If your VA disability claim for Gulf War Syndrome is being handled by one of the 6 Regional Offices listed at the bottom of this article, then your claim has most likely been improperly reviewed and rated.
In a recent GAO investigation, it was found that the VA Regional Office in Waco, Texas was 4th in the Nation in denying Gulf War Syndrome/Illness type claims and the Muskogee, Oklahoma Regional Office was 2nd highest, just behind the Roanoke Regional Office. Being in the top 6 is a dubious honor which should have every veteran in these Regional Offices very concerned about their Gulf War Syndrome claim.
The VA estimates that 44% of the 700,000+ service members who served in the 1990-1991 Persian Gulf War have developed symptoms as joint pain, chronic fatigue syndrome, breathing disorders, sleep disorders, and neurological problems after returning from the Gulf War. The illnesses are thought to have been caused by exposure to toxic elements like smoke from burning oil wells, depleted uranium and chemical warfare agents such as mustard gas. “Burn Pits” are another possible source of exposure.
While the VA denies roughly 87% of all Gulf War Syndrome claims Nationwide, the Waco Regional Office is denying 92% of these claims. The recent investigation has found that poor training and inconsistent claims handling is partly to blame for the huge denial rate. A lack of a medical opinion relating alleged Gulf War Syndrome problems is also a leading cause of continued denials.
There is no doubt but that Gulf War Illnesses/Syndromes are hard to prove. There is not usually a distinctive set of symptoms that will allow a medical provider to make an reliable diagnosis. That is why these claims are called “Medically Unexplained Chronic Multisymptom Illness” or “Undiagnosed Illness”.
GAO found that the VA does a piss poor job educating examiners and raters about how to identify the illnesses. Several VA staff noted the complexity of Gulf War illness claims and some medical examiners stated they would benefit from additional training on Gulf War illness and how to conduct these exams. In response to the GAO report, the VA said it would make the web training mandatory and hopes to get examiners trained by November.
U.S. Rep. Mike Bost, R-Ill., a member of the House Veterans subcommittee on Oversight and Investigations, noted the discrepancy in the number of Gulf War veterans with successful claims. While an estimated 44 percent of service members developed Gulf War illness symptoms, only 26 percent receive benefits. “Something does not add up,” he said.
The six VA benefits offices that handled at least 1,000 Gulf War-related claims in 2015 (which is the most recent year for statistics) and their denial rates for veterans filing VA Disability claims for Gulf War Illnesses/Syndrome. The national average was 87%.
• Roanoke, Va.: 95% (of 2,124 total claims)
• Muskogee, Okla.: 94% (2,431)
• Atlanta: 93% (1,339)
• Waco: 92% (1,088)
• Columbia, S.C.: 90% (1,130)
• Nashville, Tenn.: 83% (1,763)
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.