have an impact is VA Math. VA Math is where 2 + 2 doesn't equal 4. 

To increase from 90% to 100% is often impossible due to the Combined Ratings Table. It's an awkward device to use and if you do a search you'll find all sorts of calculators that purport to help (and don't) so I think the easiest way to see what you face is to take the time to learn how to do the tedious math yourself.

One of the better options at your rating is to seek TDIU. Learn more here.

Question:

I provided my past and current medial record, along with information regarding what a Nexus letter contains and why it is necessary to support my claim for TDIU to my Pain Management Specialist, but was told he could only provide a treatment history. I was disappointed and obviously frustrated. What is the best/ most successful way to request a Nexus letter? Thank you for your time.

Jim's Reply:

VA providers are reluctant to get involved with helping you to obtain benefits ratings. Their job is to provide care and if they start filling out all the documents you need, they won't have time for anything else. You'll need to turn to a civilian advocate to get what you need.

We don't talk about nexus letters much these days. Rather we have moved to a more formalized Independent Medical Opinion or IMO. The IMO is a file and evidence review by an expert who will provide an opinion about service connection and the degree of any disabling conditions.

You can learn more about how all this works here https://www.vawatchdog.org/imo-ime-medical-opinions-exams.html

Question:

I live in Kentucky. Where could I find a doctor that could write me a nexus letter?

Jim's Reply:

Any of the doctors you'll meet here will be happy to help you. Keep in mind that the doctor doesn't need to live in your region, your IMO doctor can be anywhere. Good luck!

Question:

Hello...I am 60% service connected, just turned 65 in April, and signed for up for SS and Medicare part A. Can you recommend a supplement to offset costs of deductibles and copays? Any other advice?

Jim's Reply:

The American approach to health insurance is unique. We can pick and choose from different insurance policies available to us, pay an enormous premium for all that and still lack coverage we need.

Health insurance is also uniquely personal. Only you can make the choices for just what level of coverage you're going to be comfortable with.

I use VA health care only when it's convenient, which it never is. I do stay registered in the VA system for the pharmacy benefit. The pharmacy services at VA actually work pretty well and you won't beat the cost.

I take Medicare Part A because it's required...you can't dump Part A. I take the elective Part B because that's very good coverage at a very low price and since I avoid VA outpatient services when I can, Part B is my most used insurance policy. While there is a deductible I find that the deductible is affordable...often less than 20 dollars or so. If you don't sign up for Part B at the first opportunity, signing up later will cost a penalty that grows over time.

I don't use Medicare supplements or Medigap policies because they're so expensive. I figure the hundreds some cost each month will be better spent if I discipline myself to stash that money away and use it for copays or unexpected expenses.

Insurance is a gamble. I accept some financial risk up front by not making myself insurance poor over the long haul. I plan my health care expenses as carefully as I can and I'm critical of any company that wants my hard earned money. I have doubts that supplements are worth it. Good luck!

Question:

Dear Jim — I won my case in May 2020 and was given a 100% total and permanent rating. I first made my claim in January of 2013 but the VA gave me an effective date of September of 2020, thereby effectively wiping out my back pay. When my attorney challenged them on that they scheduled me for another C&P exam. That resulted in them agreeing to pay me back to 2013 — but at the 70% rate with a proposal to lower my rating to 70%. Needless to say, my attorney is going to challenge this. My question is: How can they get away this? How can they take an exam that was supposed to be about my back pay and use it to try to lower my rating? Nothing is different than before. There has been no improvement in my condition whatsoever, plus I currently have a 100% permanent and total disability scheduler rating (at least until the hearing date when they’ll try to take it away from me) I thought a 100% P&T rating was supposed to protect me from rating reductions. What’s going on here? Are they free to try reduce everyone’s rating no matter what? Any insight into this situation you can provide into this situation would be greatly appreciated. Thanks so much for everything you do to help veterans. I appreciate it more than I can say.
 

Jim's Reply:

I wish I could make a rational, informed comment but I can't. The adjudication of any disability claim is complex by it's nature because there are a ton of variables involved. Without knowing the details of your claim I couldn't begin to explain what is happening.

The best I can tell you is that the VA disability process is as flawed as any governmental function you'll find anywhere.

The system is corrupt, committed and consistent leadership is non-existent, employees are poorly trained at their tasks and expectations are kept very low so that VA can meet those goals. The disability rating system was built beginning in the 1940s in America when the average worker was a laborer on a farm. The system has changed little since and is a hodge-podge of nonsensical regulations that have little to do with a more modern health care system and work place.

Is VA free to do what it wants and to deny anyone at any time? Yes. Of course they are. Not that mistakes that harm vets are official policy but inconsistent ratings and evaluations are SOP from rater to rater and VARO to VARO. There is no recrimination since there is no individual responsibility for any errors made. Nobody at VA signs your documents so there is no way to actually find any individual who rated you and ask that person what they were thinking.

Documents that are full of errors, misspellings, incorrect dates, pages from other veterans folders and missing documents are the bread and butter of the VA work product. What you are experiencing is just another day at VA.

Veterans are left with no choice but to do just what you're doing and fight to get what you earned. The VA created an industry of advocates that shouldn't exist. If VA were a friend, why would we need the army of attorneys and VSOs and charitable agencies that exist today? You and your attorney will have to keep at it until they get it right or until Congress fixes things.

My money is on you and your lawyer. Good luck.

Question:

I been waiting for VBA San Diego to processed my Aid & Attendance for 3 years, I am paying the caregiver out of my 100% Service Connection. Also, I submitted for the Caregiver Program 60 days ago, with no answer.

Jim's Reply:

If you've been waiting for any action to process for 3 years I'd have to say that something has gone wrong. Delays are common at VA, a 3 year delay isn't. Get in touch with these folks and enlist their help https://www.calvet.ca.gov/

Question:

Jim: I finally received TDIU after almost a decade of fighting with the VA. Moreover, many have advised to now pursue SSDI. I have paid more than my fair share into Social Security thus meeting the required work credits, etc for SSDI... After reviewing my Social Security benefits online, I see that I would be eligible for about $3k for SSDI (minus dependents, etc). Nevertheless, I've read and heard that SSDI and VA are two different animals when it comes to granting disability. I personally know of veterans who apply and get it on their initial filing while others take years to granted.. Question; do you have any sound advice as to strategically/correctively filing for SSDI? Also, should a law firm be used (any recommendations) or should I simply go at it on my own. Thank you for all you do.

Jim's Reply:

Yes, you should probably go ahead and file for SSDI. Do it yourself, anticipate being denied and then look for an attorney at that point. You're correct that the two systems are greatly different. However, many TDIU veterans who apply are awarded the benefit quickly, others not so much. I don't know of any secrets, the SSA is a mess...not quite as much a cluster as VA but they're trying to catch up. Just as you learned with your long battle with VA, even if you to everything right from the start, you stand a good chance of a denial just because.

Because of the pandemic, the SSA is as backed up and disorganized as it's ever been, maybe a lot more to come. If I were you I'd dive in on-line and hope for the best. Good luck!