I know we spoke about this not long ago, but I had an example that shows just how powerful a properly prepared "nexus" letter from an IMO can be in winning benefits.
The surviving spouse of a veteran had been seeking "DIC" benefits, claiming that the veterans cause of death was related to one of his service connected disabilities.
The Death Certificate found "Acute Coronary Syndrome" as the "primary" cause of death, and "renal failure" as the secondary cause of death.
The VA Regional Office repeatedly denied the claim pointing out that the veteran only had Service Connected PTSD, Tinnitus, Hearing Loss and non-compensable residuals of Malaria. They relied upon the medical opinion of their chosen C&P examiner who went into great detail explaining how none of the Service Connected disabilities were at all related to the cause of death.
The surviving spouse contacted my office and we appealed the Regional Office denial to the BVA. I also contacted the physician I deal with exclusively in VA related claims, discussed the facts of this claim and set up a time for this “Independent Medical Examiner” to meet with the surviving spouse. I also, of course, provided the IME with a complete AND specifically organized copy of the VA Claims file for his review. Following his review of the Claims File, and his meeting with the surviving spouse, this IME provided us with a written Medical Opinion containing all the “magic language” required by the VA. His report further contained his reasoning as to why the Service Connected disabilities of PTSD and Malaria were "as likely as not", the underlying cause of death.
This spouse will now receive DIC benefits which NEVER would have been granted without getting a well-reasoned IMO of our own.
To learn a bit more about "nexus" or IMO letters, read my blog post HERE
As most veterans that have suffered from a TBI know, the rating system used by the VA is anything but simple to understand. Most of these same veterans, and their families also know that the VA finally admitted to performing “improper” screenings on at least 25,000 veterans. This admission did result in major changes to the TBI screening and rating process, but it is still far from perfect.
What a lot of TBI victims or their families do not realize, is that there are multiple other “disabilities/impairments” that come into play when dealing with a TBI and the VA rating system. The VA often just messes up when evaluating these medical problems due to the underlying TBI. These problems might be mental, physical or neurological.
The VA uses a Manual called the M21-1 Compensation and Pension Manual. This “manual” is basically the “Bible” for the VA in working claims. It has 11 “Parts” but we are really only concerned about “Part III” which is further broken down into numerous Sub-parts, Chapters, Sections and Sub-Sections. I bet a lot of heads are spinning already and we have only just started! Anyway, we are going to look at “M21-1, Part III, Subpart iv, Chapter 4, Section G- Neurological Conditions and Convulsive Disorders”. This “part” of the M21-1 discusses TBI’s.
What happens in a lot of TBI claims before the VA, the veteran (or his family member) has filed a claim for a “TBI” or maybe even just said “head injury” or “brain injury”. However, there are other problems that often go along with a TBI that MIGHT be entitled to a disability rating which is IN ADDITION to the rating for the TBI itself. Things such as migraines, generalized anxiety disorders, memory problems, self-care, pain, vision or hearing problems and many, many others are associated with a TBI, and could result in additional compensation for the veteran.
The VA, in making their evaluations of the other diagnosis associated with a TBI will always rely upon the “C&P” medical exam/opinion that they have requested. The Doctor writing the opinions will sometimes take the easy way out when preparing their report and this ends up causing lost benefits for the veteran.
The veteran will be confused for sure with this type of finding. Especially since IF the “Rating Decision” sheet is included with the “Notification of Award” sheet that is sent to the veteran, and the Notification of Award letter says the veteran is entitled to 30% for “TBI and adjustment disorder with anxiety & depression”, yet the Rating Decision findings say he is entitle to 10% for the TBI and makes a separate finding of 30% for the Adjustment Disorder with anxiety & depression.
So, again, in the above example, the veteran is awarded 50% total instead of 60%.
TBI claims are very complex and the VA follows very complex regulations and policies when evaluating these injuries. I would always strongly recommending that the veteran or family member assisting the veteran, contact an experienced and accredited representative immediately after receiving an award for a TBI. In fact, contacting an accredited and experienced representative before filing your claims COULD make a huge difference in the outcome. While it is possible to “win” a TBI claim on your own, it is one of the very few claims that I believe require at least the input of an experienced and accredited representative.
Agent Orange is the name of a blend of herbicides that the U.S. military sprayed in the Republic of Vietnam and surrounding areas during the Vietnam War. It is the combination of two herbicides, the chlorinated phenoxy acids of 2,4-D and 2,4,5-T. For an explanation of the chemical make-up of Agent Orange see the post on Agent Orange, Herbicides, and TCDD Explained. Agent Orange was a part of the herbicidal warfare program Operation Ranch Hand. Agent Orange was sprayed from 1961 to 1971 to remove trees and vegetation in order to reduce areas for enemy hiding and cover. The name Agent Orange comes from the orange colored identifying label on the large, 55-gallon storage drums. Over 19 million gallons of herbicides were sprayed during the Vietnam War without the knowledge of the debilitating health risks and effects.
During the Vietnam War, over 9 million Americans served on active duty with nearly 3 million serving in the Republic of Vietnam. Many Veterans who served during this time were exposed to these toxic chemicals leading to the development of various diseases. Beginning in 1990, the Veterans Administration (VA) recognized that certain cancers and other serious health issues developed by these veterans were associated with Agent Orange and other herbicide exposure during military service in the sprayed areas. Under the Agent Orange Act of 1991, the VA must provide presumed service connection for diseases the Institute of Medicine found as positively associated with Agent Orange.
The VA lists the illnesses and diseases that are assumed to be related to a Veteran’s military service during the Vietnam War, which are presumptive diseases. This means that service connection for the disease/illness is presumed to be due to the in-service event of exposure to Agent Orange. By law, Veterans that set foot in the Republic of Vietnam or served on its inland waterways (Brown Water) during the Vietnam War, and are currently suffering from one of the listed diseases are presumed to be exposed to Agent Orange and therefore, in most cases, leads to VA Disability benefits for the disease.
This means that the Veteran may be eligible for benefits by proving that they: (1) have a current disability of one of the Agent Orange connected diseases and they (2) served in an area where the VA recognizes that Agent Orange exposure occurred. It is important to note that the Veteran must prove that he or she has a current disability or residual effects from an in-service disease. Your exposure must have produced a disease or residuals of a disease due to the exposure. Evidence of service and medical conditions can be developed from your military service records, service medical records (SMR's), private medical records, and expert medical opinions. For some of the non-cancer conditions connected with Agent Orange a third requirement is necessary for service connection. This third requirement is that the disease developed within one year of the last day of exposure to Agent Orange.
A large area of dispute in connection with exposure to Agent Orange is in regard to the veterans who served aboard ships offshore of the Republic of Vietnam without setting foot on land, known as “Blue Water” Vietnam veterans. Under current law, Blue Water Vietnam veterans are not guaranteed presumptive service connection and must prove exposure. This is unlike “Brown Water” Vietnam veterans whom service connection is presumed due to their service on vessels in inland waterways of the Republic of Vietnam. While it is difficult to prove a factual connection between your medial condition and direct exposure to Agent Orange, thousands of Blue Water Vietnam Veterans are being denied benefits they deserve from serving their country. For updated information on "Blue Water Veterans" click HERE.
This is currently only 1 way that a "Blue Water Veteran" can easily get VA Disability Benefits based on a "presumption". This would be if the veteran has Non-Hodgkin's Lymphoma. You can click on the following link to learn more about Non-Hodgkin's Lymphoma and its relation to Agent Orange.