1 Preparing a Winning Claim before the Department of Veterans Affairs 8/11/2014 Gallian Welker & Beckstrom, LC
2 Introduction. The VA is arguably one of the largest bureaucracies in human history. Currently, the VA has 850,000 active claims, 500,000 of which are more than 18 months old. Efforts to streamline the process have run into significant bureaucratic resistance. 8/11/2014 2
3 Introduction, cont. Most current claims are from veterans of the Vietnam era, who waited 20 years or more to make their claims. Thus, their claims (i) are more remote from their injuries, (ii) the evidence is difficult to obtain and (iii) the nexus between their injuries and their serviceconnected disabilities are more difficult to prove. 8/11/2014 3
4 Introduction, cont. The veterans of the more recent wars are not waiting as long to document and file their claims. Thus, their claims (i) are more recent, (ii) the documentation is more modern and accessible and (iii) the nexus between their injuries and their disabilities is easier to prove. In addition, the more recent veterans high a higher survival rate and their injuries and disabilities can be more complex; i.e. Traumatic Brain Injuries (TBI). (It isn t the same as having a finger shot off.) 8/11/2014 4
5 Introduction, cont. The Bottom Line is that there is going to be a tidal wave of claims at the same time that the VA is trying to clear the decks of the old, outstanding claims. 8/11/2014 5
6 Eligibility. Entitlement is based upon a two-party contract at time of enlistment, that in the event that the veteran is injured during service, the VA will provide (i) medical treatment for those injuries and (ii) compensation for service-connected injuries. 8/11/2014 6
7 Character of Discharge. Honorable eligible for all benefits. General (Honorable lite) eligible for most benefits. Other Than Honorable grey area where VA has discretion as to which benefits to assign. Dishonorable ineligible for most benefits. Bad Conduct ineligible for any benefits. Insufficient period of service under 24 months, generally ineligible for any benefits. 8/11/2014 7
8 VA Duty to Assist. The VA s mission is to honor the contract in a non-adversarial manner. The Duty to Assist requires the VA to identify the viable claims from the record, even if the veteran didn t make the claim. The Duty to Assist includes the requirement to account for the veteran s own inability to contribute to the development of the claims. 8/11/2014 8
9 Compensation Compensation replacement income for diminution in ability to engage in gainful employment. In-service injury there must be evidence in the service medical records of the original injury; The Veteran must have a current disability know the diagnostic codes; Chronicity there can be no intervening causes that overshadow the original injury. 8/11/2014 9
10 Improved Pension Improved Pension economic backstop for veterans who have no service-connected disability. Means tested inquiry into both income and assets. Qualifications served during time of war and is over 65 or totally disabled (if under 65). 8/11/
11 Medical Claims. Orthopedic injuries. Organic injuries. Agent Orange related diseases. Secondary Claims. Be sure to find the ICDM (Diagnostic Code) which matches the symptoms or condition. 8/11/
13 Extraordinary Benefits. TDIU Total Disability based upon Individual Unemployability. Housebound Assistance. Aid & Attendance. 8/11/
14 Timeline. Original Claim filing of the Original Claim at the VA Regional Office (VARO) establishes the Effective Date. Jurisdiction is vested in the VARO of the state where the Veteran resides. 8/11/
15 Timeline, cont. The Rating Decision - The VARO will issue a Rating Decision that catalogues the documentation reviewed and the rationale for the decision. 8/11/
16 Timeline, cont. Notice of Disagreement (NOD) - The Veteran has 1 year to file a Notice of Disagreement (appeal). Acknowledgement of NOD - The VARO will give the Veteran the option of having a DRO by a higher level rating officer at the same VARO or sending the appeal directly to the Board of Veterans Appeals. The VARO will issue a Statement of the Case and/or a Supplemental Statement of the Case (after DRO and before transmitting to the BVA). 8/11/
17 Re-opened Claims. Re-opened Claims. There is no limit to the number of re-opened claims that a veteran can file, but each successive re-opened claim must be based upon new and material evidence that was not considered in previous Rating Decisions. 8/11/
18 Appeal to Board of Veterans Appeals (BVA). The BVA is the highest level of appeal within the VA. Usually involves an in-person hearing, in either the Regional Office or Washington DC; or a teleconference from a local office. 8/11/
19 Court of Appeal for Veterans Claims (CAVC). First level of non-va review. The CAVC has very strict timelines and filing requirements, along with filing fees. 8/11/
20 Federal District Court (DC). Second level of non-va review. 8/11/
21 Getting Help with the Process. There is a large amount of poorly developed claims, over-proven claims, shotgun claims and spurious claims that are clogging the system. The VSO s (God Bless Em) are really overworked and do the best they can. But they don t work for the VA and can t be blamed for the VA s errors. Congress has statutorily barred private attorneys from being compensated for work on Original Claims, but you can always ask for pro bono assistance. 8/11/
22 Documentation. You need the Veteran s service and medical records from: NPRC- National Personnel Records Center Individual Service Branch Records Centers Veteran s C-file (claims file) from the VA Regional Office or a local VA Business Office. 8/11/
23 Medical Evidence VA treatment records from VAMC (Veterans Administration Medical Center) and CBOC (Community Based Outpatient Clinic). Be specific about the diagnostic codes that apply to the medical conditions. Private treatment records. C&P exams (Compensation and Pension). Nexus Exams - Independent medical examinations. 8/11/
24 C&P exams (Compensation and Pension). Upon the filing of a claim, the VA will send the Veteran to VA-retained doctors or experts to render an opinion regarding disability, based upon an examination and a review of the C- File. 8/11/
25 Nexus Exams - Independent medical opinions. The Veteran has the option of obtaining an independent medical opinion regarding disability, based upon an examination and a review of the C-File. The VA is rather unforgiving of nexus exams if the C-File was not reviewed. 8/11/
26 Writing a Good Appeal. Know your case. Know the medicine. Know the VA! 8/11/
27 Buddy Statements The VA gives precious little weight to Buddy Statements. To be useful, such statements need to be: Credible believable, based upon personal knowledge; and Competent reliable, based upon training and experience. (If your buddy isn t a doctor, they can t give a credible statement about most medical issues.) 8/11/
28 What Does It Mean to Win? The VA will make monthly payments to the Veteran for the rest of their life, with some exceptions. The VA will make a one-time payment of retroactive benefits, from the effective date of the Original Claim, until the date of the Rating Decision that granted the benefits. 8/11/
29 Documents needed. VA SF 180 to obtain service duty and medical records. VA 3288 to obtain a copy of the C-file. A HIPPA Release to obtain copies of private medical records. 8/11/
30 Correspondence. Be sure to keep copies of all letters sent to the VA. Be sure to put the date on everything you send. Be sure to put your claim number on the top of each page. Be sure to keep a copy of everything you receive from the VA, along with the envelope that it came in. 8/11/
31 Calendaring. Make sure to have a written calendar to keep track of deadlines. 8/11/
32 Conclusion You can do it! Take charge and do as much of the work as you can! Ask for help. Don t believe everything you read and hear. Don t give up! 8/11/
41 Appendix B to Part 4.--Numerical Index of Disabilities Diagnostic Code No. THE MUSCULOSKELETAL SYSTEM Acute, Subacute, or Chronic Diseases 5000 Osteomyelitis, acute, subacute, or chronic Bones and Joints, tuberculosis Arthritis, rheumatoid (atrophic) Arthritis, degenerative (hypertrophic or osteoarthritis) Arthritis, gonorrheal Arthritis, pneumococcic Arthritis, typhoid Arthritis, syphilitic Arthritis, streptococcic Arthritis, other types (specify) Arthritis, due to trauma Bones, caisson disease Bones, new growths, malignant Osteoporosis, with joint manifestations Osteomalacia Bones, new growths, benign Osteitis deformans Gout Hydrarthrosis, intermittent Bursitis Synovitis Myositis Periostitis Myositis ossificans Tenosynovitis Fibromyalgia. Prosthetic Implants 5051 Shoulder replacement (prosthesis) Elbow replacement (prosthesis) Wrist replacement (prosthesis) Hip replacement (prosthesis) Knee replacement (prosthesis) Ankle replacement (prosthesis). Combination of Disabilities 5104 Anatomical loss of one hand and loss of use of one foot Anatomical loss of one foot and loss of use of one hand Anatomical loss of both hands Anatomical loss of both feet Anatomical loss of one hand and one foot Loss of use of both hands Loss of use of both feet Loss of use of one hand and one foot. Amputations: Upper Extremity Arm amputation of: 5120 Disarticulation Above insertion of deltoid.
42 5122 Below insertion of deltoid. Forearm amputation of: 5123 Above insertion of pronator teres Below insertion of pronator teres Hand, loss of use of. Multiple Finger Amputations 5126 Five digits of one hand. Four digits of one hand: 5127 Thumb, index, long and ring Thumb, index, long and little Thumb, index, ring and little Thumb, long, ring and little Index, long, ring and little. Three digits of one hand: 5132 Thumb, index and long Thumb, index and ring Thumb, index and little Thumb, long and ring Thumb, long and little Thumb, ring and little Index, long and ring Index, long and little Index, ring and little Long, ring and little. Two digits of one hand: 5142 Thumb and index Thumb and long Thumb and ring Thumb and little Index and long Index and ring Index and little Long and ring Long and little Ring and little. Single finger: 5152 Thumb Index finger Long finger Ring finger Little finger. Amputations: Lower Extremity Thigh amputation of: 5160 Disarticulation Upper third Middle or lower thirds. Leg amputation of: 5163 With defective stump Not improvable by prosthesis controlled by natural knee action At a lower level, permitting prosthesis Forefoot, proximal to metatarsal bones Foot, loss of use of Toes, all, without metatarsal loss Toe, great.
43 5172 Toes, other than great, with removal of metatarsal head Toes, three or more, without metatarsal involvement. Shoulder and Arm 5200 Scapulohumeral articulation, ankylosis Arm, limitation of motion Humerus, other impairment Clavicle or scapula, impairment. Elbow and Forearm 5205 Elbow, ankylosis Forearm, limitation of flexion Forearm, limitation of extension Forearm, flexion limited Elbow, other impairment Radius and ulna, nonunion Ulna, impairment Radius, impairment. Wrist 5213 Supination and pronation, impairment Wrist, ankylosis Wrist, limitation of motion. Limitation of Motion Multiple Digits: Unfavorable Ankylosis: 5216 Five digits of one hand Four digits of one hand Three digits of one hand Two digits of one hand. Multiple Digits: Favorable Ankylosis: 5220 Five digits of one hand Four digits of one hand Three digits of one hand Two digits of one hand. Ankylosis of Individual Digits: 5224 Thumb Index finger Long finger Ring or little finger. Limitation of Motion of Individual Digits: 5228 Thumb Index or long finger. Spine
44 5230 Ring or little finger Vertebral fracture or dislocation Sacroiliac injury and weakness Lumbosacral or cervical strain Spinal stenosis Spondylolisthesis or segmental instability Ankylosing spondylitis Spinal fusion Degenerative arthritis Intervertebral disc syndrome. Hip and Thigh 5250 Hip, ankylosis Thigh, limitation of extension Thigh, limitation of flexion Thigh, impairment Hip, flail joint Femur, impairment. Knee and Leg 5256 Knee, ankylosis Knee, other impairment Cartilage, semilunar, dislocated Cartilage, semilunar, removal Leg, limitation of flexion Leg, limitation of extension Tibia and fibula, impairment Genu recurvatum. Ankle 5270 Ankle, ankylosis Ankle, limited motion Subastragalar or tarsal joint, ankylosis Os calcis or astragalus, malunion Astragalectomy. Shortening of the Lower Extremity 5275 Bones, of the lower extremity The Foot 5276 Flatfoot, acquired Weak foot, bilateral Claw foot (pes cavus), acquired Metatarsalgia, anterior (Morton's disease) Hallux valgus Hallux rigidus Hammer toe Tarsal or metatarsal bones Foot injuries, other. The Skull 5296 Loss of part of Removal of. The Ribs
45 5298 Removal of. The Coccyx MUSCLE INJURIES Shoulder Girdle and Arm 5301 Group I Function: Upward rotation of scapula Group II Function: Depression of arm Group III Function: Elevation and abduction of arm Group IV Function: Stabilization of shoulder Group V Function: Elbow supination Group VI Function: Extension of elbow. Forearm and Hand 5307 Group VII Function: Flexion of wrist and fingers Group VIII Function: Extension of wrist, fingers, thumb Group IX Function: Forearm muscles. Foot and Leg 5310 Group X Function: Movement of forefoot and toes Group XI Function: Propulsion of foot Group XII Function: Dorsiflexion. Pelvic Girdle and Thigh 5313 Group XIII Function: Extension of hip and flexion of knee Group XIV Function: Extension of knee Group XV Function: Adduction of hip Group XVI Function: Flexion of hip Group XVII Function: Extension of hip Group XVIII Function: Outward rotation of thigh. Torso and Neck 5319 Group XIX Function: Abdominal wall and lower thorax Group XX Function: Postural support of body Group XXI Function: Respiration Group XXII Function: Rotary and forward movements, head Group XXIII Function: Movements of head. Miscellaneous 5324 Diaphragm, rupture Muscle injury, facial muscles Muscle hernia Muscle, neoplasm of, malignant Muscle, neoplasm of, benign Sarcoma, soft tissue. THE EYE Diseases of the Eye
46 6000 Uveitis Keratitis Scleritis Iritis Cyclitis Choroiditis Retinitis Hemorrhage, intra-ocular, recent Retina, detachment Eye, injury of, unhealed Eye, tuberculosis Retina, localized scars Glaucoma, congestive or inflammatory Glaucoma, simple, primary, noncongestive New growths, malignant, eyeball New growths, benign, eyeball and adnexa Nystagmus, central Conjunctivitis, trachomatous, chronic Conjunctivitis, other, chronic Ptosis unilateral or bilateral Ectropion Entropion Lagophthalmos Eyebrows, loss Eyelashes, loss Epiphora Neuritis, optic Cataract, traumatic Cataract, senile, and others Aphakia Accommodation, paralysis Dacryocystitis Eyelids, loss of portion Lens, crystalline, dislocation Pterygium Keratoconus. Impairment of Central Visual Acuity 6061 Anatomical loss both eyes Blindness, both eyes, only light perception. Anatomical loss of 1 eye: 6063 Other eye 5/200 (1.5/60) Other eye 10/200 (3/60) Other eye 15/200 (4.5/60) Other eye 20/200 (6/60) Other eye 20/100 (6/30) Other eye 20/70 (6/21) Other eye 20/50 (6/15) Other eye 20/40 (6/12). Blindness in 1 eye, only light perception: 6067 Other eye 5/200 (1.5/60) Other eye 10/200 (3/60) Other eye 15/200 (4.5/60) Other eye 20/200 (6/60) Other eye 20/100 (6/30) Other eye 20/70 (6/21) Other eye 20/50 (6/15) Other eye 20/40 (6/12).
47 Vision in 1 eye 5/200 (1.5/60): 6071 Other eye 5/200 (1.5/60) Other eye 10/200 (3/60) Other eye 15/200 (4.5/60) Other eye 20/200 (6/60) Other eye 20/100 (6/30) Other eye 20/70 (6/21) Other eye 20/50 (6/15) Other eye 20/40 (6/12). Vision in 1 eye 10/200 (3/60): 6075 Other eye 10/200 (3/60) Other eye 15/200 (4.5/60) Other eye 20/200 (6/60) Other eye 20/100 (6/30) Other eye 20/70 (6/21) Other eye 20/50 (6/15) Other eye 20/40 (6/12). Vision in 1 eye 15/200 (4.5/60): 6075 Other eye 15/200 (4.5/60) Other eye 20/200 (6/60) Other eye 20/100 (6/30) Other eye 20/70 (6/21) Other eye 20/50 (6/15) Other eye 20/40 (6/12). Vision in 1 eye 20/200 (6/60): 6075 Other eye 20/200 (6/60) Other eye 20/100 (6/30) Other eye 20/70 (6/21) Other eye 20/50 (6/15) Other eye 20/40 (6/12). Vision in one 1 20/100 (6/30): 6078 Other eye 20/100 (6/30) Other eye 20/70 (6/21) Other eye 20/50 (6/15) Other eye 20/40 (6/12). Vision in 1 eye 20/70 (6/21): 6078 Other eye 20/70 (6/21) Other eye 20/50 (6/15) Other eye 20/40 (6/12). Vision in 1 eye 20/50 (6/15): 6078 Other eye 20/50 (6/15) Other eye 20/40 (6/12). Impairment of Field Vision: 6080 Field vision, impairment Scotoma. Impairment of Muscle Function: 6090 Diplopia Symblepharon Diplopia, limited muscle function. THE EAR 6200 Chronic suppurative otitis media Chronic nonsuppurative otitis media.
48 6202 Otosclerosis Peripheral vestibular disorders Meniere's syndrome Loss of auricle Malignant neoplasm Benign neoplasm Chronic otitis externa Tympanic membrane Tinnitus, recurrent. OTHER SENSE ORGANS 6275 Smell, complete loss Taste, complete loss. INFECTIOUS DISEASES, IMMUNE DISORDERS AND NUTRITIONAL DEFICIENCIES 6300 Cholera, Asiatic Visceral Leishmaniasis Leprosy (Hansen's Disease) Malaria Lymphatic Filariasis Bartonellosis Plague Relapsing fever Rheumatic fever Syphilis Tuberculosis, miliary Avitaminosis Beriberi Pellagra Brucellosis Typhus, scrub Melioidosis Lyme disease Parasitic diseases Lupus erythematosus HIV-Related Illness Chronic Fatigue Syndrome (CFS). THE RESPIRATORY SYSTEM Nose and Throat 6502 Septum, nasal, deviation Nose, loss of part of, or scars Sinusitis, pansinusitis, chronic Sinusitis, ethmoid, chronic Sinusitis, frontal, chronic Sinusitis, maxillary, chronic Sinusitis, sphenoid, chronic Laryngitis, tuberculous Laryngitis, chronic Laryngectomy, total Aphonia, complete organic Larynx, stenosis of Pharynx, injuries to Allergic or vasomotor rhinitis Bacterial rhinitis Granulomatous rhinitis.
49 Trachea and Bronchi 6600 Bronchitis, chronic Bronchiectasis Asthma, bronchial Emphysema, pulmonary Chronic obstructive pulmonary disease. Lungs and Pleura Tuberculosis Ratings for Pulmonary Tuberculosis (Chronic) Entitled on August 19, 1968: 6701 Active, far advanced Active, moderately advanced Active, minimal Active, advancement unspecified Inactive, far advanced Inactive, moderately advanced Inactive, minimal Inactive, advancement unspecified. Ratings for Pulmonary Tuberculosis Initially Evaluated After August 19, 1968: 6730 Chronic, active Chronic, inactive Pleurisy, active or inactive. Nontuberculous Diseases 6817 Pulmonary Vascular Disease Neoplasms, malignant Neoplasms, benign. Bacterial Infections of the Lung 6822 Actinomycosis Nocardiosis Chronic lung abscess. Interstitial Lung Disease 6825 Fibrosis of lung, diffuse interstitial Desquamative interstitial pneumonitis Pulmonary alveolar proteinosis Eosinophilic granuloma Drug-induced, pneumonitis & fibrosis Radiation-induced, pneumonitis & fibrosis Hypersensitivity pneumonitis Pneumoconiosis Asbestosis. Mycotic Lung Disease
50 6834 Histoplasmosis Coccidioidomycosis Blastomycosis Cryptococcosis Aspergillosis Mucormycosis. Restrictive Lung Disease 6840 Diaphragm paralysis or paresis Spinal cord injury with respiratory insufficiency Kyphoscoliosis, pectus excavatum/carinatum Traumatic chest wall defect Post-surgical residual Pleural effusion or fibrosis Sarcoidosis Sleep Apnea Syndromes. THE CARDIOVASCULAR SYSTEM Diseases of the Heart 7000 Valvular heart disease Endocarditis Pericarditis Pericardial adhesions Syphilitic heart disease Arteriosclerotic heart disease Myocardial infarction Hypertensive heart disease Hyperthyroid heart disease Supraventricular arrhythmias Ventricular arrhythmias Atrioventricular block Heart valve replacement Coronary bypass surgery Implantable cardiac pacemakers Cardiac transplantation Cardiomyopathy. Diseases of the Arteries and Veins 7101 Hypertensive vascular disease Aortic aneurysm Aneurysm, large artery Aneurysm, small artery Arteriovenous fistula, traumatic Arteriosclerosis obliterans Thrombo-angiitis obliterans (Buerger's Disease) Raynaud's syndrome Angioneurotic edema Erythromelalgia Varicose veins Post-phlebitic syndrome Cold injury residuals Soft tissue sarcoma. THE DIGESTIVE SYSTEM 7200 Mouth, injuries Lips, injuries.
52 7515 Bladder, calculus Bladder, fistula Bladder, injury Urethra, stricture Urethra, fistula Penis, removal of half or more Penis, removal of glans Penis, deformity, with loss of erectile power Testis, atrophy, complete Testis, removal Epididymo-orchitis, chronic only Prostate gland Malignant neoplasms Benign neoplasms Renal disease, chronic Kidney transplant Renal tubular disorders Kidneys, cystic diseases Atherosclerotic renal disease Toxic nephropathy Glomerulonephritis Interstitial nephritis Papillary necrosis Renal amyloid disease Disseminated intravascular coagulation Renal involvement in systemic diseases Neurogenic bladder. GYNECOLOGICAL CONDITIONS AND DISORDERS OF THE BREAST 7610 Vulva, disease or injury Vagina, disease or injury Cervix, disease or injury Uterus, disease or injury Fallopian tube, disease or injury Ovary, disease or injury Uterus and both ovaries, removal Uterus, removal Ovary, removal Ovaries, atrophy of both Uterus, prolapse Uterus, displacement Pregnancy, surgical complications Fistula, rectovaginal Fistula, urethrovaginal Breast, surgery Malignant neoplasms Benign neoplasms Endometriosis. THE HEMIC AND LYMPHATIC SYSTEMS 7700 Anemia Agranulocytosis, acute Leukemia Polycythemia vera Thrombocytopenia Splenectomy Spleen, injury of, healed Hodgkin's disease Adenitis, tuberculous.
53 7714 Sickle cell anemia Non-Hodgkin's lymphoma Aplastic anemia. THE SKIN 7800 Burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear Scar(s), unstable or painful Scars, other Dermatitis or eczema Leishmaniasis, American (New World) Leishmaniasis, Old World Lupus erythematosus, discoid Tuberculosis luposa (lupus vulgaris) Dermatophytosis Bullous disorders Psoriasis Exfoliative dermatitis Malignant skin neoplasms Benign skin neoplasms Infections of the skin Cutaneous manifestations of collagen-vascular diseases Papulosquamous disorders Vitiligo Keratinization, diseases Urticaria Vasculitis, primary cutaneous Erythema multiforme Acne Chloracne Scarring alopecia Alopecia areata Hyperhidrosis Malignant melanoma. THE ENDOCRINE SYSTEM 7900 Hyperthyroidism Thyroid gland, toxic adenoma Thyroid gland, nontoxic adenoma Hypothyroidism Hyperparathyroidism Hypoparathyroidism Cushing's syndrome Acromegaly Diabetes insipidus Addison's disease Pluriglandular syndrome Diabetes mellitus Malignant neoplasm Benign neoplasm.
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